Lower Median Birth Weight Research Articles

Clinical outcomes in patients with unintended pregnancy after liver transplantation: A multicenter registry cohort study.

The consequences of unintended pregnancy in liver transplant (LT) recipients, a growing part of the high-risk obstetric population, remain unknown. To fill this gap, we conducted a retrospective registry cohort study to describe the risk factors, obstetric and neonatal morbidity, and graft outcomes associated with unintended pregnancy after LT. This study utilized the Transplant Pregnancy Registry International (TPRI) and included 565 pregnancies of LT recipients between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcome of acute cellular rejection (ACR) and secondary outcomes of graft loss, severe maternal morbidity, and neonatal composite morbidity were compared by pregnancy intention. The study population included 60.9% with intended pregnancies and 39.1% unintended pregnancies. Recipients with unintended pregnancy were more likely to self-report as Black race, to be younger, nulliparous, and have exposure to teratogenic immunosuppression. ACR was more common with unintended pregnancy (3.7% vs 1.2%, p=0.047). Unintended pregnancies had lower median birth weight (2806.6 vs 2948.4 grams, p=0.033). Unintended pregnancy was not associated with increased neonatal morbidity or severe maternal morbidity. These findings underscore the importance of family planning counseling, access to safe and effective contraceptive options, as well as multidisciplinary prenatal care in the growing population of reproductive-aged LT recipients.

Utility of placental biomarkers and fetoplacental Dopplers in predicting likely placental pathology in early and late fetal growth restriction – A prospective study

IntroductionThe aim of this study was to evaluate the association between placental abnormalities, placental biomarkers, and fetoplacental Dopplers in a cohort of pregnancies complicated by fetal growth restriction (FGR). We also ascertained the risk of perinatal mortality, severe neurological morbidity, and severe non-neurological morbidity by type of placental abnormality. MethodsThis was a prospective cohort study. Multivariable logistic regression was used to evaluate the effect of early vs. late FGR, placental biomarkers and fetoplacental Dopplers on Maternal Vascular Malperfusion (MVM) which was the commonest placental abnormality identified. ResultsThere were 161 (53.5 %) early FGR and 140 (46.5 %) late FGR cases. MVM abnormalities were present in 154 (51.2 %), VUE in 45 (14.6 %), FVM in 16 (5.3 %), DVM in 14 (4.7 %) and CHI in 4 (1.3 %) cases. The odds of MVM were higher in early compared to late FGR cohort (OR 1.89, 95%CI 1.14, 3.14, p = 0.01). Low maternal PlGF levels <100 ng/L (OR 2.34, 95%CI 1.27,4.31, p = 0.01), high sFlt-1 level (OR 2.13, 95%CI 1.35, 3.36, p = 0.001) or elevated sFlt-1/PlGF ratio (OR 3.48, 95%CI 1.36, 8.91, p = 0.01) were all associated with MVM. Increased UA PI > 95th centile (OR 2.91, 95%CI 1.71, 4.95, p=<0.001) and mean UtA PI z-score (OR 1.74, 95%CI 1.15, 2.64, p = 0.01) were associated with higher odds of MVM. Rates of severe non-neurological morbidity were highest in the MVM, FVM, and CHI cohorts (44.8 %, 50 %, and 50 % respectively). ConclusionMVM was the commonest placental abnormality in FGR, particularly in early-onset disease. Low maternal PlGF levels, high sFlt-1 levels, elevated sFlt-1/PlGF ratio, and abnormal fetoplacental Dopplers were also significantly associated with MVM. MVM, FVM, and CHI abnormalities were associated with lower median birthweight, higher rates of preterm birth, operative birth for non-reassuring fetal status, and severe neonatal non-neurological morbidity.

Perinatal and neonatal outcomes of high-risk asymptomatic women from a specialist preterm birth surveillance clinic

ObjectivesTo report the perinatal outcomes of high-risk asymptomatic women who attended a specialist preterm surveillance clinic (PSC) to undergo screening for spontaneous preterm birth (PTB) in Ireland. MethodsSingle center, retrospective cohort study of asymptomatic high risk women who attended the PSC between January 2019 and December 2022. A comprehensive database of all patients who attended the clinic during the study period was constructed and analyzed. Overall outcomes were reported, and stratified per the occurrence of preterm or term birth. Iatrogenic PTBs were included in the outcome data. ResultsFollowing exclusions for loss-to-follow-up, 762 cases were analyzed, constituting 2262 PSC visits. Of those, 183 women were prescribed progesterone (24.0 %), and 100 women underwent cervical cerclage (13.1 %) to prevent spontaneous PTB. Overall, 2.4 %, 6.2 % and 18.6 % of participants gave birth prior to 30 weeks, 34 weeks, and 37 weeks, respectively. The median gestational age at birth for the entire cohort was 38.6 weeks (inter-quartile range (IQR) 37.2–39.6 weeks).Women who delivered < 37 weeks were significantly more likely to be smokers (p = 0.030), have a previous spontaneous PTB (p = 0.016), have multiple pregnancies (p < 0.001), type 1 or 2 diabetes (p = 0.044), or have a previous full dilatation caesarean section birth (p = 0.024). Infants born prior to 37 weeks were more likely to have a lower median birthweight (2270 vs 3300 g, p < 0.001), be admitted to a neonatal intensive care unit (53.8 % vs 2.3 %, p < 0.001) or experience short-term morbidity, including respiratory support (38.0 % vs 1.6 %, p < 0.001). ConclusionsOver 80% of women deemed to be at high risk of PTB gave birth at term gestations following attendance at a PSC during pregnancy. Most women can be successfully managed without interventions, instead employing a policy of serial cervical surveillance, to identify those at greatest risk of PTB.

Placental Findings in Infants Gestational Age < 34 Weeks and Impact on Short-Term Outcomes.

To analyse placental changes in infants' gestational age < 34 weeks and its correlation to short-term respiratory outcomes or death until hospital discharge. Information regarding all in-house born preterm infants born before 34 weeks gestation and born from January 2009 until December 2014 were collected and included among others, placental pathology and relevant data on demographics and outcomes of infants. Placental abnormalities was found in 157/253 (65.05%) cases. Acute placental inflammation was found to be the most common in both groups of premature neonates, followed by maternal vascular underperfusion. Maternal vascular underperfusion was significantly more common in GA ≤ 27 weeks compared to infants GA 28-33 weeks (35.2% vs. 13.7%; p = 0.018). Similarly, chronic placental inflammation was more common in infants GA ≤ 27 weeks compared to infants GA 28-33 weeks (14.3% vs. 3.3%; p = 0.014). Infants with placental pathology had a lower median birth weight (1460g vs. 1754g; p = 0.001, and were of shorter median GA at birth (31 vs. 32; p = 0.001). Infants with any placental disease had higher rates of death until hospital discharge (10.2% vs. 3.1%; p = 0.039) and higher rates of any stage of bronchopulmonary dysplasia (41.4% vs. 26.0%; p = 0.013). There were no significant differences in mechanical ventilation rates, duration of mechanical ventilation and duration of supplemental oxygen therapy. Identifiable placental abnormalities were found in most infants born < 34 weeks gestation. Placental pathology is associated with increased rates of bronchopulmonary dysplasia and death until hospital discharge.

Maternal and fetal outcomes of pregnant women with bacterial vaginosis.

Bacterial vaginosis (BV) is a common infection in women of reproductive age group because of vaginal dysbiosis. The impact of BV during pregnancy is still not well defined. The objective of this study is to assess the maternal-fetal outcome in women with BV. A prospective cohort study over one-year duration was conducted from December, 2014 until December, 2015, involving 237 women who presented with abnormal vaginal discharge, preterm labour or preterm prelabour rupture of membrane between 22- and 34-weeks period of gestation. Vaginal swabs were sent for culture and sensitivity, BV® Blue testing and PCR for Gardnerella vaginalis (GV). BV was diagnosed in 24/237 (10.1%) cases. The median gestational age was 31.6 weeks. GV was isolated from 16 out of 24 (66.7%) in the BV positive group. There was a significantly higher preterm birth rate, below 34 weeks (22.7% vs. 6.2%, p = 0.019) in women with BV. There was no statistically significant difference in maternal outcome such as clinical chorioamnionitis or endometritis. However, placental pathology revealed more than half (55.6%) of women with BV had histologic chorioamnionitis. Neonatal morbidity was significantly higher with exposure to BV, with a lower median birth weight, higher rate of neonatal intensive care unit admission (41.7% vs. 19.0%, p = 0.010), increased intubation for respiratory support (29.2% vs. 7.6%, p = 0.004) and respiratory distress syndrome (33.3% vs. 9.0%, p = 0.002). More research is needed to formulate guidelines for prevention, early detection and treatment of BV during pregnancy to reduce intrauterine inflammation and the associated adverse fetal outcomes.

46 Impact of early versus late medical treatment of a hemodynamically significant patent ductus arteriosus on time to reach full feeds in preterm neonates

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants has been associated with an increase in neonatal morbidities. Objectives To examine the effect of timing of medical treatment (within first 7 days of life versus after 7 days of life) for a hsPDA on the duration to achieve full feeds in infants born at &amp;lt;30 weeks of gestation. Design/Methods This was a retrospective cohort study in a quaternary neonatal intensive care unit (NICU) with a targeted neonatal echocardiography service. Infants admitted between July 2015 – June 2019 who received medical treatment for an hsPDA were included and grouped based on those who received first medical therapy within 7 days of life (early treatment) and after 7 days of life (late treatment). An hsPDA was defined using both clinical (worsening ventilation, pulmonary hemorrhage/edema, or hypotension requiring inotrope or hydrocortisone) and echocardiographic findings (LA/Ao ratio &amp;gt;1.4; LVO &amp;gt;350 mL/kg/min, PDA &amp;gt;1.4 mm, IVRT &amp;lt; 35 ms). Duration to reach full feeds was calculated based on number of days to reach a total enteral feed ≥ 120 mL/kg/day with no parenteral source of nutrition. Results Forty-six infants met the inclusion criteria. Of the 46 infants, 24 were identified as receiving early treatment and 22 received late treatment. Infants in the early treatment group had lower median birth weight than the late treatment group (802 g vs. 1016 g, p=0.022). All other clinical characteristics were not significantly different. No significant difference was found in the use of indomethacin, ibuprofen, or acetaminophen as the initial medical treatment (Table 1). The late treatment group had elevated left ventricular output (median: 286 vs. 369 mL/kg/min, p=0.013) and tricuspid annular plane systolic excursion (median: 6 vs. 8 mm, p=0.002) (Table 2). Infants in the early treatment group reached full feeds earlier than those in the late treatment group (19 vs. 30 days, p=0.042) (Table 1). Conclusion Early medical treatment of hsPDA was associated with shorter duration to reach full feeds in our cohort of preterm infants. Further larger scale study is needed to understand the association between the timing of medical therapy and prolonged exposure of splanchnic circulation to hemodynamically significant ductus.

Racial Influences on Pediatric Tracheostomy Outcomes.

To determine the impact of race on outcomes after pediatric tracheostomy. Retrospective case series. A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P= .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P= .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P= .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P< .001), less extreme prematurity (44%, P< .001), and less BPD (21%, P= .04). The proportion of Black children was higher (30% vs. 19%, P< .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P= .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P= .51), decannulation (P= .17), or death (P= .92) after controlling for age, sex, prematurity, and ventilator dependence. Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long-term outcomes after pediatric tracheostomy. Laryngoscope, 132:1118-1124, 2022.

The Danish HIV Birth Cohort (DHBC) - a nationwide, prospective cohort

PurposeThe purpose of the Danish HIV Birth Cohort (DHBC) is to investigate the significance of HIV-1 infection in pregnancy and after delivery in women living with HIV (WLWH) in Denmark...

Risk factors and incidence of third trimester stillbirths in China

About 2.6 million third-trimester stillbirths occur annually worldwide, mostly in low- and middle-income countries. However, the causes of stillbirths are rarely investigated. We performed a retrospective, hospital-based study in Zhejiang Province, southern China, of the causes of third-trimester stillbirths. Causes of stillbirths were classified using the Relevant Condition at Death classification system. From January 1, 2013, to December 31, 2018, we enrolled 341 stillbirths (born to 338 women) from 111,275 perinatal fetuses (born to 107,142 women), as well as 293 control cases (born to 291 women). The total incidence of third-trimester stillbirths was 3.06/1000 (341/111,275). There were higher proportions of women with a high body mass index, twins, pregnancy-induced hypertension, assisted reproduction and other risk factors among the antepartum than the control cases. The antepartum stillbirth fetuses were of lower median birth weight and gestational age and had a smaller portion of translucent amniotic fluid than the control cases. The antepartum stillbirth fetuses had a higher frequency of abnormalities detected prenatally and of fetal growth restriction than the control cases. Of 341 cases (born to 338 mothers), the most common causes of stillbirth were fetal conditions [117 (34.3%) cases], umbilical cord [88 (25.8%)], maternal conditions [34 (10.0%)], placental conditions [31 (9.1%)], and intrapartum [28 (8.2%)]. Only eight (2.3%), three (0.9%), and two (0.6%) stillbirths were attributed to amniotic fluid, trauma, and uterus, respectively. In 30 (8.8%) cases, the cause of death was unclassified. In conclusion, targeted investigation can ascertain the causes of most cases of third-trimester stillbirths.

The impact of excessive gestational weight gain timing on neonatal outcomes in women with class III obesity

Objective This study evaluated the influence of early gestational weight gain (GWG) on neonatal outcomes among women with class III obesity. Study Design Retrospective cohort of women with class III obesity who gained more than the Institute of Medicine (IOM) guidelines (>20lbs). Women gaining ≥75% of total gestational weight prior to 28 weeks (EWG) were compared to women gaining <75% of their total weight prior to 28 weeks (SWG). The primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Results Of 144 women identified, 42 (29.2%) had EWG and 102 (70.8%) had SWG. Though 11% of the total population had composite neonatal morbidity, this did not differ between groups (p = .4). LGA was nearly twice as common in the SWG group (41% vs 26%, p = .13). EWG was associated with decreased risk of LGA (AOR 0.25 95% CI 0.08, 0.78) and lower median birth weight (AOR −312 g 95% CI −534.7, −90.2). Conclusion Though adverse neonatal outcomes were common in this population, timing of gestational weight gain was not correlated. Increased rates of LGA and higher median birth weight in the SWG group suggests excessive GWG continuing in the third trimester of pregnancy may be of import for neonatal size.

Neurodevelopmental Outcomes of Preterm Infants With Retinopathy of Prematurity by Treatment.

Because most studies regarding neurodevelopment in retinopathy of prematurity (ROP) are small and single-center studies, we commend the authors for this retrospective multicenter analysis of prospectively collected data comparing anti–vascular endothelial growth factor (VEGF) with laser treatment.1 Although they found no difference in their primary outcome of severe neurodevelopmental impairment (NDI) or death, when examined separately, they found a higher rate of death but not of NDI. Unfortunately, as a nonrandomized study, it suffers from imbalance in baseline characteristics, which limits robustness. First, as the authors acknowledge, infants who received bevacizumab were smaller and sicker. At baseline, infants treated with bevacizumab had lower median birth weight ( P = .02), gestational age ( P = .05), and … E-mail: gnatara{at}med.wayne.edu

Hepatopulmonary fusion: A rare variant of congenital diaphragmatic hernia

BackgroundHepatopulmonary fusion (HPF), a rare anomaly associated with right congenital diaphragmatic hernia (CDH), is characterized by a fibrovascular fusion between herniated liver and lung parenchyma. We aimed to clarify patient characteristics, management strategies, and outcomes in HPF. MethodsData on infants with HPF were obtained from the Congenital Diaphragmatic Hernia Registry (CDHR). Patient characteristics, management, and outcomes were compared with the results of a literature review. ResultsTen cases of HPF were identified in the CDHR. Five patients survived. The median estimated gestational age was 38 weeks (range 36–40). Median birth weight was 2.7 kg (range 2.0–3.8 kg), but non-survivors had a lower median birth weight (2.3 kg vs. 3.5 kg). All patients had at least 1 congenital anomaly in addition to CDH. Operative approach varied, but most surgeons performed only partial separation of the liver and lung (n = 6). The 2 patients who underwent complete separation both ultimately died, 1 due to significant postoperative complications and 1 due to severe pulmonary hypertension with multiple vascular anomalies. ConclusionPartial separation of liver and lung appears to be the wisest surgical approach in HPF, as complete separation has resulted in catastrophic complications due to frequent underlying vascular anomalies. Level of evidenceIV.

Multicenter retrospective comparison of spontaneous intestinal perforation outcomes between primary peritoneal drain and primary laparotomy

PurposeThe purpose of our study was to compare outcomes of infants with spontaneous intestinal perforation (SIP) treated with primary peritoneal drain versus primary laparotomy. MethodsWe performed a multi-institution retrospective review of infants with diagnosis of SIP from 2012 to 2016. Clinical characteristics and outcomes were compared between infants treated with primary peritoneal drain vs infants treated with laparotomy. ResultsWe identified 171 patients treated for SIP (drain n = 110 vs. laparotomy n = 61). There were no differences in maternal or prenatal characteristics. There were no clinically significant differences in vital signs, white blood cell or platelet measures, up to 48 h after intervention. Patients who were treated primarily with a drain were more premature (24.9 vs. 27.2 weeks, p < 0.001) and had lower median birth weight (710 g vs. 896 g, p < 0.001). No significant differences were found in complications, time to full feeds, length of stay (LOS) or mortality between the groups. Primary laparotomy group had more procedures (median number 1 vs. 2, p = 0.002). There were 32 (29%) primary drain failures whereby a laparotomy was ultimately needed. ConclusionsSIP treated with primary drain is successful in the majority of patients with no significant differences in outcomes when compared to laparotomy with stoma. The level of evidenceIII.

Association between severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand

ABSTRACTBackground: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.

829: The impact of early gestational weight gain on neonatal outcomes in morbidly obese women

Early excessive gestational weight gain (GWG) is associated with large for gestation (LGA) neonates and adiposity. No data exists regarding the impact of early GWG in women with class III obesity. We evaluated the influence of early GWG on neonatal outcomes among this population Retrospective cohort of women with class III obesity at a single center from 7/2013-12/2017 who gained more than the Institute of Medicine (IOM) guidelines(>20lbs). Women gaining >75% of total gestational weight prior to 28 weeks(EWG) were compared to women gaining less than <75% of their total weight prior to 28 weeks(SWG). Pregnancies complicated by twins, late prenatal care, preterm birth, fetal anomalies, intrauterine demise, and missing BMI data were excluded. Primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Analysis was performed using simple statistics as appropriate. Regression models used to adjust for confounding factors. Of 144 women who gained greater than IOM guidelines, 42(29.2%) gained early(EWG) and 102(70.8%) were in the SWG group. The EWG group was more likely to be African American, multiparous, use illicit drugs, and have inadequate prenatal care. Gestational diabetes, mode of delivery, macrosomia, and IUGR were not different (Table 1). Though 11% of the total population had the composite neonatal morbidity, this did not differ between groups (p=0.4) (Table 2). LGA was nearly twice as common in the SWG group (41% vs 26%, p=0.13). In adjusted models, there was no difference between groups in the neonatal composite morbidity or NICU admission. However, EWG was associated with a decreased risk of LGA (AOR 0.25 95% CI 0.08-0.78) and lower median birth weight Though adverse neonatal outcomes were surprisingly common in this population, timing of gestational weight gain did not correlate with them. However, increased rates of LGA and higher median birth weight in the SWG group suggests that excessive GWG continuing in the third trimester of pregnancy may be of increased importance for neonatal growth in this groupView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Infants with esophageal atresia and right aortic arch: Characteristics and outcomes from the Midwest Pediatric Surgery Consortium

PurposeRight sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF. MethodsA multi-institutional, IRB approved, retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals in the United States over a 5-year period (2009 to 2014) was performed. All patients had a minimum of one-year follow-up. ResultsIn a cohort of 396 infants with esophageal atresia, 20 (5%) had RAA, with 18 having EA with a distal TEF and 2 with pure EA. Compared to infants with left sided arch (LAA), RAA infants had a lower median birth weight, (1.96 kg (IQR 1.54–2.65) vs. 2.57 kg (2.00–3.03), p = 0.01), earlier gestational age (34.5 weeks (IQR 32–37) vs. 37 weeks (35–39), p = 0.01), and a higher incidence of congenital heart disease (90% vs. 32%, p < 0.0001). The most common cardiac lesions in the RAA group were ventricular septal defect (7), tetralogy of Fallot (7) and vascular ring (5). Seventeen infants with RAA underwent successful EA repair, 12 (71%) via right thoracotomy and 5 (29%) through left thoracotomy. Anastomotic strictures trended toward a difference in RAA patients undergoing right thoracotomy for primary repair of their EA/TEF compared to left thoracotomy (50% vs. 0%, p = 0.1). Side of thoracotomy in RAA patients undergoing EA/TEF repair was not significantly associated with mortality, anastomotic leak, recurrent laryngeal nerve injury, recurrent fistula, or esophageal dehiscence (all p > 0.29). ConclusionRAA in infants with EA/TEF is rare with an incidence of 5%. Compared to infants with EA/TEF and LAA, infants with EA/TEF and RAA are more severely ill with lower birth weight and higher rates of prematurity and complex congenital heart disease. In neonates with RAA, surgical repair of the EA/TEF is technically feasible via thoracotomy from either chest. A higher incidence of anastomotic strictures may occur with a right-sided approach. Level of evidenceLevel III.

The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort.

Maternal smoking is associated with a number of adverse outcomes with a dose-dependent increase in risk. The aim of this study was to evaluate the obstetric and perinatal outcomes in women who smoked during pregnancy. This was a retrospective cohort study of women who smoked during pregnancy and birthed at a major perinatal centre in Australia between January 2000 and April 2017. The study cohort was compared to a cohort of women who did not smoke in pregnancy. Smoking status was ascertained on history and included all types of smoking. Demographic characteristics and obstetric, intrapartum and perinatal outcomes were compared between the two groups. The study cohort included 20477 (14.6%) women who smoked during pregnancy and 119396 controls. Women who smoked tended to be younger, of higher body mass index (BMI), Caucasian and Indigenous ethnicity. Smokers were less likely to be nulliparous, but more likely to be hypertensive and have a lower socioeconomic status compared to non-smokers. Women who smoked were more likely to have a caesarean section for non-reassuring fetal status (adjusted odds ratio (aOR) 1.16, 95%CI 1.07-1.26, P<0.001). The infants of women who smoked were more likely to be born preterm, have a lower median birth weight and birth weights <10th (aOR 1.76, 95%CI 1.66-1.86, P<0.001) and <5th centile (aOR 2.00, 95%CI 1.86-2.16, P<0.001). Neonatal outcomes in the smoking cohort were worse with an increase in neonatal intensive care unit admission (aOR 1.34, 95%CI 1.27-1.43, P<0.001), severe acidosis (aOR 1.41, 95%CI 1.27-1.43, P<0.001) and a composite of severe neonatal outcomes (18.0% vs 12.0%, aOR 1.35, 95%CI 1.28-1.43, P<0.001). Women who smoke in pregnancy have worse obstetric and perinatal outcomes compared to controls and should be managed as high risk.

Prenatally Diagnosed Single Umbilical Artery (SUA) - Retrospective Analysis of 1169 Fetuses.

The incidence of a fetal single umbilical artery (SUA) is about 0.5 % and has been associated with an increased risk of congenital malformations, fetal aneuploidy and intrauterine growth restriction (IUGR). A retrospective analysis of 1169 women with singleton pregnancies diagnosed with fetal SUA between 1997 and 2014 in a specialized practice for prenatal diagnostics has been performed. Data was obtained on maternal and fetal findings as well as pregnancy outcome. 989 (84.6 %) fetuses showed an isolated SUA (iSUA) while 180 (15.4 %) presented with SUA and additional structural and/or chromosomal abnormalities. Structural malformations were distributed as follows: 9.0 % cardiovascular, 3.5 % urogenital, 2.9 % musculoskeletal, 3.0 % gastrointestinal and 2.1 % cerebral. 2.1 % of the fetuses had chromosomal aberrations. 50.8 % (49.2 %) of the fetuses were female (male) and right vs. left SUA was found in 64.2 % (35.8 %) ofthe cases. Fetuses with SUA and additional abnormalities showed lower rates of live births (85.0 % vs. 98.5 %, p < 0.001), a lower median birth weight (2825 g vs. 3220 g, p < 0.001), higher rates of preterm delivery before week 34 + 0 (13.7 % vs. 3.8 %, p < 0.001) and weighed less than the 5th growth percentile in 21.6 % vs. 9.3 % (p < 0.001) of the fetuses with iSUA. In 5.1 % (60) of the children, chromosomal or structural abnormalities were detected post-partum. Once fetal SUA is diagnosed, intense sonoanatomy of the fetus is required and, if associated malformations are found, genetic testing must be offered. In iSUA intermittent biometry is recommended for the early detection of IUGR but additional genetic testing is not necessarily recommended.

133: Pregnancy outcome after multifetal pregnancy reduction of triplets to twins versus reduction to singleton

Multifetal pregnancy reduction (MPR) of triplets to twins results in improved pregnancy outcome compared with triplet gestations managed expectantly. However, it is not clear whether reduction to singleton may further improve pregnancy outcome. The aim of this study was to determine the rate of pregnancy complications and perinatal outcomes of MPR from triplets to twins versus reduction from triplets to singleton 268 trichorionic and dichorionic triplet pregnancies underwent abdominal MPR at 11-14 weeks' gestation. Cases were divided into two groups according to the final number of embryos: group A, reduction to twins (n=221) and group B, reduction to singleton (n=47). Main outcome measures were rates of pregnancy complications, late abortions, preterm delivery and neonatal outcomes. Non-parametric statistical methods were employed. Triplet pregnancies reduced to twins (group A) delivered earlier (36 vs. 38.6 weeks’ gestation, P<0.001) with lower median birth weight (2172g vs. 2820g, P<0.001) compared with triplets reduced to singleton (group B). The rate of preterm delivery prior to 37 weeks was significantly higher in group A compared with group B (61.2% vs. 21.9%, p<0.001), although twins were not more likely to be delivered prior to 34 weeks (20.1% vs. 14.3%, p=0.52). Regression analysis revealed that after adjustment for age, parity, BMI and gestational age at reduction, triplets reduced to singleton had lower risk for preterm delivery (OR=0.14; 95% CI 0.05-0.39, p<0.001). We did not find a significant difference in the rate of pregnancy loss before 24 weeks’ gestation (6.4% vs. 1.4%, p=0.07) or the rate of intrauterine fetal death after 24 weeks (4.3% vs. 0.9%, p=0.15). There was no significant difference in the prevalence of gestational diabetes, hypertensive diseases of pregnancy and intrauterine growth restriction. Both groups had comparable neonatal outcomes, except for higher rates of NICU admission (29.2% vs. 4.5%, p<0.001), oxygen support (8.2% vs. 0%, p=0.05) and neonatal hypoglycemia (13.2% vs. 0%, p=0.04) in group A. Reduction of triplet pregnancies to singleton is associated with a lower risk of prematurity and superior perinatal outcome compared with reduction to twins. Therefore, the option of reduction to singleton should be considered in cases where the risk of prematurity seems exceptionally high.

Right ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants

ObjectiveTo assess the outcomes following primary tetralogy of Fallot (TOF) repair in neonates and young infants with pulmonary stenosis (PS) and pulmonary atresia and compare differences in reintervention on the right ventricular outflow tract (RVOT) among those undergoing valve sparing repair (VSR), transannular RVOT patch (TAP), and right ventricle–to–pulmonary artery (RV-PA) conduit surgeries. MethodsData were collected retrospectively in 101 patients who underwent TOF repair over a 10-year period between January 2005 and September 2015. The primary endpoint was reintervention on the RVOT, defined as a surgical procedure or cardiac catheterization–based RVOT reintervention. ResultsForty-three patients had TOF/PS, of whom 24 (56%) underwent TAP and 19 (44%) underwent VSR. Fifty-eight patients had TOF/PA, 14 (24%) underwent TAP and 44 (76%) underwent RV-PA conduit repair. Overall patient mortality was 2.9% (3 of 101). Thirty-three patients underwent surgical reintervention, and 52 underwent catheterization-based reintervention. Patients with TOF/PA who underwent RV-PA conduit repair had a higher surgical reintervention rate than those who underwent TAP (45% vs 21%). Patients with TOF/PSs undergoing VSR with a lower median birth weight (2.5 kg vs 3.7 kg) required more surgical reintervention. ConclusionsNeonatal TOF repair can be performed with low mortality but frequent RVOT reinterventions. Surgical reintervention is earlier and the rate is higher among patients with TOF/PA undergoing RV-PA conduit repair compared with those undergoing TAP. Although there were no overall differences in RVOT reintervention rate between patients with TOF/PS undergoing VSR and those undergoing TAP, a lower birth weight in the patients undergoing VSR is associated with a higher surgical reintervention rate.