Preterm Morbidity Research Articles

Senescent Syncytiotrophoblast Secretion During Early Onset Preeclampsia.

Preeclampsia is a severe hypertensive disorder in pregnancy that causes preterm delivery, maternal and fetal morbidity, mortality, and life-long sequelae. Understanding the pathogenesis of preeclampsia is a critical first step toward protecting mother and child from this syndrome and increased risk of cardiovascular disease later in life. However, effective early predictive tests and therapies for preeclampsia are scarce. To identify novel markers and signaling pathways for early onset preeclampsia, we profiled human maternal-fetal interface units (fetal villi and maternal decidua) from early onset preeclampsia and healthy controls using single-nucleus RNA sequencing combined with spatial transcriptomics. The placental syncytiotrophoblast is in direct contact with maternal blood and forms the barrier between fetal and maternal circulation. We identified different transcriptomic states of the endocrine syncytiotrophoblast nuclei with patterns of dysregulation associated with a senescence-associated secretory phenotype and a spatial dysregulation of senescence in the placental trophoblast layer. Elevated senescence markers were validated in placental tissues of clinical multicenter cohorts. Importantly, several secreted senescence-associated secretory phenotype factors were elevated in maternal blood already in the first trimester. We verified the secreted senescence markers, PAI-1 (plasminogen activator inhibitor 1) and activin A, as identified in our single-nucleus RNA sequencing model as predictive markers before clinical preeclampsia diagnosis. This indicates that increased syncytiotrophoblast senescence appears weeks before clinical manifestation of early onset preeclampsia, suggesting that the dysregulated preeclamptic placenta starts with higher cell maturation resulting in premature and increased senescence-associated secretory phenotype release. These senescence-associated secretory phenotype markers may serve as an additional early diagnostic tool for this syndrome.

Cancer diagnosis during pregnancy is associated with severe maternal and neonatal morbidity

BackgroundData on maternal and fetal outcomes in patients diagnosed with cancer during pregnancy are limited. Given expected increase in patients diagnosed with cancer during pregnancy, there is a growing need to evaluate clinical outcomes. ObjectiveTo evaluate obstetric outcomes among women with early-stage gynecologic or breast cancer who were diagnosed during pregnancy compared to women without cancer in a population-based cohort. MethodsWe performed a population-based study of women aged 18-45 years with stage I gynecologic or stage I-III breast cancer reported to the California Cancer Registry for the years 2000-2012. Data were linked to the 2000-2012 California birth data to produce a database with cancer characteristics and obstetric outcomes. We included patients who had a delivery within the 10 months following cancer diagnosis. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included pre-term birth (PTB) and neonatal morbidity. Propensity scores were used to match similar controls to cases in a 2:1 ratio based on demographic attributes and medical comorbidities included in the Obstetric Comorbidity Index (OB-CMI). Logistic regressions were used to evaluate outcomes. ResultsThe cohort consisted of 503 women with cancer in pregnancy (319 breast, 125 ovarian, 59 cervical), and 1,006 matched controls. Cancer during pregnancy was associated with higher odds of SMM (6.8% vs <1.1%; odds ratio [OR] 8.03, 95% CI 3.82-16.88), PTB between 32-36 weeks (32.6% vs 8.3%, OR 5.38, 95% CI 4.02-7.20), and neonatal morbidity (12.5% vs 6.1%; OR 2.22, 95% CI 1.53-3.21) compared to matched controls. In sub-analysis of SMM indicators, hysterectomy and sepsis were significantly associated with cancer during pregnancy (4.8% vs <1.1%, P<.001; <2.2% vs 0.0%, P=.037, respectively). ConclusionCancer during pregnancy is associated with increased risk of maternal and neonatal morbidity. These findings highlight the need for careful management and consideration of obstetric outcomes in these patients.

Postnatally acquired cytomegalovirus infection among preterm infants.

Although there are multiple benefits of mother's own milk feeding for very-low birth weight, low gestation infants, those born to cytomegalovirus (CMV)-seropositive mothers are at risk for acquiring postnatal CMV infection. This review will describe the risk and consequences of postnatal CMV infection among very preterm infants. Postnatal CMV may manifest as clinically silent infection or as mild to severe and occasionally fatal disease. The risk of disease is balanced by the health benefits of human milk feeding to preterm infants. Postnatal CMV infection has been associated with increased risks of multiple preterm morbidities such as bronchopulmonary dysplasia, necrotizing enterocolitis and neurodevelopmental impairment, but current evidence is limited by the selection bias inherent to reporting in case series and retrospective cohort studies. Knowledge gaps exist regarding the risk-benefit balance of pasteurization to inactivate CMV in fresh breast milk, as well as the optimal dosing, duration and efficacy of treating infected infants with antiviral medications. Multicenter, prospective studies are urgently needed to accurately determine the true burden that postnatal CMV infection presents to very preterm infants. Such studies will inform the need for preventive strategies and treatment guidance.

Parental perceptions and experiences of kangaroo care for preterm infants in neonatal intensive care units in China: a qualitative study

Backgroundkangaroo care (KC), endorsed by the World Health Organization, is an evidence-based intervention that plays a pivotal role in mitigating preterm infant mortality and morbidity. However, this intervention has not been fully integrated into healthcare systems in China. This study aimed to gain insight into parents’ perceptions and experiences of KC for preterm infants to contribute to the KC implementation on a larger scale.MethodsThis study employed a descriptive qualitative design, using face-to-face, semi-structured, in-depth interviews. Fifteen parents participating in KC for preterm infants in the neonatal intensive care units (NICUs) were purposively sampled from four hospitals across four cities in Zhejiang Province, China. Thematic analysis was employed to analyze the data.ResultsFour themes and twelve subthemes regarding the parents’ perceptions and experiences about KC were identified. The four themes included: (1) Low motivation upon initial engagement with KC, (2) Dynamic fluctuations of emotional states during KC, (3) Unexpected gains, and (4) Barriers to participation.ConclusionsParents’ perceptions and experiences of KC was a staged process, with parents exhibiting distinct cognitive patterns and unique experiences at each stage. Overall, as KC progresses, parents’ experiences tended to become increasingly positive, despite potential obstacles encountered along the way. To enhance the implementation of KC, healthcare providers could utilize prenatal and postnatal education programs. These programs aim to enhance the understanding of KC among parents of preterm infants, fostering sustained engagement in KC practices.

The Association of NICU Strain with Neonatal Mortality and Morbidity.

To examine the association of admission NICU strain with neonatal mortality and morbidity. 2008-2021 South Carolina cohort using linked vital statistics and discharge data of 22-44 weeks GA infants, born at hospitals with ≥ level 2 unit and ≥5 births of infants <34 weeks GA/year. The exposure was tertiles of admission NICU strain, defined as the sum of infants <44 weeks GA with a congenital anomaly plus all infants born <33 weeks GA at midnight on the day of birth. We used Poisson generalized linear mixed models to examine the association of exposure to strain with the primary outcome of a composite of mortality and term and preterm morbidities adjusting for patient and hospital characteristics. We studied 64,647 infants from 30 hospitals. High strain was associated with increased risk of mortality and morbidity adjusting for patient/hospital factors (aIRR 1.07, 95% CI 1.01 - 1.12). NICU strain is associated with increased adverse outcomes.

Maternal Reports of Preterm and Sick Term Infants' Settling, Sleeping and Feeding in the 9 Months after Discharge from Neonatal Nursery: An Observational Study.

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU.

#848 Influence of nutrition and other factors on preterm newborns’ kidney development

Abstract Background and Aims According to WHO, in 2020, preterm newborns represented around 10% of all newborns in the world. Premature birth is deeply connected with the risk of developing a chronic kidney disease later in life. This is caused by defects in kidney development (primarily the lower number of nephrons) that are often difficult to identify in the complicated clinical picture of premature babies. Our study aims at providing knowledge on the relationship between preterm infant kidney development and morbidities, nutrition, and blood biomarkers. Method Creatinine was measured in 130 extremely preterm newborns (less than 28 weeks of gestation) enrolled in a randomized controlled trial (Mega Donna Mega) in two Swedish neonatal intensive care units. Creatinine was measured in whole blood or serum with the enzymatic method. Individuals with 4 or more serum creatinine measurements (n = 92) were shortlisted for eGFR calculation. eGFR was calculated with the Wilhelm-Bals weight-based equation due to the lack of length measurements. The patients were divided in 3 groups based upon their kidney development status. This was indirectly assessed using the exponential regression curve describing the eGFR trends as model and the doubling time as discriminating parameter. Data about morbidity, treatment, nutrition, blood lipidomics and proteomics were also collected during the MegaDonnaMega trial and has been used to investigate the differences between the three groups. A linear model adjusted for sex and gestational age was used to analyse lipidomics and proteomics data in relation to eGFR. The omics analysis used average data from the first month of age. Data analysis was performed in R, SPSS, SAS and GraphPad statistical programs. Results Subjects were divided in 3 groups from best to worst kidney function development. The parameter used, doubling time, is inversely correlated to eGFR and kidney development. Subjects in group 1 reached the normal at-term birth eGFR (40 ml/min/1.73 m2) at around 50 days of age, whereas the other two groups were delayed (66 days for group 2, 78 for group 3). Subjects in group 2 and 3 were characterized by longer stay at the NICU, lower weight and length in respect to infants in group 1. Subjects in groups 2 and 3 also showed more co-morbidities in respect to group 1. Regarding nutrition, subjects administered with maternal milk had shorter doubling times when compared to those administered with donor or mixed milk. Six serum fatty acids correlated with the eGFR trends: heptadecanoic (FA 17:0) showed a negative correlation, while palmitoleic (16:1n-7), gamma-linolenic (18:3n-6), erucic (22:1n-9) docosapentaenoic (22:5n-6) and tricosanoic (23:0) acid showed positive correlations. 45 serum proteins correlated with the eGFR trends, in particular, inflammatory and proliferative pathways showed an inverse correlation with eGFR. Conclusion We have detected differences in the eGFR trends of preterm newborns that could be traced back to nutrition and other factors. Moreover, we identified several serum fatty acids and proteins that correlated with eGFR and therefore kidney development. The data indicates that postnatal kidney development may be important to consider in the clinical care of preterm newborns.

First-year outcomes of very low birth weight preterm singleton infants with hypoxemic respiratory failure treated with milrinone and inhaled nitric oxide (iNO) compared to iNO alone: A nationwide retrospective study.

Inhaled nitric oxide (iNO) has a beneficial effect on hypoxemic respiratory failure. The increased use of concurrent iNO and milrinone was observed. We aimed to report the trends of iNO use in the past 15 years in Taiwan and compare the first-year outcomes of combining iNO and milrinone to the iNO alone in very low birth weight preterm (VLBWP) infants under mechanical ventilation. This nationwide cohort study enrolled preterm singleton infants with birth weight <1500g treated with iNO from 2004 to 2019. Infants were divided into two groups, with a combination of intravenous milrinone (Group 2, n = 166) and without milrinone (Group 1, n = 591). After propensity score matching (PSM), each group's sample size is 124. The primary outcomes were all-cause mortality and the respiratory condition, including ventilator use and duration. The secondary outcomes were preterm morbidities within one year after birth. After PSM, more infants in Group 2 needed inotropes. The mortality rate was significantly higher in Group 2 than in Group 1 from one month after birth till 1 year of age (55.1% vs. 13.5%) with the adjusted hazard ratio of 4.25 (95%CI = 2.42-7.47, p <0.001). For infants who died before 36 weeks of postmenstrual age (PMA), Group 2 had longer hospital stays compared to Group 1. For infants who survived after 36 weeks PMA, the incidence of moderate and severe bronchopulmonary dysplasia (BPD) was significantly higher in Group 2 than in Group 1. For infants who survived until one year of age, the incidence of pneumonia was significantly higher in Group 2 (28.30%) compared to Group 1 (12.62%) (p = 0.0153). Combined treatment of iNO and milrinone is increasingly applied in VLBWP infants in Taiwan. This retrospective study did not support the benefits of combining iNO and milrinone on one-year survival and BPD prevention. A future prospective study is warranted.

Comparison of competing-risks model with angiogenic factors in midgestation screening for preterm growth-related neonatal morbidity.

First, to evaluate the predictive performance for preterm growth-related neonatal morbidity of a high soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio or low PlGF at midgestation and, second, to compare the performance of a high sFlt-1/PlGF ratio or low PlGF with that of the competing-risks model for small-for-gestational age (SGA), utilizing a combination of maternal risk factors, sonographic estimated fetal weight and uterine artery pulsatility index. This was a prospective observational study in women attending for a routine hospital visit at 19-24 weeks' gestation in two maternity hospitals in England. The visit included recording of maternal demographic characteristics and medical history, carrying out an ultrasound scan and measuring serum PlGF and sFlt-1. The primary outcome was delivery < 32 and < 37 weeks' gestation of a SGA neonate with birth weight < 10th or < 3rd percentile, combined with neonatal unit (NNU) admission for ≥ 48 h or a composite of major neonatal morbidity. The detection rates in screening by PlGF < 10th percentile, sFlt-1/PlGF ratio > 90th percentile and the competing-risks model for SGA were estimated and then compared using McNemar's test. In the study population of 40 241 women, prediction of preterm growth-related neonatal morbidity provided by the competing-risks model for SGA was superior to that of screening by low PlGF concentration or high sFlt-1/PlGF ratio. For example, at a screen-positive rate of 10.0%, as defined by the sFlt-1/PlGF ratio > 90th percentile, the competing-risks model predicted 70.1% (95%CI, 61.0-79.2%) of SGA < 10th percentile and 76.9% (95%CI, 67.6-86.3%) of SGA < 3rd percentile with NNU admission for ≥ 48 h delivered < 32 weeks' gestation. The respective values for SGA with major neonatal morbidity were 73.8% (95%CI, 64.4-83.2%) and 77.9% (95%CI, 68.0-87.8%). These were significantly higher than the respective values of 35.1% (95%CI, 25.6-44.6%), 35.9% (95%CI, 25.3-46.5%), 38.1% (95%CI, 27.7-48.5%) and 39.7% (95%CI, 28.1-51.3%) achieved by the application of the sFlt-1/PlGF ratio > 90th percentile (all P < 0.0001). At midgestation, the prediction of growth-related neonatal morbidity by the competing-risks model for SGA is superior to that of a high sFlt-1/PlGF ratio or low PlGF. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

USING A MULTI-OMICS LANDSCAPE OF THE MATERNAL-FETAL INTERFACE TO MODEL THE LONGITUDINAL PATHOGENESIS OF EARLY-ONSET PRE-ECLAMPSIA

Objective: Pre-eclampsia (PE) is a syndrome that affects multiple organ systems and is the most severe hypertensive disorder in pregnancy. It frequently leads to preterm delivery, maternal and fetal morbidity and mortality and life-long complications. We currently lack efficient screening tools and early therapies to address PE. Design and method: To identify candidate biomarkers and operative pathways in early onset PE (eoPE, severe PE with onset before week 34), we performed spatio-temporal multi-omics profiling of human eoPE placentae and healthy controls, and validated targets in early gestation in a longitudinal clinical cohort. We used a single-nuclei RNA-sequencing combined with spatial proteo- and transcriptomics and mechanistic in vitro signalling analyses to bridge the gap from late pregnancy disease to early pregnancy pathomechanisms. Results: We discovered a key disruption in villous trophoblast differentiation, which is driven by the increase of transcriptional coactivator p300, that ultimately ends with a senescence-associated secretory phenotype (SASP) of trophoblasts in eoPE. We found a significant increase in the senescence markers in preeclamptic maternal serum in early gestation and late gestation, before the development of clinical symptoms, indicating that the placental syndrome drives systemic maternal syndrome, even before clinical manifestation of eoPE. Conclusions: Our work describes a new disease progression model, starting with dysregulated transition in villous trophoblast differentiation. Our study identifies potential pathophysiology-relevant biomarkers for the early diagnosis of the disease as well as possible targets for interventions, which would be crucial steps toward protecting the mother and child from gestational mortality and morbidity and an increased risk of cardiovascular disease later in life.

Need for Gastrostomy Tube in Periviable Infants.

We sought to identify clinical and demographic factors associated with gastrostomy tube (g-tube) placement in periviable infants. We conducted a single-center retrospective cohort study of live-born infants between 22 and 25 weeks' gestation. Infants not actively resuscitated and those with congenital anomalies were excluded from analysis. Of the 243 infants included, 158 survived until discharge. Of those that survived to discharge, 35 required g-tube prior to discharge. Maternal race/ethnicity (p = 0.006), intraventricular hemorrhage (p = 0.013), periventricular leukomalacia (p = 0.003), bronchopulmonary dysplasia (BPD; p ≤ 0.001), and singleton gestation (p = 0.009) were associated with need for gastrostomy. In a multivariable logistic regression, maternal Black race (Odds Ratio [OR] = 2.88; 95% confidence interval [CI]: 1.11-7.47; p = 0.029), singleton gestation (OR = 3.99; 95% CI: 1.28-12.4; p = 0.017) and BPD (zero g-tube placement in the no BPD arm; p ≤ 0.001) were associated with need for g-tube. A high percentage of periviable infants surviving until discharge require g-tube at our institution. In this single-center retrospective study, we noted that maternal Black race, singleton gestation, and BPD were associated with increased risk for g-tube placement in infants born between 22 and 25 weeks' gestation. The finding of increased risk with maternal Black race is consistent with previous reports of racial/ethnic disparities in preterm morbidities. Additional studies examining factors associated with successful achievement of oral feedings in preterm infants are necessary and will inform future efforts to advance equity in newborn health. · BPD, singleton birth, and Black race are associated with need for g-tube in periviable infants.. · Severe intraventricular hemorrhage is associated with increased mortality or g-tube placement in periviable infants.. · Further investigation into the relationship between maternal race and g-tube placement is warranted..

Value of brain tissue oxygen saturation in neonatal respiratory distress syndrome: a clinical study.

Neonatal respiratory distress syndrome (NRDS) is one of the major causes of pre-term mortality and morbidity among very-low-birth-weight infants (VLBWI) in low- and middle-income countries (LMIC). Some of the neonates pass away despite admission and care in intensive care units (ICUs). The present clinical trial seeks the application value of elevating oxygen saturation in the brain cells of pre-term neonates born with NRDS. Near-infrared spectroscopy (NIRS) was used to monitor the neonates' microscopic cerebral oxygenation levels do determine hemoglobin concentration in brain tissues, whereas the pulse oximetry was used to measure oxygenation levels among the patients. In statistical analyses, the Analysis of Variance (ANOVA), and descriptive statistics was deployed in the Jupyter Notebook environment using Python language. High saturation of oxygen in the brain tissues result in important biological and physiological processes, including enhanced oxygen supply to cells, reduced severity of NRDS, and balancing oxygen demand and supply. The correlations of oxygen saturation with systemic saturation of oxygen, the saturation of oxygen in brain tissues, the association between brain-specific and systemic saturation, and the impact of these outcomes on clinical practices were deliberated. Also, the pH gas values, the saturation of oxygen in neonates' brain tissues, metabolic acidosis, the effect of acid-base balance and cerebral oxygen supply, and the oxygenation of brain tissues and the pH values emerged as important variables of oxygenation of brain tissues in pre-term neonates. Oxygen saturation in brain cells influence vital physiological and biological processes. Balancing acid-base saturation or levels is needed despite the challenging achievement. Oxygenation of brain tissues improve the brain's overall functioning.

Racial Differences in Respiratory Morbidity in Late Preterm Infants: A Retrospective Cohort Study.

Objectives. The role of race in late preterm respiratory morbidity has not been adequately described. We aimed to determine whether neonatal respiratory morbidity differs between Black and White late preterm infants. Methods. Single-centre retrospective cohort study at King's College Hospital NHS Foundation Trust, London, UK of infants born at 34 to <37 weeks of gestational age. The incidence of invasive ventilation was used as the main outcome. Results. In the study period 354 Black and 673 White late preterm infants were admitted. Black, compared to white infants, had a lower incidence of invasive ventilation (19% vs 27%, P < .001) and a lower incidence of non-invasive ventilation (22% vs 34%, P < .001). Black infants had a shorter duration and cost of stay compared to White infants (P = .011 and <0.001 respectively). Conclusion. Black late preterm infants needed less frequently invasive and non-invasive ventilation and had a shorter duration and cost of stay compared to White late preterm infants.

Sex differences in preterm respiratory morbidity: A recent whole-population study.

To determine whether there were differences between male and female infants in respiratory morbidity in a whole population of extremely preterm infants, including infants born below 24 weeks of gestation. Retrospective whole-population study of all infants <28 weeks of gestation admitted to a neonatal unit in England from 2014 to 2019. Bronchopulmonary dysplasia (BPD) development was defined as any respiratory support at 36 weeks postmenstrual age. The 11 844 infants had a median (IQR) gestational age of 26.0 (24.9-27.1) weeks and a birth weight of 0.81 (0.67-0.96) kg. The duration of invasive ventilation was longer in male compared to female infants who were born at 24-27 completed weeks of gestation (p < 0.001), but not significantly different between male and female infants born at 22 and 23 weeks of gestation (p = 0.446). The incidence of BPD was higher in male compared to female infants born at 24-27 weeks of gestation (p < 0.001) but not different between male and female infants born at 22 and 23 weeks of gestation (p = 0.148). Respiratory morbidity was more pronounced in male compared to female extremely preterms, only in gestations 24-27 completed weeks. Male predominance was absent in infants born below 24 weeks of gestation.

Probiotics, Prebiotics, and Lactoferrin—Implications for Preterm Mortality and Morbidity

Probiotics, Prebiotics, and Lactoferrin—Implications for Preterm Mortality and Morbidity

Perinatal and Neonatal Outcomes of Refugee Infants in a Tertiary Hospital in Turkey.

Background Worldwide, the immigration problem has been increasing due to conflicts. In recent years, Turkey accepted more than 3.8 million refugees from many countries, principally Syria. Aims In this study, we aimed to evaluate the prenatal features and neonatal outcomes of refugees and Turkish controls hospitalized in a tertiary neonatal intensive care unit in Turkey. Materials and methods This retrospective case-control study included comparative data related to populations based on whether they were refugees or not. Their perinatal and neonatal "outcomes" were compared. Results Among the 254 analyzed neonates, 127 were born to refugee mothers, and 127 controls were born to non-refugee Turkish mothers. The refugee rate in our hospitalized neonates was nine, a young mother's age (p=0.010) with a higher rate of adolescent pregnancies at OR 2.78 (95% CI 0.96-8.05) (p=0.032), and consanguineous marriage at OR 0.57 (95% CI 0.32-1.02) (p=0.031) in comparison to non-refugees. The incidence of ABO incompatibility-related hemolytic jaundice (p=0.013) was higher in the refugees. The rate of formula feeding in the first month of life was significantly higher at OR 0.49 (95% CI 0.25-0.92) (p=0.027) in neonates born to refugee mothers. Despite lower perinatal care rates in refugees at OR 7.23 (95%CI 4.12-12.69) (<0.001), preterm morbidities did not differ between refugees and non-refugee preterm infants ≤32 gestational age (p>0.05). Conclusion The importance of breast milk must be strongly encouraged to initiate and promote exclusive breastfeeding for the infants of refugees. Race is still an important risk factor for ABO incompatibility-related hemolytic jaundice. Providing high-quality healthcare is sufficient to prevent worse outcomes in refugee neonates.

COVID-19 related Complications during Pregnancy: A Systematic Review

Background: The topic of COVID-19 (coronavirus disease)-associated complications during pregnancy is poorly postulated and remains an area that requires elucidation for the underlying pathophysiology mechanism in order to evaluate a new therapeutic strategy and optimize current therapies. Aim: The study aimed to assess the proportion of associated complications with COVID-19 and the underlying pathophysiology in pregnant women. Methods: The MedLine and Embase databases were searched for studies relevant to the study topic. Results: Preterm delivery and C-section have been found to be the most frequently reported complications. Approximately, 28.55% of pregnant women with symptomatic COVID-19 have been reported to require a C-section and 8.8% preterm delivery. In addition, anxiety and depression have also been frequently reported in 57% and 37% of pregnant women, respectively. Conclusion: Symptomatic pregnant women with COVID-19 have a high risk of preterm labor, mortality and morbidity rates, and C-section requirements. The underlying pathophysiology of COVID-19-associated complications during pregnancy includes homeostatic disturbances of the immune system, pulmonary system, and hemostatic system. In addition to endothelial dysfunction, excessive immune response, coagulopathy, hypoxemia, and hypotension are involved in the pathogenesis that negatively affects neonates' health outcomes.

The associations between caffeine treatment and common preterm morbidities: a retrospective cohort analysis.

Caffeine is one of the most used drugs in the neonatal intensive care units (NICUs). It is widely regarded as beneficial in preventing many morbidities by reducing apnea of prematurity and improving respiratory functions. Premature infants with gestational ages >25 and <32 weeks who were hospitalized in the NICU between 2008 and 2013 and survived up to discharge were retrospectively analyzed. Infants treated with prophylactic caffeine were compared with historical controls born in 2008 and did not receive caffeine treatment. Maternal and neonatal characteristics and common neonatal morbidities were recorded. A total of 475 patients were analyzed. The patients receiving caffeine were classified as Group 1 (n = 355), and the patients not receiving caffeine were classified as Group 2 (n = 120). Despite the higher incidence of respiratory distress syndrome requiring surfactant therapy and a longer duration of respiratory support in Group 2, the rates of bronchopulmonary dysplasia (BPD) and most other common morbidities were quite comparable. The frequency of apnea was statistically lower in the group that received caffeine prophylaxis (p < 0.01). In this retrospective cohort analysis, we found that caffeine prophylaxis significantly decreased apnea attacks however does not prevent respiratory morbidity such as BPD.

Çok düşük doğum ağırlıklı bebeklerde Erken Neonatal Sepsisin Bronkopulmoner Displazi Üzerine Etkisi

Objective&#x0D; Bronchopulmonary dysplasia (BPD) remains critical morbidity in very low birth weight (VLBW) infants. The etiology is multifactorial, and inflammation plays an essential role in the pathogenesis. We aimed to investigate the effect of early neonatal sepsis (ENS) on BPD and other preterm morbidities in VLBW infants.&#x0D; &#x0D; Materials and Methods&#x0D; Preterm infants of

Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis.

Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.