Neonatal Intensive Care Admission Research Articles

Comparative evaluation of axillary and rectal temperatures across different gestational ages in newborns admitted to the neonatal intensive care unit: a cross-sectional study.

Maintaining normothermia is crucial for neonatal survival, especially in preterm infants prone to temperature instability. This study evaluates the correlation and variability between axillary and rectal temperatures at Neonatal Intensive Care (NICU) admission across gestational age ranges of 23-28, 29-32, 33-36, and ≥ 37 weeks, aiming to inform improved neonatal thermal management strategies. This cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, from October 2023 to April 2024, involving 160 infants. Admission temperatures were measured using digital thermometers. Data analysis included ANOVA/Kruskal-Wallis for continuous variables, Chi-square tests for categorical data, Bland-Altman method for agreement assessment, and Pearson correlation coefficients to evaluate temperature correlations. Mean axillary temperature increased from 36.4°C in the 23-28 weeks gestational group, to 36.5°C in the 29-32 weeks group, and to 36.7°C in the 33-36 weeks and ≥ 37 weeks groups, (p = 0.033). Rectal temperature increased from 36.5°C in the 23-28 weeks group, to 36.6°C in the 29-32 weeks group, and reached 36.8°C in both the 33-36 weeks and ≥ 37 weeks groups (p = 0.006). Notable differences between measurement methods were observed in the 33-36 and ≥ 37 weeks groups (p < 0.001), with less pronounced differences in the 23-28 and 29-32 weeks groups. While temperature differences between rectal and axillary measurements remained consistent across all groups at 0.1°C (p = 0.779), neonatal outcomes varied significantly across gestational age groups, with younger infants exhibiting lower survival rates (p < 0.001), higher incidences of hypoglycemia (p < 0.001) and sepsis (p < 0.001), and extended durations of ventilation (p < 0.001) and hospital stay (p < 0.001). Strong correlations between rectal and axillary temperature were found across all age ranges (Pearson coefficients: 0.953 for 23-28 weeks, 0.762 for 29-32 weeks, 0.910 for 33-36 weeks, and 0.761 for ≥ 37 weeks; all p < 0.001). Bland-Altman analysis indicated higher variability in agreement for younger preterm groups, showing limits of agreement ranging from - 0.5 to 0.65°C for 23-28 weeks and - 0.5 to 0.69°C for 29-32 weeks, improving in older groups with - 0.2 to 0.4°C for 33-36 weeks and similarly narrow ranges for ≥ 37 weeks. Both rectal and axillary temperatures showed variation across different age groups, exhibiting a substantial overall correlation. Notable differences between the two methods were observed in the 33-36 weeks and ≥ 37 weeks groups. Younger preterm infants demonstrated greater variability, with enhanced agreement observed in older infants.

Incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Uganda: a prospective cohort study

BackgroundHigh rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda.Materials and methodsThis was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05.ResultsOf the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001).ConclusionsThe study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies.

Association of borderline fetal growth with progression to fetal growth restriction.

To evaluate if an estimated fetal weight (EFW) between the 10-15th percentiles at time of anatomy ultrasound, referred to as borderline fetal growth, is associated with progression to fetal growth restriction (FGR) on subsequent ultrasound, delivery of a SGA neonate or neonatal intensive care (NICU) admission. We performed a secondary analysis using the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be data (NuMom2b). The exposures were normotensive pregnancies with non-anomalous singleton gestations with normal growth, defined as EFW >15th percentile at the anatomy scan compared to borderline fetal growth fetuses defined as those with an EFW in the 10-15th percentile. The primary outcome was FGR at subsequent ultrasound, defined as EFW or AC <10%. The secondary outcomes were NICU admission and small for gestational age (SGA) neonate. Univariable analyses were performed comparing maternal baseline demographic and clinical characteristics. Multivariable analysis was performed for the primary outcome with variables adjusted a priori for body mass index, smoking status, race/ethnicity, insurance status, and drug use. 4883 patients met inclusion criteria with 114 in the borderline fetal growth group and 4769 in the normal growth group. There were no significant differences in maternal demographic or medical characteristics (Table 1). In adjusted multivariable analysis, patients with borderline growth had significantly higher odds of being diagnosed with FGR at their subsequent scan (aOR 6.68, CI 3.98-11.20) compared to those with normal growth. For secondary outcomes, patients with borderline fetal growth were significantly more likely to have SGA neonates (6.14% vs. 2.67%, p= 0.025). There was no difference in admissions to the NICU between groups. Diagnosis of borderline fetal growth at time of anatomy scan was associated with a significantly increased odds of progression to FGR at subsequent scan and delivery of a SGA neonate.

Safety of the use of dinoprostone gel and vaginal insert for induction of labor: A multicenter retrospective cohort study.

To assess adverse obstetric and neonatal outcomes associated with the use of dinoprostone for induction of labor, with particular attention on categories for which caution is recommended by the Italian Medicines Agency and the European Medicine Agency. A retrospective multicenter observational study was conducted on a population of 1687 patients undergoing induction of labor with vaginal dinoprostone (gel or insert) between August 2019 and June 2022. Patients were subdivided based on maternal age, gestational age, and obstetric disorders. Data regarding the mode of delivery, the incidence of tachysystole, and the obstetric and perinatal outcomes were collected. The main adverse event associated with the use of dinoprostone was tachysystole. However, tachysystole was not associated with an increased risk of cesarean section (CS), neonatal intensive care (NICU) admission, low 1-min Apgar, or umbilical cord acidosis. Maternal age greater than 35 years, gestational age greater than 40 weeks, and obstetric disorders were not associated with an increased rate of tachysystole, NICU admission, low 1- and 5-min Apgar scores, and cord acidosis. The only associated adverse outcomes in those categories were postpartum hemorrhage with age greater than 35 years and tachysystole with gestational diabetes mellitus and hypertensive disorders. Not a single case of severe outcome (disseminated intravascular coagulation, uterine rupture, maternal and fetal death) was reported in the cohort. Providing there is adequate maternal and fetal surveillance, in an inpatient setting, dinoprostone could be safely administered for the induction of labor and considered appropriate in high-risk pregnancies. Tachysystole can be self-identified by the patient and effectively managed.

Feto-Maternal Complications of Anticoagulant Use Before and After Childbirth

Anticoagulants prevent blood clotting, but their use in pregnancy poses challenges due to bleeding risks, particularly during delivery and postpartum. Objectives: To evaluate the maternal and fetal complications associated with anticoagulant use before and after childbirth, considering the safety and effectiveness of low molecular weight heparin and Warfarin. Methods: A cohort study was conducted at the Tertiary Care Hospital of Sindh, from August 2022 to July 2023. 266 pregnant women were chosen via consecutive sampling. Pregnant women with a gestational age of &gt; 12 weeks, aged 18-35 years probably taking anti-coagulation therapy during pregnancy and puerperium were included in the study. While women suffering from any major systemic illness and women taking any other potential teratogenic drugs were excluded. Results: Maternal complications occurred in 53% of participants, with postpartum hemorrhage being the most frequent (19.9%), significantly higher in the low molecular weight heparin group (p&lt;0.05). Pre-eclampsia affected 10.5% of participants, predominantly in low molecular weight heparin users (p=0.028). Fetal complications were reported in 59.3% of cases, with intrauterine growth restriction (13.5%) and premature birth (18.0%) being the most common. Stillbirths were more frequent among Warfarin users. Neonatal intensive care admission was required for 11.3% of infants, with low molecular weight heparin exposure showing the highest incidence. Conclusions: It was concluded that low molecular weight heparin was with poor maternal outcomes such as postpartum hemorrhage, wound hematoma, deep vein thrombosis, and pre-eclampsia, while fetal complications included intrauterine growth restriction, stillbirth, premature birth and low birth weight.

The impact of hypertensive disorders during pregnancy on maternal and fetal outcomes: A retrospective study in South Asian region of Pakistan

The current study was conducted to check the effect of high blood pressure on the health of mother and child living in south Asian region of Pakistan during all trimesters of pregnancy. For this retrospective research, 720 females during their deliveries were analyzed at Swat Medical College and Women's Hospital Mardan between June 2022 and June 2023. This current study found almost one fourth of the population suffer hypertensive disorders during any stage of pregnancy which leads to mild to severe pre-eclampsia and ultimately premature births. The observations indicated statistically high significance between hypertensive disorders and associated adverse symptoms like fetus with preterm delivery, c-sections, low birth weight, acute to chronic but reversible renal disorders, neonatal intensive care admissions and sometime central nervous system related disorders. So, this study concludes that more comprehensive parenteral care at the time of pregnancy and especially at the last trimesters. Keen attention towards symptoms and early diagnosis can help to reduce the severity of disease. The maternal and fetal health initiative schemes are required for public awareness.

De-implementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective Cohort Study.

Current practice guidelines for laboring patients with category II intrapartum tracings recommend maternal oxygen supplementation despite emerging randomized data challenging its benefit and utility. We aim to validate that de-implementing maternal oxygen supplementation for fetal resuscitation did not increase the risk of neonatal acidemia in a real-world setting. This is a retrospective observational study conducted at a single tertiary care center from January 2019 to June 2021. All laboring deliveries during the study period was reviewed and eligible participants included singleton or twin pregnancies between 23-42 weeks gestational age with persistent category II tracings. Known major fetal anomalies, contraindications to labor, and maternal indication for O2 supplementation, including active COVID-19, were excluded. Cohorts were allocated based on time of delivery. Those occurring prior to our hospital policy change identified as historical controls and deliveries after April 1, 2020, as the post-de-implementation cohort. Primary outcome was fetal acidemia, defined as umbilical cord pH < 7.2. Secondary outcomes included severe acidemia (pH < 7.0), 5-minute Apgar score < 4 and neonatal intensive care admission. Regression analyses controlling for known variables associated with neonatal acidemia generated adjusted odds ratios with 95% confidence intervals. Among 9088 deliveries during the study period, 1162 tracings were flagged as persistent category II, including 681 (59%) in the post-intervention group. The two cohorts had comparable baseline and obstetric characteristics. No difference in neonatal acidemia was observed between the post-de-implementation group and historical controls (13.8% vs 15.4%, aOR 0.87, 95% CI 0.62-1.22). Severe acidemia, 5-minute Apgar < 4 and neonatal intensive care admission were not increased in the post-de-implementation group. De-implementation of routine maternal oxygen supplementation for fetal resuscitation did not increase likelihood for neonatal acidemia in a real-world setting, validating guidelines recommending against the intervention.

Genome sequences of 70 multidrug-resistant Gram-negative isolates in high-risk neonates in the Northeast of Mexico.

Infections by multidrug-resistant pathogens are steadily increasing worldwide. A considerable proportion of neonatal intensive care admissions have a bacterial infection with multidrug-resistant bacteria during their hospital stay. In this work, we report draft genome sequences of 70 selected isolates from high-risk neonates in the Northeast of Mexico.

The development and implementation of a specialised care plan for late preterm and small for gestational age neonates admitted in maternity settings

IntroductionWhile there is recognition that Late preterm (LP) and small for gestational age (SGA) neonates have complex needs, reports on pragmatic approaches to optimise the care of these infants in practice are limited. AimTo implement and evaluate a specialised care plan to support the provision of optimal care to LP and SGA neonates admitted on maternity wards. MethodsA specialised care plan was implemented in a pre-post interventional study. Data were collected on neonates’ characteristics, hypoglycaemic incidents, and hypoglycaemia that led to a Neonatal Intensive Care admission. ResultsApproximately 10% of neonates born in the pre and post intervention periods were LP or SGA. Neonatal hypoglycaemic events reduced from six pre-intervention to three events post-intervention. Instances of neonatal hypoglycaemia that led to Neonatal Intensive Care admission reduced from three pre-intervention to one post-intervention. ConclusionThe specialised care plan was effective in optimising care for LP and SGA neonates.

Parental impact during and after neonatal intensive care admission

Parents play a pivotal role in neurodevelopmental outcomes of their children in the neonatal intensive care unit (NICU) and beyond. Integration of parents in clinical care and research is synergistic. Engaged parents yield more comprehensive clinical care and more robust and meaningful research products. Subsequently, successful clinical and research efforts improve outcomes for children. We review strategies for parental integration into NICU clinical care and research, including parental involvement in therapeutic interventions and neurodevelopmental care, and effective communication strategies for clinicians and researchers. We discuss challenges in neonatal trials and emphasize the need for building a culture of research, collaborative partnerships with patient advocacy organizations, and ongoing support beyond the NICU. Overall, we call for recognizing and fostering the impactful role of parents as teammates with clinicians and researchers in optimizing neurodevelopmental outcomes in the NICU and beyond.

Preeclampsia in pregnant women with COVID-19: a prospective cohort study from two tertiary hospitals in Southern Brazil

Background COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53–43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52–38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34–4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia.

Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?

BackgroundThe aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.MethodsTwo hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.ResultsThe primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.ConclusionsAdministration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.Trial registrationPACTR (www.pactr.org) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.

Comparison of composite adverse perinatal outcomes in early- and late-onset intrahepatic cholestasis of pregnancy

Comparison of composite adverse perinatal outcomes in early- and late-onset intrahepatic cholestasis of pregnancy

Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician–gynecologists

Objective While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN). Methods A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models. Results The survey was distributed to 556 anesthesiology and 662 obstetrics–gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician–gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001). Conclusions ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.

THE INFLUENCE OF ANEMIA ON MATERNAL AND NEONATAL OUTCOMES IN TEEN AGED PREGNANT WOMEN

This retrospective study, conducted between October 2022 and October 2023 at Maroof International Hospital &amp; Life Care International Hospital in Pakistan, aimed to assess the impact of anemia on neonatal and maternal outcomes in teenage pregnancies. The study included 585 pregnant women aged 13-19 years, with data collected on various parameters such as demographic details, pregnancy-related information, hemoglobin levels during the last trimester, birth weight, gestational age at birth, obstetric complications, neonatal intensive care admissions, and Apgar scores. Among the 585 participants, 212 (36.2%) were identified as having anemia. Further classification revealed that 57.5% experienced mild anemia, 39% had moderate anemia, and 3.5% had severe anemia. Educational status and irregularities in antepartum care showed significant differences between anemic and non-anemic groups (P &lt; 0.05). Anemia was notably higher in women with lower education levels and irregular antenatal care. The study found that anemia significantly increased the risks of postpartum hemorrhage (P=0.005) and postpartum transfusion (P&lt; 0.001). Additionally, infants born to anemic mothers exhibited a significantly higher rate of neonatal intensive care unit (NICU) admission (P&lt;0.001). Maternal anemia was also significantly associated with low birth weight, small for gestational age (SGA), and preterm delivery. However, anemia had no significant impact on Apgar scores. In conclusion, the study underscores the prevalence of anemia in teenage pregnancies and emphasizes its adverse effects on both fetal and maternal outcomes. The findings highlight the urgent need for governmental initiatives to enhance essential healthcare accessibility and improve antenatal care for this vulnerable demographic.

Identifying neonatal intensive care (NICU) admissions using administrative claims data.

To define a method for identifying neonatal intensive care unit (NICU) admissions using administrative claims data. This was a retrospective cohort study using claims from Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2016 -2020. We developed a definition to identify NICU admissions using a list of codes from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and revenue codes frequently associated with NICU admissions. We compared agreement between codes using Kappa statistics and calculated positive predictive values (PPV) and 95% confidence intervals (CI). On average, revenue codes (3.3%) alone identified more NICU hospitalizations compared to CPT codes alone (1.5%), whereas the use of CPT and revenue (8.9%) and CPT or revenue codes (13.7%) captured the most NICU hospitalizations, which aligns with rates of preterm birth. Gestational age alone (4.2%) and birthweight codes alone (2.0%) identified the least number of potential NICU hospitalizations. Setting CPT codes as the standard and revenue codes as the "test,", revenue codes resulted in identifying 86% of NICU admissions (sensitivity) and 97% of non-NICU admissions (specificity). Using administrative data, we developed a robust definition for identifying neonatal admissions. The identified definition of NICU codes is easily adaptable, repeatable, and flexible for use in other datasets.

Pregnancy in Seronegative Myasthenia Gravis: A Single-Center Case Series.

The course of double-seronegative myasthenia gravis (DSNMG) during and after pregnancy has not been well described. To assess the course of DSNMG during pregnancy and within 6 months postpartum. A retrospective cohort study of women with DSNMG seen in the Duke Myasthenia gravis (MG) Clinic after 2003. Review of the Duke MG Clinic Registry and electronic medical record identified 8 patients who became pregnant after MG onset; the mean age at disease onset was 17.6 (SD = 10.0) years. Increased MG symptoms were observed in the first and third trimester and, most commonly, postpartum in 6 of 18 pregnancies. Except for 1 infant who developed respiratory distress that required neonatal intensive care admission, all the newborns were healthy at birth. As in seropositive MG, increased MG symptoms during pregnancy and within 6 months postpartum is also seen in women with DSNMG.

Risk factors and outcomes in patients with cochlear nerve deficiency

IntroductionCochlear nerve deficiency (CND) is a cause of sensorineural hearing loss made by radiologic criteria. There is sparse literature involving audiological outcomes and cochlear implantation (CI) success in patients with CND. MethodsA retrospective chart review of all patients with sensorineural hearing loss at a tertiary children's hospital from 2000 to 2020 was conducted. Patients with CND on radiographic imaging were included and categorized as hypoplastic, aplastic, or indeterminate. ResultsIn this study, 53 patients were identified with CND, totaling 70 ears. Of the 53 patients, 30 (56.6 %) were male, 8 (16.0 %) had a family history of childhood hearing loss, 6 (11.3 %) were born preterm, and 11 (23.4 %) required neonatal intensive care admission. The median maternal age was 29 years old [IQR: 27, 35], and 8 (15 %) patients were born to mothers with diabetes. Of the 70 ears, 49 (70 %) utilized conventional hearing aids, 12 (17.1 %) utilized a bone-anchored hearing aid, and 10 (14.3 %) underwent CI. Of the 10 ears implanted, 4 (40 %) ears had nerves classified as hypoplastic, 3 (30 %) as aplastic, and 3 (30 %) as indeterminate. Improvement in pure tone averages compared to preoperative testing was demonstrated in 8 (80 %), and 6 (60 %) displayed improved speech awareness thresholds. ConclusionThis study demonstrates that there may be an association between CND and maternal diabetes and NICU admission. There are variable results with hearing amplification options in patients with CND, and further research is needed to better describe the role of CI, bone-anchored hearing aids and conventional hearing aids in patients with CND.

Effect of Anti-TNF Biologic Exposure During Pregnancy on Villitis of Unknown Etiology Diagnoses in Patients with Autoimmune Disease.

Tumor necrosis factor-α (TNF-α) antagonists are highly effective in controlling autoimmune diseases. This has led to speculation that they might also be useful in treating inflammatory placental conditions, such as chronic villitis of unknown etiology (VUE). VUE affects 10-15% of term placentas and is associated with recurrent fetal growth restriction (FGR) and pregnancy loss. We aimed to evaluate outcomes in patients with autoimmune diseases with and without anti-TNF-α biologic exposure during gestation. This retrospective cohort study compared pregnant women with autoimmune disease taking anti-TNF-α biologics (n = 89) to pregnant women with autoimmune disease but not taking a biologic (n = 53). We extracted data on all patients meeting our inclusion criteria over a 20-year period. Our primary outcome was the diagnosis of VUE by histology. Our secondary outcomes were maternal and neonatal complications such as preeclampsia, FGR, and neonatal intensive care admission. Kruskal-Wallis and chi-squared tests were performed as appropriate for statistical analysis. Maternal characteristics were comparable between groups, and there was no increase in adverse pregnancy outcomes based on anti-TNF-α treatment. Exposure to anti-TNF-α therapy had no significant effect on the incidence of VUE or other obstetric complications. Within the cohort exposed to anti-TNF-α biologics during pregnancy, the rate of VUE was 9.3%, which is comparable to the reported general population risk. Our data support the safety profile of biologic use in pregnancy.

A Cross-Sectional Study of Postpartum Depression in a Tertiary Care Hospital in South India

Background: South India has a high prevalence of postpartum depression (PPD) compared to other regions. With declining maternal mortality, physicians need to focus on decreasing maternal morbidities, including postpartum mental health disorders. Objectives: To evaluate the incidence of PPD and the influence of demographic and pregnancy related factors on PPD, and to identify major symptom subsets manifested postnatally. Methods: This cross-sectional study was conducted on 435 women between 2 weeks to 6 months postpartum, in a tertiary care centre in South India, Postnatal mothers were administered questionnaires including Edinburgh Postnatal Depression Scale (EPDS) and patient demographics and pregnancy related factors. Chi squared test was used to evaluate the association between EPDS scores and demographic and pregnancy variables. Subset analysis was carried out to identify the predominant symptoms in the patients. Results: Completed questionnaires were obtained from 427 postpartum women, among which 26.2% (n=112) had EPDS score &gt;12. Among demographic variables, EPDS scores showed a significant association with relationship problems (p=.000) only, while among pregnancy factors, preterm birth (p=.019), neonatal intensive care admission (p=.005), pregnancy complications (p=.009), and history of depression (p=.043) were significantly associated with EPDS scores. Subset analysis revealed a high mean EPDS score for anxiety (1.91), followed by depressive (1.38) and anhedonia (0.91) symptoms. Conclusion: Several clinical factors and adverse events during pregnancy, including sociodemographic factors and pregnancy-related complications itself, can set the stage for PPD and other mental health conditions. Simple assessments like EPDS can be considered part of routine postnatal check-up examinations for early recognition and treatment of PPD.