Neonatal Length Research Articles

Association of traffic-related air pollution with Newborn's anthropometric indexes at birth

An emerging body of evidence has associated exposure to traffic-related air pollution (TRAP) during pregnancy with birth outcomes. However, the evidence on the association of TRAP exposure and neonatal anthropometric measurements (NAPM) in low and middle-income countries is very scarce yet. Therefore, we investigate the association of prenatal exposure to indicators of traffic and ambient particulate matter (PM) with NAPM. This cross-sectional study was based on hospital medical records of 4053 mother-neonate pairs between May 16, 2016, and December 5, 2018. PMs were estimated at residential addresses based on validated spatiotemporal models. Moreover, total street length in 100, 300 and 500m buffers around the home, residential distance to the ring road, major roads, heavy-traffic lights, gas station, motorway junction, bank, square, bus terminal, public parking and industrial land-use were calculated as indicators of traffic. The head circumference (HC), birth weight (BW) and birth length (BL) of neonates were collected as NAPM. Multivariate regression models were applied to evaluate the relationship between PMs and indicators of traffic with NAPM, controlled for relevant covariates. The median (IQR) of BW, BL, and HC of newborns were 3250 (592) gr, 51.0 (3.5) cm, 35 (2) cm, respectively. The adjusted models revealed that higher exposure to PM2.5 and PM10 was significantly related with lower BW and BL. Similar results were observed for total street length in a 100 m buffer around maternal home with BW and BL. Moreover, higher distance to heavy traffic lights was significantly associated with higher BW and BL. An IQR increase in PM10 was significantly related to lower HC (95% CI: 0.11, −0.01, P-value = 0.03). An increase in distance from residential address to heavy traffic lights, ring roads, bus terminal, and transportation land-use was associated with higher HC. Overall, our findings suggested that higher prenatal exposure to TRAP was related with lower BW, BL and HC.

Outcomes associated with antibiotic administration for isolated maternal fever in labor

The American College of Obstetricians and Gynecologists currently recommends that antibiotic treatment should be considered for women with isolated maternal fevers during labor. However, there is little known about the maternal and neonatal impact of antibiotic treatment in this scenario. We sought to assess the outcomes in women with a nonsustained, isolated maternal fever treated with antibiotics and compare it with expectant management. This was a retrospective cohort study of laboring women with a singleton gestation at term and a single temperature of between 38.0°C and 38.9°C without other evidence of infection (leukocytosis >15,000/mm3, fetal tachycardia, malodorous amniotic fluid, suspected alternate source of infection) at a tertiary teaching hospital. A contemporaneously maintained, validated obstetrical database was used to identify women for our cohort. Women with rheumatologic or renal disease, nongestational diabetes, preterm labor, placental abruption, vaginal bleeding, HIV, malpresentation, and fetal anomalies were excluded. The primary outcome was a postpartum fever above 38.0°C. Secondary maternal outcomes were treatment for postpartum endometritis, uterine atony, postpartum hemorrhage, admission to the intensive care unit, and postpartum length of stay. Secondary neonatal outcomes were neonatal intensive care unit admission, 5-minute Apgar score of <7, 5-minute Apgar score of <4, neonatal intensive care unit length of stay, and neonatal antibiotic administration. The results were compared using univariable and multivariable analyses. From January 1, 2015, to December 31, 2018, 359 women were identified; 85 received antibiotics and 274 did not. The baseline characteristics were similar between the groups, except for gestational age at the time of delivery (39.2 weeks vs 39.5 weeks for the antibiotic and no antibiotic groups, respectively; P=.02). The incidence in postpartum fever showed a downward trend in the antibiotic group (10.59% for the antibiotic group vs 18.98% for the no antibiotic group; P=.07). Significantly fewer women in the antibiotic group were treated for postpartum endometritis (3.53% vs 11.31%; P=.03). Neonatal intensive care unit admission and neonatal antibiotic administration rates were higher in the antibiotic group (41.18% vs 17.88%; P<.001 and 36.47% vs 12.41%; P<.001, respectively). Theincidence of 5-minute Apgar score of <7 was higher in the antibiotic group (8.25% vs 2.19%; P=.016). After controlling for age,gestational age, body mass index, group B streptococci status, delivery method, parity, administration of epidural, and receipt of acetaminophen, the odds for postpartum fever were reduced by a factor of 0.42 (95% confidence interval, 0.18-0.99) among women who received antibiotics when compared with those who did not receive antibiotics. Outcome results are presented in Table 2. Although there was a lower rate of treatment for endometritis among women who received antibiotics for a single isolated maternal fever, there was a higher rate of neonatal intensive care unit admissions and 5-minute Apgar score of <7. This indicates that there likely is maternal benefit associated with antibiotic use, however, there are concerns about the neonatal risk.

Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization: the PASTIME protocol

Multidisciplinary care of placenta accreta spectrum cases improves pregnancy outcomes, but the specific components of such a multidisciplinary collaboration varies between institutions. As experience with placenta accreta spectrum increases, it is crucial to assess new surgical techniques and protocols to help improve maternal outcomes and to advocate for hospital resources. This study aimed to assess a novel multidisciplinary protocol for the treatment of placenta accreta spectrum that comprises cesarean delivery, multivessel uterine embolization, and hysterectomy in a single procedure within a hybrid operative suite. This was a matched prepost study of placenta accreta spectrum cases managed before (2010-2017) and after implementation of the Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization protocol (2018-2021) at a tertiary medical center. Historical cases were managed with internal iliac artery balloon placement in selected cases with the decision to inflate the balloons intraoperatively at the discretion of the primary surgeon. Intraoperative Embolization cases were compared with historical cases in a 1:2 ratio matched on the basis of placenta accreta spectrum severity and surgical urgency. The primary outcome was a requirement for transfusion with packed red blood cells. Secondary outcomes included estimated surgical blood loss, operative and postoperative complications, procedural time, length of stay, and neonatal outcomes. A total of 15 Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization cases and 30 matched historical cases were included in the analysis. There were no demographic differences noted between the groups. A median (interquartile range) of 0 units (0-2 units) of packed red blood cells were transfused in the Intraoperative Embolization group compared with 2 units (0-4.5 units) in the historical group (P=.045); 5 of 15 (33.3%) Intraoperative Embolization cases required blood transfusions compared with 19 of 30 (63.3%) cases in the historical group (P=.11). The estimated blood loss was significantly less in the Intraoperative Embolization group with a median (interquartile range) of 750 mL (450-1050 mL) compared with 1750 mL (1050-2500 mL) in the historical group (P=.003). There were no cases requiring massive transfusion (≥10 red blood cell units in 24 hours) in the Intraoperative Embolization group compared with 5 of 30 (16.7%) cases in the historical group (P=.15). There were no intraoperative deaths from hemorrhagic shock using the Intraoperative Embolization protocol, whereas this occurred in 2 of the historical cases. The mean duration of the interventional radiology procedure was longer in the Intraoperative Embolization group (67.8 vs 34.1 minutes; P=.002). Intensive care unit admission and postpartum length of stay were similar, and surgical and postoperative complications were not significantly different between the groups. The gestational age and neonatal birthweights were similar; however, the neonatal length of stay was longer in the Intraoperative Embolization group (median duration, 32 days vs 15 days; P=.02) with a trend toward low Apgar scores. Incidence of arterial umbilical cord blood pH <7.2 and respiratory distress syndrome and intubation rates were not statistically different between the groups. A multidisciplinary pathway including a single-surgery protocol with multivessel uterine embolization is associated with a decrease in blood transfusion requirements and estimated blood loss with no increase in operative complications. The Placenta Accreta Spectrum Treatment With Intraoperative Multivessel Embolization protocol provides a definitive surgical method that warrants consideration by other centers specializing in placenta accreta spectrum treatment.

The Need for Valid and Reliable Methods to Determine Feeding Tube Insertion Length and Verify Placement in Neonates to Improve Safe Nursing Care.

Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journalʼs requirements for Authorship.

A randomized, placebo-controlled trial of zinc supplementation during pregnancy for the prevention of stunting: analysis of maternal serum zinc, cord blood osteocalcin and neonatal birth length.

Aim To investigate the influence of zinc supplementation on pregnant women for the prevention of stunting through an analysis of maternal serum zinc, cord blood osteocalcin and neonatal birth length. Methods This study was conducted with pre-test/post-test control groups and double-blind randomization. Patients were pregnant mothers in second or third trimester and with their newborns who met the inclusion criteria. A total of 71 pregnant mothers and their newborns completed this study. They were divided into two groups of 35 and 36 patients, the supplementation (20 mg/day) and placebo groups, respectively for 12 weeks. The parameters assessed were maternal serum zinc levels, cord blood osteocalcin and birth length measurements. Results The mean maternal serum zinc level was 54.6±8.7 µg/dL from 71 patients. The mean maternal serum zinc levels after zinc supplementation were significantly higher than those of the placebo group: 55.1±9.9 to 59.1±8.6) μg/dL (p=0.017) and 54.2±7.5 to 50±8.6 μg/dL (p=0.001), respectively. The comparison of mean cord blood osteocalcin levels and median neonatal birth lengths in the supplementation group was higher than in the placebo group: 131.8±35.3 vs 90.6±35.4 ng/ml (p=0.001) and 49.3 (46.5-51.3) vs 48.3 (46-50.8) cm (p=0.004), respectively. Maternal serum zinc levels after zinc supplementation had a positive significant correlation with cord blood osteocalcin and neonatal birth length: r=0.434 (p=0.001) and r=0.597 (p=0.001), respectively. Conclusion There was a significant correlation of maternal serum zinc with cord blood osteocalcin and neonatal birth length after zinc supplementation.

Development of a core outcome set for interventions to prevent stillbirth.

To develop a core outcome set for trials investigating interventions to prevent stillbirth. Outcomes identified from a systematic literature review and semi-structured interviews with parents in Australia and the UK were entered into a two-round online Delphi survey and focus group/consensus meetings. A core outcome set containing 11 outcomes in two categories. Five outcomes were related to the mother; fetal loss, onset of and mode of delivery, maternal mortality or near miss, psychological and social impact on the women, women's knowledge. Six outcomes were related to the baby; timing of stillbirth, neonatal mortality, gestational age at delivery, birthweight, congenital anomaly, NICU/SCBU or other higher-level neonatal care length of stay. Implementation and dissemination of this core outcome set in future trials will contribute towards coordinated outcome reporting and advancing usefulness of research to guide clinical practice.

Abstract P171: A Longitudinal Study Of Maternal Thyroid Hormone Trajectories And Neonatal Anthropometric Measures

Introduction: Maternal thyroid hormones (TH) are essential for fetal growth and development. While prior studies have examined associations of TH with birthweight (BW), data on other neonatal anthropometric measures are scarce. Here we aimed to examine relations between TH and its trajectory across pregnancy with neonatal anthropometrics in a multi-racial pregnancy cohort. Hypothesis: We hypothesized that distinct TH trajectories across gestation would explain differences in neonatal anthropometrics including BW, length and sum of skinfolds (SSF). Methods: We used longitudinal data from 321 women who were included in a gestational diabetes (GDM) case-control study nested within the NICHD Fetal Growth Studies-Singletons Cohort (n=2802). Plasma free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were measured, and fT3/fT4 ratio was derived, using blood samples collected at gestational weeks (GW) 10-14, 15-26, 23-31 and 33-39. TH trajectories were identified using a latent class trajectory approach. BW was abstracted from medical records. Neonatal length and SSF were measured. To examine associations between TH levels and neonatal outcomes, we used weighted linear regression models, adjusted for maternal age, race/ethnicity, GW at blood collection, pre-pregnancy BMI, education, parity, infant sex, GDM diagnosis (33-39 GW only) and number of days post-delivery (length and SSF only). Results: Overall, neonates of women in the highest fT3 tertile at 33-39 GW had marginally higher BW (β: 205.5 g, 95% CI -23.4, 434.4) and BW z-score (β: 0.4, 95% CI 0.0, 0.8) than neonates of women in the lowest tertile. Significant interactions were observed by infant sex for associations of fT4 and BW, BW z-score and neonatal length (all p for interactions &lt;0.05). Specifically, female neonates of women in the highest fT4 tertile had lower BW, BW z-score and length than those in the lowest tertile at 15-26 (β BW -416.3 g, 95% CI -753.7, -79.0; β BW zscore -0.5, 95% CI -0.9, -0.1; β length -1.5 cm, 95% CI -2.8, -0.1, respectively) and 23-31 GW (β BW -357.0 g, 95% CI -635.6, -78.4; β BW zscore -0.7, 95% CI -1.3, -0.1; β length -1.8 cm, 95% CI -3.3, -0.2, respectively). Across gestation, a low fT3 trajectory (class size 5.5%) was associated with lower neonatal SSF (β: -3.2 mm, 95% CI -6.0, -0.5) than an intermediate/referent trajectory (60.1%). A high fT3/fT4 ratio trajectory (16.2%) was associated with higher BW (β: 300.5 g, 95% CI 41.7, 559.4), BW z-score (β: 0.6, 95% CI 0.3, 0.8), and neonatal SSF (β: 3.3 mm, 95% CI 0.7, 5.9) than an intermediate/referent trajectory (44.3%). Conclusions: Our study suggests that both overall TH trajectory across gestation and TH levels at specific timepoints in pregnancy may be related to neonatal anthropometrics, with associations varying by infant sex. These novel data support the significance of monitoring thyroid hormones longitudinally in pregnancy.

Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection at the time of birth in England: national cohort study

BackgroundSome studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear.ObjectiveThis study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes.Study DesignThis is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks’ gestation (stillbirth), preterm birth (<37 weeks’ gestation), small for gestational age infant (small for gestational age; birthweight at the <tenth centile), preeclampsia or eclampsia, induction of labor, mode of birth, specialist neonatal care, composite neonatal adverse outcome indicator, maternal and neonatal length of hospital stay after birth (3 days or more), and 28-day neonatal and 42-day maternal hospital readmission. Adjusted odds ratios and their 95% confidence interval for the association between SARS-CoV-2 infection status and outcomes were calculated using logistic regression, adjusting for maternal age, ethnicity, parity, preexisting diabetes mellitus, preexisting hypertension, and socioeconomic deprivation measured using the Index of Multiple Deprivation 2019. Models were fitted with robust standard errors to account for hospital-level clustering. The analysis of the neonatal outcomes was repeated for those born at term (≥37 weeks’ gestation) because preterm birth has been reported to be more common in pregnant women with SARS-CoV-2 infection.ResultsThe analysis included 342,080 women, of whom 3527 had laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 infection was more common in women who were younger, of non-White ethnicity, primiparous, or residing in the most deprived areas or had comorbidities. Fetal death (adjusted odds ratio, 2.21; 95% confidence interval, 1.58–3.11; P<.001) and preterm birth (adjusted odds ratio, 2.17; 95% confidence interval, 1.96–2.42; P<.001) occurred more frequently in women with SARS-CoV-2 infection than those without. The risk of preeclampsia or eclampsia (adjusted odds ratio, 1.55; 95% confidence interval, 1.29–1.85; P<.001), birth by emergency cesarean delivery (adjusted odds ratio, 1.63; 95% confidence interval, 1.51–1.76; P<.001), and prolonged admission after birth (adjusted odds ratio, 1.57; 95% confidence interval, 1.44–1.72; P<.001) were significantly higher for women with SARS-CoV-2 infection than those without. There were no significant differences (P>.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27–1.66; P<.001), need for specialist neonatal care (adjusted odds ratio, 1.24; 95% confidence interval, 1.02–1.51; P=.03), and prolonged neonatal admission after birth (adjusted odds ratio, 1.61; 95% confidence interval, 1.49–1.75; P<.001) were all significantly higher for infants with mothers with laboratory-confirmed SARS-CoV-2 infection. When the analysis was restricted to pregnancies delivered at term (≥37 weeks), there were no significant differences in neonatal adverse outcome (P=.78), need for specialist neonatal care after birth (P=.22), or neonatal readmission within 4 weeks of birth (P=.05). Neonates born at term to mothers with laboratory-confirmed SARS-CoV-2 infection were more likely to have prolonged admission after birth (21.1% compared with 14.6%; adjusted odds ratio, 1.61; 95% confidence interval, 1.49–1.75; P<.001).ConclusionSARS-CoV-2 infection at the time of birth is associated with higher rates of fetal death, preterm birth, preeclampsia, and emergency cesarean delivery. There were no additional adverse neonatal outcomes, other than those related to preterm delivery. Pregnant women should be counseled regarding risks of SARS-CoV-2 infection and should be considered a priority for vaccination.

The factors affecting the physical development of neonates in pregnant women with or without gestational diabetes mellitus.

ObjectivesTo explore the factors affecting neonatal physical development in pregnant women with or without gestational diabetes mellitus (GDM).MethodsThe subjects were selected from the pregnant woman giving birth in 2nd Affiliated Hospital of Zhengzhou University, from November 2015 to May 2016. The age, occupation, education level, gestational age, body weight before pregnancy, body weight at delivery, body height, delivery pattern, GDM status of pregnant women and neonatal gender, birth weight (BW), chest circumference (CC), head circumference (HC) and birth length (BL) were collected through medical records and questionnaires. The clinical data were retrospectively analyzed and studied.ResultsThe significant differences were found between women with GDM and without GDM in following neonatal variables (P<0.05): BW, CC, and HC. GDM status increased the incidence of macrosomia (OR = 2.241, 95% CI: 1.406–3.573), large CC (OR = 2.470, 95% CI: 1.687–3.6153). Gestational weight gain (GWG) above IOM guideline was risk factor for macrosomia (OR = 1.763, 95% CI:1.098–2.833), large HC (OR = 1,584, 95% CI: 1.093–2.296) and large CC (OR = 1.707, 95% CI:1.163–2.506). Underweight was risk factor for short BL (OR = 2.543, 95% CI:1.161–5.571) and small CC (OR = 1.901, 95% CI:1.064–3.394). Female neonate was prone to appear short BL(OR = 2.831, 95% CI: 1.478–5.422) and small HC (OR = 2.750, 95% CI: 1.413–5.350), and not likely to macrosomia (OR = 0.538, 95% CI: 0.343–0.843), longer BL (OR = 0.584, 95% CI: 0.401–0.850), large HC (OR = 0.501, 95% CI: 0.352–0.713), and (OR = 0.640, 95% CI: 0.446–0.917). For women with GDM, gestational age was an risk factor of neonatal BW (low BW: OR = 0.207, 95% CI: 0.085–0.503; macrosomia: OR = 1.637, 95% CI: 1.177–2.276), BL (short BL: OR = 0.376, 95% CI: 0.241–0.585; long BL: OR = 1.422, 95% CI: 1.054–1.919), HC (small HC: OR = 0.343, 95% CI: 0.202–0.583; large HC: OR = 1.399, 95% CI: 1.063–1.842) and CC (small CC: OR = 0.524, 95% CI: 0.374–0.733; large CC: OR = 1.485, 95% CI: 1.138–1.936).ConclusionsIn our study, gestational age, GDM status, neonatal gender, GWG and pre-pregnancy body mass index (BMI) are associated the abnormal physical development of neonates. In women with GDM, gestational age was correlate with neonatal abnormal physical developments.

Anatomical Structure of the Umbilical Cord in Sudanese and Correlation with Neonatal Outcome

Background The neonatal morbidity and mortality is very high in the Sudan, the umbilical cord association and contribution to this is planned to be answered. Therefore the present study was designed to provide some information on the morphological variations of human umbilical cord via gross anatomical assessment and their correlation with foetal factors such as foetal weight and length. Methods A prospective hospital - based study conducted in Wad Madani Maternity Teaching Hospital Department of Obstetrics and Gynecology between July 2014 and March 2018 Results The mean diameter of the 371 umbilical cords was 2.1±0.24cm. Length was 53.8±3.8 cm length ranging from 48 – 62 cm and 10 (2.7%) of 371 umbilical cords were uncoiled. of which, 1 (0.3%) cords were with absent Wharton’s Jelly. The mean neonatal indices were 2.95 kg, 33.19 cm and 44.42 cm for weight, head circumference and length respectively. There was just significant strong positive correlation between umbilical cord length and length of neonates. Also Umbilical cord diameter had a positive correlation with length of neonates and negative correlation with weight of neonates and APGAR Score. Conclusion The present study suggests that ‘normal’ cord length should be between 40 cm and 70 cm in length. Umbilical cord diameter had a positive correlation with fetal length and negative correlation with fetal weight and APGAR score. The diameter range of 1-2 cm suggests that a normal cord must not exceed 2 cm in diameter. However the umbilical cord index had negative correlation with length of neonates.

The sex-specific association between maternal urinary paraben levels and offspring size at birth

Parabens are a group of antimicrobial preservatives applied in an extensive range of products and are suspected to impair fetal growth because of their disrupting effect on the endocrine system. We aimed to examine maternal urinary paraben concentrations and their neonates' outcome indexes. Methylparaben (MP), ethylparaben (EP), propylparaben (PP), and butylparaben (BP) concentrations were measured in 105 maternal urine samples collected before delivery. Length, weight, and head circumference at birth were extracted from the mothers' delivery files. A multivariable linear regression analysis was performed to evaluate the association between paraben levels and neonatal anthropometric indices. The median levels of urinary parabens, especially BP, were higher than those in other countries. Prenatal urinary concentration of MP and BP showed a significantly positive association with birth weight in all neonates (β = 0.79, 95% CI: 0.16, 1.41, and β = 8.56, 95% CI: 3.95, 13.17, respectively), while these chemicals showed a significant negative association with head circumference (β = - 0.002, 95% CI: - 0.004, - 0.000, and β = - 0.016, 95% CI: - 0.030, - 0.002, respectively). A significant positive association between MP and birth length was also found (β = 0.004, 95% CI: 0.00, 0.00) in all the neonates. In sex-stratified adjusted models, MP and BP were found to be associated, respectively, with higher birth length and weight in male neonates (β = 0.008, 95% CI: - 0.001, 0.017, and β = 7.948, 95% CI: 1.045, 14.851). In girls, maternal urinary MP, PP, and BP were associated with increased birth weight (β = 0.831, 95% CI: 0.043, 1.620; β = 4.178, 95% CI: 0.877, 7.480; and β = 10.821, 95% CI: 3.545, 18.097, respectively), and MP and BP were associated with reduced head circumference at birth (β = - 0.003, 95% CI: - 0.005, - 0.001, and β = - 0.035, 95% CI: - 0.055, - 0.016). These results revealed potential impacts between neonatal growth and maternal exposure to parabens. However, these findings should be interpreted while considering the limitations of the present study.

Implementation and effectiveness of continuous kangaroo mother care: a participatory action research protocol

BackgroundThe efficacy of continuous kangaroo mother care (C-KMC) in reducing neonatal mortality and morbidity among low birthweight and premature infants has been confirmed. Despite the recommendations of the World Health Organization, UNICEF, and the Ministry of Health of Iran to use C-KMC for eligible hospitalized neonates, this type of care is not performed due to implementation problems. This protocol aims to describe the design, implementation, and assessment of C-KMC in one tertiary hospital by means of participatory action research.MethodsThe objective of this study is to design and implement a C-KMC program for neonates that will be performed in two phases using a stages-of-change model. The first phase will be conducted in three consecutive activities of designing, implementing, and assessing the introduction of C-KMC. The second phase of the study has a before-and-after design to assess the effectiveness of C-KMC by comparing the length of preterm neonates’ stay in hospital and exclusive breastfeeding at discharge before and after implementing C-KMC.DiscussionKMC is an important component of neonatal developmental care as part of family-centered care. Applying this type of care requires creating appropriate strategies, budget allocation, and clear and coordinated planning at different levels of the health system. The stages-of-change model is one of the appropriate approaches to the implementation of C-KMC.

Emollient Therapy in Preterm & Low Birth Weight Neonates: A Randomised Clinical Trial.

To assess the impact of emollient therapy on gain in weight and length among preterm and low birth weight babies. Randomised controlled trial. Department of Pediatric Medicine, KEMU / Mayo Hospital Lahore, from January till June 2018. Infants with birth weight between 1.5 and 2.5 Kgs or preterm neonates born between 28 and 37 completed weeks of gestation were included in the study. Neonates with genetic syndrome, infection or with a history of admission in NICU due to any reason, were excluded.They were randomly divided into two groups-A and B, by lottery method. Mothers of the neonates in group A were advised massage with sunflower oil; while mothers of the neonates in group B were advised massage without any emollient. Babies were closely followed up and their weight and length were measured at two months of age and were analysed using SPSS version 23.0. For 140 neonates, the mean increase in weight was 489.84 ± 297.48 grams among group-A neonates (emollient therapy group) and it was 373.43 ± 276.31 grams among group-B neonates (p = 0.018). The mean increase in length was 6.5 ± 1.1 cm, among group-A neonates and 4.8 ± 1.3 cm in group-B neonates (p ˂0.001). Conclusion: Massage with emollient therapy leads to significantly more increase in weight and length compared to massage alone, among preterm and low birth weight neonates.Emollient therapy is an effective non-pharmacological intervention for increasing weight and length in low birth weight and preterm neonates. Key Words: Emollient, Massage, Low birth weight, Preterm neonates, Weight, Length.

Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes.

Gestational diabetes mellitus (GDM), body mass index (BMI) and gestational weight gain (GWG) are salient predictors of pregnancy-outcomes. However, findings on the association between GDM, BMI, and GWG with fetal growth measures are limited. The aim of this study was to investigate the effect of GDM on fetal growth measures and birth outcomes. All participants came from Tongji Maternal and Child health cohort, in which pregnant women were enrolled before 16 weeks of gestation and had their weights measured regularly during antenatal visits. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Ultrasound measurements of fetal bi-parietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC) and femur length (FL) before birth were collected and neonate outcomes were obtained from the hospital records. Odds ratios were calculated using logistic regression to assess the association of GDM, pre-pregnancy BMI, and GWG with fetal growth measures of ultrasound and birth outcomes, while controlling confounding. Of 3253 singleton pregnant women, 293 (9.0%) were diagnosed with GDM, 357 (11.0%) were overweight before pregnancy, and 1995 (61.3%) had excessive GWG. GDM was associated with decreased intrauterine fetal growth measurements including BPD and AC. Maternal pre-pregnancy overweight was associated with increased fetal HC and neonatal birth weight and length, women gained excessive GWG had increased fetal growth measurements of BPD, HC, AC, FL, neonatal birth weight and length. Offspring of GDM women had increased odds of cesarean section 1.31 (1.03, 1.66) and preterm birth 2.02 (1.05, 3.91) in unadjusted models, but these associations disappeared after adjustment. Compared with neonate born to mothers with normal pre-pregnancy weight, those born to underweight mother had higher risk of SGA, and lower risk of cesarean section, LGA and macrosamia, whereas those born to overweight mother had increased risk of cesarean section, LGA and macrosamia. Compared with neonate born to mothers of adequate GWG, neonate of women with excessive GWG had elevated risk of cesarean section, LGA and macrosamia, but lower risk of preterm birth and SGA. Pre-pregnancy BMI, GWG and GDM all associated with fetal growth and birth outcomes. The effect of GDM decreased after adjusting pre-pregnancy BMI and GWG. Early screening and management of GDM, preventing excessive GWG could help protect fetuses of GDM mothers from adverse birth outcomes.

Effect of Omega-3 Supplementation in Pregnant Women with Obesity on Newborn Body Composition, Growth and Length of Gestation: A Randomized Controlled Pilot Study

Maternal obesity, a state of chronic low-grade metabolic inflammation, is a growing health burden associated with offspring adiposity, abnormal fetal growth and prematurity, which are all linked to adverse offspring cardiometabolic health. Higher intake of anti-inflammatory omega-3 (n-3) polyunsaturated fatty acids (PUFA) in pregnancy has been associated with lower adiposity, higher birthweight and longer gestation. However, the effects of n-3 supplementation specifically in pregnant women with overweight and obesity (OWOB) have not been explored. We conducted a pilot double-blind randomized controlled trial of 72 pregnant women with first trimester body mass index (BMI) ≥ 25 kg/m2 to explore preliminary efficacy of n-3 supplementation. Participants were randomized to daily DHA plus EPA (2 g/d) or placebo (wheat germ oil) from 10–16 weeks gestation to delivery. Neonatal body composition, fetal growth and length of gestation were assessed. For the 48 dyads with outcome data, median (IQR) maternal BMI was 30.2 (28.2, 35.4) kg/m2. In sex-adjusted analyses, n-3 supplementation was associated with higher neonatal fat-free mass (β: 218 g; 95% CI 49, 387) but not with % body fat or fat mass. Birthweight for gestational age z-score (−0.17 ± 0.67 vs. −0.61 ± 0.61 SD unit, p = 0.02) was higher, and gestation longer (40 (38.5, 40.1) vs. 39 (38, 39.4) weeks, p = 0.02), in the treatment vs. placebo group. Supplementation with n-3 PUFA in women with OWOB led to higher lean mass accrual at birth as well as improved fetal growth and longer gestation. Larger well-powered trials of n-3 PUFA supplementation specifically in pregnant women with OWOB should be conducted to confirm these findings and explore the long-term impact on offspring obesity and cardiometabolic health.

Anesthesia for Cesarean Section: Retrospective Comparative Study.

BackgroundCesarean section is a widely performed surgery.ObjectiveTo compare anesthetic types regarding feto-maternal outcomes.Materials and MethodsRetrospective comparative study of 3599 cesarean sections (emergency and elective categories).ResultsMean APGAR score was statistically higher in the spinal than general anesthesia among the emergency category, P = 0.000 and 0.026, respectively, with no significant difference in the elective category. Estimated blood loss among the elective category was statistically significantly higher in the spinal than general anesthesia, P = 0.001. However, among the emergency category, it was significantly higher in the general than in spinal or epidural anesthesia, P = 0.000. Diclofenac sodium was used more after spinal than general anesthesia (P = 0.000), with no significant difference between epidural and general or between epidural and spinal anesthesia. Pethidine hydrochloride (HCL) was used more after general than after spinal anesthesia (P = 0.000). However, pethidine HCL use was not statistically significantly different between spinal and epidural anesthesia. In the elective category, paracetamol was requested more after spinal than epidural or general anesthesia, P = 0.000. No significant difference was seen between epidural and general anesthesia, P = 1.000. No statistically significant difference was found among the anesthetic types in both categories regarding tramadol HCL. Length of hospital stay, operative time and neonatal intensive care unit admission were not statistically different between anesthetic modes. In the emergency category, significantly higher percentage of patients were satisfied with and would recommend epidural anesthesia.ConclusionThere was no statistically significant difference among the three types of anesthesia regarding neonatal intensive care admission and length of hospital stay for emergency and elective categories. APGAR score was higher with spinal than with general anesthesia in the emergency category with no significant difference in the elective category. More diclofenac sodium and paracetamol and less opioids were used after regional than after general anesthesia. Satisfaction was higher with epidural anesthesia.LimitationsRetrospective and single centered.

622 Racial disparities in U.S. neonatal opioid withdrawal hospital length of stay, 2009-2016

Neonatal opioid withdrawal syndrome (NOWS) incidence is on the rise amid the US opioid epidemic. Substance use surveillance data shows differences in type of opioids accessed by different racial groups. A recent study showed a difference in rates of pharmacotherapy administered to Black vs White newborns with NOWS. Differing treatment modalities and the type and amount of in-utero opioid exposure impacts hospital length of stay (LOS), a driver of healthcare expenditures and a contributor to postpartum maternal stress. We analyzed NOWS LOS trends by race, and patient and systems-level factors that may be associated with variations in LOS. We conducted a retrospective, serial, cross sectional analysis of a large sample of newborns with NOWS using the Kids’ Inpatient Database (KID) to identify newborns with NOWS from 2009 to 2016 by ICD-9 and ICD-10 codes. We performed Multivariable linear regressions to identify associations between LOS and the main independent variables (race/ethnicity), as well as other key co-variates previously associated with NOWS LOS (severity, comorbidities, sex, insurance, region). We analyzed 94,327 newborns, of which most were Non-Hispanic White (76,515, 81.12%), while 6284 (6.66%) were Non-Hispanic Black, and 5545 (5.88%) were Hispanic. Black neonates’ NOWS LOS increased from 2009 to 2016 (16.29 to 22.18 days), compared to near-steady LOS for the overall cohort, and among White neonates (16.29 to 16 16.2 days). When adjusting for NAS severity, geography, comorbidities, sex and insurance, the disparities remain: NOWS LOS is over a day longer for Black neonates (1.15, 95% CI 0.88,2.86, P <0.001) and over 2 days longer for Hispanic neonates (2.3, 95% CI, 0.81,3.79, P <0.001). County fixed-effects account for Black-White, but not White-Hispanic disparity. White newborns with NOWS have shorter LOS than Black or Hispanic newborns with NOWS. This difference may be due to variations in-utero exposure, hospital and county-level factors. These findings may have implications for pediatric and postpartum maternal mental health disparities.

853 Length of stay and perinatal outcomes after preterm premature rupture of membranes between 28-33 weeks

Pregnancies complicated by preterm premature rupture of membranes (PPROM) are associated with adverse neonatal outcomes. Length of antepartum admission before delivery can serve as a proxy for duration of PPROM diagnosis. It is standard practice for women with PPROM to be managed on an inpatient antepartum unit. We sought to investigate the association between neonatal outcomes and length of antepartum admission in pregnancies complicated by PPROM. This is a retrospective cohort study of singleton, non-anomalous gestations complicated by PPROM in California between 2007-2011 using birth registry and ICD-9 data. We categorized antepartum admission stay as <7 days or ≥7 days. Gestational age at time of delivery ranged from 28-33 weeks gestation. We investigated the association between length of antepartum admission and adverse perinatal outcomes. Outcomes include newborn septicemia, chorioamnionitis, NICU admission >24 hours, neonatal death, respiratory distress syndrome (RDS), necrotizing enterocolitis, and intraventricular hemorrhage (IVH). Analyses utilized chi-square tests and multivariable logistic regression models. A p-value of less than 0.05 was considered statistically significant. In this cohort of 6,708 deliveries complicated by PPROM between 28-33 weeks gestational age, rates of chorioamnionitis were statistically lower in the cohort with <7 day length of stay compared to a length of stay ≥7 days (9.3% vs. 22.1%, p-value < 0.001) (Table 1). Rates of RDS were statistically lower in the cohort with <7 day length of stay compared to a length of stay ≥7 days (66.4% vs. 71.9%, p-value < 0.001). Rates of NICU admission were higher in the cohort with <7 day length of stay compared to a length of stay ≥7 days (92.5% and 90.3%, p-value = 0.009). Longer antepartum length of stay ≥7 days was associated with higher rates of chorioamnionitis and some adverse neonatal outcomes in the setting of PPROM during 28-33 weeks gestation.

505 Incidence of neonatal abstinence syndrome in term pregnancies complicated by medication assisted treatment

To compare the incidence of neonatal abstinence syndrome (NAS) and related neonatal outcomes in women on medication assisted treatment (MAT, methadone, buprenorphine or buprenorphine/naloxone) across varying gestational ages (GA) at time of delivery. This is a retrospective cohort study of spontaneous singleton deliveries 1/1/2010 through 12/30/2019. Patients were categorized based on maintenance medication at the time of delivery. Incidence of NAS and related outcomes were stratified by GA intervals (in weeks): 36 0/7-36 6/7, 37 0/7-37 6/7, 38 0/7-38 6/7, and > 39 0/7 (reference group). The primary outcome was the incidence of NAS. Related neonatal outcomes of interest were peak Finnegan Score (FS), treatment of NAS, neonatal intensive care unit (NICU) admission and NICU length of stay. Chi-squared test was used for categorical data and Kruskal-Wallis test was used for continuous data to test for associations between gestational age and demographic characteristics. Regression analyses were used to identified that MAT at delivery differed between the GA groups and adjustment was performed accordingly. A p-value < 0.05 was considered significant. A total of 476 patients met inclusion criteria: 67.9% buprenorphine, 28.8% methadone and 3.3% buprenorphine/naloxone. 7.1%, 11.6%, 11.8%, 69.5% delivered at 36, 37, 38, and > 39 completed weeks, respectively. There were no differences in maternal demographic characteristics with the exception of MAT use (Table 1). No significant differences were noted for the incidence of NAS by GA at delivery (Table 2). A higher proportion of babies born > 39 weeks had a peak FS >12 compared to other GA groups (p < 0.01). Babies born at > 39 weeks required more pharmacological treatment for NAS compared to those born between 36 0/7- 36 6/7 weeks. All other secondary outcomes were not statistically significant (Table 2). Our study demonstrates that there is no difference in NAS and related neonatal outcomes across varying gestational ages among women on MAT. As such, modification of the timing of delivery is not warranted in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

127 Gestational latency associated with erythromycin vs azithromycin in patients admitted with PPROM

Administration of antibiotics after preterm premature rupture of membranes (PPROM) has been shown to increase gestational latency. While the original studies included ampicillin and erythromycin, shortages of erythromycin have led to use of azithromycin in its stead. We sought to evaluate whether the use of azithromycin compared to erythromycin, is associated with changes in perinatal outcomes including gestational latency. This retrospective cohort study included women with singleton gestations admitted to a quaternary center from 9/2014 to 3/2020 with a diagnosis of PPROM between 23w0d and 33w5d. In 2017, the hospital’s policy universally changed from a 7-day course of erythromycin to one dose of oral azithromycin 1000mg. The primary outcome was gestational latency. Secondary outcomes included gestational age (GA) at delivery; chorioamnionitis; birthweight; 5-minute Apgar <7; respiratory distress syndrome; necrotizing enterocolitis; intraventricular hemorrhage; neonatal length of stay; and neonatal death. An a priori power analysis determined that a sample of 120 patients per group would identify a 2-day difference in gestational latency (with a power of 80% and an alpha of 0.05). Bivariable and multivariable analyses were performed. 280 patients met inclusion criteria. Patients receiving erythromycin had a higher frequency of prior spontaneous preterm birth (PTB) and presented at a later GA with PPROM (Table 1). No other differences were observed in patient characteristics. There were no differences in gestational latency between patients who received azithromycin compared to erythromycin in bivariable [10 (4-15) vs 8.5 (3-14) days, p=0.16) or multivariable analyses [adjusted β = 0.13 days (95% CI: -0.08-0.34 days) (Table 2). There were no statistically significant differences in secondary outcomes. There was no difference in gestational latency or incidence of adverse perinatal outcomes when comparing azithromycin to erythromycin. A single dose of azithromycin appears to be a reasonable substitute to erythromycin for gestational latency in the setting of PPROM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)