Neonatal Malformations Research Articles

Assessment of the effect of a commercial formulation of Methomyl on reproduction of Daphnia obtusa Kürz (1874)

The aim of this study was to evaluate the effect of a commercial formulation of Methomyl on the reproduction in Daphnia obtusa. Neonates (<24 h) were exposed to concentrations of insecticide (1.0, 1.5, 2.0, 2.5, 3.0 µg L -1 ) for a period of 21 days. The results showed a significant decrease in the number of molts, total neonates, fertility and sex ratio index. Significant regressions were found between reproductive parameters and concentrations of the insecticide: molts (R 2 = 0.96), fertility (R 2 = 0.97), number of female neonates born per female (R 2 = 0.90), and the number of male neonates born per female (R 2 = 0.94). Embryotoxicity was also observed; the number of neonates born with malformations increased in the highest concentrations of Methomyl 90 SP® tested. In conclusion, Methomyl 90 SP® inhibits reproduction of D. obtusa. However, a clear effect as an endocrine disrupter was not observed. This insecticide is embryotoxic; it causes malformations in neonates of Daphnia obtusa.

The effect of hepatitis B virus infected embryos on pregnancy outcome

ObjectiveHBV vertical transmission is the main reason for chronic HBV infection, but there is no clear conclusion about the effect of HBV infection on pregnancy outcome. This study aimed to investigate the effect of HBV-infected embryos on pregnancy outcome. Study design75 couples who received ART treatment were followed up. Among them were 25 couples (group A) with at least the husband or wife infected with HBV, and 50 couples (group B) with negative serum HBV markers of both husband and wife. The clinical pregnancy rate, early abortion rate, neonatal malformation rate, neonatal HBV infection rate, and HBV infection rate of the six-month-old infant were compared between these two groups, and Fisher's exact test was applied. HBV mRNA in abandoned embryos of the patients was detected by single-cell RT-PCR. ResultsBoth the early abortion rate and the abortion rate with the mother infected HBV in group A were significantly higher than in group B (P=0.043, P=0.030 respectively). The clinical pregnancy rates of groups A and B were 36% and 44% respectively (P=0.248>0.05). The neonatal malformation rate, neonatal HBV infection rate, and HBV infection rate of six-month-old infants in group A and group B were all 0. Specific HBV mRNA fragments were detected in 6 cases of 62 cleavage embryos in group A, giving a positive rate of 9.7%. The positive rates with mother infected and father infected with HBV were 13.2% (5/38) and 5.6% (1/18) respectively. ConclusionsHBV infection can increase the early abortion rate of pregnancy, and the reason may be related to HBV-infected embryos.

Surgical decompression without dural opening for symptomatic Chiari type II malformation in young infants

Prompt surgical decompression for symptomatic Chiari type II malformation in neonates and young infants has been reported to be effective. However, the optimal operative method has been arguable. The authors present their experiences with surgical decompression without dural opening. We retrospectively analyzed surgical results of patients with symptomatic Chiari type II malformation. The charts were reviewed for demographic data, clinical presentation, surgical procedures, and clinical outcomes. Ten consecutive patients with symptomatic Chiari type II malformation were surgically treated from August 2004 to December 2012. The mean age was 3.5months. The median interval between onset of symptoms and surgery was 19.5days. Three patients were treated by upper cervical bone decompression with dural opening and duraplasty. Seven patients were treated by upper cervical bone decompression with delamination of the outer layer of the dura. There were no perioperative complications. The mean follow-up period was 55months (range 3-102months). All 10 patients remain alive. In patients with dural opening, one patient showed complete recovery, and two patients had residual deficits and required a tracheostomy, one with ventilator support and the other with home oxygen therapy. In patients without dural opening, six patients (85%) showed complete or nearly complete recovery, and one patient required tracheostomy and home oxygen therapy. Upper cervical bone decompression with delamination of the outer layer of the dura can be a safe and effective treatment for symptomatic Chiari type II malformation in neonates and young infants.

Laparoscopic Methods in the Treatment of Congenital Duodenal Obstruction for Neonates

To evaluate the feasibility of and indication for laparoscopic methods for neonates with congenital duodenal obstruction. From September 2009 to October 2012, 40 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 6-8 mm Hg and a suspending suture for the right liver elevator, the procedure was performed using four trocars 3-5 mm in diameter. Under laparoscopic vision, the causes of duodenal obstruction were diagnosed, and then the operation methods were determined by the type of obstruction. Of the 40 cases, 4 were duodenal atresia (type II), 8 were duodenal stenosis, 8 were annular pancreas, and 20 were congenital intestinal malrotation. For the cases with duodenal diaphragmatic stenosis a partial excision of the diaphragm was performed after longitudinal incision of the anterior part of the duodenum followed laparoscopically by a transverse suture. For the cases with duodenal atresia (type II) and annular pancreas, a duodenal diamond anastomosis was successfully carried out through a laparoscopic approach. Ladd's operational method was performed in the cases with congenital intestinal malrotation. Feedings were started on postoperative Day 3-7, without abdominal distention and vomiting, and discharge from the the hospital was on postoperative Day 9-14. Congenital duodenal obstruction is a common malformation in neonates. The laparoscopic procedure is an important method of diagnosing, and correct operational methods are the key to improve the therapeutic effect in the treatment of congenital duodenal obstruction. The laparoscope has the value of a small incision, microinvasion, and better recovery in diagnosis and treatment for congenital duodenal obstruction. The laparoscopic methods can be performed in neonates safely and are appropriate for a full-term newborn with tolerance to CO2 pneumoperitoneum.

Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies

ObjectivesTo determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.DesignPopulation-based registry study.SettingMedical Birth Registry of Norway 1999–2009.PopulationAll births (gestational age >16 weeks to <45 weeks) in Norway (623,478 singletons and 11,263 pairs of twins).MethodsDescriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.Main outcome measuresVelamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU), malformations, birthweight, and perinatal death.ResultsThe prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal) in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal) in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1–4.6)), and placental abruption (OR = 2.6, (95% CI = 2.1–3.2)). The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5–4.3).ConclusionThe prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.

Duplication cyst of the pylorus: a case report

IntroductionPyloric duplication is an extremely rare gastrointestinal tract malformation in neonates. This is the first case report of pyloric duplication in our country (Lithuania).Case presentationWe report the case of a 2-day-old Lithuanian girl who suffered from pyloric duplication mimicking an alternative common bile duct cyst or other intra-abdominal organs cysts. A laparotomy was performed and the cystic formation of the pyloric area was successfully resected. The postoperative course was uneventful.ConclusionsThere are only a few reports describing abdominal masses caused by pyloric duplication mimicking common bile duct cyst or other intra-abdominal organs cysts. Therefore thorough clinical and instrumental examination is needed to determine the most accurate diagnosis that allows one to choose the right treatment.

Impact of assisted reproduction treatments on Spanish newborns: report of 14,119 pregnancies

To investigate neonatal malformation, prematurity, and stillbirth in singleton and multiple pregnancies derived from different Assisted Reproductive Techniques (ART). In this prospective cohort study data were collected, from private and public Spanish IVF units, during the years 2008 and 2009. During this period, 8,682 pregnancies were analysed from the initial 14,119 pregnancies reported. Pregnancies included in the study derived from IUI (n = 1,065), IVF (n = 838), ICSI (n = 5,080), FET (n = 1,404) and PGD (n = 295). This first analysis focuses primarily on neonatal malformation, prematurity, and stillbirth both in singleton and multiple pregnancies derived from different ART. Malformations were classified according to the WHO ICD 10 code. Malformations were found in 0.83% of our newborns. No differences in malformations were observed between singletons or multiples independently of the ART used. There was a significant difference in prematurity rate among singletons depending on treatment but this association was not observed in multiple pregnancies. Stillbirth was significantly lower in singleton (0.72%) than in multiple pregnancies (1.82%). The percentage of malformations observed in ART newborns was similar to the rate observed in the normally-conceived Spanish population. Multiplicity seems to be the most important factor associated with an increased incidence of newborn complications such as prematurity or stillbirth.

Risk factors for congenital hypothyroidism in Egypt: results of a population case-control study (2003–2010)

BACKGROUND AND OBJECTIVESAlthough the prevention of the neuropsychological consequences of congenital hypothyroidism (CH) through the use of replacement therapy represents an important public health success, knowledge about the modifiable risk factors could reduce the number of infants affected by this disease. This study was carried out to identify risk factors for CH at Fayoum Governorate, Egypt.DESIGN AND SETTINGSThis was a population-based case-control study, which started in 2003 and was carried out for 8 years through Fayoum center of the Egyptian Ministry of Health and Population screening program for CH.METHODSThis study was a population-based case-control study carried out by using national project for CH. One control was enrolled for each new CH infant; 320 cases and 320 controls were enrolled in 8 years. Maternal and neonatal influences were investigated.RESULTSA statistically significant association of CH was observed with birth defects, female gender, gestational age >40 weeks, and gestational diabetes. An increased risk for CH was detected in twins by a multivariate analysis.CONCLUSIONOur results suggest a multifactorial origin of CH in which genetic (high frequency of additional malformations) and environmental factors (especially maternal diabetes) play a role in the development of the disease.

Umbilical Arteriovenous Malformation in a Healthy Neonate with Umbilical Hernia

We describe the case of a neonate with an umbilical hernia and persistent wet umbilicus. Examination revealed a pulsatile umbilical cord with palpable thrill. Doppler ultrasound suspected umbilical arteriovenous malformation and contrast-enhanced computed tomography was performed leading to a definitive diagnosis. Surgery was successfully performed on day 27.

Anthropometric data, fetal and neonatal complications in infants of diabetic mothers. Results of a 10-year retrospective study

Disturbances in carbohydrate metabolism during pregnancy may result in harmful fetal and neonatal consequences. To assess the fetal and neonatal complications of pregnancy in mothers with gestational and pregestational diabetes during a 10-year period in a county hospital in Hungary. Retrospective analysis of infants of diabetic mothers admitted to the neonatal unit between 2001 and 2010. 32% of the infants were transferred to the neonatal unit. Neonatal macrosomia (birth weight >90 centile) was observed in one quarter of the infants. 39% of the infants developed hypoglycemia (blood glucose <2.6 mmol/l), in the majority of the cases within the first 8 hours. Hypoglycaemia was symptomatic in 55% of the infants. Hypocalcemia was observed in 17%, hyperviscosity in 23%, hyperbilirubinaemia in 32%, respiratory distress syndrome and/or transient tachypnoe in 22% and cardiac complications in 13% of the infants. 10% of the inafnts were affected with birth injuries. Congenital anomalies were seen in 17% of the cases, and severe malformations were present in 4% of the infants. Despite modern diabetes management, there is still a higher incidence of fetal macrosomia, adverse neonatal outcomes and a higher rate of severe congenital malformations in neonates of diabetic mothers.

Giant neonatal thoraco-abdominal lymphatic malformations treated with sildenafil: A case report and review of the literature

Lymphatic malformations account for approximately 5% of benign tumors encountered during the neonatal period. Most often treated by surgical resection or sclerotherapy, phosphodiesterase inhibitors have recently emerged as a potential treatment modality for lymphatic malformations. Treatment with phosphodiesterase inhibitors may be particularly useful when patients are not candidates for surgical resection or sclerotherapy. We report a case of giant bilateral lymphatic malformations diagnosed prenatally and treated postnatally with sildenafil.

Results of a Single-Center Observational 10-Year Survey Study on Recurrence of Hyperprolactinemia after Pregnancy and Lactation

The current survey study investigated the recurrence rate of hyperprolactinemia after cabergoline (CAB)-induced pregnancy and after lactation as well as safety of CAB exposure during early gestation. From 1997-2008, 143 pregnancies were recorded in 91 patients with hyperprolactinemia (age 30.4 ± 4.7 yr, 76 microadenomas, 10 macroadenomas, and five nontumoral hyperprolactinemia). CAB therapy was discontinued within wk 6 of gestation in all. Pregnancies were monitored until delivery or termination, during and after lactation, twice yearly up to 60 months. The incidence of abortions, premature delivery, and fetal malformations was also analyzed. Pregnancies resulted in 13 (9.1%) spontaneous abortions and 126 (88.1%) live births. No neonatal malformations and/or abnormalities were recorded. In 29 of 91 patients (three with macroadenomas), treatment with CAB had to be restarted within 6 months after lactation because of hyperprolactinemia recurrence, whereas in 68% of cases, no additional therapy was required up to 60 months. No tumor mass enlargement was observed. All patients but three were breastfeeding, 35 (38.5%) for less than 2 months and 56 (61.5%) for 2-6 months. Three months after cessation of lactation and 60 months after pregnancy, no difference in prolactin levels was found between patients nursing for less than 2 months and 2-6 months. Fetal exposure to CAB at conception does not induce any increased risk of miscarriage or malformations. Pregnancy is associated with normalization of prolactin levels in 68% of patients. Breastfeeding does not increase the recurrence rate of hyperprolactinemia.

Disorders in Glucidic Metabolism and Congenital Heart Diseases: Detection and Prevention

The identification of gestational diabetes (GDM) through appropriate screening and its subsequent treatment have not been demonstrated to limit neonatal malformations to date. This study aimed to detect congenital heart diseases in newborns of mothers with GDM by evaluating the existence of a correlation with maternal glycemic control. This observational prospective study investigated newborns of mothers with GDM enrolled during a period of 9 months. Four subgroups were considered according to the type of maternal glucidic alteration during pregnancy and the home treatment: impaired glucose tolerance, insulin-dependent gestational diabetes mellitus (IDDM), non-insulin-dependent gestational diabetes mellitus (NIDDM), and gestational diabetes not controlled (NC: untreated diabetes). Student's t test was used to compare the subgroups. The study enrolled 65 newborns (30 boys) born to 82 of mothers with impaired glucidic metabolism. Patent ductus arteriosus was observed in 11 patients (16.9 %), pulmonary stenosis of mild grade in 4 patients ( 6.2 %), and hypertrophy of the ventricular septum in 22 patients (33.8 %). A total of 14 patients had increased thickness in the left ventricle posterior wall, and 17 patients had an abnormal electrocardiogram. Hyperglycemia can influence the development of the fetal heart, affecting both its structure and its function. A treatment with insulin for women with GDM is supported by the study data.

Prenatal Exposure to Antidepressants: How Safe Are They?

Prenatal Exposure to Antidepressants: How Safe Are They?

Outcomes of transcatheter approach for initial treatment of pulmonary atresia with intact ventricular septum

To review the short and medium term outcome of transcatheter pulmonary valve perforation (PVP) in patients with pulmonary atresia-intact ventricular septum and non-right ventricular dependant coronary circulation (PA/IVS non-RVDCC). PVP in patients with PA/IVS non-RVDCC has become more common in the past two decades. However, data on outcomes with this strategy are mixed. Data were reviewed retrospectively for all patients with PA/IVS non-RVDCC treated from 1996- 2010 at our institution. Patients who had severe neonatal Ebstein malformation, or initial interventional management at another institution were excluded. PVP was attempted in 30 of 50 patients (60%); 26 (87%) of these had a successful procedure. Twenty-four patients (48%) had surgery without PVP. There were no deaths in the cohort. Complications of PVP included 5 (17%) myocardial perforations. Of those with successful PVP, 10 (38%) did not have surgery (PVP-NS) and 16 (62%) had surgery (PVP-S) prior to discharge. Tricuspid valve (TV) Z-score was larger in the PVP-NS than in PVP-S patients, with median TV diameter Z-scores of +0.7 (-0.9, 1.7) and -1.1 (-2.8, 2), respectively (P = 0.01). Time from PVP to either hospital discharge (PVP-NS group) or surgery (PVP-S group) was significantly different between groups: 15 (7, 22) and 8 days (0, 46), respectively (P = 0.01). There were no differences in the number of trials or lowest arterial PaO2 off prostaglandins between groups. All patients in the PVP-NS group had a biventricular circulation at a median follow-up of 4.3 years. The results of a collaborative approach to treating neonates with PA/IVS non-RVDCC are excellent. Smaller TV size is associated with greater likelihood of surgery prior to discharge, and may serve as a surrogate for early RV inadequacy.

Wiek ciążowy i urodzeniowa masa ciała dzieci z województwa lubuskiego urodzonych w latach 1998–2007 z wrodzonymi wadami rozwojowymi

ObjectiveThe aim of this epidemiological and clinical analysis was estimation of prevalence of congenital malformations according to duration of pregnancy (gestational age) and birth body weight. Material and MethodsThe epidemiological analysis included 100 985 children aged 0–2 born in 1998–2007 in Lubuskie province. ResultsPrevalence of congenital malformations was 3–5 times higher in preterm neonates born (before 37st week of gestation) and with low birth body weight (below 2500g). The highest rates were observed in groups of isolated cardiovascular defects and congenital malformation syndromes. ConclusionsThe duration of pregnancy and birth body weight significantly differentiate the prevalence of congenital malformations in neonates.

Wrodzone wady rozwojowe u dzieci w wieku do 2 lat na terenie województw zielonogórskiego (1988–1997) i lubuskiego (1998–2007). Część 4. Kolejność urodzenia dziecka a występowanie wrodzonych wad rozwojowych

ObjectiveThe aim of this epidemiological and clinical analysis was estimation of prevalence of congenital malformations in children in comparison to birth order. Material and MethodsThe epidemiological analysis included total 192 438 children aged 0–2 born in 1988–2007 in Zielona Góra province (1988–1997) and Lubuskie province (1998–2007). ResultsIn the analyzed 20-years period was confirmed that prevalence of congenital malformations was higher in neonates from 4th and later deliveries, especially in relation to multiple malformations of genetic etiology (certainly Down syndrome) and congenital heart defects. ConclusionsFurther birth order was associated with a higher prevalence of congenital malformations in neonates.

625 Major Birth Defects Among Baby, S Borns in Qatar

ObjectiveTo determine the pattern of major congenital malformations in neonates admitted in a tertiaryCare NICU.Study DesignDescriptive study. Place & Duration of study; Women’s Hospital Doha Qatar, The only tertiary government...

Change in lipoperoxidation but not in scavenging enzymes activity during polyamine embryoprotection in rat embryo cultured in hyperglycemic media

DM1 complicated with pregnancy is the cause of neonatal malformations and low-for-gestational-age neonates. With the use of the whole-embryo culture system, it has been demonstrated that high glucose causes embryo dysmorphogenesis. Previously, our group has found that spermidine or spermine addition reverts almost fully the severity and frequency of dysmorphogenesis, whereas the effect of arginine and putrescine it is only partial. A hypothesis for polyamine mechanism is the amelioration of oxidative stress caused by high glucose. The purpose of this work was to evaluate the effect of polyamines over the activity of scavenging enzymes and lipoperoxidation in whole-embryo rat in culture. Post-implantation (gestational day 10.5) rat embryos were cultured for 24h in normal medium or hyperglycemic medium, alone or supplemented with L-arginine or polyamine. Embryos were recovered and visualized, and morphologic parameters were registered. Cultured embryos were homogenized, and superoxide dismutase and glutathione-reductase activities, as well as lipoperoxidation, were measured. The activity of superoxide dismutase and glutathione peroxidase were not affected by the treatment, but lipoperoxidation was increased in embryos cultured in hyperglycemic medium; spermidine or spermine supplementation restore lipoperoxidation to near-normal values, and putrescine and L-arginine reverts only partially the glucose effect. Taken together, these results pointed out that spermidine and spermine embryoprotection could be mediated by direct antioxidant activity. However, further studies are needed to support this hypothesis.

What Can We Really Tell Women With Multiple Sclerosis Regarding Pregnancy? A Systematic Review and Meta-analysis of the Literature

Please cite this paper as: Finkelsztejn A, Brooks J, Paschoal F, Fragoso Y. What can we really tell women with multiple sclerosis regarding pregnancy? A systematic review and meta-analysis of the literature. BJOG 2011;118:790–797. Background Although several papers report on pregnancy and multiple sclerosis (MS), no systematic review of the literature has been carried out. Neurologists and obstetricians need to have proper information to discuss with women presenting with MS who consider pregnancy. Objectives Literature review and meta-analysis of data on pregnancy in women with MS. Search strategy The present work followed the recommendations of the PRISMA Statement. Using the PICO framework, the authors independently searched for the terms ‘pregnancy’ OR ‘gestation’ OR ‘pregnant’ AND ‘multiple sclerosis’ OR ‘MS’ in the following databases: EMBASE/Excerpta Medica, Medline, Pubmed, Scopus, Index Medicus, Biomed Central, Ebsco Fulltext, LILACS, Scielo and the Cochrane Database of Systematic Reviews. Selection criteria: only papers presenting original work with analysis of at least one of the outcomes among pregnant women with MS were included. Data collection and analysis Two independent workers performed the literature review. All the authors selected and read the relevant papers. Two other authors summarised data for analysis. Main results Twenty-two papers reporting on 13 144 women with MS and their pregnancies were analysed. A significant decrease in relapse rate was observed during pregnancy, followed by a significant increase after delivery. Miscarriages, low birthweight, prematurity, neonatal death and malformations were assessed among these women and their offspring. There seems to be a regional influence on the rates of caesarean sections and abortions among women with MS. Neonatal death and malformation rates did not seem to be particularly high. Authors’ conclusions The present work provides evidence-based data that can be discussed with women with MS and their relatives when pregnancy is considered by these families.