Neonatal Malformations Research Articles

Molecular Insight into the Effect of a Single-Nucleotide Polymorphic Variation on the Structure and Dynamics of Methionine Synthase Reductase and Its Association with Neural Tube Defects.

Neural tube defects (NTDs) are among the common and severe congenital malformations in neonates. According to a WHO report, nearly three lakh babies are affected per year worldwide by NTDs. Most studies revealed that folate deficiency is the key element to promote NTD with other oligogenic and multifactorial elements. This folate is metabolized by the FOCM (folate one-carbon metabolism) pathway. The most important step in the FOCM pathway is the conversion of methionine to homocysteine, which is guided by the enzyme MTRR. Several single-nucleotide polymorphisms (SNPs) in the MTRR gene are strongly associated with the progression of NTD. A nonsynonymous allelic variant (rs1532268) of the protein leads to a missense mutation at the 202nd position from serine to leucine (S202L) and is associated with a higher disease prevalence in different populations. In our study, this SNP indicates a 2-fold increase in the risk of disease progression (p-value of 0.03; OR 2.76; 95% CI 1.08–7.11). Here, extensive molecular dynamics simulations and interaction network analysis reveal that the change of 202nd serine to leucine alters the structures of the FAD and NAD binding domains, which restricts the ligand binding. The S202L variation alters the functional dynamics that might impede the electron transport chain along the NADP(H)→ FAD→ FMN pathway and hamper phosphorylation by kinases like GSK-3 and CaM-II during the posttranscriptional modification of the protein. The present study provides functional insights into the effect of the genetic variations of the MTRR gene on the NTD disease pathogenesis.

Endometrial Thickness Is a Risk Factor for Singleton Low Birth Weight From Single Blastocyst Transfer: A Retrospective Cohort Study.

ObjectiveTo explore whether endometrial thickness (EMT) ≤7.5 mm is associated with singleton low birth weight (LBW) from single fresh blastocyst transfer.MethodsThis was a retrospective cohort study. Only women ≤ 40 years old who underwent single fresh blastocyst transfer and had singleton live births were included in the study. LBW was the primary outcome of this study. Neonatal malformation was the secondary outcome. Logistic regression was used to evaluate the association between (EMT) ≤7.5 mm and singleton LBW.ResultsA total number of 2847 women met the study inclusion criteria. The neonatal birthweight in the EMT ≤7.5 mm group was significantly lower than that in the EMT 7.6~12.0 mm and EMT >12.0 mm group (P<0.001). The rate of LBW in the EMT ≤7.5 mm group was 24.9%, which was significantly higher than the 4.0% in the EMT 7.6~12.0 mm group and the 5.3% in the EMT >12.0 mm group (P<0.001). The total neonatal malformation rate was similar between the groups (1.1%, 0.8% and 1.5%, P=0.21). After logistic regression analysis, EMT ≤7.5 mm was found to be an independent risk factor for LBW (adjusted odds ratio [AOR]: 4.39, 95% CI: 1.85˜10.46, P<0.001).ConclusionEMT ≤7.5 mm on the hCG trigger day is an independent risk factor for LBW in singleton pregnancies from single fresh blastocyst transfer. The neonatal birthweight in the EMT ≤7.5 mm group was significantly lower than that in the EMT 7.6~12.0 mm and EMT >12.0 mm groups. The total neonatal malformation rate was comparable between the groups.

Anorectal Malformations: The Earlier the Diagnosis, the Better the Outcome.

To estimate the impact of delayed presentation of anorectal malformation (ARM) in neonates and to compare the presenting characteristics and outcomes of early versus delayed presentation. This is a prospective observational study of all neonates (age < 28 d) with ARM over 2 y. Delayed presentation was defined as presentation beyond 48h of birth. Various presenting features and their early postoperative outcomes were compared. Nearly half (26, 48%) of the 54 neonates with ARM had delayed presentation. Early and late presenters did not differ in terms of gender, gestational age, birth weight, place of delivery, and type of ARM (p > 0.05 for all). Delayed group had lower weight at presentation (p = 0.008), higher incidence of severe abdominal distension (p = 0.05), and sepsis (p = 0.171) and required longer time for resuscitation (p = 0.007) and more inotropes (p = 0.015), preoperatively. Early postoperative outcomes including time for stoma to function, initiate feeds and time to reach full feeds were significantly delayed in late presenters. They also had more wound infections, longer hospital stay and higher mortality. Delayed diagnosis of ARM is associated with significantly higher morbidity and mortality. Adequate awareness and training of health workers for early identification of ARM by careful perineal examination of all newborns at birth is the need of the hour.

Fifteen years' experience with methylphenidate for attention-deficit disorder during pregnancy: Effects on birth weight, Apgar score and congenital malformation rates

BackgroundMethylphenidate (MPD) is increasingly prescribed to fertile women with Attention-Deficit Disorder (AD(H)D), with or without hyperactivity, despite advice for discontinuation during pregnancy. Few studies report on results concerning safety after methylphenidate exposure during pregnancy for the offspring. AimSafety for the offspring of exposure to MPD during pregnancy. MethodsThis is an observational retrospective cohort study in a population of pregnant women and their offspring, treated with MPD for ADHD in the Psychiatry-Gynaecology-Pediatrics outpatient clinic between 1 January 2005 and 1 June 2020 at Isala hospital. The primary endpoints were birth weight and Apgar score in offspring exposed to MPD during pregnancy, compared to offspring unexposed to MPD. Birth weight was analysed using linear mixed model analysis. Apgar score and (secondary endpoint) neonatal malformations, at 20 week ultrasound, were analysed using basic univariate statistical analysis. ResultsMPD continuation, compared to discontinuation, was associated with higher neonatal birth weight (p = 0.049), but lost statistical significance after incorporating covariates (p = 0.079). There were no significant differences in Apgar scores and congenital malformations between neonates exposed and unexposed to MPD. ConclusionsMPD does not seem to affect birth weight, Apgar score and the frequency of neonatal malformations at the 20 week ultrasound.

Operative Management of Neonatal Lymphatic Malformations: Lesson Learned From 57 Consecutive Cases.

Aim of the study: Lymphatic malformations (LMs) are rare entities, sometimes difficult to treat, that may be life-threatening when intricately connected to airway structures. Invasive treatments are occasionally required, with sclerotherapy considered the treatment of choice and surgery as a second-line approach. The aim of the present study was to evaluate our multidisciplinary team experience in treating newborns affected by LMs requiring operative management, while defining early outcomes.Methods: Retrospective review of all consecutive patients admitted for LMs requiring operative management between January 2000 and January 2019. Patients were mainly characterized based on anatomical district of the LM (and further stratified based on the development of respiratory distress), need for tracheostomy, number of sclerotherapies, indication for surgery, and residual disease beyond the 1st year. Morbidity and mortality were also evaluated. Fisher exact test and Mann–Whitney test were used as appropriate. Statistical significance was set at p < 0.05.Results: Fifty-seven patients were included in the study, 36 with cervicofacial and/or mediastinal LMs and 21 with LMs of other anatomical districts. Due to the risk of developing respiratory distress at birth, patients with cervicofacial and/or mediastinal LMs were divided into two groups (8/36 group A vs. 28/36 group B). Group A patients are at higher risk for tracheostomy (7/8 group A vs. 1/28 group B, p = 0.0001) and more often require surgical reduction of the residual lymphatic abnormality (5/8 group A vs. 4/28 group B, p = 0.013). They also require sclerotherapies more often, but the difference is not statistically significant (8/8 group A vs. 19/28 group B, p = 0.15). Patients with cervicofacial/mediastinal LMs frequently suffer from persistent residual disease beyond the 1st year of life, significantly more often in group A (7/8 group A vs. 12/28 group B, p = 0.043).Conclusion: LMs are rare conditions with potential life-threatening behavior. Their intrinsic clinical complexity requires a multidisciplinary approach to the affected patients. Planning a long-term follow-up is essential because of the late-term problems those patients may experience.

Gas6 drives Zika virus-induced neurological complications in humans and congenital syndrome in immunocompetent mice

Zika virus (ZIKV) has the ability to cross placental and brain barriers, causing congenital malformations in neonates and neurological disorders in adults. However, the pathogenic mechanisms of ZIKV-induced neurological complications in adults and congenital malformations are still not fully understood. Gas6 is a soluble TAM receptor ligand able to promote flavivirus internalization and downregulation of immune responses. Here we demonstrate that there is a correlation between ZIKV neurological complications with higher Gas6 levels and the downregulation of genes associated with anti-viral response, as type I IFN due to Socs1 upregulation. Also, Gas6 gamma-carboxylation is essential for ZIKV invasion and replication in monocytes, the main source of this protein, which was inhibited by warfarin. Conversely, Gas6 facilitates ZIKV replication in adult immunocompetent mice and enabled susceptibility to transplacental infection. Our data indicate that ZIKV promotes the upregulation of its ligand Gas6, which contributes to viral infectivity and drives the development of severe adverse outcomes during ZIKV infection.

Live Birth Rate of Frozen-Thawed Single Blastocyst Transfer After 6 or 7 Days of Progesterone Administration in Hormone Replacement Therapy Cycles: A Propensity Score-Matched Cohort Study.

BackgroundProgesterone administration before transfer in hormone replacement treatment (HRT) is crucial to pregnancy outcomes in frozen-thawed blastocyst transfer (FET), but the optimal progesterone duration is inconsistent. The objective of this study was to investigate live birth rate (LBR) of different progesterone duration before blastocyst transfer in HRT–FET cycles.MethodIn this retrospective cohort study, patients underwent first HRT–FET (including suppression HRT) from January 2016 to December 2019 were included. Logit-transformed propensity score matching (PSM) was performed to assess covariates. The primary outcome was live birth rate after 28 weeks’ gestation. Basing on different duration of progesterone before transfer, patients were classified into P6-protocol (blastocyst transfer performed on the sixth day), or P7-protocol (blastocyst transfer performed on the seventh day). Subgroup analyses were conducted as follows: age stratification (–35, 35–38, 38–), development days of blastocyst (D5 or D6), blastocyst quality (high-quality or poor-quality), and endometrial preparation protocols (HRT or suppression HRT).ResultAfter case matching with propensity score methods, a total of 1,400 patients were included finally: 700 with P6-protocol and 700 with P7-protocol. Significantly higher live birth rate (38.43% versus 31.57%, respectively, P = 0.01) and clinical pregnant rate (50.43% versus 44.14%, respectively, P = 0.02) were observed in P6-protocol than those of P7-protocol. First-trimester abortion rates (18.13% versus 20.71%, P = 0.40) and ectopic pregnancy rates (2.27% versus 1.94%, P = 0.77) were similar between P6- and P7-groups. Preterm birth rate, low birth weight rate, newborn sex proportion, neonatal malformation rate were comparable between groups. Significantly higher LBRs were observed in patients with: age under 35, D5 blastocyst transfer, high-quality blastocyst transfer, and undergoing HRT cycles combined P6-protocol.ConclusionFrozen-thawed blastocyst transfer on the sixth day of progesterone administration in first HRT cycle is related to higher live birth rate compared with transfer on the seventh day, especially among patients aged under 35, D5 blastocyst and/or high-quality blastocyst transfer.

P–765 Embryo donation pregnancies are at high risk even in young recipients

Abstract Study question Are pregnancies after embryo donation (ED) at higher risk of complications than those issued from autologous frozen-thawed embryo transfer (FET)? Summary answer Even in young women, the risk of pregnancy induced hypertension (PIH) is four time higher in pregnancies after ED versus controls. What is known already After oocyte donation, a higher risk of PIH is well described. It is more controversial after sperm donation. The risk origin remains uncertain, even though an immunological explanation seems most likely. In ED, the fetus being fully allogeneic to his parents may be less well-tolerated. Very few data are reported about pregnancies after ED. The same allogenic model exists in surrogacies, but pregnancy complications are not well described in the literature. Study design, size, duration This anonymous, multicenter, comparative observational retrospective cohort study included all singleton ED pregnancies diagnosed at 7–8 weeks, from January 2003 to December 2018, in six French ART centers. For each, two controls were matched among autologous FET pregnancies. 209 pregnancies were included: 73 ED and 136 controls. Multiple pregnancies were excluded because of their increased associated obstetrical risks. Participants/materials, setting, methods Controls were matched according to pregnancy date, parity and women’s age. The first two singleton pregnancies after each index case meeting the selection criteria were retained. Each center coordinator collected information on infertility, pregnancy pathologies, outcomes and newborns. Statistical methods included univariate and multivariate analyses. According to French practice, all women were under 44 y/o. The main outcome was the percentage of PIH for ED versus controls. Main results and the role of chance ED was indicated for genetic disease in 17 cases (23.3%), double total infertility in 28 cases (38.3%), and double partial/total infertility in 35 cases (47.9%). Groups were comparable in age (mean age: 34.5 ± 8.6 versus 34.5 ± 4.5; p = 0.68), BMI, except for parity (more nulliparity in ED group: 90.4% vs 79.4%; p = 0.04). Pregnancy outcomes were similar for ED and control groups, the percentages of deliveries being 80.8% and 83.8%, respectively (p = 0.58). PIH occurred significantly more frequently among ED than control pregnancies (24.6% versus 11.9%; P = 0.04), with the difference mainly observed for severe forms: preeclampsia and HELLP (17.5% vs 4.6%; p = 0.01). No eclampsia was reported. In contrast, isolated hypertension frequency was comparable (7.0% vs. 7.3%, p = 0.94). Regarding labor and delivery mode, in ED group C-section was more frequent (47.3% vs 29.2%; p = 0.03). In neonatal data, no difference was found between ED and control group for prematurity, weight and height at birth, Apgar score, Small for gestational age, Large for gestational age and sex ratio. Seven neonatal malformations were recorded in ED group and 3 in the control group (NS). Limitations, reasons for caution Retrospective study in a relatively long period when different endometrial preparation for frozen-thawed embryo transfer and embryo cryopreservation method were used. Relatively limited number of ED because of low practice in France. No analysis of embryo stage at transfer (cleaved embryo or blastocyst). Wider implications of the findings: The PIH risk must be acknowledged to inform couples and provide careful pregnancy monitoring. A special care for gestational carrier should also be done since the allogenic situation is the same than in ED recipients. Trial registration number Not applicable

Risk Factors for Maternal and Perinatal Complications during Pregnancy among Women with Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease during pregnancy. Studies of risk factors are of great significance to maternal and fetal outcomes in patients with TOF. To identify predictive risk factors for maternal and perinatal complications in women with TOF. 78 patients with TOF who delivered at Shanghai Obstetrical Cardiology Intensive Care Center between January 1993 and December 2017 were retrospective reviewed. A logistic regression model was used to identify risk factors for maternal and perinatal complications. There was no maternal death, five patients developed cardiac failure, sustained arrhythmias requiring treatments were recorded among 2 patients. Factors identified for maternal complications included previous cardiac events and oxygen saturation <90%. Oxygen saturation <90% was found to be independent predictor of maternal cardiac complications (RR = 21.455, 95%CI 2.186-210.572, P = 0.009). The perinatal survival rate was 87.18%, there were 52 term deliveries (66.67%). Perinatal poor outcomes include 9 therapeutic abortions (11.54%), 1 neonatal death (1.28%), 16 premature births (20.51%), 18 small for gestational age children (23.08%), 3 neonatal asphyxia (3.85%), and 3 neonatal cardiac malformations (3.85%). Factors identified for perinatal complications included without cardiac surgery, higher hemoglobin values, higher hematocrit values, oxygen saturation <90%, right ventricular hypertrophy, pulmonary stenosis, ventricular septal defect, and pulmonary hypertension. Oxygen saturation <90% was found to be independent predictor of perinatal complications (RR = 8.270, 95%CI 1.374-49.790, P = 0.021). Oxygen saturation <90% is associated with maternal and perinatal risks. Women with TOF whose oxygen saturation <90% are not recommended for pregnancy because of high maternal and perinatal complications.

Evaluation the Histological Effects on Brian and Skeletal Malformations in Fetuses and Neonates of Rats Treated with the Antibiotic Levofloxacin

This study desig to reveal the possible negative effects of the antibiotic Levoflexacin (Levo) on the fetuse numbers (total, living, absorbed and dead ) during three periods of pregnancy (20,16,7) days respectively and on some histological effects of brain of fetuses during two periods of pregnancy (20,16) days respectively and the skeletal malformations in fetuses for pregnancy period(20) days and neonates after birth ,the study was carried out in the animal house of the Department of biology at the College of Education for Girls - University of Kufa, This study lasted from November -2020 to March- 2021, 60 adult female rats and 60 fertile male rats Rattus ratuss were used in the current study, female rats were with an average age of 12 weeks and an average weight of 240 g, while male rats were at an average age of 11 weeks and the average weight of 230 g which was used for the purpose of mating with females only, and after mating between males and females rats and obtaining a sufficient number of pregnant females rats, the pregnant rats were divided into 4 groups, each containing 20 pregnant female rats, The first group was treated as a control group that was dosed with physiological salt only, the second group was dosed with the antibiotic levofloxacin at a concentration of 500 gm / kg of body weight and the third group was dosed with the antibiotic levofloxacin at a concentration of 750 gm / kg of body weight, the first 15 pregnant female rats from all groups were dissected during the two pregnancy periods (7,16, 20) days respectively , It included each group 5 pregnant females for each pregnancy period, while the remaining 5 pregnant females from each group were left to the birth, all pregnant animals were dosed from the first day of pregnancy by a stomach tube with single dose per day. The results of the present indicated that there was a significant decrease(P&lt;0.05) in the numbers of total and the numbers of live embryos, while the numbers of absorbed and dead embryos were significantly increased (P&lt;0.05) in groups of animals treated with the antibiotic levofloxacin at concentrations 500 g/kg and 750 g/kg of body weight for pregnancy periods (7,16,20) days respectively compared with the numbers of all embryos and for the three pregnancy periods (7,16,20) days respectively in the control groups, and the results pointed to significant differences in two groups treated with concentrations of (500,750) g/kg of body weight during the three pregnancy periods when comparing them. The results of the study showed that the brain sections of the embryos in the pregnant rats groups in the control groups during the two pregnancy periods (16,20) days respectively did not show any pathological changes in their tissues, while the brains of the embryos in the groups treated with the antibiotic levofloxacin at two concentrations 500 g/kg of body weight showed various pathological changes during pregnancy for periods (16 ,20) days respectively, and these histological structure effects increased by increasing drug concentration with 750 g/kg of body weight during pregnancy periods(16,20) days respectively.The study of the skeletons of embryos during the pregnancy period of 20 days and of the newborns after birth showed the occurrence of different skeletal malformations in the groups treated with the antibiotic levofloxacin at two concentrations 500 g/kg and 750 g/kg of body weight when compared with the skeletons of the embryos at the age of 20 days of pregnancy and for the newborns after birth in control groups for the same periods.

Examining Prevalence of Fetal Defects and Related Factors in Neonates Born and Hospitalized in Kerman Reference Hospital: A 66-Month Study

Background: Congenital malformations are one of the most important causes of disability and mortality of neonates. Many of these defects can be prevented. Therefore, recognizing and preventing the threatening factors that cause the adverse outcomes of pregnancy can prevent excessive costs to the family and society. The present study was performed to determine the prevalence of congenital malformations and some related factors in Afzalipour Hospital in Kerman, Iran. Materials and Methods: In this cross-sectional study and historical cohort, 1089 neonatal files were selected from 43076 files in the period of March 2014 to September 2019 by stratified sampling method with proportional allocation. Maternal and neonatal information including gender of infant, maternal and neonatal blood type, first and fifth minute Apgar score, LMP-based gestational week, maternal underlying disease, history of disease in pregnancy, maternal addiction, maternal number of pregnancies, number of childbirths, number of live children, number of stillbirths, history of abortion and stillbirth, type of childbirth and the congenital anomalies and its type were extracted from the files and recorded in the researcher-made checklist. Results: The prevalence of congenital malformations in neonates was 16.6%. The most common malformations were cardiovascular malformations (55.3%) and genitourinary malformations (19.3%). Girl gender, lack of maternal addiction, increasing maternal pregnancy, low Apgar score, and hospitalization in NICUs increase the chances of congenital malformations in neonates. Conclusion: The prevalence of congenital malformations in neonates was 16.6%. The most common malformations included cardiovascular malformations and genitourinary malformations.

Tension pneumothorax in a toddler with congenital cystic adenomatoid malformation

Abstract Congenital cystic adenomatoid malformations (CCAM) are the most common type of congenital parenchymal lung malformations in neonates as well as in children; presenting with sudden onset of respiratory distress, recurrent pulmonary infections, pneumothorax or haemoptysis. However they can be asymptomatic too. Here we are reporting a case of spontaneous pneumothorax occurring in a female toddler and challenges in its management.

Simplified video-assisted one-trocar diverting colostomy in pediatric patients

In pediatric age colostomy is mainly temporary and totally diverting, the major indication being neonatal anorectal malformation for which a specific double separated stoma route has been widely popularized. Out of newborn age the reasons for colon diversion in children are less common and the procedures are quite similar to the techniques employed in adults. Laparoscopy for pediatric colostomy has a short history and the original recommended procedure for newborns has been achieved only very recently with a two-trocars technique. We describe an original one-trocar method to create a double or single totally diverting colostomy avoiding any other abdominal wound at risk for complications. The procedure has been performed on newborns with anorectal malformations as well as on a teenager through minor technical variants. This one-trocar method allowed a quick and safe totally diverting colostomy in every treated patient. There was no complication during surgery and no skin infection in the whole postoperative period; at the end of treatment scars were minimal. This technique is suitable for the specific neonatal double separated colostomy and virtually for every indication of fecal stream diversion in any kind of patient. • Avoiding abdominal wounds reduces complications in colostomy management. • Simplified one-trocar technique can fit any colon diversion in pediatrics. • Laparoscopic colostomy improves assessment of anorectal malformation complex.

Pregnancy outcomes and maternal characteristics in women with pregestational and gestational diabetes: a retrospective study on 206,917 singleton live births.

To examine risk of adverse pregnancy outcomes, mothers' characteristics and incidence rate over time of pregestational type 1 (T1D), type 2 (T2D) or gestational diabetes (GDM). The study included all singleton live births born from women aged 15-45year, in Tuscany, Italy from 2010 to 2018. Pregnancy outcomes were retrieved by certificates of care at delivery compiled by midwives. Pregestational diabetes and GDM were identified by regional administrative databases. Time course of pregestational diabetes and GDM across last decade was assessed by Poisson analysis. Logistic regression analysis was used to calculate adjusted odds ratios (OR; 95% CI) for maternal characteristics or neonatal outcomes. Among 206,917 singleton live births, GDM was diagnosed in 21,613 pregnancies (10.46%) and pregestational diabetes in 979, being T2D more prevalent than T1D (606; 0.29% vs. 373; 0.18%). Pregestational T2D incidence progressively decreased over last decade, T1D remained stable while GDM progressively rose. Pre-pregnancy obesity, preterm deliveries or cesarean sections were common characteristics of pregestational diabetes and GDM. Risk of neonatal distress and neonatal malformations was higher in pregestational T1D. Risk of prior spontaneous abortions was higher in GDM and in pregestational T2D (OR: 4.19; 3.30-5.33), mostly treated with metformin. Risk of neonatal macrosomia was increased only in pregestational diabetes. In our population, pregestational T2D was more prevalent than T1D. Neonatal complications were mostly associated with pregestational T1D. Increased risk of previous spontaneous abortions was the hallmark of pregestational T2D. GDM, even if sharing adverse outcomes with pregestational T2D, was unrelated to rise in risk of neonatal macrosomia.

Regional variation in gastroschisis: a nationwide database review of demographics and outcomes.

Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis. The 2016 kid's inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson's Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data. 2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions. There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.

Commentary on early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component

This is a Commentary on “Enhanced Enteral Feeding Versus Traditional Feeding in Neonatal Congenital Gastrointestinal Malformation Undergoing Intestinal Anastomosis: A Randomized Multicenter Controlled Trial of an Enhanced Recovery After Surgery (ERAS) Component” by Peng Y, Xiao D, Xiao S, et al.

Early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component

Purposethe aim of this clinical trial was to evaluate the safety and efficacy of early enteral feeding (EEN) following intestinal anastomosis in neonates with congenital gastrointestinal malformation. Methodsa multicenter, prospective, randomized controlled trial (registered under chictr.org.cn Identifier no.ChiCTR-INR-17014179) was conducted between 2018 and 2019. Four centers in China analyzed 156 newborns of congenital gastrointestinal malformation undergoing intestinal anastomosis to EEN group (n = 78) or control (C) group (n = 78). The primary outcomes of this study were length of postoperative stay (LOPS) and time to full feeds. Secondary outcomes included morbidity of complications, parenteral nutrition (PN) duration, feeding intolerance, 30 day mortality rate and 30 day readmission rate. Resultsthe mean time to full feeds and LOPS in the EEN group were 15.0 (9.8–22.8) days and 17.6 (12.0–29.8) days, while that were 18.0 (12.0–24.0) days and 20.0 (15.0–30.3) days in C groups respectively. There was no significant difference between two groups(P >0.05). No significant intergroup difference was found with respect to postoperative morbidity, PN duration or feeding intolerance(P >0.05). Conclusionsearly enteral feeding following intestinal anastomosis in neonates with congenital gastrointestinal malformation is safe. Post-operative outcomes demonstrated a trend toward improvement. Level of evidenceLevel Ⅰ.

Occurrence of smooth endoplasmic reticulum aggregates in metaphase II oocytes: relationship with stimulation protocols and outcome of ICSI and IVF cycles.

Is there any association between the appearance of smooth endoplasmic reticulum aggregates (SERa) in oocytes and ovarian stimulation, embryological, clinical and neonatal outcomes of ICSI and IVF cycles? A suboptimal prolonged ovarian stimulation is detrimental to oocytes by inducing the occurrence of SERa, which reduces the reproductive potential of oocytes. Controlled ovarian stimulation recruits oocytes of different qualities. Based on current evidence, it was agreed that non-homogeneous cytoplasm may represent the normal variability among oocytes rather than a dysmorphism with developmental significance. The only exception is the appearance of SERa within the ooplasm. Owing to the lack of univocal evidence in this literature about the safety of injecting oocytes with SERa and the mechanism responsible for the occurrence of SERa, this topic is still a matter of debate. A retrospective, longitudinal cohort study performed at a tertiary level public infertility center. We included 1662 cycles (180 SERa+ and 1482 SERa-) from 1129 women (age: 20-44 years) who underwent IVF/ICSI treatments in 2012-2019. The SERa+ cycles had at least one SERa+ oocyte in the oocyte cohort. The SERa- cycles had morphologically unaffected oocytes. We collected stimulation data and embryological, clinical, neonatal outcomes of SERa- and SERa+ cycles and oocytes. Overall, 347 out of 12436 metaphase II oocytes (2.8%) were affected by SER. We performed only 12 transfers involving at least one SERa+ embryo. Stimulation length (P = 0.002), serum progesterone (P = 0.004) and follicle size (P = 0.046) at trigger, number of retrieved (P = 0.004) and metaphase II (P = 0.0001) oocytes were significantly higher in SERa+ than SERa- cycles. Fertilization rate was significantly (P < 0.0001) reduced in SERa+ cycles and oocytes compared to SERa- counterparts. Embryos of SERa+ cycles had a lower blastocyst formation rate compared to embryos of SERa- cycles (P = 0.059). Statistical analysis according to a generalized estimating equation model performed at patient level demonstrated that the duration of ovarian stimulation was predictive of SERa+ oocytes appearance. The clinical success of SERa+ cycles was lower than SERa- cycles, although no differences in neonatal birthweights or malformations were recorded in sibling unaffected oocytes of SERa+ cycles. Given that SERa+ oocytes were discarded in our center for years and transfers of embryos originating from affected oocytes were generally avoided, clinical outcomes of SERa+ cycles are largely attributable to the transfer of embryos derived from unaffected oocytes of SERa+ cycles and we did not have data about newborns from affected oocytes, since none of the transfers involving SERa+ embryos resulted in a progressive clinical pregnancy. For the first time, we speculate that the late-follicular phase elevated serum progesterone caused by a suboptimal prolonged ovarian stimulation may be detrimental to the oocytes by inducing the occurrence of SERa, resulting in negative effects on their reproductive potential. This raises the question of whether some stimulation regimens could be worse than others and a change in stimulation protocol would reduce the possibility of producing oocytes with suboptimal maturation. In particular, our data highlight the importance of correct timing of the trigger in order to maximize oocyte collection, not only in terms of numerosity but also their reproductive potential. None. N/A.

Impacts of gut microbiota on gestational diabetes mellitus: a comprehensive review.

Gestational diabetes mellitus (GDM) is a condition that seriously threatens mother and child health. The incidence of GDM has increased worldwide in the past decades. In addition, the complications of GDM such as type 2 diabetes (T2DM) and neonatal malformations could negatively affect the living quality of mothers and their children. It has been widely known that the imbalance of gut microbiota or called 'gut dysbiosis' plays a key role in the development of insulin resistance and chronic low-grade inflammation in T2DM patients. However, the impacts of gut microbiota on GDM remain controversial. Here, we aim to comprehensively review the alterations of gut microbiota in GDM mothers and their offspring. The alterations of Firmicutes/Bacteroidetes (F/B) ratio, short-chain fatty acid (SCFA)-producing bacteria, bacteria with probiotics properties and gram-negative lipopolysaccharide (LPS)-producing bacteria play a vital role in the development of GDM. The beneficial roles of gut microbiota modification (probiotics, synbiotics and lifestyle modification) as a treatment of GDM were found in some, but not all studies. In the near future, gut microbiota modification may be considered as one of the standard treatments for GDM. Moreover, further studies regarding the specific gut microbiota that are associated with the early development of GDM are required. This may contribute to the novel diagnostic markers for early stages of GDM.

Neonatal cervical lymphatic malformation involving the fetal airway the setting of emergency caesarean section

Abstract Objectives Lymphatic malformations are benign vascular anomalies comprised of lymphatic elements and most commonly occur in the neck. They may be diagnosed prenatally on ultrasound, and, in addition to confirming the diagnosis, fetal MRI can delineate the presence and extent of airway involvement. A variety of therapies are available for the treatment of lymphatic malformations including medical management, sclerotherapy, and surgery. Case presentation We report a case of a 28 year-old pregnant female diagnosed with a fetal neck mass by ultrasound at 21 weeks gestation. A fetal MRI was performed which demonstrated a multiseptated cystic neck mass most suggestive of a lymphatic malformation. The mass was noted to be intimately associated with the fetal airway. Follow up ultrasounds showed continued growth of the lesion throughout pregnancy. The baby was born by EXIT procedure and the lymphatic malformation was ultimately treated by a combination of medical treatment, sclerotherapy, and surgery. Conclusions Cervical lymphatic malformations have a classic imaging appearance and can enlarge throughout gestation as well as after delivery. The treatment plan typically involves a multidisciplinary approach.