Neonatal Outcome Measures Research Articles

A prospective study on maternal periodontal diseases and neonatal adverse outcomes.

It is evident that periodontitis is linked to various adverse pregnancy outcomes. This prospective study explored the potential link of maternal periodontal diseases to neonatal adverse outcomes. A total of 193 generally healthy females in their third trimester (34-36 weeks) of pregnancy were enrolled. All subjects received full-mouth periodontal assessment, and the periodontal inflamed surface area (PISA) was calculated. Demographic data, lifestyles and anthropometric measurements of the neonates (e.g., body length and head circumference) were recorded. Herein, small-for-gestational age (SGA) referred to gender- and age-adjusted birth weight below the 10th percentile in line with the standard reference. Multivariable logistic regression analysis and restricted cubic spline were performed for examining the association of periodontal parameters with SGA. Results: There were 8.3% (16/193) of neonates with SGA. Significantly positive correlation existed between the percentage of tooth sites with increased probing depth and an elevated risk of SGA (OR: 1.052; P < 0.05). Yet, the PISA was positively associated with the risk of SGA (OR: 1.002; P < 0.05) as well. No significant link occurred between maternal periodontal status and other neonatal outcome measures. Within the limitations of this study, the findings suggest that there could be a link between maternal periodontal diseases and neonatal adverse outcomes like SGA. Further investigation is required to clarify the current findings and potential implications for promoting maternal oral/periodontal health and newborn health.

Effects of Single-Course Betamethasone on the Outcomes of Late Preterm Neonates.

Background Prenatal glucocorticoids are commonly used in pregnancies before 34 weeks of gestation in women at risk of preterm delivery; however, the effects of these drugs on late preterm infants (those born after the 34th week of pregnancy) are controversial. As a result, we aimed to investigate the effect of a single course of betamethasone (two doses of betamethasone every 24 hours) on the neonatal outcome of late preterm births. Methods We retrospectively assessed all spontaneous late preterm births (34-36+6 weeks of gestation) at a tertiary hospital in Iran over a period of two and a half years. Exclusion criteria included multiple pregnancies, induced labor, and fetal malformations identified in sonograms. Neonatal outcome measures encompassed first and five-minute Apgar scores, respiratory distress syndrome, neonatal death, birth asphyxia, and the need for positive pressure ventilation, continuous positive airway pressure, tracheal intubation, and surfactant. Baseline characteristics, such as maternal age, parity, fetal gender, and high-risk pregnancy, were considered confounding variables. High-risk pregnancies were defined as any cases involving prolonged rupture of membranes or maternal comorbidities such as severe anemia, preeclampsia, diabetes, or COVID-19. Results During the study period, there were 830 spontaneous preterm births at our center. Of these, only 195 (23.5%) received complete doses of betamethasone. Low birth weight was more common in mothers who did not receive betamethasone compared to those who did (63.6% vs. 41.2%). The mean gestational age was lower in mothers who received betamethasone than in those who did not. Respiratory distress syndrome was more common in mothers who received betamethasone (P<0.001, RR 2.11, 95% CI (0.98-4.18)). However, after adjusting for confounding factors, such as gestational age and birth weight, betamethasone did not increase the risk of respiratory distress syndrome. Other adverse neonatal outcomes did not differ significantly. Conclusions There were no differences in neonatal outcomes between those who received betamethasone and those who did not.

Effect of an Obstetric Enhanced Recovery After Surgery (ERAS) Protocol on Maternal and Neonatal Outcomes [ID: 1375461

INTRODUCTION: Enhanced Recovery After Surgery (ERAS) is a protocol initiated in many specialties with the goal of reducing health care costs, postoperative complications, and patient morbidity. METHODS: We undertook a retrospective cohort study of pregnant women undergoing nonlaboring, nonurgent cesarean delivery between October 2020 and October 2021. Data pertaining to demographic characteristics, pregnancy comorbidities, and maternal and neonatal outcome measures pertaining to operative and postoperative complications, readmission, length of stay, breastfeeding, neonatal cord gases, and neonatal intensive care unit admission were abstracted from electronic health records and compared across two groups, preimplementation and postimplementation, using Student t-test, Pearson’s χ2, Mann-Whitney U, and/or Fisher’s exact test, as indicated. Statistical significance was set at P&lt;.05. Institutional review board approval was obtained. RESULTS: Demographic characteristics and rates of pregnancy comorbidities, including chronic hypertension, hypertensive disorders of pregnancy, and pregestational/gestational diabetes, were similar across pregnant women undergoing cesarean delivery in the preimplementation (N=168) and postimplementation (N=123) groups. Cesarean procedure duration, overall intraoperative and/or postoperative complication rates, readmission, breastfeeding rates, and postoperative length of stay did not change after ERAS implementation and were comparable to the pre-ERAS cohort. Postoperative Foley catheter replacement was more common after ERAS implementation (P=.03). Neonatal outcomes were comparable across both study groups. CONCLUSION: Implementation of an ERAS protocol did not significantly alter maternal and neonatal clinical outcomes in our study cohort with the exception of a small increase in Foley catheter replacement rates, which may be attributable to the protocol workflow requiring Foley removal within 6 hours postoperatively.

Does Weaning of Buprenorphine in Pregnancy (in Outpatient Setting) Improve Neonatal and Maternal Outcome? [ID: 1369357

INTRODUCTION: Treatment of opioid use disorder (OUD) in pregnancy is challenging. There are reports of successful weaning in OUD in pregnancy, even though professional bodies maintain the recommendation of nonweaning during pregnancy. METHODS: It was a prospective, nonintervention study after the local IRB's approval. We have a university group of obstetrician providers who will wean buprenorphine during pregnancy after contracting with pregnant women while providing counseling and social services. Many women choose to wean, while many continue not to wean and get their obstetric care at university but their substance use disorder care at other medical-assisted treatment centers. Women in the weaning group consented at the prenatal clinic, while the nonweaning group consented to the study at the hospital when they presented for the delivery. Women were given questionnaires in the postpartum period for the Edinburg Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS). Demographics for mothers and neonates were extracted from medical records. RESULTS: There were 34 pregnant women in the weaning group, with 13 women in the nonweaning group. Polysubstance use and low-birth-weight infant were excluded from neonatal outcome measures for the length of neonatal stay in hospital analysis for obvious reasons. The mean buprenorphine dose in the weaning group was significantly lower (1.9 versus 11.7 [mean] with P&lt;.0001 [T test]). Also, the length of neonatal stay was significantly lower (4.9 versus 7.2, P&lt;.05) and a trend towards higher birth weight (3,137 versus 3,018 g) and decreasing morphine requirement (62 versus 249 doses) in weaning group. PSS and EPDS scores did not show statistically significant differences with lower scores in the weaning group. CONCLUSION: Our results show that weaning of buprenorphine in OUD women during pregnancy in an outpatient setting is possible and improves outcomes for neonates and mothers.

Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross-sectional register study of 601 247 hospital deliveries.

To study the busy day effect on selected neonatal adverse outcomes in different sized delivery hospitals and in the entire nationwide obstetric ecosystem. A cross-sectional register study. The lowest and highest 10% of the daily delivery volume distribution were defined as quiet and busy days, respectively. The days between (80%) were defined as optimal delivery volume days. The differences in the incidence of selected adverse neonatal outcome measures were analysed between busy versus optimal days and quiet versus optimal days at the hospital category and for the entire obstetric ecosystem level. A total of 601 247 singleton hospital deliveries between 2006 and 2016, occurred in non-tertiary (C1-C4, stratified by size) and tertiary level (C5) delivery hospitals. Analyses were performed by the methods of the regression analyses with crude and adjusted odds ratios including 99% CI. Birth asphyxia. At the ecosystem level, adjusted odds ratio for birth asphyxia was 0.81 (99% CI 0.76-0.87) on busy versus optimal days. Breakdown to hospital categories show that adjusted odds ratios for asphyxia on busy versus optimal days in non-tertiary hospitals (C3, C4) were 0.25 (99% CI 0.16-0.41) and 0.17 (99% CI 0.13-0.22), respectively, and in tertiary hospitals was 1.20 (99% CI 1.10-1.32). Busy day effect as a stress test caused no extra cases of neonatal adverse outcomes at the ecosystem level. However, in non-tertiary hospitals busy days were associated with a lower and in tertiary hospitals a higher incidence of neonatal adverse outcomes.

Characteristics and Outcomes in Preterm Infants with Extubation Failure in the First Week of Life.

This study aimed to evaluate characteristics and outcomes in preterm infants with extubation failures in their first week of life. Retrospective chart review of infants born between 24 and 27 weeks' gestational age at the Sharp Mary Birch Hospital for Women and Newborns between January 2014 and December 2020 who had an extubation attempt within the first 7 days of life. Infants that were successfully extubated were compared with those who required reintubation in the first 7 days. Maternal and neonatal outcome measures were analyzed. A total of 215 extremely preterm infants had an extubation attempt in the first 7 days of life. Forty-six infants (21.4%) failed extubation and were reintubated within the first 7 days. Infants who failed extubation had a lower pH (p < 0.01), increased base deficit (p < 0.01), and more surfactant doses prior to first extubation (p < 0.01). Birth weight, Apgar scores, antenatal steroid doses, and maternal risk factors such as preeclampsia, chorioamnionitis, and duration of ruptured membranes were not different between success and failure groups. Rates of moderate to large patent ductus arteriosus (p < 0.01), severe intraventricular hemorrhage (p < 0.01), posthemorrhagic hydrocephalus (p < 0.05), periventricular leukomalacia (p < 0.01), and retinopathy of prematurity stage 3 or greater (p < 0.05) were higher in the failure group. In this cohort of extremely preterm infants that failed extubation in the first week of life, there were as increased risk of multiple morbidities. Base deficit, pH, and number of surfactant doses prior to first extubation may be useful tools in predicting which infants are likely to have early extubation success, but this needs prospective study. · Predicting extubation readiness in preterm infants remains challenging.. · Extubation failure is associated with multiple neonatal morbidities.. · Infant clinical characteristics may help predict extubation failure..

Evaluating antenatal risk in twin pregnancies-A feasibility study to identify modifiable factors associated with adverse pregnancy outcomes.

Twin pregnancies have significantly higher rates of perinatal morbidity and mortality compared to singleton pregnancies; current attempts to reduce perinatal mortality have been less successful in twin pregnancies. The paucity of information about modifiable risk factors for adverse neonatal outcomes in twin pregnancies, as well as independent effects of chorionicity may have contributed to this outcome. This study aimed to explore the feasibility of an observational study to identify modifiable factors associated with adverse neonatal outcomes in twin pregnancies. Patients pregnant with twins at six UK hospitals between December 2019-March 2021 completed researcher-administered questionnaires at approximately 20-, 28- and 36-weeks' gestation, recording a wide range of self-reported social, lifestyle and demographic factors, alongside prospectively recorded clinical data from maternity records. Descriptive statistics were used to describe frequencies of exposures; logistic regression was used to determine whether factors were associated with a composite measure of adverse neonatal outcome. Data were collected from 65% (181/277) of eligible participants. A total of 98% (175) of participants had positive views about their participation. Some exposures, including cigarette smoking, supine sleep position and reduced fetal movements were less frequent in twin pregnancies compared to singletons, whereas fertility treatment was more common. Furthermore, different patterns of exposure were seen between monochorionic and dichorionic twins. This pilot study found some associations with adverse neonatal outcomes including: low BMI (OR 8.36, 95% CI: 1.02-68.87), maternal age ≥41 years (OR 9.0 95% CI: 1.07-75.84), maternally perceived high-stress levels (OR 1.96, 95% CI: 1.03-3.75) and inadequate antenatal screening (OR 1.44, 95% CI: 1.01-2.06). Sleep duration ≥9 h and right-sided going to sleep position were more frequent among pregnancies with adverse outcomes. Participants who reported receiving no information on fetal movement and reduced maternal perception of movements were more likely to have an adverse outcome, but sample size prohibited analysis based upon chorionicity. An observational study of modifiable factors in twin pregnancy is feasible. Differences in the frequencies of exposures between twin and singleton pregnancies highlight the need for twin-specific studies to identify modifiable factors and develop preventative strategies for morbidity and mortality in twin pregnancies.

Measuring the impact of cardiotocograph decision support software on neonatal outcomes: A propensity score-matched observational study.

This study follows the 2017 UK INFANT Collaborative Group RCT, which compared neonatal outcomes with and without the use of the INFANT cardiotocograph decision support system for over 46000 patients in labour. The original trial failed to demonstrate a significant improvement to neonatal outcomes; however, the study design was subject to methodological critique. This Australian retrospective cohort study aimed to report perinatal outcomes before and after the introduction of INFANT decision support software for cardiotocograph use in labour. The study cohort was divided into two equivalent 18-month epochs, before and after the introduction of INFANT-Guardian® CTG decision support system. Propensity score matching analysis was undertaken to balance pre- and post-implementation groups by baseline covariates. The matched cohort included 11154 public-funded women between November 2016 and 2019, with a singleton live fetus ≥34+0weeks, being induced or in spontaneous labour. The main outcome measures were: a composite measure of serious adverse neonatal outcome comprising of one or more of: admission to intensive care nursery >48h, Apgar <4 at 5min, cord arterial pH <7.0, hypoxic ischaemic encephalopathy grade 2 or 3, therapeutic hypothermia, neonatal death. The incidence of the composite primary outcome was significantly lower following implementation of INFANT (0.57% vs. 1.00%; OR 0.57, 95%CI 0.37-0.88; P=0.01). A significant reduction in nursery admission >48h was also observed (0.05% vs. 0.30%; OR 0.18, 95%CI 0.05-0.60; P=0.002). INFANT software is associated with a reduction in serious adverse neonatal outcomes, without increasing the rate of operative delivery.

Association of Self-Administered Nitrous Oxide for Labor Analgesia With Maternal and Neonatal Process and Outcome Measures

ObjectiveTo describe patterns of use of self-administered nitrous oxide (N2O) during labor and to determine if maternal and neonatal process and outcome measures differ for women who use N2O compared to women who do not use N2O. DesignRetrospective, full-census, observational cohort. SettingAn upper midwestern U.S., urban, 75-bed quaternary perinatal center with more than 5,000 annual births. ParticipantsThe participants included two groups of women: 400 who used N2O during labor and a comparison group of 6,733 who met N2O eligibility but did not use N2O. MethodsWe used descriptive statistics to examine patterns of use of N2O during labor between January 2015 and March 2017. We examined associations of N2O with process (length of first and second stages of labor, time from hospital admission to birth, time from birth to hospital discharge, and total length of stay) and outcome measures (shoulder dystocia, instrumentation, vaginal lacerations, Apgar scores at 5 minutes, nursery disposition) using multivariate linear, logistic, and ordinal regression models. ResultsThree percent (12/400) of women who used N2O discontinued because of side effects. Among participants with vaginal births who used N2O, 17.6% (62/352) used N2O as the only form of pain medication during labor. We found no significant differences in maternal and neonatal outcome measures between the two groups. Among the process measures examined, we found a mean 2-hour-longer time from admission to birth and total length of stay in the N2O group (p < .05) compared to the non-N2O group. ConclusionMost participants who used N2O (290/352, 82.3%) transitioned to other pain modalities during labor. Maternal and neonatal process and outcome measures were comparable relative to other pain management modalities, with the exception of longer time durations for two measures.

Perinatal death in a term fetal growth restriction randomized controlled trial: the paradox of prior risk and consent

The disproportionate intrauterine growth intervention trial at term was an intention to treat analysis and compared labor induction with expectant monitoring in pregnancies complicated by fetal growth restriction at term and showed equivalence for neonatal outcomes. To evaluate trial participation bias and to examine the generalizability of the results of an obstetrical randomized trial. We used data from participants and nonparticipants of a randomized controlled trial-the disproportionate intrauterine growth intervention trial at term (n=1116) -to perform a secondary analysis. This study compared induction of labor and expectant management in women with term growth restriction. Data were collected in the same manner for both groups. Baseline characteristics and neonatal and maternal outcomes were compared. The primary outcome was a composite measure of adverse neonatal outcome. Secondary outcomes were delivery by cesarean delivery and instrumental vaginal delivery; length of stay in the neonatal intensive care, neonatal ward, and the maternal hospital; and maternal morbidity. Nonparticipants were older, had a lower body mass index, had a higher level of education, smoked less, and preferred expectant management. The time between study inclusion and labor onset was shorter in participants than in nonparticipants. Notably, 4 perinatal deaths occurred among nonparticipants and none among participants. Among nonparticipants, there were more children born with a birthweight below the third centile. The nonparticipants who had expectant management were monitored less frequently than the participants in both the intervention and the expectant arm. We found less favorable outcomes and more perinatal deaths in nonparticipants. Protocol-driven management, differences between participants and nonparticipants, or the fact that nonparticipants had a preference for expectant management might explain the findings.

Neonatal Outcomes and Frequency of Ultrasound in Pregnant Women With Prior Bariatric Surgery [26O

INTRODUCTION: Infants of women who have undergone bariatric surgery are more likely to be born small for gestational age (SGA). We sought to identify whether increased ultrasound surveillance lead to better neonatal outcomes. We hypothesized that women with less than 2 ultrasounds (US) after their anatomical survey were more likely to have poor neonatal outcomes. METHODS: IRB approval was obtained. This was a single center, retrospective cohort study of 189 singleton pregnancies after bariatric surgery between 2005–2019. Patients were placed in 2 categories: those with less than 2 ultrasounds after fetal anatomic survey (FAS) or those with greater than or equal to 2 ultrasounds after FAS. US information and neonatal outcomes were compared between these two groups. A neonatal composite was utilized as a measure of adverse neonatal outcome. RESULTS: Of the 189 patients, 165 had documentation of FAS or beyond. 48 patients had less than 2 US and 117 had greater than or equal to 2 US. Women with less than 2 US had their last US at approximately 26.7 weeks (vs 36.5, P&lt;.001), they were more likely to deliver at an earlier gestational age (36.6 vs. 38.2 weeks, P=.005), and had an increased likelihood of a composite adverse neonatal outcome (aOR 0.36, 95%CI 0.15–0.86) including NICU admission, jaundice, hypoglycemia, respiratory distress, and macrosomia, after controlling for confounders. CONCLUSION: Less frequent ultrasound surveillance in women with previous bariatric surgery is associated with earlier gestational age at delivery and higher rates of adverse neonatal outcomes.

Composite neonatal morbidity indicators using hospital discharge data: A systematic review.

Neonatal morbidity is associated with lifelong impairments, but the absence of a consensual definition and the need for large data sets limit research. To inform initiatives to define standard outcomes for research, we reviewed composite neonatal morbidity indicators derived from routine hospital discharge data. PubMed (updated on October 12, 2018). The search algorithm was based on three components: "morbidity," "neonatal," and "hospital discharge data." Studies investigating neonatal morbidity using a composite indicator based on hospital discharge data were included. Indicators defined for specific conditions (eg congenital anomalies, maternal addictions) were excluded. The target population, objectives, component morbidities, diagnosis and procedure codes, validation methods, and prevalence of morbidity were extracted. For each study, we assessed construct validity by describing the methods used to select the indicator components and evaluated whether the authors assessed internal and external validity. We also calculated confidence intervals for the prevalence of the morbidity composite. Seventeen studies fulfilled inclusion criteria. Indicators targeted all (n=4), low-/moderate-risk (n=9), and very preterm (VPT, n=4) infants. Components were similar for VPT infants, but domains and diagnosis codes within domains varied widely for all and low-/moderate-risk infants. Component selection was described for 8/17 indicators and some form of validation reported for 12/17. Neonatal morbidity prevalence ranged from 4.6% to 9.0% of all infants, 0.4% to 8.0% of low-/moderate-risk infants, and 17.8% to 61.0% of VPT infants. Multiple neonatal morbidity indicators based on hospital discharge data have been used for research, but their heterogeneity limits comparisons between studies. Standard neonatal outcome measures are needed for benchmarking and synthesis of research results.

Implementing Delayed Umbilical Cord Clamping in Cesarean Birth Using a Novel Method: A Pilot Study of Feasibility and Safety.

Although delayed cord clamping (DCC) is regarded as the standard of care for all vigorous newborns, those born via cesarean birth are less likely to be afforded this option, especially for longer than 30 to 60 seconds. This pilot study was undertaken to determine whether removal of the placenta before cord clamping to allow for DCC of at least 3 minutes during term, uncomplicated cesarean birth is feasible and without apparent safety issues in order to support a large prospective study on the benefits of this method. Women having a term, uncomplicated cesarean birth who consented to the study were enrolled. Safety was assessed by comparing estimated maternal blood loss, newborn Apgar scores, temperatures, transcutaneous bilirubin levels, need for phototherapy, and neonatal intensive care unit admissions with a matched historical control group of women whose newborns had immediate cord clamping. Feasibility was measured by evaluating staff and maternal comfort with the intervention and by the ability to complete the protocol steps. Seventeen women consented to participate. The protocol was successfully completed in 94% of births. There were no differences in maternal and neonatal safety outcome measures between groups. There was high comfort level with the protocol among staff, and there was universal maternal satisfaction. This method of DCC in cesarean birth appears feasible and safe in this small pilot study and was associated with high maternal satisfaction and clinician comfort. Major organizations such as the American College of Nurse-Midwives and the World Health Organization have called for DCC of up to 3 to 5 minutes in all births, and this simple method has the potential to reach that goal in cesarean birth with minimal apparent risk. A large randomized controlled trial is warranted to determine the neonatal and maternal benefits and safety of this technique compared with a 30-to-60-second delay.

219: Low 180' glucose level at Oral Glucose Tolerance Test (OGTT)- implications for glucose control

To determine the clinical significance of a low glucose value at 3 hours oral glucose tolerance test (OGTT) among women with a single abnormal value. A retrospective cohort study at a single community women's health clinic between 2009 and 2017. All participants were healthy pregnant women at 24-28 weeks of gestation. Women with a single abnormally high glucose value in the OGTT and otherwise normal plasma glucose values (control group) were compared to women with one abnormally high OGTT glucose value and a low 180' value defined as a plasma glucose level of ≤60 mg/dl (study group). The primary outcome was the need for pharmacological treatment to achieve desired level of glycemic control. Secondary outcomes included suboptimal maternal glycemic control (defined as >30% hyperglycemic measurements), birthweight, large-for-gestational-age and polyhydramnion, . We also compared gestational age at delivery, mode of delivery, rates of preeclampsia, placental pathology and neonatal outcome measures, and composite neonatal complications. Overall 82 women were included in the study group and 96 women in the control group. The groups were similar with regard to demographic and clinical characteristics (Table 1). The rate of women needed insulin to achieve an euglycemic state in the study group was higher in comparison to the control group (7.3% vs. 4.1% for, p< 0.05). There was no significant difference in the need for any other medication between the two groups. Women in the study group had a higher incidence of suboptimal glucose control and polyhydramnion (11% vs. 5.2% and 12.2% vs. 5.2%, respectively, p< 0.05). No difference was found in relation to birthweight, the rate of LGA and for the secondary outcome measures (Table 2). An abnormally low glucose at 180' and abnormally high additional value on OGTT is associated with suboptimal maternal glycemic control and might predict the need for insulin treatment to control glucose levels during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Clamping the Umbilical Cord in Premature Deliveries (CUPiD): Neuromonitoring in the Immediate Newborn Period in a Randomized, Controlled Trial of Preterm Infants Born at

To compare cerebral activity and oxygenation in preterm infants (<32weeks of gestation) randomized to different cord clamping strategies. Preterm infants born at <32weeks of gestation were randomized to immediate cord clamping, umbilical cord milking (cord stripped 3 times), or delayed cord clamping for 60seconds with bedside resuscitation. All infants underwent electroencephalogram (EEG) and cerebral near infrared spectroscopy for the first 72hours after birth. Neonatal primary outcome measures were quantitative measures of the EEG (17 features) and near infrared spectroscopy over 1-hour time frames at 6 and 12hours of life. Forty-five infants were recruited during the study period. Twelve infants (27%) were randomized to immediate cord clamping, 19 (42%) to umbilical cord milking, and 14 (31%) to delayed cord clamping with bedside resuscitation. There were no significant differences between groups for measures of EEG activity or cerebral near infrared spectroscopy. Three of the 45 infants (6.7%) were diagnosed with severe IVH (2 in the immediate cord clamping group, 1 in the umbilical cord milking group; P=.35). There were no differences in cerebral EEG activity and cerebral oxygenation values between cord management strategies at 6 and 12hours. ISRCTN92719670.

372. Does smoking cessation in pregnancy affect rate of gestational weight gain?

Objective To evaluate whether smoking cessation in early pregnancy influences gestational weight gain. Methods In this retrospective study smoking status was identified using “tobacco in pregnancy” ICD-9 and ICD-10 codes for term pregnancies with established prenatal care at or before 18 weeks gestation. Data regarding demographics, smoking status prior to and during pregnancy, weights throughout pregnancy, as well as measures of neonatal outcome were recorded. Patients were divided into groups according to smoking status at or before 18 weeks gestation. Although term, given the variability in timing of weight measurements, weight gain was assessed by rate per day. Rate of weight gain was assessed at different intervals representing weight gain in early versus late pregnancy (less than or greater than 28–32 weeks respectively). Results Patients were predominantly white (46.6%), average age of 29, with an average pre-pregnancy BMI of 28. For early pregnancy, quitters had a statistically greater rate of weight gain (0.163 lbs/day) compared to smokers (0.133 lbs/day) and compared to nonsmokers (0.110 lbs/day), p 0.05. Rate of weight gain in late pregnancy also showed a statistically significant increase for quitters (0.173 lbs/day) compared to smokers (0.131 lbs/day), p 0.05. There was no significant difference for neonatal outcomes according to maternal smoking status. Conclusion Despite a statistically greater rate of weight gain in patients who quit smoking in early pregnancy compared to continued smokers and non-smokers, neonatal outcomes were similar in all groups. Additional intervention is needed to encourage improved maternal outcomes with smoking cessation in pregnancy.

Neonatal Outcomes in High Risk Pregnancies in an Egyptian Tertiary Health Care Center

AbstractBackground: Early neonatal morbidity and mortality represents a major problem caused by maternal medical and obstetric risk factors complicated by lack of primary antenatal care. High risk pregnancy is known to negatively affect the neonatal outcomes.Aim of the Work: This study aimed to compare low and high risk pregnancy neonatal outcomes and to test individual maternal risk factors for poor neonatal outcomes.Patients and Methods: A retrospective study was conducted at a tertiary referral hospital over 6 months. After applying eligibility criteria, 157 high and 125 low risk patients were identified. The neonatal outcome measures were weight, sex, Apgar score at 1 and 5 minutes, respiratory distress, neonatal intensive care unit admission, endotracheal intubation, me-chanical ventilation, meconium aspiration and neonatal death.Results: Neonatal morbidity was higher in high risk group (p<0.05). The Relative Risk of low birth weight, poor Apgar score at 1 minute, respiratory distress, neonatal intensive care unit admission, endotracheal intubation and mechanical ven-tilation was 8.2, 1.85, 5.13, 6.83, 15.37 and 26.42 respectively emphasizing that prematurity affected early neonatal outcomes.Conclusion: The main determinants of poor neonatal outcomes were preterm delivery, previous section and hyper-tensive disorders.

Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study

Aim: In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Methods: We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age). The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (<4 mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. Results: The study included 38 women. Low FUPR was associated with clinical chorioamnionitis, longer NICU hospitalization (p = 0.01), higher rates of NEC or IVH (p = 0.008), and blood transfusion (p = 0.004). Conclusions: A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of adverse neonatal outcome.

Pregnancy outcomes after liver transplantation in Finland.

Pregnancy after liver transplantation is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after liver transplantation in Finland. All of the 25 pregnancies ending in deliveries after liver transplantation in Finland in 1998-2015 were analyzed. The data were collected from the mothers' medical records. The main outcome measures included pregnancy complications and the mode of delivery. Neonatal outcome measures were birthweight, 5-min Apgar score and umbilical artery pH. Twenty-six infants were born. Of all deliveries, 76% occurred at the ≥37 weeks of gestation and the average birthweight was 3040 g. Apgar scores were ≥7 in 25/26 (96%) of the infants and cases of birth asphyxia (umbilical artery pH ≤ 7.05) were not detected. Cesarean section rate was 32%. Preeclampsia occurred in 12% of the women and the preterm delivery rate was 24%. Co-morbidities (hypertension, intrahepatic cholestasis of pregnancy, Hodgkin's disease, colitis ulcerosa, epileptic attacks, cholangitis, splenic artery rupture, renal insufficiency and graft rejection) complicated 52% of pregnancies. Pregnancies after liver transplantation in Finland result in good perinatal outcome with healthy, mostly full-term, normally grown offspring; however, serious maternal complications related to underlying liver pathology, transplant surgery and immunosuppressive medication occur frequently.

Is There a Role for Placental Cultures in Cases of Clinical Chorioamnionitis Complicating Preterm Premature Rupture of Membranes?

Objective To assess the role of placental cultures in cases of preterm premature rupture of membranes (PPROM) complicated by chorioamnionitis and to determine the effect of positive cultures on short-term neonatal outcomes. Design A retrospective single-center study. The medical records of all women with PPROM between January 1, 2011, and December 31, 2015, were reviewed. Cases were divided into placental culture positive (group A) and placental culture negative (group B) groups. Maternal and pregnancy characteristics as well as short-term neonatal outcomes were compared between groups. Results During the 5-year study period, 61 cases of clinical chorioamnionitis complicating PPROM were diagnosed: 25 cases were culture positive (group A) and 36 were culture negative (group B). Neonatal outcome measures, including Apgar score at 5 minutes (p = 0.028; odds ratio [OR]: 5.27; confidence interval [CI]: 1.19-23.34), respiratory distress syndrome (p = 0.026; OR: 4.11; CI: 1.18-14.25), and neonatal infection (p < 0.0001; OR: 11.59; CI: 3.37-39.87) were significantly more common in group A newborns, regardless of gestational age at delivery as was the composite neonatal outcome (p = 0.017; OR: 7.35: CI: 1.42-37.79). Placental isolates were primarily Streptococci and Escherichia coli. Conclusion Placental cultures may be an essential predictor of neonatal morbidity in PPROM and may contribute to the modification of neonatal treatment.