Perinatal Risk Group Research Articles

Аналіз перинатальних наслідків у жінок із загрозою невиношування вагітності в першому триместрі залежно від факту утворення ретрохоріальної гематоми

Purpose - to evaluate the effectiveness of the developed personalized approach to the management of patients with a threat of miscarriage in the first trimester depending on the fact of the formation of a retrochorial hematoma (RCH) in order to prevent the occurrence of preeclampsia (PE) in them. Materials and methods. A prospective analysis of the course of pregnancy and childbirth was conducted in 137 women with a threat of pregnancy aged from 20 to 47 years (the Group I - 60 patients with RCH, the Group II - 77 patients with a threat of termination of pregnancy without hematoma). Bibliosemantic analysis was used in the study; estimated anthropometric data; an enzyme-linked immunosorbent assay was performed to study hormone levels; polymerase chain reaction was used to determine polymorphisms of thrombophilia and angiogenesis genes; instrumental - to assess the condition of the fetus (ultrasound diagnosis of the fetus with Doppler blood flow of the umbilical artery, uterine arteries, middle cerebral arteries, non-stress test). Results. The average age of women of the Group I was 31.2±0.6 (95% CI: 30.0-32.4) years, of the Group II - 32.2±0.6 (95% CI: 31.0-33.3) of the year (p=0.243 according to the t-criterion). According to the Alberta Perinatal Health Program (APHP) adapted perinatal risk scale, 21 (35.0%) and 36 (46.7%) patients were assigned to the low perinatal risk group, respectively, and 30 (50.0%) medium risk) and 32 (41.5%) women, and to the high-risk group - 9 (15.0%) and 9 (11.7%) at p>0.05. During the treatment and observation of women with a threat of miscarriage in the first trimester, the developed treatment algorithm was followed: stabilization of the hematoma, reduction of myometrial tone, hormonal support of pregnancy with further determination of the need for the use, dose and duration of low-molecular-weight heparin (LMWH) in combination with aspirin. Differences between the Groups I and II revealed by means of a comparative analysis made it possible to outline the clinical and anamnestic factors that can serve as predictors of the development of PE in women with RCH. Conclusions. The occurrence of RCH at the stage of early placentation increases the risks of developing placental dysfunction and obstetric complications related to it. The early appointment of aspirin (up to 12 weeks) in women with a high risk of developing PE allows to reduce the synthesis of platelets and thromboxane while preserving the synthesis of prostacyclin in the vascular wall in the initial stages of placentation. The combination of aspirin with the use of LMWH in women with the presence of genetic polymorphisms of candidate genes for thrombophilia and angiogenesis prevents the delay in the onset of uteroplacental circulation and promotes full placentation. A personalised approach to the management of pregnancy in women with a threat of termination due to the formation of RCH in the first trimester of pregnancy has made it possible to improve perinatal outcomes in the management of this category of pregnant women. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

НЕОБХОДИМОСТЬ СОЗДАНИЯ ИНДИВИДУАЛЬНОГО ПРОГНОСТИЧЕСКОГО КРИТЕРИЯ ОЦЕНКИ СОСТОЯНИЯ ЗДОРОВЬЯ БЕРЕМЕННОЙ

Due to the clear depopulation trends in the country, the problem of protecting the health of mother and child, preserving the reproductive potential has become extremely acute. The current situation causes reasonable concern of the state and the medical community for the quality of health of future generations. The increase in extragenital and gynecological morbidity, the negative nuances of the reproductive behavior of adolescent girls and women creates a real threat to the successful implementation of their reproductive function and replenishment of the country's demographic reserve in the near future.The real improvement in statistics was due to the rationalization of the prevention of full-term pregnancy. The purpose of the study: to improve the outcomes of gestation for the mother and fetus based on the creation of an individual prognostic criterion for assessing the state of health. Results and discussion. In order to determine the effectiveness of the proposed set of measures to reduce the risk of adverse pregnancy outcomes, a prospective study was conducted in the "organizational modeling" group in 174 pregnant women. In order to determine the predictors of gestational complications in the process of a comprehensive examination of patients during pregnancy registration, it was found that the predictive factors for the development of pregnancy complications that subsequently affect the realization of reproductive potential are: menstrual dysfunction, somatic and gynecological pathology, previously transferred infectious diseases, as well as neuro-metabolic-endocrine diseases. The main methodological principle of the stage-by-stage monitoring of pregnancy management is the inseparable unity of the implementation of all points, control of the full scope of a single strategy and evaluation of the result obtained. The specified components of the methodology are mandatory. Conclusions: the informational significance of evaluative and prognostic predictors (calculation of pregnancy health indices by trimesters) determines the possibility of stratifying tactics by perinatal risk groups: exclusion of obstetric aggression at a low degree (index I), therapeutic and preventive measures at an average (index II, III) and high degree of risk (index IV, V).

The Development of Young Children. The Review of Assessment Methods

The problem of the state of health of early children, especially infants of the perinatal risk group, remains relevant. Modern trials show that the first two to three years of a child's life are an important age period and the infant's nervous system has significant compensatory capabilities during this period. Delayed psychomotor development may be the first sign of distress, and may be a leading syndrome in various somatic or neurological diseases in etiology and pathogenesis. Accordingly, it is important to be able to objectively monitor the main parameters of development throughout the entire period of early childhood. Today the Prechtl's Method is a unified and reliable methodology. In recent years, the most prognostically significant features of general movements have definitely been identified and their clinical role has been considered in detail, especially with regard to the prediction of cerebral palsy. Hammersmith Neonatal Neurological Examination is a highly reliable method of neurological examination of premature and full-term newborns. Habilitation programs should be implemented within the framework of the concept of early intervention. It is necessary to have a unified methodology for monitoring, correcting or minimizing consequences of disease based on the knowledge of ontogenetic features of the child organism, objective data on structural and functional disorders thereof and the degree of restriction of activity and participation for successful habilitation of at risk kids.

Clinical significance of predictive and diagnostic indices of fetal pathology associated with placental insufficiency in women with endometriosis

BACKGROUND: Modern achievements of pharmacology, surgery and reproductive medicine have determined an increase in the implementation of reproductive function in endometriosis of various localization. The onset of pregnancy in presence of impaired endometrial receptivity and progesterone resistance, pro-inflammatory and pro-thrombotic status, abnormal functioning of the immune system, structural changes in the reproductive organs leads to impaired formation of the embryo (feto) placental system, early reproductive losses, complicated pregnancy and adverse perinatal outcomes. In this regard, the endometriosis and pregnancy issue requires close study and specific proposals to optimize pregnancy management.
 AIM: The aim of this study was to develop predictive (PIs) and diagnostic (DIs) indices of placenta-associated fetal pathology in pregnant women with endometriosis, to determine their prognostically and diagnostically significant parameters.
 MATERIALS AND METHODS: This prospective study in the dynamics of gestation included a comprehensive clinical and laboratory examination of 175 pregnant women with endometriosis (100 subjects with adenomyosis and 75 subjects with ovarian endometriosis). To develop PIs and DIs, two comparison groups with fetal pathology due to placental insufficiency were retrospectively identified, depending on the location of endometriosis. Group I consisted of 49 pregnant women with adenomyosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia; Group II comprised 29 pregnant women with ovarian endometriosis and placental insufficiency isolated from other pregnancy complications, accompanied by growth retardation and/or chronic fetal hypoxia. The control group (Group III) included 30 healthy pregnant women with a normal course of gestation. The examination was performed at 10-14 weeks, 20-24 weeks, and 28-34 weeks of gestation and included an assessment of placental insufficiency markers such as placental growth factor (PlGF), placental -1-microglobulin (PAMG-1), tumor necrosis factor (TNF), lymphocytes with membrane receptor FasR (L CD95+), C-reactive protein, placental alkaline phosphatase (PAPh), and fetal hemoglobin (HbF). The information value of individual parameters and indices was determined by ROC analysis, odds ratio, and clinical epidemiology tests.
 RESULTS: Pregnancy in presence of endometriosis in 100% of cases was complicated by placental insufficiency of varying severity (with fetal pathology in 81.5% of cases), the frequency of which had statistically significant differences between the groups of pregnant women with adenomyosis and ovarian endometriosis (2 = 4.06, p = 0.04). To predict growth retardation and / or chronic fetal hypoxia, we have developed PI I (PlGF / TNF 100) and PI II (PAMG-1 / PlGF 100), which characterize the state of placental angio-and vasculogenesis depending on systemic inflammatory response level. For early diagnosis of fetal pathology, we have proposed DI I (CRP / PAPh 100), DI II (HbF / PlGF 100) and DI III (L CD95+ / PAPh 100), which allow for diagnosing placental alterations with impaired placental energy supply due to an increase in inflammatory status. Evaluation of prognostic and diagnostic significance of PIs and DIs showed that the most informative tools are PI I (Se = 86.1%, Sp = 80.5%) and DI I (Se = 88.3%, Sp = 83.7%).
 CONCLUSIONS: The use of PIs allows for risk stratification of pregnant women from the 1st trimester of gestation to address the issue of the prevention method. The clinical capabilities of DIs optimize obstetric tactics for the timely prescription of therapy for placental insufficiency and targeted diagnosis of fetal pathology. Pregnant women with endometriosis should be classified as a high perinatal risk group, and therefore the proposed PIs and DIs should be included in the dynamic examination complex.

Сучасний підхід до діагностики серцево-судинних розладів у новонароджених із груп перинатального ризику в неонатальний період

З метою удосконалення та систематизування підходу до діагностики серцево-судинних розладів у новонароджених шляхом комплексної оцінки допплерехокардіографічних параметрів, біохімічних маркерів (рівень лактатдегідрогенази, γ-глутамілтрансферази) та поліморфними варіантами С786Т у гені ендотеліальної синтази оксиду азоту (еNOS), T58C у гені мітохондріальної супероксиддисмутази (MnSOD2) та Ser49Gly в гені β1-адренорецептора (ADRB1) обстежені 133 новонароджені, із них 73 з групи перинатального ризику (І група) та 60 здорових доношених новонароджених (ІІ група). За результатами обстеження, бівентрикулярна дисфункція встановлена в 19,1 % дітей І групи, серед яких у 4 (5,5 %) обстежених встановлена систоло-діастолічна, у 10 (13,6 %) новонароджених — діастолічна дисфункція шлуночків серця. У 12 (20,0 %) передчасно народжених дітей та в 4 (30,7 %) новонароджених із затримкою внутрішньоутробного розвитку встановлено гіпокінетичний тип центральної гемодинаміки, що супроводжувалося підвищеними рівнями лактатдегідрогенази і γ-глутамілтрансферази в сироватці крові та змінами діастолічного наповнення шлуночків серця. Встановлена наявність асоціації між генотипом СС поліморфізму гена еNOS та скоротливою здатністю міокарда лівого шлуночка, інтегральною функцією лівого шлуночка за індексом Теї у передчасно народжених дітей із групи перинатального ризику, носіїв алелі С за поліморфізмом гена MnSOD2 та з легеневою гіпертензією, в неонатальний період. Наявність генотипу GG поліморфізму гена ADRB1 можна вважати предиктором розвитку гіпокінетичного режиму центральної гемодинаміки.

The Results of a Prospective Cohort Study of the Effectiveness of the Algorithm for Monitoring Pregnancies in Patients from the Group of High Perinatal Risk to Reduce Perinatal Losses and Improve Neonatal Outcome

Prenatal prognosis is an important part of obstetric care, which aims to reduce fetal and neonatal losses. A differentiated approach to the management of different risk groups allows you to optimize existing approaches. The objective: сomparison of pregnancy results in the high perinatal risk group using the proposed monitoring algorithms and the traditional method of management in a prospective cohort study. Materials and methods. The prospective cohort study was conducted from 2016 to 2018 on the basis of the medical center LLC «Uniclinica», Medical Genetics Center «Genome», Clinic of Reproductive Genetics «Victoria», Kyiv City Maternity Hospital №2. 580 women were included in the final analysis. Exclusion criteria were: low risk (0–2) according to the adapted antenatal risk scale (Alberta perinatal health program), multiple pregnancy, critical malformations and chromosomal abnormalities of the fetus, lack of complete information about the outcome of pregnancy, lack of results of all intermediate clinical and laboratory surveys. Results. The introduction of a comprehensive differentiated approach has improved the diagnosis of late forms of growth retardation (OR 4,14 [1.42–12.09]; p=0,009), reduced the frequency of urgent cesarean sections (OR 1,61 [1,03–2,49]; p=0,046) and reduced perinatal mortality [1,09–21,3]; р=0,041) due to reduction of antenatal losses (OR 2,2 [1,06–4,378]; р=0,045). There was a significant increase in the frequency of planned cesarean sections (p<0,0001, without affecting the total number of operative deliveries) and statistically insignificant, but tendentiously clear shifts to the increase in the frequency of preterm birth between 34–37 weeks of pregnancy and intensive care unit. The latter observation can be explained by better diagnosis of threatening fetal conditions and an increase in the frequency of active obstetric tactics, which in turn affects the number of premature infants, the involvement of the neonatal service, and thus the intensification of the load on intensive. Conclusions. Adequate enhanced monitoring should combine ultrasound, cardiotocography, actography and laboratory techniques, each of which will have a clearly defined purpose in a combined approach to fetal assessment.

Modern Practices of Vaccination of Children from Perinatal Risk Groups and Necessary Precaution

Relevance. In perinatal centres problems of timely vaccination of newborns arise more often than in maternity hospitals, as vaccinations against viral hepatitis B and tuberculosis in accordance with the National Calendar are carried out in an early neonatal period and in time coincide with the stage of treatment and rehabilitation of the newborn, which implies medical withdrawal from vaccination. Vaccination of newborns from high perinatal risk groups is one of the problems of modern vaccinology and immunology.Aims. On the basis of clinical and immunological characteristics of postnatal babies from mothers with gestational diabetes and fetoplacental insufficiency justify the necessity and safety of their vaccination in the maternity hospital of the perinatal center.Materials & Methods. A cohort retrospective case-control study was conducted, and 135 birth and developmental history and newborn disease were analyzed. Statistical processing was carried out package «Statistica».Results. The main nosological forms of pathology in maternity mothers and their newborn children, the volume of primary vaccination (against viral hepatitis B, tuberculosis) in maternity hospital in children with perinatal pathology and healthy newborns have been determined, and the reasons for medical contraindications to vaccinations against viral hepatitis B and tuberculosis have been established.Conclusions. Newborns from high perinatal risk groups can be vaccinated against viral hepatitis B and tuberculosis in the maternity hospital within the time frame specified by the National Calendar of Preventive Vaccinations. In addressing this issue, the fundamental criteria are to assess the clinical condition of newborns from women with gestational diabetes and fetoplacental insufficiency. Changes in immunological values of umbilical cord blood and in children of 1 month of life are not a criterion for medical withdrawal from vaccinations against viral hepatitis B and tuberculosis.

Особенности кровотока в средней мозговой артерии плода в функциональном тесте с акустической стимуляцией

The objective: to study the characteristics of fetal cerebral blood flow in the conditions of the test with acoustic stimulation (TAS) for some types of pregnancy pathology that determine an increased perinatal risk. Materials and methods. A total of 174 women with a single pregnancy without congenital malformations of the fetus were examined in 34–40 weeks, which were divided into four clinical groups: with an uncomplicated full-term pregnancy, childbirth through the natural birth canal in a period of 38–41 weeks; and three groups with increased perinatal risk due to hypertensive complications; history of cesarean section; pelvic presentation of the fetus. For TAS, a technique developed by M. Sovilj, A. Ljubic, known as “prenatal hearing screening” was used. Vascular resistance indices were estimated in the middle cerebral artery of the fetus before and after the delivery of a sound stimulus (intensity 90 dB, frequency 1500–4500 Hz, duration 0.2 s) at a right angle at a distance of 5 cm from the pregnant woman’s abdomen in the projection of the fetal auricular. According to the measurement results, the coefficient of vascular reactivity was calculated. Results. The average indices of the initial (background) resistance of fetal cerebral blood flow to the low perinatal risk group and hight perinatal risk did not differ in the groups. Reactive TAS was observed in 73% of the total number of women. A large proportion of reactive TAS was determined in a group of women with pelvic presentation of the fetus (every second observation). A general trend was an increase in vascular resistance in high perinatal risk groups, which was confirmed by significant differences in the vascular reactivity coefficient. An individual analysis of the observations showed that the reaction in the TAS towards the maximum increase in vascular resistance coincides with impaired early neonatal adaptation in children born, which was manifested by transient and persistent cardiorespiratory and neurological disorders. Conclusion. The test with acoustic stimulation of the fetus opens up new possibilities for improving the quality of forecasting and evaluating the condition of the fetus during pregnancy of low and high risk. The feasibility of disseminating the practice of conducting functional tests is dictated by the needs of the effective implementation of the perinatal risk strategy. Key words: acoustic stimulation, perinatal pathology, prognosis.

Analysis of the perinatal risk causes and the structure of pathology in premature children in Chelyabinsk, born with extremely low and very low body weight

The purpose of the study is to analyze the history and structure of the pathology of premature infants with extremely low body weight and very low body weight under dynamic follow up in the monitoring department for children of the perinatal risk group. Using the method of continuous sampling we analyzed observation maps of 95 premature infants with extremely low body weight and very low body weight of gestation age from 24 to 36 weeks.All newborns have a low Apgar score at birth and at the 5th minute, and Apgar score was lower in children with extremely low body weight as compared with children with very low body weight. All children had congenital anomalies of the organs and systems, marked signs of immaturity, with prevailing changes in the cardiovascular system, passability of the renal pelvis, and congenital deformity of thigh.Among the conditions that occurred in the perinatal period, the authors diagnosed intraventricular hemorrhage in 50.5% of patients, 89.6% of them had hemorrhage of grade II – III, all children had respiratory distress syndrome. Bronchopulmonary dysplasia was diagnosed in 60% of premature infants, its moderate and severe forms in 1/3 of the patients. All children had anemia, and 13.7% of children had a neonatal syndrome from mothers with diabetes mellitus. 1/3 of premature infants had retinopathy; its frequency did not depend on the body weight at birth. All children had a combination of pathologies. Bronchopulmonary dysplasia was combined with respiratory distress syndrome and anemia in 100% of children. The combination of bronchopulmonary dysplasia with intraventricular hemorrhage was more often recorded in patients with extremely low body weight than in patients with very low body weight.

EXPERIENCE OF THE OPERATION OF CATHAMNESTIC OBSERVATION CENTER IN VINNYTSIA REGION

Long-term consequences and a decrease in the quality of life of children born prematurely determine the chronic pathology that develops in this category of children as a result of diseases that have been transmitted in the first months of life. The system of medical and social support is a guarantee of optimal health and development of prematurely born children, as well as provides an opportunity to evaluate further health indicators of newborns of high perinatal risk children in the medical, social and economic aspects. The article presents the formation, development and experience of the catamnestic service of the Vinnytsia Regional Children's Clinical Hospital, the main indicators of the work of the cathamnesis office in recent years are presented. Measures have been taken to reorganize the catamencing service, in particular, to expand the area, carry out repairs, to upgrade the equipment, and also to separate the cathartic surveillance from the clinic, which made it possible to bring the medical service closer to the patient, to reduce the probability of crossings of infants of the perinatal risk group and older children. The increase in the effectiveness of catamnestic observation is realized through the introduction of practices and clinical trials with high level of evidence, in particular early intervention techniques that provide timely detection of the adverse effects of premature birth and their correction in accordance with modern standards.

THE ROLE OF VARIABILITY OF CANDIDATE GENES eNOS, MnSOD2, ADRB1 IN THE DEVELOPMENT OF CARDIOVASCULAR PATHOLOGY IN NEWBORN

The study of gene polymorphism has been carried out to inform health care practitioners on genetic studies that can be used in clinical practice, and the genes under investigations aim at finding early manifestations of cardiovascular disorders. The possibility of determining the ways of correction of the detected cardiovascular pathology necessitates the prospect of further research starting from the neonatal period. To study the frequency of occurrence of genotypes of endothelial nitric oxide (eNOS) gene candidates polymorphism, mitochondrial superoxide dismutase (MnSOD2) 1 mutation and β1-adrenoreceptor (ADRB1) gene polymorphism in neonatal infants from perinatal risk groups the study involved examination of 186 newborns: 102 healthy full-term newborns, 25 newborns after asphyxia, 46 premature newborns and 13 newborns with intrauterine growth retardation. The study showed that the frequency of distribution of endothelial nitric oxide synthase (eNOS) C786T genotypes, mitochondrial superoxide dismutase (MnSOD2) T49C and β1-adrenergic receptor (ADRB1) Ser49Gly in newborns from perinatal risk groups in the neonatal period did not differ from healthy neonates.The CT genotype (p<0.05) of the endothelial nitric oxide synthase (eNOS) gene polymorphism C786T can be considered one of the predictors of cardiovascular development in newborns, which requires further clinical and instrumental comparison. Information on the prevalence of polymorphisms of genes associated with the development of cardiovascular events should be considered when developing a set of individual preventive measures.

Organization of curative and prophylactic work with the children of a perinatal risk group based at a healthcare centre

This paper demonstrates the efficacy of prophylactic measures among the children of a perinatal risk group. The effectiveness of preventive measures was estimated based on the model developed in the Children's Healthcare Centre, Reutov, Moscow region. It is concluded that the introduction of the proposed program in the practical work of other children's health centres would promote the solution of the debatable problem pertaining to the choice of optimal measures for the observation and treatment of the children under the age of 5-6 years based at the children's healthcare centres.

Mental Health in Low-to-Moderate Risk Preterm, Low Birth Weight, and Small for Gestational Age Children at 4 to 5 Years: The Role of Early Maternal Parenting

The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal parenting is in determining these outcomes. Longitudinal data were from a large nationally representative Australian cohort of 5,000 children, aged 0 to 1, 2 to 3, and 4 to 5 years of age. Participants were 354 children with LTM perinatal risk born at 33 to 36 weeks, with birth weight 1,501 to 2,499 grams, or born between the first and 10th percentiles for gestational age; and 2,461 children in the normal birth weight, term comparison group. Child mental health was measured by mother-report on the Strengths and Difficulties Questionnaire (SDQ). Parenting irritability, warmth, self-efficacy, maternal separation anxiety, and overprotective parenting were measured when children were 0 to 1 and 2 to 3 years of age. Parents in the LTM perinatal risk group were more likely to experience parenting difficulties on one of eight parenting measures (irritable parenting at age 0-1 year) when adjusting for socio-demographic differences (odds ratio = 1.43; 95% confidence interval = 1.05, 1.95, p < .02). This group difference was no longer apparent by age 2 to 3 years. Compared with healthy-term peers, there were small increases in Emotional Symptoms and Total Difficulties on the SDQ for the LTM perinatal risk group at age 4 to 5 years. When accounting for maternal-specific and socio-demographic factors, LTM perinatal risk group continued to predict Emotional Symptoms but not Total Difficulties at age 4 to 5 years. Children with LTM perinatal risk were at a small increased risk for emotional difficulties but did not differ significantly from other children of similar social backgrounds in their risk for generalized mental health problems. These findings support a biological and socio-economic, rather than parenting, pathway to psychological risk in children born with LTM perinatal risk.

THE HERPES VIRUS INFECTION INFLUENCE OF THE MOTHER TO CONDITION OF THE NEWBORN

Purpose of the objective is to study the influence of the Herpes Virus Infection on the course and the outcome of the pregnancy, pathology of the fetus and newborn. Methods: immunoassay (ELISA), immunofluorescence (MIF), polymerase chain reaction (PCR), statistical. All together 322 pregnant women from the perinatal risk group, whose pregnancy favorable resulted examined. The received results: The Chronically latent Herpes Virus Infection of the mother complicates the pregnancy, conduces to CNS affection in the form of the ischemic-hypoxic encephalopathy of the fetus and newborn. 61% pregnant women with the chronical latent HSV-2 and CMV-infection have fetoplacental disfunction, chronical hypoxya of the fetus. The Chronically HSV-2 infection with the pregnant women conduces to the small body weigh of the newborn, asphyxia of the fetus and newborn, hypoxic affection of CNS.

Risk Factors and Deliveries Associated with Preterm, Severely Small for Gestational Age Fetuses

Maternal and fetal risk factors and deliveries associated with 153 singleton, preterm, severely small for gestational age (SGA) fetuses were compared to the corresponding data of 153 next-born preterm appropriate for gestational age (AGA) fetuses matched for gestational age. Maternal history of previous delivery of an infant of SGA status, pre-eclampsia, hypertension without proteinuria, oligohydramnios, and fetal congenital anomalies were identified as risk factors for preterm, severely SGA deliveries. In the preterm, severely SGA group the rate for abdominal deliveries was 82%. Of these operations, 40% were emergency cesarean sections, many of which involved pre-eclampsia cases. If congenital malformations were excluded, perinatal mortality rate was 7% in the preterm SGA group and 4.6% in the preterm AGA group. Preterm, severely SGA fetuses constitute a perinatal risk group, which cannot be avoided. However, awareness of and familiarity with the risk factors associated with preterm, severely SGA cases can better equip the attending physician to consider appropriate perinatal care options.

The Relationship Between Encoding, Discriminative Capacities and Perinatal Risk Status in 4–12‐Month Old Infants

Response decrement and recovery to a novel visual stimulus was examined in 4-12-mth old infants. High (HR) and low (LR) perinatal risk groups were compared to well babies. For abstract stimuli, well babies showed response decrement and recovery to novelty; LR infants revealed some decrement, but no recovery; and the HR group failed to show either. Using face stimuli (Experiment 2) all groups showed decrement and recovery. Cluster analyses revealed that HR infants were more likely to be found in low information-gain clusters. Infants of lower GA who required perinatal respiratory intervention showed less efficient encoding and poorer discrimination of abstract stimuli.

Vitamin K deficiency in the newborn infant: Prevalence and perinatal risk factors

The prevalence of vitamin K deficiency in newborn infants and the influence of perinatal risk factors were studied prospectively in 934 infants. A noncarboxylated prothrombin assay to detect proteins induced in vitamin K absence (PIVKA-II) was used to determine the presence of vitamin K deficiency; of 934 cord blood samples assayed, 2.9% were positive for PIVKA-II (0.015 to 0.15 U/ml). All infants found to have detectable PIVKA-II were born at term. The number of infants positive for PIVKA-II was greater in the group small for gestational age (7.4%) than in those appropriate (2.7%) or large (3.1%) for gestational age. Nine categories of perinatal risk groups were defined: however, the majority of infants who were PIVKA-II positive (63%) were normal. All infants received prophylactic vitamin K, and no infant with PIVKA-II in the cord sample subsequently had clinical bleeding. In two patients the rate of 50% disappearance of PIVKA-II after vitamin K administration approximated 70 hours. Two PIVKA-II positive patients with active bleeding or disseminated intravascular coagulation had an accelerated disappearance of 20 to 40 hours. The long disappearance time of PIVKA-II in a steady state may allow detection of vitamin K deficiency despite administration of vitamin K. The majority of cases of neonatal vitamin K deficiency occurred in normal newborn infants. Therefore, all infants should receive prophylactic vitamin K at birth.

Growth and development in preterm infants during the first 18 months.

In a long-term prospective study 46 unselected infants born before 35 completed weeks of gestational age were followed up, and compared to 26 fullterm infants. At 9 and 18 months of chronological age their height and weight were still lower than that of fullterms, but the difference disappeared when age was corrected for gestational age at birth. The motor and neurological maturity and language development was delayed in the preterms still at 18 months, which could possibly also be explained by their lower biological age. Ten of the preterm infants showed, at one or several occasions during follow up, definite neurological abnormality. At 18 months of age two of them were handicapped, one with retrolental fibroplasia, nearly blind, and another with cerebral palsy (slight spastic diplegia). Five of them had late psychomotor development, while two were borderline and one normal. We defined pre- and perinatal risk groups, but found that development at 18 months was not correlated to degree of risk. Neither was there any correlation between neurological examination at term and later handicap or psychomotor retardation. We found more illness, mostly due to common infections, during the first 18 months in the preterm group, as measured by the number of visits to a doctor and days spent in hospital.