Neonatal Prognosis Research Articles

Neurological diseases in pregnancy.

To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother-infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed. Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Additionally, as more data is being published on medication safety in pregnancy and lactation, most medical therapy is now thought to be compatible, improving symptoms and care for women with neurologic conditions who require pharmacologic treatment. However, data remains limited from clinical trials and from more objective studies. Researchers continue to clarify the impact of pregnancy on the course of chronic neurologic diseases such as multiple sclerosis, myasthenia gravis, epilepsy, migraine, and cerebral aneurysms as well as the impact of these diseases on antepartum, labor and delivery, and postpartum management and neonatal course. Acute neurological conditions with pregnancy-associated risk such as stroke, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis are increasingly studied to determine individuals who are most vulnerable to these serious complications. Many neurological diseases coexist with pregnancy. Recent research indicates a good prognosis for both mother and neonate. Although research related to neurologic disease in pregnancy is growing, it remains an area that deserves further focus to guide evidence-based care. With advances in research on therapeutic options, some women can achieve a safe pregnancy in the setting of chronic neurological disease. VIDEO ABSTRACT: http://links.lww.com/COOG/A45.

National survey of uterine rupture in Japan: Annual report of Perinatology Committee, Japan Society of Obstetrics and Gynecology, 2018.

To clarify the frequency of occurrence of uterine rupture and its prognosis, a nationwide survey was performed. Cases of uterine rupture recorded for a period of 5 years were included. There were 152 cases of uterine rupture with an incidence rate of 0.015%. The scarred uterine rupture cases were found to have a significantly earlier occurrence of uterine ruptures in comparison to the unscarred cases: unscarred 39.0 weeks, cesarean section 37.0 weeks, myomectomy 32 weeks and adenomyomectomy 30-32 weeks. And it became apparent that the frequency of hysterectomy, cerebral palsy and neonatal death were higher in the cases of uterine rupture during labor than before delivery. Among the cases of scarred uterine rupture, neonatal prognosis was poorer in cases of pregnancy after myomectomy or adenomyomectomy in comparison with postcesarean section cases. This survey revealed the current incidence of uterine rupture in Japan.

Neural and cardiac injury markers in fetal growth restriction and their relation to perinatal outcomes.

Objective:To compare the levels of umbilical cord blood Neuron-Specific Enolase (NSE) and troponin T and venous blood gas samples between healthy newborns and growth-retarded fetuses with impaired Doppler velocity or low APGAR scores.Materials and Methods:This study was a prospective cohort study. The study group comprised 26 patients with intrauterine growth restriction and pathologic Doppler symptoms, and the control group included 24 healthy fetuses. Umbilical cord blood and blood gas samples were taken from all patients. The blood samples were centrifuged and sent to a laboratory to study NSE and troponin T Perinatal outcomes were evaluated from the medical records of the newborns.Results:Both groups were similar in terms of demographic characteristics. Fetuses with fetal growth restriction (FGR) were born earlier and had lower APGAR scores than the study group. Chronic hypoxemic fetuses in the study group had lower cord pH and HCO3 levels. Further, troponin T levels were higher in the study group than in the control group. There were no major differences in Doppler velocity measurements.Conclusion:It has been understood that cardiac and neuronal injury detection on fetuses with FGR, troponin T, and NSE are indicators that can be used. In the literature there are studies with heterogeneous paradigms using different indicators to find neuronal injury. As a result of this study, it is clear that to assess neonatal prognosis, wider-scoped and comparative studies will provide more information about the subject.

Caesarean in Case of Scar Uterus: Indications and Maternal and Neonatal Prognosis at the University Hospital of Brazzaville (Republic of Congo)

Objective: Caesarean section in case of cicatricial uterus generates a real epidemiological and prognostic obstetric problem. It is a real concern for the obstetrician with regard to all the factors that can influence the maternal and perinatal prognosis. The aim of this study is to analyze indications for caesarean section in cases of uterine scarring and to establish maternal and neonatal pronotics at the University Hospital of Brazzaville. Methods: A cross-sectional analytical study conducted from January 1, 2015 to June 30, 2017 at the University Hospital of Brazzaville in Congo, comparing 150 deliveries by caesarean to 300 by vaginal route. Results: one hundred and fifty cesarized were recorded among 1212 women giving birth with scar uterus (12.3%). They were different from vaginal deliveries with uterine scarring in age (31 vs 28 years, p <0.05) and mostly referred (70% vs 20.7%, p <0.05). Caesareans were performed more urgently (52.7%) than prophylactically (47.3%). The risk of being caesarized was higher in the case of multiple scar (OR = 9.8 [4.5-21.1]), less than 16 months (OR = 10.2 [2.2-47.6]), and without evidence of strength in connection with a previous vaginal delivery (OR = 4.5 [1.7-11.8]). Emergency caesarean were dominated by acute fetal asphyxia (OR = 7.3 [3.6-14.5]) and dynamic dystocia (OR = 13.3 [10.1-26.6]). Maternal morbidity in cesarized patients was related to parietal suppuration (14, 9.3%) and was associated with a low risk of endometritis (3.4% vs 12%, OR = 0.2 [0.1-0.6], p <0.05). Newborns born to caesarean mothers were more resuscitated (17.2% vs 4%, OR = 4.9 [2.4-10.2], p <0.05), transferred to neonatology (19.8% vs 7.6%, OR = 2.9 [1.6-5.3 p <0.05) and died in the neonatal period (2.6% vs 0.3%, OR = 8.1 [1.2-52], p <0.05]. Conclusion: Caesarean section indications for cicatricial uterus are dominated by obstetric emergencies involving maternal and neonatal prognosis.

Parturient Anemic: Epidemiology and Outcome of Pregnancy in Three Maternities of Brazzaville (Republic of Congo)

Objective: Anemia during childbirth remains a concern for reproductive health personnel, both in terms of frequency and the risks involved in all periods of pregnancy and childbirth. This work aims to analyze the epidemiological profile of anemic parturient and the outcome of their pregnancy. Methods: A multicenter case-control study conducted from February 1st to July 31st, 2017, in three Brazzaville maternity clinics, comparing the ratio of one case for two controls, the anemic parturient (n = 67) to those without anemia (n = 134). Any parturient with a hemoglobin level < 11 g / dl was considered anemic. The variables studied were sociodemographic and reproductive, related to anemia, per and postpartum. Results: Sixty-seven anemic parturient were recorded among 10,106 deliveries, a frequency of 0.7%. Anemic female parturient were older (30.1 ± 1.6 years vs 27.5 ± 1.9 years, p < 0.05), out of school (OR = 13.1 [1.5-111], p < 0.05) and unemployed (OR = 3.8 [2.1-7.2], p < 0.05). The mean hemoglobin level was 8.1 ± 0.1g / dl vs 12.1 ± 0.8g / dl. Anemia was microcytic hypochromic (28.4%) and normochromic normocytic (71.6%). Anemia was mild (40.3%), moderate (44.7%) and severe (15%). Delivery was more by caesarean section in cases (97% vs 1.5%, p < 0.05) with a higher recourse to blood transfusion (55.4% vs 3.8%, OR = 29.9 [10.8-82.6], p < 0.05). Maternal lethality was 13-fold higher in case of anemia (OR = 13 [1.5-111], p < 0.05). Neonatal morbidity was represented by poor adaptation to extrauterine life (OR = 40.7 [9.1-180.7), p < 0.05), hypotrophy (OR = 21.9 [7.2-67.1], p < 0.05), prematurity (OR = 6.6 [2.6-16.9], p < 0.05), neonatal resuscitation (OR = 35.4 [10.2-122.5), p < 0.05) and neonatal transfer (OR = 2.8 [2-4], p < 0.05). Neonatal lethality was three times higher in case of anemia (OR = 3.3 [2.6-4.8], p < 0.05). Conclusion: Maternal and neonatal prognosis is poor in anemic female parturient. Reducing the maternal and fetal impact of anemia during childbirth requires early detection and case management during prenatal contact.

The Fate of Newborns Delivered through Cesarian Section at Brazzaville University Hospital

Objectives: To assess the fate of newborns born by emergency Cesarean section during the early neonatal period at the University Hospital Centre (UHC) in Brazzaville, with a view to improving neonatal prognosis. Patients and methods: This was a descriptive and cross-sectional analytical study of exposed and unexposed type, which took place from 24 March 2018 to 24 May 2018. All cases of newborns born by Cesarean section were included. Children born by extreme emergency and urgent Cesarean section were considered as exposed, and the others not exposed. The variables studied were the epidemiological characteristics of the mothers, the history of pregnancy and its management, anthropometric data on the newborn, the state of the child at birth and monitoring up to the seventh day. The test for comparing the proportions of target groups related to the child’s condition was used. Results: The mothers were aged 20 to 29 years (extreme 16 to 44 years); 32 of them (22.5%) had a scarred uterus; 29 pregnant women (20.4%) had a pathology associated with pregnancy. The distance travelled to consult was between 5 and 10 Km (63 cases or 44.3%). Emergency Caesarean sections were performed in 110 patients (77.5%) and scheduled Caesarean sections in 32 pregnant women (22.5%). Localoregional anaesthesia by spinal anaesthesia predominated (78.9%), by the association Bipivancaine + Fentanyl (69 cases or 48.6%) whose practitioner was often the nurse anaesthetist (131 cases or 92.3%). No accidents have occurred intraoperatively. At birth we noticed: 4.2% stillbirth, 19.7% bad, requiring resuscitation of at least 5 minutes for 16 newborns (57.1%). 26 newborns (18.3%) required care in the Neonatology Department. Early neonatal morbidity was dominated by respiratory distress (10 cases or 38.5%), early neonatal infection (5 cases or 19.1%) and a lethality rate of 19.2%. Conclusion: The future of the newborn, born by emergency Cesarean section is mixed; emergency control can improve the situation.

The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes.

To investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes. We retrospectively included twin pregnancies with sonography approaching delivery in ten maternal-foetal medicine centres in China from 2013 to 2014. Estimated foetal weight (EFW) and inter-twin EFW disparity (EFWD) were calculated based on biometry parameters. Percentage errors between EFW and actual birthweight or between EFWD and actual inter-twin disparity were calculated. ROC curves and multiple logistic regression were applied to evaluate the ability of EFWD to predict inter-twin disparity ≥ 25%, stillbirth, asphyxia and admission to a neonatal intensive unit (NICU). Chorionicity-stratified analysis was further performed. Two hundred sixty-six monochorionic and 760 dichorionic twin pregnancies were analysed. The percentage errors in foetal weight estimations were 7-13%, whereas percentage errors in the estimation of inter-twin disparity were nearly 100%. Among eight formulas, Hadlock1 performed best, with a detectable rate of 65% and a false positive rate of 5% when predicting inter-twin disparity ≥ 25%. EFWD ≥ 22% was strongly associated with stillbirth (OR = 4.17, 95% CI 1.40-12.40) and NICU admission (OR = 3.48, 95% CI 2.03-5.97) after adjustment for gestational age, parity and abnormal umbilical systolic/diastolic ratio. Ultrasound had better predictive ability in monochorionic twins. The predictive value of ultrasound for isolated inter-twin discordance and adverse perinatal outcomes was limited, which was possibly due to the magnifying of systematic errors in the disparity estimation compared with weight estimation. Despite this, abnormal biometry was an independent contributor for the poor prognosis of neonates.

Risk factors for prognosis of premature infants with septic shock: analysis of 114 cases

Objective To investigate the risk factors affecting the prognosis of preterm infants with septic shock. Methods A retrospective study was conducted to analyze the clinical data of 114 preterm children with septic shock admitted to the Neonatal Intensive Care Unit (NICU) of the PLA Army General Hospital from February 2014 to January 2017. According to the outcomes, these cases were divided into two groups, the cured group and the death group (including those died after ineffective treatment and withdrawal of treatment). Clinical data including the general clinical data, perinatal risk factors, clinical features and prognosis of the two groups of children, as well as the occurrence of related complications were statistically analyzed by t-test, Wilcoxon nonparametric test, Chi-square test or Fisher's exact probability method. Logistic regression was used to analyze the factors influencing the prognosis. Predictive values of the indicators were evaluated using receiver operating characteristic (ROC) curve. Results (1) Among the 114 patients, 87(76.3%) were cured and 27(23.7%) were dead. (2) In the death group, there were more infants complicated with amniotic fluid pollution, anemia and thrombocytopenia (platelet count <100×109/L) and the C-reactive protein (CRP) levels were higher than those in the cured group [29.6% (8/27) vs 8.1% (7/87), χ2=6.618; 22.2% (6/27) vs 5.9% (5/87), χ2=4.665; 59.3% (16/27) vs 23.3% (20/87), χ2=12.546; 36.0 (1.0-80.0) mg/L vs 7.5 (1.0-25.0) mg/L, Z=2.400], while the hemoglobin level was lower [(122.2±43.3) g/L vs (140.5±34.4) g/L, t=2.260] (all P<0.05). (3) The percentages of infants with patent ductus arteriosus, pulmonary hemorrhage and coagulopathy in the death group were higher than those in the cured group [81.5% (22/27) vs 60.9% (53/87), χ2=3.871; 37.0% (10/27) vs 12.6% (11/87), χ2=6.616; 48.2% (13/27) vs 20.7% (18/87), χ2=7.847; all P<0.05]. (4) Multivariate logistic regression analysis showed that amniotic fluid contamination, coagulopathy, patent ductus arteriosus and CRP level were risk factors for poor prognosis in neonates (all P<0.05). (5) A total of 77 pathogens were isolated from the 114 infants with 66 in the cured group and 11 in the death group. Pathogens of Gram-positive and Gram-negative bacteria and fungi in the cured and death groups accounted for 37.9% (25/66) vs 3/11, 37.9% (25/66) vs 6/11, and 24.2% (16/66) vs 2/11, respectively. No significant difference in pathogen distribution was observed between the two groups. (6) The area under the ROC curve of CRP was 0.649 (P=0.024). When the cut-off value of CRP was set at 31 mg/L, the sensitivity and specificity for predicting adverse outcomes in preterm infants with septic shock were 0.802 and 0.556, respectively, and the Yoden index was 0.358. The area under the ROC curve of thrombocytopenia was 0.708 (P<0.001). When the platelet level was set at 94×109/L, its sensitivity and specificity were 0.767 and 0.593, respectively, and the Yoden index was 0.360. Conclusions Amniotic fluid contamination, patent ductus arteriosus, coagulopathy and elevated CRP are important risk factors for death in preterm infants with septic shock. Thrombocytopenia and persistently elevated CRP has predictive values for the prognosis of preterm infants with sepsis shock. Key words: Shock, septic; Infant, premature; C-reactive protein; Infant death; Risk factors

A case control study of risk factors and neonatal outcomes of preterm birth

ObjectiveThe aim is to examine risk factors and neonatal outcomes of preterm birth and to provide basis in preventing preterm birth. Materials and methodswe carried out our study on 1328 term controls and 1328 preterm birth cases. By using multivariable logistic regression procedures we estimated odds ratio (OR) of potential preterm birth risk factors. T-test and chi-square test were used to estimate differences between groups. ResultsMaternal age, prior history of pregnancy and abortion, prenatal care, complications of pregnancy (includes hypertension, intrahepatic cholestasis of pregnancy (ICP), fetal growth restriction (FGR), premature rupture of the membranes (PROM), placenta previa, abnormal presentation, abnormal S/D ratio et al.) were significantly associated with preterm birth. Several factors emerged as being statistically significant risk factors for preterm birth, such as prior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation. The time of prenatal care was shown to be a protective factor. Additionally, we observed evidence suggested that male babies are known to have a significant higher risk of preterm birth than female babies. ConclusionPrior history of pregnancy, hypertension, ICP, FGR, PROM, placenta previa and abnormal presentation were covariates identified in this study as risk factors for preterm birth. Preterm birth is an important reason of neonatal poor prognosis and death.

Long-term prognosis of neonates with necrotizing enterocolitis

To investigate the long-term prognosis of neonates with necrotizing enterocolitis (NEC). A total of 83 preterm infants with NEC who survived and were discharged between December 2014 and September 2016 were enrolled and divided into surgery group (n=57) and non-surgery group (n=26). There were 0, 33 and 24 cases of stage I, II and III NEC respectively in the surgery group and 7, 19 and 0 cases respectively in the non-surgery group. The physical development and neurodevelopmental outcomes of the infants were followed up after discharge. Of the 83 infants, the mean corrected age at the end of follow-up was 21±6 months. Of the 83 infants, 31 (37%) had subnormal body weight, and the surgery group had a higher rate of subnormal body weight than the non-surgery group (P<0.05). Twenty-two infants (27%) had subnormal body length and 14 children (17%) had subnormal head circumference among the 83 infants. Eighteen infants (22%) had motor developmental delay/developmental disorders, and the surgery group had a higher incidence rate of the disorders than the non-surgery group (28% vs 8%; P<0.05). Five infants (6%) were diagnosed with cerebral palsy, among whom 4 were in the surgery group and 1 was in the non-surgery group. Long-term physical development and neurodevelopmental outcomes may be adversely affected in neonates with NEC, in particular in those with severe conditions who need surgical treatment, suggesting that long-term follow-up should be performed for neonates with NEC.

Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures.

Introduction Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

PLPBP mutations cause variable phenotypes of developmental and epileptic encephalopathy.

SummaryObjectiveVitamin B6–dependent epilepsies are treatable disorders caused by variants in several genes, such as ALDH7A1,PNPO, and others. Recently, biallelic variants in PLPBP, formerly known as PROSC, were identified as a novel cause of vitamin B6–dependent epilepsies. Our objective was to further delineate the phenotype of PLPBP mutation.MethodsWe identified 4 unrelated patients harboring a total of 4 variants in PLPBP, including 3 novel variants, in a cohort of 700 patients with developmental and epileptic encephalopathies. Clinical information in each case was collected.ResultsEach patient had a different clinical course of epilepsy, with seizure onset from the first day of life to 3 months of age. Generalized tonic–clonic seizures were commonly noted. Myoclonic seizures or focal seizures were also observed in 2 patients. Interictal electroencephalography showed variable findings, such as suppression burst, focal or multifocal discharges, and diffuse slow activity. Unlike previous reports, all the patients had some degree of intellectual disability, although some of them had received early treatment with vitamin B6, suggesting that different mutation types influence the severity and outcome of the seizures.Significance PLPBP variants should be regarded as among the causative genes of developmental and epileptic encephalopathy, even when it occurs after the neonatal period. Early diagnosis and proper treatment with pyridoxine or pyridoxal phosphate is essential to improve the neurologic prognosis in neonates or young children with poorly controlled seizures.

The significance of early video electroencephalogram in the assessment of neonatal brain injury and prognosis

目的 分析早期视频脑电图(video electroencephalogram，VEEG)在窒息新生儿脑损伤及预后评估中的意义。 方法 选取2015年9月至2017年3月，我院新生儿科收治的51例足月分娩窒息新生儿(窒息组)及同期因其他疾病(新生儿肺炎、新生儿高胆红素血症及新生儿呕吐等非神经系统疾病)住院的78例足月儿(对照组)作为研究对象，均于生后24～72 h行VEEG检查，对结果进行分析。 结果 (1)窒息组新生儿脑电图背景活动异常率为96.1%(49/51)，对照组异常率为9.0%(7/78)，对照组和窒息组间VEEG异常率差异有统计学意义(P<0.05)。(2)轻度窒息组VEEG轻度异常80.0%(24/30)，中度异常16.7%(5/30)，重度异常3.3%(1/30)；重度窒息组VEEG轻度异常9.5%(2/21)，中度异常19.1%(4/21)，重度异常71.4%(15/21)。轻度窒息组患儿VEEG轻度异常率较重度窒息组高，差异有统计学意义(P<0.05)；重度窒息组患儿VEEG重度异常率较轻度窒息组高，差异有统计学意义(P<0.05)。轻度窒息组30例(失访2例)，余28例患儿中92.9%(26/28)预后良好，7.1%(2/28)预后差。重度窒息组21例，死亡2例，余19例患儿中10.5%(2/19)预后达正常水平，89.5%(17/19)均留有不同程度的神经系统疾病，预后差。不同窒息程度患儿VEEG异常率及预后间差异有统计学意义(P<0.05)。(3)预后良好者VEEG轻度异常85.2%(23/27)，中度异常11.1%(3/27)，重度异常3.7%(1/27)；预后不良者VEEG轻度异常5.0%(1/20)，中度异常25.0%(5/20)，重度异常70.0%(14/20)，预后良好组较预后不良组VEEG轻度异常发生率高，预后不良组较预后良好组VEEG重度异常发生率高，预后良好组与预后不良组VEEG中度异常发生率差异无统计学意义，不同预后患儿VEEG异常率比较差异有统计学意义(P<0.05)。 结论 早期VEEG与足月窒息新生儿临床症状及脑损伤严重程度相关，是预后判断的有效工具，可作为早期脑损伤及预后评估的参考指标。

Caesarean Delivery in the Second Stage of Labour at a Tertiary Care Hospital.

Caesarean section performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. A study was conducted to analyse the indications and maternal and neonatal prognosis of caesarean sections performed in the second stage of labour. Four percentage of caesarean sections were performed in the second stage of labour; 60% of these were referred cases. Most common indication was non-descent of head. Forty-three percentage of newborns were admitted in the neonatal intensive care unit. Hospital stay was prolonged which further increased the hospital burden. A proper judgement is required by the obstetrician to take decision for instrumental delivery or caesarean section. Early diagnosis and timely referral with a good infrastructure would help to decrease the maternal and neonatal morbidity.

Rupture utérine sur utérus non cicatriciel : à propos de 10 cas

IntroductionUterine rupture in the healthy uterus is a rare obstetrical complication, not much suspected and with badly identified risk factors. Thus, there exists frequent delay for treatment and therefore fetal-maternal important morbidity and mortality. This article describes clinical signs and symptoms, management, and maternal and neonatal prognosis of uterine rupture. MethodsDescriptive retrospective study within 13 maternity hospitals, reporting 10 series of cases of uterine rupture on gravid healthy uterus during the third trimester of pregnancy. ResultThe incidence was 2.8/100,000 births. Surgical treatment was conservative in 9 out of 10 cases, the maternal prognosis was good with no maternal deaths and 6 out of 7 patients had at least one subsequent pregnancy. The fetal prognosis was more reserved, with 2 fetal or neonatal deaths and 1 with motor disability. 6/6 patients (100%) had at least one iterative Caesarean section during the following pregnancies with healthy fetuses. ConclusionIn this series of 10 cases over 25years, maternal-fetal morbidity and mortality were significant, in agreement with the literature. Maternal prognosis remained favorable. When surgical treatment is conservative a subsequent pregnancy is possible and an iterative cesarean section must be performed.

Utility and limitations of perimortem cesarean section: A nationwide survey in Japan

Perimortem cesarean section (PCS) is a procedure performed as part of cardiopulmonary resuscitation (CPR). This study aims to clarify maternal and neonatal prognosis and establish PCS's utility and limitations. We sent structured questionnaires to obstetrics facilities regarding the cases of PCS performed in Japan between April 2010 and April 2015. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of the time from cardiopulmonary arrest (CPA) to return of spontaneous circulation to predict the onset of disseminated intravascular coagulation (DIC). PCS was performed for 18 patients. Out of 18 patients, 12 were resuscitated. The women who were discharged without major sequelae (n = 6) were compared with the non-discharged women who were dead or in persistent vegetative state (n = 12), and median interval time from arrest to PCS was significantly shorter in the former group (P = 0.002). Median interval time from CPA to PCS in the cases in which the neonates survived without major morbidities was significantly shorter than that in the cases of neonatal death and hypoxic encephalopathy (P = 0.01). DIC was observed in 8/9 (89%) patients whose resuscitation took more than 20 min from the diagnosis of CPA. Percutaneous cardiopulmonary support (PCPS) was introduced in 4/9 patients. However, more cases with uncontrolled bleeding, possibly caused by a sudden increase in blood flow and DIC after resuscitation, were observed in the PCPS group compared to the non-PCPS group. PCS can be an effective CPR procedure. However, if PCS is not performed within 20 min from CPA, starting PCPS before PCS is an option.

Use of potassium adsorption filter for the removal of ammonia and potassium from red blood cell solution for neonates.

Ammonia in the plasma usually does not pass through the blood-brain barrier (BBB). However, it can affect the brain as a neurotoxin in neonates with anemia of prematurity. Excess intake of ammonia should therefore be restricted in conditions involving BBB breakdown, such as in premature neonates. A potassium adsorption filter (PAF) can remove not only potassium, but also ammonia from red blood cell (RBC) solution. PAF for neonates (PAF-n) has been recently introduced using small satellite packs. We evaluated the effects of PAF-n on the removal of ammonia and potassium from RBC solution in small satellite packs. RBC solutions were obtained from the Japanese Red Cross Society. Two units of RBC solution (280 mL) were divided into four satellite packs (70 mL/pack). The RBC solution was passed through PAF-n (Kawasumi Laboratories Inc.) that was primed with saline (100 mL) before use. The concentrations of ammonia and potassium were measured in the solution before and after filtration (four samples of 10 mL each of filtered RBC solution) by Biomedical Laboratories. Approximately 47 to 82 and 84% to 93% of ammonia and potassium were removed from the RBC solution, respectively, without dilution with saline. PAF-n can remove ammonia and potassium from RBC solution in small satellite packs. PAF-n could therefore improve the clinical prognosis of neonates with poorly developed BBB by limiting the delivery of excess ammonia found in the RBC solution.

Ethical Issues in Intrauterine Myelomeningocele Surgery

Intrauterine surgery shows that the prognosis of neonates with myelomeningocele (MMC) has improved, both in survival and in quality of life. In order to study the current efficacy of intrauterine surgery for MMC and to make an ethical analysis of its proportionality, we conducted a PubMed search using the keywords “myelomeningocele”, “intrauterine surgery”, “MOMS”, and “trial”. Thirty-eight articles were found. The literature investigated the risks and benefits of intrauterine surgery based on the physiological parameters of MMC. Intrauterine surgery produces clear benefits. However, it also has disadvantages, such as premature birth, fetal or neonatal death, and uterine complications. The option of surgery is positive. However, since the intervention is risky, the final decision must be prudential, and thus should involve an ethical analysis of therapeutic proportionality. This requires a specific clinical evaluation of the fetus ensuring fetal survival in all cases and minimizing the risks arising from extremely premature birth.

Effects of touch nursing on neonatal nursing effect and prognosis

目的 观察抚触护理用于新生儿的护理效果及对新生儿预后的影响。 方法 选取温州市中心医院2015年6月至2016年12月出生的新生儿80例为研究对象，采用随机数字表法将新生儿分成观察组和对照组各40例，对照组采用常规护理，观察组采用抚触护理，比较两组新生儿20项行为神经测定评分(NBNA)、头围、身长、体质量、吃奶量、哭闹时间以及睡眠时间等。 结果 两组新生儿出生时NBNA评分差异无统计学意义(P>0.05)；出生30 d后，观察组NBNA评分为(36.19±0.62)分，显著高于对照组的(34.78±0.57)分(t＝10.588，P＝0.000)。两组新生儿出生1 d时头围、身长以及体质量差异均无统计学意义(均P>0.05)；出生30 d后，观察组新生儿头围、身长、体质量分别为(36.09±1.34)cm、(53.29±2.43)cm、(3.94±0.49)kg，均高于对照组的(35.15±0.76)cm、(49.68±1.95)cm、(3.22±0.36)kg，两组差异均有统计学意义(t＝3.859，P＝0.000；t＝7.328，P＝0.000；t＝7.489，P＝0.000)。观察组新生儿吃奶量、哭闹时间、睡眠时间分别为(562.43±66.79)mL/d、(2.52±0.86)h/d、(21.24±0.87)h/d，对照组分别为(459.50±58.47)mL/d、(3.38±1.43)h/d、(20.52±0.82)h/d，两组差异均有统计学意义(t＝7.333，P＝0.000；t＝4.282，P＝0.000；t＝3.808，P＝0.000)。观察组黄疸、呕吐、腹胀、呼吸暂停发生率分别为2.50%、7.50%、12.50%、2.50%，均低于对照组的17.50%、25.00%、32.50%、15.00%，两组差异均有统计学意义(χ2＝5.000，P＝0.025；χ2＝4.500，P＝0.033；χ2＝4.587，P＝0.032；χ2＝3.913，P＝0.047)。 结论 抚触护理可明显改善新生儿体格发育情况，促进婴幼儿体质量、身长和头围增长，降低新生儿黄疸、腹胀、呕吐等不良事件发生概率，有利于新生儿身心健康发育。

Disseminated Intravascular Coagulation in the Neonate.

Disseminated intravascular coagulation (DIC) is a serious secondary disease that alters the events in the clotting cascade. DIC leads to microclots in the peripheral vasculature. The uncontrolled formation of these clots consumes the body's clotting factors, which precipitates bleeding. Neonates, defined as newborns zero to one month old, are born with slightly altered hemostasis, also known as developmental coagulopathy. This coagulopathy puts neonates at a greater risk of developing DIC, specifically when additional body systems have been compromised by a primary disease. Because of the serious nature of this disease and its precipitating factors, advanced practitioners should study the nuances of DIC to provide accurate diagnosis and proper treatment. The aim of this article is to discuss the pathophysiology behind DIC along with etiologies, diagnosis, treatment, and prognosis in neonates, along with gaps in current research.