Neonatal Intensive Care Unit Admission Rate Research Articles

Gestational hypertensive disease in twin pregnancy: Influence on outcomes in a large national prospective cohort.

Gestational hypertensive disease (GHD) is associated with pregnancy-related complications and poor maternal and fetal outcomes in singleton pregnancies. We sought to examine the influence of GHD in a large prospective cohort of twin pregnancies. The ESPRIT study was a national multicenter observational cohort study of 1028 structurally normal twin pregnancies. Each pregnancy underwent sonographic surveillance with two-week ultrasound from 24 weeks for dichorionic and from 16 weeks for monochorionic gestations. Characteristics and demographics as well as labour and delivery outcome data were prospectively recorded. Perinatal mortality, admission to the neonatal intensive care unit (NICU) and a composite of morbidity of respiratory distress syndrome, hypoxic ischaemic encephalopathy, periventricular leukomalacia, necrotising enterocolitis and sepsis were documented for all cases. Outcomes for patients with documented GHD (pre-eclampsia and gestational hypertension) were compared with those without GHD. Perinatal outcome data were recorded for 977 patients. Women with GHD had a higher body mass index (27.1 ± 6.4 vs 25.2 ± 4.5, P < 0.0001) than those without and were more likely to be nulliparous (65% (59/92) vs 46% (407/885), P = 0.001). Both groups had similar mean birthweights, but those with GHD were more likely to have a birthweight discordance ≥18% (35% (32/92) vs 20% (179/885), P = 0.001). Rates of caesarean delivery were higher in those twin pregnancies affected by GHD, and while the rate of composite morbidity was similar in both groups, twins in the GHD group had higher rates of NICU admission. In twin gestations, gestational hypertension independently confers an increased risk for emergency caesarean delivery, birthweight discordance and NICU admission, such that intensive maternal-fetal monitoring is justified when hypertension develops in a twin pregnancy.

Neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery.

To investigate the neonatal outcomes of twin pregnancies delivered at late-preterm versus term gestation based on chorionicity and indication for delivery. This is a retrospective cohort study of women with twin pregnancies delivered at ≥34 weeks of gestation from 1995 to 2014. Subjects were categorized into two groups according to gestational age at delivery: late-preterm group (34-36 weeks) and term group (≥37 weeks). Neonatal outcome measures including neonatal intensive care unit (NICU) admission, mechanical ventilator support, and respiratory distress syndrome (RDS) were compared between the late-preterm and term group based on chorionicity (monochorionic or dichorionic) and delivery indication (elective or non-elective). A total of 1198 twin pregnancies were included in the study: 679 in the late-preterm group and 519 in the term group. Late-preterm twin infants had higher rates of NICU admission, mechanical ventilator support, and RDS than did term twin infants, regardless of the chorionicity and indication for delivery. In the multivariable analysis, late-preterm birth, monochorionicity, and non-elective delivery were independently associated with a significantly higher risk of NICU admission and mechanical ventilator support. The late-preterm birth was associated with a higher risk of adverse neonatal outcome regardless of chorionicity and indication for delivery, and showed significantly increased risk by monochorionicity and non-elective delivery.

Increasing maternal body mass index during pregnancy increases neonatal intensive care unit admission in near and full-term infants

Background: Obesity is becoming an increasingly commonplace health problem. Obesity during pregnancy is important because the condition adversely affects not only the mother, but also the developing fetus and the newborn.Objective: The primary objective of this study was to evaluate the association between maternal body mass index (mBMI) at the time of delivery and neonatal intensive care unit (NICU) admission of offspring and to analyze the role of possible confounding variables that are often associated with obesity. Comorbidities, such as gestational diabetes mellitus (DM), hypertension (HT) and/or pre-eclampsia (PEC), are more common in more obese mothers, as is a higher association of obesity among non-Caucasian patients.Methods: Using a retrospective cohort design, 1736 mothers and their singleton live-born at ≥35 weeks’ gestation were analyzed for mBMI, maternal conditions of DM, HT and/or PEC, and whether NICU care was required and the reason for NICU admission.Results: NICU admission rate was significantly associated with maternal obesity. In comparing women with mBMI < 30 versus mBMI ≥ 30, OR was 1.39 (p = 0.045); OR increased to 1.76 (p = 0.006) in comparing patients with mBMI ≥ 35. mBMI was significantly associated with an increased rate of maternal DM, HT and PEC (p < 0.05 each); however, NICU admission rate was not correlated with DM, HT or PEC. The relationship between NICU admission and mBMI was significant in Caucasian mothers versus a borderline significance in African-American mothers (p = 0.035 versus p = 0.05). After controlling for neonatal hypoglycemia (NH) as the reason for admission to the NICU, no mBMI-NICU association persisted. The rate of infants with NH increased in higher mBMI groups, independent of maternal DM diagnosis.Conclusion: This study demonstrated a significant association between higher mBMI groups and NICU admissions independent of diagnosis of maternal comorbidities. However, accounting for NH eliminating this association suggests a pre-clinical diabetic pathology in obese women that affects newborn outcome. Despite increased percentage of nonwhite mothers in higher mBMI groups, African–American race does not seem to be a significant contributing factor in the increased rate of NICU admission in our population.

Comparison of Perinatal Outcomes in Late Preterm Spontaneous and Indicated Preterm Birth Neonates

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

Geç Preterm Yenidoğanlar ve Yoğun Bakım Ünitelerine Yatış Nedenleri

Objective: To evaluate the clinical and demographic characteristics and the causes of admission of late preterm (LP) neonates admitted to our neonatal intensive care unit (NICU). weeks of gestation and admitted to the NICU were included in the study. Neonates were evaluated in terms of the reasons for hospitalization and the clinical and demographic characteristics and then compared with term ones. Results: During the study period there were 17690 births in our hospital; these included 13975 (79%) term births, 1981 (11.2%) LP births. The number of neonates admitted to the NICU was 2844. The NICU admission rates for LP infants and term infants were 21.5% (n=426) and 5.5% (n=765), respectively. The mean gestational age of the LP and term neonates was 35.1±0.8 and 38.5±1.2 weeks, and the mean birth weight was 2384±502 and 3185±593g, respectively. The most common reason for hospitalization was respiratory distress in both groups (55.2%, n=235 in the LP neonates, 52.3%, n=400 in the term neonates). The mean duration of hospitalization was 8.2 ± 5.5 days in LP infants and 6.9 ± 5.2 days in term infants. Compared with term infants, LP infants had signifi cantly higher rates of hypoglycemia (p=0.014), polycythemia (p=0.046), and feeding diffi culty (p=0.009). Conclusion: LP infants who have not completed the physiological and metabolic aspects of maturation than term infants are at risk for many complications such as hypoglycemia, polycythemia and feeding diffi culty. They should therefore be monitored more closely for development of complications.

Impact of Prophylactic Continuous Positive Airway Pressure on Transient Tachypnea of the Newborn and Neonatal Intensive Care Admission in Newborns Delivered by Elective Cesarean Section.

This study aims to evaluate the effect of the prophylactic continuous positive airway pressure (CPAP) administration in the delivery room to newborns who were delivered by elective cesarean section (CS). Inborn infants with gestational age between 34(0/7) to 38(6/7) and born by elective CS were prospectively randomized to receive either prophylactic CPAP for 20 minutes via face mask or standardized care without CPAP in the delivery room. Primary outcomes were the incidence of transient tachypnea of the newborn (TTN) and neonatal intensive care unit (NICU) admission due to respiratory distress. A total of 259 infants with a mean gestational age of 37.7 ± 0.8 weeks and birth weight of 3,244 ± 477 g were included. A total of 134 infants received prophylactic CPAP and 125 received control standard care. The rate of NICU admission was significantly lower in prophylactic CPAP group (p = 0.045). Although the rate of TTN was lower in the prophylactic CPAP group, the difference was not statistically significant (p = 0.059). The rate of NICU admission due to respiratory distress was significantly higher in late-preterm cohort than early-term cohort (p < 0.0001). Prophylactic CPAP administration decreases the rate of NICU admission without any side effect in late-preterm and early-term infants delivered by elective CS.

Improved neonatal prognosis following restriction in the number of transferred embryos in assisted reproduction – single center yearly comparison from Turkey

To evaluate the impact of new legislation for assisted reproductive technology (ART) restricting the number of transferred embryos on neonatal prognosis of infants born after infertility treatments. Neonatal records of all live born infants in Ege University Maternity Ward were reviewed for 2006 and 2012. Neonatal outcome measures such as birth weight (BW), gestational age (GA), preterm birth (PTB), very low birth weight (VLBW), and neonatal intensive care unit (NICU) admission were evaluated. Compared to 2006 percentage of newborns conceived by medically assisted reproduction (MAR) decreased from 14.6% to 5% in all live births, from 23.8% to 8.2% in NICU patients in 2012. The number of fetuses in the last pregnancy, frequency of intrauterine reductions, spontaneous pregnancy losses, antenatal bleeding, and premature delivery decreased. Percentage of multiples among MAR newborns (31.7% vs. 55.7%), twins from 51.4% to 30.9%, triplets from 4.3% to 0.8% all decreased significantly. Mean BW and gestational age increased resulting in decreased frequency of PTB and VLBW. Consequently Level 3 NICU admission rate significantly decreased from 44.3% to 22%. The new ART legislation in Turkey resulted in decreased rate of multiple births, prematurity and related complications, and NICU admissions in MAR newborns. However the twin rates are still high. Since uncontrolled ovulation stimulation and intrauterine insemination techniques are also associated with multiple births and unfavorable neonatal outcomes, these procedures deserve close monitorization.

Impact of Specialized Nursery Care for Late Preterm Infants on NICU Admission Rate and Length of Stay.

To compare neonatal intensive care unit (NICU) admission rates and length of stay (LOS) of late preterm infants (LPIs) born before and after opening a specialized care nursery (SCN) at our academic, pediatric tertiary care center with ∼4,500 total deliveries annually. Retrospective chart review of inborn LPIs (35(0/7)-36(6/7) weeks) who were asymptomatic or minimally symptomatic at birth and delivered 7 months before the opening of the SCN (pre-SCN) or 7 months subsequently (post-SCN). Infants were excluded for major congenital anomalies or other conditions requiring immediate NICU admission. The pre-SCN options for care were standard couplet care or NICU. The post-SCN options for care were standard couplet care, SCN, or NICU. Pre-SCN (n = 109), 73 (67%) infants received standard couplet care, while 36 (33%) infants were ever admitted/transferred to the NICU. Post-SCN (n = 112), 59 (53%) infants received standard couplet care, while 20 (18%) were ever admitted/transferred to the NICU. A total of 33 (29%) infants were admitted/transferred to the SCN and avoided a NICU stay. Median LOS for all infants was 3 days. The frequency of LPIs admitted/transferred to the NICU decreased by ∼50% after the opening of the SCN. LOS did not differ by birth cohort, but did differ significantly by location of care (standard couplet care < SCN < NICU).

Integration of umbilical venous and arterial Doppler flow parameters for prediction of adverse perinatal outcome

Background: Quantification of umbilical vein (UV) blood flow rate and umbilical artery Doppler indices might be valuable in assessing fetuses at increased risk of perinatal complications as they receive their supply of oxygen and nutrients through this vessel. Previous studies have indicated that UV blood volume flow rate to umbilical artery pulsatility index (UAPI) ratio (venous arterial index [VAI]) evaluates both venous and arterial arm of fetal umbilical circulation and hence, can be adopted as a screening tool in management of high risk pregnancy. Objectives: To compare umbilical VAI with adverse perinatal outcome and also to evaluate its efficacy with other flow indices in determining perinatal outcome. Materials and Methods: Various Doppler indices such as normalized blood flow rate in UV (nUV, ml/kg estimated fetal weight/min), VAI (nUV/UAPI), umbilical artery resistance index (RI), UAPI, and systolic diastolic ratio were determined in 103 pregnant women within 2 weeks of the delivery. A risk score was devised using APGAR at 5 min, birth weight, preterm delivery, fetal distress, Neonatal Intensive Care Unit (NICU) care, and perinatal death and this score was correlated with antenatal Doppler findings. Results: Subjects with low VAI were found to have a greater association with intrauterine growth restricted fetuses (28.5%) and low liquor (35.7%), preterm deliveries (46.4%), lower mean birth weight (2.25 kg), higher NICU admission rates (32.1%). The unfavorable score was noticed in 25.2% of the neonates. They had lower VAI (156 vs. 241), UV diameter (6.2 mm vs. 7.8 mm), UV velocity (16.2 vs. 17.8), nUV (163.7 vs. 206.4), and higher PI (1.3 vs. 0.9). A cut-off of VAI of 105 ml/kg/min had sensitivity of 86.7% and a specificity of 93.5% for predicting poor perinatal outcome. Conclusion: VAI with a cut-off of 105 ml/kg/min can be used as an additional tool along with the other conventional Doppler indices in order to predict adverse fetal outcome.

Magnesium sulfate exposure and neonatal intensive care unit admission at term

The aim of this study was to investigate the effect of maternal magnesium sulfate (MgSO4) exposure for eclampsia prophylaxis on neonatal intensive care unit (NICU) admission rates for term newborns. A secondary analysis of the Maternal-Fetal Medicine Unit Network Cesarean Registry, including primary and repeat cesarean deliveries, and failed and successful trials of labor after cesarean was conducted. Singleton pregnancies among women with preeclampsia and >37 weeks of gestation were included. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Logistic regression analysis was used to determine associations between MgSO4 exposure and NICU admission. P<0.05 was considered statistically significant. Two thousand one hundred and sixty-six term pregnancies of women with preeclampsia were included, of whom 1747 (81%) received MgSO4 for eclampsia prophylaxis and 419 (19%) did not. NICU admission rates were higher among newborns exposed to MgSO4 vs unexposed (22% vs 12%, P<0.001). After controlling for neonatal birth weight, gestational age and maternal demographic and obstetric factors, NICU admission remained significantly associated with antenatal MgSO4 exposure (adjusted odds ratio 1.9, 95% confidence interval 1.3 to 2.6, P<0.001). Newborns exposed to MgSO4 were more likely to have Apgar scores <7 at 1 and 5 min (15% vs 11% unexposed, P=0.01 and 3% vs 0.7% unexposed, P=0.008). There were no significant differences in NICU length of stay (median 5 (range 2 to 91) vs 6 (3 to 15), P=0.5). Antenatal maternal MgSO4 treatment was associated with increased NICU admission rates among exposed term newborns of mothers with preeclampsia. This study highlights the need for studies of maternal MgSO4 administration protocols that optimize maternal and fetal benefits and minimize risks.

Risk Factors for Neonatal Intensive Care Unit Admission After Term Twin Deliveries

INTRODUCTION: The rate of twin delivery has increased by 76% since the 1980s and is associated with risk of neonatal intensive care unit (NICU) admission. Research on twin outcomes at term is limited. Our objective was to profile twin term pregnancies at increased risk of NICU admission. METHODS: The U.S. Natality database of birth certificate data from all births in the nation from 2007 to 2010 was reviewed. Inclusion criteria were twin delivery, term gestational age (37–42 weeks of gestation), and admission compared with no admission to a NICU. Congenital anomalies and missing data were excluded. Variables considered were demographics (maternal race, live birth order, fetal gender), obstetric complications (hypertension and diabetes-related disorders), labor complications (fetal distress, chorioamnionitis, meconium), labor outcomes (induction of labor, delivery method), and newborn status (Apgar score). Adjusted odds ratios for NICU admission were obtained from logistic regression. RESULTS: From 2007 to 2010, NICU admission rates for term twin deliveries increased from 19.9% to 30.2%. Table 1 shows NICU admission was higher for African American, male newborns delivered by cesarean of primiparas with premature rupture of membranes and chorioamnionitis as well as preeclampsia, chronic hypertension, diabetes mellitus, and meconium (P=.000).CONCLUSIONS: In term twins, the profile of neonates requiring NICU admission includes medical complications of pregnancy with evidence of infection during labor. Although these neonates tend to be African American males born to primiparas, the major warning signs for adverse perinatal outcome are premature rupture of membranes, chorioamnionitis, and low 5-minute Apgar scores. Recognition of this high-risk profile may allow for timely assessment and early intervention to improve outcomes for these high-risk perinates.

Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: A systematic review and meta‐analysis

Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min. Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's <6) were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated. The use of misoprostol was significantly effective in increasing the rate of vaginal delivery within 24 h and less oxytocin augmentation when compared with dinoprostone. However, the incidents of uterine hyperstimulation and tachysystole were significantly higher under the misoprostol protocol than dinoprostone protocol. Furthermore, we found similar efficiency in the rate of cesarean delivery, NICU admission and Apgar score at 1 and 5 min among the study groups. Intravaginal misoprostol appears to be more efficient for labor induction than intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted.

Adverse Neonatal Outcomes Associated With Early-Term Birth

Full-term neonates born between 37 and 41 weeks' gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies based on mode of delivery has pointed toward increased morbidity associated with early-term cesarean section births (37-38 weeks) compared with term neonates (39-41 weeks). To compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service. Retrospective population-based 3-year birth cohort study (January 1, 2006-December 31, 2008) at all major birth hospitals in Erie County, New York. All full-term live births comprised the birth cohort; this information was obtained from the hospitals' perinatal databases, and data pertaining to NICU or neonatology service admissions were extracted from individual medical records. Gestational age of early term (37(0/7)-38(6/7) weeks) vs term (39(0/7)-41(0/7) weeks). Admission to the NICU or neonatology service. There were 33,488 live births during the 3-year period, of which 29,741 had a gestational age between 37 and 41 weeks. Of all live births, 9031 (27.0%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycemia (4.9% vs 2.5%; adjusted odds ratio [OR], 1.92), NICU or neonatology service admission (8.8% vs 5.3%; adjusted OR, 1.64), need for respiratory support (2.0% vs 1.1%; adjusted OR, 1.93), requirement for intravenous fluids (7.5% vs 4.4%; adjusted OR, 1.68), treatment with intravenous antibiotics (2.6% vs 1.6%; adjusted OR, 1.62), and mechanical ventilation or intubation (0.6% vs 0.1%; adjusted OR, 4.57). Delivery by cesarean section was common among early-term births (38.4%) and increased the risk for NICU or neonatology service admission (12.2%) and morbidity (7.5%) compared with term births. Among vaginal deliveries, early-term neonates (6.8%) had a significantly higher rate of NICU or neonatology service admission compared with term neonates (4.4%). Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.

A History of Prior Preeclampsia As a Risk Factor for Preterm Birth

The objectives of this study are to evaluate the frequency and type of preterm birth (PTB) in women with prior preeclampsia and to compare neonatal outcomes between spontaneous PTB (SPTB) and medically indicated PTB (IPTB) groups. A secondary analysis of data in women with prior preeclampsia enrolled in a multicenter randomized trial for preeclampsia prevention. Delivery indications were categorized as SPTB and IPTB. Primary outcomes were rates of SPTB and IPTB by gestational age (GA). The rates of composite respiratory morbidity and neonatal intensive care unit (NICU) admission were compared between the PTB groups. Of the 606 pregnancies studied, 142 (23%) pregnancies were delivered at < 37 weeks: 67 (47%) pregnancies were caused by SPTB and 75 (53%) pregnancies were caused by IPTB. Of those who delivered preterm, 89 (63%) were in the late preterm period. The overall rate of the composite neonatal morbidity was 23%. The rates of composite neonatal morbidity, NICU admission, and perinatal death were not different between the groups. The frequency of small for gestational age (SGA) infants was higher in the IPTB group as compared with the SPTB group (21.3 vs. 1.4%, p = 0.01). Women with prior preeclampsia are at high risk for PTB (SPTB and IPTB), particularly late PTB, as well as increased risk for SGA.

Perinatal Outcome in Women Treated With Progesterone for the Prevention of Preterm Birth

Screening of pregnant women for preterm birth, based on their obstetric history and sonographic measurement of the cervical length, can identify greater than 50% of those at risk. Administration of progesterone to at-risk women with a singleton pregnancy can significantly reduce rates of preterm birth. However, effects of this agent on the actual perinatal and long-term consequences of prematurity are difficult to assess. Existing randomized controlled trials (RCTs) and systematic reviews have focused mainly on the primary outcome of reduction of preterm birth rates. The aim of this meta-analysis was to systematically review published evidence and pool data on the perinatal outcome in women treated with progesterone for the prevention of preterm birth. MEDLINE and SCOPUS databases were searched for clinical trials in which progesterone was given to prevent preterm birth in pregnant women at risk compared with placebo. Randomized controlled trials that compared progesterone versus placebo in women with singleton or multiple pregnancies at risk for preterm birth based on previous history or short cervix were selected. The CONSORT statement was used to address the reporting quality of the RCTs. The risk of bias in the RCTs was assessed with the “risk-of-bias” tool from the Cochrane Collaboration. The primary outcomes were the rates of neonatal and perinatal mortality. Secondary outcomes were the rates of perinatal complications, including respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) grade 3–4, sepsis, necrotizing enterocolitis (NEC), sepsis, retinopathy, and admission to the neonatal intensive care unit (NICU); a composite adverse outcome was also determined and defined as the presence of any perinatal morbidity or mortality. Of 628 retrieved items, 16 RCTs reporting on the use of progesterone in asymptomatic women to prevent preterm birth were included in the meta-analysis. Pooled data indicated that progesterone administration in these women significantly decreased the risk for composite adverse outcome (RR, 0.576; 95% confidence interval [CI], 0.373–0.891), neonatal death (relative risk, 0.487; 95% CI, 0.290–0.818), RDS (RR, 0.677; 95% CI, 0.490–0.935), and admission to the NICU (RR, 0.410; 95% CI, 0.204–0.823). No significant differences were found in rates of perinatal death, grade 3–4 IVH, NEC, retinopathy, or sepsis. Pooled data from 3 studies that used vaginal progesterone in women with a short cervix showed that progesterone significantly decreased the rate of composite adverse outcome (RR, 0.576; 95% CI, 0.373–0.891) and RDS (RR, 0.464; 95% CI, 0.275–0.786), but results did not reach statistical significance for rates of neonatal death, perinatal death, grade 3–4 IVH, NEC, sepsis, or admission to the NICU. Three studies tested systemic progesterone in women with a singleton pregnancy and a history of preterm birth; pooled results found that progesterone significantly decreased rates of neonatal death (RR, 0.412; 95% CI, 0.201–0.842) and NICU admission (RR, 0.277; 95% CI, 0.160–0.479). In 7 RCTs reporting on women with twin pregnancies, progesterone administration did not significantly affect the rates of neonatal death, grade 3–4 IVH, NEC, retinopathy, sepsis, or NICU admission. Progesterone significantly increased the rates of composite adverse outcome (RR, 1.211; 95% CI, 1.029–1.425), perinatal death (RR, 1.551; 95% CI, 1.014–2.372), and RDS (RR, 1.218; 95% CI, 1.038–1.428). The pooled data from 2 RCTs on women with triplets did not show significant differences in the rates of composite adverse outcome, neonatal death, RDS, grade 3–4 IVH, NEC, or sepsis. Preterm birth is a major cause of perinatal mortality and morbidity with long-term consequences. Results of this meta-analysis indicate that prophylactic progesterone administration in singleton pregnancies at risk can lower the rates of neonatal mortality, RDS, admission to the NICU, and a composite adverse outcome. Data, however, also indicate that use of progesterone in multiple pregnancies may lead to increased rates of perinatal death, RDS, and a composite adverse outcome.

Maternal and fetal outcome in oligohydramnios- Study of 100 cases

Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal morbidity in form of operative delivery and induced labour. Material and Methods: Present study was done over a period from May 2009 to November 2011. 100 patients in third trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring AFI. Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7% patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of growth retardation and NICU (neonatal intensive care unit) admission. Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and mortality.

1281 A Common Problem for Neonatal Intensive Care Unit’s: Late Preterm Infants

BackgroundLate preterm infants are physiologically and metabolically immature than term infants, and the incidence of late preterm birth is increasing. These infants have higher risks of medical complications such as...

Induction of labour for improving birth outcomes for women at or beyond term.

As a pregnancy continues beyond term the risks of babies dying inside the womb or in the immediate newborn period increase. Whether a policy of labour induction at a predetermined gestational age can reduce this increased risk is the subject of this review. To evaluate the benefits and harms of a policy of labour induction at term or post-term compared with awaiting spontaneous labour or later induction of labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2012). Randomised controlled trials conducted in women at or beyond term. The eligible trials were those comparing a policy of labour induction with a policy of awaiting spontaneous onset of labour. Cluster-randomised trials and cross-over trials are not included. Quasi-random allocation schemes such as alternation, case record numbers or open random-number lists were not eligible. Two review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. Outcomes are analysed in two main categories: gestational age and cervix status. We included 22 trials reporting on 9383 women. The trials were generally at moderate risk of bias.Compared with a policy of expectant management, a policy of labour induction was associated with fewer (all-cause) perinatal deaths: risk ratio (RR) 0.31, 95% confidence interval (CI) 0.12 to 0.88; 17 trials, 7407 women. There was one perinatal death in the labour induction policy group compared with 13 perinatal deaths in the expectant management group. The number needed to treat to benefit (NNTB) with induction of labour in order to prevent one perinatal death was 410 (95% CI 322 to 1492).For the primary outcome of perinatal death and most other outcomes, no differences between timing of induction subgroups were seen; the majority of trials adopted a policy of induction at 41 completed weeks (287 days) or more.Fewer babies in the labour induction group had meconium aspiration syndrome (RR 0.50, 95% CI 0.34 to 0.73; eight trials, 2371 infants) compared with a policy of expectant management. There was no statistically significant difference between the rates of neonatal intensive care unit (NICU) admission for induction compared with expectant management (RR 0.90, 95% CI 0.78 to 1.04; 10 trials, 6161 infants). For women in the policy of induction arms of trials, there were significantly fewer caesarean sections compared with expectant management in 21 trials of 8749 women (RR 0.89, 95% CI 0.81 to 0.97). A policy of labour induction compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections. Some infant morbidities such as meconium aspiration syndrome were also reduced with a policy of post-term labour induction although no significant differences in the rate of NICU admission were seen.However, the absolute risk of perinatal death is small. Women should be appropriately counselled in order to make an informed choice between scheduled induction for a post-term pregnancy or monitoring without induction (or delayed induction).

The impact of the new Turkish regulation, imposing single embryo transfer after assisted reproduction technology, on neonatal intensive care unit utilization: a single center experience

IVF has become an efficient and widely used treatment for infertile couples, however, it is responsible for an increasing number of multifetal pregnancies and adverse neonatal outcomes. This study aimed to assess a health service utilization in one neonatal intensive care unit (NICU), as a response to the 2010 Turkish reproductive regulation requiring single embryo transfer (SET). All assisted reproductive technology (ART) pregnancies delivered at Zekai Tahir Burak Maternity Teaching Hospital between February 2010 and October 2011 were included in this study. Subjects were divided into two groups: Group 1 consisted of infants conceived before the ART regulation, and born between February 2010 and October 2010, and Group 2 consisted of infants conceived after the ART regulation, and born between November 2010 and October 2011. Upon comparing the study groups, we observed a significant decrease in the incidence of multiple births in Group 2. The mean gestational age and mean birthweight were significantly higher in Group 2. The rates of prematurity and low birthweight, very low birthweight and extremely low birthweight infants were significantly lower in Group 2. Similarly, the rates of NICU admission, respiratory distress syndrome, necrotizing enterocolitis anemia and pneumonia/sepsis, and the need for respiratory support (mechanical ventilation and nasal continuous positive airway pressure) were significantly lower in Group 2. According to our data, NICU utilization was reduced and the early post-natal outcomes of the babies were improved after the new Turkish regulation on ART imposing SET. However, multicenter studies are needed to generalize our results to the whole country.

Comparison of perinatal outcomes in small‐for‐gestational‐age infants classified by population‐based versus customised birth weight standards

The objective of this study was to derive a customised birth weight standard curve in our institute and to compare the perinatal outcomes of small-for-gestational-age (SGA) births classified by population-based versus customised birth weight standards. We surveyed 9052 normal singleton deliveries and generated customised standards by adjusting for maternal characteristics and neonatal gender. We compared adverse perinatal outcomes between SGA and non-SGA births classified by both standards. According to the population-based standards, mothers of SGA infants were younger, thinner and shorter and had higher rates of nulliparity and female births. We adjusted for these maternal characteristics and neonatal gender in our customised standards. Multivariate analysis revealed that there were no differences in neonatal composite morbidity between the standards. However, infants classified as SGA by the customised standards showed a significantly higher rate of neonatal intensive care unit (NICU) admission than those classified by the population-based standards. Our study showed that customised SGA made no significant differences in neonatal composite morbidity, only a modest increase in NICU admission rate compared to population-based standard. To clarify the association of adverse perinatal outcomes with customised SGA, larger studies are required.