Risk Factor For Neonatal Morbidity Research Articles

Predictors of adverse short-term outcomes in late preterm infants

BackgroundInfants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide.AimTo analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants.Patients and methodsIn this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children’s Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs.ResultsWe analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 − 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1–5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs.ConclusionA younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.

Sex-specific placental gene expression signatures of small for gestational age at birth.

Small for gestational age at birth (SGA), often a consequence of placental dysfunction, is a risk factor for neonatal morbidity and later life cardiometabolic diseases. There are sex differences in placental gene expression and fetal growth. Here, we investigated sex-specific associations between gene expression in human placenta measured using RNA sequencing and SGA status using data from ethnic diverse pregnant women in the NICHD Fetal Growth Studies cohort (n=74). Gene expression measures were obtained using RNA-Sequencing and differential gene expression between SGA (birthweight <10th percentile) and appropriate for gestational age (AGA: ≥10th and <90th percentile) was tested separately in males (12 SGA and 27 AGA) and females (9 SGA and 26 AGA) using a weighted mean of log ratios method with adjustment for mode of delivery and ethnicity. At 5% false discovery rate (FDR), we identified 40 differentially expressed genes (DEGs) related to SGA status among males (95% up- and 5% down-regulated) and 314 DEGs among females (32.5% up- and 67.5% down-regulated). Seven female-specific DEGs overlapped with known imprinted genes (AXL, CYP24A1, GPR1, PLAGL1, CMTM1, DLX5, LY6D). The DEGs in males were significantly enriched for immune response and inflammation signaling pathways whereas the DEGs in females were enriched for organ development signaling pathways (FDR<0.05). Sex-combined analysis identified no additional DEGs, rather 98% of the sex-specific DEGs were no longer significant and the remaining 2% were attenuated. This study revealed sex-specific human placental gene expression changes and molecular pathways associated with SGA and underscored that unravelling the pathogenesis of SGA warrants consideration of fetal sex as a biological variable. https://www. gov, Unique identifier: NCT00912132.

Low-Hemoglobin Levels During Pregnancy with Low-Birth Weight: A Systematic Review and Meta-Analysis

Introduction: Low birth weight (LBW) is one of the main risk factors for neonatal morbidity and mortality. Anemia in developing countries is still quite high compared to developed countries. Low hemoglobin levels in pregnancy can affect the birth of low birth weight babies.Methods: This study used a systematic review method. Studies published between 2015 and 2019. Search for articles was reviewed systematically through Scopus, ScienceDirect, Cochrane, and PubMed databases. The final results obtained 10 articles following the inclusion and exclusion criteria. Calculation result using Meta-Analysis with help of Comprehensive Meta-Analysis (CMA) software.Results: Compare the odds ratio and confidence interval of hemoglobin levels compared to low birth weight events. The results obtained OR 1.449 (95% CI 0.964 – 2.177) and p-Value 0.074 so that there is no relationship of hemoglobin levels in pregnant women ≤ 11gr / dL with the incidence of low birth weight babies. In the heterogeneity test results, I-Squared results obtained by 79.191%, which indicates the value of I-squared heterogeneity&gt; 50% so that the sample used is heterogeneous. Maternal age less than 20 years or more than 35 years, number of parity, pregnancy spacing, and number of problems in the assessment of pregnancy and previous labor.Conclusion: There is no correlation between low maternal hemoglobin levels with the incidence of low birth weight because there are other factors that can affect outcomes such as different respondent characteristics, number of samples, different research countries, different trimester of pregnancy and other factors that can cause research bias.

Late preterm births and associated neonatal outcomes in a tertiary care center-A prospective observational study.

Background: Prematurity is one of the leading causes of morbidity and mortality among newborns. The incidence of preterm deliveries especially the late preterm births have unfortunately gone up in the last decade. Late preterm births are associated with increased neonatal complications compared to term births. This study makes an effort to find out the relevant maternal and fetal factors associated with late preterm births. This study also assesses the maternal and neonatal outcomes associated with late preterm births. Methods: This prospective observational study was conducted at Maternal and Child Health Unit of Shri B M Patil Medical College Hospital Vijayapur, Karnataka over a period of 1 year. 200 late preterm births and 200 term births were enrolled in the study. During the study period, all neonates delivered in the hospital were divided into two groups as late preterm group and term group. Maternal and neonatal data was collected in predefined structured proforma. Results: The mother's mean age in the late preterm group was 24.34 ± 4.07 years, and among the term group was 25.24 ± 4.54 years, which was not statistically significant (P=0.857). The obstetric risk factors observed for late preterm births were inadequate antenatal care (39%), premature rupture of membranes (31%), hypertensive disease of pregnancy (24.5%), previous preterm delivery (21%), and maternal anemia (13%). When two or more factors were found, late preterm labor incidence was 32.6% in this study. 14.5% late preterm's needed resuscitation (P=0.003), 45% late preterm neonates had difficulty establishing feeding at birth (P<0.001), 34% late preterm’s had respiratory distress at birth (P<0.001), 12% had hypoxic-ischemic encephalopathy (Stage2/3) (0.003), 35% had early-onset sepsis (P<0.001), 28% had jaundice (P<0.001), 24% had hypoglycemia (P<0.001), 41% had hypothermia (P<0.001), 13.5% had HSPDA (P<0.006). The duration of hospital stay was significantly more in late preterm neonates (8.7 ± 1.6 days) as compared to term neonates (3.9 ± 1.1 days) with a pvalue of <0.05. Most important is the mortality, which was significantly more among late preterm neonates (18%) than term neonates (6%) with a p-value of 0.011. Conclusion: Maternal risk factors such as preterm premature rupture of membrane, inadequate antenatal care, hypertensive disorders of pregnancy, and maternal anemia were associated with late preterm births. Since late preterm birth is an independent risk factor for neonatal morbidity and mortality compared to term neonates, knowing maternal and perinatal risk factors is essential. Early identification and management of these risk factors reduces the neonatal morbidities and mortalities.

Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003-2016.

Research suggests that neonatal morbidity differs by maternal region of birth at different gestational ages. This study aimed to determine the overall and gestation-specific risk of neonatal morbidity by maternal region of birth, after adjustment for maternal, infant and birth characteristics, for women giving birth in New South Wales, Australia, from 2003 to 2016. The study utilized a retrospective cohort study design using linked births, hospital and deaths data. Modified Poisson regression was used to determine risk with 95% confidence intervals (95% CI) of neonatal morbidity by maternal region of birth, overall and at each gestational age, compared with Australian or New Zealand-born women giving birth at 39weeks. There were 1074930 live singleton births ≥32weeks' gestation that met the study inclusion criteria, and 44394 of these were classified as morbid, giving a neonatal morbidity rate of 4.13 per 100 live births. The gestational age-specific neonatal morbidity rate declined from 32weeks' gestation, reaching a minimum at 39weeks in all maternal regions of birth. The unadjusted neonatal morbidity rate was highest in South Asian-born women at most gestations. Adjusted rates of neonatal morbidity between 32 and 44weeks were significantly lower for babies born to East (adjusted relative risk [aRR] 0.65, 95% CI 0.62-0.68), South-east (aRR 0.76, 95% CI 0.73-0.79) and West Asian-born (aRR 0.93, 95% CI 0.88-0.98) mothers, and higher for babies of Oceanian-born (aRR 1.11, 95% CI 1.04-1.18) mothers, compared with Australian or New Zealand-born mothers. Babies of African, Oceanian, South Asian and West Asian-born women had a lower adjusted risk of neonatal morbidity than Australian or New Zealand-born women until 37 or 38weeks' gestation, and thereafter an equal or higher risk in the term and post-term periods. Maternal region of birth is an independent risk factor for neonatal morbidity in New South Wales.

Risk Factors for Neonatal Morbidity and Mortality: Empowering the Adolescent Mothers through Evidence Based Health Education, Busia County Referral Hospital

Risk Factors for Neonatal Morbidity and Mortality: Empowering the Adolescent Mothers through Evidence Based Health Education, Busia County Referral Hospital

325: Preterm birth in nullips: Is labor duration predictive of neonatal morbidity?

Defining a “normal” preterm birth (PTB) labor duration has been understudied. To date, labor norms have largely focused on centiles as opposed to morbidity risk. We investigated the relationship between preterm labor duration and neonatal morbidity. This is a planned secondary analysis of a prospective cohort study of spontaneous and induced preterm nulliparous women with singleton pregnancies from 2010-2014 between 30 weeks 0 days to 36 weeks and 6 days. Baseline maternal/labor characteristics were collected. The primary outcomes were 1) a composite of neonatal morbidity (death, therapeutic hypothermia, mechanical ventilation, respiratory distress, meconium aspiration, seizures, and treatment for sepsis) and 2) composite of neonatal neurologic morbidity (hypoxic ischemic encephalopathy, therapeutic hypothermia, or seizures). Adjusted odds ratios were estimated using multivariable logistic regression. Receiver operator curves (ROC) were created to asses predictive ability for preterm labor duration and neonatal morbidity. Of the 1,327 nulliparous women with a PTB, 531 (40%) neonates had the composite morbidity and 21 (1.6%) had the composite neurologic morbidity. After adjusting for labor type, labor duration >90th and >95th percentile had significantly increased odds of composite neonatal morbidity (55% vs 38%, aOR [95% CI] 1.97 [1.36, 2.84]) & (59% vs 38%, 2.21 [1.33, 3.67]) respectively, while there was no difference in composite neurologic neonatal morbidity. Among the components of the composite, labor duration at the extremes led to neonates with increased odds of respiratory distress syndrome and treatment for sepsis. Labor duration at the extremes were not predictive of neonatal morbidity (ROC area 0.5996 spontaneous, 0.5540 induced). Preterm labor duration at the extremes of duration is an independent risk factor for neonatal morbidity, however, it is not predictive. Regardless of induced or spontaneous PTB, neonates who experience a prolonged labor are at an increased risk of respiratory distress and treatment for sepsis.

Maternal Weight Gain and Neonatal Outcomes in Women With Class III Obesity [29C

INTRODUCTION: Class III obesity is an independent risk factor for neonatal morbidity. Institute of Medicine (IOM) guidelines recommend 11-20 lbs of gestational weight gain (GWG) in women with obesity. We evaluated the association between GWG and neonatal outcomes in women with Class III obesity. METHODS: Retrospective cohort of women delivering a liveborn neonate at term at a single institution between 7/2013-12/2017 with a baseline BMI ≥40 in the first trimester. Pregnancies complicated by multiple gestation or fetal anomalies were excluded. Primary outcome was a neonatal composite including 5 m apgar <7, intubation, grade 3/4 IVH, sepsis or intensive care unit (NICU) admission. Secondary outcomes included NICU admission >7 days. Demographic, pregnancy & delivery characteristics of women who gained >20 lbs (mIOM) were compared to those that gained <20 lbs (lIOM) using bivariate statistics. Stepwise backward regression was used to estimate odds ratios. RESULTS: Of 374 women, 144 (38.5%) gained mIOM, who were less likely to be multiparous, use tobacco or have a lower BMI at delivery. The neonatal composite occurred in 30 (8.0%) neonates, 16 (11.1%) in mIOM versus 14 (6.1%) in the lIOM group (p=0.12, OR=1.93, 95% CI 0.91,4.08). When adjusted for multiparity and BMI at delivery, the aOR was 1.55 (95% CI 0.85-2.82). Neonates in the mIOM group were more likely to be admitted to the NICU (10.4% v 4.4%, p=0.03, OR=2.56, 95% CI 1.12-5.86) and have an admission >7days (6.9% v 2.2%, p=0.03, OR=3.36, 95% CI 1.12-10.03). CONCLUSION: In women with class III obesity, excess GWG was associated with increased odds of NICU admission and admission >7 days.

Group B Streptococcus Serotypes in Pregnant Women From the Western Cape Region of South Africa.

Background: Maternal colonization of Group B streptococci (GBS) during pregnancy is an important risk factor for neonatal morbidity and mortality. The aim of this study was to determine the prevalence and serotype distribution of GBS isolated from a cohort of pregnant women in the Western Cape, South Africa.Methods: Two ano-vaginal swabs were collected from 301 women at 28–37 weeks of gestation. Participants were recruited from four different antenatal clinics in the Western Cape, South Africa. GBS were detected by culture and PCR and serotypes confirmed by latex agglutination tests. Antibiotic sensitivity was performed using disc diffusion.Results: The GBS colonization rate was 16.6%. Serotype distribution revealed serotype V as the predominant serotype (66.67%) followed by serotype III (21.05%). Serotypes Ia, II, IV, and IX constituted 1.75% each and 3 GBS isolates were non-typeable. Serotype V demonstrated resistance to most of the antibiotics tested, while serotype III demonstrated better susceptibility, except for tetracycline. No significant differences were observed for GBS colonization or serotype distribution according to HIV status.Conclusion: Predominating serotypes differed from those previously reported from other regions in South Africa. Global surveillance of serotype distribution plays an important role in informing vaccine development and antibiotic prophylaxis.

Fetal parameters and early evidence of fetal macrosomia in prepregnancy diabetic women

Background: Diabetes in pregnancy with macrosomia is an important risk factor for neonatal morbidity and mortality. Prediction of macrosomia is significantly improved by adding ultrasound to clinical findings. Objective: For earlier detection of macrosomia in prepregnancy diabetic mothers using fetal growth profile including biparietal diameter, femoral length, and also abdominal circumference (AC). Patients and Methods: A historical prospective cohort study was performed at National Endocrine and Diabetic Center in addition to the Obstetrics and Gynecology Department at Al-Yarmouk Hospital for 2 years, from September 2014 to 2016. A hundred and sixty pregnant women were enrolled in this study, 80 of them with a history of prepregnancy diabetes mellitus were taken as a patient group and the other 80 pregnant women with a compatible gestational age and without a history of diabetes mellitus were taken as a comparison group. Abdominal ultrasound was done for patients in both groups at 20, 28, and 36 weeks of gestation and then birth weight was measured for each. Results were compared between two groups. Results: The incident of macrosomia was 30% in patient group and 10% in comparison group. Regarding early prediction of macrosomia by ultrasound using biparietal diameter, femoral length, and AC, the results of the current study revealed that those macrosomic babies have higher femoral length, AC but not biparietal diameter in comparison with babies of average weight using ultrasound performed at 20-week gestation and repeated at 28 and 36 weeks. Conclusion: In diabetic mother, fetal macrosomia can be predicted by ultrasound during pregnancy as early as 20-week gestation.

841: Select microbes present in early 2nd trimester in the cervicovaginal space are associated with subsequent Group B Strep colonization

Microbial communities at different sites influence both health and disease. The cervicovaginal (CV) microbiota have documented associations with sexually transmitted infection acquisition and spontaneous preterm birth. While colonization with Group B Streptococcus (GBS) is prevalent, it remains a significant risk factor for neonatal morbidity. There are no data on how CV microbial communities might influence colonization with GBS. Therefore, the objective of this study was to determine if the CV microbiota is associated with GBS colonization (GBS-C) in pregnant women. A 3 year prospective cohort study of women with singleton pregnancies was utilized (“M&M,” n=1,943). We performed a nested case-control study of 394 GBS- and 158 GBS+ women with 16s rRNA gene analysis of CV specimens collected at 16-20 weeks. Women were considered GBS-C if they were treated with antibiotics for GBS+ in labor. Nine bacteria were selected for analysis based on prior associations with adverse pregnancy outcomes. Odds of GBS colonization (GBS-C) by quartile of relative abundance was estimated with logistic regression adjusting for race and intercourse ≤ 24hrs of visit. The overall rate of GBS+ was 27.3%. GBS+ women were more likely to have had intercourse within 24 hours of the biospecimen collection but otherwise the cases and controls were similar (Table 1). At 16-20 weeks, increasing levels of Sneathia sanguinegens were associated with an increasing rate of GBS+ (0= 14.6%, Q1= 27.1%, Q2= 28.2%, Q3=34.7%, Q4=34.2%), which remained significant after adjustment with odds ranging from Q1 aOR: 2.49 (95% CI 1.16-5.37) up to Q4 aOR: 3.50 (95% CI 1.62-7.54). GBS+ rates also increased with Gardnerella vaginalis levels from 20.3% at Q1 to 31.9% at Q4, which was significant after adjustment: Q2: aOR 1.78 [1.01-3.13], Q3: aOR 1.82 [1.01-3.27], Q4: aOR 1.96 [1.10-3.48]. Certain bacteria present early in the 2nd trimester in the CV space are associated with increased rates of GBS colonization. Microbial communities at various biological sites can be modified without the use of antibiotics. As such, future research should investigate if GBS colonization may be prevented by modifying the CV microbiota, thus limiting, if not preventing, the use of antibiotics during labor without compromising neonatal risk. (NRO14784 ME)

Predicting birth weight with conditionally linear transformation models.

Low and high birth weight (BW) are important risk factors for neonatal morbidity and mortality. Gynecologists must therefore accurately predict BW before delivery. Most prediction formulas for BW are based on prenatal ultrasound measurements carried out within one week prior to birth. Although successfully used in clinical practice, these formulas focus on point predictions of BW but do not systematically quantify uncertainty of the predictions, i.e. they result in estimates of the conditional mean of BW but do not deliver prediction intervals. To overcome this problem, we introduce conditionally linear transformation models (CLTMs) to predict BW. Instead of focusing only on the conditional mean, CLTMs model the whole conditional distribution function of BW given prenatal ultrasound parameters. Consequently, the CLTM approach delivers both point predictions of BW and fetus-specific prediction intervals. Prediction intervals constitute an easy-to-interpret measure of prediction accuracy and allow identification of fetuses subject to high prediction uncertainty. Using a data set of 8712 deliveries at the Perinatal Centre at the University Clinic Erlangen (Germany), we analyzed variants of CLTMs and compared them to standard linear regression estimation techniques used in the past and to quantile regression approaches. The best-performing CLTM variant was competitive with quantile regression and linear regression approaches in terms of conditional coverage and average length of the prediction intervals. We propose that CLTMs be used because they are able to account for possible heteroscedasticity, kurtosis, and skewness of the distribution of BWs.

Neonatal Mortality and Long-Term Outcome of Infants Born between 27 and 32 Weeks of Gestational Age in Breech Presentation: The EPIPAGE Cohort Study.

ObjectiveTo determine whether breech presentation is an independent risk factor for neonatal morbidity, mortality, or long-term neurologic morbidity in very preterm infants.DesignProspective population-based cohort.PopulationSingletons infants without congenital malformations born from 27 to 32 completed weeks of gestation enrolled in France in 1997 in the EPIPAGE cohort.MethodsThe neonatal and long-term follow-up outcomes of preterm infants were compared between those in breech presentation and those in vertex presentation. The relation of fetal presentation with neonatal mortality and neurodevelopmental outcomes was assessed using multiple logistic regression models.ResultsAmong the 1518 infants alive at onset of labor included in this analysis (351 in breech presentation), 1392 were alive at discharge. Among those eligible to follow up and alive at 8 years, follow-up data were available for 1188 children. Neonatal mortality was significantly higher among breech than vertex infants (10.8% vs. 7.5%, P = 0.05). However the differences were not significant after controlling for potential confounders. Neonatal morbidity did not differ significantly according to fetal presentation. Severe cerebral palsy was less frequent in the group born in breech compared to vertex presentation but there was no difference after adjustment. There was no difference according to fetal presentation in cognitive deficiencies/learning disabilities or overall deficiencies.ConclusionOur data suggest that breech presentation is not an independent risk factor for neonatal mortality or long-term neurologic deficiencies among very preterm infants.

Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies

ObjectiveTo determine the independent association of post-term pregnancy with neonatal outcome in low-risk newborns.DesignRetrospective cohort.SettingTertiary university-affiliated medical centre.PatientsAll newborns of low-risk singleton pregnancies born at 39+0 to 44+0 weeks’ gestation...

Sepsis as a risk factor for neonatal morbidity in extremely preterm infants.

This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities. This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27 weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses. We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage. Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

FATORES ASSOCIADOS À MORBIMORTALIDADE NEONATAL: UM ESTUDO DE REVISÃO

Objective – To identify factors associated with neonatal mortality described in the Brazilian scientific production in the period 1989 to 2012. Method – Integrative review held at Virtual Health Library with descriptors neonatal mortality and infant mortality. We included research articles with abstracts in Portuguese available in electronic media. The organization of the data sample of 160 productions was described in a summary table. Results – The risk factors for neonatal morbidity and mortality were categorized as related to the neonate; pregnant and pregnancy, access and quality of care. Noteworthy is the low birth weight, prematurity, socioeconomic status, maternal age, quality of prenatal care, labor and birth. Conclusion – It is concluded that it is necessary to identify these factors, offering subsidies in order to minimize the rates of morbidity and mortality.

PP.65 Study of Factors Associated with Low Birth Weight

BackgroundLow birth weight is a significant risk factor for neonatal morbidity and mortality as well as a general indicator of the health status of a population. Objectives: To determine the...

Perinatal outcomes of fetal growth restriction between late preterm and term birth infants

Objective To estimate the absolute increase in the risk for adverse neonatal outcomes of fetal growth restriction between late preterm and term birth and to identify risk factors for neonatal morbidity among late preterm and term birth infants. Methods A retrospective review of 2,954 singleton infant between 34 and 42 weeks of gestation born at our hospital over the 5 years were enrolled and they were divided into four groups as late preterm small for gestational age (SGA), late preterm adequate for gestational age (AGA), term SGA and term AGA, respectively. The prenatal ultrasonographic findings between SGA and AGA in late preterm birth were assessed. Maternal and neonatal complications were compared with SGA and AGA between late preterm and term birth infants. The statistical analyses for frequencies and relative risks in each group were calculated by SPSS ver. 19.0. Results In prenatal evaluation between SGA and AGA in late preterm birth, amniotic fluid volume, abdominal circumference and umbilical artery Doppler resistance index value were different significantly ( P<0.001). Preeclampsia and oligohydramnios were found more common in SGA of late preterm birth compared with AGA of term birth. Jaundice, respiratory distress syndrome, necrotizing enterocolitis, sepsis, congenital anomalies, hypoglycemia, and germinal matrix`s hemorrhage, occurred more frequent in SGA of late preterm birth than in AGA of term birth. Conclusion Not only adequate prenatal evaluation and obstetrical decision-making but also long-term evaluation are needed to improve perinatal outcomes of growth restricted infants in late preterm birth.

Antenatal Depressive Symptoms and Preterm Birth: A Prospective Study of a Swedish National Sample

Preterm birth is the principal risk factor for neonatal morbidity and mortality. The objective of this study was to investigate the association between antenatal depressive symptoms and preterm birth. The study included a national sample of 2,904 pregnant women who were recruited at their first booked visit to antenatal clinics in Sweden. Data on depressive symptoms, and sociodemographic and reproductive background were collected by questionnaires. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS). The average length of gestation at the time for completion of the questionnaire was 16 weeks. Data on gestational length were extracted from the Swedish Medical Birth Register. Multiple logistic regression analyses were conducted to estimate the risk of preterm birth associated with antenatal depressive symptoms. The presence of antenatal depressive symptoms above a cutoff score of 12 or higher on the EPDS increased the risk for preterm birth (OR: 1.56; 95% CI: 1.03-2.35). Being of age 35 years and over, being a primipara, and having experienced a previous miscarriage were also shown to be significant predictors in a multivariate model. Pregnant women reporting antenatal depressive symptoms are at elevated risk of preterm birth.

150 Incidence of and Risk Factors for Neonatal Morbidity After Active Perinatal Care: Extremely Preterm Infants Study in Sweden (Express)

Aims: To determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotising enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥ 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusions: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.