Significant Neonatal Morbidity Research Articles

Paediatric intensive care admissions of preterm children born

ObjectiveSurvival of babies born very preterm (<32 weeks gestational age) has increased, although preterm-born children may have ongoing morbidity. We aimed to investigate the risk of admission to paediatric intensive...

The Role of Biochemical Markers in the Prediction of Preeclampsia

Preeclampsia is disorder unique to human pregnancy, defined by the international society of the study of hypertension in pregnancy (ISSHP). It causes significant maternal and neonatal morbidity and mortality. Measures to predict preeclampsia are very valuable for fetal and maternal health. This review aims to focus on the role of biochemical markers in the prediction of preeclampsia, which may help early detection and improve outcome of pregnancy. It was found that the efficiency and accuracy heavily depended on the timeline of pregnancy, moreover, some biochemical markers are considered more accurate when accompanied with ultrasound scan. Many of these biochemical markers are measured in the first trimester, and the normal ranges in normal pregnant women and preeclamptic women differ majorly, where some are notably increased during the first trimester, opposed to others that are decreased. The results of this review showed the markers that are important in picking up women at risk of developing preeclampsia early from the first trimester.

Application of Next-Generation Sequencing to Enterobacter Hormaechei Subspecies Analysis during a Neonatal Intensive Care Unit Outbreak.

The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the molecular level, ECC exhibits genomic heterogeneity, with six closely related species and subspecies. Genetic variability poses a challenge in accurately identifying outbreaks by determining the clonality of ECC isolates. This difficulty is further compounded by the limitations of the commonly used molecular typing methods, such as pulsed field gel electrophoresis, which do not provide reliable accuracy in distinguishing between ECC strains and can lead to incorrect conclusions. Next-generation sequencing (NGS) offers superior resolution in determining strain relatedness. Therefore, we investigated the clinical pertinence of incorporating NGS into existing bundle measures to enhance patient management during an outbreak of ECC in a level-3 neonatal intensive care unit (NICU) in Germany. As the standard of care, all neonates on the NICU received weekly microbiological swabs (nasopharyngeal and rectal) and analysis of endotracheal secretion, where feasible. During the 2.5-month outbreak, colonisation with ECC was detected in n = 10 neonates. The phylogenetic relationship and potential antimicrobial resistance genes as well as mobile genetic elements were identified via bacterial whole-genome sequencing (WGS) using Illumina MiSeq followed by in silico data analysis. Although all ECC isolates exhibited almost identical antimicrobial susceptibility patterns, the WGS data revealed the involvement of four different ECC clones. The isolates could be characterised as Enterobacter hormaechei subspecies steigerwaltii (n = 6, clonal), subsp. hoffmannii (n = 3, two clones) and subsp. oharae (n = 1). Despite the collection of environmental samples, no source of this diffuse outbreak could be identified. A new standardised operating procedure was implemented to enhance the management of neonates colonised with MRGN. This collaborative approach involved both parents and medical professionals and successfully prevented further transmission of ECC. Initially, it was believed that the NICU outbreak was caused by a single ECC clone due to the similarity in antibiotic resistance. However, our findings show that antibiotic susceptibility patterns can be misleading in investigating outbreaks of multi-drug-resistant ECC. In contrast, bacterial WGS accurately identified ECC at the clonal level, which significantly helped to delineate the nature of the observed outbreak.

X-RAY DIAGNOSIS OF LUNG HYPOPLASIA

Pulmonary hypoplasia is a rare form of congenital disorder that leads to the underdevelopment of structural elements of the lungs. Although rare, it is associated with significant neonatal morbidity and mortality. Congenital lung abnormalities are frequently discovered in the early life following routine radiographic imaging and investigations. We report the case of a baby, at the age of one day. He was transferred to the NICU (Neonatal Intensive Care Unit, Tbilisi) with acute respiratory failure. This case report aims to aid future early detection to achieve better diagnostic outcomes.

Determinants of Prelabor Rupture of Membrane among Pregnant Women Admitted to Hospitals in Wolaita Zone, Southern Ethiopia, 2022

Introduction: Prelabor rupture of membrane refers to rupture of the membranes and leakage of amniotic fluid before the onset of true labor. It can lead to significant maternal, fetal, and neonatal morbidities, resulting in mortality and lifelong complications. It complicates 8% to 10% of all pregnancies. Objective: To identify the determinants of prelabor membrane rupture among pregnant women admitted to hospitals in the Wolaita zone in southern Ethiopia in 2022. Methods and Materials: A facility-based, unmatched case-control study was conducted at selected hospitals in Wolaita zone from 15 August to 20 October, 2022. Three consecutive controls were included in the study. The study population included all pregnant women admitted to the selected hospitals. The collected data were coded, cleaned, entered into Epi data version 4.6.0.2 and exported to the Statistical Package for Social Science (SPSS) version 25.0. Bivariable and multivariable logistic regression analyses were performed to determine the association between the outcome and explanatory variables. Result: A total of 384 participants (96 cases and 288 participants) were included in this study. A history of abortion (AOR 3.21 [95% CI: 1.15–8.92]), history of prelabor rupture of membrane (AOR 3.76 [95% CI: 1.46–9.62]), history of caesarean delivery (AOR 3.57 [95% CI: 1.83–6.96]), history of invasive uterine procedures (AOR 6.23 [95% CI: 2.08–18.55]), history of chronic medical conditions (AOR 5.20 [95% CI: 1.18–23.02]), and history of ever using contraceptive methods (AOR 0.33 [95% CI: 0.19–0.58]) were significantly associated. Conclusion: Advancing health technology contributes to the early detection, treatment, and workup of obstetric complications to reduce risk and maximize fetomaternal well-being. Women of reproductive age should be encouraged to use contraceptives.

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction.

BACKGROUNDSevere, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth.METHODSWomen with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data.RESULTSThe most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94).CONCLUSIONUltrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians.TRIAL REGISTRATIONClinicalTrials.gov NCT02097667.FUNDINGThe European Union, Rosetrees Trust, Mitchell Charitable Trust.

An obstetric-specific surgical Apgar score predicts maternal morbidity from cesarean hysterectomy for placenta accreta spectrum.

Placenta accreta spectrum (PAS) is a continuum of placental conditions characterized by significant maternal and neonatal morbidity. Tools to accurately predict postoperative morbidity have been lacking due to the hemodynamic changes of pregnancy. The surgical Apgar score (SAS) is a 10-point scale that assesses heart rate, mean arterial pressure, and estimated blood loss. The SAS has been validated to predict morbidity such as blood transfusion and reoperation. We created an obstetric-specific SAS (ObSAS) scale for physiologic changes of pregnancy (two-fold increase in blood loss, 10% increased heart rate, and 5% decreased mean arterial pressure) and analyzed 110 cases of PAS who underwent cesarean hysterectomy. An ObSAS of 0-4 (poorest score) was significantly associated with increased risk of intensive care unit (ICU) admission (odds ratio [OR] 40.6, 95% confidence interval [CI] 7.9-742.9), transfusion >4 units (26/26 patients), and greater surgical morbidity (OR 22.7, 95% CI 4.4-415.0). ObSAS of 9-10 resulted in no ICU admissions (0/12), fewer blood transfusions (OR 0.1, 95% CI 0.1-0.4). and less surgical morbidity (OR 0.09, 95% CI 0.01-0.37). Given the overall surgical morbidity associated with PAS cesarean hysterectomy, the ObSAS score is a powerful tool with excellent predictive capabilities for ICU admission, blood transfusion, and surgical morbidity, allowing for resource allocation, prophylactic interventions, and optimal patient outcomes.

The prevalence of group B streptococcal infection during intrapartum period among high-risk group in labour

Background and objective: Pregnancy associated Group B streptococcal infection is a well-established cause of significant neonatal morbidity and mortality. A cross-sectional study was conducted to determine the prevalence of Group B streptococcal infection among women presenting in labor at different ages and gestational ages and its correlation with different risk factors. Methods: Vaginal swab and urine sample for culture from 150 women having risk factors and being in labor and having risk of developing Group B streptococcal infection from 2nd of November 2020 to 2nd of December 2021. Results: The prevalence of Group B streptococcal infection among risky group women during labor in Maternity Teaching Hospital was 8%. The rate of agreement between the vaginal swab results and urine culture results was 92%. There was no significant association between urine culture results with age, parity and prolonged rupture of membrane. A significant high rate of infected urine in culture was found among women with a very extreme preterm gestational age (p value 0.049), and it was also significant among women with pyrexia (p value 0.001). Conclusion: The prevalence of Group B streptococcal infection among high-risk group of women during labor in Maternity Teaching Hospital of Erbil city was 8%.

Comparing the efficacy in reducing brain injury of different neuroprotective agents following neonatal hypoxia–ischemia in newborn rats: a multi-drug randomized controlled screening trial

Intrapartum hypoxia–ischemia leading to neonatal encephalopathy (NE) results in significant neonatal mortality and morbidity worldwide, with > 85% of cases occurring in low- and middle-income countries (LMIC). Therapeutic hypothermia (HT) is currently the only available safe and effective treatment of HIE in high-income countries (HIC); however, it has shown limited safety or efficacy in LMIC. Therefore, other therapies are urgently required. We aimed to compare the treatment effects of putative neuroprotective drug candidates following neonatal hypoxic-ischemic (HI) brain injury in an established P7 rat Vannucci model. We conducted the first multi-drug randomized controlled preclinical screening trial, investigating 25 potential therapeutic agents using a standardized experimental setting in which P7 rat pups were exposed to unilateral HI brain injury. The brains were analysed for unilateral hemispheric brain area loss after 7 days survival. Twenty animal experiments were performed. Eight of the 25 therapeutic agents significantly reduced brain area loss with the strongest treatment effect for Caffeine, Sonic Hedgehog Agonist (SAG) and Allopurinol, followed by Melatonin, Clemastine, ß-Hydroxybutyrate, Omegaven, and Iodide. The probability of efficacy was superior to that of HT for Caffeine, SAG, Allopurinol, Melatonin, Clemastine, ß-hydroxybutyrate, and Omegaven. We provide the results of the first systematic preclinical screening of potential neuroprotective treatments and present alternative single therapies that may be promising treatment options for HT in LMIC.

The Effects Between Spinal and General Anesthesia for Pre-Eclamptic Mothers Underwent Caesarean Delivery in a Tertiary Care Hospital- A Comparative Study

Background: Preeclampsia is a multisystem disorder characterized by new onset of hypertension systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and proteinuria &gt;300 mg/24 h arising after 20 weeks of gestation in a previously normotensive woman and associated with significant maternal and neonatal morbidity and mortality worldwide. Women with preeclampsia have an increased rate of cesarean section consequent upon the high incidence of intrauterine growth restriction, fetal distress, and prematurity. The aim of this study was to determine and compare maternal &amp; neonatal outcome among pre-eclamptic women following caesarian delivery under general and spinal anesthesia. Material &amp; Methods: This was a comparative observational study and was conducted in the Department of Anesthesiology of Holy Family red crescent Medical College Hospital, Dhaka, Bangladesh during the period from February,2020 to February,2023. In this study we included 250 preeclamptic women undergoing cesarean delivery. The patients were randomly divided into two groups – GA group (Patients who were given general anesthesia) &amp; SA group (Patients who were given spinal anesthesia). Results: In total 250 patients from both the groups completed the study. In our study we found majority (44.8%) of our patients were aged 28-32 years. The mean age was 27.13 ± 3.76 years. Majority (62.8% ) of our patients were cases of emergency caesarean delivery &amp; 37.2% were elective caesarean delivery classes. Most of the students (41.2%) used magnesium sulfate. Intraoperative systolic BP, diastolic BP was significantly lower in SA group than GA group. We found headache, vomiting, fever and wound gaping, postpartum hemorrhage &amp; lower respiratory tract infection was significantly higher in GA group. On contrary, hypotension &amp; pulmonary edema was higher in SA group. Apgar score at 1st, 5th &amp; 10th minutes was significantly higher in GA group than SA group. In GA group, neonatal mortality at 48 h was 10.4% whereas it was 4.8% in SA group. Conclusion: In our study, we found intra-operative blood pressure and pulse rate was observed significantly higher in GA group than SA. Severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia. Therefore, spinal anesthesia is a safer alternative to general anesthesia among women with severe preeclampsia following caesarean delivery with less postoperative morbidity and mortality.

Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term

Determining the optimal time of birth at term is challenging given the ongoing risks of stillbirth with increasing gestation vs the risks of significant neonatal morbidity at early-term gestations. These risks are more pronounced in small infants. This study aimed to evaluate the risks of stillbirth, neonatal mortality, and severe neonatal morbidity by comparing expectant management with delivery from 37+0 weeks of gestation. This was a retrospective cohort study evaluating women with singleton, nonanomalous pregnancies at 37+0 to 40+6 weeks' gestation in Queensland, Australia, delivered from 2000 to 2018. Rates of stillbirth, neonatal death, and severe neonatal morbidity were calculated for <3rd, 3rd to <10th, 10th to <25th, 25th to <90th, and ≥90th birthweight centiles. The composite risk of mortality with expectant management for an additional week in utero was compared with rates of neonatal mortality and severe neonatal morbidity. Of 948,895 singleton, term nonanomalous births, 813,077 occurred at 37+0 to 40+6 weeks' gestation. Rates of stillbirth increased with gestational age, with the highest rate observed in infants with birthweight below the third centile: 10.0 per 10,000 (95% confidence interval, 6.2-15.3) at 37+0 to 37+6 weeks, rising to 106.4 per 10,000 (95% confidence interval, 74.6-146.9) at 40+0 to 40+6 weeks' gestation. The rate of neonatal mortality was highest at 37+0 to 37+6 weeks for all birthweight centiles. The composite risk of expectant management rose sharply after 39+0 to 39+6 weeks, and was highest in infants with birthweight below the third centile (125.2/10,000; 95% confidence interval, 118.4-132.3) at 40+0 to 40+6 weeks' gestation. Balancing the risk of expectant management and delivery (neonatal mortality), the optimal timing of delivery for each birthweight centile was evaluated on the basis of relative risk differences. The rate of severe neonatal morbidity sharply decreased in the period between 37+0 to 37+6 and 38+0 to 38+6 weeks, particularly for infants with birthweight below the third centile. Our data suggest that the optimal time of birth is 37+0 to 37+6 weeks for infants with birthweight <3rd centile and 38+0 to 38+6 weeks' gestation for those with birthweight between the 3rd and 10th centile and >90th centile. For all other birthweight centiles, birth from 39+0 weeks is associated with the best outcomes. However, large numbers of planned births are required to prevent a single excess death. The healthcare costs and acceptability to women of potential universal policies of planned birth need to be carefully considered.

Aneurysmal subarachnoid hemorrhage in pregnancy: National trends of treatment, predictors, and outcomes.

Aneurysmal subarachnoid hemorrhage (aSAH) is a rare event associated with significant pregnancy-associated maternal and neonatal morbidity and mortality. The optimal treatment strategy and clinical outcome of aSAH in pregnancy remains unclear. We aimed to investigate the treatment utilizations and outcomes of aSAH in pregnant people. Using the 2010-2018 National Inpatient Sample, we identified all birth hospitalizations of women between ages of 18 to 45 associated with subarachnoid hemorrhage and aneurysm treatment were included. Multivariate analyses were used to evaluate the effect of pregnancy state, mode of treatment of aneurysms, severity of subarachnoid hemorrhage on mortality and discharge destination of this cohort. Trends in mode of treatment utilized for aneurysmal treatment in this time interval was evaluated. 13,351 aSAH with treatment were identified, of which 440 were associated with pregnancy. There was no significant difference in mortality or rate of discharge to home in pregnancy related hospitalization. Worse aSAH severity, chronic hypertension, and smaller hospital size was associated with significantly higher rate of mortality from aSAH during pregnancy. Worse aSAH severity was associated with lower rate of discharge to home. Like the non-pregnant cohort, the treatment of ruptured aneurysms in pregnancy are increasingly through endovascular approaches. The mode of treatment does not change the mortality or discharge destination. Pregnancy does not alter mortality or the discharge destination for aSAH. Ruptured aneurysms during pregnancy are increasingly treated endovascularly. Mode of aneurysm treatment does not affect mortality or discharge destination in pregnancy.

Previable preterm premature rupture of membranes: 117 cases with neonatal outcomes in light of current research.

ppPROM < 24 + 0 weeks of gestation complicates < 1 % of all pregnancies but is responsible for significant maternal and neonatal morbidity. It is associated with 18-20% of perinatal deaths. To evaluate neonatal outcome after expectant management in ppPROM in order to obtain evidence-based information for purposes of future counselling. A single-centre, retrospective cohort study of 117 neonates born 1994 to 2012 after ppPROM < 24 weeks of gestation with a latency period > 24 hours and admission to the NICU of the Department of Neonatology, University of Bonn. Data of pregnancy characteristics and neonatal outcome were collected. The results were compared to those found in the literature. The mean gestational age at ppPROM was 20.45±2,9 weeks (range 11 + 2 -22 + 6) with a mean latency period of 44.7±34.8 days (range 1-135). Mean gestational age at birth was 26.77±3.22 weeks (range 22 + 2-35 + 3). 117 newborns were admitted to the NICU, the overall survival rate at discharge was 72.6% (85/117). Non-survivors had a significantly lower gestational age and higher rates of intra-amniotic infections. The most common neonatal morbidities were RDS (76.1%), BPD (22.2%), pulmonary hypoplasia (PH) (14.5%), neonatal sepsis (37.6%), IVH (34.1% all grades, 17.9% grades III/IV), NEC (8.5%) and musculoskeletal deformities (13.7%). Mild growth restriction as a new complication of ppPROM was observed. Neonatal morbidity after expectant management is similar to that described for infants without ppPROM, but carries a higher risk of pulmonary hypoplasia and mild growth restriction.

The Association of Anesthesia Type and Neonatal Outcomes Following Category-1 Cesarean Delivery: A Retrospective Cohort Study.

Objectives Neuraxial anesthesia is the preferred anesthesia technique for cesarean delivery due to a decreased risk of adverse events. However, general anesthesia is often employed during emergent cesarean deliveries to achieve a shorter decision-to-delivery interval. The objective of this study was to determine if the conversion of epidural labor analgesia to surgical anesthesia for a category-1 cesarean delivery is associated with significant neonatal morbidity. Study design This was a retrospective cohort study of all intrapartum category-1 cesarean deliveries performed at an academic tertiary care institution between August 2016 and July 2021. The primary outcome was neonatal morbidity, defined as a composite of neonatal umbilical artery pH < 7.10 and/or 5-min Apgar score < 7, and/or neonatal intensive care unit admission. A multivariate regression analysis was performed to control for the presence of covariates and examine the degree to which they influenced the outcome. Results A total of 185 mother-neonate pairs qualified for inclusion, of which 23 had cesarean delivery under general anesthesia and 162 under epidural anesthesia. There was no significant difference in adverse neonatal outcomes between category-1 cesarean deliveries done under general anesthesia compared to epidural anesthesia (47% vs 35%,p = 0.3). The incidence of umbilical arterial pH < 7.10 was higher in the general anesthesia group compared to the epidural anesthesia group (35% vs 12%,p = 0.018). The multivariate regression model showed that gestational age (OR = 0.63; 95% CI = 0.51-0.75, p = <0.001) and non-reassuring fetal heart trace (OR = 0.18; 95% CI = 0.05-0.58, p = 0.005) were significant predictors of adverse neonatal outcome. Conclusion Our results suggest that the conversion of epidural analgesia to surgical anesthesia for category-1 cesarean delivery in women with a functional labor epidural catheter is not associated with poorer neonatal outcomes.

Aspirin and Pravastatin for Preeclampsia Prevention in High-Risk Pregnancy

Preeclampsia is a hypertensive disorder of pregnancy affecting up to 8% of pregnancies. It is associated with significant neonatal and maternal morbidities and mortality. Although its pathogenesis is not completely understood, abnormal placentation resulting in imbalance in angiogenic factors, increased inflammation, and endothelial dysfunction are thought to be key pathways in the development of the disease. Administration of low-dose aspirin is recommended by professional societies for the prevention of preeclampsia in high-risk individuals. In this review, we summarize the evidence behind the use of low-dose aspirin and pravastatin in pregnant individuals at high risk of preeclampsia.

Causes, survival rates, and short-term outcomes of preterm births in a tertiary hospital in a low resource setting: An observational cohort study.

Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and long-term disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana. An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test. Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28-31 weeks), and 130 (73%) moderate to late preterm (GA 32-37 weeks) births. Most deliveries (n = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy (n = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% (n = 52/62) at six weeks corrected age in this group. Most infants (90%, n = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis. The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.

Complete Congenital Heart Block in a Newborn Associated with Maternal Systemic Lupus Erythematosus: A Case Report

Background: Complete Congenital Heart Block (CCHB) is an uncommon life threatening disease of the newborn which leads to significant neonatal morbidity and mortality. It is usually diagnosed early in life and highly associated with maternal autoimmune and connective tissue disorders. CCHB frequently presents with bradycardia which can be diagnosed by fetal electrocardiogram. Results: This is a case report of a male neonate born with a third degree heart block to a mother with high Ro/SSA titer. Conclusion: Neonates born to women with SLE have an increased risk of CHD, and an increased risk of having a CHD repair procedure later on. It is important to diagnose, treat or refer neonates with CCHB early for definite management with pacemaker insertion as it helps for a better prognosis and prevention of associated complications, but this is not often possible in low resource settings lie Ethiopia. Keywords: Congenital Heart Block, Systemic Lupus Erythematosus, Bradycardia, SS-A/Ro Antibodies

The management of congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is a structural birth defect that with varying degrees of severity that results in significant neonatal morbidity and mortality. CDH occurs in 1:2,500 live births, and despite the advances in prenatal diagnosis and neonatal intensive care, the mortality and morbidity rate in infants with CDH is significant. In this article, we tried to summarize the main modalities of diagnosis, prognosis and medical treatment in CDH cases, found in specialty literature.

2127. Is Routine TORCH Screening Necessary For Isolated Intrauterine Growth Restriction?

Abstract Background Perinatal TORCH infections (Toxoplasma gondii, rubella, cytomegalovirus [CMV], herpes simplex virus [HSV]) cause significant fetal and neonatal morbidity and mortality. While perinatal infections are associated with a variety of clinical manifestations in the fetus, they rarely cause isolated intrauterine growth restriction (IUGR). TORCH screens are often ordered to investigate isolated IUGR, but there is limited evidence to support screening for these infections in the absence of other ultrasound abnormalities. Methods A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. Records were reviewed to identify indications for testing, serology results, and subsequent antenatal investigations. Neonatal outcomes were also evaluated. Serology performed for stillbirth or pregnancy losses were excluded. Results Medical records of 718 pregnancies were reviewed, representing 760 fetuses. 82.5% of screens were ordered in the third trimester, with 43.5% ordered after 32 weeks gestation. TORCH serology was performed for the following indications: isolated IUGR (71.2%), neurological abnormality (6.8%), echogenic bowel (3.4%), and maternal illness (1.7%). Screens ordered for isolated IUGR were positive in 7.4% (95% CI 5.5-10.0%). TORCH screening identified 49 positive maternal IgM results (CMV = 34, toxoplasma = 15) Two acute maternal infections during pregnancy were diagnosed (CMV = 1, toxoplasma = 1). Both were identified due to symptomatic maternal illness. There was one confirmed neonatal CMV infection. Eight women did not have follow-up to determine the significance of a positive IgM result. No TORCH screen changed maternal management or neonatal outcomes. Rubella IgM was ordered in 83.5% of women who had clearly documented evidence of prior rubella immunity. No acute HSV infections were identified. Conclusion Antenatal TORCH screening for IUGR is of minimal utility and is often performed as a reflex rather than in response to specific clinical syndromes. A more guided approach with selective testing is needed. Disclosures All Authors: No reported disclosures.

Outcomes of higher-order multiple pregnancies in an Australian setting.

Higher-order multiple (HOM) pregnancies are associated with significant maternal and neonatal morbidity, especially consequent to preterm birth. Multi-fetal pregnancy reduction (MFPR) may be provided, though its benefits in prolonging gestation and improving neonatal outcomes must be weighed against its risks. The aim was to compare outcomes of HOM pregnancies where expectant management was chosen (EM) with those where MFPR was provided. The method involved a retrospective study of HOM pregnancies referred to a single quaternary hospital between 2007 and 2016. The primary outcome was gestational age. Secondary outcomes included miscarriage, nursery admission, hospital stay, Apgar scores, early fetal loss, stillbirth, neonatal death and composite fetal loss. Fifty-seven pregnancies were eligible for inclusion. Median gestation at birth (weeks) was significantly higher for MFPR (35.3 vs 33.1, P < 0.01). Pregnancies after MFPR were less likely to lead to preterm birth (63.2 vs 100.0%, P < 0.001), half as likely to birth before 34 weeks (31.6 vs 60.0%, P=0.09) but similarly likely to extremely preterm birth (<28 weeks, 8.6 vs 10.5%, P=0.58). Miscarriage was more likely after MFPR (13.6 vs 0%, P=0.05). EM neonates were more likely to be admitted to the nursery (P < 0.01) and have longer hospital stay (29.6 vs 20.2 days, P=0.05); however, they had similar Apgar scores. Our study demonstrates that MFPR is associated with an increase in gestational age, with a reduction by almost half of births before 34 weeks, but no difference in extremely preterm births; the latter represents the highest risk group. This should be used to guide management counselling for HOM pregnancies.