Singleton Neonates Research Articles

Application of 2- and 3-Dimensional Sonography Using the Virtual Organ Computer-Aided Analysis Technique to Measure the Hippocampal Formation and Its Correlation With Corrected Gestational Age in Neonates.

The purpose of this study was to use transcranial 2- and 3-dimensional sonography with the Virtual Organ computer-aided analysis (GE Healthcare, Milwaukee, WI) technique to observe the morphologic characteristics of the hippocampal formation and to analyze its correlation with the corrected gestational age. Transcranial sonography was performed from the sagittal plane of the anterior fontanel to the sagittal plane of the posterior horn of the lateral ventricle. The morphologic characteristics of the hippocampal formation in 183 singleton neonates with a corrected gestational age of 32 to 43 weeks were observed. The long diameter, short diameter, area, and perimeter of the hippocampal formation were all quantitatively measured. The volume of the hippocampal formation was measured by 3-dimensional sonography using the Virtual Organ computer-aided analysis technique. The correlation between the corrected gestational age and each parameter was analyzed. The display rate of the hippocampal formation was 100% in the neonates with a typical hippocampus shape. In healthy neonates with a corrected gestational age of 32 to 43 weeks, the long and short diameters, area, perimeter, and volume of the hippocampal formation were all positively correlated with the gestational age. Transcranial sonography could be used as a conventional approach for evaluation of the development of the hippocampal formation in neonates.

Intestinal microbiota in neonates within three days after birth

Objective To investigate the characteristics of intestinal microbiota in neonates on the first and third day after birth. Methods A total of 50 healthy singleton neonates who were born between June 15, 2016 and August 3, 2016 in Shanghai First Maternity and Infant Hospital were enrolled. Their stool samples were collected on the first and third day after birth and the samples were labeled according to the time of collection (D1 and D3 groups, n=50 each). Illumina NexSeq high-throughput sequencing platform was used to sequence the variable region 4 and 5 of all bacterial 16S rRNA genes in the samples. The composition of intestinal microbial communities was determined and the differences between the two groups were compared by Metastats analysis. Results (1) A total of 100 stool samples were sequenced and the retrieved sequences were from 25 bacterial phyla, 119 families, 227 genera and 159 species. (2) Major phyla in the two groups were the same, namely, Proteobacteria, Frimicutes, Bacteroidetes and Actinobacteria. The relative abundances of Frimicutes (0.27±0.03 vs 0.41±0.05) and Bacteroidetes (0.07±0.01 vs 0.09±0.03) increased over time, while that of Actinobacteria (0.10±0.01 vs 0.01±0.00) decreased on day 3. No significant difference in the relative abundance of Proteobacteria (0.51±0.03 vs 0.49±0.05) was observed between D1 and D3 groups. There were significant difference in relative abundances of Frimicutes and Actinobacteria between the two groups (both q=-0.01, both P<0.05). (3) Among the top ten most abundant families, Enterobacteriaceae, Staphylococcaceae, Enterococcaceae, Streptococcaceae and Lachnospiraceae were detected in both of the two groups. The relative abundances of Enterobacteriaceae (0.25±0.02 vs 0.46±0.06), Staphylococcaceae (0.07±0.02 vs 0.12±0.03), Enterococcaceae (0.04±0.02 vs 0.10±0.04), Streptococcaceae (0.03±0.02 vs 0.06±0.01) increased over time, while that of Lachnospiraceae (0.03±0.01 vs 0.02±0.02) decreased on day 3. Only the relative abundance of Enterobacteriaceae had statistical difference between the two groups (q=0.00, P<0.05). (4) Among the top ten most abundant genera, Staphylococcus, Enterococcus, Streptococcus, Bacteroides and Pseudomonas were detected in both groups. The relative abundances of aerobic and facultative anaerobic bacteria which belonged to genera of Stenotrophomonas, Propionibacterium, Acinetobacter, Bacillus, Sphingomonas and so on decreased on day 3 as compared with those on day 1 (0.00±0.00 vs 0.07±0.02, 0.00±0.00 vs 0.06±0.01, 0.00±0.00 vs 0.03±0.01, 0.00±0.00 vs 0.02±0.01, 0.00±0.00 vs 0.02±0.00, all q=0.00, all P<0.05). However, the relative abundances of anaerobic bacteria which belonged to Bacteroides, Veillonella, Parabacteroides and so on increased on day 3 (0.01±0.00 vs 0.08±0.03, 0.00±0.00 vs 0.03±0.02, 0.00±0.00 vs 0.01±0.00, q=0.01, 0.01 and 0.00, all P<0.05). (5) The most abundant species in intestinal microbiota was escherichia coli in both groups. Three less abundant species including lactobacillus gasseri, lactobacillus animalis and bifidobacterium bifidum were detected in both groups. (6) Regardless of the mode of delivery, Staphylococcus, was the highest predominant genera in meconium samples, followed by stenotrophomonas. Stool samples collected on the third day after birth were divided into four groups based on deliver modes and feeding patterns. Neonates who were born abdominally with exclusive breastfed thereafter were different from those of the other three groups in predominant intestinal bacteria, but the difference was not statistically significant. Bifidobacterium and Subdoligranulum were only detected in the vaginally born neonates. Conclusions Meconium is not sterile. Although the intestinal microbiota on the first day of life is different from that on the third day of life, the dominant bacteria are common. During the first three days of life, the relative abundances of aerobic and facultative anaerobic bacteria decreased significantly over time, while the relative abundance of anaerobic bacteria increased. Key words: Gastrointestinal tract; Microbial consortia; High-throughput nucleotide sequencing; Infant, newborn

Maternal Social Disadvantage and Newborn Telomere Length in Archived Dried Blood Spots from the Michigan Neonatal Biobank

ABSTRACTTelomeres are the protective caps at the ends of eukaryotic chromosomes. Short telomere length is associated with morbidity and mortality among adults and may mark the biological impact of social experiences. Using archived dried blood spots from the Michigan Neonatal Biobank, this study examined markers of maternal social disadvantage (educational attainment, receipt of public assistance, marital status, and race/ethnicity) from linked birth certificates as predictors of telomere length at birth in a sample of 192 singleton neonates born to non-Hispanic black, non-Hispanic white, and Latina mothers aged 20–35 years. Consistent with two recent studies in newborns, but counter to the idea that maternal social disadvantage is associated with shorter offspring telomere length, we found that infants born to black mothers had longer telomeres than those born to white mothers (b = 0.12, SE = 0.06, p = .05). However, black/white differences in newborn telomere length varied by receipt of public assistance. Among newborns whose mothers received WIC and/or Medicaid, there were no significant black/white differences in telomere length (b = 0.09, SE = 0.08, p = .25). In contrast, among those whose mothers did not receive public assistance—just 6 out of 69 infants born to black mothers versus 41 out of 69 infants born to white mothers—we found that babies born to black mothers had longer telomere length than babies born to white mothers (b = 0.37, SE = 0.16, p = .03). The interaction between black race/ethnicity and receipt of public assistance did not reach the conventional threshold for statistical significance (b = −0.22, SE = 0.15, p = .13), suggesting that this finding may be due to chance. No other markers of maternal social disadvantage were related to infant telomere length. Although replication of these results in a larger sample with more infants born to black mothers with relatively high socioeconomic status is needed, this study offers preliminary support for the hypothesis that race/ethnic differences in newborn telomere length depend on social context.

Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room

BackgroundBody temperature of a neonate continues to be under-documented, under-recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We aimed to reduce neonatal hypothermia (body temperature <36.5°C) at 1h following normal vaginal delivery in term and late preterm neonates in delivery room from 50% at baseline to less than 10% by 6 weeks. MethodsWe implemented a quality improvement (QI) initiative using the rapid-cycle Plan-Do-Study-Act approach (PDSA) improvement model and the project was conducted from 15 Jan 2017 to 25 Feb 2017. All singleton neonates with gestational ages above 34 completed weeks born by vaginal delivery were targeted. Exclusion criteria included neonates needing any form of resuscitation, those developing respiratory distress after birth needing any form of respiratory support or observation in NICU. We ran PDSA cycles (including pre-warmed cloths, skin to skin care with mother, early breast feeding, delaying weight check by 1h and checklist of planned steps), every week, after taking the baseline data in the first week. ResultsA total of 46 neonates were studied. After 4 PDSA cycles, incidence of neonatal hypothermia at 1h of birth dropped to zero from 50% at baseline and we were able to sustain 100% normal temperature (36.5–37.5°C) since then. ConclusionThis QI project has significantly reduced the incidence of hypothermia in term and late preterm neonates born by vaginal delivery in our institute.

The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity*

Introduction: An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies. Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analysis was limited to births between 34 and 42 weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGApop) and another using obese pregnancies (SGAcust). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation >6 h. Results: Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGApop, and 1.21 [0.54, 2.74] for SGAcust-pop. The risks for the following neonatal complications were slightly higher for SGAcust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGApop. Conclusions: Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.

Use of Delayed Cord Clamping in Preterm Dichorionic Twin Gestations [27B

INTRODUCTION: Delayed cord clamping (DCC) for premature neonates has become standard of care in singleton gestations, but the outcomes after DCC in twin gestations are unclear. The aim of this study was to examine feasibility and outcomes associated with DCC in twins. METHODS: This is a retrospective cohort study of women delivering dichorionic-diamniotic twin gestations between 23-32 weeks gestation at a single center (2013-2015). In 6/2013, this institution introduced a DCC protocol for singleton neonates delivering &lt; 32 weeks, with some dichorionic twins who also received DCC. Clinical characteristics and neonatal outcomes of twins receiving DCC were compared to those who did not. Bivariable assessments and fixed effects multivariable logistic and linear regression were utilized. RESULTS: Of 58 women delivering dichorionic twins &lt; 32 weeks, 8 (13.8%) had both neonates receive DCC, resulting in 16 neonates who received DCC. DCC occurred both among those who were delivered vaginally (n=7), and by cesarean section (n=9). Neonates who received DCC, compared to those who did not, had similar umbilical artery pH, initial temperature, 5-minute Apgar score, and peak bilirubin. Additionally, there were no differences in neonatal intensive care unit length of stay, birth hematocrit, total number of blood transfusions or transfusions received in the first week, mechanical ventilation, need for pressors, death, or other adverse outcomes. CONCLUSION: Performance of DCC in dichorionic twin gestations born &lt; 32 weeks is feasible and not associated with worse neonatal outcomes in this small cohort. Further investigation of expansion of DCC protocols to dichorionic twin gestations appears worthy of exploration.

Vitamin D levels during pregnancy and associations with birth weight and body composition of the newborn: a longitudinal multiethnic population-based study.

We investigated associations between serum 25-hydroxyvitamin D (25(OH)D) in pregnancy and birth weight and other neonatal anthropometric measures. The present study was a population-based, multiethnic cohort study of 719 pregnant women (59 % ethnic minorities) in Oslo, Norway, delivering a singleton neonate at term and with birth weight measurements. In a representative sample, anthropometric measurements were taken. Maternal 25(OH)D was measured at gestational weeks 15 and 28. Women with 25(OH)D <37 nmol/l were recommended vitamin D3 supplementation. Separate linear regression analyses were performed to model the associations between 25(OH)D and each of the outcomes: birth weight, crown-heel length, head circumference, abdominal circumference, sum of skinfolds, mid-upper arm circumference and ponderal index. In early pregnancy, 51 % of the women were vitamin D deficient (25(OH)D<50 nmol/l). In univariate analyses and in models adjusting for maternal age, parity, education, prepregnancy BMI, season, gestational age and neonate sex, maternal 25(OH)D was significantly associated with birth weight, head circumference, abdominal circumference and ponderal index (P<0·05 for all), when used as a continuous variable and categorised (consistently low, consistently high, increasing and decreasing level). However, after adjusting for ethnicity, 25(OH)D was no longer associated with any of the outcomes. Sex-specific associations for abdominal circumference and sum of skinfolds were found (P for interaction<0·05). In conclusion, in a multiethnic cohort of pregnant women with high prevalence of vitamin D deficiency, we found no independent relation between maternal vitamin D levels and any of the neonatal anthropometric measures, and the strong association between ethnicity and neonatal outcomes was not affected by maternal vitamin D status.

Birthweights and Down syndrome in neonates that were delivered after frozen-thawed embryo transfer: The 2007-2012 Japan Society of Obstetrics and Gynecology National Registry data in Japan.

AimTo evaluate the use of frozen embryos on the outcome of assisted reproductive technology (ART), a retrospective study of the Japanese Assisted Reproductive Technology Registry data during the years 2007‐2012 was conducted.MethodsA total of 124 946 singleton neonates who reached term gestation following ART from 2007‐2012, with 80 660 achieved through frozen‐thawed embryo transfer (ET) and 44 286 being achieved through fresh ET, were analyzed for their birthweights and chromosomal abnormalities.ResultsThe birthweight of the neonates from the frozen‐thawed ETs was significantly higher than that of those from the fresh ETs throughout all the study years. The frequency of Down syndrome was 0.17% for the fresh ETs and 0.13% for the frozen‐thawed ETs in the period 2007‐2012. This study showed that frozen‐thawed ETs result in a constant increase of the average birthweight between 37 and 41 weeks gestational age and lower frequencies of Down syndrome.ConclusionFrozen‐thawed ETs were comparable to the fresh ET method, with the exceptions of higher birthweights and a lower frequency of Down syndrome in the neonates that were born from frozen‐thawed ET. The increase in birthweights was not proportional to the gestational ages. This cannot be explained with any well‐known mechanism. The frequency of chromosomal abnormalities needs detailed data for analysis.

Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO Global Survey

Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors hampering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding >1 hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI <24 hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section.

Metabolic Acidemia in Live Births at 35 Weeks of Gestation or Greater

(Obstet Gynecol. 2015;126:279–283) Metabolic acidemia, defined as umbilical artery pH&lt;7.0 and base deficit ≥12 mmol/L, is one of the diagnostic tools indicative of intrapartum hypoxia, which at sufficient levels, can lead to neonatal encephalopathy, ischemia-induced neuroimaging patterns, and cerebral palsy. The authors of the present study examined the incidence of metabolic acidemia in singleton neonates born between 35 and 42 weeks gestation, in order to assess the link between metabolic acidemia and negative obstetric outcomes. The primary outcome was neonatal seizures (an index of neonatal encephalopathy) in the first 24 hours after birth.

Vaginal birth after cesarean: neonatal outcomes and United States birth setting

Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score <7 or <4, neonatal seizures), with higher morbidity noted in the out-of-hospital setting (neonatal seizures, 23 [0.02%] vs 6 [0.19%; P<.001]; Apgar score <7, 2859 [2.68%] vs 139 [4.42%; P<.001; Apgar score <4, 431 [0.4%] vs 23 [0.73; P=.01]). A similar, but nonsignificant, pattern of increased risk was observed for neonatal death and ventilator support among those neonates who were born in the out-of-hospital setting. Multivariate regression estimated that neonates who were born in an out-of-hospital setting had higher odds of poor outcomes (neonatal seizures [adjusted odds ratio, 8.53; 95% confidence interval, 2.87-25.4); Apgar score <7 [adjusted odds ratio, 1.62; 95% confidence interval, 1.35-1.96]; Apgar score <4 [adjusted odds ratio, 1.77; 95% confidence interval, 1.12-2.79]). Although the odds of neonatal death (adjusted odds ratio, 2.1; 95% confidence interval, 0.73-6.05; P=.18) and ventilator support (adjusted odds ratio, 1.36; 95% confidence interval, 0.75-2.46) appeared to be increased in out-of-hospital settings, findings did not reach statistical significance. Women birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. Fewer than 1 in 10 women in the United States with a previous cesarean delivery delivered by vaginal birth after cesarean delivery in any setting, and increasing proportions of these women delivered in an out-of-hospital setting. Adverse outcomes were more frequent for neonates who were born in an out-of-hospital setting, with risk concentrated among women birthing their second child and women without a history of vaginal birth. This information urgently signals the need to increase availability of in-hospital vaginal birth after cesarean delivery and suggests that there may be benefit associated with increasing options that support physiologic birth and may prevent primary cesarean delivery safely. Results may inform evidence-based recommendations for birthplace among women who seek vaginal birth after cesarean delivery.

Effects of growth-discordant twin pregnancies on thyroid function of neonates

Objective To investigate the effects of growth-discordant twin pregnancies on neonatal thyroid stimulating hormone (TSH) level and congenital hypothyroidism (CH). Methods A total of 3 444 live-birth twin neonates born between January 1, 2012 and December 30, 2014 in Ningbo City were enrolled. Blood samples via heel puncture were collected and tested. Incidence of CH in singleton and twin neonates was compared. Deviation of birth weight larger than 25% in twin neonates was set as the criteria for discordant growth. TSH and 17α-hydroxylase levels in CH twins and normal twins, with or without discordant growth, were compared. Chi-square and non-parametric statistics were performed for data analysis. Results The incidence of CH in twin neonates was 0.56% (19/3 444), higher than that in singleton neonates [0.09% (203/225 712), χ2=76.225, P<0.01]. Among nineteen CH twins, CH occurred in both twins in eight cases (four twins) and in one of the twins in eleven cases. The gestational age at birth in the eight CH twins were less than 37 weeks, with four males and four females; five were low birth weight infants; one twin were dichorionic, and three twins were monochorionic. In the eleven cases of CH occurring in one of the twins, the gestational age was less than 37 weeks in nine cases, eight were low birth weight infants, six were male and five female; seven were monochorionic and four were dichoronic twins. Five cases of temporary hypothyroidism were all low birth weight infants among the growth-discordant twins. CH cases in growth-discordant group had lower birth weight than their normal twins [M(P25-P75), 2 100 (1 800-2 600) vs 2 770 (2 530-2 960) g, Z=4.369], and a higher TSH level [15.4 (11.8-18.5) vs 6.4 (4.8-7.9) mU/L, Z=6.339] (both P<0.05). In normal twins with or without discordant growth, the neonates with a lower birth weight had a higher TSH level [3.6(2.5-4.7) vs 2.4(1.8-2.9) mU/L, Z=0.962] in weight consistent group, compared with 6.0(4.4-7.8) vs 3.4(1.9-4.1) mU/L in weight inconsistent group (Z=4.369), both P<0.05. Conclusions In the growth-discordant twins, neonates with a lower birth weight have a higher TSH level and a higher risk of temporary hypothyroidism. Key words: Congenital hypothyroidism; Thyrotropin; Twins; Infant, low birth weight

Relation between amniotic fluid infection or cytokine levels and hearing screen failure in infants at 32 wk gestation or less.

To determine whether the presence of intra-amniotic infection and elevated proinflammatory cytokine levels in amniotic fluid (AF) are associated with failure in the newborn hearing screen (NHS) test in very preterm neonates. This is a retrospective cohort study of 112 premature singleton neonates born to women with preterm labor or preterm premature rupture of membranes at ≤32 wk. AF obtained through amniocentesis was cultured, and interleukin-6 (IL-6) and IL-8 levels were determined. Fourteen (12.5%) neonates failed the NHS test. The prevalence of a positive AF culture was 40% (45/112). Multiple logistic regression analyses indicated that intra-amniotic infection was significantly associated with failure in the NHS test after adjusting for baseline covariates such as maternal white blood cell count (WBC) and periventricular leukomalacia. However, the IL-6 and IL-8 levels in AF were not significantly associated with hearing screen failure. Moreover, neither gestational age at birth nor birth weight was associated with NHS failure. The presence of intra-amniotic infection, but not elevated levels of AF IL-6 and IL-8, may contribute to the risk for failure in the NHS test in very preterm neonates. This finding suggests that intra-amniotic infection in utero might contribute to the development of congenital sensorineural hearing loss.

Socioeconomic and Reproductive Factors Related to Low Birth Weight Babies

Background Birth weight is a major determinant of morbidity, mortality and disability in neonates and children. Low birth weight (LBW) is associated with high morbidity, mortality and lifelong consequences. Hence, it is prudent to identify the risk factors causing LBW neonates and manage them promptly.Material and Methods This study was conducted at Nobel Medical College Teaching Hospital (P.) Ltd.which included term singleton neonates born via normal vaginal route without gross congenital anomalies and sickness at birth. Birth weight of neonate and mother’s socioeconomic and reproductive history was taken within 24 hrs of birth.Results There were 429 infants with birth weight ranging from 1500 gm to 4000 gm with mean birth weight of 2815.84 gm. The incidence of LBW was 21.9% (n=105). Body Mass Index at first Ante Natal Visit (ANV), mother’s age, occupation, smoking, history of abortion and last pregnancy interval were the most important associated variables for LBW.Conclusion Better nutrition during pregnancy, better education of mothers, avoidance of smoking, regular ANV and early commencement of ANV, increasing birth spacing and iron and folic acid supplementation will decrease the incidence of LBW and its consequences.Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, 57-60

The effects of embryo culture media on the birthweight of singletons via fresh or frozen-thawed embryo transfer: a large-scale retrospective study.

BackgroundEmbryo culture media used for IVF treatment might affect fetal growth and thus birthweight of the newborns.MethodsA retrospective study was conducted in South China using data from 2370 singleton neonates born after IVF/ICSI between 2009 and 2012. Two culture media, i.e., either Vitrolife or SAGE were used as embryo culture media during the study period. Neonates’ birthweights were compared between the two embryo culture media groups.ResultsAmong the 2370 singletons, 1755 cases came from fresh cleavage embryo transfer while 615 were from frozen-thawed cleavage embryo transfer. Within the fresh embryo transfer newborns, no statistical difference was observed in either birthweight (mean ± SD: 3196.0 ± 468.9 versus 3168.4 ± 462.0g, p > 0.05) or adjusted birthweight controlled for gestational age and gender (z-score mean ± SD: 0.11 ± 1.02 versus 0.11 ± 0.99 g, P > 0.05) between the Vitrolife (n = 419) and the SAGE group (n = 1336). Likewise within frozen embryo transfer neotates, no statistical difference of the birthweight (3300.6 ± 441.3 vs.3256.0 ± 466.7 g, P > 0.05) and adjusted birthweight (0.30 ± 0.99 g versus 0.29 ± 0.97 g, P > 0.05) was found between the Vitrolife (n = 202) and the SAGE group (n = 413). The sex ratio [OR1.17, 95 % CI (0.94–1.46)/OR1.1, 95 % CI (0.78–1.54)], rate of small for gestational age [OR1.14, 95 % CI (0.82–1.59)/OR1.06, 95 % CI (0.56–2.02)] and large for gestational age [OR1.07, 95 % CI (0.64–1.76)/OR0.98, 95 % CI (0.47–2.02)] in fresh and frozen-thawed subgourps are all comparable respectively between the two culture media. No group differences were found in the rate of low birthweight and macosomia. Multiple linear regression analysis demonstrated that maternal weight, gestational age, frozen-thawed embryo transfer and infant gender were significantly related to neonatal birthweight (P < 0.001).ConclusionsIt appears that embryos cultured in SAGE or Vitrolife media after fresh or frozen-thawed cleavage embryo transfer did not affect neonate’s birthweight.

The effects of maternal obesity on perinatal outcomes among those born small for gestational age*

Background: Maternal obesity has been associated with higher birth weight. Small for gestational age (SGA) neonates born to obese women may be associated with pathological growth with increased neonatal complications.Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analyses were limited to births between 34 and 42 weeks gestation with birth weight ≤10th percentile. Results were stratified by maternal pre-pregnancy BMI class. The risk for stillbirth, neonatal death, neonatal intensive care unit (NICU) admission and five minute Apgar scores <7 were estimated for each obesity class and compared to the normal weight group. Multivariable logistic regression analyses were performed to control for potential confounding variables.Results: The rate of stillbirth was 1.4/1000 births for normal weight women, and 2.9/1000 among obese women (p < 0.001, aOR: 1.83 [1.43, 2.34]). The rate of neonatal deaths among normal weight women was 4.3/1000 births, whereas among obese women it was 4.7/1000 (p = 0.94, aOR: 1.10 [0.92, 1.30]). A dose-dependent relationship between maternal obesity and stillbirths was seen, but not for other neonatal outcomes.Conclusion: Among SGA neonates, maternal pre-pregnancy obesity was associated with increased risks for stillbirth, NICU admission and low Apgar scores but not neonatal death.

Maternal and Placental Factors Associated with Congenital Hearing Loss in Very Preterm Neonates

Sensorineural hearing loss (SNHL) is a multifactorial disease that more frequently affects preterm newborns. Although a number of maternal conditions have been reported to be associated with preterm birth, little information is available concerning maternal risk factors for the development of SNHL. We aimed to identify maternal and placental risk factors associated with a "refer" result on the newborn hearing screening (NHS) test and subsequently confirmed SNHL in very preterm neonates. This retrospective cohort study included 267 singleton neonates who were born alive after≤32weeks. Histopathologic examination of the placenta was performed, and clinical data were retrieved from a computerized perinatal database. Cases with two abnormal findings, "refer" on the NHS test, and presence of SNHL on the confirmation test were retrospectively reviewed based on electronic medical records. Forty-two neonates (15.7%) showed a "refer" result, and, on the confirmation test, permanent SNHL was identified in 1.87% (5/267) of all neonates. Multivariate regression analysis revealed that the presence of funisitis was independently associated with a "refer" on the NHS test, whereas use of antenatal corticosteroids was statistically significantly associated with a reduced incidence of "refer" on the screening test. Neither histologic chorioamnionitis nor prematurity (as defined by low gestational age and birth weight) was associated with a "refer" on the NHS test. By contrast, multivariate analysis with occurrence of SNHL as a dependent variable identified no significant associations with the parameters studied, probably owing to the small total number of neonates with permanent SNHL. Presence of funisitis was significantly and independently associated with increased risk of abnormal NHS results, while administration of antenatal corticosteroids was related to a normal NHS result. These findings support the hypothesis that a systemic fetal inflammatory response, manifested as funisitis, might play a role in the pathogenesis of SNHL in preterm neonates.

Recurrence of Preterm Birth and Early Term Birth.

To examine recurrent preterm birth and early term birth in women's initial and immediately subsequent pregnancies. This retrospective cohort study included 163,889 women who delivered their first and second liveborn singleton neonates between 20 and 44 weeks of gestation in California from 2005 through 2011. Data from hospital discharge records and birth certificates were used for analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models adjusted for risk factors. Shorter gestational duration in the first pregnancy increased the risk of subsequent preterm birth (both early, before 32 weeks of gestation, and later, from 32 to 36 weeks of gestation) as well as early term birth (37-38 weeks of gestation). Compared with women with a prior term birth, women with a prior early preterm birth (before 32 weeks of gestation) were at the highest risk for a subsequent early preterm birth (58/935 [6.2%] compared with 367/118,505 [0.3%], adjusted OR 23.3, 95% CI 17.2-31.7). Women with a prior early term birth had more than a twofold increased risk for subsequent preterm birth (before 32 weeks of gestation: 171/36,017 [0.5%], adjusted OR 2.0, 95% CI 1.6-2.3; from 32 to 36 weeks of gestation: 2,086/36,017 [6.8%], adjusted OR 3.0, 95% CI 2.9-3.2) or early term birth (13,582/36,017 [37.7%], adjusted OR 2.2, 95% CI 2.2-2.3). Both preterm birth and early term birth are associated with these outcomes in a subsequent pregnancy. Increased clinical attention and research efforts may benefit from a focus on women with a prior early term birth as well as those with prior preterm birth.

Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.

Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity.

Breastfeeding pattern and the risk of neonatal illnesses among urban poor in Lucknow, Northern India: A prospective follow-up study

BackgroundExclusive breastfeeding has been shown to be protective against infants’ illnesses. Evidence is sparse about the association of different breastfeeding patterns on neonatal illnesses. MethodsThe study was conducted at two urban public hospitals at Lucknow. Neonates who did not have any morbidity or congenital malformation and were residents of Lucknow were enrolled within 48h of birth and followed up once at 6 weeks of age, at the outpatients clinic or home to assess neonatal illnesses and established (voluntary) breastfeeding pattern (exclusive, predominant, partial, never breastfed). Association of established breastfeeding patterns with neonatal illnesses was studied using multivariate logistic regression, adjusting for potential confounders. ResultsA total of 1020 neonates were enrolled. Follow-up information on occurrence of neonatal illnesses (if any) as well as established breastfeeding pattern was available for 937 (91.8%) enrolled neonates. Among these, 46% (431/937) presented with any illness, with 20.2% (189/937) reported with at least one danger sign of severe illnesses as mentioned in Integrated Management of Neonatal and Childhood Illnesses (IMNCI).Partially breastfed neonates were significantly more likely to develop any illness (Adj. OR=6.6; 95% CI: 4.0–10.8, p<0.001) as well as IMNCI illnesses (Adj. OR=5.8; 95% CI: 2.9–11.8, p<0.001) as compared to exclusively breastfed neonates. Similarly, predominantly breastfed neonates were also significantly more likely to develop any illness (Adj. OR=3.4; 95% CI: 2.0–5.8, p<0.001) as well as IMNCI illnesses (Adj. OR=2.9; 95% CI: 1.3–6.4, p<0.01) as compared to exclusively breastfed neonates. The strength and consistency of these associations remained similar on refitting the model with term, singleton, and normal birth weight neonates. ConclusionsExclusive breastfeeding during the neonatal period was significantly protective against the occurrence of any illness as well as illnesses mentioned in the IMNCI program, as compared to predominant or partial breastfeeding.