Small Infants Research Articles

Safety and Short-Term Outcomes for Infants < 2.5kg Undergoing PDA Device Closure: A C3PO Registry Study.

To evaluate short-term procedural outcomes and safety for infants < 2.5kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0kg (range 0.7-2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.

Laparoscopic nipple invagination combined extravesical (NICE) reimplantation technique in the management of primary obstructed megaureter

Villanueva challenged Paquin's 5:1 tunnel length and showed in a computer simulation model that UVJ competence was more sensitive to a 2-mm protrusion of ureteric orifice into the bladder compared to an increase in the intravesical tunnel. Thompson later successfully applied the Shanfield technique of invaginating the spatulated primary obstructed megaureter (POM) laparoscopically, causing a nipple antireflux mechanism. In this study we have reported the outcomes of our modification: Nipple Invagination Combined Extravesical (NICE) reimplantation, in the management of POM. Patients with POM who underwent NICE reimplantation (summary figure) were followed up and outcomes were analysed. There were three modifications in this compared to Shanfield technique: 1. Detrusor myotomy was performed before opening the bladder mucosa. The detrusor edges were closed later over the invaginated ureter as an extravesical reimplantation. 2. The ureter was held invaginated inside the bladder mucosal opening by two sutures at 6 & 12 O' clock positions instead of a single suture, 3. The dilated ureter was not spatulated inferiorly, as it automatically opens out later inside the bladder to form a nipple. Eleven patients underwent laparoscopic NICE reimplantation; median age: 6 months (5-24); demographics (R: L=5:6; M:F=7:4). The mean duration of surgery was 133min (110-180) and the mean length of hospital stay was 3.6 days (3-5). There were no immediate post-operative complications in the form of leak in any patient. The median follow-up duration was 20 months (18-29). DRF improved in 7 patients while in 4 it remained static; no patient had deterioration. On follow-up VCUG, none had vesico-ureteric reflux (VUR). The nipple effect could be noticed later at follow-up ultrasonograms and at cystoscopy during stent removal. Paquin emphasised on 5:1 ureteral re-implant tunnel length while Lyon felt that the shape of the ureteral orifice was more important. Shanfield introduced a technique of creating a nipple valve effect by invaginating the ureter intravesically. However it was held by a single suture and had no detrusor backing. NICE reimpantation incorporates a short extra vesical reimplant to the Shanfield technique and literally eliminates post-operative VUR. It is simple and could easily be performed laparoscopically even in small infant bladders. The ureteric orifice kept in line enables future upper-tract access. Our preliminary data suggests that the NICE reimplantation for POM is very successful. Limitations are small numbers and short follow-up. Further larger studies are warranted to authenticate this novel technique.

Pigtail chest drain-related organ injuries in preterm neonates

Pigtail catheters are increasingly used in Neonatal Intensive Care Units. Despite being easier to position, presumably less invasive, and non-inferior to classic trocar drains, complications related to placement have been sporadically reported. We describe 3 cases of traumatic injury to neighboring organs and structures related to pigtail catheter positioning in small preterm infants. In the absence of formal neonatal guidelines, accurate estimation of needle and guidewire depth and ultrasonography guidance may contribute to prevent such dreadful complications.

ROCURONIUM BROMIDE – ESMERON

&lt;div&gt;&lt;p&gt;Repeated neuromuscular-blocking agent administration lengthens the duration of action, and intraoperative use of high doses of neuromuscular-blocking agent may compromise respiratory security. We tested the main hypothesis that intermediate-acting neuromuscular-blocking agents are dose dependently associated with the risk of postoperative respiratory complications in a hospital-based registry study that took place between January 2022 and June 2022 on 70 patients that we worked with who received these medications. Additionally, we looked at the relationship between respiratory problems and the dose of neostigmine used to reverse neuromuscular blockers. We assessed the impact of proper neostigmine reversal on respiratory complications post hoc. Compared to low doses, high doses of neuromuscular-blocking drugs were linked to a higher risk of postoperative respiratory complications. A dose-dependent increase in the risk of postoperative respiratory complications was linked to neostigmine. According to post hoc analysis, the dose-dependent relationship between neuromuscular-blocking drugs and respiratory complications was eliminated by the proper neostigmine reversal. The risk of postoperative respiratory complications was dose-dependently correlated with the use of neuromuscular-blocking drugs. The risk of respiratory complications increased dose-dependently after neostigmine reversal. The exploratory data analysis, however, indicates that the proper use of neostigmine, guided by the results of the monitoring of neuromuscular transmission, can help eliminate the postoperative respiratory complications brought on by the use of neuromuscular-blocking drugs. For newborns and small infants, rocuronium should be administered in lower doses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;span&gt;Keywords: &lt;/span&gt;&lt;/strong&gt;&lt;span&gt;respiratory complications, Esmeron, neostigmine, surgery, anesthetic, intubation, etc.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;

Adverse Maternal and Infant Outcomes of Women Who Differ in Smoking Status: E-Cigarette and Tobacco Cigarette Users.

The electronic cigarette (e-cigarette) became commercially available around 2004, yet the characteristics of pregnant women who use these devices and their effects on maternal and infant health remain largely unknown. This study aimed to investigate maternal characteristics and pregnancy outcomes according to maternal smoking status. We conducted a cross-sectional study of Dutch women with reported pregnancies between February 2019 and May 2022, using an online questionnaire to collect data on smoking status and demographic, lifestyle, pregnancy, and infant characteristics. Smoking status is compared among non-smokers, tobacco cigarette users, e-cigarette users, and dual users (tobacco and e-cigarette). We report descriptive statistics and calculate differences in smoking status between women with the chi-square or Fisher (Freeman-Halton) test. Of the 1937 included women, 88.1% were non-smokers, 10.8% were tobacco cigarette users, 0.5% were e-cigarette users, and 0.6% were dual users. Compared with tobacco users, e-cigarette users more often reported higher education, having a partner, primiparity, and miscarriages. Notably, women who used e-cigarettes more often had small infants for gestational age. Despite including few women in the e-cigarette subgroup, these exploratory results indicate the need for more research to examine the impact of e-cigarettes on pregnancy outcomes.

Lumasiran for primary hyperoxaluria type 1: What we have learned?

Primary hyperoxaluria type 1 (PH1) is a rare autosomal recessive genetic disorder caused by mutations in the AGXT gene. The hepatic peroxisomal enzyme alanine glyoxylate aminotransferase (AGT) defects encoded by the AGXT gene increase oxalate production, resulting in nephrocalcinosis, nephrolithiasis, chronic kidney disease, and kidney failure. Traditional pharmacological treatments for PH1 are limited. At present, the treatment direction of PH1 is mainly targeted therapy which refer to a method that targeting the liver to block the pathway of the production of oxalate. Lumasiran (OxlumoTM, developed by Alnylam Pharmaceuticals), an investigational RNA interference (RNAi) therapeutic agent, is the first drug approved for the treatment of PH1, which was officially approved by the US Food and Drug Administration and the European Union in November 2020. It is also the only drug that has been shown to decrease harmful oxalate. Currently, there are 5 keys completed and ongoing clinical trials of lumasiran in PH1. Through the three phase III trials that completed the primary analysis period, lumasiran has been shown to be effective in reducing oxalate levels in urine and plasma in different age groups, such as children, adults, and patients with advanced kidney disease, including those on hemodialysis. In addition to clinical trials, cases of lumasiran treatment for PH1 have been reported in small infants, twin infants, and children diagnosed with PH1 after kidney transplantation. These reports confirm the effectiveness and safety of lumasiran. All adverse events were of mild to moderate severity, with the most common being mild, transient injection-site reactions. No deaths or severe adverse events were reported. This article reviews PH1 and lumasiran which is the only approved therapeutic drug, and provide new options and hope for the treatment of PH1.

Small for gestational age offspring of short stature mothers and the risk of respiratory morbidity

Small for gestational age (SGA) definition does not distinguish SGA infants who are constitutionally small from small infants with intrauterine growth restriction. It remains challenging to determine whether a neonate is constitutionally small, but this diagnosis is more likely when one or both parents are also small and after excluding other reasons. SGA newborns are at increased risk for pulmonary hypertension and hypoxia. We aimed to study the association between SGA infants born to short-stature mothers (assuming constitutional) and long-term respiratory related morbidity compared to SGA infants born to non-short mothers.

Efficacy and outcomes of pulmonary artery banding: Our experience in Azerbaijan

Aim: We conducted a retrospective analysis of 35 patients with various congenital heart defects who underwent pulmonary artery banding (PAB) between January 2018 and September 2023. Our objective was to evaluate the outcomes of PAB and discuss its application in a staged approach for these patients. Material and Methods: The median age at PAB was 5 months (range: 2 to 20 months) with a median weight of 5.2 kg (range: 3 to 9 kg). Results: The hospital and total mortality rates were 11.4% (4). The median intensive care unit stay was 2 days (range: 1 to 22 days), and the median hospital stay was 5 days (range: 5 to 36 days). The second stage (either total correction or cava-pulmonary anastomosis) was achieved in 40% (14/35) of patients at a median age of 15 months. The mean interval to repair was 8 months, with 12 out of 14 patients undergoing complete biventricular repair. Conclusion: Our study demonstrates that PAB could be performed with acceptable outcomes, serving as a viable palliative measure for neonates and extremely small infants who are at high risk for cardiopulmonary bypass. Our study results exhibit a comparable trend to previously reported findings, emphasizing the importance of PAB in managing congenital heart malformations characterized by increased pulmonary blood flow. While the effectiveness of PAB has been validated in our study, future investigations could delve into refining surgical protocols, optimizing band adjustment techniques, and exploring potential preventive measures for common postoperative complications.

Pure laparoscopic left lateral graft procurement with removing segment 3 employing Glissonean approach, indocyanine green fluorescence imaging and in situ splitting for a small infant.

We report on a pure laparoscopic left lateral graft procurement with removing segment 3 that employs the Glissonean approach, indocyanine green (ICG) fluorescence imaging and in situ splitting. We first mobilised the liver and confirmed the root of the left hepatic vein (LHV). We then encircled the left Glissonean pedicle, and the segment 3 Glissonean pedicle (G3) was also individually encircled. We performed parenchymal transection of the left lateral segmentectomy using Pringle's manoeuvre. We clipped G3 and confirmed the demarcation line using ICG fluorescence imaging. The inflow in the S2 area was confirmed via intraoperative sonography, and we split segment 3 (S3) from the left lateral sector graft in situ. The left hepatic artery, left portal vein and left hepatic duct were also encircled and divided. The LHV was transected using a linear stapler, and the S2 monosegment liver graft and removed S3 were procured. Our technique reasonably prevents graft-related complications.

Single-Incision Open versus Laparoscopic Gastrostomy in Infants: A Comparative Study

Abstract Background: Gastrostomy tube can be inserted through a single incision without laparoscopic or endoscopic guidance. The superiority of this approach over the laparoscopic technique is still debated. Therefore, we aimed to compare single-incision open and laparoscopic gastrostomy in infants. Materials and Methods: We retrospectively reviewed paediatric patients aged 12 months or less who required enteral feeding between 2006 and 2019. Patients were grouped according to the technique into two groups. Group 1 (n = 42) included patients who had a single incision open gastrostomy, and Group 2 (n = 45) included patients who underwent laparoscopic gastrostomy. Results: The median age was 2 months (Q1-Q3: 1–4 months) in Group 1 and 5 months (3–6 months) in Group 2 (P &lt; 0.001). Male presented 52.38% in Group 1 and 37.78% in Group 2 (P = 0.17). There were no differences in cardiac and neurological comorbidities between the groups. Operative time was significantly shorter in Group 1 (23 [20–25] vs. 40 [35–45] min; P &lt; 0.001). There were no differences in the post-operative leak around the tube (P &gt; 0.99), granulation tissue formation (P = 0.36), wound dehiscence (P = 0.61), surgical site infection (P &gt; 0.99) and pneumonia (P = 0.10) between the groups. Conclusion: Single-incision open and laparoscopic gastrostomy could be effective and safe techniques in infants. The minimal anaesthesia without gas insufflation and short time for the open gastrostomy make it not inferior to laparoscopic gastrostomy and should be considered in small infants.

Maternal Plasma Choline during Gestation and Small for Gestational Age Infants.

Small for gestational age (SGA) infants are at increased risk for neonatal morbidity and developmental problems in childhood. No current interventions during human pregnancy address this problem. This study investigated the possible relationship between maternal choline concentration during pregnancy and SGA infants. Maternal plasma choline concentrations were sampled at 16 and 28 weeks' gestation from women in a public prenatal clinic. Additional factors assessed were maternal age, body mass index, infection, C-reactive protein, hair cortisol, and compliance with prenatal vitamins and folate. Infants below the 10th percentile for gestational age were classified as SGA. Binary logistic regression was used to identify significant associated factors in pregnancies resulting in SGA infants compared with pregnancies resulting in non-SGA infants. Thirteen (8%) of 159 women had SGA infants. Maternal plasma choline concentrations were low for pregnant participants whose infants were SGA, with the 28-week concentration significantly lower compared with other participants. Plasma choline concentrations ≥7 μM at 28 weeks, consistent with a minimally adequate dietary intake of choline-containing foods, were achieved by only 2 (15%) of mothers with SGA infants, compared with 51% of mothers whose infants were not SGA. Choline concentrations <7 μM at 28 weeks' gestation were associated with an odds ratio for SGA of 16.6 (95% confidence interval: 1.5-189.2, p = 0.023). Other significant factors were female sex and maternal C-reactive protein plasma concentration during gestation. This observational study suggests that higher maternal choline levels may influence the risk for SGA. Maternal plasma choline concentrations are not routinely available in clinical laboratories. However, plasma choline levels can be increased by the mothers' intake of choline or phosphatidylcholine supplements. No nutritional intervention is currently recommended to prevent SGA, but the evidence from this study suggests that further consideration of the role of maternal choline may be warranted. · More females are small for gestational age.. · Low maternal choline is related to small infants.. · Maternal choline ≥7 μM at 28 weeks appears optimal..

Definitive repair of pulmonary atresia with ventricular septal defect using valved conduit for low body weight infant

Pulmonary atresia with ventricular septal defect is a complex congenital heart defect whose management varies depending on the anatomy of pulmonary circulation and surgeon’s preferences. The surgical outcomes of complete repair in small infants and neonates in Vietnam have been seldomly reported. We reported our medium-term results of complete repair of this complex lesion using valved conduit in infants and neonates at our institution. The study included 25 patients with the body weight of less than 5kg who underwent definitive repair using valved conduit between January 2016 and December 2021. The median age at surgery was 66 days (IQR 45 – 116 days), and the mean body weight was 4 kg (3 – 5). Most (96%) attended all follow-up visits, and the average follow-up time was 37.4 months (8.4 – 69.3). There was 1 in-hospital death and 2 late mortalities. The 30-days and 5 years survival rate were 96% and 83%, respectively. One patient required conduit replacement at 3 years post operative because of conduit failure. The proportion of patients with freedom from conduit replacement at 5 years was 95%. Three cases required balloon dilatation of the left pulmonary artery due to stenosis. Freedom from all reinterventions and reoperations at 5 years was 52%. Definitive repair of this type of complex heart defect in small infants can be performed safely and resulted in good surgical outcomes.

Novel trace elements detected in multiple stages of pregnancy impact neonatal birth weight by affecting gestational age

Prenatal exposure to elements may be associated with birth weight via shortening of gestation. This study aimed to determine if prenatal exposure is associated with birth weight, and to explore the potential mediating role of gestational age in the association. Within an established Bangladesh prospective birth cohort (2008–2011), we analyzed the concentrations of 15 elements in maternal serum samples collected during the first (n = 780) and second (n = 610) trimesters using inductively coupled plasma mass spectrometry. Mediation analyses explored the relationships between these elements, gestational age, and birth weight. Serum concentrations of cobalt (Co) (first trimester: b = 56.5; 95% confidence interval [CI]: 13.5–99.0; false discovery rate [FDR]-q = 0.035; second trimester: b = 73.3; 95% CI: 20.4–130.2; FDR-q = 0.037) and antimony (Sb) in both trimesters (first trimester:b = 92.1; 95% CI: 66.0–118.9; FDR-q < 0.001; second trimester: b = 93.3; 95% CI: 67.3–118.4; FDR-q < 0.001), and strontium (Sr) in the first trimester (b = 142.4; 95% CI: 41.6–247.9; FDR-q = 0.035) were positively associated with birth weight, while negative associations were observed for barium (Ba) (first trimester: b = −154.8; 95% CI: −217.9 to 91.8; FDR-q <0.001; second trimester: b = −26.7; 95% CI: −44.9 to 10.2; FDR-q < 0.001). These elements act partially by affecting gestation age and appear to have heightened impact among smaller infants. Further research is needed to determine the biological underpinnings of these effects, which may inform strategies to avert low birth weight.

Risk factors associated with device embolisation or malposition during transcatheter closure of patent ductus arteriosus.

Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation. Demographic parameters, echocardiographic anatomy, haemodynamics, and procedural characteristics of consecutive duct closures in a tertiary centre over 8 years were analysed. Procedures complicated by embolisation were compared to uncomplicated procedures. Fifteen embolisations occurred during 376 procedures. All except one embolisation were in infants. The pulmonary artery: aortic pressure ratio was 0.78 ± 0.22. Embolisation was seen significantly more commonly in Type C tubular ducts. Vascular plugs were more significantly associated with embolisations. Logistic regression analysis showed device embolisation was significantly higher in age group of < 6 months compared to 6-12 months (p = 0.02), higher in those with tubular ducts versus conical ducts (p = 0.003), use of vascular plugs compared to conventional duct occluders (p = 0.05), and in duct closure with undersized devices (p = 0.001). There was no in-hospital mortality. Three patients needed surgical retrieval while others were successfully managed in catheterisation laboratory. Device embolisation complicates 4% of transcatheter duct closures, with need for surgery in one-fifth of them. Larger ducts with high pulmonary artery pressures in younger and smaller infants are more often associated with device embolisation. Tubular ducts are more prone for embolisation compared to usual conical ducts. Softer vascular plugs are often associated with embolisations. Intentional device undersizing to avoid vascular obstruction in small patients is a frequent risk factor for embolisation. Precise echocardiographic measurements, correct occluder choice, proper technique and additional care in patients with high pulmonary artery pressures are mandatory to minimise embolisations.

The confound of head position in within-session connectome fingerprinting in infants

Individuals differ in their functional connectome, which can be demonstrated using a “fingerprinting” analysis in which the connectome from an individual in one dataset is used to identify the same person from an independent dataset. Recently, the origin of these fingerprints has been studied by examining if they are present in infants. The results have varied considerably, with identification rates from 10 to 90%. When fingerprinting has been performed by splitting a single imaging session into two split-sessions (within session), identification rates were higher than when two full-sessions (between sessions) were compared. This study examined whether a methodological difference could account for this variation. It was hypothesized that the infant's exact head position in the head coil may affect the measured connectome, due to the gradual inhomogeneity of signal-to-noise in phased-array coils and the breadth of possible positions for a small infant head in a head coil. This study examined the impact of this using resting state functional MRI data from the Developing Human Connectome Project second release. Using functional timeseries, fingerprinting identification was high (84-91%) within a session while between sessions it was low (7%).Using N = 416 infants’ head positions, a map of the average signal-to-noise across the physical volume of the head coil was calculated and was used (independent group of 44 infants with two scan sessions) to demonstrate a significant relationship between head position in the head coil and functional connectivity. Using only the head positions (signal-to-noise values extrapolated from the group average map) of the independent group of 44 infants, high identification success was achieved across split-sessions (within session) but not full-sessions (between sessions). Using a model examining factors influencing the stability of the functional connectome, head position was seen as the strongest of the explanatory variables. We conclude within-session fingerprinting is affected by head position and future infant functional fingerprint analyses must use a different strategy or account for this impact.

Splenic Vessels as a Rescue for Pediatric Kidney Retransplantation in Children With Iliac-caval Agenesis or Thrombosis.

Unavailability of the iliac-caval system due to thrombosis or aberrant anatomy may preclude kidney transplantation (KT) in small infants, exposing them to the complications of long-term dialysis. A tailored approach may enable KT also in these difficult patients. We report the cases of 2 pediatric patients with a history of long-term hemodialysis, a previously failed KT, pending exhaustion of vascular accesses for dialysis, and unsuitability of the iliac-caval axis as a site for KT. Both patients were successfully managed by using splenic vessels as a source of arterial inflow or venous drainage during KT. Notably, one patient also had a previous liver transplant. Both kidney grafts showed primary function. Posttransplant courses were uneventful, and no rejection episode was observed. At 64- and 10-mo follow-ups, both children had optimal renal function and excellent quality of life. When the iliac-caval system is unavailable, kidney graft implantation on splenic vessels represents a safe and effective option for pediatric KT.

Flexible treatment of gestational diabetes mellitus adjusted according to intrauterine fetal growth versus treatment according to strict maternal glycemic parameters: a randomized clinical trial

IntroductionTo compare the conventional treatment of gestational diabetes mellitus (GDM) with flexible treatment according to the measurement of fetal abdominal circumference (AC) in daily clinical practice.Research design and methodsTwo hundred...

Pathogenesis of Bronchopulmonary Dysplasia: Role of Oxidative Stress from 'Omics' Studies.

Bronchopulmonary dysplasia (BPD) remains the most common respiratory complication of prematurity as younger and smaller infants are surviving beyond the immediate neonatal period. The recognition that oxidative stress (OS) plays a key role in BPD pathogenesis has been widely accepted since at least the 1980s. In this article, we examine the interplay between OS and genetic regulation and review 'omics' data related to OS in BPD. Data from animal models (largely models of hyperoxic lung injury) and from human studies are presented. Epigenetic and transcriptomic analyses have demonstrated several genes related to OS to be differentially expressed in murine models that mimic BPD as well as in premature infants at risk of BPD development and infants with established lung disease. Alterations in the genetic regulation of antioxidant enzymes is a common theme in these studies. Data from metabolomics and proteomics have also demonstrated the potential involvement of OS-related pathways in BPD. A limitation of many studies includes the difficulty of obtaining timely and appropriate samples from human patients. Additional 'omics' studies could further our understanding of the role of OS in BPD pathogenesis, which may prove beneficial for prevention and timely diagnosis, and aid in the development of targeted therapies.

Machine learning-based placental clusters and their associations with adverse pregnancy outcomes.

Placental abnormalities have been described in clinical convenience samples, with predominately adverse outcomes. Few studies have described placental patterns in unselected samples. We aimed to investigate associations between co-occurring placental features and adverse pregnancy outcomes in a prospective cohort of singletons. Data were from the Safe Passage study (U.S. and South Africa, 2007-2015). Before 24 weeks' gestation, participants were randomly invited to donate placental tissue at delivery for blinded, standardised pathological examination. We used hierarchical clustering to construct statistically derived groups using 60 placental features. We estimated associations between the placental clusters and select adverse pregnancy outcomes, expressed as unadjusted and adjusted risk ratios (RRs) and robust 95% confidence intervals (CI). We selected a 7-cluster model. After collapsing 2 clusters to form the reference group, we labelled the resulting 6 analytic clusters according to the overarching category of their most predominant feature(s): severe maternal vascular malperfusion (n= 117), fetal vascular malperfusion (n= 222), other vascular malperfusion (n= 516), inflammation 1 (n= 269), inflammation 2 (n= 175), and normal (n= 706). Risks for all outcomes were elevated in the severe maternal vascular malperfusion cluster. For instance, in unadjusted analyses, this cluster had 12 times the risk of stillbirth (RR 12.07, 95% CI 4.20, 34.68) and an almost doubling in the risk of preterm delivery (RR 1.93, 95% CI 1.27, 2.93) compared with the normal cluster. Small infant size was more common among the abnormal clusters, with the highest unadjusted RRs observed in the fetal vascular malperfusion cluster (small for gestational age birth RR 2.99, 95% CI 2.24, 3.98, head circumference <10th percentile RR 2.86, 95% CI 1.60, 5.12). Upon adjustment for known risk factors, most RRs attenuated but remained >1. Our study adds to the growing body of epidemiologic research, finding adverse pregnancy outcomes may occur through etiologic mechanisms involving co-occurring placental abnormalities.

Ultrasound-Guided Dynamic Needle-Tip Positioning Method Is Superior to Conventional Palpation and Ultrasound Method in Arterial Catheterization.

Background: Dynamic needle-tip positioning (DNTP) was shown to improve arterial cannulation efficiency with fewer complications than conventional palpation and ultrasound methods by some studies. However, this is still controversial, and we performed this meta-analysis to comprehensively assess its value in arterial cannulation. Methods: A literature search of randomized controlled trials was conducted, and 11 studies were finally included. Efficiency outcomes (first-attempt success, overall success, and total cannulation time) and complications (hematoma, thrombosis, posterior wall puncture, and vasospasm) were separately analyzed. Subgroup analyses in different populations under cannulation were also performed. Results: DNTP was associated with increased first-attempt success (pooled RR = 1.792, p < 0.001), overall success (pooled RR = 1.368, p = 0.001), and decreased cannulation time (pooled SMD = −1.758, p = 0.001) than palpation. DNTP gained even more advantage in small children and infants. No significant difference in these outcomes between DNTP and conventional ultrasound method was detected. Fewer hematoma occurred in DNTP than palpation (pooled RR = 0.265, p < 0.001) or traditional ultrasound (pooled RR = 0.348, p < 0.001). DNPT was also associated with fewer posterior wall punctures (pooled RR = 0.495, p = 0.001) and vasospasm (pooled RR = 0.267, p = 0.007) than traditional ultrasound. Conclusions: DNTP was a better choice in artery cannulation than conventional palpation and ultrasound method, especially in small children and infants.