Speciality
Spotlight

 




 

Obstetric & Gynaecology

 

 




New Born

   

  • Ira M Bernstein, Jeffrey D Horbar, et al for the Vermont Oxford Network.

    Morbidity and mortality among very low-birth weight neonates with intrauterine growth restriction.

    Am J Obstet Gynecol, 2000, 182(1), Part I, pg. 198-206.

       


    The influence of intrauterine growth restriction (IUGR) on the neonatal morbidity associated with prematurity has been disputed in the literature. Initial evidence suggested that IUGR was associated with reductions in the incidences of respiratory distress syndrome (RDS) and intraventricular hemorrhage. These observations supported a view of IUGR as an adaptive reaction to adverse intrauterine conditions that, through the initiation of a fetal stress response, led to improvements in gestational age-specific neonatal morbidity. Recent data have suggested that there is either no change or a significant increase in the risk of RDS associated with IUGR and no difference in the incidence of intraventricular hemorrhage. However, these studies failed to adjust for potential confounding variables that can alter the interpretation of the risk specific to IUGR. This study therefore examined the association of IUGR with neonatal morbidity and mortality while adjusting for perinatal variables that have been demonstrated to influence neonatal illness and survival in the very-low-birth-weight population.

        


    The potential benefit of antenatal glucocorticoid therapy for the infant with IUGR is unclear. In the National Institutes of Health consensus report the use of prenatal glucocorticoid therapy in the presence of IUGR was recommended, but no specific data were cited. A recent trial suggested that there is no benefit to the prenatal administration of glucocorticoids when IUGR is present. The effect of prenatal glucocorticoid administration on neonates with IUGR has been identified by the National Institutes of Health consensus report as an area in need of further clarification. The authors therefore also sought to determine the impact of prenatal glucocorticoid administration on the frequencies of specific complications of prematurity in the neonates with
    IUGR.

         


    Study Design: The authors examined the association between the intrauterine growth restriction and adverse neonatal outcomes in a population of 19,75789 singleton very low-birth-weight neonates without major birth defects. The neonates included were from 25 to 30 weeks’ gestation entered in the Vermont Oxford Network database between 1991 and 1996 by 196 institutions. Intrauterine growth restriction was defined as the 10th percentile for birth weight according to the 1993 US national statistics. Odd ratios were estimated according to stepwise logistic regression for each neonatal outcome. Potential explanatory variables included gestational age, intrauterine growth restriction, race, prenatal care, prenatal glucocorticoid administration, route of delivery, fetal sex, and birth within versus postnatal transfer to a network institution.

        


    Results : There was a statistically significant association of intrauterine growth restriction with neonatal death (odds ration, 2.77; 95% confidence interval, 2.31-3.33), necrotizing enterocolitis (odds ratio, 1.27; 95% confidence interval, 1.05-1.53), and respiratory distress syndrome (odds ratio, 1,19; 95% confidence interval 1.03-1.36). There was a trend (P<. 10) toward association of intrauterine growth restriction with increased risks of intraventricular hemorrhage (odds ratio, 1.13; 95% confidence interval, 0.99-1.29) and severe intraventricular hemorrhage (grades III and IV; odds ratio, 1.25; 95% confidence interval, 0.98-1.59). Maternal prenatal glucocorticoid administration was associated with significantly lower risks of respiratory distress syndrome (odds ratio, 0.51; 95% confidence interval, 0.44-0.58), intraventricular hemorrhage (odds ratio, 0.67; 95% confidence interval, 0.61-0.73), severe intraventricular hemorrhage (odds ratio, 0.50; 95% confidence interval, 0.43-0.57), and death (odds ratio, 0.54; 95% confidence interval, 0.48-0.62). The benefits of prenatal glucocorticoid therapy for growth restricted newborns were similar to those among normally grown infants.

        


    Conclusions: Intrauterine growth restriction within the range of 501 to 1500 g birth weight is associated with increased risks of neonatal death, necrotizing enterocolitis, and respiratory distress syndrome. Prenatal corticosteroid use was associated with decreased risks of all outcomes studied except necrotizing enterocolitis. The authors found no evidence that this benefit was dependent on fetal size.

       

  • Cytomegalovirus
    Infection and HIV-1 Disease Progression in Infants
    Born to HIV-1-infected Women.

    A Kovacs,  for the Pediatric Pulmonary and
    Cardiovascular Complications of Vertically Transmitted
    HIV Infection Study Group (Univ of Southern
    California, Los Angeles).

    N Engl J Med 341: 77-84, 1999

       

    Background – Cytomegalovirus (CMV) appears to play a
    role in the progression of HIV-1 disease progression
    was studied in 365 uninfected patients and 75 HIV-1
    infected patients.

       

    Infants with and without HIV-1 infection have similar
    rates of CMV infection in utero. However, HIV-1
    infected infants have greater rates of CMV infection
    acquired perinatally or in the first 4 years of life.
    Co-infection with CMV is significantly associated with
    rapid HIV-1 disease progression and, in some children,
    early devastating CNS disease. Future studies should
    focus on strategies to prevent CMV infection in these
    high-risk babies.

       

  • AL
    Stewart, et al (Univ College, London; Inst of
    Psychiatry, King’s College, London; Univ College
    London; et al)

    Brain Structure and Neurocognitive and Behavioural
    Function in Adolescents Who were Born Very Preterm. 


    Lancet 353: 1653-1657,1999.

        

    Background : Neonatal ultrasound can predict the neuro
    developmental outcomes of children born before 33
    weeks of gestation up to the age of 8 years. However,
    their later function is not well documented. The
    effects of very preterm birth on brain structure and
    neurocognitive and behavioural functioning in
    adolescence were investigated.

       

    Conclusion: Children born very preterm have an excess
    of neurocognitive and behavioral problems in
    adolescence. More than half of these adolescents had
    abnormal MRI brain scans.

        

    In the interest of providing perinatologists with
    solid information for predicting the long-term
    consequences of cranial ultrasound findings on infants
    born at or before 33 weeks gestational age, the
    authors provide us with their fifth review of
    follow-up data derived from MRI, this time conducted
    at a mean age of 14.9 years.

        

    Of the 72 infants born preterm, 55% had abnormal MRIs
    on follow-up and 42% were normal. Perinatal ultrasound
    therefore grossly underestimates the likelihood of
    abnormal MRI findings in the teen years. The results
    are not so clear with respect to cognitive and
    behavioral function. There was no clear relationship
    between brain structure and neurologic outcome.

       

  • JH
    Dussault, DA Fisher 
    (CHUL, Quebec; Nichols Inst, San Juan
    Capistrano, Calif; Harbor UCLA Med Ctr, Torrence,
    California)

    Thyroid Function in Mothers of
    Hypothyroid Newborns.


    Obstet Gynecol  93:15-20, 1999.

        

    Background:  autoimmune
    thyroid disease is relatively common in women in their
    childbearing years. The
    etiologic significance of maternal autoimmune thyroid
    disease in the incidence of transient congenital
    hypothyroidism in newborns was investigated.

        

    It was found that if not all, cases of transient
    congenital hypothyroidism could be attributed to
    maternal autoimmune thyroid disease and, presumably,
    to maternal TSH receptor-blocking antibody. 
    Maternal autoimmune thyroid disease appears to
    be associated with a much greater prevalence of
    autoimmune thyroid disease and thyroid dysfunction in
    the mothers of congenitally hypothyroid infants was
    20%, thyroid assessment is indicated in such women.

        

      



 

 

Speciality Spotlight

 

 

New Born
   

  • Ira M Bernstein, Jeffrey D Horbar, et al for the Vermont Oxford Network.
    Morbidity and mortality among very low-birth weight neonates with intrauterine growth restriction.
    Am J Obstet Gynecol, 2000, 182(1), Part I, pg. 198-206.
       
    The influence of intrauterine growth restriction (IUGR) on the neonatal morbidity associated with prematurity has been disputed in the literature. Initial evidence suggested that IUGR was associated with reductions in the incidences of respiratory distress syndrome (RDS) and intraventricular hemorrhage. These observations supported a view of IUGR as an adaptive reaction to adverse intrauterine conditions that, through the initiation of a fetal stress response, led to improvements in gestational age-specific neonatal morbidity. Recent data have suggested that there is either no change or a significant increase in the risk of RDS associated with IUGR and no difference in the incidence of intraventricular hemorrhage. However, these studies failed to adjust for potential confounding variables that can alter the interpretation of the risk specific to IUGR. This study therefore examined the association of IUGR with neonatal morbidity and mortality while adjusting for perinatal variables that have been demonstrated to influence neonatal illness and survival in the very-low-birth-weight population.
        
    The potential benefit of antenatal glucocorticoid therapy for the infant with IUGR is unclear. In the National Institutes of Health consensus report the use of prenatal glucocorticoid therapy in the presence of IUGR was recommended, but no specific data were cited. A recent trial suggested that there is no benefit to the prenatal administration of glucocorticoids when IUGR is present. The effect of prenatal glucocorticoid administration on neonates with IUGR has been identified by the National Institutes of Health consensus report as an area in need of further clarification. The authors therefore also sought to determine the impact of prenatal glucocorticoid administration on the frequencies of specific complications of prematurity in the neonates with IUGR.
         
    Study Design: The authors examined the association between the intrauterine growth restriction and adverse neonatal outcomes in a population of 19,75789 singleton very low-birth-weight neonates without major birth defects. The neonates included were from 25 to 30 weeks’ gestation entered in the Vermont Oxford Network database between 1991 and 1996 by 196 institutions. Intrauterine growth restriction was defined as the 10th percentile for birth weight according to the 1993 US national statistics. Odd ratios were estimated according to stepwise logistic regression for each neonatal outcome. Potential explanatory variables included gestational age, intrauterine growth restriction, race, prenatal care, prenatal glucocorticoid administration, route of delivery, fetal sex, and birth within versus postnatal transfer to a network institution.
        
    Results : There was a statistically significant association of intrauterine growth restriction with neonatal death (odds ration, 2.77; 95% confidence interval, 2.31-3.33), necrotizing enterocolitis (odds ratio, 1.27; 95% confidence interval, 1.05-1.53), and respiratory distress syndrome (odds ratio, 1,19; 95% confidence interval 1.03-1.36). There was a trend (P<. 10) toward association of intrauterine growth restriction with increased risks of intraventricular hemorrhage (odds ratio, 1.13; 95% confidence interval, 0.99-1.29) and severe intraventricular hemorrhage (grades III and IV; odds ratio, 1.25; 95% confidence interval, 0.98-1.59). Maternal prenatal glucocorticoid administration was associated with significantly lower risks of respiratory distress syndrome (odds ratio, 0.51; 95% confidence interval, 0.44-0.58), intraventricular hemorrhage (odds ratio, 0.67; 95% confidence interval, 0.61-0.73), severe intraventricular hemorrhage (odds ratio, 0.50; 95% confidence interval, 0.43-0.57), and death (odds ratio, 0.54; 95% confidence interval, 0.48-0.62). The benefits of prenatal glucocorticoid therapy for growth restricted newborns were similar to those among normally grown infants.
        
    Conclusions: Intrauterine growth restriction within the range of 501 to 1500 g birth weight is associated with increased risks of neonatal death, necrotizing enterocolitis, and respiratory distress syndrome. Prenatal corticosteroid use was associated with decreased risks of all outcomes studied except necrotizing enterocolitis. The authors found no evidence that this benefit was dependent on fetal size.
       

  • Cytomegalovirus Infection and HIV-1 Disease Progression in Infants Born to HIV-1-infected Women.
    A Kovacs,  for the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study Group (Univ of Southern California, Los Angeles).
    N Engl J Med 341: 77-84, 1999
       
    Background – Cytomegalovirus (CMV) appears to play a role in the progression of HIV-1 disease progression was studied in 365 uninfected patients and 75 HIV-1 infected patients.
       
    Infants with and without HIV-1 infection have similar rates of CMV infection in utero. However, HIV-1 infected infants have greater rates of CMV infection acquired perinatally or in the first 4 years of life. Co-infection with CMV is significantly associated with rapid HIV-1 disease progression and, in some children, early devastating CNS disease. Future studies should focus on strategies to prevent CMV infection in these high-risk babies.
       

  • AL Stewart, et al (Univ College, London; Inst of Psychiatry, King’s College, London; Univ College London; et al)
    Brain Structure and Neurocognitive and Behavioural Function in Adolescents Who were Born Very Preterm. 
    Lancet 353: 1653-1657,1999.
        
    Background : Neonatal ultrasound can predict the neuro developmental outcomes of children born before 33 weeks of gestation up to the age of 8 years. However, their later function is not well documented. The effects of very preterm birth on brain structure and neurocognitive and behavioural functioning in adolescence were investigated.
       
    Conclusion: Children born very preterm have an excess of neurocognitive and behavioral problems in adolescence. More than half of these adolescents had abnormal MRI brain scans.
        
    In the interest of providing perinatologists with solid information for predicting the long-term consequences of cranial ultrasound findings on infants born at or before 33 weeks gestational age, the authors provide us with their fifth review of follow-up data derived from MRI, this time conducted at a mean age of 14.9 years.
        
    Of the 72 infants born preterm, 55% had abnormal MRIs on follow-up and 42% were normal. Perinatal ultrasound therefore grossly underestimates the likelihood of abnormal MRI findings in the teen years. The results are not so clear with respect to cognitive and behavioral function. There was no clear relationship between brain structure and neurologic outcome.
       

  • JH Dussault, DA Fisher  (CHUL, Quebec; Nichols Inst, San Juan Capistrano, Calif; Harbor UCLA Med Ctr, Torrence, California)
    Thyroid Function in Mothers of Hypothyroid Newborns.
    Obstet Gynecol  93:15-20, 1999.
        
    Background:  autoimmune thyroid disease is relatively common in women in their childbearing years. The etiologic significance of maternal autoimmune thyroid disease in the incidence of transient congenital hypothyroidism in newborns was investigated.
        
    It was found that if not all, cases of transient congenital hypothyroidism could be attributed to maternal autoimmune thyroid disease and, presumably, to maternal TSH receptor-blocking antibody.  Maternal autoimmune thyroid disease appears to be associated with a much greater prevalence of autoimmune thyroid disease and thyroid dysfunction in the mothers of congenitally hypothyroid infants was 20%, thyroid assessment is indicated in such women.
        

      

 

By |2022-07-20T16:43:03+00:00July 20, 2022|Uncategorized|Comments Off on New Born

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