RESUMO
BACKGROUND: Twin pregnancies are associated with a high risk of perinatal mortality and morbidity. Late preterm or early term delivery is frequently performed to avoid unexpected fetal death in uncomplicated twin pregnancies. Nonetheless, delivery before full term is associated with neonatal respiratory complications. This study aimed to evaluate perinatal respiratory complications in twins delivered between 36 and 38 weeks of gestation. METHODS: A retrospective cohort study was conducted on twins delivered between 36 and 38 weeks of gestation from January 2008 to June 2020. The primary outcomes were the incidence of composite neonatal respiratory morbidity, which included respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, mechanical ventilation or continuous positive airway pressure according to gestational age at delivery, and chorionicity. The relationship between gestational age at delivery and composite neonatal respiratory morbidity was evaluated using multivariate logistic regression analysis adjusted for potential confounders. RESULTS: This study included 1608 twins (614 monochorionic diamniotic twins, 994 dichorionic diamniotic twins). At 36, 37, and 38 weeks of gestation, the frequencies of composite neonatal respiratory morbidity were 19.4%, 10.7%, and 9.2% in dichorionic diamniotic twins and 13.6%, 8.7%, and 9.4% in monochorionic diamniotic twins, respectively. In dichorionic diamniotic twins, the composite neonatal respiratory morbidity rate was higher for twins delivered at 36 weeks of gestation than for those delivered at 37 weeks. No significant differences between monochorionic diamniotic twins were detected. CONCLUSIONS: In uncomplicated dichorionic diamniotic twin pregnancies, delivery should be considered after 37 weeks of gestation to reduce neonatal respiratory complications.
Assuntos
Idade Gestacional , Gravidez de Gêmeos , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Recém-Nascido , Feminino , Estudos Retrospectivos , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Masculino , Taquipneia Transitória do Recém-Nascido/epidemiologia , Síndrome de Aspiração de Mecônio/epidemiologia , Incidência , Respiração Artificial , Pressão Positiva Contínua nas Vias Aéreas , GêmeosRESUMO
BACKGROUND: The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period. METHODS: Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity. RESULTS: The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties. CONCLUSIONS: Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth. TRIAL REGISTRATION: PACTR ( www.pactr.org ) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.
Assuntos
Dexametasona , Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Feminino , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Gravidez , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Adulto , Estudos Prospectivos , Glucocorticoides/administração & dosagem , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/métodos , Taquipneia Transitória do Recém-Nascido/epidemiologia , Idade GestacionalRESUMO
BACKGROUND: A systematic review and meta-analysis from 2013 reported increased risks of congenital malformations, neonatal death and neonatal hospitalization amongst infants born to women with asthma compared to infants born to mothers without asthma. OBJECTIVE: Our objective was to update the evidence on the associations between maternal asthma and adverse neonatal outcomes. SEARCH STRATEGY: We performed an English-language MEDLINE, Embase, CINAHL, and COCHRANE search with the terms (asthma or wheeze) and (pregnan* or perinat* or obstet*). SELECTION CRITERIA: Studies published from March 2012 until September 2023 reporting at least one outcome of interest (congenital malformations, stillbirth, neonatal death, perinatal mortality, neonatal hospitalization, transient tachypnea of the newborn, respiratory distress syndrome and neonatal sepsis) in a population of women with and without asthma. DATA COLLECTION AND ANALYSIS: The study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality of individual studies was assessed by two reviewers independently using the Newcastle-Ottawa Scale. Random effects models (≥3 studies) or fixed effect models (≤2 studies) were used with restricted maximum likelihood to calculate relative risk (RR) from prevalence data and the inverse generic variance method where adjusted odds ratios (aORs) from individual studies were combined. MAIN RESULTS: A total of 18 new studies were included, along with the 22 studies from the 2013 review. Previously observed increased risks remained for perinatal mortality (relative risk [RR] 1.14, 95% confidence interval [CI]: 1.05, 1.23 n = 16 studies; aOR 1.07, 95% CI: 0.98-1.17 n = 6), congenital malformations (RR 1.36, 95% CI: 1.32-1.40 n = 17; aOR 1.42, 95% CI: 1.38-1.47 n = 6), and neonatal hospitalization (RR 1.27, 95% CI: 1.25-1.30 n = 12; aOR 1.1, 95% CI: 1.07-1.16 n = 3) amongst infants born to mothers with asthma, while the risk for neonatal death was no longer significant (RR 1.33, 95% CI: 0.95-1.84 n = 8). Previously reported non-significant risks for major congenital malformations (RR1.18, 95% CI: 1.15-1.21; aOR 1.20, 95% CI: 1.15-1.26 n = 3) and respiratory distress syndrome (RR 1.25, 95% CI: 1.17-1.34 n = 4; aOR 1.09, 95% CI: 1.01-1.18 n = 2) reached statistical significance. CONCLUSIONS: Healthcare professionals should remain aware of the increased risks to neonates being born to mothers with asthma.
Assuntos
Asma , Mortalidade Perinatal , Complicações na Gravidez , Humanos , Gravidez , Asma/epidemiologia , Feminino , Recém-Nascido , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Anormalidades Congênitas/epidemiologia , Hospitalização/estatística & dados numéricos , Morte Perinatal , Natimorto/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , LactenteRESUMO
BACKGROUND: To investigate the relationship between neonatal urine bisphenol A (BPA) levels and the prevalence and prognosis of transient tachypnea of the newborn (TTN). METHODS: This prospective study was conducted between January and April 2020 in the Neonatal Intensive Care Unit (NICU) of Gaziantep Cengiz Gökçek Obstetrics and Pediatric Hospital. The study group consisted of patients diagnosed with TTN and the control group was made up of healthy neonates housed together with their mothers. Urine samples were collected from the neonates within the first 6 hours postnatally. RESULTS: Urine BPA levels and urine BPA/creatinine levels were statistically higher in the TTN group (P < 0.005). The receiver operating characteristic (ROC) curve analysis determined the cut-off value of urine BPA for TTN to be 1.18 µg/L (95% confidence interval [CI]: 0.667-0.889, sensitivity: 78.1%, and specificity: 51.5%) and the cut-off value of urine BPA/creatinine to be 2.65 µg/g (95% CI: 0.727-0.930, sensitivity: 84.4%, and specificity: 66.7%). Furthermore, the ROC analysis indicated that the cut-off value of BPA for neonates requiring invasive respiratory support was 15.64 µg/L (95% CI: 0.568-1.000, sensitivity: 83.3%, and specificity: 96.2%) and the cut-off value for BPA/creatinine was 19.10 µg/g (95% CI: 0.777-1.000, sensitivity: 83.3%, and specificity: 84.6%) among the TTN patients. CONCLUSIONS: BPA and BPA/creatinine values were higher in the urine of newborns diagnosed with TTN which is a fairly common cause of NICU hospitalization, in samples collected within the first 6 hours after birth, which may be a reflection of intrauterine factors.
Assuntos
Taquipneia Transitória do Recém-Nascido , Recém-Nascido , Feminino , Gravidez , Criança , Humanos , Creatinina , Estudos Prospectivos , Taquipneia Transitória do Recém-Nascido/diagnóstico , Taquipneia Transitória do Recém-Nascido/epidemiologia , UrinaRESUMO
OBJECTIVE: While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. STUDY DESIGN: Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. RESULTS: History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2-13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5-89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks. CONCLUSION: Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. KEY POINTS: · Steroids administered prior to scheduled cesarean lead to decreased neonatal respiratory morbidity.. · Steroid administration was not associated with increased adverse neonatal outcomes.. · Steroid administration was most beneficial between 37 and 38 weeks..
Assuntos
Nascimento Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Taquipneia Transitória do Recém-Nascido , Corticosteroides/uso terapêutico , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Morbidade , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Taquipneia , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
OBJECTIVES: Considering the effects of bile-acid levels on fetal lungs and pulmonary surfactants, we hypothesized that in the presence of intrahepatic pregnancy cholestasis (ICP), poor neonatal respiratory problems are observed in relation to the severity of the disease. Delivery timing with the presence of ICP is scheduled during late-preterm and early term gestational weeks. The aim of this study was to assess ICP and disease severity effects on transient tachypnea of the newborn (TTN) in uncomplicated fetuses. METHODS: This study comprised 1,097 singleton pregnant women who were separated into three groups-control, mild ICP, and severe ICP. The pregnant women diagnosed with ICP between January 2010 and September 2020 was investigated using the hospital's database. For the control group, healthy pregnant women who met the same exclusion criteria and were similar in terms of maternal age, gestational age at delivery, and mode of delivery were analyzed. RESULTS: The TTN rate was 14.5% in the severe ICP group, 6.5% in the mild ICP group, and 6.2% in the control group. The TTN rate in the severe ICP group was significantly higher than that in the other groups (p<0.001). Similarly, the rate of admission to the neonatal intensive care unit was significantly higher in the severe ICP group than in the other groups (p<0.001). According to Pearson correlation analyses, maternal serum bile-acid levels were positively correlated with TTN (r=0.082; p=0.002). CONCLUSIONS: Severe ICP, but not mild ICP, and serum bile-acid levels were positively correlated with increased TTN risk and reduced pulmonary surfactant levels.
Assuntos
Colestase Intra-Hepática/fisiopatologia , Complicações na Gravidez/fisiopatologia , Taquipneia Transitória do Recém-Nascido/etiologia , Adulto , Estudos de Casos e Controles , Colestase Intra-Hepática/diagnóstico , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Complicações na Gravidez/diagnóstico , Fatores de Risco , Índice de Gravidade de Doença , Taquipneia Transitória do Recém-Nascido/diagnóstico , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
OBJECTIVES: To compare the incidence of transient tachypnea of the newborn (TTN) before and after the implementation of a Baby-Friendly protocol and to determine changes in the rates of TTN symptoms, interventions, completion of skin-to-skin contact. DESIGN: Retrospective cohort study using data in the electronic medical record. SETTING: Community-based tertiary obstetric facility. PARTICIPANTS: We reviewed 934 charts of neonates born at or greater than 34 weeks gestation to women ages 18 years or older and included 790 neonates: 491 in the preimplementation group and 299 in the postimplementation group. Group assignment was based on time of Baby-Friendly protocol implementation. The preimplementation group included neonates born in April, August, and December of 2014, and the postimplementation group included neonates born during these months in 2018. METHODS: The primary outcome was incidence of TTN. Secondary outcomes were rates of the following: tachypnea symptoms, hypoglycemia, antibiotic administration, and completion of skin-to-skin contact. RESULTS: The incidence of TTN was 2% (n = 8/491) in the preimplementation group and 1% (n = 4/299) in the postimplementation group (p = 1.000). The rate of tachypnea symptoms decreased from 5% (n = 25/491) to 1% (n = 3/299, p = .003), the rate of hypoglycemia decreased from 11% (n = 54/491) to 3% (n = 10/299, p < .001), and the rate of antibiotic administration decreased from 13% (n = 66/491) to 4% (n = 11/299, p < .001). The skin-to-skin completion rate increased from 16% (n = 79/491) to 61% (n = 183/299, p < .001). CONCLUSION: Although skin-to-skin contact facilitates physiologic transition to extrauterine life, incidence of TTN was not significantly reduced after the implementation of the Baby-Friendly protocol. However, increased practice of skin-to-skin contact was an improvement in care with implications for the transition to extrauterine life.
Assuntos
Taquipneia Transitória do Recém-Nascido , Adulto , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Gravidez , Estudos Retrospectivos , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adulto JovemRESUMO
Background: Neonatal respiratory disorders, such as transient tachypnea of the newborn and respiratory distress syndrome, occur frequently after an elective cesarean delivery. Although conventional pulse oximetry is recommended for neonatal resuscitation, it often requires several minutes after birth to obtain a reliable signal. In a previous study, we used novel tissue oximetry equipment to detect fetal and neonatal early tissue oxygen saturation (StO2) before and immediately after vaginal delivery. Therefore, we hypothesized that low neonatal StO2 levels measured by tissue oximetry may lead to neonatal respiratory disorder after a scheduled cesarean delivery. Hence, this study aimed to evaluate the StO2 levels measured by tissue oximetry in neonates with or without a respiratory disorder subsequently diagnosed after an elective cesarean delivery. Materials and methods: We enrolled 78 pregnant Japanese women who underwent an elective cesarean section at ≥36 weeks' gestation. After combined spinal and epidural anesthesia were administered to the mother, fetal StO2 levels were measured by tissue oximetry using an examiner's finger-mounted sensor during a pelvic examination immediately before the cesarean section. We measured the neonatal StO2 levels at 1, 3, and 5 minutes after birth and retrospectively compared the fetal and neonatal StO2 levels with the incidence of subsequent diagnoses of neonatal respiratory disorders. Results: The data of StO2 levels in 35 neonates were collected. Seven neonates (respiratory disorder (RD) group) were subsequently diagnosed with respiratory disorders by neonatal medicine specialists, whereas the 28 remaining neonates (NR group) were not. The median fetal StO2 (interquartile range) of the RD and NR groups was 52.0% (41.8%-60.8%) and 42.5% (39.0%-52.5%), respectively (P = 0.12). The median neonatal StO2 (interquartile range) of the RD and NR groups at 1 minute after birth was 42.0% (39.0%-44.0%) and 46.0% (42.0%-49.0%), respectively (P = 0.091). At 3 minutes after birth, the median neonatal StO2 (interquartile range) of the RD and NR groups was 41.0% (39.0%-46.0%) and 47.0% (44.3%-53.5%), respectively (P = 0.004). Finally, at 5 minutes after birth, the median neonatal StO2 (interquartile range) of the RD and NR groups was 45.0% (44.0%-52.0%) and 54.0% (49.3%-57.0%), respectively (P = 0.007). Conclusions: The StO2 values in the RD group were lower than those in the NR group at 3 and 5 minutes after birth, suggesting that neonates with low StO2 levels soon after birth may be predisposed to clinically diagnosed neonatal respiratory disorders.
Assuntos
Cesárea/efeitos adversos , Feto/metabolismo , Oxigênio/análise , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Oximetria/instrumentação , Oxigênio/metabolismo , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Taquipneia Transitória do Recém-Nascido/etiologiaRESUMO
OBJECTIVES: To examine the impact of early term caesarean section (CS) on respiratory morbidity and early neonatal outcomes when elective caesarean section was carried out before 39 completed weeks gestation in our population. METHODS: A one-year population-based retrospective cohort analysis using routinely collected hospital data. Livebirths from women who had elective lower segment cesarean section (ELSCS) for uncomplicated singleton pregnancies at early term (ET) 37+0 to 38+6 weeks were compared to full term (FT)≥39+0 weeks gestation. Exclusion criteria included diabetes, antenatal corticosteroid use, stillbirths, immediate neonatal deaths, normal vaginal deliveries and emergency caesareans sections. The outcomes were combined respiratory morbidity (tachypnea [TTN] and respiratory distress syndrome [RDS]), Apgar <7 at 5 min of age, respiratory support, duration of respiratory support and NICU admission. RESULTS: Out of a total of 1,466 elective CS with term livebirths, the timing of CS was early term (ET) n=758 (52%) and full term (FT) n=708 (48%). There was a higher incidence of respiratory morbidities and neonatal outcomes in the ET in comparison to FT newborns. In the univariable analysis, significant risks for outcomes were: the need for oxygen support OR 2.42 (95% C.I. 1.38-4.22), respiratory distress syndrome and/or transient tachypnea of newborn (RDSF/TTN) OR 2.44 (95% C.I. 1.33-4.47) and neonatal intensive care unit (NICU) admission OR 1.91 (95% C.I. 1.22-2.98). Only the need for oxygen support remained (OR 1.81, 95% C.I. 1.0-3.26) in the multivariable analysis. These results were observed within the context of a significantly higher proportion of older, multiparous, and higher number of previous caesarean sections in the early term CS group. CONCLUSIONS: There is a significant risk of respiratory morbidities in infants born by elective cesarean section prior to full term gestation. Obstetricians should aim towards reducing the high rate of women with previous multiple cesarean sections including balancing the obstetric indication of early delivery among such women with the evident risk of neonatal respiratory morbidity.
Assuntos
Cesárea/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Taquipneia Transitória do Recém-Nascido/etiologia , Índice de Apgar , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricos , Modelos Logísticos , Masculino , Gravidez , Catar/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Terapia Respiratória/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Nascimento a Termo , Taquipneia Transitória do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/terapiaRESUMO
BACKGROUND: Antenatal corticosteroids improve newborn outcomes for preterm infants. However, predicting which women presenting for threatened preterm labor will have preterm infants is inaccurate, and many women receive antenatal corticosteroids but then go on to deliver at term. OBJECTIVE: This study aimed to compare the short-term outcomes of infants born at term to women who received betamethasone for threatened preterm labor with infants who were not exposed to betamethasone in utero. STUDY DESIGN: We performed a retrospective cohort study of infants born at or after 37 weeks' gestational age to mothers diagnosed as having threatened preterm labor during pregnancy. The primary neonatal outcomes of interest included transient tachypnea of the newborn, neonatal intensive care unit admission, and small for gestational age and were evaluated for their association with betamethasone exposure while adjusting for covariates using multiple logistic regression. RESULTS: Of 5330 women, 1459 women (27.5%) received betamethasone at a mean gestational age of 32.2±3.3 weeks. The mean age of women was 27±5.9 years and the mean gestational age at delivery was 38.9±1.1 weeks. Women receiving betamethasone had higher rates of maternal comorbidities (P<.001 for diabetes mellitus, asthma, and hypertensive disorder) and were more likely to self-identify as White (P=.022). Betamethasone-exposed neonates had increased rates of transient tachypnea of the newborn, neonatal intensive care unit admission, small for gestational age, hyperbilirubinemia, and hypoglycemia (all, P<.05). Controlling for maternal characteristics and gestational age at delivery, betamethasone exposure was not associated with a diagnosis of transient tachypnea of the newborn (adjusted odds ratio, 1.10; 95% confidence interval, 0.80-1.51), although it was associated with more neonatal intensive care unit admissions (adjusted odds ratio, 1.49; 95% confidence interval, 1.19-1.86) and higher odds of the baby being small for gestational age (adjusted odds ratio, 1.78; 95% confidence interval, 1.48-2.14). CONCLUSION: Compared with women evaluated for preterm labor who did not receive betamethasone, women receiving betamethasone had infants with higher rates of neonatal intensive care unit admission and small for gestational age. Although the benefits of betamethasone to infants born preterm are clear, there may be negative impacts for infants delivered at term.
Assuntos
Betametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Cuidado Pré-Natal , Nascimento a Termo , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Unidades de Terapia Intensiva Neonatal , Trabalho de Parto Prematuro , Admissão do Paciente/estatística & dados numéricos , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Estudos Retrospectivos , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
OBJECTIVE: This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. STUDY DESIGN: This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p < 0.05) and there was biologic plausibility that they would affect neonatal respiratory morbidity. RESULTS: Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18-0.89). CONCLUSION: Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. KEY POINTS: · Labor is associated with less respiratory morbidity.. · We should limit elective cesarean delivery with GDM.. · This approach could reduce health care costs..
Assuntos
Diabetes Gestacional , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adulto , Cesárea/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Modelos Logísticos , Morbidade , Gravidez , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Taquipneia Transitória do Recém-Nascido/etiologiaRESUMO
BACKGROUND: Transient tachypnea of the newborn (TTN) is one of the most frequent causes of respiratory distress in neonates. A relationship has been shown between vitamin D deficiency and respiratory disorders in neonates. This research was carried out to evaluate the serum level of vitamin D in TTN newborns and their mothers compared to the control group. METHODS: This case-control research was conducted during 2016-2019 in a general hospital affiliated with Mashhad University of Medical Sciences, Iran. Thirty-four infants with TTN and 82 neonates in the control group as well as their mothers were investigated. The levels of umbilical cord serum vitamin D in infants with TTN and also their mothers were compared to the control group. RESULTS: The mean levels of serum vitamin D in infants with TTN and their mothers were 8.11 ± 4.32 and 12.6 ± 10.12 ng/mL, respectively (P<0.001), whereas they were 19.21 ± 12.71 and 25.96 ± 16.6 ng/mL in the newborns of the control group and their mothers, respectively (P<0.001). The mean differences (95% CI) of neonatal and maternal vitamin D level between the two groups were 11.10 (7.92-14.28) and 13.36 (7.90-18.08), respectively. In the TTN group, 100% of the infants had vitamin D levels less than 30 ng/mL (79.4% had severe, 17.6% had moderate and 2.9% showed mild deficiency). However, vitamin D levels lower than 30 ng/mL were observed in 76.4% of the neonates in the control group (28.8% had severe, 31.1% showed moderate and 16.3% had a mild deficiency) (P<0.001). CONCLUSION: The serum vitamin D levels of infants with TTN and their mothers were significantly lower than the control group. Therefore, TTN in infants may be reduced through the treatment of vitamin D deficiency in mothers.
Assuntos
Sangue Fetal , Taquipneia Transitória do Recém-Nascido/sangue , Deficiência de Vitamina D/sangue , Adulto , Estudos de Casos e Controles , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/etiologia , Vitamina D/metabolismo , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND: Maternal hypotension after spinal anesthesia, and time from anesthesia to delivery, are potentially modifiable risk factors for neonatal acidosis. OBJECTIVE: This study aimed to examine the relationship between the time from spinal anesthesia to delivery and spinal hypotension in planned cesarean deliveries and their effect on neonatal outcome, primarily neonatal acidosis. STUDY DESIGN: We performed a retrospective analysis of women with singleton pregnancy undergoing spinal anesthesia for planned cesarean delivery between 37 0/7 and 41 6/7 weeks' gestation using electronic medical records. The occurrence of spinal hypotension and anesthesia-to-incision and incision-to-delivery intervals (minutes) were the primarily studied variables. In addition, spinal hypotension index was developed to account for the duration and magnitude of maternal hypotension. The 90th percentile for the spinal hypotension index defined the sustained spinal hypotension group. The primary outcome was neonatal acidosis (pH of ≤7.1 or base deficit of ≥12.0). The odds ratios were calculated using univariate and multivariate logistic regression models. The multivariate analysis included sporadic spinal hypotension or sustained spinal hypotension, use of vasopressor treatment, and anesthesia-to-incision and incision-to-delivery intervals. RESULTS: We included 3150 women in the study. Notably, 43.4% experienced at least 1 event of spinal hypotension (sporadic) and 14.8% experienced sustained spinal hypotension. Neonatal acidosis occurred in 3.4% cases of sporadic spinal hypotension (odds ratio, 1.83; 95% confidence interval, 2.27-2.87) and in 5.8% cases of sustained hypotension (odds ratio, 3.00; 95% confidence interval, 1.87-4.80). Both anesthesia-to-incision and incision-to-delivery intervals were significantly associated with neonatal acidosis as follows: at 90th percentile cutoff, the odds ratios for neonatal acidosis were 3.82 (95% confidence interval, 2.03-7.19) and 2.94 (95% confidence interval, 1.70-5.10), respectively. The use of ephedrine (odds ratio, 2.42; 95% confidence interval, 1.35-4.32) but not phenylephrine (odds ratio, 0.76; 95% confidence interval, 0.34-1.72) treatment was also associated with more cases of neonatal acidosis. The woman's age, gestational age, neonatal birthweight, fetal presentation, and the number of previous cesarean deliveries were not associated with neonatal acidosis. In multivariate analysis, anesthesia-to-incision and incision-to-delivery intervals, use of vasopressor treatment, and sustained spinal hypotension were independently associated with neonatal acidosis. After adjustment, the risk for neonatal acidosis did not increase in women who experienced sporadic spinal hypotension only. Neither neonatal acidosis nor the primary research variables were associated with neonatal complications such as transient tachypnea of the newborn, respiratory distress, or admission to the neonatal unit. CONCLUSION: Neonatal acidosis in planned cesarean delivery was common. However, serious perinatal consequences were rare. The adverse effects of sustained spinal hypotension and prolonged anesthesia-to-incision and incision-to-delivery intervals on neonatal acid-base balance were additive. This supports the adoption of prevention strategies for spinal hypotension, which is widely evidenced based on the obstetrical anesthesia literature, but still not universally used. Whether the reduction in intraoperative time intervals would benefit the neonate should be determined by future prospective studies.
Assuntos
Acidose/epidemiologia , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/métodos , Hipotensão/etiologia , Doenças do Recém-Nascido/epidemiologia , Vasoconstritores/uso terapêutico , Adulto , Índice de Apgar , Apresentação Pélvica , Recesariana/métodos , Efedrina/uso terapêutico , Feminino , Macrossomia Fetal , Humanos , Hipotensão/tratamento farmacológico , Recém-Nascido , Terapia Intensiva Neonatal/estatística & dados numéricos , Análise Multivariada , Fenilefrina/uso terapêutico , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
OBJECTIVE: We evaluated the association between the presence of predelivery uterine contractions and transient tachypnoea of the newborn (TTN) in women undergoing an elective caesarean section. DESIGN: A retrospective cohort study. SETTING: National Hospital Organization Kofu National Hospital, which is a community hospital, between January 2011 and May 2019. PARTICIPANTS: The study included 464 women who underwent elective caesarean section. The exclusion criteria were missing data, twin pregnancy, neonatal asphyxia, general anaesthesia and elective caesarean section before term. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were grouped according to the presence or absence of uterine contractions on a 40-min cardiotocogram (CTG) performed within 6 hours before caesarean delivery. We performed a multivariable logistic regression analysis to examine the association between predelivery uterine contractions and TTN. RESULTS: The incidence of TTN was 9.9% (46/464), and 38.4% (178/464) of patients had no uterine contraction. The absence of uterine contractions was significantly associated with an increased risk of TTN (adjusted OR 2.04; 95% CI 1.09 to 3.82) after controlling for gestational diabetes mellitus, small for gestational age, male sex and caesarean section at 37 weeks. CONCLUSIONS: Accurate risk stratification using a CTG could assist in the management of infants who are at risk of developing TTN.
Assuntos
Cesárea , Procedimentos Cirúrgicos Eletivos , Taquipneia Transitória do Recém-Nascido/etiologia , Contração Uterina , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
Background: Respiratory diseases in newborns are considered major causes of neonatal morbidity and mortality especially in developing countries. Its causes are diverse and require early detection and management. This study aimed for detection of the prevalence and risk factors of respiratory diseases in addition to outcome among neonates admitted in neonatal intensive care unit. Methods: Our study was a prospective observational study that was undertaken at the neonatal intensive care unit of Qena University Hospital, Egypt from July 2017 to July 2018. Demographic and clinical data of newborns and their mothers were evaluated and tabulated. Results: In this period, 312 neonates were admitted to the neonatal intensive care unit, out of them 145 suffered respiratory diseases giving a prevalence of (46.5%), and (55.9%) were males. The mean neonatal age at admission was 4.33 ± 7.19 days and mean gestational age was 34.49 ± 3.31 weeks. The most common detected respiratory diseases were respiratory distress syndrome (RDS; 49.6%), transient tachypnea of newborn (TTN; 22%), neonatal pneumonia (17.2%) and meconium aspiration syndrome (MAS; 6.21%). Premature rupture of membrane (PROM), maternal diabetes and fetal prematurity had the highest risk factors for respiratory diseases occurrence in neonates. Neonatal mortality rate was 26.2%, mainly due to hyaline membrane disease and pneumonia. Conclusion: Respiratory diseases constitute major part of total admission in neonatal intensive care unit especially RDS, TTN, pneumonia and MAS. Prematurity and maternal diabetes were the most important risk factors associated with respiratory diseases. Respiratory distress syndrome carried the highest risk of mortality and TTN carried the highest survival rate.
Assuntos
Doença da Membrana Hialina/epidemiologia , Síndrome de Aspiração de Mecônio/epidemiologia , Pneumonia/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Egito/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Idade Gestacional , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/epidemiologia , Hospitais Universitários , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Síndrome de Aspiração de Mecônio/complicações , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia Aspirativa/complicações , Pneumonia Aspirativa/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Fatores de Risco , Fístula Traqueoesofágica/complicações , Fístula Traqueoesofágica/epidemiologia , Hemorragia Uterina/epidemiologia , Adulto JovemRESUMO
PURPOSE: We aimed to investigate the association between thyroid hormone levels and transient tachypnea of the newborn (TTN) among late-preterm, early-term, and term infants admitted to neonatal intensive care unit (NICU). MATERIALS AND METHOD: In the current retrospective study, neonates admitted to the NICU due to TTN were assigned to the TTN group (n = 404). Healthy neonates who were followed up in the well-baby nursery comprised the control group (n = 7335). Infants were grouped by gestational age into late-preterm (34-366 weeks), early-term (37-386 weeks), and term subgroups (39-416 weeks). Serum levels of thyroid-stimulating hormone (TSH) and thyroxin (T4) were determined from venipuncture samples taken at least 48 hours after birth. The relationship between thyroid hormone levels and the need for NICU admission for TTN was compared between groups. RESULTS: Compared to control infants, term neonates with TTN had significantly higher TSH levels, whereas late-preterm and early-term neonates with TTN had significantly lower T4 levels. Birth weight and mode of delivery had no effect on NICU admission for TTN. CONCLUSIONS: Infants admitted to NICU due to TTN had significantly different thyroid hormone levels with differences depending on gestational age.
Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tireotropina/sangue , Tiroxina/sangue , Taquipneia Transitória do Recém-Nascido/sangue , Peso ao Nascer , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
INTRODUCTION: Respiratory distress in newborns is a very common reason for admission in Neonatal Intensive Care Unit which may be transient or pathological; morbidity is high if not prompted for early diagnosis and treatment. The present study is undertaken to find out the clinical profile of neonates with respiratory distress in infants in a tertiary care hospital in western Nepal. METHODS: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from April 2017 to March 2018 after approval from the institutional review committee. Sample size was calculated and consecutive sampling was done to reach the sample size. Data were collected from the study population after taking consent and entered in a predesigned proforma. It was then entered in a Statistical Package for Social Sciences, data analysis was done to find frequency and proportion for binary data. RESULTS: Tachypnea was the most common presentation 77 (69.36%). Out of 1694 live deliveries during the study period, the prevalence of respiratory distress was 6.55 % in the total live deliveries while 30.83 % in admitted cases in Neonatal Intensive Care Unit. Survival rate was 95.50% while mortality rate accounted for 4.50%. CONCLUSIONS: Perinatal asphyxia accounted for the commonest cause of respiratory distress. To lessen the morbidity and mortality of the neonates with respiratory distress it is advocated that we practice proper and timely neonatal resuscitation, recognize the risk factors as early as possible so that perinatal asphyxia can be minimized.
Assuntos
Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Taquipneia/fisiopatologia , Asfixia Neonatal/epidemiologia , Peso ao Nascer , Estudos Transversais , Cianose/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Síndrome de Aspiração de Mecônio/epidemiologia , Nepal/epidemiologia , Prevalência , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Taxa de Sobrevida , Centros de Atenção Terciária , Taquipneia Transitória do Recém-Nascido/epidemiologiaRESUMO
OBJECTIVE: To determine the association between pregnancy-induced hypertension (PIH) and transient tachypnea of the newborn (TTN) and to identify the predictive risk factors. MATERIALS AND METHODS: Pregnant women with a newly diagnosed PIH (between 2000 and 2013) from the Taiwan National Health Insurance Research Database (NHIRD) were compared with a matched (with respect to age and year of delivery) cohort of pregnant women without PIH. The occurrence of TTN was evaluated in both cohorts. RESULTS: Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. According to a multivariate analysis, PIH (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.69-2.03, p < 0.0001), age ≥ 30 years (OR = 1.38, 95% CI = 1.26-1.51, p < 0.0001), primiparity (OR = 1.37, 95% CI = 1.24-1.5, p < 0.0001), preterm birth (OR = 3.4, 95% CI = 3.09-3.75, p < 0.0001), multiple births (OR = 2.54, 95% CI = 2.24-2.89, p < 0.0001), and cesarean section (OR = 1.71, 95% CI = 1.56-1.88, p < 0.0001) were independent risk factors for the development of TTN. CONCLUSION: Women with PIH have an increased risk of having infants who develop TTN compared with those without PIH. Additionally, age ≥30 years, primiparity, preterm birth, multiple births, and cesarean section were independent risk factors for the development of TTN.
Assuntos
Hipertensão Induzida pela Gravidez/fisiopatologia , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adulto , Cesárea/efeitos adversos , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Idade Materna , Razão de Chances , Paridade , Gravidez , Nascimento Prematuro , Fatores de Risco , Taiwan/epidemiologiaRESUMO
BACKGROUND: Studies of early-term birth after demonstrated fetal lung maturity show that respiratory and other outcomes are worse with early-term birth (370-386 weeks) even after demonstrated fetal lung maturity when compared with full-term birth (390-406 weeks). However, these studies included medically indicated births and are therefore potentially limited by confounding by the indication for delivery. Thus, the increase in adverse outcomes might be due to the indication for early-term birth rather than the early-term birth itself. OBJECTIVE: We examined the prevalence and risks of adverse neonatal outcomes associated with early-term birth after confirmed fetal lung maturity as compared with full-term birth in the absence of indications for early delivery. STUDY DESIGN: This is a secondary analysis of an observational study of births to 115,502 women in 25 hospitals in the United States from 2008 through 2011. Singleton nonanomalous births at 37-40 weeks with no identifiable indication for delivery were included; early-term births after positive fetal lung maturity testing were compared with full-term births. The primary outcome was a composite of death, ventilator for ≥2 days, continuous positive airway pressure, proven sepsis, pneumonia or meningitis, treated hypoglycemia, hyperbilirubinemia (phototherapy), and 5-minute Apgar <7. Logistic regression and propensity score matching (both 1:1 and 1:2) were used. RESULTS: In all, 48,137 births met inclusion criteria; the prevalence of fetal lung maturity testing in the absence of medical or obstetric indications for early delivery was 0.52% (n = 249). There were 180 (0.37%) early-term births after confirmed pulmonary maturity and 47,957 full-term births. Women in the former group were more likely to be non-Hispanic white, smoke, have received antenatal steroids, have induction, and have a cesarean. Risks of the composite (16.1% vs 5.4%; adjusted odds ratio, 3.2; 95% confidence interval, 2.1-4.8 from logistic regression) were more frequent with elective early-term birth. Propensity scores matching confirmed the increased primary composite in elective early-term births: adjusted odds ratios, 4.3 (95% confidence interval, 1.8-10.5) for 1:1 and 3.5 (95% confidence interval, 1.8-6.5) for 1:2 matching. Among components of the primary outcome, CPAP use and hyperbilirubinemia requiring phototherapy were significantly increased. Transient tachypnea of the newborn, neonatal intensive care unit admission, and prolonged neonatal intensive care unit stay (>2 days) were also increased with early-term birth. CONCLUSION: Even with confirmed pulmonary maturity, early-term birth in the absence of medical or obstetric indications is associated with worse neonatal respiratory and hepatic outcomes compared with full-term birth, suggesting relative immaturity of these organ systems in early-term births.
Assuntos
Cesárea/métodos , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Idade Gestacional , Hiperbilirrubinemia/epidemiologia , Trabalho de Parto Induzido/métodos , Nascimento a Termo , Taquipneia Transitória do Recém-Nascido/epidemiologia , Adolescente , Adulto , Amniocentese , Índice de Apgar , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Hiperbilirrubinemia/terapia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Pulmão/embriologia , Masculino , Pessoa de Meia-Idade , Sepse Neonatal/epidemiologia , Fototerapia , Gravidez , Pontuação de Propensão , Respiração Artificial/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: This study was conducted to compare neonatal complications in scheduled cesarean sections (CS) between 38 and 39 gestational weeks with CS performed after 39 gestational weeks in Iranian low -risk pregnant women. METHODS: In this cohort study, 2086 patients were enrolled based on the inclusion and exclusion criteria. The neonates were evaluated in terms of the following items: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, need for NICU hospitalization, birth weight, birth height, head circumference, and the first minute and fifth minute Apgar score. Several multiple logistic regression models were performed for each response variable (adverse outcome) separately. RESULTS: The incidence of NICU admission was significantly higher in neonates born at 38-39 gestational weeks than those who were born after 39 gestational weeks. No significant differences were found in the incidence of neonatal sepsis, TTN, and RDS between the two groups. CONCLUSION: According to our study results, elective CS at 38-9 weeks' gestation is associated with a higher rate of TTN and NICU admission in comparison with elective CS performed after 39 completed gestational weeks.