Perinatal morbidity and mortality for extremely low-birthweight infants: A population-based study of regionalized maternal and neonatal transport.

AIM: The aim of this study was to clarify the mortality and long-term outcomes of extremely low-birthweight infants according to the process of maternal or infant transport and indications for maternal transport. MATERIAL AND METHODS: We conducted a population-based study between 2005 and 2009. The collected data included the process and indications for maternal or neonatal transport, maternal and infant characteristics and the prognosis of extremely low-birthweight infants. Intergroup comparisons were made using the Mann-Whitney U-test, while multiple group comparisons were made using the Kruskal-Wallis test followed by the post-hoc paired t-test according to the Dunn procedure. Comparisons of the cumulative survival rates based on postnatal age according to the process of maternal or neonatal transport were performed using a Kaplan-Meier survival analysis and the log-rank test. RESULTS: The study subjects included 195 infants from 189 mothers following 50,632 deliveries during the study period. Overall, 32 (16.4%) infants died and 33 (20.2%) infants had neurological impairments. The rates of mortality and handicaps among the infants in the maternal transport group were 15.2% and 23.2%, respectively, compared to 25% and 44%, respectively, in the neonatal transport group. There were no differences in the prognoses of the infants according to the process of maternal transport, although more premature neonates were managed in the tertiary center. There were no differences in the cumulative survival rates based on the institution that managed the neonate. The incidence of a poor prognosis was significantly higher among the infants born from mothers transported to the tertiary center due to bulging membranes (P = 0.047). All mothers with placental abruption were transported to the nearest secondary center. CONCLUSION: The morbidity and mortality of extremely low-birthweight infants demonstrated a low incidence following the regionalization of high-risk pregnancies in our region. Further reductions in severe neonatal morbidities may depend on reducing the rate of neonatal transport.

Risk-based screening for thyroid dysfunction during pregnancy.

OBJECTIVE: We conducted the study to see the incidence of thyroid dysfunction in women with obstetrical high-risk factors. METHODS: We retrospectively reviewed medical charts of high-risk pregnant women who had examination for thyroid function during pregnancy. Women were divided according to clinical presentation, symptoms of thyroid disease and those with a personal history of thyroid disease (thyroid disease, n = 32), intrauterine growth restriction (IUGR, n = 115), diabetes mellitus (diabetes, n = 115), hypertension (n = 63), intrauterine fetal death (IUFD, n = 52), and placental abruption (abruption, n = 15). The incidence of thyroid dysfunctions including hyperthyroidism or hypothyroidism was compared. RESULTS: The overall prevalence of thyroid dysfunction was 24.7%. The incidence of thyroid dysfunction in each group was as follows: 31% in thyroid disease, 25% in IUGR, 30% in diabetes, 27% in hypertension, 12% in IUFD, and 7% in abruption. Except IUFD, the incidence was not statistically significant from the group of thyroid disease (thyroid disease versus IUFD, P = 0.03 by χ (2) test). Thyroid disease represented for only 10% of all thyroid dysfunctions. CONCLUSION: Testing of women with a personal history or current symptoms of thyroid disease during pregnancy may be insufficient to detect women with thyroid dysfunction, who will become at high-risk pregnancy.

Mortality rates for extremely low-birthweight infants: a regional, population-based study in Japan during 2005-2009.

AIM: We investigated neonatal and infant mortality rates for extremely low-birthweight infants and clarified clinical factors associated with death. MATERIAL AND METHODS: A population-based study was conducted for 195 infants born from 2005 to 2009. RESULTS: The infant mortality rate was 28.6%, 21.7%, 34.2%, 6.7%, 6.3%, 13%, and 4.8% at 22, 23, 24, 25, 26, 28, and ≥28 weeks, respectively. The infant mortality rate according to birthweight was 50%, 9%, 31%, 16.7%, 19.4%, 7.5%, and 2.9% for <400 g, 400-499 g, 500-599 g, 600-699 g, 700-799 g, 800-899 g, and 900-999 g, respectively. Log-rank tests revealed a significant difference in the cumulative survival rates according to gestational age (P < 0.001). In the 24-week group, this rate in a tertiary center was higher than in a non-tertiary center (P = 0.001). The mortality of infants born by cesarean section (73%) was lower than that of infants born vaginally (P < 0.05). Multiple regression analyses show that the significant factors associated with death were 22-24 weeks of gestational age, management at non-tertiary centers, and multiple births. CONCLUSION: Survival of infants (<1000 g) depends on gestational age, centralization and multiple births.

Severe variable deceleration is associated with intestinal perforation in infants born at 22-27 weeks' gestation.

OBJECTIVE: Intestinal perforation in extremely premature infants is an important cause of death. The aim of the study was to identify fetal heart rate patterns, which were associated with intestinal perforation. METHODS: A retrospective cohort study was performed in 92 women who delivered at 22-27 weeks' gestation at a tertiary center in Miyazaki. They delivered 74 singletons, 17 twins and one triplet. Intrapartum fetal heart rate monitoring charts of at least 2-h were examined. Intestinal perforation was diagnosed by the clinical manifestations and operative findings. Multiple logistic regression analysis was used to compare between intestinal perforation group and non-perforation group. RESULTS: Of the 111 neonates, 17 had intestinal perforation. Severe variable deceleration (p < 0.05), prematurity (p < 0.05), postnatal corticosteroid (p < 0.05), intraventricular hemorrhage of grade III or IV (p < 0.01) and poor survival (p < 0.05) were more frequent in infants with perforation than in the 94 without perforation. Multivariate analysis adjusted for the other risk factors revealed that only severe variable deceleration remained as a risk factor: (odds ratio 3.7; 95% CI 1.1-12.1; p = 0.03). CONCLUSIONS: Intrapartum severe variable deceleration is associated with subsequent intestinal perforation in extremely premature infants, suggesting that preventing prolonged periods of these decelerations may prevent intestinal perforation.

Staged operations for posthemorrhagic hydrocephalus in extremely low-birth-weight infants with preceding stoma creation after bowel perforation: surgical strategy.

CASE REPORT: We report a complicated extremely low-birth-weight (ELBW) infant with posthemorrhagic hydrocephalus after intraventricular hemorrhage and preceding stoma creation after bowel perforation who was treated with staged operations, including shunting and external ventricular drainage. The first operation was a temporary valveless ventriculoperitoneal (VP) shunt placement until the time of the stoma closure. The stoma was successfully closed 3 months after the first operation when the peritoneal tube was drawn out from the chest wall and the VP shunt system was temporarily used as an external drainage with a long subcutaneous tunnel. One month after the second operation, final VP shunt placement was performed after good healing of bowel anastomosis was surely confirmed. The previous peritoneal shunt tube was cut behind the ear, removed, and replaced with a valve-regulated VP shunt system. CONCLUSION: This staged strategy is a safe and feasible option for complicated ELBW infants with preceding stoma and hydrocephalus.