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1.
BMC Pregnancy Childbirth ; 22(1): 254, 2022 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-35346088

RESUMEN

OBJECTIVE: Our aim was to assess diagnostic accuracy in the prediction of small for gestational age (SGA <10th centile) and fetal growth restricted (FGR) (SGA <3rd centile) fetuses using three different sonographic methods in pregnancies at increased risk of fetal growth restriction: 1) fetal abdominal circumference (AC) z-scores, 2) estimated fetal weight (EFW) z-scores according to postnatal reference standard; 3) EFW z-scores according to a prenatal reference standard. METHODS: Singleton pregnancies at increased risk of fetal growth restriction seen in two university hospitals between 2014 and 2015 were studied retrospectively. EFW was calculated using formulas proposed by the INTERGROWTH-21st project and Hadlock; data derived from publications by the INTEGROWTH-twenty-first century project and Hadlock were used to calculate z-scores (AC and EFW). The accuracy of different methods was calculated and compared. RESULTS: The study group included 406 patients. Prenatal standard EFW z-scores derived from INTERGROWTH-21st project and Hadlock and co-workers performed similarly and were more accurate in identifying SGA infants than using AC z-scores or a postnatal reference standard. The subgroups analysis demonstrated that EFW prenatal standard was more or similarly accurate compared to other methods across all subgroups, defined by gestational age and birth weight. CONCLUSIONS: Prenatal standard EFW z-scores derived from either INTERGROWTH-21 st project or Hadlock and co-workers publications demonstrated a statistically significant advantage over other biometric methods in the diagnosis of SGA fetuses.


Asunto(s)
Retardo del Crecimiento Fetal , Peso Fetal , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Feto , Edad Gestacional , Humanos , Embarazo , Diagnóstico Prenatal , Estudios Retrospectivos , Ultrasonografía Prenatal/métodos
2.
J Coll Physicians Surg Pak ; 32(6): 722-727, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35686402

RESUMEN

OBJECTIVE: To examine the performance of first-trimester visceral (pre-peritoneal), subcutaneous, and total adipose tissue thickness (ATT) to predict the patients with subsequently developing gestational Diabetes mellitus (GDM). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital from January 2021 to July 2021. METHODOLOGY: A total of 100 pregnant women underwent sonographic measurement of subcutaneous and visceral ATT at 11-14 weeks' gestation. A 75-g oral glucose tolerance test (OGTT) was conducted between 24-28 weeks of pregnancy for the diagnosis of GDM. RESULTS: The mean visceral, subcutaneous, and total ATT were significantly higher in the GDM group (24.75 ± 10.34 mm, 26.33 ± 5.33 mm, 51.08 ± 14.4 mm) than in the group without a GDM diagnosis (16.68 ± 6.73 mm, 17.68 ± 4.86 mm, 34.25 ± 11.04, respectively, p<0.001). A pre-gestational BMI >30 kg/m2 (Odds ratio [OR]=10.20, 95% CI=2.519-41.302, p=0.001), visceral ATT (OR=33.2, 95% CI=7.395-149.046, p<0.001), subcutaneous ATT (OR=4.543, 95% CI=1.149-17.960, p=0.031), and total ATT (OR=10.895, 95% CI=2.682-44.262, p=0.001) were the factors that were found to be significantly associated with the subsequent development of GDM after adjusting for potential confounders (maternal age, and parity). The most significant risk factor for the prediction of GDM is visceral ATT with an OR of 33.2. CONCLUSION: US measurement of maternal visceral ATT during first-trimester fetal aneuploidy screening is a reliable, reproducible, cost-effective, and safe method to identify pregnant women at high risk for GDM. KEY WORDS: Gestational diabetes mellitus, Visceral adipose tissue thickness, Subcutaneous adipose tissue thickness.


Asunto(s)
Diabetes Gestacional , Diabetes Gestacional/diagnóstico , Femenino , Edad Gestacional , Prueba de Tolerancia a la Glucosa , Humanos , Grasa Intraabdominal/diagnóstico por imagen , Embarazo , Primer Trimestre del Embarazo
3.
Clin Perinatol ; 49(2): 295-311, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35659088

RESUMEN

The needs to assess preterm infant growth clinically differ from the needs to summarize growth for research. Clinically, growth assessments are used to understand individuals' growth relative to their individual genetic potential, morbidity status and nutrition care. Growth quantification for research purposes is used to quantify growth of groups using meaningful metrics. Historically, neonatology has lacked consistency in the use of growth metrics, over-used irrelevant categories and over-diagnosed growth failure. Understanding the numerous preterm infant expected growth patterns can help identify concerning growth.


Asunto(s)
Enfermedades del Recién Nacido , Neonatología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional
4.
J Trop Pediatr ; 68(4)2022 06 06.
Artículo en Inglés | MEDLINE | ID: mdl-35666181

RESUMEN

OBJECTIVE: To create a nomogram based on transcutaneous bilirubin values (TCB) in first week of life for term and late preterm (>34 weeks) neonates. METHODS AND DESIGN: Prospective longitudinal study. SETTING: Four tertiary-care teaching hospitals (one each in eastern and southern India, two in northern India) between February 2019 and March 2020. PARTICIPANTS: A total of 2492 term and late preterm (>34 weeks) neonates. INTERVENTION: Bilirubin was measured by transcutaneous bilirubinometer (Drager JM-105, Germany) in all neonates in pre-specified times of the day, 12 hourly every day since birth till discharge between 48 and 72 h, and data were recorded in epochs of 6 hourly intervals. Post-discharge, all neonates were called for review in next 48 h. OUTCOME MEASURES: Primary-TCB in first week of life. Secondary-factors having significant association with significant hyperbilirubinaemia requiring phototherapy. RESULTS: Total of 2492 neonates (males 1303 and female 1189), with a total of 14 162 TCB recordings were analysed and mean hourly bilirubin (TCB) at hourly intervals till 120 h and then daily bilirubin values on Days 6 and 7 were tabulated. We have constructed hour-specific bilirubin nomogram with percentiles as per gestational age in term and near-term Indian neonates till 120 h of life. Amongst the known risk factors, delayed cord clamping, primipara and breastfeeding jaundice had significant association for hyperbilirubinaemia needing phototherapy. CONCLUSIONS: We have created gestation-specific nomogram of TCB levels in 6 hourly intervals for the first 120 postnatal hours, obtained from a large predominantly breast fed healthy, term and near-term Indian neonates.


Asunto(s)
Hiperbilirrubinemia Neonatal , Nacimiento Prematuro , Cuidados Posteriores , Bilirrubina , Femenino , Edad Gestacional , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Recién Nacido , Estudios Longitudinales , Masculino , Tamizaje Neonatal/métodos , Nomogramas , Alta del Paciente , Estudios Prospectivos
5.
Artículo en Inglés | MEDLINE | ID: mdl-35682092

RESUMEN

Children born preterm (<37 weeks' gestation) show a specific vulnerability for socio-emotional difficulties, which may lead to an increased likelihood of developing behavioral and psychiatric problems in adolescence and adulthood. The accurate decoding of emotional signals from faces represents a fundamental prerequisite for early social interactions, allowing children to derive information about others' feelings and intentions. The present study aims to explore possible differences between preterm and full-term children in the ability to detect emotional expressions, as well as possible relationships between this ability and socio-emotional skills and problem behaviors during everyday activities. We assessed 55 school-age children (n = 34 preterm and n = 21 full-term) with a cognitive battery that ensured comparable cognitive abilities between the two groups. Moreover, children were asked to identify emotional expressions from pictures of peers' faces (Emotion Recognition Task). Finally, children's emotional, social and behavioral outcomes were assessed with parent-reported questionnaires. The results revealed that preterm children were less accurate than full-term children in detecting positive emotional expressions and they showed poorer social and behavioral outcomes. Notably, correlational analyses showed a relationship between the ability to recognize emotional expressions and socio-emotional functioning. The present study highlights that early difficulties in decoding emotional signals from faces may be critically linked to emotional and behavioral regulation problems, with important implications for the development of social skills and effective interpersonal interactions.


Asunto(s)
Cognición , Emociones , Adulto , Niño , Emociones/fisiología , Edad Gestacional , Humanos , Recién Nacido , Relaciones Interpersonales , Habilidades Sociales
6.
Nutrients ; 14(11)2022 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-35683989

RESUMEN

Little information exists about the plasma target nutritional needs of the >15 million premature infants <37 weeks gestation. Investigating ascorbic acid's (AscA) role in infant health, our study details the relationship of infant characteristics and maternal health on infant plasma AscA level (pAscA) during postnatal development. Furthermore, we determined pAscA influence during the first week of life (EpAscA) with later infant morbidities. We hypothesize that pAscA is influenced by gestational organ immaturity, as well as maternal factors, with EpAscA associated with greater morbidity risk. We conducted a prospective longitudinal observational study of pAscA, demographics and hospital course detailed in infants ≤34 weeks. Sixty-three subjects were included, with >200 urine and plasma data points analyzed. Maternal smoking, exposure to magnesium sulfate (MgSO4) and advancing gestational and postnatal age were associated with lower pAscA. Non-white infants and those ≤30 weeks that developed bronchopulmonary dysplasia or retinopathy of prematurity had lower pAscA. Prenatal smoking, MgSO4, birth gestational age and race negatively influence pAscA. These results show prenatal and postnatal developmental factors influencing initial pAscA and metabolism, potentially setting the stage for organ health and risk for disease. Assessment of dietary targets may need adjustment in this population.


Asunto(s)
Ácido Ascórbico , Enfermedades del Prematuro , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , Sulfato de Magnesio , Embarazo , Estudios Prospectivos
7.
Nutrients ; 14(11)2022 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-35684032

RESUMEN

BACKGROUND: Early postnatal growth monitoring and nutrition assessment for preterm infants is a public health and clinical concern. We aimed to establish a set of postnatal growth monitoring curves of preterm infants to better help clinicians make in-hospital and post-discharge nutrition plan of these vulnerable infants. METHODS: We collected weight, length and head circumference data from a nationwide survey in China between 2015 and 2018. Polynomial regression and the modified LMS methods were employed to construct the smoothed weight, length and head circumference growth curves. RESULTS: We established the P3, P10, P25, P50, P75, P90, P97 reference curves of weight, length and head circumference that allowed for continuous use from 24 weeks of preterm birth to 50 weeks and developed a set of user-friendly growth monitoring charts. We estimated approximate ranges of weight gain per day and length and head circumference gains per week. CONCLUSIONS: Our established growth monitoring curves, which can be used continuously without correcting gestational age from 24 weeks of preterm birth to 50 weeks, may be useful for assessment of postnatal growth trajectories, definition of intrauterine growth retardation at birth, and classification of early nutrition status for preterm infants.


Asunto(s)
Recien Nacido Prematuro , Nacimiento Prematuro , Cuidados Posteriores , Peso al Nacer , China , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Alta del Paciente
8.
Nutrients ; 14(11)2022 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-35684057

RESUMEN

Vitamin E deficiency (VED) is associated with clinical repercussions in preterm newborns (PTN), but low levels are also found in full-term newborns (TN). As this inadequacy can compromise neurogenesis in childhood, studies are needed to assess whether there is a difference in vitamin E status among newborns according to gestational age to provide support for neonatal monitoring protocols. This systematic review presents a synthesis of the available information on the vitamin E status among PTN and TN. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies that evaluated alpha-tocopherol levels were searched in the databases reported in the protocol registered in PROSPERO (CRD42021165152). The Newcastle-Ottawa Scale was used to assess the methodological quality. Overall, 1809 articles were retrieved; 10 were included in the systematic review. In the PTN, the alpha-tocopherol levels ranged from 3.9 to 8.5 mmol/L, while in TN, they were 4.9 to 14.9 mmol/L, and VED ranged from 19% to 100% in newborns. Despite substantial heterogeneity in research methodology and VED classification, the results suggest that the alpha-tocopherol levels among preterm and full-term newborns is below the recommended levels. Our findings demonstrate that further investigations are needed to standardize this classification and to monitor vitamin E status in birth and postnatal with adequate bias control.


Asunto(s)
Deficiencia de Vitamina E , Vitamina E , Edad Gestacional , Humanos , Lactante , Recién Nacido , alfa-Tocoferol
9.
Stem Cell Res Ther ; 13(1): 246, 2022 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-35690786

RESUMEN

BACKGROUND: Cord blood plays a very important role in stem cell transplantation and therapy with an emerging implication also in regenerative medicine. The number of cells available in a single cord blood unit (CBU), in particular, the CD34+ and total nucleated cell (TNC) content influences the transplantation clinical outcome. We analysed a very large series of CBUs, collected for private banking without any specific volume restriction, to deeply investigate the best predictors of cord blood stem cells content. METHODS: Maternal and neonatal clinic laboratory data of a total 2583 UCBs were obtained from the InScientiaFides cord blood bank based in Republic of San Marino. Univariate and multivariate analysis were conducted to better interpret the data and to build a predictive model to select, the CBU with high CD34+ content. RESULTS: Our univariate analysis shows that seasonality and the geographical area affects the quality of umbilical cord blood. Gestational age, babie's gender and birth weight have a positive correlation with CB TNC content. The babie's birth weight affects positively also CD34+ content and CBU volume while the cesarean delivery affect the CB volume only. Our predictive model, based on multivariate analysis, shows that male babie's, gestational age lower to 39 weeks, cesarean delivery and CBUs with a content of TNC higher than 3.44 × 108 (group A) have a significant higher CD34+ content than group B (female babie's, gestational age higher than 39 weeks and vaginal delivery). The group A have a 37.5% of CBUs with a concentration of CD34+ > 2 × 106, while no CBUs with high concentration of CD34+ were detect in group B. CONCLUSION: This study, conducted on a very large series of CBUs without any specific volume constraint, highlighted the prenatal and maternal factors that significantly influence the quality of the CBU collected. Specifically, it highlights that volume is not the best predictor of CD34+ CBU content; for this reason it cannot be taken into consideration alone for the analysis of the collected samples. Our final aim is to identify relevant factors, immediately available, that help to choice UCB with high CD34+ cell content, especially in simultaneous deliveries.


Asunto(s)
Bancos de Sangre , Sangre Fetal , Antígenos CD34 , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Masculino , Embarazo
10.
PLoS One ; 17(6): e0269610, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35666987

RESUMEN

We aimed to determine the risk of perinatal complications during delivery in mothers with non-normal glucose tolerance in a large Japanese birth cohort. We analysed data of 24,295 neonate-mother pairs in the Japan Environment and Children's Study cohort between 2011 and 2014. We included 67 mothers with type 1 diabetes, 102 with type 2 diabetes (determined by questionnaire), 2,045 with gestational diabetes (determined by diagnosis), and 2,949 with plasma glucose levels ≥140 mg/dL (shown by a screening test for gestational diabetes). Gestational age, birth weight, placental weight, and proportions of preterm birth, and labour and neonatal complications at delivery in mothers with diabetes were compared with those in mothers with normal glucose tolerance. Mean gestational age was shorter in mothers with any type of diabetes than in mothers without diabetes. Birth weight tended to be heavier in mothers with type 1 diabetes, and placental weight was significantly heavier in mothers with type 1 and gestational diabetes and elevated plasma glucose levels (all p<0.05). The relative risks of any labour complication and any neonatal complication were 1.49 and 2.28 in type 2 diabetes, 1.59 and 1.95 in gestational diabetes, and 1.22 and 1.30 in a positive screening test result (all p<0.05). The relative risks of preterm birth, gestational hypertension, and neonatal jaundice were significantly higher in mothers with types 1 (2.77; 4.07; 2.04) and 2 diabetes (2.65; 5.84; 1.99) and a positive screening test result (1.29; 1.63; 1.12) than in those without diabetes (all p<0.05). In conclusion, placental weight is heavier in mothers with non-normal glucose tolerance. Preterm birth, gestational hypertension, and jaundice are more frequent in mothers with types 1 and 2 diabetes. A positive result in a screening test for gestational diabetes suggests not only a non-normal glucose tolerance, but also a medium (middle-level) risk of perinatal complications.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Intolerancia a la Glucosa , Hipertensión Inducida en el Embarazo , Nacimiento Prematuro , Peso al Nacer , Glucemia/análisis , Niño , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Edad Gestacional , Intolerancia a la Glucosa/complicaciones , Intolerancia a la Glucosa/epidemiología , Humanos , Recién Nacido , Japón/epidemiología , Placenta/química , Embarazo , Nacimiento Prematuro/epidemiología
11.
BMC Ophthalmol ; 22(1): 251, 2022 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-35668518

RESUMEN

PURPOSE: To analyze the incidence and severity of retinopathy of prematurity (ROP) in north China, and to evaluate the effectiveness of different ROP screening criteria. PATIENTS AND METHODS: The screening data of premature infants were collected from 2016 to 2021. The severity of ROP was graded according to the International Classification of Retinopathy of Prematurity (2005). And the treatment for ROP followed the Early Treatment for Retinopathy of Prematurity Cooperative Group. The effects of gestational age (GA) and birth weight (BW) on the incidence and severity of ROP were evaluated. The screening data were also analyzed using different ROP screening guidelines. RESULTS: A total of 4069 infants underwent ROP screening, and 728 infants (17.9%) were diagnosed with ROP. Of those, 78 infants (1.9%) received treatments. Gestational age and BW showed significant differences between infants with and without ROP (29.1 ± 2.1w vs. 32.9 ± 2.6w, p < 0.001; 1362.7 ± 427.3 g vs. 1751.9 ± 509.4 g, p < 0.001; respectively). Fifty-six infants (7.69%), 188 infants (25.82%), and 104 infants (14.29%) in all infants with ROP would have been missed according to the China, USA, and UK screening guidelines respectively. If GA ≤ 33 weeks and/or BW ≤ 2100 g were considered as screening criteria, only one infant (0.14%) with critical systemic illness was missed diagnosed with severe ROP. CONCLUSION: Gestational age and BW are major risk factors for the incidence and severity of ROP. And the incidence and treatment rate of ROP in Tianjin is similar to that reported in the other regions of China. Modified ROP screening criteria were considered to be more effective in Tianjin.


Asunto(s)
Retinopatía de la Prematuridad , Peso al Nacer , Edad Gestacional , Humanos , Incidencia , Lactante , Recién Nacido , Recien Nacido Prematuro , Tamizaje Neonatal , Retinopatía de la Prematuridad/diagnóstico , Retinopatía de la Prematuridad/epidemiología , Estudios Retrospectivos , Factores de Riesgo
12.
Obstet Gynecol ; 139(6): 1155-1167, 2022 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-35675615

RESUMEN

OBJECTIVE: First, to evaluate the risks of stillbirth and neonatal death by gestational age in twin pregnancies with different levels of growth discordance and in relation to small for gestational age (SGA), and on this basis to establish optimal gestational ages for delivery. Second, to compare these optimal gestational ages with previously established optimal delivery timing for twin pregnancies not complicated by fetal growth restriction, which, in a previous individual patient meta-analysis, was calculated at 37 0/7 weeks of gestation for dichorionic pregnancies and 36 0/7 weeks for monochorionic pregnancies. DATA SOURCES: A search of MEDLINE, EMBASE, ClinicalTrials.gov, and Ovid between 2015 and 2018 was performed of cohort studies reporting risks of stillbirth and neonatal death in twin pregnancies from 32 to 41 weeks of gestation. Studies from a previous meta-analysis using a similar search strategy (from inception to 2015) were combined. Women with monoamniotic twin pregnancies were excluded. METHODS OF STUDY SELECTION: Overall, of 57 eligible studies, 20 cohort studies that contributed original data reporting on 7,474 dichorionic and 2,281 monochorionic twin pairs. TABULATION, INTEGRATION, AND RESULTS: We performed an individual participant data meta-analysis to calculate the risk of perinatal death (risk difference between prospective stillbirth and neonatal death) per gestational week. Analyses were stratified by chorionicity, levels of growth discordance, and presence of SGA in one or both twins. For both dichorionic and monochorionic twins, the absolute risks of stillbirth and neonatal death were higher when one or both twins were SGA and increased with greater levels of growth discordance. Regardless of level of growth discordance and birth weight, perinatal risk balanced between 36 0/7-6/7 and 37 0/7-6/7 weeks of gestation in both dichorionic and monochorionic twin pregnancies, with likely higher risk of stillbirth than neonatal death from 37 0/7-6/7 weeks onward. CONCLUSION: Growth discordance or SGA is associated with higher absolute risks of stillbirth and neonatal death. However, balancing these two risks, we did not find evidence that the optimal timing of delivery is changed by the presence of growth disorders alone. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42018090866.


Asunto(s)
Enfermedades del Recién Nacido , Muerte Perinatal , Femenino , Retardo del Crecimiento Fetal/epidemiología , Edad Gestacional , Humanos , Recién Nacido , Muerte Perinatal/etiología , Embarazo , Embarazo Gemelar , Estudios Prospectivos , Estudios Retrospectivos , Mortinato/epidemiología , Gemelos
13.
Saudi Med J ; 43(6): 599-609, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35675930

RESUMEN

OBJECTIVES: To investigate the prevalence of preterm birth (PTB) and the risk factors for different gestational age subgroups of preterm birth in China. METHODS: We carried out a descriptive cross-sectional study encompassing all singleton live births (24+0 to 41+6 weeks) with completed data in 23 provinces in China from 2010 to 2017 during investigation period. We compared both the preterm group (24+0 to 36+6 weeks) and preterm subgroups (<32 weeks, 32+0 to 33+6 weeks, and 34+0 t0 36+6 weeks) with the term group (37+0 to 41+6 weeks). We collected information on maternal and fetal characteristics from medical records. Logistic regression was use. RESULTS: The prevalence of PTB was 7.4% (15,833/215,254) in singleton births. After adjusting for maternal age, parity, and potential risk factors in univariate analysis, the high-risk factors for PTB at <32 weeks were placental abruption (aOR=41.52; 95% CI, 25.89-66.58), placenta previa (aOR=40.04; 95% CI, 32.00-50.09), chorioamnionitis (aOR=11.06; 95% CI, 8.738-14.02), and hypertension disorders in pregnancy (HDP) (aOR=3.564; 95% CI, 2.930-4.335). Intrahepatic cholestasis of pregnancy (ICP) was significantly associated with PTB at 34-36 weeks (aOR=5.763; 95% CI, 5.049-6.577), particularly with spontaneous PTB (aOR=10.04; 95% CI, 8.79-11.47). Gestational diabetes mellitus (GDM) was significantly associated with PTB at 34-36 weeks only (aOR=1.156; 95% CI, 1.054-1.267). CONCLUSION: Placental abruption, placenta previa, chorioamnionitis, and HDP were more predictive of early PTB; GDM and ICP were more predictive of late PTB.


Asunto(s)
Desprendimiento Prematuro de la Placenta , Corioamnionitis , Placenta Previa , Preeclampsia , Nacimiento Prematuro , Desprendimiento Prematuro de la Placenta/epidemiología , Colestasis Intrahepática , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Placenta , Embarazo , Complicaciones del Embarazo , Nacimiento Prematuro/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo
14.
Zhonghua Er Ke Za Zhi ; 60(6): 545-550, 2022 Jun 02.
Artículo en Chino | MEDLINE | ID: mdl-35658360

RESUMEN

Objective: To investigate the incidence and perinatal risk factors of congenital hypothyroidism (CH) in very preterm infants. Methods: This prospective, multicenter observational cohort study was conducted at 33 neonatal intensive care units based on the data from Sina-northern Neonatal Network (SNN). Perinatal information and thyroid function of 3 179 very preterm infants with gestational age <32 weeks who were born from January 2019 to June 2021 was collected. According to the occurrence of CH during hospitalization, all the infants were assigned into CH group and non-CH group. Chi square test, Fisher exact probability method, rank sum test and multivariate Logistic regression model were tested to detect the perinatal risk factors for CH. Results: A total of 3 179 very preterm infants were enrolled with 56.4% (1 793/3 179) male. The incidence of CH was 6.9% (220/3 179), in which the incidence for extremely low birth weight infant (ELBWI) and extremely preterm infants (EPI) of gestational age <28 weeks were 13.5% (64/475) and 13.9% (66/475), respectively. On Logistic regression analysis, maternal hypertensive disorders of pregnancy (OR=1.59, 95%CI 1.14-2.23, P=0.007) and multiple birth (OR=1.60, 95%CI 1.18-2.17, P=0.003) were both significant perinatal risk factors of CH. In addition, gestational age (OR=0.81, 95%CI 0.71-0.93, P=0.002), birth weight (OR=0.99, 95%CI: 0.98-0.99, P<0.001) and 1 min Apgar score (OR=0.92, 95%CI 0.86-0.98, P=0.008) were protective factors. Conclusions: The incidence of CH is high in very preterm infants which increased with the decreased birth weight and gestational age. For very premature infants with perinatal high risk factors such as hypertensive disorders of pregnancy, attention should be paid to assess thyroid function status dynamically.


Asunto(s)
Hipotiroidismo Congénito , Hipertensión Inducida en el Embarazo , Enfermedades del Prematuro , Peso al Nacer , Hipotiroidismo Congénito/epidemiología , Hipotiroidismo Congénito/etiología , Femenino , Retardo del Crecimiento Fetal , Edad Gestacional , Humanos , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Extremadamente Prematuro , Recién Nacido , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/etiología , Masculino , Embarazo , Estudios Prospectivos , Factores de Riesgo
15.
BMC Pregnancy Childbirth ; 22(1): 467, 2022 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-35659606

RESUMEN

BACKGROUND: With the development of assisted reproductive technology, the twinning rate in China has been increasing. However, little is known about twinning from 2014 onwards. In addition, previous studies analysing optimal gestational times have rarely considered maternal health conditions. Therefore, whether maternal health conditions affect the optimal gestational time remains unclear. METHODS: Data of women delivered between January 2012 and December 2020 were collected through China's National Maternal Near Miss Surveillance System. Interrupted time series analysis was used to determine the rates of twinning, stillbirth, smaller than gestational age (SGA), and low Apgar scores (< 4) among twins in China. To estimate the risk of each adverse perinatal outcome for separate gestational weeks, a multivariate generalised linear model was used. Infants born at 37 weeks of gestational age or foetuses staying in utero were used as reference separately. The analyses were adjusted for the sampling distribution of the population and the cluster effect at the hospital and individual levels were considered. RESULTS: There were 442,268 infants enrolled in this study, and the adjusted rates for twinning, stillbirth, SGA, and low Apgar scores were 3.10%, 1.75%, 7.70%, and 0.79%, respectively. From 2012 to 2020, the twinning rate showed an increasing trend. Adverse perinatal outcomes, including stillbirth, SGA, and low Apgar scores showed a decreasing trend. A gestational age between 34 and 36 weeks decreased most for rate of stillbirth (average changing rate -9.72%, 95% confidence interval [CI] -11.41% to -8.00%); and a gestational age of between 37 and 38 weeks decreased most for rates of SGA (average changing rate -4.64%, 95% CI -5.42% to -3.85%) and low Apgar scores (average changing rate -17.61%, 95% CI -21.73% to -13.26%). No significant difference in changes in twinning rate or changes of each perinatal outcome was observed during periods of different fertility policies. Infants born at 37 weeks of gestation had a decreased risk of stillbirth, SGA, and low Apgar scores. Maternal antepartum or medical complications increased the risk of SGA and low Apgar scores in different gestational weeks. CONCLUSION: China's twinning rate showed an increasing trend, while adverse perinatal outcomes decreased from 2012 to 2020. Fertility policy changes have had little effect on the twinning rate or the rate of adverse perinatal outcomes such as stillbirth, SGA, or low Apgar scores. The optimal gestational age for twins was 37 weeks. Women pregnant with twins and with antepartum or medical complications should be cautious due to an increased risk of SGA and low Apgar scores.


Asunto(s)
Embarazo Gemelar , Mortinato , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Parto , Embarazo , Mortinato/epidemiología
16.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(5): 482-491, 2022 May 15.
Artículo en Chino | MEDLINE | ID: mdl-35644187

RESUMEN

OBJECTIVES: To develop the birth weight curve of singleton neonates with a gestational age of 24-42 weeks, and to investigate the regional differences of the birth weight curve. METHODS: A total of 11 maternal and child health hospitals with more than 7 000 neonates delivered annually were selected in 11 cities of China (Haikou, Guangzhou, Shenzhen, Liuzhou, Guilin, Quanzhou, Chongqing, Chengdu, Changsha, Ningbo, and Lianyungang), and all live singleton neonates delivered in the 11 hospitals from January 1, 2017 to December 31, 2020 were enrolled for the development of birth weight curves. RESULTS: A total of 93 720 singleton neonates with a gestational age of 24-42 weeks from the 11 cities were included in the study. The reference values of the 3rd-97th percentiles of birth weight of singleton neonates for the total of the 11 cities and for each of the 11 cities were established, and the birth weight percentile curves were drawn. The birth weight curve level of singleton neonates in Shenzhen and Quanzhou was almost the same as the average level of the 11 cities; the birth weight curve level of singleton neonates in Haikou, Guangzhou, Guilin, and Liuzhou was slightly lower than the average level of the 11 cities; the birth weight curve level of singleton neonates in Chongqing, Chengdu, and Changsha was slightly higher than the average level of the 11 cities; the birth weight curve level of singleton neonates in Ningbo and Lianyungang was higher than the average level of the 11 cities. The average birth weight curve level of singleton neonates in the 11 cities were very close to that of China Neonatal Cooperation Network in 2011-2014. CONCLUSIONS: The reference values of the 3rd-97th percentiles of birth weight of singleton neonates for the total of the 11 cities and for each of the 11 cities are developed, which can be used as a reference for evaluating the intrauterine growth of singleton neonates in the region. The level of intrauterine growth of neonates in some cities is different from the national level.


Asunto(s)
Edad Gestacional , Peso al Nacer , Niño , China , Ciudades , Humanos , Lactante , Recién Nacido , Valores de Referencia
17.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(5): 492-499, 2022 May 15.
Artículo en Chino | MEDLINE | ID: mdl-35644188

RESUMEN

OBJECTIVES: To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks. METHODS: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis. RESULTS: A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05). CONCLUSIONS: Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.


Asunto(s)
Recien Nacido Prematuro , Hemorragia Cerebral , Constricción , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Embarazo , Pronóstico , Cordón Umbilical/fisiología
18.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(5): 500-506, 2022 May 15.
Artículo en Chino | MEDLINE | ID: mdl-35644189

RESUMEN

OBJECTIVES: To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI). METHODS: The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed. RESULTS: A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups. CONCLUSIONS: Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option.


Asunto(s)
Conducto Arterioso Permeable , Conducto Arterioso Permeable/cirugía , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recién Nacido de muy Bajo Peso , Ligadura , Estudios Retrospectivos
19.
Zhongguo Dang Dai Er Ke Za Zhi ; 24(5): 521-529, 2022 May 15.
Artículo en Chino | MEDLINE | ID: mdl-35644192

RESUMEN

OBJECTIVES: To study the effect of improvement in antibiotic use strategy on the short-term clinical outcome of preterm infants with a gestational age of <35 weeks. METHODS: The medical data were retrospectively collected from 865 preterm infants with a gestational age of <35 weeks who were admitted to the Neonatal Intensive Care Unit of Xiangya Hospital of Central South University from January 1, 2014 to December 31, 2016. The improved antibiotic use strategy was implemented since January 1, 2015. According to the time of implementation, the infants were divided into three groups: pre-adjustment (January 1, 2014 to December 31, 2014; n=303), post-adjustment Ⅰ (January 1, 2015 to December 31, 2015; n=293), and post-adjustment Ⅱ (January 1, 2016 to December 31, 2016; n=269). The medical data of the three groups were compared. RESULTS: There were no significant differences among the three groups in gestational age, proportion of small-for-gestational-age infants, sex, and method of birth (P>0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had a significant reduction in the rate of use of antibiotics and the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days or 4-7 days and a significant reduction in the proportion of infants with a duration of antibiotic use of >7 days in the early postnatal period (P<0.05). Compared with the post-adjustment Ⅰ group, the post-adjustment Ⅱ group had a significant reduction in the duration of antibiotic use in the early postnatal period and during hospitalization (P<0.05), with a significant increase in the proportion of infants with a duration of antibiotic use of ≤3 days and a significant reduction in the proportion of infants with a duration of antibiotic use of 4-7 days or >7 days (P<0.05). Compared with the pre-adjustment group, the post-adjustment I and post-adjustment Ⅱ groups had significantly shorter duration of parenteral nutrition and length of hospital stay (P<0.05). There were gradual reductions in the incidence rates of grade ≥Ⅲ intraventricular hemorrhage (IVH) and late-onset sepsis (LOS) after the adjustment of antibiotic use strategy. The multivariate logistic regression analysis showed that the adjustment of antibiotic use strategy had no effect on short-term adverse clinical outcomes, and antibiotic use for >7 days significantly increased the risk of adverse clinical outcomes (P<0.05). CONCLUSIONS: It is feasible to reduce unnecessary antibiotic use by the improvement in antibiotic use strategy in preterm infants with a gestational age of <35 weeks, which can also shorten the duration of parenteral nutrition and the length of hospital stay and reduce the incidence rates of grade ≥Ⅲ IVH and LOS.


Asunto(s)
Enfermedades del Recién Nacido , Sepsis , Antibacterianos/uso terapéutico , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Estudios Retrospectivos , Sepsis/epidemiología
20.
Ultrasound Obstet Gynecol ; 59(6): 731-736, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35642909

RESUMEN

OBJECTIVES: To examine the potential value of maternal ophthalmic artery Doppler at 11-13 weeks' gestation, alone and in combination with the established first-trimester biomarkers of pre-eclampsia (PE), including uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A), in the prediction of subsequent development of PE. METHODS: This was a prospective observational study in women attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the second-to-first peak systolic velocity (PSV) ratio, and measurement of MAP and serum PAPP-A. In addition, a case-control study was carried out for measurement of PlGF in stored samples from cases that developed PE and unaffected controls. The values of PSV ratio, UtA-PI, MAP, PAPP-A and PlGF were converted to multiples of the median or deltas to remove the effects of maternal characteristics and medical history. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at < 37 and < 41 + 3 weeks' gestation for various combinations of markers. Performance was assessed using detection rates, at a fixed false-positive rate (FPR), and areas under the receiver-operating-characteristics curves. Modeled performance was also assessed. RESULTS: The study population of 4066 pregnancies contained 114 (2.8%) that developed PE, including 25 (0.6%) that delivered with PE at < 37 weeks' gestation. The PSV ratio was significantly increased in PE pregnancies, and the effect of PE depended on gestational age at delivery, with the deviation from normal being greater for early than for late PE. Modeling demonstrated that the addition of PSV ratio improved the detection rate, at a 10% FPR, of preterm PE provided by maternal risk factors alone (from 46.3% to 58.4%), maternal factors, MAP and UtA-PI (65.9% to 70.6%), and maternal factors, MAP, UtA-PI and PlGF (74.6% to 76.7%). The PSV ratio did not improve the prediction of term PE provided by any combination of biomarkers. CONCLUSION: Ophthalmic artery PSV ratio at 11-13 weeks' gestation is a potentially useful biomarker for prediction of subsequent development of preterm PE, but larger studies are needed to validate this finding. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.


Asunto(s)
Preeclampsia , Biomarcadores , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Arteria Oftálmica/diagnóstico por imagen , Factor de Crecimiento Placentario , Preeclampsia/diagnóstico por imagen , Embarazo , Proteína Plasmática A Asociada al Embarazo/metabolismo
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