Perinatal morbidity and mortality in late-term and post-term pregnancy. NEOSANO perinatal network's experience in Mexico.

OBJECTIVE: The objective of this study is to identify adverse perinatal outcomes associated with pregnancies at or beyond 40 weeks. STUDY DESIGN: Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO's Perinatal Network Database from April 2006 to April 2009. Multiple births, babies with inaccurate gestational age or babies with congenital malformations were excluded. Logistic regression models were used to analyze perinatal complications associated with pregnancies ≥ 40 weeks. RESULT: A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were of 40 to 40[frac67] weeks, 3024 (14.2%) 41 to 41[frac67] weeks and 388 (1.8%) 42 to 44 weeks of gestation. Adverse perinatal outcomes associated with 40 to 40[frac67] weeks deliveries were (odds ratio; 95% confidence interval): macrosomia (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse perinatal outcomes associated with 41 to 41[frac67] weeks were macrosomia (2.5; 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 to 13.8), stillbirth (4.3; 1.4 to 13.5), 5' Apgar <4 (4.2; 1.1 to 15.7), chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean delivery (1.8; 1.3 to 2.4). CONCLUSION: An increased risk for perinatal and maternal complications were detected as early as 40 weeks' gestation. The risks of stillbirth and neonatal death were significantly higher in the post-term group than the control group.

Short-term neurophysiologic consequences of intrapartum asphyxia in piglets born by spontaneous parturition.

Piglets appear to be neurologically sensitive to intrapartum asphyxia. Our aim was to investigate the short-term neurophysiologic consequences of intrapartum asphyxia in piglets. We studied 10 piglets suffering intrapartum asphyxia and 10 control piglets. Glucose and blood gas levels, tympanic membrane temperature, and body weight were measured within the first 2 min after birth. Animals were followed up for a 5-day period. As surrogated markers of piglets' neurological function, a viability score and the time elapsed from birth to the first contact with the maternal udder were recorded. In the control group, temperature and blood pH levels at birth were significantly higher (p < or = .001), whereas calcium, lactate and PCO2 levels were statistically lower (p < or = .05) than in the piglets experiencing intrapartum asphyxia. Lower temperature and blood pH levels as well as higher blood PCO2 and lactate levels were observed in piglets with lower viability scores and in piglets with prolonged times until first udder contact. At the end of the study, asphyxiated piglets weighed on average 200 g less (p = .023) than control piglets. In conclusion, intrapartum asphyxia in spontaneously born piglets was associated with signs of acute neurological dysfunction and lower weight gain, supporting the hypothesis that they may be used as a naturalistic model for the study of asphyxia in newborns.

A systematic review of experimental and clinical studies of sildenafil citrate for intrauterine growth restriction and pre-term labour.

Sildenafil could be an alternative in the treatment of intrauterine growth retardation (IUGR) and premature delivery. In order to systematically review the reproductive-related effects of sildenafil, a search was made on PubMed and the Science Citation Index for studies evaluating the effects of sildenafil on uterine vessels or myometrium either in vitro or in experimental animal models as well as for any clinical trial or case reporting the outcome of pregnant women treated with sildenafil. The information was obtained from: three in vitro studies, five studies performed in experimental animal models, four studies on women with fertility and sterility disorders receiving 100 mg/day of sildenafil intravaginally, and two case reports of pregnant women who received sildenafil for the treatment of pulmonary hypertension. Incubation with sildenafil of different in vitro preparations resulted in vasodilator and uterine relaxant effects. No evidence of teratogenicity was observed in the studies performed in mice, rats and dogs. Sildenafil increased fetal weight in rats. In women, contradictory results on uterine blood flow and endometrial development were reported after the intravaginal administration of sildenafil. No adverse fetal outcomes were reported in the two pregnant women with pulmonary hypertension receiving sildenafil late in their pregnancy. In conclusion, there is still limited information about the efficacy of sildenafil for the treatment of IUGR and premature delivery. However, studies in experimental animal models and two human case reports have reported no deleterious effects on the mother or offspring.

Validation of a prognostic index in the critically ill newborn.

OBJECTIVE: Elaborate and assess the degree of validity of a prognostic model for evaluating patients admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: Cases and controls nested in a cohort. SETTING: NICU of two tertiary hospitals and another second level hospital. PATIENTS: The study was carried out in two phases. During the first phase (elaboration of a model), 336 newborns were studied; 112 belonged to the case group (dead patients) and 224 to the control group (live patients discharged). For the second phase (model validation), 300 patients were included that did not participate in the first phase, 100 cases and 200 controls. MEASUREMENTS: For each patient admitted to the study, clinical, paraclinical, perinatal and comorbidity factors were determined within the first 12 hours. Variables of statistical significance in the bivariate analysis were included in a logistic regression model with the objective of identifying a prognostic model. RESULTS: The variables that constituted the prognostic index were gestational age x birth weight, the paO2/FiO2 ratio x O2 saturation, arrest cardiac, major congenital malformations, septicemia and base excess. The model showed to have a sensitivity of 70% and a specificity of 91% during the elaboration cohort. In the validation cohort, sensitivity was 68% and specificity was 92%, a positive predictive value of 80%, negative predictive value of 85% and a correct classification rate was 84%. CONCLUSIONS: The Neonatal Mortality Prognostic Index (NMPI) developed in this study showed to be useful for the evaluation of hospital mortality for severely ill newborns admitted to NICU.

Neonatal status epilepticus I: Clinical aspects.

Fifteen newborns with neonatal status epilepticus were prospectively identified from a protocol of convulsion in the newborn, at the neonatal intensive care unit. The mean postnatal age was 7.1 days, with fourteen full term babies and one premature. Previous complications during childbirth existed in twelve infants. The principal etiology associated was hypoxic-ischemic-encephalopathy, and four patients died. In thirteen cases the antecedent of subtle seizures existed; only in four cases was status epilepticus suspected. Difficulty in clinical recognition makes it necessary to perform an EEG on each newborn with risk factors, abnormal neurological manifestations, or with prolonged and or repeated hypoxic perinatal antecedents.

Estado de mal epileptico en el recien nacido. / Status epilepticus in the newborn infant

Se analiza el estudio prospectivo de 15 recien nacidos en quienes se identifico estado de mal epileptico. La etiologia mas frecuente fue la encefalopatia hipoxica; el antecedente de crisis tonicas y la forma sutil fueron las manifestaciones que se presentaron con mayor frecuencia. En cuanto al registro electroencefalografico, en 11 casos las descargas ocurrieron durante su primer estudio sin manifestaciones clinicas (estado de mal epileptico electrico) y en cuatro casos se presentaron simultaneamente descargas electroencefalograficas y crisis clinicas (estado de mal neonatal epileptico electrocilnico). En este trabajo tambien se informa de la respuesta al tratamiento y se enfatiza en las ventajas del control continuo terapeutico y electroencefalografico

Tetanos neonatal: presentacion de cinco casos y discusion del manejo actual. / Neonatal tetanus: report of 5 cases and discussion of the present management

Se presentan cinco neonatos con tetanos neonatal manejados en una unidad de cuidados intensivos a base de penicilina sodica gammaglobulina humana hiperinmune y fenobarbital sodico; 4 de ellos recibieron ademas bromuro de pancuronio a infusion continua como bloqueador muscular y ventilacion mecanica asistida con buenos resultados. Se discuten aspectos actuales del manejo de sedacion,paralisis muscular,ventilacion asistida y neutralizacion de la toxina circulante con antitoxina humana y heterologa