Association between interpregnancy interval and maternal and neonatal adverse outcomes in women with a cesarean delivery: a population-based study.

BACKGROUND: Interpregnancy interval (IPI) has been linked with several maternal and neonatal adverse events in the general population. However, the association between IPI and maternal and neonatal outcomes in women whose first delivery was by cesarean delivery is unclear. We aimed to investigate the association between IPI after cesarean delivery and the risk of maternal and neonatal adverse events. METHODS: Women (aged ≥ 18 years) whose first delivery was cesarean delivery with 2 consecutive singleton pregnancies from the National Vital Statistics System (NVSS) database between 2017 and 2019 were included in this retrospective cohort study. In this post-hoc analysis, logistic regression analyses were used to examine IPI (≤ 11, 12-17, 18-23 [reference], 24-35, 36-59, and ≥ 60 months) in relation to the risk of repeat cesarean delivery, maternal adverse events (maternal transfusion, ruptured uterus, unplanned hysterectomy, and admission to an intensive care unit), and neonatal adverse events (low birthweight, premature birth, Apgar score at 5 min < 7, and abnormal conditions of the newborn). Stratified analysis based on age (< 35 and ≥ 35 years) and previous preterm birth. RESULTS: We included 792,094 maternities, 704,244 (88.91%) of which underwent a repeat cesarean delivery, 5,246 (0.66%) women had adverse events, and 144,423 (18.23%) neonates had adverse events. After adjusting for confounders, compared to an IPI of 18-23 months, the IPI of ≤ 11 months [odds ratio (OR) = 1.55, 95% confidence interval (CI): 1.44-1.66], 12-17 months (OR = 1.38, 95%CI: 1.33-1.43), 36-59 months (OR = 1.12, 95%CI: 1.10-1.15), and ≥ 60 months (OR = 1.19, 95%CI: 1.16-1.22) were associated with an increased risk of repeat cesarean delivery. In terms of maternal adverse events, only IPI of ≥ 60 months (OR = 0.85, 95%CI: 0.76-0.95) was observed to be associated with decreased risk of maternal adverse events in women aged < 35 years. In analysis of neonatal adverse events, IPI of ≤ 11 months (OR = 1.14, 95%CI: 1.07-1.21), 12-17 months (OR = 1.07, 95%CI: 1.03-1.10), and ≥ 60 months (OR = 1.05, 95%CI: 1.02-1.08) were related to an increased risk of neonatal adverse events. CONCLUSION: Both short and long IPI were associated with an increased risk of repeat cesarean delivery and neonatal adverse events, and women < 35 years may benefit from a longer IPI.

SIRT3 improves alveolar epithelial cell damage caused by bronchopulmonary dysplasia through deacetylation of FOXO1.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a serious and long-term lung condition commonly observed in premature babies. Sirtuin 3 (SIRT3) has been reported to reduce pulmonary injury and pulmonary fibrosis. OBJECTIVE: The present study investigated the specific role of SIRT3 in BPD by establishing hyperoxia-induced BPD rat and cell models. Hematoxylin and eosin staining was used to observe pathological changes in lung tissues. MATERIALS AND METHODS: The expression levels of SIRT3 and forkhead box protein O1 (FOXO1), as well as its acetylation levels, were detected in hyperoxia-induced lung tissues and cells by Western blot analysis and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Levels of reactive oxygen species, superoxide dismutase, and malondialdehyde were assessed by using biochemical kits. Following SIRT3 overexpression, the levels of inflammatory cytokines were assessed by RT-qPCR. Apoptosis was determined by terminal deoxynucleotidyl transferase dUTP nickend labeling (TUNEL) and Western blot analysis. Upon FOXO1 knockout, cell inflammation, oxidative stress and apoptosis were evaluated again. RESULTS: Compared to the control group, the SIRT3 and FOXO1 expression levels were decreased and the FOXO1 acetylation levels were increased in hyperoxia-induced lung tissues and cells. In addition, SIRT3 reduced hyperoxia-induced inflammation, oxidative stress, and apoptosis in A549 cells, and inhibited FOXO1 acetylation to activate FOXO1. However, FOXO1 knockdown reversed the effects of SIRT3 overexpression in hyperoxia-induced A549 cells. CONCLUSION: SIRT3 relieved alveolar epithelial cell damage caused by BPD via deacetylation of FOXO1, suggesting that SIRT3 could be a therapeutic target in BPD.

SIRT3 improves alveolar epithelial cell damage caused by bronchopulmonary dysplasia through deacetylation of FOXO1

Background: Bronchopulmonary dysplasia (BPD) is a serious and long-term lung condition commonly observed in premature babies. Sirtuin 3 (SIRT3) has been reported to reduce pulmonary injury and pulmonary fibrosis. Objective: The present study investigated the specific role of SIRT3 in BPD by establishing hyperoxia-induced BPD rat and cell models. Hematoxylin and eosin staining was used to observe pathological changes in lung tissues. Materials and methods: The expression levels of SIRT3 and forkhead box protein O1 (FOXO1), as well as its acetylation levels, were detected in hyperoxia-induced lung tissues and cells by Western blot analysis and reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Levels of reactive oxygen species, superoxide dismutase, and malondialdehyde were assessed by using biochemical kits. Following SIRT3 overexpression, the levels of inflammatory cytokines were assessed by RT-qPCR. Apoptosis was determined by terminal deoxynucleotidyl transferase dUTP nickend labeling (TUNEL) and Western blot analysis. Upon FOXO1 knockout, cell inflammation, oxidative stress and apoptosis were evaluated again. Results: Compared to the control group, the SIRT3 and FOXO1 expression levels were decreased and the FOXO1 acetylation levels were increased in hyperoxia-induced lung tissues and cells. In addition, SIRT3 reduced hyperoxia-induced inflammation, oxidative stress, and apoptosis in A549 cells, and inhibited FOXO1 acetylation to activate FOXO1. However, FOXO1 knockdown reversed the effects of SIRT3 overexpression in hyperoxia-induced A549 cells. Conclusion: SIRT3 relieved alveolar epithelial cell damage caused by BPD via deacetylation of FOXO1, suggesting that SIRT3 could be a therapeutic target in BPD (AU)

The specific signs of lung ultrasound to diagnose pulmonary hemorrhage of the newborns: Evidence from a multicenter retrospective case-control study.

Objectives: Pulmonary hemorrhage (PH) is one kind of critical lung diseases in newborn infants, which is the most difficult one to be diagnosed by ultrasound. This study was to investigate the specific ultrasonic signs of PH in order to better diagnose neonatal PH by using lung ultrasound (LUS). Methods: A total 168 newborn infants were enrolled in this study, which included PH, pneumonia, meconium aspiration syndrome, and newborns without lung diseases, there were 42 cases in each group. In a quiet state, infants were placed in the supine, lateral or prone position for the examination. Each lung was divided into the anterior, lateral and posterior regions, then each region of both lungs was scanned with the probe perpendicular to the ribs or parallel to the Intercostal spaces. Results: The major results showed that: (1) the common LUS manifestation of PH includes lung consolidation, air bronchograms, fluid bronchograms, pleural effusion, shred signs, pleural line abnormality and B-lines, while fibrin deposition sign is a rare sign of PH. (2) Co-existing of lung consolidation with fluid bronchograms and pleural effusion is the specific sign of PH with a sensitivity of 81.0%, specificity of 98.4% and the positive predictive value (PPV) was 94.4%. (3) Fibrin deposition sign is an uncommon specific LUS sign of PH with a sensitivity 28.6%, specificity of 100% and the PPV was 100%. (4) Nine patients (21.4%) were diagnosed with PH based on ultrasound findings before oronasal bleeding. (5) The survival rate of infants with PH was 100% in this study. Conclusion: LUS is helpful for the early diagnosis of neonatal PH and may therefore improve the prognosis. The lung consolidation with fluid bronchograms and pleural effusion as well as fibrin deposition sign are specific to diagnose PH by using LUS.

Generation of an induced pluripotent stem cell line from a patient with surfactant metabolism dysfunction carrying ABCA3 mutations.

Surfactant dysfunction is a genetically heterogeneous pulmonary disease that causes dyspnea. ATP binding cassette protein transporter subunit A3 (ABCA3) is the main pathogenic gene of pulmonary surfactant dysfunction. In this study, we established an induced pluripotent stem cell line (SMCPGHi001-A) from the peripheral blood cells of a 49-day-old male infant, carrying compound heterozygous variations of the ABCA3 gene (c.3997_3998del, p.R1333fs, and c.3137C > T, p.A1046V). This iPSC line would be a useful tool to study the pathogenesis, disease development, and treatment of pulmonary surfactant dysfunction.

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure.

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Observation of curative effect of nasal continuous positive airway pressure combined with high-dose ambroxol for neonatal respiratory failure.

To observe and analyze the effectiveness of nasal continuous positive airway pressure for neonatal respiratory failure. The 200 newborns with respiratory failure treated in our hospital. They were enrolled as study subjects and assigned to study group and reference group with equal number of cases. The study group was treated with continuous positive airway pressure plus high-dose ambroxol, while the reference group only received high-dose ambroxol. The overall treatment effect was compared between the two groups. Observation of the overall treatment efficacy of the study group and the reference group showed that the study group was superior to the reference group, P<0.05; comparison of such treatment indicators as disappearance of shortness of breath, disappearance of cyanosis, disappearance of groaning, assisted ventilation duration, hospital stay showed that the study group was significantly superior to the reference group, P<0.05; comparison of arterial oxygen partial pressure, oxygen saturation, and carbon dioxide partial pressure showed differences between groups, P<0.05. Treatment of neonatal respiratory failure with nasal continuous positive airway pressure plus high-dose ambroxol can achieve good results and reduce hospital stay.

Lung ultrasonography to diagnose pneumothorax of the newborn.

OBJECTIVE: To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. METHODS: This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. RESULTS: (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. CONCLUSION: Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.

Desferrioxamine regulates HIF-1 alpha expression in neonatal rat brain after hypoxia-ischemia.

Hypoxia-inducible factor 1α (HIF-1α) promotes cell survival after hypoxia-ischemia by regulating its target genes. Desferrioxamine (DFO) has been found to up-regulate HIF-1α expression in ischemia brain injury. However, the signaling pathway to mediate this regulation remains unclear in neonatal hypoxia-ischemia brain damage (HIBD). Since phosphoinositide 3-kinase (PI3K/Akt) pathway and extracellular signal-related protein kinase pathway (Erk1/2 MAPK) have proven to be involved in the regulation of HIF-1α in neonatal rat brain after hypoxia-ischemia (HI), we hypothesized that DFO might regulate HIF-1α by activating PI3K/Akt and Erk1/2 MAPK pathways in developing rat brain after HI. To test this hypothesis, we subjected postnatal day 10 rats to DFO intraperitoneal injection 30 min before HI. Rat brains were collected to detect the expression of HIF-1α and its target gene VEGF, as well as PI3K/Akt and Erk1/2 MAPK using Western blot analysis. We found that the expression of HIF-1α, VEGF, and p-Erk1/2 was significantly upregulated and peaked at 4 h after HI in DFO treated group, with higher level and earlier peak time than control group. However, the expression of p-Akt was unchanged in DFO treated group compared with control group. Our findings suggest that DFO might up-regulate HIF-1α and its target gene VEGF through Erk1/2 MAPK pathway in the developing rat brain after HI.

[Comparative study on application of Duo positive airway pressure and continuous positive airway pressure in preterm neonates with respiratory distress syndrome].

OBJECTIVE: To determine whether early application of Duo positive airway pressure (DuoPAP), in comparison with nasal continuous positive airway pressure (NCPAP), can reduce the need for endotracheal intubation and mechanical ventilation and decrease the incidence of bronchopulmonary dysplasia (BPD) in preterm neonates with respiratory distress syndrome (RDS). METHODS: In a single-center, randomized controlled trial, preterm neonates (gestational ages 30-35 weeks) with RDS were randomly assigned to receive DuoPAP (n=34) or NCPAP (n=33) within 6 hours of birth. If the two noninvasive ventilations were not effective, endotracheal intubation and mechanical ventilation were used, and pulmonary surfactant was administered as rescue therapy. The total invasive respiratory support rate and incidence of BPD within 24, 48 and 72 hours of birth were observed. The two groups were compared in terms of PaCO2, PaO2 and oxygenation index (OI) at 1, 12, 24, 48 and 72 hours after using the noninvasive respiratory support. RESULTS: The total invasive respiratory support rates within 48 and 72 hours after birth were significantly lower in the DuoPAP group than in the NCPAP group (P<0.05). There was no difference in the incidence of BPD between the two groups (P>0.05). The OI in the DuoPAP group was significantly higher than in the NCPAP group at 1, 12, 24, 48 and 72 hours after noninlasive respiratory support (P<0.05). The DuoPAP group showed significantly lower PaCO2 than the NCPAP group at 1, 12, and 24 hours after noninvasive respiratory support (P<0.05). PaO2 was significantly higher in the DuoPAP group than in the NCPAP group at 1 and 12 hours after noninvasive respiratory support (P<0.05). CONCLUSIONS: Compared with NCPAP, early application of DuoPAP can decrease the need for endotracheal intubation and mechanical ventilation in preterm neonates with RDS, showing promise for broad use.