RESUMO
OBJECTIVE: To identify whether histologically confirmed chorioamnionitis (hCAM) is associated with development of retinopathy of prematurity (ROP). STUDY DESIGN: We retrospectively analyzed 2 different cohorts. Cohort 1 was the national database of newborns in Japan born at ≤1500g or <32 weeks' gestation (January 2003 through April 2021, n = 38â013). Cohort 2 was babies born at <1500g from a single institution in Tsuchiura, Japan, (April 2015 through March 2018, n = 118). RESULTS: For Cohort1, after adjusting for potential confounders, stage III CAM (n = 5554) was associated with lower odds of severe ROP (stage ≥3 or required peripheral retinal ablation) by 14% (OR: 0.86; 95% CI: 0.78-0.94]. CAM of stage I (n = 3277) and II (n = 4319) was not associated with the risk of ROP. For Cohort 2, the odds of severe ROP were significantly reduced in moderate to severe hCAM groups (stage II, OR: 0.06, 95% CI: 0.05-0.82; stage III, OR: 0.10, 95% CI: 0.01-0.84). Neonates with funisitis, comorbidity of hCAM, and a finding of fetal inflammatory response had lower odds of severe ROP (OR: 0.11; 95% CI: 0.01-0.93). CONCLUSIONS: After adjusting for confounders, severe hCAM with fetal inflammatory response was associated with reduced risk of ROP.
Assuntos
Corioamnionite , Retinopatia da Prematuridade , Humanos , Retinopatia da Prematuridade/epidemiologia , Corioamnionite/epidemiologia , Feminino , Recém-Nascido , Estudos Retrospectivos , Gravidez , Masculino , Japão/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Recém-Nascido Prematuro , Idade GestacionalRESUMO
OBJECTIVE: To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm. STUDY DESIGN: EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 240/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively. RESULTS: Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8). CONCLUSIONS: We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane.
Assuntos
Corioamnionite , Ruptura Prematura de Membranas Fetais , Nascimento Prematuro , Recém-Nascido , Lactente , Gravidez , Criança , Feminino , Humanos , Idoso de 80 Anos ou mais , Corioamnionite/epidemiologia , Estudos de Coortes , Idade Gestacional , Taquicardia , Ruptura Prematura de Membranas Fetais/epidemiologiaRESUMO
OBJECTIVE: To determine whether outcomes among infants with very low birth weight (VLBW) vary according to the birthplace (Japan or California) controlling for maternal ethnicity. STUDY DESIGN: Severe intraventricular hemorrhage (IVH) and mortality were ascertained for infants with VLBW born at 24-29 weeks of gestation during 2008-2017 and retrospectively analyzed by the country of birth for mothers and infants (Japan or California). RESULTS: Rates of severe IVH, mortality, or combined IVH/mortality were lower in the 24 095 infants born in Japan (5.1%, 5.0%, 8.8% respectively) compared with infants born in California either to 157 mothers with Japanese ethnicity (12.5%, 9.7%, 17.8%) or to a comparison group of 6173 non-Hispanic white mothers (8.4%, 8.8%, 14.6%). ORs for adverse outcomes were increased for infants born in California to mothers with Japanese ethnicity compared with infants born in Japan for severe IVH (OR, 3.31; 95% CI, 1.93-5.68), mortality (3.73; 95% CI, 2.03-6.86), and the combined outcome (3.26; 95% CI, 2.02-5.27). The odds of these outcomes also were increased for infants born in California to non-Hispanic white mothers compared with infants born in Japan. Outcomes of infants born in California did not differ by Japanese or non-Hispanic white maternal ethnicity. CONCLUSIONS: Low rates of severe IVH and mortality for infants with VLBW born in Japan were not seen in infants born in California to mothers with Japanese ethnicity. Differences in systems of regional perinatal care, social environment, and the quality of perinatal care may partially account for these differences in outcomes.
Assuntos
Entorno do Parto , Hemorragia Cerebral Intraventricular/epidemiologia , Mortalidade Infantil , Recém-Nascido de muito Baixo Peso , Adolescente , Adulto , Índice de Apgar , Povo Asiático , California/epidemiologia , Cesárea/estatística & dados numéricos , Corioamnionite/epidemiologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Idade Gestacional , Glucocorticoides/uso terapêutico , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Japão/epidemiologia , Idade Materna , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , População Branca , Adulto JovemRESUMO
OBJECTIVES: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). MATERIALS AND METHODS: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. RESULTS: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). CONCLUSIONS: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.
OBJETIVOS: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). MATERIALES Y MÉTODOS: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. RESULTADOS: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). CONCLUSIONES: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.
Assuntos
Lesões Encefálicas , Corioamnionite , Doenças do Prematuro , Efeitos Tardios da Exposição Pré-Natal , Lesões Encefálicas/epidemiologia , Corioamnionite/epidemiologia , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Masculino , Peru/epidemiologia , Gravidez , RiscoRESUMO
RESUMEN Objetivos: Evaluar el riesgo de daño cerebral en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH). Materiales y métodos: Se realizó un estudio de cohortes en el Hospital Cayetano Heredia, durante el 2015. Fueron incluidos prematuros menores de 34 semanas que tuvieran examen histopatológico de la placenta. Los tipos de CAH evaluados fueron subcorionitis, corionitis, corioamnionitis, con o sin funisitis. El daño cerebral se evaluó en tres periodos de edad, entre 0 y 7 días, entre 7 y 30 días y a las 40 semanas gestacionales corregidas. Se realizó un seguimiento neurológico y controles con ecografía cerebral. Resultados: Se estudiaron 85 prematuros, 47,1% eran mujeres y la media de la edad gestacional fue de 30,9 semanas. El 42% (36/85) nacieron expuestos a CAH. La ruptura prematura de membrana fue la principal generatriz de sepsis, y la sepsis se relacionó con daño neurológico. La CAH estuvo asociada con hemorragia intraventricular (HIV) durante la primera semana y con lesiones de la sustancia blanca entre los 7 y 30 días de edad (p = 0,035). El tipo corioamnionitis de CAH se asoció al daño neurológico durante la primera semana (RR = 2,11; IC 95%: 1,09-4,11) y entre los 7 y 30 días de vida (RR = 2,72; IC 95%: 1,07-6,88). Conclusiones: La corioamnionitis fue un factor de riesgo para desarrollar lesiones cerebrales en prematuros menores de 34 semanas, para HIV durante los primeros 7 días y lesiones de sustancia blanca entre los 7 y los 30 días de edad. A las 40 semanas de edad corregida, los prematuros extremos con CAH tuvieron lesiones cerebrales más extensas.
ABSTRACT Objectives: To assess the risk of brain damage in premature infants under 34 weeks of gestational age exposed to histological chorioamnionitis (HCA). Materials and methods: A cohort study was conducted at the Hospital Cayetano Heredia, during 2015. Premature infants under 34 weeks of gestational age, who had histopathological examination of the placenta, were included. The types of HCA evaluated were sub-chorionitis, chorionitis, chorioamnionitis, with or without funisitis. Brain damage was evaluated in three age periods, between 0 and 7 days, between 7 and 30 days and at 40 weeks of corrected gestational age. A neurological follow-up and regular controls were performed with brain ultrasound. Results: A total of 85 premature infants were included, 47.1% were women and the mean gestational age was 30.9 weeks. From the total, 42% (36/85) were born exposed to HCA. Premature rupture of membranes was the main cause of sepsis, which was related to neurological damage. HCA was associated with intraventricular hemorrhage (IVH) during the first week and with white matter lesions between 7 and 30 days of age (p = 0.035). The chorioamnionitis type of HCA was associated with neurological damage during the first week (RR = 2.11, 95% CI: 1.09-4.11) and between 7 and 30 days of age (RR = 2.72, 95% CI: 1.07-6.88). Conclusions: Chorioamnionitis was a risk factor for developing brain injuries in premature infants under 34 weeks of gestational age. It was also a risk factor for HIV during the first 7 days and for white matter injuries between 7 and 30 days of age. At 40 weeks of corrected gestational age, extreme premature infants with HCA had more extensive brain damage.
Assuntos
Humanos , Recém-Nascido , Efeitos Tardios da Exposição Pré-Natal , Lesões Encefálicas , Recém-Nascido Prematuro , Corioamnionite , Doença Cerebrovascular dos Gânglios da Base , Doenças do Prematuro , Neonatologia , Neurologia , Peru/epidemiologia , Leucomalácia Periventricular , Lesões Encefálicas/epidemiologia , Risco , Estudos de Coortes , Corioamnionite/epidemiologia , Idade Gestacional , Hemorragia Cerebral Intraventricular , Doenças do Prematuro/epidemiologiaRESUMO
OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.
Assuntos
Infecções/epidemiologia , Nascimento Prematuro/epidemiologia , Brasil/epidemiologia , Corioamnionite/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Vigilância da População , Gravidez , Fatores de Risco , Infecções Urinárias/epidemiologia , Vaginose Bacteriana/epidemiologiaRESUMO
INTRODUCCIÓN: La corioamnionitis histológica (CH) es causa importante de parto pretérmino y se asocia a resultados neonatales adversos, con secuelas del neurodesarrollo. Ocurre en alrededor de un 20% de embarazos a término y 60% de pretérmino. Este proceso está asociado a varias complicaciones neonatales, entre las más frecuentes: sepsis neonatal temprana, menor edad gestacional y mayor estancia hospitalaria. OBJETIVO: Establecer la asociación de complicaciones neonatales con el diagnóstico de CH en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad. MÉTODOS: Estudio retrospectivo, se incluyeron 160 pacientes con parto pretérmino espontáneo con estudio histopatológico de la placenta según protocolo institucional. Se recolectan las características basales de la gestante y complicaciones neonatales. Se calcula la prevalencia de CH, y se comparan dos grupos (con y sin) la asociación de complicaciones neonatales, distribuidas por edad gestacional y peso neonatal. RESULTADOS: La prevalencia de CH es de 69% (IC95%: 61-76). Al distribuir por edad gestacional se reporta: 87% en 34 (IC 95%: 45 -67). La CH entre las 28 - 34 y > 34 semanas, se asocia a mayor sepsis neonatal temprana (p 2000 g se asocia con sepsis neonatal (p<0.05). CONCLUSIÓN: La prevalencia de CH es alta, principalmente a menor edad gestacional, se asocia a complicaciones neonatales como la sepsis neonatal temprana.
INTRODUCTION: Histological chorioamnionitis (HC) is an important cause of preterm delivery and is associated with adverse neonatal outcomes, with sequelae of neurodevelopment. It occurs in about 20% of full-term and 60% preterm pregnancies. This process is associated with several neonatal complications, among the most frequent: early neonatal sepsis, younger gestational age, and longer hospital stay. OBJECTIVE: To establish the association of neonatal complications with HC diagnosis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia. RESULTS: The prevalence of HC is 69% (95% CI: 61-76). When distributed by gestational age, it is reported: 87% in 34 (95% CI: 45-67). HC between 28 - 34 and > 34 weeks, is associated with higher early neonatal sepsis (p 2000 g is associated with early neonatal sepsis (p <0.05). CONCLUSION: The prevalence of HC is high, mainly at a lower gestational age, it is associated with neonatal complications such as early neonatal sepsis.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Adulto Jovem , Corioamnionite/patologia , Corioamnionite/epidemiologia , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Prevalência , Estudos Retrospectivos , ColômbiaRESUMO
OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Nascimento Prematuro/epidemiologia , Infecções/epidemiologia , Infecções Urinárias/epidemiologia , Brasil/epidemiologia , Vigilância da População , Estudos Transversais , Fatores de Risco , Corioamnionite/epidemiologia , Vaginose Bacteriana/epidemiologiaRESUMO
OBJECTIVE: To perform a descriptive analysis of preterm premature rupture of membranes (PPROM) cases attended in a tertiary hospital. METHOD: Retrospective analysis of medical records and laboratory tests of patients admitted to a Brazilian tertiary hospital between 2006 and 2011, with a confirmed diagnosis of PPROM and gestational age (GA) at delivery <37 weeks. RESULTS: A total of 299 pregnant women were included in the study. Nine patients evolved to abortion, and 290 pregnant women remained for the final analysis. There was initial diagnostic doubt in 17.6% of the cases. The oligohydramnios rate [amniotic fluid index (AFI) <5] was 27.9% on admission. Chorioamnionitis was initially diagnosed in 10.8% of the patients and was retrospectively confirmed in 22.9% of the samples. The latency period had a mean of 9.1 days. The main reasons for interruption were premature labor (55.2%), GA ≥36 weeks (27.2%), and fetal distress (6.9%). The delivery method was cesarean section in 55% of cases. The mean birth weight was 2,124 grams, and 67% of the neonates had a low birth weight (<2500 g). The GA at delivery averaged 33.5 weeks. The stillbirth rate was 5.3%, and the early neonatal mortality rate was 5.6%. There were complications at delivery in 18% of mothers. CONCLUSION: In one of the few Brazilian reports on the epidemiological profile of PPROM, with GA until 37 weeks and intercurrences generally excluded from assessments (such as twinning and fetal malformations), there is a favorable evolution, with an acceptable rate of complications.
Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Adolescente , Adulto , Peso ao Nascer , Brasil/epidemiologia , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto JovemRESUMO
OBJECTIVE: To perform a descriptive analysis of preterm premature rupture of membranes (PPROM) cases attended in a tertiary hospital. METHOD: Retrospective analysis of medical records and laboratory tests of patients admitted to a Brazilian tertiary hospital between 2006 and 2011, with a confirmed diagnosis of PPROM and gestational age (GA) at delivery <37 weeks. RESULTS: A total of 299 pregnant women were included in the study. Nine patients evolved to abortion, and 290 pregnant women remained for the final analysis. There was initial diagnostic doubt in 17.6% of the cases. The oligohydramnios rate [amniotic fluid index (AFI) <5] was 27.9% on admission. Chorioamnionitis was initially diagnosed in 10.8% of the patients and was retrospectively confirmed in 22.9% of the samples. The latency period had a mean of 9.1 days. The main reasons for interruption were premature labor (55.2%), GA ≥36 weeks (27.2%), and fetal distress (6.9%). The delivery method was cesarean section in 55% of cases. The mean birth weight was 2,124 grams, and 67% of the neonates had a low birth weight (<2500 g). The GA at delivery averaged 33.5 weeks. The stillbirth rate was 5.3%, and the early neonatal mortality rate was 5.6%. There were complications at delivery in 18% of mothers. CONCLUSION: In one of the few Brazilian reports on the epidemiological profile of PPROM, with GA until 37 weeks and intercurrences generally excluded from assessments (such as twinning and fetal malformations), there is a favorable evolution, with an acceptable rate of complications.
Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Adolescente , Adulto , Adulto Jovem , Ruptura Prematura de Membranas Fetais/epidemiologia , Peso ao Nascer , Brasil/epidemiologia , Resultado da Gravidez , Mortalidade Infantil , Estudos Retrospectivos , Corioamnionite/epidemiologia , Idade Gestacional , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN: All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS: We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS: We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Sepse Neonatal/epidemiologia , Corioamnionite/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/microbiologia , Comorbidade , Infecção Hospitalar/microbiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Meningites Bacterianas/epidemiologia , Sepse Neonatal/microbiologia , Gravidez , Respiração Artificial/estatística & dados numéricos , Fatores Sexuais , Suíça/epidemiologia , Infecções Urinárias/epidemiologiaRESUMO
OBJECTIVES: To evaluate the performance of the early-onset sepsis (EOS) risk calculator in a cohort of neonates born to mothers with clinical chorioamnionitis, and to compare the diagnostic utility of the EOS calculator, clinical signs, and laboratory evaluations for correctly identifying EOS in this cohort. STUDY DESIGN: This was a retrospective study of neonates born at ≥35 weeks of gestation to mothers with chorioamnionitis. The risk and management categories for all neonates were calculated using the EOS calculator, and these results were analyzed and compared with laboratory data and clinical signs. RESULTS: Of the 1159 neonates born to mothers with chorioamnionitis, 5 (0.43%) had culture-proven EOS. Data for calculation of EOS risk were available for 896 neonates, including the 5 neonates with culture-proven EOS. The management recommendation based on the calculator was no empiric antibiotic treatment for 67% of the neonates, including 2 of the 5 with EOS. All neonates with culture-proven EOS had abnormal complete blood counts and C-reactive protein levels at 6-12 hours. Three of the 5 neonates with EOS had clinical signs of sepsis. CONCLUSIONS: The risk of EOS in neonates born to mothers with chorioamnionitis is low. The use of an EOS calculator may reduce the use of empiric antibiotics in chorioamnionitis-exposed neonates, but in our cohort, some neonates with culture-confirmed EOS would have been missed. A larger study is needed to evaluate whether limiting antibiotics to chorioamnionitis-exposed neonates with clinical and/or laboratory signs of infection can safely decrease antibiotic use.
Assuntos
Corioamnionite , Técnicas de Apoio para a Decisão , Sepse Neonatal/diagnóstico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Proteína C-Reativa/análise , Corioamnionite/diagnóstico , Corioamnionite/tratamento farmacológico , Corioamnionite/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/etiologia , Sepse Neonatal/prevenção & controle , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
OBJECTIVE: To investigate the association between histologic chorioamnionitis (HCA) and bronchopulmonary dysplasia (BPD) in very preterm infants, both in a general population and for those born after spontaneous preterm labor and after preterm premature rupture of membranes (pPROM). STUDY DESIGN: This study included 2513 live born singletons delivered at 24-31 weeks of gestation from a national prospective population-based cohort of preterm births; 1731 placenta reports were available. HCA was defined as neutrophil infiltrates in the amnion, chorion of the membranes, or chorionic plate, associated or not with funisitis. The main outcome measure was moderate or severe BPD. Analyses involved logistic regressions and multiple imputation for missing data. RESULTS: The incidence of HCA was 28.4% overall: 38% in cases of preterm labor, 64% in cases of pPROM, and less than 5% in cases of vascular disorders. Overall, the risk of BPD after adjustment for gestational age, sex, and antenatal steroids was reduced for infants with HCA (HCA alone: aOR 0.6 [95% CI 0.4-0.9]; associated with funisitis: aOR 0.5 [95% CI 0.3-0.8]). This finding was explained by the high rate of BPD and low rate of chorioamnionitis among children with fetal growth restriction. HCA was not associated with BPD in the preterm labor (13.4% vs 8.5%; aOR 0.9; 95% CI 0.5-1.8) or in the pPROM group (12.9% vs 12.1%; aOR 0.6; 95% CI 0.3-1.3). CONCLUSION: In homogeneous groups of infants born after preterm labor or pPROM, HCA is not associated with BPD.
Assuntos
Displasia Broncopulmonar/epidemiologia , Corioamnionite/epidemiologia , Displasia Broncopulmonar/complicações , Estudos Epidemiológicos , Feminino , Ruptura Prematura de Membranas Fetais , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Modelos Logísticos , Masculino , Gravidez , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the association of Oregon's hard-stop policy limiting early elective deliveries (before 39 weeks of gestation) and the rate of elective early-term inductions and cesarean deliveries and associated maternal-neonatal outcomes. METHODS: This was a population-based retrospective cohort study of Oregon births between 2008 and 2013 using vital statistics data and multivariable logistic regression models. Our exposure was the Oregon hard-stop policy, defined as the time periods prepolicy (2008-2010) and postpolicy (2012-2013). We included all term or postterm, cephalic, nonanomalous, singleton deliveries (N=181,034 births). Our primary outcomes were induction of labor and cesarean delivery at 37 or 38 weeks of gestation without a documented indication on the birth certificate (ie, elective early term delivery). Secondary outcomes included neonatal intensive care unit admission, stillbirth, macrosomia, chorioamnionitis, and neonatal death. RESULTS: The rate of elective inductions before 39 weeks of gestation declined from 4.0% in the prepolicy period to 2.5% during the postpolicy period (P<.001); a similar decline was observed for elective early-term cesarean deliveries (from 3.4% to 2.1%; P<.001). There was no change in neonatal intensive care unit admission, stillbirth, or assisted ventilation prepolicy and postpolicy, but chorioamnionitis did increase (from 1.2% to 2.2%, P<.001; adjusted odds ratio 1.94, 95% confidence interval 1.80-2.09). CONCLUSIONS: Oregon's statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes.
Assuntos
Cesárea/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Trabalho de Parto Induzido/tendências , Adulto , Índice de Apgar , Transfusão de Sangue/estatística & dados numéricos , Cesárea/legislação & jurisprudência , Cesárea/estatística & dados numéricos , Corioamnionite/epidemiologia , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Macrossomia Fetal/epidemiologia , Idade Gestacional , Humanos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Trabalho de Parto Induzido/legislação & jurisprudência , Trabalho de Parto Induzido/estatística & dados numéricos , Oregon/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Mortalidade Perinatal , Gravidez , Estudos Retrospectivos , Natimorto/epidemiologiaRESUMO
OBJECTIVES: To determine the expected proportion of term cerebral palsy (CP) after neonatal encephalopathy (NE) that could theoretically be prevented by hypothermia and elucidate the perinatal factors associated with CP after NE in those who do not meet currently used clinical criteria required to qualify for hypothermia ("cooling criteria"). STUDY DESIGN: Using the Canadian CP Registry, we categorized children born at ≥ 36 weeks with birth weight ≥ 1800 g with CP after moderate or severe NE according to the presence or absence of cooling criteria. Maternal, perinatal, postnatal, and placental factors were compared between the 2 groups. A number needed to treat of 8 (95% CI 6-17) to prevent one case of CP was used for calculations. RESULTS: Among the 543 term-born children with CP, 155 (29%) had moderate or severe NE. Sixty-four of 155 (41%) met cooling criteria and 91 of 155 (59%) did not. Shoulder dystocia was more common in those who did not meet cooling criteria (OR 8.8; 95% CI 1.1-71.4). Low birth weights (20% of all singletons), small placentas (42%), and chorioamnionitis (13%) were common in both groups. CONCLUSIONS: The majority of children with CP after NE did not meet cooling criteria. An estimated 5.1% (95% CI 2.4%-6.9%) of term CP after NE may be theoretically prevented with hypothermia. Considering shoulder dystocia as an additional criterion may help recognize more neonates who could potentially benefit from cooling. In all cases, a better understanding of the antenatal processes underlying NE is essential in reducing the burden of CP.
Assuntos
Paralisia Cerebral/prevenção & controle , Hipotermia Induzida/estatística & dados numéricos , Hipóxia-Isquemia Encefálica/epidemiologia , Paralisia Cerebral/epidemiologia , Corioamnionite/epidemiologia , Diabetes Gestacional/epidemiologia , Distocia/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Placenta/patologia , Gravidez , Quebeque/epidemiologia , Sistema de Registros , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Stillbirth remains a problem; therefore requires delving analyzed to assess their causes and strategies that prevent or decrease. OBJECTIVE: To establish the frequency, describe the sociodemographic and medical characteristics, and factors associated with fetal death in a high complexity hospital in Bogotá, Colombia. MATERIALS AND METHODS: A cross-sectional study quantifying stillbirth and associated factors was conducted in the period from January 1, 2010 to December 31, 2013. RESULTS: There were 112 fetal deaths, from a total of 15408 births, for a fetal mortality rate of 7.3 per 1000 live births. The average age of the patients was 27.9 years (SD 7.7), 70.5 % of fetal deaths occurred in mothers aged 20-35 years, in primigravidae (33%), between 20 and 28 weeks gestational age (42.9%), in fetuses with weights between 500 and 1000 gr (47.8%). The most frequent medical history was hypothyroidism (5.4%) and chronic hypertension (4.5%). The most common diseases associated with pregnancy were oligohydramnios (21.4%), hypertensive disorders of pregnancy (17%), intrauterine growth restriction (IUGR) (17%), and polyhydramnios (16.9%). The most frequently altered test for evaluation of fetal wellbeing was the absent or decreased fetal movements (44.6%), autopsy was performed in 45.5% of cases being the main reported causes of death, chorioamnionitis (21.5%) and placental insufficiency (15.6%). CONCLUSION: Stillbirth remains a prevalent problem, our findings suggest the need to develop methods to implement the fetal surveillance in patients with risk factors in order to make timely decisions.
Assuntos
Corioamnionite/epidemiologia , Morte Fetal/etiologia , Insuficiência Placentária/epidemiologia , Natimorto/epidemiologia , Adolescente , Adulto , Colômbia , Comorbidade , Estudos Transversais , Feminino , Doenças Fetais/epidemiologia , Idade Gestacional , Hospitais Urbanos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Idade Materna , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: Search Histologic Chorioamnionitis frequency in patients in week 28 (+/-) and pregnancy with premature rupture of membranes. PATIENTS AND METHOD: Retrospective and observational study in which we studied all patients who came between June 28, 2011 and November 15, 2011 to receive obstetric care in the service of Tocochirurgical of the University Hospital of Saltillo, with greater than or equal 28 weeks of pregnancy. RESULTS: 598 patients were studied, and the frequency of premature rupture of membranes with histologic chorioamnionitis at term patients was, respectively, 1.7 and 5.3% in preterm labor. In the total sample frequency of histologic chorioamnionitis was 0.6% (4 patients) and, of these, 25% were term and 75% with preterm rupture. In patients with premature rupture of membranes the clinical chorioamnionitis was 0% valued by the criteria of Gibbs. CONCLUSIONS: The premature rupture of membranes is a risk factor important for histological chorioamnionitis. To decrease risk factors and possible complications, an established protocol must be taken.
Assuntos
Corioamnionite/epidemiologia , Corioamnionite/patologia , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Gravidez , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To validate established neonatal neutrophil reference ranges (RRs) and determine the utility of serial measurements of neutrophil values in the first 24 hours to predict the absence of neonatal early-onset sepsis (EOS). STUDY DESIGN: Retrospective study of 2073 admissions to the neonatal intensive care unit (2009-2011). Neonates were classified as blood culture-positive, proven EOS (n = 9), blood culture-negative but clinically suspect EOS (n = 292), and not infected (n = 1292). Neutrophil values from 745 not-infected neonates without perinatal complications were selected to validate RR distributions. Positive and negative predictive values were calculated; area under receiver operating characteristic curves (AUCs) were constructed to predict the presence or absence of EOS. Neutrophil value scores were established to determine whether serial neutrophil values predict the absence of EOS. RESULTS: Seventy-seven percent of admissions to the neonatal intensive care unit were evaluated for EOS: 9 (0.56%) had proven EOS with positive blood culture ≤ 37 hours; 18% had clinically suspect EOS. Neutropenia occurred in preterm neonates, and nonspecific neutrophilia was common in uninfected neonates. The distribution of neutrophil values differed significantly between study groups. The specificity for absolute total immature neutrophils and immature to total neutrophil proportions was 91% and 94%, respectively, with negative predictive value of 99% for proven and 78% for proven plus suspect EOS. Absolute total immature neutrophils and immature to total neutrophil proportions had the best predictability for EOS >6 hours postnatal with an AUC â¼ 0.8. Neutrophil value scores predicted the absence of EOS with AUC of 0.9 and 0.81 for proven and proven plus suspect EOS, respectively. CONCLUSION: Age-dependent neutrophil RRs remain valid. Serial neutrophil values at 0, 12, and 24 hours plus blood culture and clinical evaluation can be used to discontinue antimicrobial therapy at 36-48 hours.
Assuntos
Neutrófilos/metabolismo , Sepse/sangue , Índice de Apgar , Asfixia Neonatal/epidemiologia , Corioamnionite/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/diagnóstico , Unidades de Terapia Intensiva Neonatal , Masculino , Mecônio , Valor Preditivo dos Testes , Gravidez , Curva ROC , Valores de Referência , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/diagnósticoRESUMO
El cerclaje es un factor de riesgo de rotura prematura pretérmino de membranas (RPPM). La RPPM ocurre en aproximadamente un 38-65 por ciento de los embarazos con cerclaje y no existe consenso aún sobre cuál es el manejo más adecuado: retirar o mantener el cerclaje. En esta revisión presentamos la evidencia disponible en relación al retiro versus mantención del cerclaje y su directa influencia sobre el resultado materno-perinatal, con el objetivo de proponer una pauta de manejo. La mantención del cerclaje se asoció a un aumento de la latencia al parto mayor a 48 horas, a un aumento en la incidencia de corioamnionitis clínica, y aumento en la incidencia de mortalidad neonatal por sepsis. Conclusión: en pacientes embarazadas con cerclaje que presentan RPPM antes de las 34 semanas proponemos como la conducta más adecuada la mantención del cerclaje sólo hasta completar la inducción de madurez pulmonar con corticoides, luego retirar el cerclaje y proceder al manejo habitual de un embarazo con RPPM antes de las 34 semanas.
Cervical cerclage is a risk factor for preterm premature rupture of membranes (PPROM). PPROM occurs in about 38-65 percent of pregnancies with cerclage. There is no consensus on whether to remove or retain the cerclage after PPROM. Here we review the evidence about clinical management of PPROM in women with cerclage and its influence on maternal and neonatal outcome. Retained cerclage was found to be associated to a prolongation of pregnancy by more than 48 hours, to a higher incidence of maternal chorioamnionitis and to a higher incidence of neonatal mortality from sepsis. In pregnancies with cerclage complicated with PPROM before 34 weeks we propose to retain the cerclage just enough time to complete fetal lung maturation with corticosteroid therapy, then remove the cerclage and manage pregnancy as any PPROM before 34 weeks.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Cerclagem Cervical/efeitos adversos , Ruptura Prematura de Membranas Fetais/epidemiologia , Cerclagem Cervical/métodos , Complicações Infecciosas na Gravidez , Corioamnionite/epidemiologia , Idade Gestacional , Doenças do Prematuro/epidemiologia , Fatores de Risco , Mortalidade Infantil , Resultado da Gravidez , Sepse/epidemiologia , Tomada de DecisõesRESUMO
INTRODUCTION: Previable (less than 24 weeks) premature rupture of membranes complicates about 1 in every thousand births and is responsible for substantial perinatal mortality. SUBJECTS AND METHODS: In this paper, we retrospectively analyzed one twin and 35 singleton pregnancies. RESULTS: Twenty cases occurred before and 16 after 20 weeks. Latency period ranged from 0 to 137 days, with an average of 35 days. Amniotic fluid index was reduced in 27 cases and normal in 6 cases. Expectant management was adopted in 31 cases (86%), five patients declined and opted for termination (14%) at admission or during the course of pregnancy. Steroids were prescribed for 12 patients at or after 24 weeks (39%), leukocyte count at admission varied from 6,000 to 16,200/mm(3), with an average of 11,310, in only 9% it was greater than 15,000, immature forms were present in 10 cases (28%). Clinical chorioamnionitis occurred in 71%, being three times more frequent in parous women. Bacteriuria was present in 2 of 30 cases (6.6%). Two women developed laboratorial and clinical signs of sepsis, none of them needed hysterectomy. There were no maternal deaths. Mean gestational age at delivery was 24 weeks, ranging from 16 to 39 weeks. In the expectant group, preterm delivery rate was 68%. There was one case of abruption. Cesarean rate was 31%. Neonatal mortality was 42% (8 cases). Overall neonatal survival was 35% (11 in 32 newborns). CONCLUSION: Perinatal mortality is high in pregnancies complicated by previable rupture of membranes, however gestational age at occurrence is a strong predictor of outcome. An individualized approach is the best management option regarding maternal risks and fetal outcomes.