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1.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593285

RESUMO

The recently documented high survival of extremely preterm infants in Sweden is related to a high degree of centralization of pre- and postnatal care and to recently issued national consensus guidelines providing recommendations for perinatal care at 22-24 gestational weeks. The prevalence of major neonatal morbidity remains high and exceeded 60 % in a recent study of extremely preterm infants born at < 27 gestational weeks delivered in Sweden in 2014-2016 and surviving to 1 year of age. Damage to immature organ systems inflicted during the neonatal period causes varying degrees of functional impairment with lasting effects in the growing child. There is an urgent need for evidence-based novel interventions aiming to prevent neonatal morbidity with a subsequent improvement of long-term outcome.


Assuntos
Lactente Extremamente Prematuro , Doenças do Prematuro , Nascimento Prematuro , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/fisiopatologia , Displasia Broncopulmonar/prevenção & controle , Serviços Centralizados no Hospital , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/prevenção & controle , Ventrículos Cerebrais/irrigação sanguínea , Ventrículos Cerebrais/diagnóstico por imagem , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/fisiopatologia , Doenças do Prematuro/prevenção & controle , Assistência Perinatal/organização & administração , Gravidez , Nascimento Prematuro/mortalidade , Retinopatia da Prematuridade/sangue , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/fisiopatologia , Retinopatia da Prematuridade/prevenção & controle , Taxa de Sobrevida , Suécia/epidemiologia
2.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593288

RESUMO

Late and moderately preterm infants, born between 32+0/7 and 36+6/7 gestational weeks, comprise more than 80 % of all preterm infants and account for almost 40 % of all days of neonatal care. While their total number of days of care has not changed, an increasing part of their neonatal stay (from 29 % in 2011 to 41 % in 2017) is now within home care programmes. Late and moderate preterm birth is often complicated by respiratory disorders, hyperbilirubinemia, hypothermia and feeding difficulties. These infants also have an increased risk of perinatal death and neurologic complications. In the long run, they have higher risks of cognitive impairment, neuropsychiatric diagnoses and need for asthma medication. As young adults, they have a lower educational level and a lower average salary than their full-term counterparts. They also have an increased risk of long-term sick leave, disability pension and need for economic assistance from society.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Educação Especial/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Tempo
3.
BMC Med ; 17(1): 140, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31319860

RESUMO

BACKGROUND: The objectives of this study were to understand the differences in mortality rate, risk factors for mortality, and cause of death distribution in three neonatal age sub-groups (0-2, 3-7, and 8-27 days) and assess the change in mortality rate with previous assessments to inform programmatic decision-making in the Indian state of Bihar, a large state with a high burden of newborn deaths. METHODS: Detailed interviews were conducted in a representative sample of 23,602 live births between January and December 2016 (96.2% participation) in Bihar state. We estimated the neonatal mortality rate (NMR) for the three age sub-groups and explored the association of these deaths with a variety of risk factors using a hierarchical logistic regression model approach. Verbal autopsies were conducted using the PHMRC questionnaire and the cause of death assigned using the SmartVA automated algorithm. Change in NMR from 2011 to 2016 was estimated by comparing it with a previous assessment. RESULTS: The NMR 0-2-day, 3-7-day, and 8-27-day mortality estimates in 2016 were 24.7 (95% CI 21.8-28.0), 13.2 (11.1 to 15.7), 5.8 (4.4 to 7.5), and 5.8 (4.5 to 7.5) per 1000 live births, respectively. A statistically significant reduction of 23.3% (95% CI 9.2% to 37.3) was seen in NMR from 2011 to 2016, driven by a reduction of 35.3% (95% CI 18.4% to 52.2) in 0-2-day mortality. In the final regression model, the highest odds for mortality in 0-2 days were related to the gestation period of ≤ 8 months (OR 16.5, 95% CI 11.9-22.9) followed by obstetric complications, no antiseptic cord care, and delivery at a private health facility or home. The 3-7- and 8-27-day mortality was driven by illness in the neonatal period (OR 10.33, 95% CI 6.31-16.90, and OR 4.88, 95% CI 3.13-7.61, respectively) and pregnancy with multiple foetuses (OR 5.15, 95% CI 2.39-11.10, and OR 11.77, 95% CI 6.43-21.53, respectively). Birth asphyxia (61.1%) and preterm delivery (22.1%) accounted for most of 0-2-day deaths; pneumonia (34.5%), preterm delivery (33.7%), and meningitis/sepsis (20.1%) accounted for the majority of 3-7-day deaths; meningitis/sepsis (30.6%), pneumonia (29.1%), and preterm delivery (26.2%) were the leading causes of death at 8-27 days. CONCLUSIONS: To our knowledge, this is the first study to report a detailed neonatal epidemiology by age sub-groups for a major Indian state, which has highlighted the distinctly different mortality rate, risk factors, and causes of death at 0-2 days versus the rest of the neonatal period. Monitoring mortality at 0-2 and 3-7 days separately in the traditional early neonatal period of 0-7 days would enable more effective programming to reduce neonatal mortality.


Assuntos
Mortalidade Infantil , Nascimento Vivo/epidemiologia , Morte Perinatal , Adolescente , Adulto , Fatores Etários , Autopsia , Causas de Morte , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Doenças do Recém-Nascido/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/mortalidade , Nascimento Prematuro/patologia , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
4.
PLoS Med ; 16(6): e1002831, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31199800

RESUMO

BACKGROUND: Socioeconomic disparities in infant mortality have persisted for decades in high-income countries and may have become stronger in some populations. Therefore, new understandings of the mechanisms that underlie socioeconomic differences in infant deaths are essential for creating and implementing health initiatives to reduce these deaths. We aimed to explore whether and the extent to which preterm birth (PTB) and small for gestational age (SGA) at birth mediate the association between maternal education and infant mortality. METHODS AND FINDINGS: We developed a population-based cohort study to include all 1,994,618 live singletons born in Denmark in 1981-2015. Infants were followed from birth until death, emigration, or the day before the first birthday, whichever came first. Maternal education at childbirth was categorized as low, medium, or high. An inverse probability weighting of marginal structural models was used to estimate the controlled direct effect (CDE) of maternal education on offspring infant mortality, further split into neonatal (0-27 days) and postneonatal (28-364 days) deaths, and portion eliminated (PE) by eliminating mediation by PTB and SGA. The proportion eliminated by eliminating mediation by PTB and SGA was reported if the mortality rate ratios (MRRs) of CDE and PE were in the same direction. The MRRs between maternal education and infant mortality were 1.63 (95% CI 1.48-1.80, P < 0.001) and 1.19 (95% CI 1.08-1.31, P < 0.001) for low and medium versus high education, respectively. The estimated proportions of these total associations eliminated by reducing PTB and SGA together were 55% (MRRPE = 1.27, 95% CI 1.15-1.40, P < 0.001) for low and 60% (MRRPE = 1.11, 95% CI 1.01-1.22, P = 0.037) for medium versus high education. The proportions eliminated by eliminating PTB and SGA separately were, respectively, 46% and 11% for low education (versus high education) and 48% and 13% for medium education (versus high education). PTB and SGA together contributed more to the association of maternal educational disparities with neonatal mortality (proportion eliminated: 75%-81%) than with postneonatal mortality (proportion eliminated: 21%-23%). Limitations of the study include the untestable assumption of no unmeasured confounders for the causal mediation analysis, and the limited generalizability of the findings to other countries with varying disparities in access and quality of perinatal healthcare. CONCLUSIONS: PTB and SGA may play substantial roles in the relationship between low maternal education and infant mortality, especially for neonatal mortality. The mediating role of PTB appeared to be much stronger than that of SGA. Public health strategies aimed at reducing neonatal mortality in high-income countries may need to address socially related prenatal risk factors of PTB and impaired fetal growth. The substantial association of maternal education with postneonatal mortality not accounted for by PTB or SGA could reflect unaddressed educational disparities in infant care or other factors.


Assuntos
Escolaridade , Retardo do Crescimento Fetal/mortalidade , Mortalidade Infantil/tendências , Vigilância da População , Nascimento Prematuro/mortalidade , Adolescente , Adulto , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Retardo do Crescimento Fetal/diagnóstico , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Nascimento Prematuro/diagnóstico , Fatores de Risco , Adulto Jovem
6.
Ghana Med J ; 53(1): 20-28, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31138940

RESUMO

Background: To determine the prevalence of preterm delivery and identify the associated risk factors. Design: This was a five - month prospective case control study of two cohorts of women who had preterm and term deliveries. Setting: Central Hospital (CH), Warri, and Delta State University Teaching Hospital (DELSUTH), Oghara, respectively in southern Nigeria. Participants: 522 women which consisted of 174 who presented in preterm labour or with preterm prelabour rupture of membranes as cases and 348 parturient with term deliveries served as controls. Interventions: The study was conducted from May 1st 2015 to September 30th 2015. Socio - demographic characteristics, past gynaecological/obstetric factors, maternal/obstetric factors, and fetal outcomes were compared, and associations between these variables and gestational age at delivery were determined. Main outcome measures: Prevalence of preterm delivery associated clinical and socio-demographic correlates and the fetal salvage rates. Results: The incidence of preterm birth was 16%. Maternal age (p < 0.002), parity (p < 0.000), booking status (p < 0.000), and socio - economic class (p < 0.000) were significantly associated with preterm births. Others were multiple pregnancy (p < 0.000), pre - eclampsia/eclampsia (p < 0.000), anaemia (p < 0.000), malaria (p < 0.000), UTI (p < 0.012), premature rupture of membrane (p < 0.000) and antepartum haemorrhage (p < 0.000). Fetal salvage rate was zero for extreme preterm neonates and 100% at late preterm. Conclusion: Preterm birth was common, with well-defined correlates and predictors. The fetal salvage rates were significantly different across the categories of preterm neonates. Funding: The study was self-funded by the authors.


Assuntos
Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Idade Materna , Análise Multivariada , Nigéria/epidemiologia , Paridade , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
7.
Scand J Trauma Resusc Emerg Med ; 27(1): 37, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953532

RESUMO

The aim of this Letter to the Editor was to report some methodological shortcomings in a recently published Article. We proved that the obtained results are subjected to the sparse data bias and presented some remedial tools such as penalization approaches. In addition, model fitting and performance aroused some controversies. In conclusion, the results of this study should be interpreted with caution and further reanalysis is necessary.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Doenças do Recém-Nascido/mortalidade , Nascimento Prematuro/mortalidade , Medição de Risco , Feminino , Seguimentos , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Mortalidade Perinatal/tendências , Gravidez , Estudos Prospectivos , Fatores de Risco
8.
PLoS One ; 14(4): e0214295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30946761

RESUMO

BACKGROUND: Intrapartum antibiotic prophylaxis (IAP) to reduce the likelihood of neonatal early-onset group B streptococcal infection (EOGBS) has coincided with major reductions in incidence. While the decline has been largely ascribed to IAP following either universal screening or a risk-based approach to identify mothers whose babies may most benefit from IAP, there is lack of high quality evidence to support this view. AIMS: To describe management of maternal GBS colonisation in one local health district using universal screening and assess rates of EOGBS over time. METHODS: A retrospective cohort study was undertaken to describe compliance with GBS management, to determine the incidence of EOGBS and association between rates and maternal screening. Linking routinely collected maternity and pathology data, we explored temporal trends using logistic regression and covariates for potential effect modifiers. RESULTS: Our cohort included 62,281 women who had 92,055 pregnancies resulting in 93,584 live born babies. Screening occurred in 76% of pregnancies; 69% had a result recorded, 21.5% of those were positive for GBS. Prophylaxis was used by 79% of this group. Eighteen babies developed EOGBS, estimated incidence/1000 live births in 2006 and 2016 was 0.35 (95% CI, 0.07 to 0.63) and 0.1 (95% CI, 0 to 0.2) respectively. Seven of 10 term babies with EOGBS were born to mothers who screened negative. Data were unable to provide evidence of difference in rates of EOGBS between screened and unscreened pregnancies. We estimated the difference in EOGBS incidence from crude and weighted models to be 0 (95% CI, -0. 2 to 0.17) and -0.01 (95% CI, -0.13 to 0.10) /1000 live births respectively. CONCLUSION: No change was detected in rates of EOGBS over time and no difference in EOGBS in babies of screened and unscreened populations. Screening and prophylaxis rates were modest. Limitations of universal screening suggest alternatives be considered.


Assuntos
Antibioticoprofilaxia , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/microbiologia , Triagem Neonatal , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/fisiologia , Idade de Início , Austrália/epidemiologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Gravidez , Nascimento Prematuro/microbiologia , Nascimento Prematuro/mortalidade , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade
9.
J Pediatr Surg ; 54(6): 1147-1152, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30902457

RESUMO

INTRODUCTION: The purpose of this study is to evaluate splenic effects during artificial placenta (AP) support. METHODS: AP lambs (118-121 d, n = 14) were delivered and placed on the AP support for a goal of 10-14 days. Cannulation used right jugular drainage and umbilical vein reinfusion. Early (ETC; 115-120 d; n = 7) and late (LTC; 125-131 d; n = 7) tissue controls were delivered and immediately sacrificed. Spleens were formalin fixed, H&E stained, and graded for injury, response to inflammation, and extramedullary hematopoiesis (EMH). CD68 and CD163 stains were used to assess for macrophage activation and density. Clinical variables were correlated with splenic scores. Groups were compared using Fisher's Exact Test and descriptive statistics. p < 0.05 indicated significance. RESULTS: Mean survival for AP lambs was 12 ±â€¯5 d. There was no necrosis found in any of the groups. Vascular congestion and sinusoidal histiocytosis did not significantly differ between AP and control groups (p = 0.72; p = 0.311). There were significantly more pigmented macrophages (p = 0.008), CD163 (p = <0.001), and CD68 (p = <0.001) stained cells in the AP group. ETC and LTC demonstrated more EMH than AP spleens (p = <0.001). CONCLUSIONS: During AP support, spleens appear to develop normally and exhibit an appropriate inflammatory response. After initiation of AP support, EMH transitions away from the spleen. STUDY TYPE: Research Paper/Therapeutic Potential. LEVEL OF EVIDENCE: N/A.


Assuntos
Órgãos Artificiais , Placenta/fisiologia , Nascimento Prematuro , Carneiro Doméstico/crescimento & desenvolvimento , Baço , Animais , Feminino , Gravidez , Nascimento Prematuro/mortalidade , Nascimento Prematuro/veterinária , Ovinos , Baço/crescimento & desenvolvimento , Baço/imunologia , Baço/fisiologia
10.
BMJ Open ; 9(1): e023004, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30782691

RESUMO

OBJECTIVE: After a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34-36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants. DESIGN, SETTING AND PARTICIPANTS: This retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004-2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery. OUTCOME MEASURES: The primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI. RESULTS: The rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p<0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32-33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34-36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11). CONCLUSIONS: Timing of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.


Assuntos
Parto Obstétrico/mortalidade , Ruptura Prematura de Membranas Fetais/mortalidade , Mortalidade Infantil/tendências , Nascimento Prematuro/mortalidade , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Morbidade , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Washington/epidemiologia , Adulto Jovem
11.
Indian Pediatr ; 56(1): 13-17, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30806353

RESUMO

When delivery is anticipated near the limit of viability, both the family and the caregiver are faced with many complex and ethically challenging decisions. It must be remembered that the decisions that are made are going to impact the entire life of the baby and the family. Such decisions should be based on the best available evidence about the prognosis for the infant. If the chance of mortality and serious morbidity for an infant is high (but not too high), parental discretion around provision of life-sustaining treatment is appropriate. In this article, we discuss issues on survival and outcomes of extremely premature infants, and the available guidelines.


Assuntos
Tomada de Decisão Clínica/ética , Parto Obstétrico/ética , Lactente Extremamente Prematuro , Nascimento Prematuro/mortalidade , Feminino , Humanos , Gravidez
12.
Epidemiol Serv Saude ; 28(1): e2018132, 2019 02 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30785573

RESUMO

OBJECTIVE: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. METHODS: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. RESULTS: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. CONCLUSION: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.


Assuntos
Causas de Morte , Morte Perinatal , Mortalidade Perinatal/tendências , Nascimento Prematuro/mortalidade , Adulto , Brasil/epidemiologia , Parto Obstétrico/normas , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Nascimento Vivo , Masculino , Serviços de Saúde Materna/normas , Morte Perinatal/prevenção & controle , Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Adulto Jovem
13.
J Matern Fetal Neonatal Med ; 32(19): 3278-3287, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29621920

RESUMO

Objective: In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. Study design: This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term (n = 242,286), spontaneous (n = 10,063), and medically indicated (n = 4833) late preterm deliveries. Results: (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups (p < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. Conclusions: (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.


Assuntos
Parto Obstétrico/mortalidade , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Prematuro , Complicações do Trabalho de Parto/prevenção & controle , Nascimento Prematuro/epidemiologia , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Israel/epidemiologia , Mortalidade Materna , Morbidade , Complicações do Trabalho de Parto/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Nascimento Prematuro/mortalidade , Estudos Retrospectivos , Adulto Jovem
14.
J Matern Fetal Neonatal Med ; 32(22): 3757-3763, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29764255

RESUMO

Objective: To study the effect of McDonald cerclage knot position on the different maternal and neonatal outcomes. Methods: This historical cohort study included women with singleton pregnancy who had a prophylactic McDonald cervical cerclage between 1 May 2010 and 31 September 2017. Maternal and neonatal outcome parameters were compared between the anterior and posterior knot cerclage procedures. The primary outcome measure was the rate of term birth. Results: 550 Women had a prophylactic McDonald cervical cerclage, 306 with anterior knot (Group A) and 244 with posterior knot (Group B). There were no statistically significant differences regarding gestational age (GA) at delivery (36.3 ± 4.2 versus 35.8 ± 5.3 for groups A and B respectively), term birth rate, post-cerclage cervical length, symptomatic vaginitis, urinary tract infection, difficult cerclage removal and cervical lacerations. Similarly, there were no statistically significant differences as regards the studied neonatal outcomes including take home babies, neonatal intensive care admission, respiratory distress syndrome and neonatal sepsis. Survival analysis on GA at delivery demonstrated no statistically significant difference as regards the proportion of term deliveries in the anterior and posterior knot cerclage groups (log-rank test p-value = .478). Conclusions: Knot positioning during McDonald cervical cerclage, anteriorly or posteriorly, didn't significantly impact the studied maternal and neonatal outcomes.


Assuntos
Cerclagem Cervical/métodos , Trabalho de Parto Prematuro/prevenção & controle , Técnicas de Sutura , Incompetência do Colo do Útero/cirurgia , Adulto , Cerclagem Cervical/efeitos adversos , Cerclagem Cervical/mortalidade , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Masculino , Trabalho de Parto Prematuro/mortalidade , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Análise de Sobrevida , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/mortalidade , Incompetência do Colo do Útero/mortalidade , Adulto Jovem
15.
Semin Fetal Neonatal Med ; 24(1): 3-10, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30309813

RESUMO

Late preterm (34-36 weeks of gestational age (GA)), and early term (37-38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.


Assuntos
Nascimento Prematuro/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Nascimento Prematuro/mortalidade , Prevalência , Fatores de Risco
16.
Ultrasound Obstet Gynecol ; 53(2): 184-192, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29900612

RESUMO

OBJECTIVES: To determine the prevalence of monochorionic monoamniotic (MCMA) twin pregnancy and to describe perinatal outcome and clinical management of these pregnancies. METHODS: In this multicenter cohort study, the prevalence of MCMA twinning was estimated using population-based data on MCMA twin pregnancies, collected between 2000 and 2013 from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units. Pregnancy outcome at < 24 weeks' gestation, antenatal parameters and perinatal outcome (from ≥ 24 weeks to the first 28 days of age) were analyzed using combined data on pregnancies confirmed to be MCMA from NorSTAMP and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000-2013. RESULTS: The estimated total prevalence of MCMA twin pregnancies in the North of England region was 8.2 per 1000 twin pregnancies (59/7170), and the birth prevalence was 0.08 per 1000 pregnancies overall (singleton and multiple). Using combined data from NorSTAMP and STORK, the rate of fetal death (at < 24 weeks' gestation), including terminations of pregnancy and selective feticide, was 31.8% (54/170); the overall perinatal mortality rate was 14.7% (17/116), ranging from 69.2% at < 30 weeks to 4.5% at ≥ 33 weeks' gestation. MCMA twins that survived in utero beyond 24 weeks were delivered, usually by Cesarean section, at a median of 33 (interquartile range, 32-34) weeks of gestation. CONCLUSIONS: In MCMA twins surviving beyond 24 weeks of gestation, there was a higher survival rate compared with in previous decades, presumably due to early diagnosis, close surveillance and elective birth around 32-34 weeks of gestation. High perinatal mortality at early gestations was attributed mainly to extreme prematurity due to preterm spontaneous labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Mortalidade Fetal , Mortalidade Perinatal , Gravidez de Gêmeos/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Gêmeos Monozigóticos/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Estudos de Coortes , Inglaterra/epidemiologia , Feminino , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Nascimento Vivo/epidemiologia , Masculino , Vigilância da População , Gravidez , Nascimento Prematuro/mortalidade , Prevalência , Ultrassonografia Pré-Natal , Adulto Jovem
17.
J Matern Fetal Neonatal Med ; 32(2): 258-264, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28950738

RESUMO

OBJECTIVE: Premature rupture of the membranes (PROM) remains a leading cause of neonatal morbidity. The objectives of the present study were to analyze the outcomes of pregnancies complicated by PROM between 22 and 27+6 weeks of gestation (WG) and to study antepartum risk factors that might predict neonatal death. PATIENTS AND METHODS: One hundred and seven pregnancies were analyzed over a 3-year period in a tertiary maternity hospital. The collected maternal and neonatal data were used to model and predict the outcome of PROM. RESULTS: Prevalence of PROM (for live births) was 1.08%, and the overall survival rate was 59.8%. From preselected candidate variables, gestational age (GA) at PROM (p = .0002), a positive vaginal culture for pathogenic bacteria (p = .01), primiparity (p = .02), and the quantity of amniotic fluid (p = .03) were included in a multivariable logistic regression analysis. The corresponding adjusted odds ratios [95% confidence interval] were, respectively, 0.91 [0.87-0.96], 11.08 [1.65-74.42], 0.55 [0.33-0.91], and 0.97 [0.95-0.99]. These parameters were used to build a predictive score for neonatal death. CONCLUSIONS: The survival rate after PROM at 22-27+6 weeks of gestation was 59.8%. Our predictive model (built using multivariable logistic regression) may be of value for obstetricians and neonatologists counseling couples after PROM.


Assuntos
Ruptura Prematura de Membranas Fetais/diagnóstico , Morte Perinatal , Segundo Trimestre da Gravidez , Nascimento Prematuro/diagnóstico , Diagnóstico Pré-Natal/métodos , Adulto , Feminino , Ruptura Prematura de Membranas Fetais/mortalidade , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/mortalidade , Projetos de Pesquisa , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
18.
PLoS One ; 13(12): e0207298, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517142

RESUMO

We aimed to test the hypothesis that determinants of the perinatal clinical exposome related to the underlying etiology of premature birth (PTB) impact differently on select neonatal outcomes. We conducted a prospective longitudinal study of 377 singleton preterm neonates [gestational age (GA) at birth: 23-34 weeks] separated into three distinct contemporaneous newborn cohorts: i) spontaneous PTB in the setting of intra-amniotic infection/inflammation (yes-IAI, n = 116); ii) spontaneous PTB in the absence of IAI (no-IAI, n = 130), and iii) iatrogenic PTB for preeclampsia (iPTB-PE, n = 131). Newborns (n = 372) were followed until death or discharge. Amniotic fluid defensins 1&2 and calgranulins A&C were used as biomarkers of IAI. An algorithm considering cord blood interleukin-6 (IL-6) and haptoglobin (Hp switch-on) was used to assess fetal exposure to IAI. Intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), early-onset neonatal (EONS) and late-onset (LOS) sepsis, death. Independent risk factors for adverse outcomes were: i) IVH (n = 53): histologic chorioamnionitis, GA, fetal growth restriction, male sex, Hp switch-on; ii) PVL (n = 11): cord blood IL-6; iii) NEC (n = 25), GA; iv) BPD (n = 53): ventilator support, need for surfactant, GA; v) ROP (n = 79): ventilator support, Hp switch-on, GA; vi) fetal and neonatal death (n = 31): GA, amniotic fluid IL-6; vii) suspect EONS (n = 92): GA, Hp switch-on; viii) LOS (n = 81): GA. Our findings are applicable to pregnancies delivered between 23 and 34 weeks' gestation in the setting of IAI and PE, and suggest that GA and inflammatory intrauterine environment play key roles in occurrence of IVH, PVL, ROP, death, EONS and LOS. Postnatal determinants seem to play major role in NEC and BPD.


Assuntos
Meio Ambiente , Recém-Nascido Prematuro/fisiologia , Nascimento Prematuro/etiologia , Adulto , Líquido Amniótico/efeitos dos fármacos , Líquido Amniótico/microbiologia , Biomarcadores , Estudos de Coortes , Feminino , Sangue Fetal , Interação Gene-Ambiente , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Parto , Período Periparto , Período Pós-Parto , Gravidez , Nascimento Prematuro/genética , Nascimento Prematuro/mortalidade , Estudos Prospectivos , Resultado do Tratamento
19.
BMC Med ; 16(1): 227, 2018 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-30514388

RESUMO

BACKGROUND: Emerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival without increased disability. METHODS: Foetuses alive at maternal admission to a level 3 hospital in France in 2011, subsequently delivered between 22 and 26 weeks gestational age (GA) and included in the EPIPAGE-2 national prospective observational cohort study formed the baseline population. Level of intensity of perinatal care was assigned according to hospital of birth, categorised into three groups using 'perinatal intensity' ratios (ratio of 24-25 weeks GA babies admitted to neonatal intensive care to foetuses of the same GA alive at maternal admission to hospital). Multiple imputation was used to account for missing data; hierarchical logistic regression accounting for births nested within centres was then performed. RESULTS: One thousand one hundred twelve foetuses were included; 473 survived to 2 years of age (126 of 358 in low-intensity, 140 of 380 in medium-intensity and 207 of 374 in high-intensity hospitals). There were no differences in disability (adjusted odds ratios 0.93 (95% CI 0.28 to 3.04) and 1.04 (95% CI 0.34 to 3.14) in medium- and high- compared to low-intensity hospitals, respectively). Compared to low-intensity hospitals, survival without sensorimotor disability was increased in the population of foetuses alive at maternal admission to hospital and in live-born babies, but there were no differences when considering only babies admitted to NICU or survivors. CONCLUSIONS: No difference in sensorimotor outcome for survivors of extremely preterm birth at 2 years of age was found according to the intensity of perinatal care provision. Active management of periviable births was associated with increased survival without sensorimotor disability.


Assuntos
Retroalimentação Sensorial/fisiologia , Doenças do Prematuro/fisiopatologia , Assistência Perinatal/métodos , Nascimento Prematuro/fisiopatologia , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/mortalidade , Masculino , Morbidade , Gravidez , Nascimento Prematuro/mortalidade , Estudos Prospectivos
20.
Arq Bras Cardiol ; 111(5): 666-673, 2018 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30281694

RESUMO

BACKGROUND: Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out. OBJECTIVES: To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period. METHODS: A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors. RESULTS: The risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock. CONCLUSION: Preterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/mortalidade , Cardiopatias Congênitas/mortalidade , Brasil , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Estado Terminal , Doenças em Gêmeos/mortalidade , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Oximetria/mortalidade , Gravidez , Nascimento Prematuro/mortalidade , Fatores de Risco , Análise de Sobrevida
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