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1.
Medicine (Baltimore) ; 99(42): e22748, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080738

RESUMO

To compare clinical features and outcomes between early and late onset of neonatal bacterial meningitis (NBM).Patients were allocated in 2 groups: early onset neonatal bacterial meningitis (ENBM) and late onset neonatal bacterial meningitis (LNBM). Data analysis includes asphyxia at birth, premature rupture of membranes (PROM), amnionitis, amniotic fluid contamination, maternal age, clinical manifestations of the patients, laboratory findings, radiological results, complications related to meningitis, duration of hospitalization and therapeutic effect.There was no difference in gender, birth weight, gestational age, and incidence of asphyxia between 2 groups. The incidence of PROM, chorioamnionitis and amniotic fluid contamination, proportion of small-for-gestational-age infants, convulsions, intracranial hemorrhage, hyperbilirubinemia, and the protein level of cerebrospinal fluid in ENBM group were higher than that in LNBM group (P < .05); the proportion of fever, elevated C-reaction protein and the abnormal of platelet counts in LNBM group was higher than that in ENBM group (P < .05). There was no difference in the incidence of complications and hospitalization time between 2 groups. The rate of effective treatment in LNBM group was significantly higher than that in ENBM group (P < .05).Patients with conditions of amniotic fluid contamination, chorioamnionitis, small-for-gestational-age and PROM might be more prone to develop ENBM and ENBM had worse outcomes than LNBM.


Assuntos
Meningites Bacterianas/epidemiologia , Adulto , Líquido Amniótico , Proteína C-Reativa/análise , Proteínas do Líquido Cefalorraquidiano/análise , China/epidemiologia , Corioamnionite/epidemiologia , Diarreia/epidemiologia , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperbilirrubinemia Neonatal/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Hemorragias Intracranianas/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Contagem de Plaquetas , Gravidez , Complicações na Gravidez/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Convulsões/epidemiologia , Nascimento a Termo
2.
BMJ ; 371: m3377, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004347

RESUMO

OBJECTIVES: To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. DESIGN: Cohort study using linked electronic maternity records. PARTICIPANTS: 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. MAIN OUTCOME MEASURE: A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. RESULTS: Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). CONCLUSIONS: Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.


Assuntos
Parto Obstétrico , Complicações do Trabalho de Parto , Paridade , Nascimento a Termo , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez/epidemiologia , Melhoria de Qualidade , História Reprodutiva , Medição de Risco , Fatores de Risco
3.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32917847

RESUMO

BACKGROUND: International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for self-inflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response. METHODS: This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded. RESULTS: Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.9 [1.9-8.2] vs 6.3 [3.9-10.5] mL/kg; P = .02) and had borderline lower expired CO2 (2.9 [1.5-4.3] vs 3.3 [1.9-5.0] %; P = .05). Twenty four-hour mortality was 9% in both groups. CONCLUSIONS: We found no evidence for improved heart rate response during bag-mask ventilation with PEEP compared with no PEEP. The PEEP valve delivered a median PEEP within the intended range. The findings do not support routine use of PEEP during resuscitation of newborns around term.


Assuntos
Frequência Cardíaca/fisiologia , Respiração com Pressão Positiva/instrumentação , Respiração Artificial/métodos , Ressuscitação/instrumentação , Eletrocardiografia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Tocologia , Respiração com Pressão Positiva/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Tamanho da Amostra , Nascimento a Termo
4.
PLoS One ; 15(8): e0237420, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790709

RESUMO

OBJECTIVE: To prevent the rapid spread of COVID-19, the Chinese government implemented a strict lockdown in Wuhan starting on 23 January, 2020, which inevitably led to the changes in indications for the mode of delivery. In this retrospective study, we present the changes in the indications for cesarean delivery (CD) and the birth weights of newborns after the lockdown in Wuhan. METHODS: A total of 3,432 pregnant women in the third trimester of their pregnancies who gave birth in our hospital from 23 January 2019 to 24 March 2020 were selected as the observation group, while 7,159 pregnant women who gave birth from 1 January 2019 to 22 January 2020 were selected as the control group; control group was matched using propensity score matching (PSM). A comparative analysis of the two groups was performed with the chi-square test, t test and rank sum test. RESULTS: The difference in the overall rate of CD between the two groups was not statistically significant (p<0.05). Among the indications for CD, CD on maternal request (CDMR) and fetal distress were also significantly more common in the observation group (p<0.05) than the control group. Furthermore, we found that the weight of newborns was significantly heavier in the observation group than in the control group when considering full-term or close-to-full-term births (p<0.05). CONCLUSIONS: The results may provide useful information to management practices regarding pregnancy and childbirth after lockdown in other cities or countries, enabling better control of the rate of CD due to CDMR, reducing fetal distress, and controlling newborn weight. We recommend that pregnant women pay more attention to controlling the weight of newborns through diet and exercise.


Assuntos
Betacoronavirus , Peso ao Nascer , Cesárea , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Adolescente , Adulto , China/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Sofrimento Fetal , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Parto Normal , Pneumonia Viral/virologia , Gravidez , Estudos Retrospectivos , Nascimento a Termo , Adulto Jovem
5.
Cochrane Database Syst Rev ; 7: CD012241, 2020 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-32710657

RESUMO

BACKGROUND: Education of family members about infant weaning practices could affect nutrition, growth, and development of children in different settings across the world. OBJECTIVES: To compare effects of family nutrition educational interventions for infant weaning with conventional management on growth and neurodevelopment in childhood. SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5), MEDLINE via PubMed (1966 to 26 June 2018), Embase (1980 to 26 June 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 June 2018). We searched clinical trials databases, conference proceedings, and references of retrieved articles. We ran an updated search from 1 January 2018 to 12 December 2019 in the following databases: CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA: We included randomised controlled trials that examined effects of nutrition education for weaning practices delivered to families of infants born at term compared to conventional management (standard care in the population) up to one year of age. DATA COLLECTION AND ANALYSIS: Two review authors independently identified eligible trial reports from the literature search and performed data extraction and quality assessments for each included trial. We synthesised effect estimates using risk ratios (RRs), risk differences (RDs), and mean differences (MDs), with 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We included 21 trials, recruiting 14,241 infants. Five of the trials were conducted in high-income countries and the remaining 16 were conducted in middle- and low-income countries. Meta-analysis showed that nutrition education targeted at improving weaning-related feeding practices probably increases both weight-for-age z scores (WAZ) (MD 0.15 standard deviations, 95% CI 0.07 to 0.22; 6 studies; 2551 infants; I² = 32%; moderate-certainty evidence) and height-for-age z scores (0.12 standard deviations, 95% CI 0.05 to 0.19; 7 studies; 3620 infants; I² = 49%; moderate-certainty evidence) by 12 months of age. Meta-analysis of outcomes at 18 months of age was heterogeneous and inconsistent in the magnitude of effects of nutrition education on WAZ and weight-for-height z score across studies. One trial that assessed effects of nutrition education on growth at six years reported an uncertain effect on change in height and body mass index z score. Two studies investigated effects of nutrition education on neurodevelopment at 12 to 24 months of age with conflicting results. No trials assessed effects of nutrition education on long-term neurodevelopmental outcomes. AUTHORS' CONCLUSIONS: Nutrition education for families of infants may reduce the risk of undernutrition in term-born infants (evidence of low to moderate certainty due to limitations in study design and substantial heterogeneity of included studies). Modest effects on growth during infancy may not be of clinical significance. However, it is unclear whether these small improvements in growth parameters in the first two years of life affect long-term childhood growth and development. Further studies are needed to resolve this question.


Assuntos
Família , Fenômenos Fisiológicos da Nutrição do Lactente , Desmame , Anemia Ferropriva/epidemiologia , Viés , Estatura , Peso Corporal , Desenvolvimento Infantil , Países Desenvolvidos , Países em Desenvolvimento , Humanos , Lactente , Morte do Lactente , Alimentos Infantis , Transtornos da Nutrição do Lactente/prevenção & controle , Recém-Nascido , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Nascimento a Termo
6.
PLoS One ; 15(6): e0234403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520951

RESUMO

MicroRNAs (miRNAs) are important regulators of gene expression, and their expression is associated with many physiological conditions. Here, we investigated potential associations between expression levels of miRNAs in human placenta and the onset of spontaneous term birth. Using RNA sequencing, we identified 54 miRNAs differentially expressed during spontaneous term labor compared to elective term births. Expression levels of 23 miRNAs were upregulated, whereas 31 were downregulated at least 1.5-fold. The upregulated miRNA miR-371a-5p putatively targets CPPED1, expression of which decreases during spontaneous birth. We used a luciferase reporter-based assay to test whether a miR-371a-5p mimic affected translation when it bound to the 3' untranslated region of CPPED1. In this setting, the miR-371a-5p mimic resulted in lower luciferase activity, which suggests that miR-371a-5p regulates levels of CPPED1. In conclusion, inversely correlated levels of miR-371a-5p and CPPED1 suggest a role for both in spontaneous delivery.


Assuntos
MicroRNAs/genética , Placentação/genética , Nascimento a Termo/genética , Regiões 3' não Traduzidas/genética , Adulto , Calcineurina/genética , Calcineurina/metabolismo , Parto Obstétrico , Feminino , Finlândia , Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica/genética , Humanos , MicroRNAs/metabolismo , Placenta/metabolismo , Gravidez , Transcriptoma/genética
7.
Doc Ophthalmol ; 141(3): 259-267, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32506270

RESUMO

PURPOSE: Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age. METHODS: Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA). RESULTS: At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00-17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83-3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (ß = -2.66, p = .003). Neither GA (ß = 0.21, p = .28) nor BW (ß = 0.001, p = .32) showed any relationship with P2 amplitude. CONCLUSIONS: Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants.


Assuntos
Potenciais Evocados Visuais/fisiologia , Recém-Nascido Prematuro/fisiologia , Nascimento a Termo/fisiologia , Peso ao Nascer , Eletrorretinografia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Estimulação Luminosa/métodos , Tempo de Reação/fisiologia , Vias Visuais/fisiologia
8.
BMJ ; 369: m1007, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349968

RESUMO

OBJECTIVE: To explore conditions and outcomes of a first delivery at term that might predict later preterm birth. DESIGN: Population based, prospective register based study. SETTING: Medical Birth Registry of Norway, 1999-2015. PARTICIPANTS: 302 192 women giving birth (live or stillbirth) to a second singleton child between 1999 and 2015. MAIN OUTCOME MEASURES: Main outcome was the relative risk of preterm delivery (<37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age. RESULTS: Women with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265 043), 6.1% after term pre-eclampsia (688/11 225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term. CONCLUSIONS: Pre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother's predisposition to disorders of placental function.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Morte Perinatal , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Nascimento a Termo , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Noruega/epidemiologia , Gravidez , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto Jovem
9.
Arch Gynecol Obstet ; 302(1): 85-91, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32409926

RESUMO

PURPOSE: To determine whether there is an association between term cesarean breech delivery in the first pregnancy and maternal and neonatal morbidities in the subsequent pregnancy and delivery. METHODS: We conducted a retrospective, nationwide Finnish population-based cohort study, including all deliveries from January 2000 to December 2017. We included all women with the first two consecutive singleton deliveries of which the first one was a breech delivery regardless of mode of delivery (n = 11,953), and constructed a data set in which the first two deliveries for these women were connected. The outcomes of the second delivery of the women with a first pregnancy that resulted in cesarean breech delivery at term were compared with women whose first pregnancy resulted in a vaginal breech delivery at term. P-value, odds ratio, and adjusted odds ratio were calculated. RESULTS: Neonates of a subsequent delivery after cesarean breech delivery had an increased risk for arterial umbilical cord pH below seven, a higher rate of a 5 min APGAR score < 7 and a higher rate of neonatal intensive care unit admission. The women with a history of cesarean section with the fetus in breech presentation were more often in need of a blood transfusion and suffered more often a uterus rupture. In this group, the second delivery was more often a planned cesarean section, an emergency cesarean section, or an instrumental vaginal delivery. CONCLUSIONS: Primary cesarean breech section in the first pregnancy is associated with adverse neonatal and maternal outcomes in the subsequent delivery.


Assuntos
Apresentação Pélvica , Cesárea/estatística & dados numéricos , Nascimento a Termo , Adulto , Estudos de Coortes , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Número de Gestações , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos , Ruptura Uterina/epidemiologia
11.
J Perinat Med ; 48(5): 441-445, 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32401228

RESUMO

Background The pandemic caused by the new coronavirus SARS-CoV-2 (Covid-19) is quite a challenging experience for the world. At the moment of birth, the fetus is prepared to face the challenge of labor and the exposure to the outside world, meaning that labor and birth represent the first extrauterine major exposure to a complex microbiota. The vagina, which is a canal for reproduction, is by evolution separated (but not far) from the anus and urethra. Passing through the birthing canal is a mechanism for intergenerational transmission of vaginal and gut microorganisms for the vertical transmission of microbiota not only from our mothers and grandmothers but also from earlier ancestors. Methods Many national and international instructions have been developed since the beginning of the Covid-19 outbreak in January 2020 in Wuhan in China. All of them pointed out hygiene measures, social distancing and avoidance of social contacts as the most important epidemiological preventive measures. Pregnancy and neonatal periods are considered as high risk for Covid-19 infection. Results The instructions defined the care for pregnant women in the delivery room, during a hospital stay and after discharge. The controversial procedures in the care of Covid-19-suspected or -positive asymptomatic women in labor were: mode of delivery, companion during birth and labor, skin-to-skin contact, breastfeeding, and visits during a hospital stay. Conclusion There is a hope that instruction on coping with the coronavirus (Covid-19) infection in pregnancy with all proposed interventions affecting mothers, babies and families, besides saving lives, are beneficial and efficient by exerting no harm.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/métodos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/terapia , China , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Humanos , Recém-Nascido , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Nascimento a Termo
12.
Cochrane Database Syst Rev ; 4: CD013141, 2020 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-32266712

RESUMO

BACKGROUND: Recently conducted randomised controlled trials (RCTs) suggest that late commencement of parenteral nutrition (PN) may have clinical benefits in critically ill adults and children. However, there is currently limited evidence regarding the optimal timing of commencement of PN in critically ill term and late preterm infants. OBJECTIVES: To evaluate the benefits and safety of early versus late PN in critically ill term and late preterm infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (5 April 2019), MEDLINE Ovid (1966 to 5 April 2019), Embase Ovid (1980 to 5 April 2019), EMCare (1995 to 5 April 2019) and MEDLINE via PubMed (1966 to 5 April 2019). We searched for ongoing or recently completed clinical trials, and also searched the grey literature and reference lists of relevant publications. SELECTION CRITERIA: We included RCTs comparing early versus late initiation of PN in term and late preterm infants. We defined early PN as commencing within 72 hours of admission, and late PN as commencing after 72 hours of admission. Infants born at 37 weeks' gestation or more were defined as term, and infants born between 34 and 36+6 weeks' gestation were defined as late preterm. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials, extracted the data and assessed the risk of bias. Treatment effects were expressed using risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous data. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: Two RCTs were eligible for inclusion. Data were only available from a subgroup (including 209 term infants) from one RCT in children (aged from birth to 17 years) conducted in Belgium, the Netherlands and Canada. In that RCT, children with medium to high risk of malnutrition were included if a stay of 24 hours or more in the paediatric intensive care unit (PICU) was expected. Early PN and late PN were defined as initiation of PN within 24 hours and after day 7 of admission to PICU, respectively. The risk of bias for the study was considered to be low for five domains and high for two domains. The subgroup of term infants that received late PN had significantly lower risk of in-hospital all-cause mortality (RR 0.35, 95% confidence interval (CI) 0.14 to 0.87; RD -0.10, 95% CI -0.18 to -0.02; number needed to treat for an additional beneficial outcome (NNTB) = 10; 1 trial, 209 participants) and neonatal mortality (death from any cause in the first 28 days since birth) (RR 0.29, 95% CI 0.10 to 0.88; RD -0.09, 95% CI -0.16 to -0.01; NNTB = 11; 1 trial, 209 participants). There were no significant differences in rates of healthcare-associated blood stream infections, growth parameters and duration of hospital stay between the two groups. Neurodevelopmental outcomes were not reported. The quality of evidence was considered to be low for all outcomes, due to imprecision (owing to the small sample size and wide confidence intervals) and high risk of bias in the included studies. AUTHORS' CONCLUSIONS: Whilst late commencement of PN in term and late preterm infants may have some benefits, the quality of the evidence was low and hence our confidence in the results is limited. Adequately powered RCTs, which evaluate short-term as well as long-term neurodevelopmental outcomes, are needed.


Assuntos
Estado Terminal/terapia , Nutrição Parenteral/estatística & dados numéricos , Aminoácidos/administração & dosagem , Aminoácidos/efeitos adversos , Viés , Infecção Hospitalar/epidemiologia , Emulsões Gordurosas Intravenosas/administração & dosagem , Emulsões Gordurosas Intravenosas/efeitos adversos , Mortalidade Hospitalar , Humanos , Hipoglicemia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Tempo de Internação , Lipídeos/administração & dosagem , Lipídeos/efeitos adversos , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/mortalidade , Soluções de Nutrição Parenteral/administração & dosagem , Soluções de Nutrição Parenteral/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/estatística & dados numéricos , Nascimento a Termo , Fatores de Tempo
13.
Artigo em Inglês | MEDLINE | ID: mdl-32321672

RESUMO

The partograph (sometimes called partogram) is a labour monitoring tool that is used in countries worldwide to enable early detection of complications, so that referral, action or closer observations can ensue. While the partograph has received global support, from health professionals, there are concerns that it has not reached its full potential in improving clinical outcomes. This has resulted in several variations of the tool and a plethora of studies aimed at exploring the barriers and facilitators to its use. In this chapter, we will discuss the history of the partograph, outlining how it has evolved over time. We will also suggest reasons why the tool may not be meeting the needs of all practitioners. In particular, we will explore partograph use as a complex intervention, suggesting that its success is likely to be dependent on multiple contextual factors.


Assuntos
Parto Obstétrico/métodos , Trabalho de Parto/fisiologia , Nascimento a Termo/fisiologia , Técnicas de Apoio para a Decisão , Feminino , Humanos , Gravidez , Resultado da Gravidez , Monitorização Uterina/métodos
14.
Acta Obstet Gynecol Scand ; 99(9): 1174-1180, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32242917

RESUMO

INTRODUCTION: To investigate the safety of balloon catheter for cervical ripening in women with term pre-labor rupture of membranes (PROM) and to compare the incidence of maternal and neonatal infections in women with PROM and women with intact membranes undergoing cervical ripening with a balloon catheter. MATERIAL AND METHODS: This retrospective cohort study of 1923 women with term singleton pregnancy and an unfavorable cervix undergoing cervical ripening with a balloon catheter was conducted in Helsinki University Hospital between January 2014 and December 2018. For each case of PROM, two controls were assigned. The main outcome measures were the rates of maternal and neonatal infections. Statistical analyses were performed by SPSS. RESULTS: In all, 641 (33.3%) women following PROM and 1282 (66.6%) women with intact amniotic membranes underwent labor induction. The rates of intrapartum infection (3.7% vs 7.7%; P = .001) and neonatal infection (1.7% vs 3.8%; P = .01) were not increased in women induced by balloon catheter following PROM. Intrapartum infections were associated with nulliparity (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.6-6.5), history of previous cesarean section (OR 2.8, 95% CI 1.2-6.4), extended gestational age ≥41 weeks (OR 1.9, 95% CI 1.2-3.0) and an induction to delivery interval of 48 hours or more (OR 2.0, 95% CI 1.2-3.3). The risk of neonatal infection was associated with nulliparity (OR 3.3, 95% CI 1.4-8.0), gestational age ≥41 weeks (OR 1.9, 95% CI 1.09-3.36) and induction to delivery interval of 48 hours or more (OR 3.4, 95% CI 1.9-6.0). CONCLUSIONS: Use of balloon catheter in women with term PROM appears safe and was not associated with increased maternal or neonatal infectious morbidity.


Assuntos
Cateteres , Maturidade Cervical , Trabalho de Parto Induzido/métodos , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Nascimento a Termo
15.
BJOG ; 127(9): 1074-1080, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32180311

RESUMO

OBJECTIVE: To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN: Retrospective cohort study of births in five 2-year epochs: 1983-84, 1993-94, 2003-2004, 2013-2014 and 2016-2017. POPULATION: 665 205 singleton births at ≥32 weeks' gestation. SETTING: All maternity services in Victoria, Australia. METHODS: For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation. We calculated rates of iatrogenic delivery over time. We then calculated the number of babies whose birthweight would have classified them as ≥3rd centile based on 1983-84 centile definitions but as <3rd centile based on 2016-2017 centile definitions. MAIN OUTCOME MEASURES: Birthweight centile, and gestation at delivery. RESULTS: From 1983-84 to 2016-2017, the rate of iatrogenic delivery for singleton pregnancies increased at all term gestations: 1.6-6.4% at 37 weeks', 4.5-18.3% at 38 weeks', 7.6-23.9% at 39 weeks' and 18.4-25.1% at 40 weeks' (all P < 0.001). Over the same period, the birthweight cutoffs defining the 3rd, 5th and 10th centiles increased significantly at term, but not preterm, gestations. This led to increasing numbers of term births being classified as small for gestational age (SGA). Of the 2748 babies born in 2016-2017 at 37-39 weeks' gestation with a birthweight <3rd centile in that period, 1478 (53.8%) would have been classified as ≥3rd centile based on 1983-84 centile definitions. CONCLUSION: Increasing intervention is shifting the birthweight cutoffs that define birthweight centiles and thereby redefining what constitutes SGA. This undermines the use of population-derived birthweight centiles to audit clinical care. TWEETABLE ABSTRACT: Increasing obstetric intervention is shifting birthweight centiles and therefore definitions of normality.


Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/diagnóstico , Idade Gestacional , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Feminino , Retardo do Crescimento Fetal/terapia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Auditoria Médica/métodos , Gravidez , Estudos Retrospectivos , Nascimento a Termo
16.
Acta Obstet Gynecol Scand ; 99(9): 1155-1162, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32142154

RESUMO

INTRODUCTION: The associations of epidural analgesia and low Apgar score found in the Swedish Registry might be a result of confounding by indication. The objective of this study was to assess the possible effect of intrapartum epidural analgesia on low Apgar score and neonatal intensive care unit (NICU) admission in term born singletons with propensity score matching. MATERIAL AND METHODS: This was a propensity score matched study (n = 257 872) conducted in a national cohort of 715 449 term live born singletons without congenital anomalies in the Netherlands. Mothers with prelabor cesarean section were excluded. Main outcome measures were 5-minute Apgar score <7, 5-minute Apgar score <4 and admission to a NICU for at least 24 hours. First, an analysis of the underlying risk factors for low Apgar score <7 was performed. Multivariable analyses were applied to assess the effect of the main risk factor, intrapartum epidural analgesia, on low Apgar score to adjust the results for confounding factors. Second, a propensity score matched analysis on the main risk factors for epidural analgesia was applied. By propensity score matching the (confounding) characteristics of the women who received epidural analgesia with the characteristics of the control women without epidural analgesia, the effect of possible confounding by indication is minimized. RESULTS: Intrapartum epidural analgesia was performed in 128 936 women (18%). Apgar score <7 was present in 1.0%, Apgar score <4 in .2% and NICU admission in .4% of the deliveries. The strongest risk factor for Apgar score <7 was epidural analgesia (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.8-2.0). The propensity score matched adjusted analysis of women with epidural analgesia showed significant adverse neonatal outcomes: aOR 1.8 (95% CI 1.7-1.9) for AS <7, aOR 1.6 (95% CI 1.4-1.9) for AS <4 and aOR 1.7 (95% CI 1.6-1.9) for NICU admission. The results of epidural analgesia on AS <7 were also significantly increased for spontaneous start of labor (aOR 2.0, 95% CI 1.8-2.1) and for spontaneous delivery. CONCLUSIONS: Intrapartum epidural analgesia at term is strongly associated with low Apgar score and more NICU admissions, especially in spontaneous deliveries. This association needs further research and awareness.


Assuntos
Analgesia Epidural , Índice de Apgar , Trabalho de Parto , Nascimento a Termo , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Idade Materna , Países Baixos , Gravidez , Pontuação de Propensão , Adulto Jovem
18.
JAMA Netw Open ; 3(2): e1919498, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32049289

RESUMO

Importance: Unexpected complications in term newborns have been recently adopted by the Joint Commission as a marker of obstetric care quality. Objective: To understand the variation and patient and hospital factors associated with severe unexpected complications in term neonates among hospitals in the United States. Design, Setting, and Participants: This cross-sectional study collected data from all births in US counties with 1 obstetric hospital using county-identified birth certificate data and American Hospital Association annual survey data from January 1, 2015, through December 31, 2017. All live-born, term, singleton infants weighing at least 2500 g were included. The data analysis was performed from December 1, 2018, through June 30, 2019. Exposures: Severe unexpected newborn complication, defined as neonatal death, 5-minute Apgar score of 3 or less, seizure, use of assisted ventilation for at least 6 hours, or transfer to another facility. Main Outcomes and Measures: Between-hospital variation and patient and hospital factors associated with unexpected newborn complications. Results: A total of 1 754 852 births from 576 hospitals were included in the analysis. A wide range of hospital complication rates was found (range, 0.6-89.9 per 1000 births; median, 15.3 per 1000 births [interquartile range, 9.6-22.0 per 1000 births]). Hospitals with high newborn complication rates were more likely to care for younger, white, less educated, and publicly insured women with more medical comorbidities compared with hospitals with low complication rates. In the adjusted models, there was little effect of case mix to explain the observed between-county variation (11.3%; 95% CI, 10.0%-12.6%). Neonatal transfer was the primary factor associated with complication rates, especially among hospitals with the highest rates (66.0% of all complications). The risk for unexpected neonatal complication increased by more than 50% for those neonates born at hospitals without a neonatal intensive care unit compared with those with a neonatal intensive care unit (adjusted odds ratio, 1.55; 95% CI, 1.38-1.75). Conclusions and Relevance: In this study, severe unexpected complication rates among term newborns varied widely. When included in the metric numerator, neonatal transfer was the primary factor associated with complications, especially among hospitals with the highest rates. Transfers were more likely to be necessary when infants were born in hospitals with lower levels of neonatal care. Thus, if this metric is to be used in its current form, it would appear that accreditors, regulatory bodies, and payers should consider adjusting for or stratifying by a hospital's level of neonatal care to avoid disincentivizing against appropriate transfers.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Doenças do Recém-Nascido/epidemiologia , Índice de Apgar , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Nascimento Vivo , Masculino , Gravidez , Nascimento a Termo , Estados Unidos/epidemiologia
19.
Taiwan J Obstet Gynecol ; 59(1): 34-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039797

RESUMO

OBJECTIVE: To determine the effect of obesity on the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes in term pregnancies. MATERIAL AND METHODS: 242 obese and 244 non-obese pregnant women ≥37 gestational weeks were compared in terms of the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes. RESULTS: Obese pregnant women had statistically significantly lower onset of spontaneous labor and higher rates of scheduled delivery. No difference was determined in respect of the type of delivery, 1st and 5th minutes APGAR scores and the need for intensive care. Higher values of birth weight, large for gestational age, macrosomia, gestational diabetes mellitus and preeclampsia were determined in obese women. CONCLUSION: The onset of spontaneous labor rates in term obese pregnancies were lower and scheduled delivery rates were higher than in the non-obese pregnancies. However, more extensive studies are needed to better understand this relationship.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto/fisiologia , Obesidade/fisiopatologia , Complicações na Gravidez/fisiopatologia , Nascimento a Termo/fisiologia , Adulto , Índice de Apgar , Peso ao Nascer , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Fatores de Risco
20.
J Perinatol ; 40(4): 646-654, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32066844

RESUMO

OBJECTIVE: To identify differences in feeding skill performance among preterm infants at term equivalent age compared with full-term infants. STUDY DESIGN: Ninety-two infants (44 preterm infants born ≤32 weeks gestation at term equivalent age and 48 full-term infants within 4 days of birth) had a standardized oral feeding assessment. RESULT: Preterm infants at term equivalent age had lower Neonatal Eating Outcome Assessment scores (67.8 ± 13.6 compared with 82.2 ± 8.1; p < 0.001) and were more likely to have poor arousal (p = 0.04), poor tongue positioning (p = 0.04), suck-swallow-breathe discoordination (p < 0.001), inadequate sucking bursts (p = 0.01), tonal abnormalities (p < 0.001), discoordination of the jaw and tongue during sucking (p < 0.001), lack of positive engagement with the feeder and/or discomfort (p < 0.001), signs of aspiration (p < 0.001), difficulty regulating breathing (p < 0.001), and have an inability to maintain an appropriate state (p < 0.001), and complete the feeding (<0.001). CONCLUSION: A broad range of feeding-related difficulties appear to remain evident in preterm infants at term equivalent age.


Assuntos
Comportamento Alimentar/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos , Recém-Nascido Prematuro/fisiologia , Comportamento de Sucção , Alimentação Artificial , Aleitamento Materno , Feminino , Humanos , Recém-Nascido , Masculino , Nascimento a Termo
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