Inflammatory Response in Preterm Newborns Born after Prolonged Premature Rupture of Membranes: Is There a Correlation with Placental Histological Findings?

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality among neonates in the United States. Early recognition of sepsis in this population is a challenging task since overt clinical signs can be difficult to determine. C-reactive protein (CRP), one of the most frequently non-specific used laboratory test, can indirectly aid the diagnosis of neonatal sepsis. OBJECTIVES: To evaluate the relationship between histological findings in the placenta of preterm newborns born after prolonged rupture of membranes, CRP levels, and blood cultures. METHODS: Medical records were reviewed of all preterm newborns born after prolonged premature rupture of membranes at a medical center in Israel between 2011 and 2014. RESULTS: Of 128 newborns with prolonged rupture of membranes, 64 had evidence of histological chorioamnionitis (HCA). Gestational age, birth weight, and Apgar scores were significantly lower, while CRP levels (on admission and 10-12 hours post-delivery) were significantly higher in preterm newborns born to mothers with histological evidence of chorioamnionitis, but values were within normal ranges. Duration of the rupture of membranes and white blood cell counts did not differ between groups. CONCLUSIONS: CRP levels taken on admission and 10-12 hours after delivery were higher when HCA was present, but since there was a substantial overlap between those with and without HCA and the values for most were within normal range, the differences were not enough to serve as a tool to diagnose placental histological chorioamnionitis in preterm infants born after prolonged premature rupture of membranes and exposed to intrapartum antibiotics.

The association between gestational impaired glucose tolerance and hyperglycemic markers: A prospective study.

OBJECTIVE: To investigate the association between gestational impaired glucose tolerance (GIGT), and laboratory and clinical hyperglycemic markers. METHODS: A prospective study in Holon between 2017 and 2019. Women with a singleton term delivery and one abnormal value in their last three oral glucose tolerance test measurements (OGTTs; GIGT group, n = 60) were compared with control women with normal glucose challenge test (GCT) and/or OGTT measurements (n = 60). Primary outcomes were elevated cord-blood C-peptide (>90th percentile), maternal hemoglobin A1c (HbA1c), abnormal HbA1c (>5.7%), and neonatal skinfold thickness. Secondary outcomes included large for gestational age (LGA). RESULTS: Women in the GIGT group were older (33.3 ± 5.3 vs 31.1 ± 4.8 years; P = 0.019), and had a higher rate of LGA (26.7% vs 6.7%; P = 0.005), macrosomia (13.3% vs 0%; P = 0.006), elevated C-peptide (16.7% vs 1.7%, P = 0.008), and abnormal HbA1c (13.3% vs 0%, P = 0.006). Skinfold thickness was also significantly higher in the GIGT group. HbA1c (adjusted odds ratio [aOR], 10.48; 95% confidence interval [CI], 1.19-91.91; P = 0.033) and GIGT (aOR, 11.43; 95% CI, 1.78-73.39; P = 0.01) were independently associated with LGA. CONCLUSION: Women with GIGT on OGTT demonstrated "hyperglycemic characteristics" relative to those with normal GCT and/or OGTT.

Amniotic fluid transitioning from clear to meconium stained during labor-prevalence and association with adverse maternal and neonatal outcomes.

OBJECTIVE: The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor). METHODS: The medical records and neonatal charts of all deliveries ≥ 370/7 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications. RESULTS: Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004). CONCLUSION: Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.

Prevalence and risk of sleep disturbances in adolescents after minor head injury.

Sleep disturbances were reported in patients during the acute stage after minor head injury, and for some of these patients, the disturbances may become chronic. The purpose of the present study was to assess the prevalence and risk factors of the long-term sleep disturbances in adolescents after minor head injury. Unselected adolescents (98) who had experienced a minor head injury 0.5-6 years before the institution of the study and 80 matched control subjects were interviewed and completed a detailed questionnaire. The prevalence of sleep disturbances was significantly larger among adolescents who experienced minor head injury compared with the control subjects (28% versus 11%, P < 0.05). Within the study group, those who developed long-term sleep disturbances manifested a greater body mass index (20.8 +/- 4.0 vs 18.4 +/- 2.8 kg/m(2), P = 0.005) and poorer parental education (fathers 11.0 +/- 4.0 vs 13.4 +/- 3.0 years, mothers 11.8 +/- 3.3 vs 13.2 +/- 2.9 years, P < 0.05 for both), compared with those who did not develop sleep disturbances. Our data indicate that subjective sleep disturbances may be evident in a fairly high percentage of adolescents after minor head injury, up to 28%, suggesting that minor head injury may not be as benign as previously estimated. Risk factors include heavier body mass and poorer parental education.

Controlled sleep restriction for rhythmic movement disorder.

Rhythmic movement disorder is a parasomnia that is difficult to treat. In our study, 3 weeks of controlled sleep restriction with hypnotic administration in the first week resulted in almost complete resolution of the movements in 6 children. This therapeutic success suggests that rhythmic movement disorder results from a voluntary self-soothing behavior.