MedWorm: Perinatology & Neonatology

Trends in the postfortification prevalence of spina bifida and anencephaly in the united states

Birth Defects Research Part A: Clinical and Molecular Teratology — Fri, 16 May 2008 04:00:00 +0100

BACKGROUND: The prevalence of NTDs in the US declined significantly after mandatory folic acid fortification; however, it is not known if the prevalence of NTDs has continued to decrease in recent years relative to the period immediately following the fortification mandate. METHODS: Population-based data from 21 birth defects surveillance systems were used to examine trends in the birth prevalence of spina bifida and anencephaly during 1999-2000, 2001-2002, and 2003-2004. Prevalence data were stratified by non-Hispanic White, non-Hispanic Black, and Hispanic race or ethnicity. Prevalence ratios were calculated by dividing the birth prevalences during the later time periods (2001-2002 and 2003-2004) by the birth prevalences during 1999-2000. RESULTS: During 1999-2004, 3,311 cases of spina bifida and 2,116 cases of anencephaly were reported. Hispanic infants had the highest prevalences of NTDs for all years. For all infants, the combined birth prevalences of spina bifida and anencephaly decreased 10% from the 1999-2000 period to the 2003-2004 period. The decline in spina bifida (3%) was not significant; however the decline in anencephaly (20%) was statistically significant. CONCLUSIONS: While the prevalences of spina bifida and anencephaly in the United States have declined since folic acid fortification in the food supply began, these data suggest that reductions in the prevalence of anencephaly continued during 2001-2004 and that racial and ethnic and other disparities remain. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

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Maternal periconceptional smoking and alcohol consumption and risk for select congenital anomalies

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 15 May 2008 04:00:00 +0100

BACKGROUND: This study examined the association between maternal smoking and alcohol use (including binge drinking) during the periconceptional period (i.e., 2 months before through 2 months after conception) and the risk of orofacial clefts, NTDs, and conotruncal heart defects in offspring. METHODS: Data were drawn from a population-based case-control study of fetuses and live-born infants among a cohort of California births between July 1999 and June 2003. The 1,355 cases comprised of 701 orofacial clefts, 337 NTDs, and 323 conotruncal heart defects. Information on smoking and alcohol consumption was obtained via telephone interviews with mothers of 1,355 (80% of eligibles) cases and 700 (77% of eligibles) nonmalformed, live-born controls. RESULTS: Maternal smoking of five cigarettes or less per day was associated with reduced risks of NTDs (OR 0.7; 95% CI: 0.3, 1.4), whereas the risk associated with higher cigarette consumption was lower for conotruncal heart defects (OR 0.5; 95% CI: 0.2, 1.2). Maternal intake of alcohol less than 1 day per week was associated with a 1.6- to 2.1-fold higher risk of NTDs (95% CI: 0.9, 2.6), d-transposition of the great arteries (95% CI: 1.1, 3.2), and multiple cleft lip with or without cleft palate (CLP) (95% CI: 0.8, 4.5). Risks associated with more frequent alcohol intake were 2.1 for NTDs (95% CI: 1.1, 4.0) and 2.6 for multiple CLP (95% CI: 1.1, 6.1). CONCLUSIONS: This study observed that maternal alcohol intake increased the risk for d-transposition of the great arteries, NTDs, and multiple CLP in infants. By contrast, smoking was associated with a lower risk of NTDs and conotruncal heart defects. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Depressive symptoms during pregnancy in relation to fish consumption and intake of n-3 polyunsaturated fatty acids

Paediatric and Perinatal Epidemiology — Thu, 08 May 2008 18:42:50 +0100

Paediatric and Perinatal Epidemiology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. Summary Sontrop J, Avison WR, Evers SE, Speechley KN, Campbell MK. Depressive symptoms during pregnancy in relation to fish consumption and intake of n-3 polyunsaturated fatty acids. Paediatric and Perinatal Epidemiology 2008. An inverse association ... (Source: Paediatric and Perinatal Epidemiology)

Preface.

Clinics in Perinatology — Tue, 06 May 2008 19:43:02 +0100

Preface.

Clin Perinatol. 2008 Jun;35(2):xi-xii

Authors: Jain L, Wapner R

PMID: 18456069 [PubMed - in process]

(Source: Clinics in Perinatology)

Cesarean birth in the united states: epidemiology, trends, and outcomes.

Clinics in Perinatology — Tue, 06 May 2008 19:42:57 +0100

Cesarean birth in the United States: epidemiology, trends, and outcomes.

Clin Perinatol. 2008 Jun;35(2):293-307

Authors: Macdorman MF, Menacker F, Declercq E

The percentage of United States cesarean births increased from 20.7% in 1996 to 31.1% in 2006. Cesarean rates increased for women of all ages, race/ethnic groups, and gestational ages and in all states. Both primary and repeat cesareans have increased. Increases in primary cesareans in cases of "no indicated risk" have been more rapid than in the overall population and seem the result of changes in obstetric practice rather than changes in the medical risk profile or increases in "maternal request." Several studies note an increased risk for neonatal and maternal mortality for medically elective cesareans compared with vaginal births.

PMID: 18456070 [PubMed - in process]

(Source: Clinics in Perinatology)

The relationship between cesarean delivery and gestational age among us singleton births.

Clinics in Perinatology — Tue, 06 May 2008 19:42:51 +0100

The Relationship Between Cesarean Delivery and Gestational Age Among US Singleton Births.

Clin Perinatol. 2008 Jun;35(2):309-23

Authors: Bettegowda VR, Dias T, Davidoff MJ, Damus K, Callaghan WM, Petrini JR

The increasing trend of delivering at earlier gestational ages has raised concerns of the impact on maternal and infant health. The delicate balance of the risks and benefits associated with continuing a pregnancy versus delivering early remains challenging. Among singleton live births in the United States, the proportion of preterm births increased from 9.7% to 10.7% between 1996 and 2004. The increase in singleton preterm births occurred primarily among those delivered by cesarean section, with the largest percentage increase in late preterm births. For all maternal racial/ethnic groups, singleton cesarean section rates increased for each gestational age group. Singleton cesarean section rates for non-Hispanic black women increased at a faster pace among all preterm gestational age groups compared with non-Hispanic white and Hispanic women. Further research is needed to understand the underlying reasons for the increase in cesarean section deliveries resulting in preterm birth.

PMID: 18456071 [PubMed - in process]

(Source: Clinics in Perinatology)

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Late preterm infants, early term infants, and timing of elective deliveries.

Clinics in Perinatology — Tue, 06 May 2008 19:42:47 +0100

Late preterm infants, early term infants, and timing of elective deliveries.

Clin Perinatol. 2008 Jun;35(2):325-41

Authors: Engle WA, Kominiarek MA

Delivery of infants who are physiologically mature and capable of successful transition to the extrauterine environment is an important priority for obstetric practitioner. A corollary of this goal is to avoid iatrogenic complications of prematurity and maternal complications from delivery. The purpose of this review is to describe the consequences of birth before physiologic maturity in late preterm and term infants, to identify factors contributing to the decline in gestational age of deliveries in the United States, and to describe strategies to reduce premature delivery of late preterm and early term infants.

PMID: 18456072 [PubMed - in process]

(Source: Clinics in Perinatology)

The influence of obstetric practices on late prematurity.

Clinics in Perinatology — Tue, 06 May 2008 19:42:43 +0100

The influence of obstetric practices on late prematurity.

Clin Perinatol. 2008 Jun;35(2):343-60

Authors: Fuchs K, Gyamfi C

In this article, the authors review the standard management of several maternal and fetal complications of pregnancy and examine the effect these practices may have on the late preterm birth rate. Given the increasing rate of late preterm birth and the increased recognition of the morbidity and mortality associated with delivery between 34 and 37 weeks, standard obstetric practices and practice patterns leading to late preterm birth should be critically evaluated. The possibility of expectant management of some pregnancy complications in the late preterm period should be investigated. Furthermore, prospective research is warranted to investigate the role of antenatal corticosteroids beyond 34 weeks.

PMID: 18456073 [PubMed - in process]

(Source: Clinics in Perinatology)

Neonatal morbidity and mortality after elective cesarean delivery.

Clinics in Perinatology — Tue, 06 May 2008 19:42:41 +0100

Neonatal Morbidity and Mortality After Elective Cesarean Delivery.

Clin Perinatol. 2008 Jun;35(2):361-371

Authors: Signore C, Klebanoff M

This article explores the effects of elective cesarean delivery (ECD) at term on neonatal morbidity and mortality. Available data have limitations, and do not provide conclusive evidence regarding the safety of planned ECD versus planned vaginal delivery. Some data suggest an association between ECD and increased neonatal respiratory morbidity and lacerations, and possibly decreased central and peripheral nervous system injury. Potentially increased risks of neonatal mortality with ECD at term may be counterbalanced by risks for fetal demise in ongoing pregnancies. Patients and physicians considering ECD should review competing risks and benefits; further research is needed to inform these discussions.

PMID: 18456074 [PubMed - as supplied by publisher]

(Source: Clinics in Perinatology)

Elective cesarean section: its impact on neonatal respiratory outcome.

Clinics in Perinatology — Tue, 06 May 2008 19:42:38 +0100

Elective cesarean section: its impact on neonatal respiratory outcome.

Clin Perinatol. 2008 Jun;35(2):373-93

Authors: Ramachandrappa A, Jain L

Physiologic events in the last few weeks of pregnancy coupled with the onset of spontaneous labor are accompanied by changes in the hormonal milieu of the fetus and its mother, resulting in preparation of the fetus for neonatal transition. Rapid clearance of fetal lung fluid is a key part of these changes, and is mediated in large part by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells, with only a limited contribution from mechanical factors and Starling forces. This article discusses the respiratory morbidity associated with elective cesarean section, the physiologic mechanisms underlying fetal lung fluid absorption, and potential strategies for facilitating neonatal transition when infants are delivered by elective cesarean section before the onset of spontaneous labor.

PMID: 18456075 [PubMed - in process]

(Source: Clinics in Perinatology)

Cesarean delivery and its impact on the anomalous infant.

Clinics in Perinatology — Tue, 06 May 2008 19:42:35 +0100

Cesarean delivery and its impact on the anomalous infant.

Clin Perinatol. 2008 Jun;35(2):395-406

Authors: Hamrick SE

Although cesarean deliveries frequently are performed for anomalous fetal conditions, available data do not always support a fetal benefit from this delivery management. The literature on cesarean delivery for anomalous infants reports insufficient information on comorbid neonatal conditions, so these complications are unknown in this population of newborns. In a minority of cases, a cesarean delivery is reasonable to prevent dystocia or optimize outcome. Areas for future investigation include prospective, randomized, controlled trials of prelabor cesarean compared with vaginal deliveries for myelomeningocele and anterior abdominal wall defects. The rarity of other lesions likely precludes randomized controlled trials.

PMID: 18456076 [PubMed - in process]

(Source: Clinics in Perinatology)

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The impact of cesarean delivery on transmission of infectious agents to the neonate.

Clinics in Perinatology — Tue, 06 May 2008 19:42:32 +0100

The impact of cesarean delivery on transmission of infectious agents to the neonate.

Clin Perinatol. 2008 Jun;35(2):407-20

Authors: Sharma D, Spearman P

The rate of cesarean deliveries has increased dramatically over the past decade. Studies to date have highlighted a number of factors on the part of the treating physician and the expectant mother contributing to this increase. Maternal infections are not a major cause of this increase. There are a limited number of infections in a pregnant woman that warrant cesarean delivery to prevent perinatal transmission. This article outlines those infections known to be transmitted perinatally through the infected birth canal and details the current recommendations for cesarean delivery. Pregnant women with active genital herpes lesions or with known herpes simplex virus infection and a prodromal illness consistent with recurrence at the time of presentation in labor should undergo cesarean delivery. Pregnant women who are HIV infected and have detectable viremia (>1000 copies/mL) should be counseled regarding the potential benefits of cesarean delivery as an adjunct to antiretroviral therapy. Hepatitis C virus (HCV) can be transmitted intrapartum, but prevention of HCV transmission by cesarean delivery has not been proved effective and is not generally indicated. A limited number of other infectious agents can be transmitted through the birth canal but do not constitute an indication for cesarean delivery.

PMID: 18456077 [PubMed - in process]

(Source: Clinics in Perinatology)

Cesarean section and the outcome of very preterm and very low-birthweight infants.

Clinics in Perinatology — Tue, 06 May 2008 19:42:29 +0100

Cesarean section and the outcome of very preterm and very low-birthweight infants.

Clin Perinatol. 2008 Jun;35(2):421-35

Authors: Malloy MH, Doshi S

Births of extremely preterm infants, less than 26 weeks' gestation, by cesarean section have increased significantly in the United States over the past decade. The justification for this increase is not well supported in the literature. This review examines recent analyses that suggest there may be some survival advantage for infants less than 26 weeks delivered by cesarean section. The appropriateness of intervening with cesarean sections for these very immature infants, however, remains uncertain.

PMID: 18456078 [PubMed - in process]

(Source: Clinics in Perinatology)

Long-term neurologic outcome of infants born by cesarean section.

Clinics in Perinatology — Tue, 06 May 2008 19:42:26 +0100

Long-term neurologic outcome of infants born by cesarean section.

Clin Perinatol. 2008 Jun;35(2):437-54

Authors: Adams-Chapman I

Prevention of neurologic injury to the fetus through skilled and attentive care during the peripartum period is designed to identify signs of fetal distress so that appropriate obstetric interventions can occur. The impact of mode of delivery on neurologic outcome varies depending on the clinical indication for cesarean delivery and the associated maternal and fetal conditions. This review summarizes current knowledge of the impact of mode of delivery on long-term neurologic outcome.

PMID: 18456079 [PubMed - in process]

(Source: Clinics in Perinatology)

The ethical debate of maternal choice and autonomy in cesarean delivery.

Clinics in Perinatology — Tue, 06 May 2008 19:42:23 +0100

The ethical debate of maternal choice and autonomy in cesarean delivery.

Clin Perinatol. 2008 Jun;35(2):455-62

Authors: Williams HO

Cesarean delivery as a result of maternal request is increasingly popular, leading to important ethical questions. One of the challenging issues is balancing respect for the autonomy of a pregnant woman with concerns of beneficence and nonmaleficence for her and the fetus. The perceived benefit of cesarean section is protection of the pelvic floor. Increased rates of respiratory morbidity in infants born by cesarean section cannot be ignored. Societal concerns of distribution of resources must be considered in ongoing discussions of this critical issue. This article reviews the current ethical debate of maternal choice and autonomy in elective cesarean delivery.

PMID: 18456080 [PubMed - in process]

(Source: Clinics in Perinatology)

Analysis of five single nucleotide polymorphisms in the esr1 gene in cryptorchidism

Birth Defects Research Part A: Clinical and Molecular Teratology — Fri, 02 May 2008 04:00:00 +0100

Recent findings suggest that a specific haplotype, including five single nucleotide polymorphisms (SNPs) in the 3[prime]-terminal region of the estrogen receptor [alpha] gene (ESR1), is associated with the risk for cryptorchidism, but results have been conflicting in different populations. The goal of this study was to further define the association between this specific ESR1 haplotype and the risk for nonsyndromic cryptorchidism in a multiracial American population including Caucasian, African American, and Asian American subjects.Applied Biosystems TaqMan SNP Genotyping Assays were used to identify the genotypes of the five SNPs in ESR1 in 152 nonsyndromic cryptorchidism cases and 160 healthy controls.For the five SNPs, there were no significant differences in genotype frequencies between cases and controls. The four estimated haplotypes at the 3[prime] region of ESR1 gene were also not associated with the occurrence of cryptorchidism, but the haplotype AGATC was associated with the severity of cryptorchidism. SNP12 (rs6932902) in ESR1 was not associated with cryptorchidism per se, but was associated with increasing severity of cryptorchidism. Severe cases were more likely to have GG genotype (93%) than moderate (54%) cases (p = .04), and this association was in recessive mode (p = .02). The allele distribution of this SNP was also significantly different between moderate and severe cases: 97% of severe cases had the G allele while only 76% of moderate cases had the G allele (p = .03).SNP12 in ESR1 is not associated with the occurrence of cryptorchidism but is associated with the severity of cryptorchidism. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

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Maternal urinary tract infections and selected cardiovascular malformations

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 01 May 2008 04:00:00 +0100

BACKGROUND: In a population-based case-control study, we investigated the association between congenital cardiovascular malformations (CVMs) and maternal urinary tract infections (UTIs). METHODS: Within the National Birth Defects Prevention Study, 3,690 women who had singleton livebirths with nonsyndromic CVMs, and 4,760 women who had infants without birth defects were identified. Affected infants had: conotruncal, septal, anomalous pulmonary venous return, atrioventricular septal defects, or left- or right-sided obstructive heart defects. Mothers had a UTI if they reported having at least one infection during the first trimester. Adjusted ORs and 95% CIs were computed to determine the association between CVMs and UTIs. Stratified analyses were conducted to investigate if sulfonamide use and/or fever modified the effect between CVMs and UTIs. RESULTS: Women who had offspring with either left ventricular outflow tract obstructive defects or atrioventricular septal defects were more likely than controls to report a UTI. These associations remained among women who did not have fever or used sulfonamides. Maternal use of sulfonamides during the UTI did not appear to modify the relationship between CVM subtypes and maternal UTIs. CONCLUSIONS: In the National Birth Defects Prevention Study there was little evidence to support an association between CVMs and UTIs during the first trimester of pregnancy. Associations between left ventricular outflow tract obstructive defects and maternal UTI as well as between atrioventricular septal defects and maternal UTI were found. Our findings, while not conclusive, suggest that the possible association between maternal UTI and CVMs should be investigated further. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Refinement of 2q and 7p loci in a large multiplex ntd family

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 01 May 2008 04:00:00 +0100

BACKGROUND: NTDs are considered complex disorders that arise from an interaction between genetic and environmental factors. NTD family 8776 is a large multigenerational Caucasian family that provides a unique resource for the genetic analysis of NTDs. Previous linkage analysis using a genome-wide SNP screen in family 8776 with multipoint nonparametric mapping methods identified maximum LOD* scores of [sim]3.0 mapping to 2q33.1-q35 and 7p21.1-pter. METHODS: We ascertained an additional nuclear branch of 8776 and conducted additional linkage analysis, fine mapping, and haplotyping. Expression data from lymphoblast cell lines were used to prioritize candidate genes within the minimum candidate intervals. Genomic copy number changes were evaluated using BAC tiling arrays and subtelomeric fluorescent in situ hybridization probes. RESULTS: Increased evidence for linkage was observed with LOD* scores of [sim]3.3 for both regions. Haplotype analyses narrowed the minimum candidate intervals to a 20.3 Mb region in 2q33.1-q35 between markers rs1050347 and D2S434, and an 8.3 Mb region in 7p21.1-21.3 between a novel marker 7M0547 and rs28177. Within these candidate regions, 16 genes were screened for mutations; however, no obvious causative NTD mutation was identified. Evaluation of chromosomal aberrations using comparative genomic hybridization arrays, subtelomeric fluorescent in situ hybridization, and copy number variant detection techniques within the 2q and 7p regions did not detect any chromosomal abnormalities. CONCLUSIONS: This large NTD family has identified two genomic regions that may harbor NTD susceptibility genes. Ascertainment of another branch of family 8776 and additional fine mapping permitted a 9.1 Mb reduction of the NTD candidate interval on chromosome 7 and 37.3 Mb on chromosome 2 from previously published data. Identification of one or more NTD susceptibility genes in this family could provide insight into genes that may affect other NTD families. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Two mthfr polymorphisms, maternal b-vitamin intake, and chds

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 01 May 2008 04:00:00 +0100

BACKGROUND: The methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms are associated with complex congenital malformations. Whether these polymorphisms are associated with CHDs is not clear. We studied both MTHFR polymorphisms, folate and vitamin B2 by maternal food intake and supplements, and CHD risk. METHODS: A case-control family study was conducted in a European population in the Netherlands including 230 case and 251 control children with both parents. Approximately 17 months after the index pregnancy, mothers filled out standardized questionnaires on periconception use of folic acid supplements and a validated food frequency questionnaire on current dietary folate and vitamin B2 intake. All subjects were genotyped for the MTHFR C677T and A1298C polymorphisms. Data were analyzed by logistic regression analysis and ORs and 95% CIs were calculated. For the interaction analysis the dominant model was used. RESULTS: The risk estimates for the MTHFR 677 CT genotypes were 1.4 (0.9-2.0) in mothers, 1.1 (0.8-1.6) in fathers, and 1.2 (0.8-1.7) in children, and for the MTHFR 677 TT genotypes 0.9 (0.6-1.2), 1.4 (1.0-1.9), and 1.0 (0.7-1.3), respectively. The MTHFR 1298 CC genotype in fathers and the MTHFR 1298 AC genotype in children significantly reduced CHD risk, 0.6 (0.5-0.9) and 0.6 (0.4-0.9), respectively. Of interest is the significant interaction (p = .008) towards a nearly twofold increased risk in mothers carrying the MTHFR 1298C allele and using a periconception folic acid supplement. CONCLUSIONS: The MTHFR C677T and A1298C polymorphisms are not strong risk factors for CHDs. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Within prisons, is there an association between the quantity of prenatal care and infant birthweight?

Paediatric and Perinatal Epidemiology — Tue, 29 Apr 2008 19:26:43 +0100

Paediatric and Perinatal Epidemiology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. Summary Howard DL, Strobino D, Sherman S, Crum R. Within prisons, is there an association between the quantity of prenatal care and infant birthweight? Paediatric and Perinatal Epidemiology 2008. There is still controversy surrounding the effectiveness ... (Source: Paediatric and Perinatal Epidemiology)

The impact of past pregnancy experience on subsequent perinatal outcomes

Paediatric and Perinatal Epidemiology — Tue, 29 Apr 2008 18:22:22 +0100

Paediatric and Perinatal Epidemiology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. Summary Hutcheon JA, Platt RW. The impact of past pregnancy experience on subsequent perinatal outcomes. Paediatric and Perinatal Epidemiology 2008. In perinatal epidemiology, the basic unit of analysis has traditionally been the individual pregnancy. In ... (Source: Paediatric and Perinatal Epidemiology)

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Degree of rural isolation and birth outcomes

Paediatric and Perinatal Epidemiology — Tue, 29 Apr 2008 18:21:53 +0100

Paediatric and Perinatal Epidemiology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. Summary Luo Z-C, Wilkins R. Degree of rural isolation and birth outcomes. Paediatric and Perinatal Epidemiology 2008. Little is known about how birth outcomes vary in rural areas by degree of rural isolation. We conducted a retrospective cohort study of ... (Source: Paediatric and Perinatal Epidemiology)

A long-term monitoring of fetal movement at home using a newly developed sensor: an introduction of maternal micro-arousals evoked by fetal movement during maternal sleep.

Early Human Development — Tue, 29 Apr 2008 04:00:00 +0100

A long-term monitoring of fetal movement at home using a newly developed sensor: An introduction of maternal micro-arousals evoked by fetal movement during maternal sleep.

Early Hum Dev. 2008 Apr 29;

Authors: Nishihara K, Horiuchi S, Eto H, Honda M

BACKGROUND: Pregnant women's sleep disturbance due to fetal movement is well known. Fetal movement is thought to be an index of fetal well-being. However, as there has never been a way to easily and reliably record fetal movement, psychophysiological studies of pregnant women's sleep disturbance and fetal well-being have not been done. AIMS: To solve these methodological issues, we developed a new sensor with electrostatic capacity that can pick up acceleration of fetal movement. METHODS AND RESULTS: Experiment I: We verified the reliability of our fetal movement recording system. Thirty-two pregnant women (from 19 to 39 weeks of gestation) were asked to lie down on a bed for about 1 h and to press a button as a subjective marker when they felt fetal movement. We simultaneously recorded maternal polysomnograms and fetal movement from the mothers' abdomens using a Medilog recorder. The mean of prevalence-adjusted bias-adjusted kappa for agreements, based on time between fetal movement signals recorded and subjective maternal markers, was substantial at 0.75. Experiment II: We recorded seven pregnant women's polysomnograms and fetal movement simultaneously during all-night sleep at home using our sensor during weeks 33 and 36 of gestation. We succeeded in recording maternal micro-arousals evoked by fetal movement. The mean value of the number of micro-arousals at 33 weeks was slightly larger than that at 36 weeks. CONCLUSIONS: There was a high agreement between subjective maternal markers and fetal movement. Our recording system using the new sensor can be used for home monitoring of fetal movement.

PMID: 18450390 [PubMed - as supplied by publisher]

(Source: Early Human Development)

Maternal blood pressure in pregnancy and stillbirth: a case-control study of third-trimester stillbirth

American Journal of Perinatology — Mon, 28 Apr 2008 23:01:00 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1075031ABSTRACTAn immense body of literature on the effects of hypertension on perinatal morbidity and mortality exists, but only a handful of studies have reported adverse outcomes associated with low maternal blood pressure during pregnancy. This study aimed to investigate if there is an increased risk of fetal loss associated with hypotension during pregnancy. A matched case-control study of stillbirth and maternal blood pressure was conducted in which maternal blood pressures for a total of 124 pregnancies culminating in stillbirth were compared with maternal blood pressures in 243 (matched) pregnancies resulting in a liveborn infant. Women whose diastolic blood pressures fell in a borderline range (60 to 70 mm Hg) were consistently at greater risk of stillbirth relative to normotensive pregnancies. Women who had three or more mean arterial pressure values ≤ 83 mm Hg during the course of their pregnancy were at nearly twice the risk of stillbirth (odds ratio 1.78; 95% confidence interval [CI] 1.06 to 2.99; = 0.03). Systolic hypotension was not significantly associated with stillbirth, but proportionately more control women were noted to have systolic hypertension (SBP ≥ 130 mmHg) than cases, and the adjusted odds of stillbirth in women who were hypertensive at either their first or last antenatal visit or whose antenatal average SBP was ≥ 130 mm Hg were all very close to 0.4 (95% CI 0.37 to 0.43; = 0.02 to 0.03) relative to normotensives. We concluded that maternal hypotension, particularly borderline hypotension, may be a contributory risk factor for stillbirth. Women with hypertension in pregnancy may now be at a decreased risk of stillbirth as a result of the close care and treatment they receive.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

General movements in infants born from mothers with early-onset hypertensive disorders of pregnancy in relation to one year's neurodevelopmental outcome.

Early Human Development — Mon, 28 Apr 2008 04:00:00 +0100

General movements in infants born from mothers with early-onset hypertensive disorders of pregnancy in relation to one year's neurodevelopmental outcome.

Early Hum Dev. 2008 Apr 28;

Authors: van Schie PE, Rep A, Ganzevoort W, de Groot L, Wolf H, van Wassenaer AG, de Vries JI,

BACKGROUND:: Assessment of general movements (GMs) at three months is considered useful for prediction of adverse neurological outcome in high risk infants. AIMS:: To study the prevalence of abnormal GMs in infants born from women with early-onset hypertensive disorders of pregnancy and the association of GMs with neurodevelopmental outcome at one year. STUDY DESIGN:: Prospective study, part of a randomised controlled trial of pre-birth management strategies. SUBJECTS:: Infants born from women with early-onset hypertensive disorders of pregnancy. OUTCOME MEASURES:: GMs observation and neurological examination at term and three months corrected age; at one year neurological examination and Bayley Scales of Infant Development. RESULTS:: From 216 women included, 175 of 178 surviving infants (mean gestational age 31.6 weeks [SD 2.3], mean birth weight 1346 grams [SD 458]), were examined at three months. At term age normal, mildly abnormal and definitely abnormal GMs were observed in 54%, 36% and 10% respectively; and at three months in 47%, 40% and 13%. Mildly or definitely abnormal GMs at three months were not associated with abnormal neurological examination at one year, however, they were associated with delayed psychomotor development at one year (p=0.01). CONCLUSIONS: In this prospective study, including small for gestational age, preterm infants about half of them did not have normal GMs at term and three months. There was no association of GMs at term nor three months with neurological outcome at one year, but there was a significant association of GMs at three months with one year psychomotor development.

PMID: 18448276 [PubMed - as supplied by publisher]

(Source: Early Human Development)

Morbid adherent placenta: prediction, diagnosis and management

Fetal and Maternal Medicine Review — Sun, 27 Apr 2008 20:31:55 +0100

Research ArticlesJM PALACIOS JARAQUEMADA, CH BRUNO, WA CLAVELLI, Fetal and Maternal Medicine Review, Volume 18 Issue 04 , pp 357-381Abstract (Source: Fetal and Maternal Medicine Review)

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Myometrial activation – coordination, connectivity and contractility

Fetal and Maternal Medicine Review — Sun, 27 Apr 2008 20:31:55 +0100

Research ArticlesDAVID A MACINTYRE, ENG-CHENG CHAN, ROGER SMITH, Fetal and Maternal Medicine Review, Volume 18 Issue 04 , pp 333-356Abstract (Source: Fetal and Maternal Medicine Review)

Mechanical heart valves and pregnancy

Fetal and Maternal Medicine Review — Sun, 27 Apr 2008 20:31:55 +0100

Research ArticlesCYNTHIA MAXWELL, MATHEW SERMER, Fetal and Maternal Medicine Review, Volume 18 Issue 04 , pp 311-331Abstract (Source: Fetal and Maternal Medicine Review)

The ethics of fetocide

Fetal and Maternal Medicine Review — Sun, 27 Apr 2008 20:31:55 +0100

Research ArticlesFRANK A CHERVENAK, LAURENCE B McCULLOUGH, Fetal and Maternal Medicine Review, Volume 18 Issue 04 , pp 289-309Abstract (Source: Fetal and Maternal Medicine Review)

Blood glucose determinations in large for gestational age infants

American Journal of Perinatology — Fri, 25 Apr 2008 11:43:57 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1076602ABSTRACTOur purpose was to identify factors that may contribute to hypoglycemia in large for gestational age (LGA) infants and subsets of infants for whom blood glucose screening would be clinically helpful. LGA infants of 36 to 42 weeks of gestational age using the Denver criteria were identified from the 1999 through 2001 birth log at Marquette General Hospital, Marquette, Michigan, a rural referral hospital, for a retrospective chart review. Infants of mothers with diabetes were excluded. The impact of maternal factors, intrauterine factors, and birthweight on blood glucose levels was assessed using marginal mixed models, Poisson regression, and receiver operating characteristic curves. We found 457 infant records documented blood glucose levels among the 727 infant records analyzed. The lowest blood glucose levels occurred in the first 90 minutes of life. Blood glucose levels were positively associated with weeks of gestation and breastfeeding. Birthweight did not predict hypoglycemia in any of the multivariable models constructed. Symptoms consistent with hypoglycemia occurred only in boys and were negatively associated with gestational age. Models using prenatal and perinatal factors to predict hypoglycemia or symptomatic hypoglycemia had little clinical value. In this large community-based sample of LGA infants, we found no evidence that higher birthweight increases the risk for hypoglycemia. The clinical usefulness of routine blood glucose monitoring in healthy LGA infants is not supported by this retrospective analysis and needs to be established by prospective studies.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

Diagnosing intestinal perforation: a new approach

American Journal of Perinatology — Fri, 25 Apr 2008 11:43:57 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1076606ABSTRACTSpontaneous intestinal perforation has been shown to be a significant morbidity in the extremely low birthweight neonate. Occult spontaneous intestinal perforation (SIP), without pneumoperitoneum on abdominal radiograph, typically occurs in neonates > 2 weeks of age and is usually diagnosed by visualization of particulate matter seen on an abdominal ultrasound. We present a case of a 25-week growth-restricted neonate at 12 days of life who was diagnosed with occult SIP by a novel mechanism.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

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Hemangiomatosis in two sets of premature twins

American Journal of Perinatology — Fri, 25 Apr 2008 11:43:57 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1076604ABSTRACTWe attempted to identify the association of multifocal hemangiomas, specifically hepatic hemangiomatosis, in twins. We retrospectively reviewed our database of infants with hemangiomas, identifying those twins who both had hemangiomas, and we report two cases of twins with hemangiomatosis, including hepatic hemangiomas. Of 39 sets of twins in our Hemangioma Program, both twins had hemangiomas in seven twin sets. Of these seven sets, only the two reported in this article had hemangiomatosis. There were also five sets of triplets, with one set having two siblings affected by hemangiomas. We concluded that although hemangiomas in multiple gestation infants is well known, hemangiomatosis including hepatic hemangiomatosis is unusual.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

Stillbirth at term in women of advanced maternal age in the united states: when could the antenatal testing be initiated?

American Journal of Perinatology — Fri, 25 Apr 2008 11:43:57 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1076605ABSTRACTWe sought to determine if advanced maternal age (AMA) is a risk factor for intrauterine fetal demise (IUFD). We used a U.S. Centers for Disease Control and Prevention database and analyzed outcomes in women 15 to 44 years of age with term singleton gestations. Cox proportional hazards models and Cochran-Mantel-Haenszel tests were used. Results were controlled for maternal race and smoking. After excluding congenital anomalies and medical complications, 6,239,399 singleton term deliveries were identified. When compared with women 25 to 29 years of age, the risk of IUFD increased with advancing age: 30 to 34 years, odds ratio [OR] = 1.24 (95% confidence interval [CI], 1.13 to 1.36); 35 to 39 years, OR = 1.45 (95% CI, 1.21 to 1.74), and 40 to 44 years, OR = 3.04 (95% CI, 1.58 to 5.86). The risk of IUFD for women 40 to 44 years of age at 39 weeks is comparable with that of 42 weeks in those 25 to 29 years of age. We concluded that AMA is an independent predictor of IUFD, and a strategy of antenatal testing in those ≥ 40 years of age beginning at 38 weeks may be considered.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

Enrichment of collagen plugs with platelets and amniotic fluid cells increases cell proliferation in sealed iatrogenic membrane defects in the foetal rabbit model

Prenatal Diagnosis — Fri, 25 Apr 2008 04:00:00 +0100

The purpose of this study was to evaluate cell proliferation in platelet-enriched collagen plugs with and without addition of amniotic fluid-derived heterologous foetal cells to seal an iatrogenic membrane defect in the foetal rabbit model.Amniotic fluid cells were harvested from three donor does at 23 days of gestation (term = 32 days) and labelled with carboxyfluorescein diacetate succinimidyl ester (CFDA-SE). In 42 other does, foetal membrane defects were induced by foetoscopic needle puncture at 23 days of gestation, and closed with either a platelet-enriched collagen plug with (n = 44) or without (n = 32) amniotic fluid cells. At 30 days of gestation, the defects were harvested and assessed microscopically.The plugs enriched with heterologous amniotic fluid cells more commonly had proliferating cells in the centre of the plug than those without cell addition. CFDA-SE labelling confirmed the presence of heterologous amniotic fluid cells over the entire membrane plug. Cell typing showed a mixture of fibroblasts and epithelial cells at the wound edges, whereas in the centre, there was an abundance of fibroblasts.When sealing iatrogenic membrane defects in the foetal rabbit model, enrichment of collagen plugs with platelets and amniotic fluid-derived heterologous foetal cells increases local cell proliferation. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Prenatal Diagnosis)

Biomarkers for detection of prenatal alcohol exposure: a critical review of fatty acid ethyl esters in meconium

Birth Defects Research Part A: Clinical and Molecular Teratology — Fri, 25 Apr 2008 04:00:00 +0100

BACKGROUND: The objective of this study was a review of published studies utilizing measurement of fatty acid ethyl esters (FAEE) in meconium as biomarkers for prenatal alcohol exposure. METHODS: We completed a literature search of PubMed using the terms meconium, fatty acid ethyl esters, biomarkers, and prenatal alcohol exposure. We included only peer reviewed studies utilizing analysis of meconium for the presence of FAEE in humans through the year 2007. RESULTS: We found 10 articles reporting on original research examining the relationship of FAEE from meconium and prenatal alcohol exposure (PAE). The 10 articles used six different PAE assessment strategies and four different analytical techniques for determining FAEE endpoints. The articles included 2,221 subjects (range 4 to 725) with 455 (20.5%) subjects identified as exposed using the methods stated in the articles. FAEE levels above the studies' respective cutoffs were reported for 502 (22.6%) subjects. CONCLUSIONS: The accurate identification of alcohol-exposed pregnancies represents a significant challenge in the development of FAEE detection cutoffs to maximize the sensitivity and specificity of the test. We present several options for the improvement of exposure assessment in future studies of FAEE as biomarkers for PAE. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Metabolic assessment of the brain using proton magnetic resonance spectroscopy in a growth-restricted human fetus: case report

American Journal of Perinatology — Thu, 24 Apr 2008 23:00:56 +0100

Amer J PerinatolDOI: 10.1055/s-2008-1076603ABSTRACTProton magnetic resonance spectroscopy (MRS) is a noninvasive method to assess concentrations of different metabolites in tissues, including the brain. We evaluated a fetus with growth restriction using Doppler ultrasound and proton MRS. Doppler assessment revealed absent end diastolic flow in the umbilical artery. Diastolic flow was increased in the middle cerebral artery. Proton MRS of the fetal brain showed lactate and a low N-acetylaspartate/choline index, metabolic markers of starvation/hypoxia. Proton MRS gave us in vivo metabolic information of the brain of a fetus under starvation/hypoxic conditions. It is potentially a new tool for fetal surveillance. To our knowledge, this is the first report of cerebral lactate detection using proton MRS in a growth-restricted human fetus with no associated malformations in the English literature. Further experimental and clinical longitudinal investigations are needed to evaluate its efficacy in the clinical setting.[...]© Thieme Medical PublishersGet connected:Table of contents | Abstract | Full text (Source: American Journal of Perinatology)

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Serum leptin in first-trimester down syndrome pregnancies

Prenatal Diagnosis — Thu, 24 Apr 2008 04:00:00 +0100

Leptin is a key regulator of satiety; and the serum concentration is considered to reflect nutritional status. Expressed predominantly by the adipocytes, leptin is also expressed in placenta, which is a major source of both leptin and the leptin receptor in pregnancy serum. As a placenta protein, leptin serum concentrations may be perturbed in Down syndrome (DS) pregnancies as seen for pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotrophin-[beta] (hCG[beta]). We examined whether leptin is a maternal serum marker for foetal DS in the first trimester.Serum samples from 44 pregnant women with a DS foetus, and 135 control pregnant women in week 8 to 14 had the leptin concentration determined by immunoassay and the concentrations were converted into multiples of the median (MoM) of controls based on log-regression analysis. The distributions of log10 MoM leptin was compared in DS and control pregnancies.Serum leptin increased significantly with gestational age in controls (p = 0.02). The mean log10 MoM in controls was - 0.0486, with a median empirical MoM of 0.89, and - 0.0618, with a median empirical MoM of 0.80, in DS pregnancies. This difference was not significant. The log10 MoM leptin values in DS pregnancies did not change with gestational age (p = 0.32).Leptin is not a first-trimester marker for foetal DS. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Prenatal Diagnosis)

Clinical, sonographic, and epidemiologic features of second- and early third-trimester spontaneous antepartum uterine rupture: a cohort study

Prenatal Diagnosis — Thu, 24 Apr 2008 04:00:00 +0100

To present prenatal findings and maternal and neonatal outcomes following second- and early third-trimester spontaneous antepartum uterine rupture events in our institute.Charts of patients with full-thickness second- or early third-trimester symptomatic uterine ruptures locally treated between 1984 and 2007 were evaluated.There were seven events involving six women, all requiring emergency laparotomy, and cesarean section (CS). During the study period in our institute, there were 120 636 singleton deliveries ([ge]22 weeks' gestation), including 5 of our cases, while in 2 cases, the rupture occurred earlier ( (Source: Prenatal Diagnosis)

Trisomy 18 presenting with severe limb deformations

Prenatal Diagnosis — Thu, 24 Apr 2008 04:00:00 +0100

No Abstract. (Source: Prenatal Diagnosis)

Polymorphisms in genes related to folate and cobalamin metabolism and the associations with complex birth defects

Prenatal Diagnosis — Thu, 24 Apr 2008 04:00:00 +0100

To investigate the associations between biomarkers and genetic variants involved in homocysteine metabolism and the risk of complex birth defects.Total homocysteine (tHcy), folate, cobalamin, apo-transcobalamin (apo-TC) and apo-haptocorrin (apo-HC) were measured in the amniotic fluid of 82 women who were pregnant with a child having a complex birth defect, such as neural tube defect, cleft lip and/or palate, heart defect or omphalocele, and in 110 women pregnant with a non-malformed child. The determined genotypes of the child comprised of 5, 10-methylenetetrahydrofolate reductase (MTHFR 677C > T, 1298A > C), methionine synthase (MTR 2756A > G), methionine synthase reductase (MTRR 66A > G) and transcobalamin (TCN2 776C > G). Univariate and multivariate logistic regression analyses were performed.Significantly lower cobalamin and higher apo-TC, apo-HC, tHcy and folate concentrations were determined in amniotic fluids of cases compared with controls (p[les]0.001). Logistic regression analysis revealed that after adjustment for maternal age, children carrying the MTHFR 677T allele showed a four-fold increased risk of having a complex birth defect, OR (95% CI) = 4.0 (1.1-15.4). Other genotypes did not show significant associations.The MTHFR 677C > T polymorphism in conjunction with reduced folate- and/or cobalamin status may increase the risk of complex birth defects. Copyright © 2008 John Wiley & Sons, Ltd. (Source: Prenatal Diagnosis)

Book review

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 24 Apr 2008 04:00:00 +0100

No abstract. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

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Oxidative stress during diabetic pregnancy disrupts cardiac neural crest migration and causes outflow tract defects

Birth Defects Research Part A: Clinical and Molecular Teratology — Thu, 24 Apr 2008 04:00:00 +0100

BACKGROUND: Maternal diabetes increases risk for congenital malformations, particularly cardiac outflow tract defects. Maternal diabetes inhibits expression of Pax3 in neuroepithelium through hyperglycemia-induced oxidative stress. The neuroepithelium gives rise to the neural crest, and Pax3 expression in cardiac neural crest (CNC) is required for CNC migration to the heart and for outflow tract septation. Here we tested whether maternal diabetes, through hyperglycemia-induced oxidative stress, before the onset of CNC delamination, impairs CNC migration and cardiac outflow tract septation. METHODS: CNC migration was mapped in mouse embryos whose mothers were diabetic, or transiently hyperglycemic, or in which oxidative stress was transiently induced, using reporters linked to Pax3 expression. CNC apoptosis was examined by TUNEL assay. Outflow tract septation was examined histologically and by gross inspection. RESULTS: Few, if any, migrating CNC cells were observed in embryos of diabetic mice, and this was associated with increased apoptosis along the path of CNC migration. Outflow tract defects were significantly increased in fetuses of diabetic mice. Notably, induction of hyperglycemia or oxidative stress on the day prior to the onset of Pax3 expression and CNC migration also impaired CNC migration, increased apoptosis, and caused outflow tract defects. However, antioxidants administered on the day prior to the onset of Pax3 expression and CNC migration prevented these effects of hyperglycemia or oxidative stress. CONCLUSIONS: In diabetic pregnancy, oxidative stress, which inhibits expression of genes required for CNC viability, causes subsequent CNC depletion by apoptosis during migration, which leads to outflow tract defects. Birth Defects Research (Part A), 2008. © 2008 Wiley-Liss, Inc. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

Placental expression of insulin-like growth factor-i, fibroblast growth factor-basic and neural cell adhesion molecule in pregnancies with small for gestational age fetuses

Journal of Perinatology — Thu, 24 Apr 2008 04:00:00 +0100

Placental expression of insulin-like growth factor-I, fibroblast growth factor-basic and neural cell adhesion molecule in pregnancies with small for gestational age fetuses Journal of Perinatology advance online publication, April 24, 2008. doi:10.1038/jp.2008.27 Authors: S Özkan, B Vural, C Dalçık, A Taş & H Dalçık (Source: Journal of Perinatology)

Comments on inositol supplementation in pregnancies at risk of apparently folate-resistant ntds

Birth Defects Research Part A: Clinical and Molecular Teratology — Tue, 22 Apr 2008 04:00:00 +0100

No abstract. (Source: Birth Defects Research Part A: Clinical and Molecular Teratology)

[postscript] meta-variability of advice on drugs in the breastfeeding mother: the example of {beta}-blockers

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

[postscript] group b streptococcus and preventive strategies in europe

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

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[perinatal lessons from the past] dr leonard colebrook, frs (1883-1967) and the chemotherapeutic conquest of puerperal infection

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

[images in neonatal medicine] kneeling delivery in america 2000 years ago

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

(Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

[reviews] difficult extubation in low birthweight infants

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

Randomised trials have demonstrated that ventilation techniques which support every spontaneous breath are the most efficacious weaning modes. Nasal continuous positive airway pressure after extubation reduces the likelihood of incidents leading to the need for reintubation in very low birthweight infants; further work is needed to determine if there are advantages of particular delivery techniques. Both methylxanthines and dexamethasone facilitate weaning and extubation; the efficacy of low-dose dexamethasone merits further investigation. Assessments of the efficacy of respiratory efforts and hence the balance of respiratory drive, muscle performance and respiratory load appear to best predict weaning and extubation success. Essential to the success of weaning and extubation are dedicated staff, whether this will be assisted by computerised decision-making tools requires testing. The above approaches are not mutually exclusive and those indicated by this review as appropriately evidence based should be considered by practitioners for current use to reduce difficult/unsuccessful extubation. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)

[case reports] transient neonatal diabetes mellitus in extremely preterm infant

Archives of Disease in Childhood - Fetal and Neonatal Edition — Mon, 21 Apr 2008 04:00:00 +0100

A report of transient neonatal diabetes mellitus in an extremely preterm infant (gestational age 27 weeks, birth weight 718 g). The patient had intrauterine growth retardation and developed hyperglycaemia on the first day of life. Insulin administration was discontinued on the 89th day of life, which was 1 day before the original due date. This case suggests that (a) insufficient insulin secretion started at least from the second trimester of the pregnancy; (b) the duration needed for recovery of insulin secretion was not dependent on the maturity. (Source: Archives of Disease in Childhood - Fetal and Neonatal Edition)