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Postnatal outcomes in extreme prematurity

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7 papers 500 to 1000 followers
By Chad Klauser Maternal Fetal Medicine physician in NYC
Hamisu M Salihu, Abraham A Salinas-Miranda, Latoya Hill, Kristen Chandler
The objective of this paper is to review observational studies that addressed the survival of pre-viable gestations in the United States. We searched PubMed, Ovid, CINAHL, and Web of Knowledge for studies reporting survival of infants born at <24 gestational weeks and/or <500g in the United States and published between January 2003 and January 2013. The full texts of 70 articles were examined and a total of 15 studies qualified and were selected. We analyzed fixed-effect and random-effects models for eight studies on survival to discharge...
December 2013: Seminars in Perinatology
Gary D V Hankins, Luis D Pacheco, Tony Soo-Tung Wen
Assessments of gestational age are critical in dealing with the pregnancy at the limits of viability, 22-25-weeks gestation, where neonatal outcomes reveal very significant differences from week to week. The obstetrical team can estimate gestational age within a window of 7-10 days during this critical threshold at the window of viability via determination of last menstrual period, bimanual exam, early pregnancy test, and/or ultrasound. One must also take into account the impact of maternal disease processes, congenital abnormalities, number of fetus(es), and/or fetal growth restriction, along with ongoing evaluation and parental involvement in this decision-making process during the peri-viability period...
December 2013: Seminars in Perinatology
Alexandros A Moraitis, Angela M Wood, Michael Fleming, Gordon C S Smith
OBJECTIVE: To estimate the association between birth weight percentile and the risk of perinatal death at term in relation to the cause of death. METHODS: We performed a retrospective cohort study of all term singleton births in delivery units in Scotland between 1992 and 2008 (n=784,576), excluding perinatal deaths ascribed to congenital anomaly. RESULTS: There were 1,700 perinatal deaths in the cohort, which were not the result of congenital anomaly (21...
August 2014: Obstetrics and Gynecology
Allan Colver, Charles Fairhurst, Peter O D Pharoah
The syndrome of cerebral palsy encompasses a large group of childhood movement and posture disorders. Severity, patterns of motor involvement, and associated impairments such as those of communication, intellectual ability, and epilepsy vary widely. Overall prevalence has remained stable in the past 40 years at 2-3ยท5 cases per 1000 livebirths, despite changes in antenatal and perinatal care. The few studies available from developing countries suggest prevalence of comparable magnitude. Cerebral palsy is a lifelong disorder; approaches to intervention, whether at an individual or environmental level, should recognise that quality of life and social participation throughout life are what individuals with cerebral palsy seek, not improved physical function for its own sake...
April 5, 2014: Lancet
Tonse N K Raju, Brian M Mercer, David J Burchfield, Gerald F Joseph
This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) and the treatment options for the newborn infant. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support)...
May 2014: American Journal of Obstetrics and Gynecology
Tracy A Manuck, Xiaoming Sheng, Bradley A Yoder, Michael W Varner
OBJECTIVE: Neonatal diagnoses are often used as surrogate endpoints for longer-term outcomes. We sought to characterize the correlation between neonatal diagnoses and early childhood neurodevelopment. STUDY DESIGN: We conducted secondary analysis of a multicenter randomized controlled trial of antenatal magnesium sulfate vs placebo administered to women at imminent risk for delivery <32.0 weeks to prevent death and cerebral palsy in their offspring. Singletons and twins delivering 23...
May 2014: American Journal of Obstetrics and Gynecology
Gehan Roberts, Jeanie L Y Cheong
Given the improving survival rates of extremely preterm (EP, gestational age <28 weeks) infants, there is a need to understand their general growth and health outcomes not only in childhood, but also into adulthood. EP children are shorter and lighter compared with term children at term-equivalent age; with time, the weight disadvantage diminishes but the height disadvantage remains relatively unchanged. EP children and young adults also have higher rates of reported health concerns, medical conditions and visual impairment...
April 2014: Seminars in Fetal & Neonatal Medicine
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