Perinatology

INTRODUCTION: Knowledge about the time of birth and its impact on premature infants is essential when planning perinatal and neonatal care and resource allocation. We studied the time of birth and its contribution to early death and morbidity in preterm infants. METHODS: We explored the time and mode of birth of infants with birthweight of <1,500 g and gestational age of <32+0/7 weeks. Additionally, we divided the infants into three groups stratified by their time of birth, i...

There is confusion regarding the dynamics of the umbilical cord circulation and the concomitant placental transfusion. How long does it continue, and at what rate? These questions remain an enigma for many. In this article we will address some common misconceptions about the management of cord circulation, try to explain why there is a lack of clarity, and call in to question the conclusions from an influential meta-analysis and a recently published guideline on cord clamping. We will do that partly by reviewing the rather extensive literature published on the subject over the past 50 to 70 years, which is easily forgotten, but worth considering...

INTRODUCTION: Magnesium sulphate (MgSO4 ) therapy has shown to be useful as a neurological protector in the preterm newborn below 32 weeks of gestation. The most documented adverse effect is cardiorespiratory failure, whereas its relationship with meconium obstruction is controversial. The main objective of this study was to analyse the possible association between prenatal MgSO4 therapy and meconium obstruction. PATIENTS AND METHODS: An analytical retrospective study was conducted on < 32 weeks preterm babies admitted to a tertiary-level hospital (January 2016-December 2017)...

BACKGROUND: Intrauterine infection and/or inflammation (Triple I) is an important cause of preterm birth (PTB) and adverse newborn outcomes. N-acetylcysteine (NAC) is a Food and Drug Administration (FDA)-approved drug safely administered to pregnant women with acetaminophen toxicity. METHODS: We conducted a single-center, quadruple-blind, placebo-controlled trial of pregnant women with impending PTB due to confirmed Triple I. Participants (n = 67) were randomized to an intravenous infusion of NAC or placebo mimicking the FDA-approved regimen...

Background: Variability in clinical practice may influence morbidity and mortality in extremely preterm infants. We aimed to know if there are differences in survival and survival without bronchopulmonary dysplasia (BPD) in extremely preterm infants in Spanish tertiary hospitals and the potential associated factors. Methods: Fifteen hospitals from the SEN1500 network were studied. The overall rate of survival without BPD was 61.4%. Hospitals with extreme results were grouped for comparison (Group 1; N  = 2480 versus Group 2; N  = 2367)...

It is inherent to human logic that both doctors and patients want to suppress uterine contractions when a woman presents in threatened preterm labor. Tocolysis is widely applied in women with threatened preterm labor with a variety of drugs. According to literature, tocolysis is indicated to enable transfer to a tertiary center as well as to ensure the administration of corticosteroids for fetal maturation. There is international discrepancy in the content and the implementation of guidelines on preterm labor...

BACKGROUND: The probabilities of survival and survival without major brain damage (MBD) are low in newborns at the limit of viability. Survival without MBD constitutes a major concern for parents and professionals. OBJECTIVES: To know the probabilities of survival without MBD in newborns ≤26 weeks' gestational age (GA) relative to the total number of survivors, whether these probabilities vary with GA, and how end-of-life (EoL) decisions influence these results...

The global burden of preterm birth (PTB) includes the morbidity and mortality of babies born before 37 completed weeks of gestation. Prematurity has been the leading worldwide cause of neonatal mortality for at least a decade, but has now also become the leading cause of childhood mortality through age five years. Globally, each year, 15 million babies are born preterm, which is estimated to be about 11% of all deliveries. Preterm birth appears to be increasing in most countries. This review will address the epidemiology, rates, and etiology of PTB around the globe as well as survival by gestational age and interventions and preventative measures known to improve outcomes in high-burden countries...

After decades of rising preterm birth rates in the USA and other countries, recent prematurity rates seem to be on the decline. Despite this optimistic trend, preterm birth rates remain higher in the USA, where nearly one in every eight infants is born early, compared to other developed countries. The prevention of preterm birth is considered a public health priority because of the potential to reduce infant and childhood morbidity and mortality related to this condition. Unfortunately, progress has been modest...

The use of non-steroidal anti-inflammatory drugs like diclofenac in the third trimester of pregnancy can cause severe side effects, in particular oligohydramnios, premature closure of ductus arteriosus, and fetal kidney damage. However, the treatment with non-steroidal anti-inflammatory drugs until gestational week 28 is accepted as relatively safe. Here we describe two retrospectively reported cases of early-onset oligohydramnios associated with long-term diclofenac exposure of at least 150mg per day. The pathological findings were detected at gestational weeks 22 and 23, respectively...

OBJECTIVE: The purpose of this study was to provide an updated summary of the literature regarding the effects of tocolysis with indomethacin on neonatal outcome by systematically reviewing previously and recently reported data. STUDY DESIGN: All previously reported studies pertaining to indomethacin tocolysis and neonatal outcomes along with recently reported data were identified with the use of electronic databases that had been supplemented with references that were cited in original studies and review articles...

AIM: Fetoplacental Doppler abnormalities have been associated with increased neonatal mortality and morbidity. This study evaluated the associations between prenatal Doppler assessments and neonatal mortality and morbidity in premature infants born small for gestational age or after pre-eclampsia. METHODS: This was a population-based study of infants born alive at 22(0) -33(6) weeks of gestation, a birthweight <10th percentile for gestational age and/or maternal pre-eclampsia...

OBJECTIVE: Magnesium sulfate (MgSO4) administered to women at risk for preterm delivery decreases the risk of cerebral palsy in their children. However, the neuroprotective effect of MgSO4 has not been shown in twin gestations. Thus, the aim of this study was to determine the maternal serum levels of magnesium in twin vs. singleton pregnancies following intravenous treatment of MgSO4. METHODS: Case control study including two groups of pregnant women who received intravenous MgSO4: (1) twin gestations (n=83) and (2) singleton pregnancies (n=83)...

INTRODUCTION: The objective of this study was to prove that the chronic use of indomethacin as a tocolytic agent does not affect neonatal outcomes. METHODS: This is a retrospective cohort study of obstetrical patients from All Children's Perinatology Group diagnosed with preterm labor, cervical insufficiency, or both and exposed to prolonged indomethacin therapy (more than 48 hours). Patients were given a loading dose of 50 mg every 6 hours for 48 hours followed by a maintenance dose of 50 mg twice a day...