Effect of maternal and neonatal interleukin-6 − 174 G/C polymorphism on preterm birth and neonatal morbidity

Objective: The aim of this study was to analyze maternal and neonatal interleukin 6 (IL-6) (?174?G/C) polymorphism and to determine effect on preterm birth and neonatal morbidity.

Study Design: One hundred and sixty-four mothers (100 term births, 64 preterm births) and 183 newborn infants who were 100 healthy term and 83 preterm babies followed in newborn intensive care units were evaluated. PCR-RFLP was performed for IL-6 (?174?G/C) genotyping.

Results: The rate of GG genotype in mothers of term and preterm infants were 54% (n?=?54/100), 75% (n?=?48/64), respectively (p?>?.05) and the rate of GC?+?CC genotype was 46% (n?=?46/100) and 25% (n?=?16/64) in mothers giving term and preterm birth (PTB), respectively (p?n?=?65/100) and 81.9% (n?=?68/83) in term infants and preterm infants, respectively. GC?+?CC genotype was 35% (n?=?35/100) in term infants and 18.1% (n?=?15/83) in preterm infants (p?Conclusion: The IL-6 174?G/C gene polymorphism was significantly different between mothers who were giving to term and preterm birth. The presence of polymorphism is protective against preterm birth and was not associated with neonatal outcome.     

Long-acting reversible contraception in adolescents in Sub-Saharan Africa: evidence from demographic and health surveys

Abstract

Objective: To explore (1) long-acting reversible contraception (LARC) use and (2) future contraceptive preferences in Sub-Saharan African adolescents as undesired pregnancies in Sub-Saharan African adolescents are associated with significant maternal/neonatal morbidity.

Methods: Nationally-representative Demographic and Health Surveys (USAID) obtained informed consent and interviewed 45,054 adolescents, including 19,561 (43.4% of total) sexually active adolescents (aged 15–19) from 18 least developed Sub-Saharan African nations regarding contraception (years 2005–2011, response rate 89.8–99.1% for all women interviewed). Frequencies and percentages of contraceptive use, prior pregnancies, and unwanted births were reported. Categorical variables were analyzed through χ² and unadjusted and binary logistic regression, adjusted for confounders, evaluated LARC use.

Results: A majority of sexually active adolescents were not using contraception (n?=?16,165 non-users; 82.6% of all sexually active adolescents). Many (n?=?8465, 43.3% of sexually active adolescents) interviewed already had at least one child, with 31.5% (n?=?2646) of those with previous children reporting the pregnancy was not wanted at the time it occurred. Sexually active adolescents using contraception (n?=?3384) used LARCs (injectable contraception, implants, or intrauterine devices; 29.8%, n?=?1007) barrier contraceptives (31.9%), oral contraceptives (10.9%), and other methods (27.4%). Adolescents using LARCs were more likely to be urban [OR 1.76 (95% CI 1.39–2.22)], to have been visited by a family planning worker in the last 12 months [OR1.62 (95% CI 1.24–2.11)], and to have visited a health facility in the past 12 months [OR1.84 (95% CI 1.53–2.21)]. Injectable contraception was the most preferred (39.9%, n?=?3036) future method by sexually-active non-contracepting adolescents who were asked about future methods (n?=?7605) compared to other methods. An unfortunate percentage of adolescents surveyed cannot read (35.7%, n?=?16,084).

Conclusion: A majority of sexually-active adolescents in Sub-Saharan Africa are not using contraception and are desirous of doing so. Offering LARCs during post-abortive or postpartum care with particular focus on rural adolescents may reduce undesired pregnancy and subsequent morbidity/mortality. Educational materials should limit printed information as many teens are unable to read.     

Congenital malformations in infants conceived following assisted reproductive technology in comparison with spontaneously conceived infants

Abstract

Objective: To evaluate the risk for congenital malformations diagnosed at birth following assisted reproductive technology (ART) treatments compared with live births conceived spontaneously.

Methods: A retrospective cohort study including 9042 live births following ART and 213?288 spontaneously conceived (SC) live births during the period 1997–2004.The cohort was linked to the national live birth registry to determine the outcome of the pregnancies including congenital malformations.

Results: An increased adjusted risk for all congenital malformations was observed in ART compared with SC infants [2.4% versus 1.9%; OR_adj?=?1.45; 95% CI: 1.26, 1.68]. The increased risk was observed in singleton births [2.4% versus 1.8%; OR_adj?=?1.41; 95% CI: 1.14, 1.71] but not in the ART conceived multiple births [2.5% versus 2.6%.; OR_adj?=?1.15; 95% CI: 0.90, 1.46]. Significantly increased adjusted risks for nervous, circulatory, digestive and genital system malformations were evident in the ART singleton group compared to SC infants. In addition, increased risks were also observed in separate comparisons of IVF births versus SC [OR_adj?=?1.28; 95% CI: 1.00, 1.63] and ICSI births versus SC [OR_adj?=?1.56; 95% CI: 1.31, 1.84]. Data regarding pregnancy termination or congenital malformation diagnosed later in life were not included.

Conclusion: Infants born following ART were at significantly increased risk for congenital malformations compared to live birth conceived spontaneously.     

Short-term outcomes comparison between preterm infants with and without acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia after prolonged preterm premature rupture of membranes before 25 gestational weeks

Objective: To determine the updated outcomes of preterm infants with acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia (PH) following maternal midtrimester prolonged preterm premature rupture of membranes (PPROM).

Study design: Among preterm infants with birthweight <1500?g and 23–34 weeks gestational age in a single center, infants exposed to maternal prolonged (≥7 days) PPROM before 25 gestational weeks (PPPROM25, n?=?76) were retrospectively reviewed. They were 1:1 matched with infants of matched control group (n?=?76) who were unexposed to or exposed to maternal PPROM within 24?hours of delivery by year, gestational age, and weight at birth, sex, and antenatal steroid exposure. The PPPROM25 group was subdivided into infants with and without acute hypoxic respiratory failure attributable to PH (with PH, n?=?20, without PH, n?=?56, respectively). Clinical characteristics and major outcomes were compared. Risk factors for mortality and morbidity were analyzed using a multivariate logistic regression in the PPPROM25 group.

Results: The PH incidence rates were 1.3 and 26.3% and in the matched control and PPPROM25 group, respectively (p?p?>?.05); 87.5 in the PPPROM25 group without PH and 65.0% in group with PH, respectively (p?Conclusions: Despite the improved outcomes in the infants with maternal prolonged PPROM before 25 gestational weeks, presumed PH is still a significant risk factor for their mortality and morbidity.     

A prospective study of the severity of early respiratory distress in late preterms compared to term infants

Objective: To compare the severity of early respiratory distress in late preterm (LPT) versus term infants.

Methods: A prospective cohort study was conducted in a tertiary care neonatal unit in Thailand. Levels of respiratory support, duration of intubation, and short term morbidities were compared between LPT and term infants.

Results: Two-hundred nineteen LPT and 564 term infants were included over a period of 2 years (2009–2011). 106 (48.4%) LPTs versus 58 (10.3%) term infants received non-invasive ventilation or intubation [p?<?0.001; OR (95% CI) 8.2 (5.6, 12.0)]. The intubation rate was 24.7% in LPTs versus 7.3% in term infants [p?<?0.001; OR (95% CI) 4.18 (2.7, 6.5)]. The duration of intubation was longer in LPT infants (median 5.0 versus 2.0 days. p?=?0.03). There was a non-significant trend towards a higher mortality rate in the LPT group [p?=?0.14; OR (95% CI) 3.9 (0.7, 23.5)].

Conclusions: This is one of three published prospective studies on the topic. The study design lends more robust credence to the results previously identified only in retrospective and systematic reviews. LPT infants are more likely to require positive-pressure ventilation support and incur a longer duration of intubation. A trend towards greater mortality is prevalent compared to term infants.     

Outcomes of tracheostomy in the neonatal intensive care unit: is there an optimal time?

Abstract

Objective: To compare short-term outcomes of infants who underwent early versus late tracheostomy during their initial hospitalization after birth and determine the association, if any, between tracheostomy timing and outcomes.

Study design: Retrospective chart review of infants who underwent a tracheostomy during their initial hospitalization at a single site.

Results: The median (range) gestational age of our cohort (n?=?127) was 28 (23–42) weeks and birth weight was 988 (390–4030) g. Tracheostomy indications included airway lesions (47%), bronchopulmonary dysplasia (25%), both (22%) and others (6%). Median postmenstrual age (PMA) at tracheostomy was 45 (35–75) weeks. Death occurred in 27 (21%) infants and 65 (51%) infants were mechanically ventilated. G-tube was present at discharge in 42 (33%) infants. Infants who underwent early tracheostomy (<45 weeks PMA) (n?=?66) had significantly lower gestational ages, weights and respiratory support than the late (≥45 weeks PMA) (n?=?61) group. Death (29.5% versus 14%), home ventilation (41% versus 21%) and G tube (44% versus 14%) were significantly more frequent in the late tracheostomy group. On bivariate regression, outcomes were not independently associated with tracheostomy timing, after adjustment for gestational age and respiratory support.

Conclusions: Of infants who underwent tracheostomy during the initial hospitalization after birth, 21% died. On adjusted analysis, tracheostomy timing was not independently associated with outcomes.     

Echocardiography may cause significant pain response in preterm infants

Objective: The objective of this study is to evaluate if echocardiographic examination causes any pain response in term and preterm infants.

Methods: Term and preterm neonates who admitted to Neonatal Intensive Care Unit at Gazi University Hospital and Etlik Zubeyde Hanim Training and Research Hospital and were performed echocardiography for any reason were included into the study. Neonates were evaluated before, during and 10?minutes after the examination. Vital signs (heart rate, respiratory rate, blood pressure, transcutaneous oxygen saturation) were recorded. All subjects were also evaluated with Neonatal Infant Pain Scale during the examination.

Results: In this study, we evaluated 99 newborn infants. Five infants who received fentanyl treatment were excluded. The heart rate (p?=?0.000), respiratory rate (p?=?0.000), diastolic blood pressure (p?=?0.001) and oxygen saturation (p?=?0.000) during the examination were significantly different than the values before and 10?minutes after the examination. Infants whose gestational age ≤32 weeks (n:20) have significantly higher NIPS scores (mean?±?SEM?=?3.3?±?0.4) than the infants whose gestational age is greater than 32 weeks (n:71) (mean?±?SEM?=?2.4?±?0.2).

Conclusions: Echocardiographic examination which is known as noninvasive and painless causes significant pain in preterm infants.     

Differential expression of cord blood neurotrophins in gestational diabetes: the impact of fetal growth abnormalities

Objective: Gestational diabetes mellitus (GDM) may induce fetal macrosomia or growth restriction and is associated with later offspring neurodevelopmental disorders. We aimed to determine whether neurotrophins brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and neurotrophin-4 (NT-4) are differentially expressed in cord blood samples at birth in large-for-gestational-age (LGA), intrauterine-growth-restricted (IUGR) and appropriate-for-gestational-age (AGA) offspring of diabetic mothers, as compared to AGA controls from non-diabetic mothers.

Methods: BDNF, NGF and NT-4 concentrations were prospectively determined in 80?cord blood samples from LGA (n?=?15), IUGR (n?=?12) and AGA (n?=?33) diabetic, as well as from AGA normal (controls, n?=?20) singleton full-term pregnancies.

Results: Fetal BDNF concentrations considerably decreased in GDM, as compared with normal pregnancies [(b?=??2.836, 95%CI ?5.067 to (?0.604), p?=?0.013)] and were higher in females (b?=?2.298, 95%CI 0.357–4.238, p?=?0.021). Cord blood NGF concentrations were lower in IUGR than AGA infants (p?=?0.038).

Conclusions: BDNF is down-regulated in the fetus exposed to GDM, independently of the fetal growth pattern, probably representing a candidate mechanism underlying the association between maternal diabetes and later psychopathology. IUGR fetuses born to diabetic mothers present with NGF deficiency, which may contribute to their long-term neurodevelopmental sequelae. Gender-dependent differences in fetal BDNF may partly explain the higher prevalence of adverse neurodevelopmental outcomes following brain insults in male infants.     

Comparison of three non-invasive ventilation strategies (NSIPPV/BiPAP/NCPAP) for RDS in VLBW infants

Background: Non-invasive ventilation (NIV) significantly changed the management of respiratory distress syndrome (RDS) in preterm infants. Further perspectives for neonatologists regard the assessment of different NIV strategies in terms of availability, effectiveness, and failure.

Objective: The aim of the present study is to evaluate the effectiveness of three different NIV strategies: nasal continuous positive airway pressure (N-CPAP), nasal synchronized intermittent positive pressure ventilation (N-SIPPV), and nasal bilevel-CPAP (BiPAP), as first intention treatment for RDS in very low birth-weight infants (VLBW).

Methods: A multicenter retrospective study was conducted in three neonatal intensive care unit (NICUs) that enrolled 191 VLBW infants complicated by RDS, who received, as first intention treatment for RDS, three different NIV approaches (N-CPAP: n?=?66; N-SIPPV: n?=?62, BiPAP: n?=?63). We evaluated the performance of different NIV strategies by primary (failure within the first 5 d of life) and some selected secondary end-points.

Results: The incidence of NIV failure was significantly higher in the N-CPAP group (22/66) versus N-SIPPV/BiPAP groups (11/62; 11/63) (p?Conclusions: The present study shows that first intention N-SIPPV/BiPAP, as NIV support, augment the beneficial effects of N-CPAP contributing to a reduced risk of failure in VLBW infants complicated by RDS. Data open up to further RCTs on a wider population to evaluate NIV effectiveness on long-term outcomes.     

To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women

Objective: To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women.

Methods: We conducted this prospective cross-sectional study on 365 singleton adolescent pregnancies (aged between 16 and 20 years) at a Maternity Hospital, between December 2014 and March 2015. We divided participants into two groups based on pre-pregnancy body mass index (BMI): overweight and obese adolescent (BMI at or above 25.0?kg/m) and normal weight (BMI between 18.5 and 24.99?kg/m) adolescent. We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI.

Results: The prevalence of maternal overweight/obesity and normal weight was 34.6% (n?=?80) and 65.4% (n?=?261) in the study population, respectively. Compared with normal-weight teens (n?=?234), overweight/obese teens (n?=?71) were at higher risk for cesarean delivery (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.4–1.4), preeclampsia (adjusted odds ratio [OR] 0.1, 95% confidence interval [CI] 0.02–0.9) and small of gestational age (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1–0.9).

Conclusion: BMI increased during pre-pregnancy could be an important preventable risk factor for poor obstetric complications in adolescent pregnancies, and for these patients prevention strategies (e.g., nutritional counseling, weight-loss, regular physical activity) for obesity are recommended before getting pregnant.     

Risk of neonatal and childhood morbidity among preterm infants exposed to marijuana

Background: Limited data exist regarding the neonatal and neurodevelopmental outcomes of infants exposed to marijuana (MJ) in-utero, particularly among preterm infants. We hypothesized that MJ-exposed preterm infants would have worse neonatal and childhood developmental outcomes compared to MJ-unexposed infants.

Methods: Secondary analysis of multicenter randomized-controlled trial of antenatal magnesium sulfate for the prevention of cerebral palsy was conducted. Singleton nonanomalous infants delivered?<35 weeks exposed to MJ in-utero were compared to MJ-unexposed. Primary neonatal outcome was death, grade 3/4 intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or stage II/III necrotizing enterocolitis before discharge. Primary childhood outcome was death, moderate/severe cerebral palsy, or/and Bayley II Scales?<70 at age 2. Backward-stepwise regression used to estimate odds of primary outcomes.

Results: 1867 infants met inclusion criteria; 135(7.2%) were MJ-exposed. There were no differences in neonatal (20% vs. 26%, p?=?0.14) or childhood (26% vs. 21%, p?=?0.21) outcomes in MJ-exposed infants compared to MJ-unexposed infants. In adjusted models, MJ-exposure was not associated with adverse neonatal outcomes (aOR 0.83 95% CI 0.47,1.44) or early childhood outcomes (aOR 1.47, 95% CI 0.97,2.23).

Conclusions: Among infants born?<35 weeks of gestation, MJ-exposure was not associated with adverse neonatal or childhood outcomes. Long-term follow-up studies are needed to assess later childhood neurodevelopmental outcomes following MJ-exposure.     

High frequency jet ventilation in preterm infants: experience from Western Australia

Objective: To assess if high frequency jet ventilation (HFJV) is associated with reduced odds of death or discharge home on oxygen in preterm infants.

Methods: A case control study (1 February 2010 – 1 June 2014) comparing the primary outcome as “death or discharge home on oxygen” in preterm infants who needed HFJV (Cases) versus those who did not (Controls). Controls were matched to cases (1:1) on gestation, birthweight, gender, place of birth, growth status, antenatal glucocorticoids, and dexamethasone as treatment for severe bronchopulmonary dysplasia (BPD). Logistic regression analysis was used to control for confounders.

Results: Data on all preterm infants who needed HFJV (Cases: n?=?50) and 50 controls during the study period were analysed. Primary outcome was more frequent in cases versus controls, but not significant after adjusting for mean airway pressure and adjuvant therapy (e.g. diuretics) [aOR: 1.46 (0.23–9.14), p?=?.687]. Death before discharge [odds ratios (OR): 6.00 (1.34–55.2), p?=?.013] was more frequent in cases; discharge on home oxygen [OR: 0.88 (0.27–2.76), p?=?1.000] was comparable between groups. Duration of oxygen [adjusted hazard ratios (aHR): 1.23 (0.69–2.17), p?=?.475] and incidence of treatment warranting retinopathy of prematurity [aOR: 0.10 (0.01–1.96), p?=?.127] was not significant between cases versus controls.

Conclusions: HFJV was not associated with reduced odds of death or discharge home on oxygen in preterm infants in our study. Adequately powered randomized trials are required to assess the efficacy and safety of HFJV in preterm infants.     

The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care

Purpose: The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC).

Material and methods: This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n?=?283) and post-intervention (n?=?257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider).

Results: Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02–2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05–2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77–1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81–1.92)].

Conclusions: Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.     

Activity restriction and risk of preterm delivery*

Purpose: We sought to determine whether activity restriction (AR) in a cohort of women at high risk for preterm delivery is associated with the risk of preterm delivery.

Materials and methods: This is a secondary analysis of the Maternal-Fetal Medicine Units MFMU’s Preterm Prediction Study; a multicenter prospective cohort study designed to identify risk factors of preterm birth (PTB). The study group consisted of women with a singleton gestation that at their first study visit (23–24 weeks) had at least one of the following criteria: patient reported contractions, severe back pain, a cervical length <15?mm, spotting, protruding membranes, or positive fetal fibronectin. Women were assessed for AR at a 27- to 29-week study visit. Associations between AR and preterm delivery (<37 weeks) were examined through logistic regression models before and after adjustment for confounders.

Results: Of the 1086 women that met the inclusion criteria, 16.5% (n?=?179) delivered preterm. In this cohort, 9.7% (n?=?105) of women were recommended AR, with 37.1% (n?=?39) having a PTB. In the group not recommended AR (n?=?981), 14.3% (n?=?140) delivered preterm.

Conclusion: In this cohort of women at high risk for PTB, activity restriction was associated with an increased risk of PTB. The use of AR in this population should be discouraged.     

Prenatal diagnosis of chromosomal polymorphisms: most commonly observed polymorphism on Chromosome 9 have associations with low PAPP-A values*

Introduction: To identify the prevalence and types of fetal chromosomal polymorphisms in pregnant women and to examine possible associations with screening test parameters.

Materials and methods: Fetal chromosomal polymorphism rate was investigated in pregnant women who had been implemented for invasive prenatal test in a tertiary reference center in Thrace Region of Turkey. Fetal chromosomal polymorphisms were determined and their effects on screening tests’ parameters were investigated. Possible differences in the first and second-trimester screening test parameters between women; with fetal chromosomal polymorphism who had screening test results (Group 1) and those with a normal karyotype (Group 2) were evaluated.

Results: Fetal chromosomal polymorphism prevalence was 5.3% (n?=?101). The most common polymorphisms were identified on chromosome 9, 1, and 16 [54.5% (n?=?55); 8.9% (n?=?9), and 6.9% (n?=?7), respectively]. The most common polymorphic variant was 9qh+ (n?=?23; 22.8%). Among the screening test parameters, significantly lower pregnancy-associated plasma protein-A (PAPP-A) (p?=?.028) and higher unconjugated estriol (uE3) (p?=?.019) values were found in Group 1. In patients having fetuses with polymorphic variants on chromosome 9, a significantly lower PAPP-A values were observed compared to women with other fetal polymorphic variants (p?=?.048) or women having fetuses with normal karyotype (p?=?.007).

Conclusions: Lower PAPP-A and higher uE3 levels were observed in women having fetuses with chromosomal polymorphisms, which might affect screening test results. Lower PAPP-A levels were apparent in women having fetuses with polymorphism on chromosome 9.     

Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter-associated infections in neonates

Objective: To compare clinical outcomes and hospital resource utilization of infants who had peripherally inserted central catheters removed early versus retained following diagnosis of central line-associated bloodstream infection.

Study Design: In a single centre retrospective cohort study, we compared outcomes of infants who had peripherally inserted central catheters removed early versus retained after diagnosis of central line-associated bloodstream infection. Mortality, cardio-respiratory deterioration, use of blood products and antibiotics were compared between groups.

Results: Over a 10-year period, of the 119 eligible infants, 38 had peripherally inserted central catheters removed early and 81 had catheters retained after diagnosis of central line-associated bloodstream infection. Baseline demographics, illness severity at onset of sepsis and distribution of organisms were similar between the groups. Infants in “catheter–retained” group required longer antibiotic usage (17?±?9 versus 13?±?6 days; p?=?0.025) and more frequent sequential positive blood cultures [31/81 (47%) versus 8/38 (22%), p?=?0.014). Infants with Gram-negative bacteremia demonstrated higher mortality when catheters were retained [43% (9/21) versus 7% (1/14); p?=?0.028].

Conclusions: Retaining peripherally inserted central catheters after diagnosis of central line-associated bloodstream infection was associated with longer duration of bacteremia and prolonged exposure to systemic antibiotics as well as increased mortality in Gram-negative bacteremia.     

Fetal proximal humeral epiphysis as an indicator of term gestation in different ethnic groups*

Objectives: Accurate pregnancy dating is critical for appropriate clinical management. Our aim was to determine the time of appearance of proximal humeral epiphysis (PHE), consistency of its appearance among ethnic groups and whether 3D imaging helps with its visualization.

Methods: A cross-sectional study was done on 360 patients with 563 scans in different ethnic groups between August 2013 and July 2015. Inclusion criteria were singleton pregnancies (34–40+ weeks of gestation), well dated by <20 weeks sonogram.

Results: PHE was not seen at 34 (n?=?44) or 35 weeks (n?=?36) and was present at gestational ages 36 (n?=?3), 37 (n?=?126), 38 (n?=?96), 39 (n?=?100) and 40 weeks (n?=?28) in 2%, 12%, 51%, 75% and 100%, respectively. PHE was seen in 20 of 50 (60%) African–Americans, 22 of 61 (64%) south Asians, 41 of 72 (57%) Caucasians, 45 of 86 (48%) Hispanics and 41 of 80 (49%) Asians.

Conclusion: Appearance of PHE did increase with gestational age, prior to 40 weeks, it was not uniformly present and was seen as early as 36 weeks independent of ethnic group.     

Very low birth weight preterm infants are at risk for hypoglycemia once on total enteral nutrition

Abstract

Objective: To determine the occurrence of hypoglycemic episodes in very low birth weight preterm infants under total enteral nutrition and identify potential risk factors.

Methods: In this single centre cohort study, we analyzed the patients’ charts of preterm infants with a gestational age <32 weeks (n?=?98). Infants were analyzed in two groups (group 1: birth weight <1000?g, n?=?54; group 2: birth weight 1000–1499?g, n?=?44). A total of 3640 pre-feeding blood glucose measurements were screened. Risk factors for the development of hypoglycemia were identified by linear and multiple logistic regression analyses.

Results: In group 1, 44% (24 of 54) of infants experienced at least one asymptomatic episode of blood glucose <45?mg/dl (<2.5?mmol/l) as compared with 23% (10 of 44) in group 2. Regression analysis identified low gestational age and high carbohydrate intake as potential risk factors for the development of hypoglycemia.

Conclusions: Our results indicate that numerous preterm infants experience hypoglycemic episodes once on total enteral nutrition, especially those who are <1000?g at birth and those with a higher carbohydrate intake. Further studies evaluating a possible impact of these common although asymptomatic episodes on later development could help to better define thresholds that should be considered as “hypoglycemia” in this population.     

Morbidities associated with patent ductus arteriosus in preterm infants. Nationwide cohort study

Purpose: To evaluate the predictive factors for the development of haemodynamically significant patent ductus arteriosus (PDA) in preterm infants and to study the morbidities associated with the treatment of PDA during the first hospitalization.

Materials and methods: Data were collected from the Finnish national register of preterm infants (<32 gestational weeks) born in 2005–2013. In total, 3668 infants were included. Morbidities during the first hospitalization were analysed and compared between infants who received treatments for the closure of PDA (n?=?1132) and infants who received no treatment for PDA (n?=?2536). The results were adjusted for the duration of pregnancy, intrauterine growth pattern, antenatal steroids, delivery hospital and respiratory distress syndrome (RDS).

Results: RDS and mechanical ventilation were independently associated with an increased risk of PDA requiring treatment. Medical and surgical treatments were associated with the risk of severe bronchopulmonary dysplasia (BPD). Primary surgical ligation was associated with an increased risk of severe intraventricular haemorrhage (IVH) and necrotizing enterocolitis (NEC). Medical treatment itself and also followed by surgical ligation was associated with lower mortality.

Conclusion: The severity of lung disease rather than prematurity per se was associated with the development of PDA requiring therapy. Both medical and surgical therapies for PDA were associated with severe BPD, and primary surgical ligation was associated with NEC and severe IVH.