Outcomes of extremely-low-birth-weight infants between 1982 and 1988

Infants with birth weights under 750 g are disproportionately represented in perinatal mortality and morbidity rates. We reviewed the outcomes of 98 infants delivered at our perinatal center between July 1982 and June 1985 (period 1) whose lengths of gestation were 20 or more weeks and whose birth weights were under 750 g, and compared them with the outcomes of 129 such infants born between July 1985 and June 1988 (period 2). The frequency of cesarean section increased from 12 to 19 percent between the two periods. During the entire six-year period, 12 percent of the infants with birth weights under 500 g were intubated, as compared with 28 percent of those between 500 and 599 g, 60 percent of those between 600 and 699 g, and 90 percent of those between 700 and 749 g. The frequency of endotracheal intubation increased between the two periods only for infants with birth weights above 500 g (P less than 0.02). Despite more aggressive treatment, survival did not change, although the mean time to death among infants transferred to the neonatal intensive care unit increased from 73 to 880 hours. Among all live-born infants with birth weights under 750 g, the rate of survival was 20 percent during period 1 and 18 percent during period 2, but 48 and 43 percent of those transferred to the neonatal intensive care unit survived in the two periods reviewed. Neonatal morbidity also did not change. Among survivors at a corrected age of 20 months, 4 of 18 born during period 1 and 7 of 14 born during period 2 had moderate-to-severe neurodevelopmental impairment. When all live-born infants of less than 28 weeks' gestation were considered, only 8 percent of those born at 23 weeks survived, as compared with 16 percent of those born at 24 weeks, and 53, 63, and 72 percent of those born at 25, 26, 27 weeks, respectively. Thus, despite a tendency to perform more cesarean sections and active resuscitations, no improvement in the survival of babies with lengths of gestation below 25 weeks or birth weights under 750 g was observed. The probability of survival is very poor if the length of gestation is less than 24 weeks or the birth weight less than 600 g.     

Umbilical vein serum amino acid levels in African Americans: relationship to birthweight and maternal variables.

Compared with other racial groups, African-American women show a disproportionately high risk of delivering low birthweight babies. In a retrospective study of African-American infants born at Meharry Hubbard Hospital, which predominantly serves the underprivileged inner-city poor, free amino acid concentrations were measured in umbilical venous serum from infants born following 34 to 42 weeks gestation. Significant reductions in levels of glycine, serine, alanine, the branched-chain amino acids, and the sum of the so-called dispensable amino acids were associated with decreased birthweight. Glycine, a quantitatively important residue in collagen and a component of reduced glutathione (gamma-glutamyl-cysteinyl-glycine), which is featured in the gamma-glutamyl amino acid transport cycle, was most consistently and severely affected. This study not only indicated that selective reduction in transplacental amino acid transport may be an important factor in intrauterine growth retardation in African Americans, but also confirmed the dietary necessity of the structurally simple amino acid glycine during pregnancy.     

Obstetric and perinatal outcome of children conceived from cryopreserved embryos

The main purpose of this study was to evaluate the obstetric and neonatal outcome of children conceived from cryopreserved embryos. The medical records of 270 infants (163 singletons, 98 twins and nine triplets) were reviewed and compared with two control populations of children born after in-vitro fertilization (IVF) with fresh embryos and children born after spontaneous pregnancies. The controls were matched according to maternal age, parity, plurality and date of delivery. In the cryopreserved group the gestational age at delivery for singletons was 279 +/- 13 days with birthweight 3476 +/- 616 g; for twins gestational age was 257 +/- 19 days with birthweight 2574 +/- 560 g; for triplets gestational age was 228 +/- 3 days with birthweight 1752 +/- 183 g. The incidence of preterm birth (< 37 weeks gestation) was 5.6% for singletons, 44.9% for twins and 100% for triplets. Seven children had major malformations (2.7%) and perinatal mortality occurred in two children (8/1000). Gestational age at delivery, birthweight, the incidence of malformations and the perinatal mortality were comparable with the two control groups both for singletons and twins. Significantly more singletons in the cryopreserved group were delivered by Caesarean section compared with the spontaneous group. The number of infants with low Apgar score (< 7 at 5 min) and the number of infants admitted to neonatal intensive care units were similar in the cryopreserved and spontaneous groups. In conclusion, the cryopreservation process did not seem to adversely influence fetal development and no increased perinatal risk was found.      

The continuing value of the Apgar score for the assessment of newborn infants

BACKGROUND: The 10-point Apgar score has been used to assess the condition and prognosis of newborn infants throughout the world for almost 50 years. Some investigators have proposed that measurement of pH in umbilical-artery blood is a more objective method of assessing newborn infants. METHODS: We carried out a retrospective cohort analysis of 151,891 live-born singleton infants without malformations who were delivered at 26 weeks of gestation or later at an inner-city public hospital between January 1988 and December 1998. Paired Apgar scores and umbilical-artery blood pH values were determined for 145,627 infants to assess which test best predicted neonatal death during the first 28 days after birth. RESULTS: For 13,399 infants born before term (at 26 to 36 weeks of gestation), the neonatal mortality rate was 315 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 5 per 1000 for infants with five-minute Apgar scores of 7 to 10. For 132,228 infants born at term (37 weeks of gestation or later), the mortality rate was 244 per 1000 for infants with five-minute Apgar scores of 0 to 3, as compared with 0.2 per 1000 for infants with five-minute Apgar scores of 7 to 10. The risk of neonatal death in term infants with five-minute Apgar scores of 0 to 3 (relative risk, 1460; 95 percent confidence interval, 835 to 2555) was eight times the risk in term infants with umbilical-artery blood pH values of 7.0 or less (180; 95 percent confidence interval, 97 to 334). CONCLUSIONS: The Apgar scoring system remains as relevant for the prediction of neonatal survival today as it was almost 50 years ago.     

Antenatal events and postnatal growth and survival of children in a rural Guatemalan village

The biological features of all pregnant women and newborn infants in a typical rural village of Guatemala have been studied from 1964 to the present; 458 pregnancies have been analysed. The mothers averaged 143·1 cm in height, 52·9 kg in weight and 9 mm in triceps skinfold. The diet of most was adequate in percentage protein but inadequate in iron and other nutrients. Infection was common, two or more episodes occurring in 40 per cent of pregnancies.

The newborn population had a birthweight averaging 2533 g and length 45·6 cm. Thirty-four per cent were less than 2501 g at 37 weeks gestation or over; seven per cent were pre-term. The infants' growth was followed till age six years. Survival correlated strongly with birth weight and gestational age. Pre-term infants showed the poorest survival in neonatal and postneonatal infancy; but the survivors thrived thereafter. The term-small-for-gestational age infants had poor survival in infancy and during the second and third years. Term infants with adequate weight-for-gestational age had the best survival rate. Postnatal physical growth correlated with birth weight and gestational age but pre-term adequate-for-gestational age infants showed a rate of growth as good as that of term infants.     

Trends in Survival and Incidence of Bronchopulmonary Dysplasia in Extremely Preterm Infants at 23–26 Weeks Gestation

The aim of this study was to investigate the relationship between survival and incidence of bronchopulmonary dysplasia (BPD) in extremely premature infants, and identify clinical factors responsible for this association. Medical records of 350 infants at 23–26 weeks gestation from 2000 to 2005 (period I, n = 137) and 2006 to 2010 (period II, n = 213) were retrospectively reviewed. The infants were stratified into 23–24 and 25–26 weeks gestation, and the survival, BPD incidence, and clinical characteristics were analyzed. BPD was defined as oxygen dependency at 36 weeks postmenstrual age. The overall survival rate was significantly improved in period II compared to period I (80.3% vs. 70.0%, respectively; P = 0.028), especially in infants at 23–24 weeks gestation (73.9% vs. 47.4%, respectively; P = 0.001). The BPD incidence in survivors during period II (55.0%) was significantly decreased compared to period I (67.7%; P = 0.042), especially at 25–26 weeks gestation (41.7% vs. 62.3%, respectively; P = 0.008). Significantly improved survival at 23–24 weeks gestation was associated with a higher antenatal steroid use and an improved 5-minute Apgar score. A significant decrease in BPD incidence at 25–26 weeks gestation was associated with early extubation, prolonged use of less invasive continuous positive airway pressure, and reduced supplemental oxygen. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased BPD incidence in extremely premature infants.     

Is neonatal intensive care justified in all preterm infants?

A proactive policy of resuscitation at birth and prompt initiation of intensive care have been shown to be associated with an improvement in the survival of very preterm infants in both institution-based and population-based studies. As a greater percentage of live births were offered intensive care, the survival rate rose progressively in all birth weight and gestation subgroups among extremely low birth weight infants, including those who were born at borderline viability between 23 weeks and 25 weeks of gestational age. Their quality-adjusted survival rate also rose progressively, since the large gains in survival over time had not been offset by significant increases in survival with disability. Cost-effectiveness and cost-utility ratios remained stable overall, with efficiency gains in the smaller infants over time, as more such infants were being born in Level III perinatal centers with the regionalization of perinatal-neonatal healthcare programs. National and international surveys of obstetricians and neonatologists on their perception of viability and their management decisions in extremely preterm infants have shown significant variations on the application use of intensive care in those born extremely preterm. If doctors believe that such infants have little prospect for intact survival, their management would be suboptimal or delayed, thus creating a self-fulfilling prophecy. Both developed and developing countries need to develop appropriate policies for initiating and withdrawing intensive care, taking into consideration their own cultural, social, and economic factors.     

Adequacy of prenatal care utilization, maternal ethnicity, and infant birthweight in Chicago.

This study examines the extent to which the Adequacy of Prenatal Care Utilization Index explains the racial disparity in infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and non-Latino white singleton infants born in Chicago, Illinois between 1982 and 1983. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. The adequacy of prenatal care utilization varied by race and place of residence. However, in moderate-income areas (median family annual income of $20,001 to $30,000), the African-American birthweight disadvantage persisted among infants born to mothers who received adequate and adequate-plus prenatal care. Similarly, although race-specific term (gestational age > 37 weeks) low birthweight rates declined as prenatal care usage rose, the position of African Americans relative to Mexican Americans and whites was essentially unchanged. These findings indicate that maternal race or some factor closely related to it affects pregnancy outcome regardless of the adequacy of prenatal care utilization.     

Maternal factors, birthweight, and racial differences in infant mortality: a Georgia population-based study.

Black infant mortality rates (IMRs) are approximately twice those of whites in Georgia and nationwide. This study evaluates maternal factors, particularly marital status, that influence racial differences in infant mortality. Population-based data on 565,730 live births and 7269 infant deaths in Georgia from 1980 to 1985 were examined. The IMR ratio for unmarried compared to married mothers was calculated and adjusted singly for maternal education, age and race, and infant birthweight. In addition, racial differences in IMR were estimated using stratified analysis on the basis of four factors: infant birthweight, maternal age, marital status, and education. When only normal birthweight infants were considered, the IMR, adjusted for maternal education level, was highest for infants born to unmarried black teens (9.5/1000 live births), followed by that for infants born to married black teens (9.1), unmarried black adults (7.5), married black adults (4.8), married white teens (4.4), married white adults (3.4), unmarried white adults (2.4), and unmarried white teens (1.3). When only low birthweight infants were considered, the highest IMR per 1000 was found in infants born to married black adults (119), followed by unmarried black adults (103), married black teens (99.9), unmarried black teens (92.5), married white adults (92.1), married white teens (79.0), unmarried white adults (38.0), and unmarried white teens (26.3). These differences led to a black-to-white IMR risk ratio from 1.3 for low birthweight infants born to unmarried teen or adult mothers to 3.7 for normal birthweight infants born to unmarried teen mothers.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17±12 vs 11±8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

Graphical Abstract

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Immunoblot analysis of anti-Ureaplasma urealyticum antibody in pregnant women and newborn infants.

The purpose of the present study was to determine the frequency in which antibody reactive to Ureaplasma urealyticum could be detected in a population of pregnant women and newborn infants. Serum samples from a prospective cohort of 80 healthy, U. urealyticum culture-positive and culture-negative pregnant women and a retrospective cohort of 522 infants born at between 25 and 42 weeks of gestation were studied by immunoblot analysis. Cultures of specimens from the lower genital tract were positive for U. urealyticum for 83% of the pregnant women, and serum immunoglobulin G (IgG) antibody which reacted to U. urealyticum was detectable in 93% of the pregnant women. Samples from five women (8%) had increases in the number of anti-U. urealyticum IgG bands over the course of the pregnancy. Samples from four of these five women had corresponding increases in the number of antibody bands present in IgA immunoblots. Six of the 522 samples from newborns or cord blood (1.1%) were positive for anti-U. urealyticum IgA; 5 of these 6 samples were also positive for IgM. The six anti-U. urealyticum IgA-positive infants were distributed as follows; 3 of 67 (4.5%) infants were delivered at 25 to 30 weeks of gestation, 3 of 176 (1.7%) infants were delivered at 31 to 34 weeks of gestation, and 0 of 279 infants were delivered at > or = 35 weeks of gestation. An antibody response to U. urealyticum can be detected in pregnant women and preterm infants and may serve as a marker of infection.     

Diagnosis of and screening for cytomegalovirus infection in pregnant women

No single diagnostic test for cytomegalovirus (CMV) infection is currently available for pregnant women at all stages of gestation. Improved accuracy in estimating the timing of primary infections can be used to identify women at higher risk of giving birth to congenitally infected infants. A diagnostic algorithm utilizing immunoglobulin G (IgG), IgM, and IgG avidity was used to prospectively screen serum from 600 pregnant women enrolled from two groups: < or =20 weeks gestation (n = 396) or >20 weeks gestation (n = 204). PCR testing of urine and/or blood was performed on all seropositive women (n = 341). The majority (56.8%) of women were CMV IgG seropositive, with 5.5% being also CMV IgM positive. In the IgM-positive women, 1.2% had a low-avidity IgG, indicating a primary CMV infection and a high risk of intrauterine transmission. Two infants with asymptomatic CMV infection were born of mothers who had seroconverted in the second trimester of pregnancy. Baseline, age-stratified CMV serostatus was established from 1,018 blood donors. Baseline seropositivity from a blood donor population increased with age from 34.9% seroprevalence at less than 20 years of age to 72% seroprevalence at 50 years of age. Women at high risk of intrauterine transmission of CMV were identified at all stages of gestation. Women infected with CMV during late gestation may be more likely to transmit the virus, so failure to detect seroconversions in late gestation may result in failure to detect infected neonates.     

Predictors of infant mortality among college-educated black and white women, Davidson County, Tennessee, 1990-1994.

Strategies to reduce US infant mortality rates often focus on the black-white disparity in rates. Linked Infant Birth and Death Files for Davidson County, Tennessee, from 1990 through 1994 were used to determine infant outcomes for infants born to college-educated white and black women. Risks for adverse outcomes were identified by comparing infant deaths to live births using logistic regression analyses. The following variables entered the logistic model process: maternal and paternal age; race and education; nativity status; maternal risk factors; interpregnancy interval; parity; infant gender; tobacco or alcohol use; number of prenatal visits; trimester in which prenatal care began; marital status; gestational age; and birthweight. After adjustment for the effects of the other variables, a gestational age < 28 completed weeks of gestation was the most significant independent predictor of infant death. Black race was not identified as a significant predictor of infant mortality. Regardless of race, a decrease in infant mortality rates among college-educated women in this country depends on the prevention of preterm births. Strategies to diagnose early preterm labor must proceed from a comprehensive maternal care program for all women. Open channels of communication between patient and provider will form the cornerstone for preterm prevention-intervention programs. Analysis of state and local infant mortality data may identify regional differences in infant mortality rates and differences in risk factors associated with adverse infant outcomes.     

Birth weight in relation to morbidity and mortality among newborn infants

BACKGROUND: At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which morbidity and mortality are significantly greater, or whether that threshold varies with gestational age. METHODS: We analyzed the neonatal outcomes of death, five-minute Apgar score, umbilical-artery blood pH, and morbidity due to prematurity for all singleton infants delivered at Parkland Hospital, Dallas, between January 1, 1988, and August 31, 1996. A distribution of birth weights according to week of gestation at birth was created. Infants in the 26th through 75th percentiles for weight served as the reference group. Data on preterm infants (those born at 24 to 36 weeks of gestation) were analyzed separately from data on infants delivered at term (37 or more weeks of gestation). RESULTS: A total of 122,754 women and adolescents delivered singleton live infants without malformations between 24 and 43 weeks of gestation. Among the 12,317 preterm infants who were analyzed, there was no specific birth-weight percentile at which morbidity and mortality increased. Among 82,361 infants who were born at term and whose birth weights were at or below the 75th percentile, however, the rate of neonatal death increased from 0.03 percent in the reference group (26th through 75th percentile for weight) to 0.3 percent for those with birth weights at or below the 3rd percentile (P<0.001). The incidence of five-minute Apgar scores of 3 or less and umbilical-artery blood pH values of 7.0 or less was approximately doubled for infants at or below the 3rd birth-weight percentile (P=0.003 and P<0.001, respectively). The incidence of intubation at birth, seizures during the first day of life, and sepsis was also significantly increased among term infants with birth weights at or below the 3rd percentile. These differences persisted after adjustment for the mother's race and parity and the infant's sex. CONCLUSIONS: Mortality and morbidity are increased among infants born at term whose birth weights are at or below the 3rd percentile for their gestational age.     

Neurologic and developmental disability after extremely preterm birth. EPICure Study Group

BACKGROUND AND METHODS: Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria. RESULTS: At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (+/-SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84+/-12 and 87+/-13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more than 3 SD below the mean), and a further 32 children (11 percent) had scores from 2 SD to 3 SD below the mean. Twenty-eight children (10 percent) had severe neuromotor disability, 7 (2 percent) were blind or perceived light only, and 8 (3 percent) had hearing loss that was uncorrectable or required aids. Overall, 138 children had disability (49 percent; 95 percent confidence interval, 43 to 55 percent), including 64 who met the criteria for severe disability (23 percent; 95 percent confidence interval, 18 to 28 percent). When data from 17 assessments by local pediatricians were included, 155 of the 314 infants discharged (49 percent) had no disability. CONCLUSIONS: Severe disability is common among children born as extremely preterm infants.     

Placental transfer of naturally acquired,maternal cytomegalovirus antibodies in term and preterm neonates

Maternal antibodies may protect the fetus and neonate against severe forms of CMV-caused disease, therefore this study investigated the efficiency of the placental transfer of naturally acquired, maternal total anti-cytomegalovirus (CMV) IgG and neutralizing antibodies at different gestational ages. The study was conducted on 182 healthy CMV-seropositive Brazilian mothers and their 196 infants who were not infected congenitally with CMV, as determined by CMV detection in urine. The study groups were composed of 44 infants aged 28-30 weeks; 51 infants aged 31-33 weeks; 62 infants aged 34-36 weeks, and 39 infants of gestational age > or = 37 weeks. Quantitative detection of total CMV IgG was carried out using EIA and virus neutralizing titers were determined by a microneutralization assay in sera from mothers and infants. CMV IgG levels and neutralizing titers of the infants correlated with maternal levels (r=0.873 and r=0.841, respectively). The efficiency of placental transfer of these antibodies was enhanced significantly as gestation progressed until 34-36 weeks, when values similar to those of full-term infants (90-100%) were found. Transfer ratios were significantly higher for neutralizing compared to total CMV IgG antibodies at gestational age 31-33 weeks (100% vs. 84%, respectively) and at gestational age 28-30 weeks (75% vs. 60%, respectively). We conclude that placental transfer of naturally acquired maternal CMV neutralizing and total CMV IgG antibodies are similarly efficient above 34 weeks of gestational age. At less than 34 weeks of gestational age, transfer of neutralizing antibodies may be favored and these antibodies reach the neonatal serum of 99% of these premature infants.     

Histological characteristics of singleton placentas delivered before the 28th week of gestation

AIMS: The placenta is a record of the fetal environment and its examination may provide information about the baby's subsequent growth and development. We describe the histological characteristics of 947 singleton placentas from infants born between 23 and 27 weeks gestation. METHODS: Consent was obtained from mothers who delivered before 28 weeks (clinical estimate). We evaluated the gross and histopathological features of the placenta and assessed pair-wise correlations between variables. RESULTS: Lesions of uteroplacental circulation (abruption, extensive infarction or thrombosis, marked basal or perivillous fibrin deposition, increased syncytial knots) were inversely related to those associated with inflammation of the membranes and cord. Earlier age favoured inflammatory variables, while older age favoured characteristics attributed to impaired blood flow. We observed inflammation of the chorionic plate in 43%, the cord in 19%, and of chorionic plate vessels in 30%. Of the placentas with umbilical cord inflammation, 8% had no inflammation of the chorionic plate. CONCLUSIONS: This study population is unique in its size and recruitment by gestational age rather than birth weight. Inflammation occurred frequently, but not in placentas that had characteristics of vasculopathy. The prevalence of inflammation decreased with increasing gestational age, while vasculopathy increased. Funisitis need not be accompanied by chorionic inflammation.     

Differential effect of ecologic risk factors on the low birthweight components of African-American, Mexican-American, and non-Latino white infants in Chicago.

This study explored the relationship between ecologic risk factors and infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and white infants born in Chicago in 1990. One half of African-American mothers (n = 26,799) resided in communities with multiple ecologic risk factors, yet their very low birthweight rates were unaffected by the number of these factors. By contrast, only 5% of Mexican-American mothers (n = 9913) and 5% of white mothers (n = 13,596) lived in communities with multiple ecologic risk factors. Their very low birthweights were twice that of infants born to mothers who resided in communities with no ecologic risk factors. These results indicate that ecologic risk factors affect the very low birthweight rates of Mexican Americans and whites but not African Americans.     

Mortality and Morbidities according to Time of Birth in Extremely Low Birth Weight Infants

BackgroundAlthough the overall quality of high-risk neonatal care has improved recently, there is still concern about a difference in the quality of care when comparing off-hour births and regular-hour births. Moreover, there are no data in Korea regarding the impact of time of birth on mortality and morbidities in preterm infants.MethodsA total of 3,220 infants weighing < 1,000 g and born at 23–34 weeks in 2013–2017 were analyzed based on the Korean Neonatal Network data. Mortality and major morbidities were analyzed using logistic regression according to time of birth during off-hours (nighttime, weekend, and holiday) and regular hours. The institutes were sub-grouped into hospital group I and hospital group II based on the neonatal intensive care unit (NICU) care level defined by the mortality rates of < 50% and ≥ 50%, respectively, in infants born at 23–24 weeks'' gestation.ResultsThe number of births during regular hours and off-hours was similar. In the total population and hospital group I, off-hour births were not associated with increased neonatal mortality and morbidities. However, in hospital group II, increased early mortality was found in the off-hour births when compared to regular-hour births.ConclusionEfforts to improve the overall quality of NICU are required to lower the early mortality rate in off-hour births. Also, other sensitive indexes for the evaluation of quality of NICU care should be further studied.     

Esophageal atresia and tracheoesophageal fistula in two infants born to hyperthyroid women receiving methimazole (tapazol®) during pregnancy

We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA + TEF) born to hyperthyroid mothers receiving methimazole (Tapazol ®) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. Hypo-thyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA + TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA + TEF. © 1992 Wiley-Liss, Inc.