Preeclampsia is an independent risk factor for spontaneous intestinal perforation in very preterm infants

Abstract

Background: Spontaneous intestinal perforation (SIP) is an important surgical emergency in preterm infants.

Aims: To evaluate the effect of maternal preeclampsia on development of SIP in premature infants.

Study design: Retrospective observational study in a large tertiary neonatal intensive care unit.

Subjects: The preterm infants of ≤32 weeks of gestational age and birthweight ≤1500?g who were hospitalized were enrolled.

Outcome measures: The primary outcome was to determine the association between preeclampsia and SIP.

Results: A total of 22 infants had SIP diagnosis. The incidence of SIP in infants born to preeclamptic mothers (6.2%) was significantly higher compared with those born to normotensive mothers (0.2%). In multinominal logistic regression model, preeclampsia was found to be an independent risk factor of SIP with an odds ratio of 13.5 (95% confidence interval 2.82–65.1).

Conclusions: Maternal preeclampsia seemed to be an independent risk factor for development of SIP in premature infants.     

Severe hemorrhage after low-molecular-weight heparin treatment in a preterm neonate

Thromboembolic events in preterm neonates are increasingly being diagnosed due to the increasing use of umbilical catheters and central venous catheters. Whether thromboembolic events should be treated routinely with low-molecular-weight heparin (LMWH) is controversial and the optimal management is still not clear due to the lack of randomized controlled trials. Most importantly, knowledge about the safety of treatment with LMWH in neonates with thromboembolic events is very limited. We present a case of severe hemorrhage in a preterm neonate after LMWH treatment and summarize the scarce data reported in the literature.     

Fatal influenza B virus pneumonia in a preterm neonate: case report and review of the literature.

Although less common than influenza A, influenza B infections can cause significant mortality and morbidity in children who are immunocomprised and have underlying medical conditions. We report a preterm neonate with fatal influenza B virus pneumonia. This infant presented with signs and symptoms indistinguishable from any other cause of sepsis.     

A population-based study of prognostic factors related to major disability in very preterm survivors.

OBJECTIVE: This study was conducted to determine the rates and risk factors for major disability in very preterm survivors born to residents of Nova Scotia, Canada between 1992 and 1996. STUDY DESIGN: A cohort study was conducted of all 355 infants born to Nova Scotia residents between 22 and 30 weeks gestation. Major disability was defined by mental development index <70, moderate or severe cerebral palsy, bilateral visual acuity <20/200, or deafness requiring bilateral hearing aids. Logistic regression analysis was used to determine which factors were significantly associated with major disability. RESULTS: Of the infants who survived 1 year and had follow-up data, 21 (8.3%) developed a major disability. Cystic periventricular leukomalacia (PVL), hypernatremia and surgery requiring general anesthesia were independently associated with the development of a major disability. CONCLUSION: This study confirms the association between cystic PVL and major disability observed in other studies. Surgery and hypernatremia will be important to verify in future studies since preventive measures may be possible.     

Gastrointestinal presentation of relative adrenal insufficiency in a sick preterm neonate

We report a sick preterm neonate with a dramatic ileus presentation mimicking necrotizing enterocolitis that promptly reversed upon hydrocortisone supplementation. Because our case illustrates a previously unsuspected clinical visage of inadequate adrenal responses in sick preterm neonates, it also emphasizes the need for improved diagnostic algorithms to identify neonates who could potentially benefit from treatment while avoiding the morbid consequences of unwarranted corticosteroids use in this population.     

Heterotopic brain tissue on the face and neck in a neonate: A rare case report and literature review

Heterotopic brain tissue (HBT) most commonly occurs in the nasal region and it is often referred to as a nasal glioma. Nonnasal locations for ectopic brain tissue are less commonly described. In English literature, only six cases have been reported that share some features (face or neck location) of this case. The presented case is the fourth case, located in both face and neck, and the one, which is the most extensive with its dimensions. According to location of heterotopic brain may lead to dystocia. We reported HBT of the face and neck in a neonate and the differential diagnosis, etiopathogenic mechanisms and clinical courses are reviewed and discussed.     

Prediction of chorioamnionitis in cases of intraamniotic infection by ureaplasma urealyticum in women with very preterm premature rupture of membranes or preterm labour

Objectives: First, to determinate the frequency of chorioamnionitis and funisitis in cases of intramniotic detection of Ureaplasma urealyticum. Second, to assess the predictive capability of some biological markers in the amniotic fluid of these women to predict histological inflammation.

Subjects and methods: We prospectively studied 20 cases of women with premature rupture of membranes or preterm labour (PROM) or preterm labour and intraamniotic detection of Ureaplasma urealyticum. Gestational age at admission was 26.74?±?2.53?weeks. Amniotic fluid concentrations of IL18, IL 2, IL4, IL6, IL10, IL12, TNF-alpha, IFN-g, and MMP-8 were measured by the Multiplex method. Amniotic fluid glucose and leukocyte count were also measured by standard methods. Placental detailed histological studies were performed. Student’s t-test, forward stepwise conditional binary logistic regression analysis and ROC curves were used.

Results: Histological chorioamnionitis was present in 45% of cases (9/20) and funisitis just in 15% (3/20). Interleukins 6, 8, 12, MMP-8, and leukocyte count were significantly elevated in cases of histological inflammation, defined as choriamnionitis or chorioamniotis?+?funisitis (p?=?.007, .03, .01, .03, .03, respectively) while glucose was decreased (p?=?.04). Binary logistic regression for the prediction of inflammation showed a high predictive value (R²?=?.66, p?=?.002) including in the equation only the IL6 value.

Conclusions: A significant percentage of cases with intraamniotic detection of Ureaplasma urealyticum shows no pathological signs of histological inflammation. Concentration of Interleukin 6 in amniotic fluid can be useful for the diagnosis of subclinical chorioamnionitis in these cases.     

A rare case of pregnancy and delivery of a healthy neonate by a woman with microprolactinoma and review of the literature

A rare case of a term-pregnancy and delivery in a patient with microprolactinoma is presented. The patient had been treated with bromocriptine since she was 17 due to primary amenorrhea for 60 months with short intervals. Pharmacological tests with dopamine antagonists and X-ray diagnostics revealed the presence of microprolactinoma. The patient was constantly under specialist endocrinological care and the level of prolactin in her blood serum was continuously being monitored. After getting pregnant she was placed under strict gynecological scrutiny with special attention devoted to the developing fetus and possible congenital defects. The patient continued receiving bromocriptine therapy up to the 16th week of pregnancy. In the course of pregnancy in the 26th week, a circular suture was placed on the uterine cervix due to symptoms of isthmus-cervical insufficiency. In the 38th week of pregnancy a cesarean (C) section was performed and a healthy child in good general condition (Apgar score 10) was born. The child weighed 2,900 grams.     

Uni- and bilateral torsion of the testes in the neonate; a report of two cases

One case of unilateral and one case of bilateral torsion of the testes in the neonate are presented together with a review of the literature for bilateral cases. Finally some recommendations are made for the dealing with this rare but important illness of the neonate.     

Antenatal magnesium sulfate is beneficial or harmful in very preterm and extremely preterm neonates: a new insight

Aims: To evaluate whether antenatal MgSO₄ is beneficial or harmful in very preterm and extremely preterm neonates.

Materials and methods: We retrieved published literature through searches of PubMed or Medline, CINAHL, and the Cochrane Library. Results were restricted to systematic reviews, meta-analysis, randomized controlled trials (RCTs), and relevant observational studies.

Results: Evidence revealed that antenatal MgSO₄ has neuroprotective role in preterm neonates and it decreased the risk of cerebral palsy and gross motor dysfunction. Evidences regarding association of antenatal MgSO₄ with feed intolerance, NEC and SIP were from cohort studies and controversial.

Conclusions: We should continue use antenatal MgSO₄ to all eligible patients according to protocol till the more robust evidence will suggest association with gastrointestinal complications. In the meantime, we should have a high index of suspicion of gastrointestinal complications in extremely preterms particularly <26 weeks of gestation.     

Successful preterm pregnancy in a rare variation of Herlyn-Werner-Wunderlich syndrome: a case report

Background

Herlyn–Werner-Wunderlich syndrome (HWWS) is an uncommon congenital anomaly of the female urogenital tract, characterised by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We reported the difficult pregnancy course complicated by an extremely rare and unique case of this syndrome associated with ectrodactyly, a clinical combination never described in literature.

Case presentation

A 28- year-old nulliparous woman previously diagnosed for HWWS associated with ectrodactyly of the right foot and with a history of abdominal left hemi-hysterectomy, ipsilateral salpingectomy, vaginal reconstruction when she was an adolescent. She suffered from threats of abortion in the first trimester, recurrent urinary tract infections during all pregnancy. At 33 weeks + 5 days of gestational age, she was hospitalized for premature rupture of the membranes and uterine contractions and a caesarean section was performed because of breech presentation. Postpartum period was complicated by a pelvic abscess resolved with parental antibiotic therapies.

Conclusions

Our literature review shows an unusual aspect in our case: HWWS is not classically associated with skeletal anomalies. Moreover, the most frequent urogenital side affected is the right, not left side as in this woman. Preterm spontaneous rupture of membranes and fetal abnormal presentation represent frequent complications and probably post-caesarean infections are related to pregnancies in the context of this syndrome.