Early versus late inguinal hernia repair in extremely low-birthweight infants

Objective: Compare outcomes of extremely low-birthweight (ELBW) infants following early (before discharge) versus late (after discharge) inguinal hernia (IH) repair.

Study design: In a retrospective study of ELBW infants with IH, data were abstracted for clinical characteristics, IH and related outcomes.

Result: Of the 39/252 (15.4%) ELBW infants who developed IH, those with early (59%) versus late (41%) repair were comparable in birth weight (753?±?158 versus 744?±?131?g, p?=?0.84), gestation age (26?±?2 versus 26.2?±?2 weeks, p?=?0.92), with comparable rate of broncopulmonary dysplasia (87% versus 75%, p?=?0.41), but early repair group had prolonged respiratory support (60.6?±?28.6 versus 39?±?30 days, p?=?0.032). Both groups had comparable diagnosis to repair interval (51.2?±?29.2 versus 60.5?±?30.6 days, p?=?0.38) and early repair group has earlier corrected gestation (41.6?±?3.9 versus 45.4?±?4.6 weeks, p?Conclusions: We did not find significant differences in outcomes of IH in early and late repair groups of ELBW infants.     

Early versus late tocolytic treatment for preterm premature membrane rupture

The effect of tocolytic therapy before labor was evaluated in 33 pregnant women with preterm premature rupture of the membranes. Either intravenous magnesium sulfate or oral terbutaline was administered at the time of presentation. Intensive surveillance to detect signs of infection was carried out for all patients. In 29 of the patients in this treatment group who were seen at less than 34 weeks, a significantly longer prolongation of pregnancy was achieved when compared with 24 similar women treated after onset of labor in the hospital (169 hours versus 77 hours, p = 0.05). Duration of infant hospitalization was less for those mothers receiving tocolytic agents before labor. Maternal and infant infection were not different in the two groups; nor was the cesarean section rate. When this treatment group was compared with another control group of 96 women already in labor at presentation, the difference in time from admission to delivery was substantial, but it did not achieve statistical significance. In this group the rate of maternal infection was significantly higher, but newborn morbidity was not. Aggressive early treatment with tocolytic agents in pregnant women with preterm premature membrane rupture is more productive but not more dangerous than conservative management.     

Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis

Concurrent with the trend of increasing cesarean delivery numbers, there has been an epidemic of both autoimmune diseases and allergic diseases. Several theories have emerged suggesting that environmental influences are contributing to this phenomenon, most notably, the hygiene hypothesis. This article provides background about the human microbiota and its relationship to the developing immune system as well as the relationship of mode of delivery on the colonization of the infant intestine, development of the immune system, and subsequent childhood allergies, asthma, and autoimmune diseases.     

Early versus late amniotomy for labour induction: a randomized controlled trial

Objective: To evaluate the impact of early vs. late amniotomy on delivery mode in women undergoing induction of labor. Study design: 143 women admitted for induction were randomized to early amniotomy (EA, concomitant with the beginning of oxytocin infusion; n = 71) or to late amniotomy (LA, four hours after the beginning of oxytocin; n = 72). Randomization was stratified by parity. The primary outcome was the rate of cesarean. Secondary outcomes were duration of labor and intrapartum fever. Results: The cesarean rate was similar between groups (18% vs. 17% among nulliparous; and 3% vs. 0% among parous women, in EA and LA group, respectively). However, EA was associated with shorter oxytocin-to-delivery interval (12 vs. 15?h) and a non-significant decrease in intrapartum fever (3% vs. 25%) than LA in nulliparous women (p = 0.05). Conclusion: For women undergoing oxytocin induction, early amniotomy is associated with shorter labor in nulliparous women with no effect on the risk of cesarean section in both nulliparous and multiparous women.     

Glucose metabolism in the late preterm infant

Prematurity and low birth weight are important determinants of neonatal morbidity and mortality. A rising trend of preterm births is caused by an increase in the birth rate of near-term infants. Near-term infants are defined as infants of 34 to 36 6/7 weeks gestation. It is dangerous to assume that the incidence of hypoglycemia in the later preterm infant is similar to the infant born at full term. Although current methods for assessing effects of hypoglycemia are imperfect, the injury to central nervous system depends on the degree of prematurity, presence of intrauterine growth restriction (IUGR), intrauterine compromise, genotype, blood flow, metabolic rate, and availability of other substrates. Therefore, early recognition of glucose metabolic abnormalities pertaining to late preterm infants is essential to provide appropriate and timely interventions in the newborn nursery. Although many of the investigations have targeted full-term infants, premature infants inclusive of the extremely low birth weight infants and the intrauterine growth-restricted infants, adequately powered studies restricted to only the late preterm infants are required and need future consideration.     

Feeding problems in the late preterm infant

Much of the neonatal nutrition literature has focused on the management of very low birth weight infants, a group of infants usually less than 33 weeks gestation. Much less attention has been paid to nutritional management issues in preterm infants at higher gestations. This article reviews nutritional issues that exist from the 239th day (34 0/7 weeks gestation) and ending on the 259th day (36 6/7 weeks gestation) since the first day of the mother's last normal menstrual period.     

Neurodevelopmental outcome of the late preterm infant

There is very limited information about the developmental outcome of the late preterm infant. The developing brain is vulnerable to injury during this very active and important stage of fetal brain development; therefore, it is important to carefully monitor the neurologic outcome of these infants. This article discusses gestational brain development and complications of late preterm birth that contribute to the overall risk of brain injury.     

Early versus late rehabilitation of erectile function after nerve-sparing radical cystoprostatectomy: a prospective randomized study

IntroductionPharmacological rehabilitation of erectile function (EF) after nerve‐sparing radical prostatectomy was repeatedly advocated.AimTo compare early vs. late penile rehabilitation in patients with nerve‐sparing (NS) radical cystoprostatectomy based on a prospective randomized trial.MethodsEighteen patients without spontaneous erection 8 weeks after NS radical cystoprostatectomy were randomly divided into two groups; group I and II who started the erectogenic therapy at the 2nd and 6th month postoperatively, respectively. The pharmacological therapy constitutes of sildenafil citrate twice weekly to be shifted to intracavernosal injection (ICI) of prostaglandin E1 (PGE1) if not responding. The treatment continued for 6 months in both groups.Main Outcome MeasuresThe EF status was evaluated before and at the end of the treatment by International Index of Erectile Function questionnaire and penile Doppler ultrasonography (PDU).ResultsSix out of nine patients recovered unassisted erection after treatment in group I compared to three out of nine patients in group II. Two patients in group I and three patients in group II were maintained on sildenafil therapy on demand basis. The remaining four patients were dependent on ICI of PGE1. At final evaluation, a significant improvement was found in the EF, the intercourse satisfaction and overall satisfaction domains (P = 0.02, 0.03, and 0.02, respectively) in group I compared with group II. Regarding PDU findings, significant improvement in end‐diastolic velocity was elicited in the early rehabilitation group compared with the pretreatment value (P = 0.03) with no significant difference between both groups.ConclusionEarly compared with delayed erectile rehabilitation brings forward the natural healing time of potency and maintains nerve‐assisted erection. Mosbah A, El Bahnasawy M, Osman Y, Hekal IA, Abou‐Beih E, and Shaaban A. Early versus late rehabilitation of erectile function after nerve‐sparing radical cystoprostatectomy: A prospective randomized study. J Sex Med 2011;8:2106–2111.     

Hypoxic respiratory failure in the late preterm infant

Hypoxic respiratory failure in late preterm infants has received increased attention in the last decade, and while the incidence is low, it accounts for a significant number of admissions to neonatal ICUs because of the large number of late preterm births in the United States and worldwide. Causes of respiratory distress include transient tachypnea of the newborn, surfactant deficiency, pneumonia, and pulmonary hypertension. The physiologic mechanisms underlying delayed transition caused by surfactant deficiency and poor fetal lung fluid absorption have been reviewed recently elsewhere. This article focuses on the less-explored problem of severe hypoxic respiratory failure in the late preterm infant and discusses potential strategies for management.     

Prehypertension in early versus late pregnancy

Introduction: Hypertensive disorders play a significant role in maternal morbidity and mortality. Limited data on prehypertension (preHTN) in pregnancy exist. We examine the risk of adverse outcomes in patients with preHTN in early (<20 weeks) versus late pregnancy (>20 weeks).

Materials and methods: Retrospective cohort study of singleton gestations between August 2013 and June 2014. Patients were divided based on when they had the highest blood pressure in pregnancy, as defined per the Joint National Committee 7 (JNC-7). Groups were compared using χ², Fisher’s exact, Student’s t-test, and Mann–Whitney U test with p?Results: There were 125 control, 95 early preHTN, 136 late preHTN, and 21 chronic hypertension (CHTN). Early preHTN had an increased risk of pregnancy-related hypertension (PRH) (OR 12.26, p?p?p?=?.02) compared with normotensive and decreased risk for PRH (OR 0.26, p?=?.02), and composite adverse outcomes (OR 0.379, p?=?.04) compared with CHTN. Compared with late preHTN, early preHTN had more PRH (OR 2.85, p?p?=?.04).

Conclusions: Early prehypertension increases the risk of adverse obstetrical outcomes. Other than an increased risk of PRH, patients with late prehypertension have outcomes similar to normotensive women.     

Neonatal and infant care and outcomes.

A major advance in neonatal care, surfactant replacement therapy, has received wide endorsement and approval after being subject to over 30 clinical trials. Details of clinical application and full impact on outcomes are in the process of being determined. Neonatal outcome data indicate that the focus of improvement in survival now rests primarily on the extremely low birth weight (less than 750 g) infant. There is additional need for clarity of actual survival by gestational age in the less-than-28-week cohort. The differences and limitations of neonatal and obstetric methods of gestational age assessment are important. Significant contributions to our knowledge of problems such as retinopathy of prematurity, syphilis, and infants of diabetic mothers have recently appeared.