Neonatal outcome following cesarean birth: a prospective study

Neonatal morbidity and mortality in 573 singleton cesarean born infants was recorded. In 70% of women, it was a primary cesarean section. The neonatal mortality was 3.6% in babies born to primigravida mothers and 9.8% in infants of multigravida. Mortality in male and female infants was 5.73 and 9.65%, respectively. Preterm infants registered more than 7 times higher mortality than term infants. Birth weight below 2000 g and above 3500 g were associated with higher asphyxia rate and neonatal death. Neonatal morbidity frequently encountered was birth asphyxia (19.19%), septicemia (13.43%), jaundice (15.70%) and respiratory problems (23.0%).     

Cranial birth injuries in term newborn infants

While cranial birth injuries in term infants are well recognized, to date, only small case series have been described. In an attempt to further define the spectrum of cranial birth injuries, we analyzed 41 consecutive cranial birth injuries at our institution over the period 1991-1998. The most common clinical presentations were apnea (39%) and seizures (37%). Average Apgar scores were 5.7 at 1 min and 7.3 at 5 min; 54% of infants had abnormally low Apgar scores at 1 min and 31% had abnormally low scores at 5 min. The most common intracranial lesion was subdural hemorrhage, present in 73% of infants; most had either a tentorial (57%) and/or interhemispheric (50%) location. Operative treatment was required in 5 infants (12%). Two of the 41 infants (4.8%) died. The study group was compared with a control group of 63 randomly selected births without cranial injury. Using a stepwise logistic regression model, independently significant variables included neonatal birth weight, Apgar scores at 1 and 5 min and mode of delivery. Compared with the controls, the study group had a significantly higher incidence of forceps and/or vacuum deliveries. Combining vacuum, forceps and urgent cesarean section deliveries together as 'urgent' and elective cesarean and spontaneous vaginal deliveries as 'nonurgent', we could find no significant differences between these two groups. Our data conflict with those of Towner et al. [N Engl J Med 1999;341:1709-1714], and suggest that the method of assisted delivery, rather than the urgency of the delivery or dysfunctional labor per se, is a more important variable in cranial birth injuries.     

剖宫产对学龄期儿童注意力影响的研究

目的:探讨不同原因剖宫产对学龄期儿童注意力的影响。方法:将308例健康学龄期儿童分为自然分娩组（n＝105）、社会因素剖宫产组（n＝101）和医学指征剖宫产组（n＝102）。采用视听整合持续操作测试（IVA-CPT）进行注意力测试。结果:①三组间综合控制、听觉反应控制、综合注意、听觉注意力、视觉注意力、听觉警醒、视觉一致性、视觉警醒、视觉注意集中等9项商数差异有显著性（P＜0.05）;②医学指征剖宫产组IVA-CPT结果明显差于自然分娩组和社会因素剖宫产组,而社会因素剖宫产组与自然分娩组差异无显著性意义。结论:剖宫产手术本身对健康学龄期儿童的注意力无明显影响,影响剖宫产儿童注意力的真正原因是导致剖宫产的医学指征。［中国当代儿科杂志,2009,11（11）：913-916］     

剖宫产对学龄期儿童注意力影响的研究

目的探讨不同原因剖宫产对学龄期儿童注意力的影响。方法将308例健康学龄期儿童分为自然分娩组(n=105)、社会因素剖宫产组(n=101)和医学指征剖宫产组(n=102)。采用视听整合持续操作测试(IVA-CPT)进行注意力测试。结果①三组间综合控制、听觉反应控制、综合注意、听觉注意力、视觉注意力、听觉警醒、视觉一致性、视觉警醒、视觉注意集中等9项商数差异有显著性(P<0.05);②医学指征剖宫产组IVA-CPT结果明显差于自然分娩组和社会因素剖宫产组,而社会因素剖宫产组与自然分娩组差异无显著性意义。结论剖宫产手术本身对健康学龄期儿童的注意力无明显影响,影响剖宫产儿童注意力的真正原因是导致剖宫产的医学指征。     

Health economic aspects of late preterm and early term birth

Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. The article highlights the limited perspective and time horizon of most studies of economic costs in this area; the limited evidence surrounding health economic aspects of early term birth; the gaps in current knowledge; and it discusses directions for future research in this area, including the need for validated tools for measuring preference-based health-related quality-of-life outcomes in infants that will aid cost-effectiveness-based decision-making.     

Socioeconomic inequalities in very preterm birth rates

AIMS: To investigate the extent of socioeconomic inequalities in the incidence of very preterm birth over the past decade. METHODS: Ecological study of all 549 618 births in the former Trent health region, UK, from 1 January 1994 to 31 December 2003. All singleton births of 22(+0) to 32(+6) weeks gestation (7 185 births) were identified from population surveys of neonatal services and stillbirths. Poisson regression was used to calculate incidence of very preterm birth (22-32 weeks) and extremely preterm birth (22-28 weeks) by year of birth and decile of deprivation (child poverty section of the Index of Multiple Deprivation). RESULTS: Incidence of very preterm singleton birth rose from 11.9 per 1000 births in 1994 to 13.7 per 1000 births in 2003. Those from the most deprived decile were at nearly twice the risk of very preterm birth compared with those from the least deprived decile, with 16.4 per 1000 births in the most deprived decile compared with 8.5 per 1000 births in the least deprived decile (incidence rate ratio 1.94; 95% CI (1.73 to 2.17)). This deprivation gap remained unchanged throughout the 10-year period. The magnitude of socio-economic inequalities was the same for extremely preterm births (22-28 weeks incidence rate ratio 1.94; 95% CI (1.62 to 2.32)). CONCLUSIONS: This large, unique dataset of very preterm births shows wide socio-economic inequalities that persist over time. These findings are likely to have consequences on the burden of long-term morbidity. Our research can assist future healthcare planning, the monitoring of socio-economic inequalities and the targeting of interventions in order to reduce this persistent deprivation gap.     

Increasing rates of prematurity and epidemiology of late preterm birth

Preterm birth rates in Australia have risen in the last two decades, mostly accounted for by the rise in late preterm births. Late preterm births (34–36 weeks) comprise 70% of all preterm births, which translates to approximately 16 000 births annually in Australia. The precise causes for this trend are unclear; however, possible aetiologies include increasing maternal age, increased use of artificial reproductive technologies and increased multiple births. Compared with term‐born children, late preterm children not only have increased mortality and in‐hospital morbidity including respiratory difficulties, but also long‐term cognitive, school performance, behaviour and psychiatric problems. The potential public health and educational burden of late preterm birth is considerable. More research is required in this area to understand the risk factors for late preterm birth and to help identify those children at highest risk of developmental deficits.     

Hypersomatotropism in the dysmature infant at term and preterm birth

Growth hormone (GH) concentrations were measured in cord serum of small (less than 2.4 kg), appropriate (3.4 +/- 0.1 kg) and large (greater than 4.4 kg) infants born at term (38-42 weeks), and in cord serum of prematurely born twins (28-36 weeks) which were either appropriate (greater than P10) or small (less than P10) for gestational age. Cord serum GH levels were found to be significantly elevated in small for gestational age infants, both at term and preterm birth. In view of the insulin-antagonizing action of fetal GH, these results further support a homeostatic function for GH in the late-gestational human fetus.     

选择性剖宫产对新生儿近远期的影响

剖宫产手术技术的日臻完善、临床上对剖宫产手术指征的放宽以及对剖宫产术对新生儿不利影响的认识不足,都在一定程度上促使了剖宫产率的大幅上升.该文围绕选择性剖宫产手术对新生儿近期及远期的影响,分析其与新生儿呼吸系统疾病、医源性早产、免疫系统建立以及特异反应性疾病等之间的联系.目前认为,剖宫产手术虽不能作为独立危险因素存在,但可与其他因素产生协同作用,增加新生儿的病死率.所以,临床上应严格掌握手术指征,降低无手术指征的选择性剖宫产率.     

Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome

OBJECTIVE: To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemic Candida infection during intensive care stay. METHOD: We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed with Candida sepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994. RESULTS: Forty-six extremely low birth weight infants with systemic Candida infection, mean (+/-SD) gestational age of 24.7 +/- 1.6 weeks and birth weight 699 +/- 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P = 0.0001), a high incidence of periventricular leukomalacia (26% vs. 12%, P = 0.06) and an increase in severe retinopathy of prematurity (22% vs. 9%, P = 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41% vs. 12% had severe disabilities (P = 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous system Candida involvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome. CONCLUSIONS: Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants. Candida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.