scholarly journals Increased Risk Of Early-Onset Neonatal Sepsis After Laser Surgery For Twin-to-Twin Transfusion Syndrome

2016 ◽  
Vol 19 (3) ◽  
pp. 234-240 ◽  
Author(s):  
Liselotte E. M. van Kempen ◽  
Depeng Zhao ◽  
Sylke J. Steggerda ◽  
Vincent Bekker ◽  
Johanna M. Middeldorp ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Laser Surgery ◽  
Premature Delivery ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

Objective: To investigate the occurrence of early-onset neonatal sepsis (EOS) in twin–twin transfusion syndrome (TTTS) managed with laser surgery.Study design: We performed a prospective cohort study of all consecutive TTTS cases treated with laser surgery (TTTS group) delivered at the Leiden University Medical Center. We recorded the occurrence of EOS, defined as a positive blood culture ≤72 hours postpartum (proven sepsis) or administration of a full course of antibiotics due to risk factors or signs of sepsis, in the absence of a positive blood culture (suspected sepsis). Perinatal variables in the TTTS group were compared with uncomplicated monochorionic twins (no-TTTS group). A multivariate model was generated, examining the association between EOS and gestational age at birth, interval between laser surgery and birth, anterior placenta, laser period (first study period: 2002–2008; second study period: 2009–2015), and preterm premature rupture of membranes (PPROM).Results: The rates of combined suspected and proven EOS in the TTTS group and no-TTTS group were 16% (68/416) and 10% (55/542), respectively (relative ratio [RR] 1.74, 95% confidence interval [CI] 1.19–2.55). Multivariate analysis showed that EOS in the TTTS group was independently associated with lower gestational age at birth (odds ratio [OR] 0.75, 95% CI 0.63–0.88), first study period (OR 2.25, 95% CI 1.08–4.67) and PPROM (OR 2.47, 95% CI 1.28–4.75).Conclusion: The rate of EOS in the TTTS group is low, but increased compared to the no-TTTS group. EOS in TTTS is independently associated with premature delivery, earlier laser period, and PPROM.

scholarly journals 512: Are appropriately sized fetuses who “fall off the curve” at increased risk for small-for-gestational age at birth?

2018 ◽  
Vol 218 (1) ◽  
pp. S306-S307
Author(s):  
Nathan R. Blue ◽  
Mariam Savabi ◽  
Meghan E. Beddow ◽  
Vivek R. Katukuri ◽  
Cody M. Fritts ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

scholarly journals Utility of Red Cell Distribution Width (RDW) In Diagnosis and Prognosis of Early-Onset Neonatal Sepsis in Term Neonates

2021 ◽  
Vol 3 (3) ◽  
pp. 257-264
Author(s):  
Sandeep Golhar ◽  
Abhishek Madhura ◽  
Urmila Chauhan ◽  
Abinash Nayak
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Term Neonates ◽  
Diagnosis And Prognosis

Objective: To assess the increased Red Cell Distribution Width (RDW) in diagnosis and prognosis of early-onset neonatal sepsis in term neonates. Methods: In a prospective, observational study, we enrolled term neonates ( 37 weeks of gestation) clinically suspected for Early-Onset Neonatal Sepsis (EONS) (within 7 days of birth). A cut-off of 18% and above was taken to consider RDW as abnormal or increased. The primary outcome was to assess the relation of increased RDW with in-hospital mortality. The secondary outcome was to determine the diagnostic yield of increased RDW in culture-proven sepsis. Results: In 166 neonates, 60% were males. Increased RDW was seen in 42.42% of neonates and 15.75% of neonates had positive blood culture. Compared to normal RDW, in-hospital mortality was significantly higher in neonates with increased mortality (27.14% vs. 10.52%, respectively; p=0.006). Also, abnormal RDW was seen in 46.15% of neonates with positive blood culture compared to 35.25% of neonates with negative blood culture (p<0.0001). Thus, elevated RDW had a sensitivity of 44.4% and specificity of 57.97% in the diagnosis of EONS. Conclusion: Increased RDW can be a diagnostic as well as a prognostic marker in neonates with EONS. Such observation indicates it may serve as a simple and easily available marker for EONS in resource-limited settings. However, these findings need to be confirmed in a larger sample. Doi: 10.28991/SciMedJ-2021-0303-7 Full Text: PDF

scholarly journals Risk of hypertension into adulthood in persons born prematurely: a national cohort study

2019 ◽  
Vol 41 (16) ◽  
pp. 1542-1550 ◽  
Author(s):  
Casey Crump ◽  
Jan Sundquist ◽  
Kristina Sundquist
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Environmental Factors ◽  
Gestational Age ◽  
Large Population ◽  
Increased Risk ◽  
Extremely Preterm ◽  
National Cohort ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Aims Preterm birth has been associated with elevated blood pressure early in life; however, hypertension risks from childhood into adulthood remain unclear. We conducted a large population-based study to examine gestational age at birth in relation to hypertension risks from childhood into adulthood. Methods and results A national cohort study was conducted of all 4 193 069 singleton live births in Sweden during 1973–2014, who were followed up for hypertension identified from nationwide inpatient and outpatient (specialty and primary care) diagnoses from any health care encounters through 2015 (maximum age 43 years; median 22.5). Cox regression was used to examine gestational age at birth in relation to hypertension risk while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. In 86.8 million person-years of follow-up, 62 424 (1.5%) persons were identified with hypertension (median age 29.8 years at diagnosis). Adjusted hazard ratios for new-onset hypertension at ages 18–29 years associated with preterm (&lt;37 weeks) and extremely preterm (22–27 weeks) birth were 1.28 [95% confidence interval (CI), 1.21–1.36] and 2.45 (1.82–3.31), respectively, and at ages 30–43 years were 1.25 (1.18–1.31) and 1.68 (1.12–2.53), respectively, compared with full-term birth (39–41 weeks). These associations affected males and females similarly and appeared substantially related to shared genetic or environmental factors in families. Conclusions In this large national cohort, preterm birth was associated with increased risk of hypertension into early adulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for the development of hypertension.

scholarly journals High-Dose Erythropoietin in Extremely Low Gestational Age Neonates Does Not Alter Risk of Retinopathy of Prematurity

Neonatology ◽  
2020 ◽  
pp. 1-8
Author(s):  
Dennis E. Mayock ◽  
Zimeng Xie ◽  
Bryan A. Comstock ◽  
Patrick J. Heagerty ◽  
Sandra E. Juul ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Retinopathy Of Prematurity ◽  
High Frequency ◽  
High Dose ◽  
Heart Murmur ◽  
Treatment Groups ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

<b><i>Introduction:</i></b> The Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial sought to determine the safety and efficacy of early high-dose Epo as a potential neuroprotective treatment. We hypothesized that Epo would not increase the incidence or severity of retinopathy of prematurity (ROP). <b><i>Methods:</i></b> A total of 941 infants born between 24–0/7 and 27–6/7 weeks’ gestation were randomized to 1,000 U/kg Epo or placebo intravenously for 6 doses, followed by subcutaneous or sham injections of 400 U/kg Epo 3 times a week through 32 weeks post-menstrual age. In this secondary analysis of PENUT trial data, survivors were evaluated for ROP. A modified intention-to-treat approach was used to compare treatment groups. In addition, risk factors for ROP were evaluated using regression methods that account for multiples and allow for adjustment for treatment and gestational age at birth. <b><i>Results:</i></b> Of 845 subjects who underwent ROP examination, 503 were diagnosed with ROP with similar incidence and severity between treatment groups. Gestational age at birth, birth weight, prenatal magnesium sulfate, maternal antibiotic exposure, and presence of heart murmur at 2 weeks predicted the development of any ROP, while being on high-frequency oscillator or high-frequency jet ventilation (HFOV/HFJV) at 2 weeks predicted severe ROP. <b><i>Conclusion:</i></b> Early high-dose Epo followed by maintenance dosing through 32 weeks does not increase the risk of any or severe ROP in extremely low gestational age neonates. Gestational age, birth weight, maternal treatment with magnesium sulfate, antibiotic use during pregnancy, and presence of a heart murmur at 2 weeks were associated with increased risk of any ROP. Treatment with HFOV/HFJV was associated with an increased risk of severe ROP.

scholarly journals Gestational age at birth and child special educational needs: a UK representative birth cohort study

2021 ◽  
pp. archdischild-2020-320213
Author(s):  
Neora Alterman ◽  
Samantha Johnson ◽  
Claire Carson ◽  
Stavros Petrou ◽  
Oliver Rivero-Arias ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Sociodemographic Factors ◽  
Educational Needs ◽  
Birth Cohort Study ◽  
Special Educational Needs ◽  
Early Term ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

ObjectiveTo examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.MethodsThe Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.ResultsThe sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37–38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.ConclusionChildren born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.

Preterm birth, low fetal growth and risk of suicide in adulthood: a national cohort and co-sibling study

2021 ◽  
Author(s):  
Casey Crump ◽  
Jan Sundquist ◽  
Kenneth S Kendler ◽  
Alexis C Edwards ◽  
Kristina Sundquist
Keyword(s):  
Preterm Birth ◽  
Environmental Factors ◽  
Fetal Growth ◽  
Gestational Age ◽  
Cox Regression ◽  
Suicide Death ◽  
Increased Risk ◽  
National Cohort ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Background Adverse perinatal exposures have been associated with psychiatric disorders and suicidal behaviours later in life. However, the independent associations of gestational age at birth or fetal growth with suicide death, potential sex-specific differences, and causality of these associations are unclear. Methods A national cohort study was conducted of all 2 440 518 singletons born in Sweden during 1973–98 who survived to age 18 years, who were followed up through 2016. Cox regression was used to compute hazard ratios (HRs) for suicide death associated with gestational age at birth or fetal growth while mutually adjusting for these factors, sociodemographic characteristics and family history of suicide. Co-sibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors. Results In 31.2 million person-years of follow-up, 4470 (0.2%) deaths by suicide were identified. Early preterm birth (22–33 weeks) was associated with an increased risk of suicide among females [adjusted hazard ratio (HR), 1.97; 95% confidence interval CI), 1.29, 3.01; P = 0.002) but not males (0.90; 0.64, 1.28; P = 0.56), compared with full-term birth (39–41 weeks). Small for gestational age was associated with a modestly increased risk of suicide among females (adjusted HR, 1.27; 95% CI, 1.08, 1.51; P = 0.005) and males (1.14; 1.03, 1.27; P = 0.02). However, these associations were attenuated and non-significant after controlling for shared familial factors. Conclusions In this large national cohort, preterm birth in females and low fetal growth in males and females were associated with increased risks of suicide death in adulthood. However, these associations appeared to be non-causal and related to shared genetic or prenatal environmental factors within families.

scholarly journals Placental Abruption after Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: The Role of the Solomon Technique

2021 ◽  
pp. 1-7
Author(s):  
Patricia J.C. Knijnenburg ◽  
Enrico Lopriore ◽  
Yuchun Ge ◽  
Irene M. Scholl ◽  
Jeanine M.M. van Klink ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Laser Surgery ◽  
Placental Abruption ◽  
Group Versus ◽  
Cerebral Injury ◽  
Laser Technique ◽  
Solomon Technique ◽  
Gestational Age At Birth ◽  
Age At Birth

<b><i>Introduction:</i></b> Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a possible association between the Solomon laser technique and placental abruption. <b><i>Methods:</i></b> The objective of this study is to compare the rate of and to explore potential risk factors for placental abruption in TTTS treated with fetoscopic laser surgery according to the Selective and Solomon laser technique. We conducted a large retrospective cohort study of consecutive TTTS-cases treated with fetoscopic laser surgery in Shanghai, China, and Leiden, The Netherlands treated with either the Selective laser technique (Selective group) or Solomon laser technique (Solomon group). <b><i>Results:</i></b> The rate of placental abruption in the Selective group versus the Solomon group was 1.7% (5/289) and 3.4% (15/441), respectively (<i>p</i> = 0.184). No risk factors for placental abruption were identified. Placental abruption was associated with lower gestational age at birth (<i>p</i> = 0.003) and severe cerebral injury (<i>p</i> = 0.003). <b><i>Conclusion:</i></b> The prevalence of placental abruption in TTTS after fetoscopic laser surgery is low, although it appears higher than in the overall population. Placental abruption is associated with a lower gestational age at birth, which is associated with severe cerebral injury. The rate of placental abruption was not significantly increased with the use of the Solomon technique. Continued research of placental abruption in TTTS is necessary to determine why the rate is higher than in the overall population.

scholarly journals Black American Maternal Prenatal Choline, Offspring Gestational Age at Birth, and Developmental Predisposition to Mental Illness

2020 ◽  
Author(s):  
Sharon K Hunter ◽  
M Camille Hoffman ◽  
Lizbeth McCarthy ◽  
Angelo D’Alessandro ◽  
Anna Wyrwa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Black Americans ◽  
Mental Illnesses ◽  
Black American ◽  
American Women ◽  
Black American Women ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Black Americans have increased risk for schizophrenia and other mental illnesses with prenatal origins. Prenatal choline promotes infant brain development and behavioral outcomes, but choline has not been specifically assessed in Black Americans. Pregnant women (N = 183, N = 25 Black Americans) enrolled in a study of prenatal stressors and interactions with prenatal choline. Black American women had lower 16-week gestation plasma choline than Whites. Lower choline was not related to obesity, income, or metabolic genotypes. Pregnant women in rural Uganda have higher choline levels than Black American women. Black Americans’ lower choline was associated with higher hair cortisol, indicative of higher stress. Lower maternal choline was associated with offsprings’ lower gestational age at birth and with decreased auditory P50 inhibition, a marker of inhibitory neuron development. Behavioral development was assessed on the Infant Behavior Questionnaire-R-SF (IBQ-R) at 3 months. Lower Black American maternal gestational choline was associated with lower infant IBQ-R Orienting/Regulation, indicating decreased attention and relation to caregivers. Additional evidence for developmental effects of choline in Black Americans comes from a randomized clinical trial of gestational phosphatidylcholine supplementation versus placebo that included 15 Black Americans. Phosphatidylcholine increased gestational age at birth and newborn P50 inhibition and decreased Social Withdrawn and Attention problems at 40 months of age in Black Americans’ offspring compared to placebo. Inhibitory and behavioral deficits associated with lower prenatal choline in offspring of Black American women indicate potential developmental predispositions to later mental illnesses that might be ameliorated by prenatal choline or phosphatidylcholine supplementation.

scholarly journals Greater genetic risk for adult psychiatric diseases increases vulnerability to adverse outcome after preterm birth

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Harriet Cullen ◽  
Saskia Selzam ◽  
Konstantina Dimitrakopoulou ◽  
Robert Plomin ◽  
A. David Edwards
Keyword(s):  
Bipolar Disorder ◽  
Preterm Birth ◽  
Gestational Age ◽  
Interaction Effect ◽  
Genetic Risk ◽  
Autism Spectrum ◽  
Cognitive Outcome ◽  
Increased Risk ◽  
Gestational Age At Birth ◽  
Age At Birth

AbstractPreterm birth is an extreme environmental stress associated with an increased risk of later cognitive dysfunction and mental health problems. However, the extent to which preterm birth is modulated by genetic variation remains largely unclear. Here, we test for an interaction effect between psychiatric polygenic risk and gestational age at birth on cognition at age four. Our sample comprises 4934 unrelated individuals (2066 individuals born < 37 weeks, 918 born <  = 34 weeks). Genome-wide polygenic scores (GPS’s) were calculated for each individual for five different psychiatric pathologies: Schizophrenia, Bipolar Disorder, Major Depressive Disorder, Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder. Linear regression modelling was used to estimate the interaction effect between psychiatric GPS and gestational age at birth (GA) on cognitive outcome for the five psychiatric disorders. We found a significant interaction effect between Schizophrenia GPS and GA (β = 0.038 ± 0.013, p = 6.85 × 10–3) and Bipolar Disorder GPS and GA (β = 0.038 ± 0.014, p = 6.61 × 10–3) on cognitive outcome. Individuals with greater genetic risk for Schizophrenia or Bipolar Disorder are more vulnerable to the adverse effects of birth at early gestational age on brain development, as assessed by cognition at age four. Better understanding of gene-environment interactions will inform more effective risk-reducing interventions for this vulnerable population.

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