Maternal and Neonatal Risk Factors Affecting the Occurrence of Neurodevelopmental Disorders: A Population-Based Nationwide Study

To investigate the maternal and neonatal risk factors related to pregnancy and birth affecting the occurrence of neurodevelopmental disorders to their children using the medical claim data for the whole population. The study was conducted on all the babies born in Korea from 2005 to 2009 based on data from the National Health Information Database. All birth records were tracked from birth to December 31, 2015. To analyze factors related to the mother, data related to the mother of the newborn were collected. Increased maternal age was found to increase the risk of cerebral palsy (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] [1.22, 1.75]) and autism spectrum disorder (aOR = 1.48, 95% CI [1.25, 1.76]), while lowering the risk of intellectual disability (aOR = 1.83, 95% CI [1.33, 2.53]) and speech and language impairment (aOR = 1.41, 95% CI [1.08, 1.83]) compared with the reference group aged 25 to 29 years old. The incidence affected by socioeconomic factors varied according to the types of disorders. Among various risk factors, prematurity or low birth weight, problems associated with amniotic fluid or amniotic membrane, preeclampsia or eclampsia, and cesarean section affect the incidence of neurodevelopmental disorders. To reduce the incidence or severity of neurodevelopmental disorders, a better understanding of the risk factors of neurodevelopmental disorders is important. The results of this study can be used as basic data to help such understanding.

Lung function trajectories in children with post-prematurity respiratory disease: identifying risk factors for abnormal growth

Background Survivors of prematurity are at risk for abnormal childhood lung function. Few studies have addressed trajectories of lung function and risk factors for abnormal growth in childhood. This study aims to describe changes in lung function in a contemporary cohort of children born preterm followed longitudinally in pulmonary clinic for post-prematurity respiratory disease and to assess maternal and neonatal risk factors associated with decreased lung function trajectories. Methods Observational cohort of 164 children born preterm ≤ 32 weeks gestation followed in pulmonary clinic at Boston Children’s Hospital with pulmonary function testing. We collected demographics and neonatal history. We used multivariable linear regression to identify the impact of neonatal and maternal risk factors on lung function trajectories in childhood. Results We identified 264 studies from 82 subjects with acceptable longitudinal FEV1 data and 138 studies from 47 subjects with acceptable longitudinal FVC and FEV1/FVC data. FEV1% predicted and FEV1/FVC were reduced compared to childhood norms. Growth in FVC outpaced FEV1, resulting in an FEV1/FVC that declined over time. In multivariable analyses, longer duration of mechanical ventilation was associated with a lower rate of rise in FEV1% predicted and greater decline in FEV1/FVC, and postnatal steroid exposure in the NICU was associated with a lower rate of rise in FEV1 and FVC % predicted. Maternal atopy and asthma were associated with a lower rate of rise in FEV1% predicted. Conclusions Children with post-prematurity respiratory disease demonstrate worsening obstruction in lung function throughout childhood. Neonatal risk factors including exposure to mechanical ventilation and postnatal steroids, as well as maternal atopy and asthma, were associated with diminished rate of rise in lung function. These results may have implications for lung function trajectories into adulthood.

Clinical profile of hypoglycemia in neonates admitted in neonatal intensive care unit of a tertiary care hospital

Background: This study was conducted to study the clinical profile of hypoglycemia in newborn and to determine the prevalence of hypoglycemia among neonates admitted in NICU.Methods: All newborns admitted in NICU were examined and those with hypoglycemia (GMR<45 mg/dl) were included in the study and observed. In neonates with risk factors blood sugar was screened at 2, 6, 12, 24, 48 and 72 hours of life or whenever symptoms suggestive of hypoglycemia developed in any neonates and for critically sick neonates blood sugar was screened in every 6 hour in active phase of illness. Any neonates with blood glucose level less than 45 mg/dl were analysed for maternal risk factors, neonatal risk factors and course in the NICU.Results: The prevalence of neonatal hypoglycemia was 14.9% among NICU admissions. The maternal risk factors were GDM, PIH, and PROM. The neonatal risk factors were prematurity, SGA, LGA and comorbid conditions which include perinatal asphyxia, sepsis, polycythemia, shock. The common symptoms were poor feeding, lethargy, jitteriness, convulsions, irritability, hypotonia and cyanosis. Majority of the neonates required only oral feeds for correction of hypoglycemia.Conclusions: Blood glucose screening in neonates with this risk factor is mandatory as many of the neonates were asymptomatic. The importance of early initiation of breast feeding to prevent hypoglycemia should be emphasized.

Necrotizing enterocolitis in term neonates: Possible risk factors

Background: Necrotizing enterocolitis (NEC) is a common surgical disease in premature neonates, however, it may occasionally occur in term neonates. The etiology of NEC in prematurity is multifactorial but is still not well understood in term neonates. In this study, the maternal and neonatal risk factors, along with underlying pathology that may precipitate NEC in term neonates are investigated. Methods: A retrospective study investigating the maternal and neonatal risk factors for NEC in term neonates (G.A ≥37 weeks) was performed over an 8-years period (January 2009 to March 2017). We used the second group of healthy term neonates over the same period as a control group. The data were collected from medical records. Term babies with the primary diagnosis of NEC were included in the review. Premature neonates (G.A <37 weeks) and NEC secondary to intestinal obstruction (e.g. Hirschsprung’s disease) were excluded from the study. Results: Of 194 babies with NEC, 14 were term neonates. Maternal risk factors: maternal age, Rhesus status, nicotine use, medication use, chronic and gestational illness were not found to be significant, however, maternal methamphetamine (MA) abuse was found to be a significant risk factor. Neonatal risk factors: genetic disorder, mode of delivery, type of milk, and invasive procedure were not found to be significant, but the presence of congenital heart disease (CHD) was a significant risk factor. Three neonates with CHD (3/4) in the group of term neonates with NEC also had maternal MA use. Conclusion: NEC in term neonates is rarely encountered. CHD is well known to precipitate the disease in premature or full-term neonates, as also noted in this cohort. MA usage was also noted as a possible underlying cause.