Obstetrical outcomes of emergency compared with elective cervical cerclage

Objective: To study obstetric outcomes of emergency cerclage compared with elective cerclage.

Study design: Retrospective cohort study of pregnancy outcomes of patients who underwent cervical cerclage, performed according to ACOG guidelines, between January 2006 and December 2014. Patients who underwent emergency cerclage, due to cervical shortening or cervical dilation (emergency cerclage group) were compared with patients who underwent history-indicated cerclage (elective cerclage group). Emergency cerclage was not performed in patients with uterine contractions, vaginal bleeding, or signs of chorioamnionitis. Procedure-related complications were defined as rupture of membranes or chorioamnionitis occurring after cerclage placement and before 24 weeks of gestation.

Results: Overall, 154 patients with elective cerclage and 47 patients with emergency cerclage were included. Mean gestational age at cerclage operation was 13.1?±?1 and 20.2?±?3 weeks, respectively. There were no differences between the emergency cerclage group and the elective cerclage group regarding mean gestational age at delivery (36.1?±?3 versus 35.6?±?3, respectively, p?=?0.7), rate of deliveries beyond 34 weeks of gestation (81.81% versus 78.72%, respectively, p?=?0.67), rate of deliveries beyond 37 weeks of gestation (64.93% versus 59.57%, respectively, p?=?0.6), cesarean deliveries (33.11% versus 39.13%, p?=?0.48, respectively), or birthweight (2848 versus 2862 grams, respectively, p?=?0.9). Regarding procedure-related complications, there were no differences between the elective and the emergency cerclage groups in the rate of chorioamnionitis (1.29% versus 4.34%, respectively, p?=?0.22), or ruptured membranes (1.29% versus 4.34%, respectively, p?=?0.22).

Conclusion: Pregnancy outcomes of emergency cerclage are comparable with those of elective cerclage.     

Effect of early administration of probiotics on gut microflora and feeding in pre-term infants: a randomized controlled trial

Background: This study aimed to evaluate the effect of early probiotic administration on gut microflora and influence on feeding in pre-term infants.

Methods: A double-blind, randomized, controlled clinical study was conducted to assess the effect of probiotics [live, combined lactobacillus and bifidobacterium (LCB)] supplementation in pre-term infants. Sixty hospitalized pre-term babies were randomly assigned to two groups: a probiotics-supplemented group and the control group. The primary endpoint was measurement of lactobacillus and bifidobacterium in the gut. The secondary outcome was the rate of feeding intolerance.

Results: In the first weekend, the quantity of gut lactobacillus and bifidobacterium was significantly higher in the probiotics-supplemented group than in the control group [7.84?±?0.35 versus 6.39?±?0.53 (log copy number/g wet fecal weight), p?=?0.013; 8.52?±?0.23 versus 7.01?±?0.48, p?=?0.024, respectively]. In the second weekend, the amount of gut lactobacillus and bifidobacterium in the probiotics-supplemented group remained significantly higher (8.62?±?0.28 versus 7.34?±?0.59, p?=?0.036 and 9.45?±?0.64 versus 7.85?±?0.43, p?=?0.007, respectively). Fewer patients in the probiotics-supplemented group developed a feeding intolerance (13.3% versus 46.7%, p?=?0.013).

Conclusions: Probiotic supplementation in the hospitalized pre-term infants in the first 2 weeks of life resulted in higher amounts of lactobacillus and bifidobacterium in the gut and a concomitant lower rate of feeding intolerance.     

Evaluation of tissue Doppler-derived myocardial performance index in fetuses with intracardiac echogenic focus

Abstract

Objective: To compare cardiac function between fetuses with and without intracardiac echogenic foci (IEFs) by conventional echocardiography and tissue Doppler (TD) imaging.

Methods: Fetuses having IEF and no additional cardiac or extracardiac anomaly between 20 and 28 weeks (median 22 weeks) of gestation (n?=?61) were compared with healthy fetuses between 18 and 29 weeks (median 23 weeks) of gestation (n?=?55). Pulmonary artery and aortic peak velocities, atrioventricular (AV) early diastole (E) and atrial contraction (A) velocities and E/A ratios were measured. TD-derived myocardial performance index (MPI) was also measured.

Results: Tricuspid valve E/A ratios, which were 0.634?±?0.07 versus 0.639?±?0.06 (p?=?0.697), mitral valve E/A ratios, which were 0.604?±?0.08 versus 0.612?±?0.07 (p?=?0.600), aorta peak velocities, which were 0.709?±?0.11 versus 0.697?±?0.11 (p?=?0.592) and pulmonary artery peak velocities, which were 0.699?±?0.12 versus 0.694?±?0.11 (p?=?0.800) in the study and the control groups, respectively. TD-derived measurements in the study and control groups included tricuspid valve MPI, which were 0.452?±?0.08 versus 0.473?±?0.09 (p?=?0.221) and mitral valve MPI values, which were 0.444?±?0.1 versus 0.445?±?0.09 (p?=?0.965), respectively, and this difference was not statistically significant.

Conclusion: An isolated IEF is not associated with abnormal cardiac function. We suggest that the presence of an isolated IEF should not be an indication for fetal cardiac function examination either with conventional Doppler or TD imaging techniques, unless there is a coexisting cardiac or extracardiac anomaly.     

CRP levels in extremely low birth weight (ELBW) septic infants

Objective: Testing the validity of C-reactive protein (CRP) in extremely low birth weight (ELBW) infants.

Methods: During a five-year period, 483 infants with probable (36%) and definite sepsis (64%) were enrolled in the study.

Results: ELBW infants with definitive sepsis had CRP levels comparable with full-terms (p?=?0.992). However, the highest (hs) values were observed in infants >2500?g, 24?h after the septic work up whereas in those with birth weight (BW) <1000?g after 48?h. Highest CRP levels of infants with early sepsis were similar to those of the late onset ones (p?=?0.825). The causative microorganism had a strong influence on CRP values, as Gram negative germs produced significantly higher CRP levels in comparison to infants with Gram positive sepsis.

Conclusions: Highest CRP values in <1000?g infants increase in levels comparable to full terms, but with a 24-h delay.     

Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre

Objective: Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival.

Methods: Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group.

Results: Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/7?±?3.610 versus 29 and 3/7?±?3.530 weeks, p?=?0.009) and lower one-minute (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and five-minute Apgar scores (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and required aggressive resuscitation (p?=?0.003) and a greater number of inotropes (2.195?±?1.346 versus 1.069?±?0.704, p?<?0.001). Deceased infants were administered increased amounts of fluid during the first 24?h after birth (117.783?±?32.325 versus 99.379?±?17.728?mL/kg, p?=?0.004). A relatively short prothrombin time impacted survival (p?=?0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p?=?0.01).

Conclusion: Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.     

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography

Objectives: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case–control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Preeclamptic and control group consisted of 27 (mean age: 28.90?±?5.95 years, mean gestation: 32.0?±?4.55 weeks) and 54 (mean age: 29.48?±?5.78 years, mean gestation: 32.61?±?4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62?±?91.69 versus 370.98?±?167.82?cm³; p?=?0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24?±?8.41 versus 33.50?±?8.90%; p?=?0.043). Placental volume was significantly correlated with the estimated fetal weight (r?=?0.319; p?=?0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r?=?–0.244, p?=?0.024; r?=?–0.283, p?=?0.005; r?=?–0.241, p?=?0.024, respectively).

Conclusions: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.     

First trimester fetal heart rate as a predictor of newborn sex

Objective: To predict the sex of newborns using first trimester fetal heart rate (FHR).

Methods: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student’s t-tests while categorical variables were compared using Chi-square test.

Results: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0?±?9.1?bpm and for male fetuses 167.3?±?10.1?bpm (p?=?0.62). There was no significant difference in crown rump length between female and male fetuses (4.01?±?1.7 versus 3.98?±?1.7?cm; p?=?0.78) or in gestational age at birth (38.01?±?2.1 versus 38.08?±?2.1 weeks; p?=?0.67). The males were significantly heavier than females (3305.3?±?568.3 versus 3127.5?±?579.8?g; p?<?0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants.

Conclusions: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.     

Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter-associated infections in neonates

Objective: To compare clinical outcomes and hospital resource utilization of infants who had peripherally inserted central catheters removed early versus retained following diagnosis of central line-associated bloodstream infection.

Study Design: In a single centre retrospective cohort study, we compared outcomes of infants who had peripherally inserted central catheters removed early versus retained after diagnosis of central line-associated bloodstream infection. Mortality, cardio-respiratory deterioration, use of blood products and antibiotics were compared between groups.

Results: Over a 10-year period, of the 119 eligible infants, 38 had peripherally inserted central catheters removed early and 81 had catheters retained after diagnosis of central line-associated bloodstream infection. Baseline demographics, illness severity at onset of sepsis and distribution of organisms were similar between the groups. Infants in “catheter–retained” group required longer antibiotic usage (17?±?9 versus 13?±?6 days; p?=?0.025) and more frequent sequential positive blood cultures [31/81 (47%) versus 8/38 (22%), p?=?0.014). Infants with Gram-negative bacteremia demonstrated higher mortality when catheters were retained [43% (9/21) versus 7% (1/14); p?=?0.028].

Conclusions: Retaining peripherally inserted central catheters after diagnosis of central line-associated bloodstream infection was associated with longer duration of bacteremia and prolonged exposure to systemic antibiotics as well as increased mortality in Gram-negative bacteremia.     

Maternal cardiovascular profiling in the first trimester of pregnancies complicated with gestation-induced hypertension or fetal growth retardation: a pilot study

Abstract

Objective: In this study, we determine whether maternal cardiovascular (CV) profiling can detect first trimester differences between women with uncomplicated pregnancies (UP) and those who will develop gestational hypertensive disorders (GHD) or normotensive fetal growth retardation (FGR).

Methods: Cardiac, arterial, and venous function were evaluated in 242 pregnant women around 12 weeks of gestation, using impedance cardiography (ICG) and combined electrocardiogram – Doppler ultrasonography. After postnatal determination of gestational outcome, first trimester measurements were compared between groups using Mann–Whitney U test for continuous data or Fisher’s Exact test for categorical variables (SPSS 20.0).

Results: Compared to UP, first trimester aortic flow velocity index [71?±?0.96 versus 61?±?4.91 1/1000/s (p?=?0.016)], acceleration index [133?±?2.25 versus 106?±?11.26 1/100/s² (p?=?0.023)] and Heather index [23.1?±?0.35 versus 19.2?±?1.70?Ω/s² (p?=?0.019)] were lower in GHD pregnancies, and first trimester stroke volume [77?±?1.16 versus 67?±?3.97?ml (p?=?0.033)] and cardiac output [7.3?±?0.10 versus 6.2?±?0.31?l/min (p?=?0.025)] were lower in FGR pregnancies.

Conclusions: Maternal CV function in the first trimester of pregnancy differs between UP and those destined to develop GHD or FGR. This can be assessed with non-invasive maternal CV profiling, opening perspectives for the application of this technique in early gestational screening for GHD and FGR.     

Glycated albumin level during late pregnancy as a predictive factor for neonatal outcomes of women with diabetes

Purpose: To investigate the association between glycated albumin (GA) in diabetic mothers and complications in their children, and to determine GA cutoff values for predicting complications in infants.

Materials and methods: This hospital-based case-control study involved 71 Japanese diabetic mothers and their children. Mean GA values were compared between mothers of infants with and without complications, and relationship with number of complications was analyzed by Pearson’s correlation. Receiver operating characteristic analysis determined GA cutoff values for complications in infants.

Results: GA was significantly higher in mothers of children with neonatal hypoglycemia (15.8?±?3.2 versus 12.6?±?1.2%, p?<.001), respiratory disorders (15.7?±?3.6 versus 12.9?±?1.9%, p?<.001), hypocalcemia (15.9?±?3.7 versus 13.1?±?1.8%, p?<.001), polycythemia (15.7?±?2.3 versus 13.8?±?2.1%, p?=.009), myocardial hypertrophy (16.1?±?3.7 versus 13.1?±?2.3%, p?<.001), and large-for-date status (15.8?±?2.4 versus 13.7?±?3.1%, p?=?.006), showing significant positive correlation with number of complications in infants (r?=?.704, 95%CI: 0.579–0.797, p?Conclusions: GA is useful for predicting pregnancy outcomes in mothers with diabetes and must be maintained at low levels to prevent complications in infants.     

Management of patent ductus arteriosus in preterm infants: clinical judgment might be a fair option

Abstract

Objective: The objective of this study was to find out the percentage of preterm infants that needed treatment for patent ductus arteriosus (PDA), when treatment decision was based on clinical signs and symptoms, besides echocardiographic findings.

Methods: Daily echocardiographic evaluation was conducted in 39 preterms ≤29^6/7 weeks’ gestation. Patients with ductus arteriosus were closely followed-up for clinical symptoms of PDA for treatment decision until ductus arteriosus was closed either spontaneously or by treatment.

Results: PDA was found in 25 (64%) infants. Mean gestational age and birth weight (BW) of the patients with PDA were 27.8?±?1.2 and 998?±?221?g, respectively. PDA closed spontaneously or had minimal ductal shunting before any signs and symptoms attributable to PDA were observed in 16 (41%) infants. Mean ductus size/BW ratio and mean left atrial/aortic root ratio were significantly higher in 9 (23%) symptomatic patients (2.06?±?0.75 versus 1.32?±?0.75?mm, p?=?0.012 and 1.31?±?0.52 versus 1.19?±?0.2?mm, p?=?0.043, respectively). PDA closure was observed after the first dose of ibuprofen in six of nine patients.

Conclusion: Correlation of clinical signs with echocardiographic findings for the decision of PDA treatment can be appropriate to prevent unnecessary medical treatments.     

Comparison of non-synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as post-extubation respiratory support in preterm infants with respiratory distress syndrome: a randomized controlled trial

Objective: To determine whether post-extubation respiratory support via nsNIPPV decreases the need for mechanical ventilation (MV) compared to nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress syndrome (RDS).

Methods: In this randomized, controlled, open, prospective, single-center clinical trial, we randomly assigned preterm ventilated infants with RDS to either nsNIPPV or NCPAP after extubation. The primary outcome, extubation failure, was defined by pre-specified failure criteria in the 72 hours after extubation.

Results: A total of 63 preterm ventilated infants were randomized to receive either nsNIPPV (n?=?31) or NCPAP (n?=?32). Extubation failure occurred in six (19.3%) of nsNIPPV group compared with nine (28.12%) of NCPAP group and was statistically not significant (p?=?0.55). The duration of NIV was significantly lower in nsNIPPV group as compared to NCPAP group (40.4?±?39.3 hours versus 111.8?±?116.4 hours, p?=?0.003). The duration of supplementary oxygen was significantly lower in nsNIPPV versus NCPAP group (84.9?±?92.1 hours versus 190.1?±?140.5 hours, p?=?0.002). The rates of BPD in nsNIPPV group (2/29, 6.9%) were significantly lower than in NCPAP group (9/28, 32.14%) (p?=?0.02).

Conclusions: Compared to NCPAP, nsNIPPV appears to be a feasible mode of extubation in preterm infants with significant beneficial effects of reduced duration of NIV support, supplementary oxygen and decreased rates of BPD.     

Nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure for transient tachypnea of newborn: a randomized,prospective study

Abstract

Objective: To evaluate the efficacy of nasal intermittent mandatory ventilation (NIMV) in reducing the duration of respiratory distress compared with nasal continuous positive airway pressure (NCPAP) in transient tachypnea of the newborn (TTN).

Patient and methods: ?n this randomized-prospective study, 40 infants with a gestational age ≥37 weeks and birth weight ≥2000?g with TTN were randomized to either nonsynchronized NIMV (n?=?20) or NCPAP (n?=?20). The primary end point was the reduction of the duration of respiratory distress. Secondary end points were the duration and level of oxygen supplementation, the incidence of complications such as pneumothorax, pneumonia and respiratory failure requiring entubation.

Results: There were no significant difference in the duration of respiratory support (28.0?±?19.2?h versus 32.2?±?23.3?h, p?=?0.231), O₂ therapy (31.2?±?15.6?h versus 29.0?±?19.3?h, p?=?0.187), duration of TTN (67.6?±?36.5?h versus 63.3?±?39.1?h, p?=?0.480) and hospitalization (6.2?±?2.6?d versus 5.4?±?2.0?d, p?=?0.330) between the groups. The rate of complications were not significantly different between the groups.

Conclusion: Our study indicates that NIMV is well tolerated and as effective as NCPAP in the treatment of TTN.     

Low-birth-weight,but not catch-up growth,correlates with insulin resistance and resistin level in SGA infants at 12 months

Objective: To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters.

Methods: One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated.

Results: The SGAs had increased insulin (5.2?±?2.7 versus 2.9?±?2.4 μIU/ml, p?=?0.012) and HOMA-IR (1.09?±?0.9 versus 0.59?±?0.55, p?=?0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β?=??2.92, p?=?0.015 for insulin, β?=??2.98, p?=?0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1?±?2.1 versus 3.9?±?2.1?ng/ml, p?=?0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R?=??0.33, p?=?0.007) and positively with lipoprotein(a) (R?=?0.49, p?=?0.001).

Conclusion: Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification.     

Fetal cardiac axis in non-anomalous pregnancies: does fetal gender or maternal body mass index (BMI) matter?

Objectives: To determine if cardiac axis obtained at an early ultrasound study (11–15 weeks) differs from that obtained at a late ultrasound study (18–22 weeks) in the same fetus and to evaluate the impact of fetal gender and/or maternal body mass index (BMI).

Methods: Cardiac axes of 324 non-anomalous fetuses at 11–15 weeks gestation were measured, with follow-up measurements obtained at 18–22 weeks. Comparisons were performed based on gestational age period, fetal gender and obese/non-obese maternal status.

Results: (1) Mean fetal cardiac axis did not change between 11 and 15 weeks; p?=?0.8, (2) mean fetal cardiac axis was more levorotated at 11–15 weeks than measurements obtained at 18–22 weeks; 48.1?±?7.1° versus 43.7?±?8.9°; p?<?0.0001, (3) male fetuses had less levorotated cardiac axis than female fetuses in late ultrasound studies but there was no difference between them at early ultrasound studies; 18–22 weeks male fetus, 42.7?±?9.3° versus female fetus, 45.2?±?8.3°; p?=?0.02 and 11–15 weeks male fetus, 48.1?±?7.0° versus female fetus, 48.4?±?7.4°, p?=?0.7, respectively, and (4) similar trends with the overall study population were observed in the comparison between fetuses of obese and non-obese women.

Conclusion: Fetal cardiac axis remains stable at 11–15 weeks, becoming less levorotated at 18–22 weeks. This may be attributed to increments in fetal lung volume. The differences in cardiac axis measurements between male and female fetuses examined at 18–22 weeks may also be attributable to differences in increment of fetal lung volume during this gestational age period.     

In resource limited areas complete enteral feed in stable very low birth weight infants (1000–1500 g) started within 24 h of life can improve nutritional outcome

Objective: To evaluate feasibility of complete enteral feed (CEF) in stable very low birth weight neonates weighing 1000–1500?g.

Subjects and interventions: One hundred and three stable very low birth weight (vlbw) neonates (1000–1500?g) irrespective of gestational age (GA) were randomized to receive either CEF with expressed breast milk (EBM) (n?=?51) or minimal enteral feed (MEF) supplemented with intravenous fluid (IVF). (MEF) (n?=?52). Feed volume was increased progressively. Primary outcome measures were feed intolerance (FI) and necrotizing enterocolitis (NEC) in first 21 days of life or discharge from NICU, whichever was earlier. Secondary outcome measures were the time taken to reach calorie intake of 110?kcal/kg/D and regain of birthweight.

Results: FI was observed in n?=?12 (23.53%) in CEF group versus n?=?6 (11.53%) in MEF group (p?=?0.1264). NEC was observed in 4 (7.8%) in CEF group versus 1(1.9%) in MEF group (p?=?0.16) and results were comparable in both groups. Birthweight regain (10.6?±?1.6 days versus 11.8?±?1.6 days, p?=?0.038), NICU discharge (11.7?±?2.6 days versus 13.0?±?3.45 days, p?=?0.038) and time to reach 110?kcal/kg/day (9.571?±?1.458 days versus 10.833?±?1.655 days, p?=?0.001) were significantly earlier in CEF compared to MEF group.

Conclusion: Complete enteral feeds started within 24?h of life is feasible in vlbw neonates.     

Correlation between fetal heart rate reactivity and mortality and severe neurological morbidity in extremely low birth weight infants

Objective: To determine the correlation between specific fetal heart rate (FHR) abnormalities and the incidence of death, severe (grade 3–4) intraventricular hemorrhage (IVH) and periventricular echogenicity (PVE) in extremely low birth weight infants (ELBW) within the first 4 days after birth. Methods: The study included live-born ELBW infants ≤ 30 weeks’ gestation who were born in 2000–2007 at Kaplan Medical Center, Rehovot, Israel, and, who had FHR monitoring during the 24?h before delivery and cranial ultrasound during the first 4 days of life. FHR pattern was analyzed for the presence of baseline rate, reactivity, variability and decelerations. Results: 96 infants with mean birth weight 757?±?150?g and mean gestational age 25.8?±?1.5 weeks were included. By 4 days of life, 23/96 (24%) died, 17/96 (18%) developed severe IVH and 31/96 (32%) had PVE. Absence of reactivity was significantly associated with increase in both death (p?=?0.02, OR 3.45, 95% CI: 1.22–9.47 and severe IVH (p?=?0.029, OR 3.33, 95% CI: 1.25–10) but not with PVE. Other FHR parameters were not associated with adverse outcome. Conclusion: These results suggest that FHR reactivity may be of value in predicting short-term outcome in ELBW infants. This may be helpful in counseling parents with imminent extremely preterm birth.     

Prebiotics for the management of hyperbilirubinemia in preterm neonates

Objective: We evaluated if prebiotics have benefits for the management of hyperbilirubinemia in preterm neonates.

Methods: Preterm neonates were entered into the study when enteral feeding volume met 30?mL/kg/day. They randomly received a mixture of short-chain galacto-oligosacarids/long-chain fructo-oligosacarids or distilled water (placebo) for 1 week. Total serum bilirubin level was measured by transcutaneous bilirubinometry. Stool frequency and meeting full enteral feeding during the study period were considered as secondary outcomes.

Results: Twenty-five neonates in each group completed the trial. Bilirubin level was decreased with the prebiotic (?1.3?± 1.8?mg/dL, p?=?0.004), but not placebo (?0.1?±?3.3?mg/dL, p?=?0.416). Peak bilirubin level was lower with the prebiotic than placebo (8.3?±?1.7 versus 10.1?±?2.2?mg/dL, p?=?0.003). Stool frequency was increased with the prebiotic (0.7?±?1.9 defecation/day, p?=?0.014), but not with placebo (0.6?± 1.5 defecation/day, p?=?0.133). Average stool frequency (2.4?± 0.4 versus 1.9?±?0.5 defecation/day, p?=?0.003) and frequently of meeting full enteral feeding (60% versus 16%, p?=?0.002) were higher with the prebiotic than placebo.

Conclusions: Prebiotic oligosaccharides increase stool frequency, improve feeding tolerance and reduce bilirubin level in preterm neonates and therefore can be efficacious for the management of neonatal hyperbilirubinemia.     

Does gender of the fetus have any relation with fetal heart monitoring during the first and second stage of labor?

Objective: To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being.

Methods: We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation.

A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight.

Results: A total of 682 pregnancies were included in the study, of them 56% (n?=?383) were carrying a male fetus and 44% (n?=?299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1, p?=?0.001) and the second stage (77.6 versus 67.7, p?=?0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%, p?p?2, PO₂) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28–2.43, p?=?0.001) and second stage (OR 1.73, 95% CI 1.20–2.50, p?Conclusions: The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor.     

Evaluation of point-of-care maternal venous lactate testing in normal pregnancy

Objective: There is little information about whether the established non-pregnant adult venous lactate reference range is appropriate for pregnancy. This prospective observational study examined whether the non-pregnant adult reference range is appropriate during pregnancy.

Methods: Women attending for routine prenatal appointments or elective cesarean delivery in a tertiary hospital were recruited. Clinical details were recorded and venous lactate concentration was measured using a point-of-care (POC) device.

Results: Of the 246 women, 199 were 6–18 weeks’ gestation and 47 were 36–42 weeks’ gestation. Mean lactate concentration was within the non-pregnant reference range in early and late pregnancy (0.86 SD?±?0.46?mmol/L and 1.15 SD?±?0.40?mmol/L, respectively). The mean time between phlebotomy and result was 6.1 SD?±?1.7?min. There was no correlation between lactate levels and either maternal age or time interval from tourniquet placement to lactate measurement. In women of 6–18 weeks’ gestation positive bivariate relationships were found between lactate and BMI (p?=?0.03, r?=?0.158), earlier gestational age (p?=?0.04, r=??0.145), and smoking (p?=?0.01, r?=?0.183), but these were not found in late pregnancy.

Conclusions: The venous lactate reference range for the non-pregnant adult may be applied in pregnancy. Further studies should examine lactate dynamics in labor and postpartum.