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Seminars in Fetal & Neonatal Medicine

Eero Kajantie, Sonja Strang-Karlsson, Kari Anne Indredavik Evensen, Peija Haaramo
The literature on adult outcomes of people born late preterm (LPT, 34-36 completed weeks) or early term (ET, 37-38 weeks) was reviewed. In PubMed, 9547 articles were identified; 53 were eligible. Of these, 12 were based on clinical cohorts, 32 on medical birth register linkages, and nine on historical birth cohorts; 48 out of 53 on Nordic countries; 50 out of 53 reported on LPT and eight out of 53 reported on ET. LPT plus ET have increased early (<45 years) adult all-cause mortality. Despite increased cardiometabolic risk factors and slightly lower cardiorespiratory fitness in LPT, no studies showed increased risk for coronary heart disease, some showed increased risk for stroke, and all showed increased risk for type 2 diabetes...
November 3, 2018: Seminars in Fetal & Neonatal Medicine
Trishula Muganthan, Elaine M Boyle
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity...
October 16, 2018: Seminars in Fetal & Neonatal Medicine
Jeanie Ling Yoong Cheong, Deanne Kim Thompson, Joy Elizabeth Olsen, Alicia Jane Spittle
With increasing evidence of neurodevelopmental problems faced by late preterm children, there is a need to explore possible underlying brain structural changes. The use of brain magnetic resonance imaging has provided insights of smaller and less mature brains in infants born late preterm, associated with developmental delay at 2 years. Another useful tool in the newborn period is neurobehavioural assessment, which has also been shown to be suboptimal in late preterm infants compared with tern infants. Suboptimal neurobehaviour is also associated with poorer 2-year neurodevelopment in late preterm infants...
October 14, 2018: Seminars in Fetal & Neonatal Medicine
Scott W White, John P Newnham
Late preterm and early term birth is associated with adverse short- and long-term consequences, particularly for neurodevelopment. A clear reduction in these births can be achieved by avoidance of non-medically indicated births prior to 39 weeks gestation, as shown following the introduction of prohibitive policies in the USA. However, clinicians and policy-makers must always consider the potential for unintended adverse consequences of such action, such as a potential for an increase in term stillbirth. Finding the balance between optimising long-term neurological outcomes and avoiding rare but devastating term stillbirths is one of the challenges of modern maternity care...
October 12, 2018: Seminars in Fetal & Neonatal Medicine
Brian A Darlow, Jeanie L Y Cheong
No abstract text is available yet for this article.
October 12, 2018: Seminars in Fetal & Neonatal Medicine
Mariana Muelbert, Jane E Harding, Frank H Bloomfield
Late preterm (LP) and early term (ET) infants can be considered the "great dissemblers": they resemble healthy full-term infants in appearance, but their immaturity places them at increased risk of poor short- and long-term outcomes. Nutritional requirements are greater than for full-term babies, but there are few good data on the nutritional requirements for LP and ET babies, leading to substantial variation in practice. Recent data indicate that rapid growth may be beneficial for neurocognitive function but not for body composition and later metabolic health...
October 12, 2018: Seminars in Fetal & Neonatal Medicine
Melissa Woythaler
Late preterm infants (born at 340/7 -366/7 weeks gestation) have been found to have increased morbidity and mortality compared to full term infants. Research has also been done to explore longer-term neurodevelopmental outcomes. This review details neurodevelopmental outcomes from birth to adulthood for late preterm infants. Outcome studies indicate that they are at increased risk of developmental disability, school failure, behavior problems, social and medical disabilities, and death. Many questions still remain regarding late preterm infant neurodevelopmental outcomes and future research should be done into this topic...
October 4, 2018: Seminars in Fetal & Neonatal Medicine
Hagar Rahel Haviv, Joanne Said, Ben Willem Mol
Infants born in the late preterm period and via non-labour caesarean section in the early term period are at increased risk of respiratory morbidity when compared to their term-born counterparts. The morbidity in these infants is less frequent and severe than in early preterm infants. Antenatal corticosteroids reduce respiratory morbidity in these populations; however, the magnitude of the reduction appears to be small and predominantly in the self-limiting condition of transient tachypnoea of the neonate. The smaller benefit, along with possible harmful effects of corticosteroids, raises a question about the role of antenatal corticosteroids in this population...
October 4, 2018: Seminars in Fetal & Neonatal Medicine
Natalie Suff, Lisa Story, Andrew Shennan
Preterm birth, defined as birth occurring prior to 37 weeks gestation, is a serious obstetric problem accounting for 11% of pregnancies worldwide. It is associated with significant neonatal morbidity and mortality. Predictive tests for preterm birth are incredibly important, given the huge personal, economic, and health impacts of preterm birth. They can provide reassurance for women who are unlikely to deliver early, but they are also important for highlighting those women at higher risk of premature delivery so that we can offer prophylactic interventions and help guide antenatal management decisions...
September 28, 2018: Seminars in Fetal & Neonatal Medicine
Gonzalo L Mariani, Nestor E Vain
In the poorest populations of the world the difficulties of performing a surgical procedure lead to extremely low cesarean section rates associated with very high perinatal mortality. Meanwhile the proportion of births by cesarean section has been increasing for several decades in many areas of the world, reaching alarmingly high rates especially in Latin America. This review aims to describe this secular trend. The causes of the increase in cesarean deliveries are analyzed with a multidimensional approach, trying to recognize the reasons behind the choice of the route of delivery...
September 26, 2018: Seminars in Fetal & Neonatal Medicine
Stavros Petrou
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...
September 26, 2018: Seminars in Fetal & Neonatal Medicine
Marie Delnord, Jennifer Zeitlin
Late preterm (34-36 weeks of gestational age (GA)), and early term (37-38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors...
September 18, 2018: Seminars in Fetal & Neonatal Medicine
Rakhee M Bowker, Xiaocai Yan, Isabelle G De Plaen
Necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm neonates, is a devastating disease characterized by intestinal tissue inflammation and necrosis. NEC pathogenesis is multifactorial but remains unclear. Translocation of bacteria and/or bacterial products across a weak intestinal barrier in the setting of impaired mucosal immunity leads to an exaggerated inflammatory response and secondary mucosal epithelial injury. In addition to prematurity, other risk factors for NEC include congenital heart disease, maternal pre-eclampsia with placental vascular insufficiency, severe anemia and blood transfusion - all conditions that predispose the intestine to ischemia...
September 6, 2018: Seminars in Fetal & Neonatal Medicine
Josef Neu
No abstract text is available yet for this article.
August 24, 2018: Seminars in Fetal & Neonatal Medicine
Charles R Hong, Sam M Han, Tom Jaksic
Necrotizing enterocolitis (NEC) is a potentially devastating condition that preferentially affects premature and low birth weight infants, with approximately half requiring acute surgical intervention. Surgical consult should be considered early on, and deterioration despite maximal medical therapy or the finding of pneumoperitoneum are the strongest indications for emergent surgical intervention. There is no clear consensus on the optimal surgical approach between peritoneal drainage and laparotomy; the best course of action likely depends on the infant's comorbidities, hemodynamic status, size, disease involvement, and available resources...
August 20, 2018: Seminars in Fetal & Neonatal Medicine
Alain Cuna, Lovya George, Venkatesh Sampath
The role of genetics in the pathogenesis of necrotizing enterocolitis (NEC) was initially informed by epidemiological data indicating differences in prevalence among different ethnic groups as well as concordance in twins. These early observations, together with major advances in genomic research, paved the way for studies that begin to reveal the contribution of genetics to NEC. Using the candidate gene or pathway approach, several potential pathogenic variants for NEC in premature infants have already been identified...
August 18, 2018: Seminars in Fetal & Neonatal Medicine
Taylor Sawyer, Henry C Lee, Khalid Aziz
A majority of babies initiate spontaneous respirations shortly after birth. Up to 10%, however, require resuscitative measures to make the transition from fetus to newborn. Ideally, the need for resuscitation at birth would be predicted before delivery, and a skilled neonatal resuscitation team would be available and ready. This is not always possible. Therefore, neonatal resuscitation teams must be prepared to provide lifesaving resuscitation at every delivery. In this report, we examine risk factors for resuscitation at birth, discuss the importance of communication between obstetric and newborn teams, review key questions to ask before delivery, and investigate antenatal counseling methods...
October 2018: Seminars in Fetal & Neonatal Medicine
Lindsay F J Mildenhall, Tetsuya Isayama
The majority of newborn resuscitations require very little beyond simple airway management and assisted ventilation. If cardiovascular collapse is serious enough to warrant additional support, resuscitation algorithms recommend moving to chest compressions and then on to medications and possibly volume replacement if vital signs remain marginal or absent. The evidence base upon which this part of the neonatal resuscitation algorithm is structured is sparse. Chest compressions and medications are rare interventions that do not lend themselves easily to clinical trials...
October 2018: Seminars in Fetal & Neonatal Medicine
M H Wyckoff, J Wyllie
No abstract text is available yet for this article.
October 2018: Seminars in Fetal & Neonatal Medicine
Anup Katheria, Shigeharu Hosono, Walid El-Naggar
In the past five years, umbilical cord management in both term and preterm infants has come full circle, going from the vast majority of infants receiving immediate cord clamping to virtually all governing organizations promoting placental transfusion, mainly in the form of delayed cord clamping (DCC). Placental transfusion refers to the transfer of more blood components to the infant during the first few minutes after birth. The different strategies for ensuring placental transfusion to the baby include delayed (deferred) cord clamping, milking of the attached cord before clamping, and milking of the cut cord...
October 2018: Seminars in Fetal & Neonatal Medicine
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