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American Journal of Perinatology Reports

Keliana O'Mara, Michael D Weiss
Hypoxic-ischemic encephalopathy (HIE) is a significant cause of morbidity and mortality in neonates. Therapeutic hypothermia reduces the risk of death or disability. Providing optimal sedation while neonates are undergoing therapeutic hypothermia is likely beneficial but may present therapeutic challenges. There are limited data describing the use of dexmedetomidine for sedation in patients undergoing therapeutic hypothermia. The objective of this study is to evaluate the efficacy and short-term safety of dexmedetomidine infusion for sedation in term neonates undergoing therapeutic hypothermia for HIE...
July 2018: American Journal of Perinatology Reports
Susan H Wootton, Sean C Blackwell, George Saade, Pamela D Berens, Maria Hutchinson, Charles E Green, Sujatha Sridhar, Kara M Elam, Jon E Tyson
Introduction  Despite strong recommendations, only 40.6% of pregnant women attending two prenatal clinics were vaccinated against influenza during the 2009 pandemic. We tested whether an opting-out approach would improve vaccine uptake. Methods  We conducted a randomized quality improvement (QI) trial to compare opting-out with conventional opting-in consent for influenza immunization. Women age ≥ 18 years attending the University of Texas Health Science Center at Houston (UTHealth) or UT-Medical Branch (UTMB) prenatal clinics during the 2010-2011 influenza season, were eligible...
July 2018: American Journal of Perinatology Reports
Yuji Kanai, Yoshinobu Honda, Tsuyoshi Honda, Minoru Sanpei
Background  Birth-related femur fractures are rare. They have been reported following difficult delivery and are commonly diagnosed immediately after birth or on the following day. However, some birth-related femur fractures are diagnosed several days after birth. Mechanisms underlying the development of delayed femur fracture are incompletely understood. Case  We report the case of a girl diagnosed with a left spiral femur fracture with associated edema and hypoesthesia on postpartum day 9. A nondisplacement femur fracture was identified on plain radiography at birth after cesarean section; however, it was undiagnosed due to the lack of symptoms...
July 2018: American Journal of Perinatology Reports
Dotun Ogunyemi, Andrew Jovanovski, James Liu, Perry Friedman, Nathaniel Sugiyama, James Creps, Ichchha Madan
Objective  To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design  From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results  Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy...
July 2018: American Journal of Perinatology Reports
Theresa Kuhn, Kristina Martimucci, Abdulla Al-Khan, Robyn Bilinski, Stacy Zamudio, Jesus Alvarez-Perez
Objective  To evaluate if prophylactic hypogastric artery ligation (HAL) decreases surgical blood loss and blood products transfused. Study Design  This is a retrospective cohort study comparing patients with placenta percreta undergoing prophylactic HAL at the time of cesarean hysterectomy versus those who did not. Data were presented as means ± standard deviations, proportions, or medians with interquartile ranges. Demographic and clinical data were compared in the groups using Student's t -test for normally distributed data or the Mann-Whitney U test for nonnormally distributed data...
April 2018: American Journal of Perinatology Reports
Ahmad Abdul Aziz, Sumesh Thomas, David Lautner, Essa Hamadan Al Awad
Scimitar syndrome is characterized by partial or total anomalous pulmonary venous return from the right lung along with pulmonary hypoplasia. We present a case of a 37 weeks' gestation male infant with antenatal ultrasound findings of suspected partial anomalous pulmonary venous return (PAPVR) and coarctation of the aorta. The newborn presented with respiratory distress, a chest X-ray and chest computed tomography (CT) angiogram confirmed the diagnosis of scimitar syndrome. The combination of scimitar syndrome with aortic coarctation is extremely rare with only a few cases previously reported...
April 2018: American Journal of Perinatology Reports
Veronica Mugarab Samedi, Amy Shafey, Essa Al Awad, Luis Murguia Favela
Healthy looking newborns may have severe combined immunodeficiency (SCID), and neonatologists frequently are the first physicians to encounter these patients. Physicians usually have a high index of suspicion for this condition in presence of certain risk factors (unexplained infants' deaths, consanguinity); however, >80% of infants with SCID have no positive family history. A timely diagnosis of this condition is crucial in decreasing both mortality and morbidity. The only way to detect SCID prior to the onset of infections is newborn screening (NBS)...
April 2018: American Journal of Perinatology Reports
Lisa C Bain, Alexandria I Kristensen-Cabrera, Henry C Lee
Objective  The objective of this study is to identify characteristics of neonatal intensive care unit (NICU) practice that influence successful retinopathy of prematurity (ROP) screening. Study Design  In this qualitative study, top, improved, and bottom performing NICUs in the California Perinatal Quality Care Collaborative were identified based on ROP screening rates and invited to participate. NICU personnel were interviewed using a semistructured questionnaire. Using thematic analysis, key factors that influence ROP screening were identified...
April 2018: American Journal of Perinatology Reports
Leen Al-Hafez, Michael L Pirics, Suneet P Chauhan
Objectives  The objective was to assess the composite neonatal morbidity (CNM) among diabetic women with sonographic estimated fetal weight (SEFW) at 10 to 90th versus >90th percentile for gestational age (GA). Study Design  The inclusion criteria for this retrospective study were singleton pregnancies at 34 to 41 weeks, complicated by diabetes, and that had SEFW within 4 weeks of delivery. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Results  Among the 140 cohorts that met the inclusion criteria, 72% had SEFW at 10th to 90th percentile for GA, and 28% at >90th percentile...
April 2018: American Journal of Perinatology Reports
Kristin Ashford, Niraj R Chavan, Amanda T Wiggins, Molly Malany Sayre, Andrea McCubbin, Agatha S Critchfield, John O'Brien
Objective  To assess differences in cytokine levels in cervicovaginal fluid (CVF) and serum across trimesters between women with preterm births (PTBs) and full-term births. Study Design  This multicenter study enrolled 302 women with a singleton gestation. CVF and serum cytokines, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-8, were measured. Women with at least one cytokine assessment and noted PTB status in their medical record were retained in the study ( N  = 272)...
April 2018: American Journal of Perinatology Reports
Kim A Boggess, Jeffrey B Baker, Amy P Murtha, Alan M Peaceman, Dinesh M Shah, Sylvia L Siegfried, Robert Birch
Objective  To measure pharmacokinetics of hydroxyprogesterone caproate (OHPC) and its major metabolites throughout pregnancy. Study Design  Thirty women were prescribed OHPC for recurrent preterm birth prevention. Three cohorts of subjects had blood drawn for 7 consecutive days at one of three times: cohort 1 ( n  = 6) after the first dose (weeks 16-20), cohort 2 ( n  = 8) between weeks 24 and 28, and cohort 3 ( n  = 16) between weeks 32 and 36. We measured serum trough levels after week 1 in cohort 1 or after two consecutive weekly doses in cohorts 2 and 3...
April 2018: American Journal of Perinatology Reports
Judith Gronbach, Harald Ehrhardt, Klaus-Peter Zimmer, Markus Waitz
Early pulmonary interstitial emphysema in extreme preterm neonates is closely linked with respiratory distress syndrome and exposure to mechanical ventilation. In severe cases, maintaining adequate gas exchange aiming to avoid further lung damage and other neonatal morbidities associated with systemic/pulmonary hypoperfusion, prolonged hypoxia, and respiratory acidosis can be challenging and requires in-depth knowledge into the pathophysiology of the disease. Herein, we report on very low birth weight twins who developed early pulmonary interstitial emphysema during noninvasive respiratory support...
April 2018: American Journal of Perinatology Reports
Jayasree Nair, Vasantha H S Kumar
Neonatal liver failure (NLF) is a rare diagnosis but carries with it significant risks of mortality and morbidity. Common etiologies for NLF include metabolic causes, gestational alloimmune liver disease (GALD or neonatal hemochromatosis), and viral infections. We report a case of liver failure in a premature infant with abnormal iron profile within 48 hours of birth. Lack of accepted guidelines for the initial management of severe jaundice with a high direct component in the first week after birth made treatment challenging...
April 2018: American Journal of Perinatology Reports
Tetsuya Kawakita, Chun-Chih Huang, Helain J Landy
Objective  The aim of the study was to examine the association between cervical exam at the time of artificial rupture of membranes (AROM) and cord prolapse. Study Design  We conducted a retrospective cohort study using the data from the Consortium on Safe Labor. We included women with cephalic presentation and singleton pregnancies at ≥ 23 weeks' gestation who underwent AROM during the course of labor. Multivariable logistic regression was used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (95% CI), controlling for prespecified covariates...
April 2018: American Journal of Perinatology Reports
Stefani Doucette, Anne Tierney, Anne Roggensack, Kamran Yusuf
Neonatal hyperthyroidism is rare disorder due to the passage of thyroid receptor antibodies (TRBs) from the mother to the fetus. Neonatal thyrotoxicosis can present in several ways and if unrecognized, can be fatal. We present a preterm neonate who developed fetal hydrops and tricuspid regurgitation in utero. The mother had a history of treated Grave's disease. The infant responded to maternal treatment antenatally and postnatal anti-thyroid treatment, with resolution of both the tricuspid regurgitation and hydrops...
April 2018: American Journal of Perinatology Reports
Alexander M Friedman, Mary L Campbell, Carolyn R Kline, Suzanne Wiesner, Mary E D'Alton, Laurence E Shields
Severe maternal morbidity and mortality are often preventable and obstetric early warning systems that alert care providers of potential impending critical illness may improve maternal safety. While literature on outcomes and test characteristics of maternal early warning systems is evolving, there is limited guidance on implementation. Given current interest in early warning systems and their potential role in care, the 2017 Society for Maternal-Fetal Medicine (SMFM) Annual Meeting dedicated a session to exploring early warning implementation across a wide range of hospital settings...
April 2018: American Journal of Perinatology Reports
Alison C Wortman, Stephanie L Schaefer, Donald D McIntire, Jeanne S Sheffield, Diane M Twickler
Objective  To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa. Study Design  This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge...
April 2018: American Journal of Perinatology Reports
B Petrikovsky, M Terrani, L Sichinava
Most commercial airlines allow pregnant women to fly up to 36 weeks of gestation. Available information suggests that noise, vibration, and cosmic radiation present a small risk for the pregnant air traveler. The goal of the study was to assess the possible effect of transatlantic flights on the condition of the third-trimester fetus. In total, 112 patients were recruited into the study between January 2005 and June 2016. All underwent a transatlantic flight in the third trimester of pregnancy. All underwent nonstress test before and within 12 hours after the transatlantic flight, and 24 hours later...
April 2018: American Journal of Perinatology Reports
Erika Uehara, Hiro Nakao, Yusuke Tsumura, Hisaya Nakadate, Shoichiro Amari, Hideshi Fujinaga, Yoshiyuki Tsutsumi, Dongchon Kang, Shouichi Ohga, Akira Ishiguro
Severe protein C (PC) deficiency leads to purpura fulminans and stroke in newborns. However, the clinical impact of plasma PC activity on the development of neonatal cerebral disease remains elusive. We report a case of hemorrhagic stroke associated with neonatal asphyxia and severe PC deficiency. Plasma PC and protein S activity 7 days after birth was 12% and 43%, respectively. No PROC mutation was found. PC levels did not exceed 20% until 2 months of age, even in the absence of consumption coagulopathy or vitamin K deficiency...
April 2018: American Journal of Perinatology Reports
Sarah Dotters-Katz, Alexis Panzer, Matthew Givens, Marcela Smid, Alice Chuang
Objective  We sought to determine the impact of preclinical exposure (shadowing) to labor and delivery (L&D) on medical students' perceptions of obstetrics and gynecology (OB/GYN). Study Design  We administered a written survey to rising third-year medical students at a single center prior to any clerkship. We described motivation/deterrents for shadowing among students, and experiences/perceptions of those students who shadowed. Results  In total, 119/136 (86%) students completed the survey. Of those, 29% participated in shadowing on L&D...
April 2018: American Journal of Perinatology Reports
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