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R R Malla, R Asimi, M A Teli, F Shaheen, M A Bhat
OBJECTIVE: Erythropoietin (EPO) is neuroprotective after asphyxia in animal studies. The efficacy and safety of EPO monotherapy in term neonates with hypoxic ischemic encephalopathy (HIE) is uncertain. STUDY DESIGN: Hundred term neonates with moderate or severe HIE were randomized by random permuted block algorithm to receive either EPO 500 U kg(-1) per dose in 2 ml saline intravenously (50 neonates) on alternate days for a total of five doses with the first dose given by 6 h of age (treatment group) or 2 ml of normal saline (50 neonates) similarly for a total of five doses (placebo group) in a double-blind study...
March 9, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Ruth Martis, Ova Emilia, Detty S Nurdiati, Julie Brown
BACKGROUND: The goal of fetal monitoring in labour is the early detection of a hypoxic baby. There are a variety of tools and methods available for intermittent auscultation (IA) of the fetal heart rate (FHR). Low- and middle-income countries usually have only access to a Pinard/Laënnec or the use of a hand-held Doppler device. Currently, there is no robust evidence to guide clinical practice on the most effective IA tool to use, timing intervals and length of listening to the fetal heart for women during established labour...
February 13, 2017: Cochrane Database of Systematic Reviews
Zarko Alfirevic, Declan Devane, Gillian Ml Gyte, Anna Cuthbert
BACKGROUND: Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. OBJECTIVES: To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour...
February 3, 2017: Cochrane Database of Systematic Reviews
Ashley K Boyle, Sara F Rinaldi, Jane E Norman, Sarah J Stock
Preterm birth (PTB) is the leading cause of childhood mortality in children under 5 and accounts for approximately 11% of births worldwide. Premature babies are at risk of a number of health complications, notably cerebral palsy, but also respiratory and gastrointestinal disorders. Preterm deliveries can be medically indicated/elective procedures or they can occur spontaneously. Spontaneous PTB is commonly associated with intrauterine infection/inflammation. The presence of inflammatory mediators in utero has been associated with fetal injury, particularly affecting the fetal lungs and brain...
December 2, 2016: Journal of Reproductive Immunology
Ryosuke Hara, Shuhei Hara, Chin Siang Ong, Gary Schwartz, Christopher Sciortino, Narutoshi Hibino
We describe the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in a 35-year-old female with severe fixed pulmonary hypertension who went into cardiogenic shock during a Cesarean section. Pregnancy in the presence of severe pulmonary hypertension is typically contraindicated due to high maternal mortality rates. This patient visited our hospital at 37 weeks of gestation after experiencing dyspnea and chest pain. Clinical evaluation revealed severe fixed pulmonary hypertension. At the time of the planned delivery, femoral lines were placed; in case of emergency, ECMO became necessary during the delivery...
November 25, 2016: General Thoracic and Cardiovascular Surgery
R S Monteiro, D P Dob, M R Cauldwell, M A Gatzoulis
Women with a single ventricle circulation palliated with the Fontan operation require specialist multidisciplinary management. We report 14 such cases with successful pregnancies and detail the pathophysiology encountered. A combined obstetric and cardiac service between Chelsea and Westminster Hospital and Royal Brompton Hospital provides care for women with heart disease, and maintains a prospective database of referred women. We searched this database for women with a known Fontan circulation and reviewed the case notes and electronic patient records between January 1994 and December 2015...
December 2016: International Journal of Obstetric Anesthesia
A J Spittle, J Olsen, A Kwong, L W Doyle, P B Marschik, C Einspieler, Jly Cheong
INTRODUCTION: Infants born extremely preterm (EP; <28 weeks' gestation) and/or with extremely low birth weight (ELBW; <1000 g birth weight) are at increased risk for adverse neurodevelopmental outcomes. However, it is challenging to predict those EP/ELBW infants destined to have long-term neurodevelopmental impairments in order to target early intervention to those in most need. The General Movements Assessment (GMA) in early infancy has high predictive validity for neurodevelopmental outcomes in preterm infants...
October 3, 2016: BMJ Open
Ingeborg Forthun, Allen J Wilcox, Katrine Strandberg-Larsen, Dag Moster, Ellen A Nohr, Rolv Terje Lie, Pål Surén, Mette C Tollånes
OBJECTIVES: To investigate the association between maternal pre-pregnancy BMI and risk of cerebral palsy (CP) in offspring. METHODS: The study population consisted of 188 788 children in the Mothers and Babies in Norway and Denmark CP study, using data from 2 population-based, prospective birth cohorts: the Norwegian Mother and Child Cohort Study and the Danish National Birth Cohort. Prepregnancy BMI was classified as underweight (BMI <18.5), lower normal weight (BMI 18...
October 2016: Pediatrics
Sean Copson, Katrina Calvert, Puvaneswary Raman, Elizabeth Nathan, Mathias Epee
BACKGROUND: Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes. AIMS: This study aimed to determine if the introduction of a simulation-based training course was associated with an improvement in the management of cord prolapse, in particular the diagnosis to delivery interval...
September 7, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
Mette C Tollånes, Katrine Strandberg-Larsen, Ingeborg Forthun, Tanja Gram Petersen, Dag Moster, Anne-Marie Nybo Andersen, Camilla Stoltenberg, Jørn Olsen, Allen J Wilcox
PURPOSE: The purpose of MOthers and BAbies in Norway and Denmark cerebral palsy (MOBAND-CP) was to study CP aetiology in a prospective design. PARTICIPANTS: MOBAND-CP is a cohort of more than 210 000 children, created as a collaboration between the world's two largest pregnancy cohorts-the Norwegian Mother and Child Cohort study (MoBa) and the Danish National Birth Cohort. MOBAND-CP includes maternal interview/questionnaire data collected during pregnancy and follow-up, plus linked information from national health registries...
2016: BMJ Open
James C Johnston, Knut Wester, Thomas P Sartwelle
A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myths. Myths that may lead not only to misdiagnosis and treatment harms but to seemingly never-ending medical malpractice lawsuits, potentially culminating in a settlement or judgment against an unsuspecting neurologist...
August 2016: Neurologic Clinics
Sarah J Stock, Leanne Bricker, Jane E Norman, Helen M West
BACKGROUND: Immediate delivery of the preterm fetus with suspected compromise may decrease the risk of damage due to intrauterine hypoxia. However, it may also increase the risks of prematurity. OBJECTIVES: To assess the effects of immediate versus deferred delivery of preterm babies with suspected fetal compromise on neonatal, maternal and long-term outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2016) and reference lists of retrieved studies...
2016: Cochrane Database of Systematic Reviews
Kanya Mukhopadhyay, Rama Mahajan, Prahbhjot Malhi, Ashok Kumar
OBJECTIVE: To assess the neurodevelopmental, cognitive and behavioral function of extremely low birth weight babies (ELBW) till corrected age of two years. METHODS: 79 ELBW babies were enrolled and followed at 1 year (n=50), 18 months (n=47) and 2 years (n=36). Adverse composite outcome was defined as death or moderate-to-severe neurodevelopmental impairment (defined as either cerebral palsy or DQ score <70 or deafness or blindness). RESULTS: At 1 year, 24% were neurologically abnormal...
May 8, 2016: Indian Pediatrics
Prakasham Rumajogee, Tatiana Bregman, Steven P Miller, Jerome Y Yager, Michael G Fehlings
Cerebral palsy (CP) is a complex multifactorial disorder, affecting approximately 2.5-3/1000 live term births, and up to 22/1000 prematurely born babies. CP results from injury to the developing brain incurred before, during, or after birth. The most common form of this condition, spastic CP, is primarily associated with injury to the cerebral cortex and subcortical white matter as well as the deep gray matter. The major etiological factors of spastic CP are hypoxia/ischemia (HI), occurring during the last third of pregnancy and around birth age...
2016: Frontiers in Neurology
A Dussart, J De Buyst, C Djeunang, M Janssens, M-F Müller, E Strebelle, K Mathe, S Infantino, G Malfilâtre
This is the clinical history of a term baby born at home who presents a severe hyperbilirubinémia. The medical monitoring was assessed by a private midwife according to parental choice. On the third day of life, the newborn presented an icterus and was exposed to natural daylight in the familial greenhouse under the midwife recommandations. On that day, no laboratory test precised the bilirubin level. On the fifth day, a blood sampling revealed a very high blood bilirubinémia (31 mg/dl or 527 mmol/L), the baby is refered to our NICU and underwent an exchange transfusion...
January 2016: Revue Médicale de Bruxelles
Dominic Wilkinson, Emily Shepherd, Euan M Wallace
BACKGROUND: Melatonin is an antioxidant with anti-inflammatory and anti-apoptotic effects. Animal studies have supported a fetal neuroprotective role for melatonin when administered maternally. It is important to assess whether melatonin, given to the mother, can reduce the risk of neurosensory disabilities (including cerebral palsy) and death, associated with fetal brain injury, for the preterm or term compromised fetus. OBJECTIVES: To assess the effects of melatonin when used for neuroprotection of the fetus...
March 29, 2016: Cochrane Database of Systematic Reviews
Federica Accordino, Sara Consonni, Tiziana Fedeli, Gaia Kullman, Francesca Moltrasio, Alessandro Ghidini, Anna Locatelli
OBJECTIVE: Gestational age (GA) at delivery and spontaneous prematurity are independent risk factors for cerebral palsy (CP). The aim of this study is to investigate perinatal risk factors for CP in spontaneous preterm delivery. METHODS: A retrospective cohort study of all single pregnancies complicated by spontaneous preterm labor (PTL) or PPROM with delivery at <34 weeks from January 2006 to December 2012 was performed. We compared demographic, obstetric, neonatal, and placental histology variables in cases of spontaneous preterm birth in reference to the development of CP...
December 2016: Journal of Maternal-fetal & Neonatal Medicine
Radhika Sujatha, Naveen Jain
OBJECTIVES: To study the incidence of major neurodevelopmental disability (NDD) at 1 y age (corrected for prematurity) in a cohort of preterm Indian babies (≤33 wk) and to predict NDD based on perinatal risk factors. METHODS: This prospective cohort study was conducted at a referral neonatal intensive care unit (NICU) with a developmental follow up clinic in private sector in Kerala, India. The study was conducted for 4.5 y - January 2005 to July 2009. All preterm babies ≤33 wk at birth, discharged from the NICU were included...
July 2016: Indian Journal of Pediatrics
Giovanni Mento, Chiara Nosarti
Many survivors of preterm birth experience neurodevelopmental disabilities, such as cerebral palsy, visual and hearing problems. However, even in the absence of major neurological complications, premature babies show significant neuropsychological and behavioural deficits during childhood and beyond. While the clinical tools routinely used to assess neurocognitive development in those infants have been useful in detecting major clinical complications in early infancy, they have not been equally sensitive in identifying subtle cognitive impairments emerging during childhood...
July 2015: Translational pediatrics
Liam Dunn, Vicki Flenady, Sailesh Kumar
BACKGROUND: Labour is perhaps the most hazardous time in pregnancy. As many as 20 % of cerebral palsy cases in term infants result from intrapartum events and up to 63 % of babies who develop intrapartum compromise have no prior risk factors. Sildenafil citrate (SC), a phosphodiesterase 5 inhibitor, improves uterine blood supply through vasodilatation and potentially could improve placental perfusion and hence reduce the risk of intrapartum fetal hypoxia. The aim of this study is to evaluate the efficacy of SC to reduce the risk of intrapartum fetal compromise and the need for emergency operative delivery...
January 14, 2016: Journal of Translational Medicine
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