摘要:

ObjectiveTo assess the neurodevelopmental outcome of infants born at 24–26 weeks' gestation.MethodsOne hundred thirty-eight nonanomalous infants were born at our hospital after pregnancies of 24–26 weeks' gestation between 1990 and 1994. Ninety-four infants survived to discharge and 86 were followed in a nursery follow-up program for outcome. Associations between gestational age and neurodevelopmental outcome and risk factors and outcome were analyzed. Mean age at follow-up was 32 months.ResultsThe frequency of cerebral palsy did not differ significantly in the three groups (11, 20, and 11% at 24, 25, and 26 weeks, respectively). The incidence of normal cognitive outcome was associated significantly with gestational age at birth (28, 47, and 71% normal at 24, 25, and 26 weeks, respectively). Poor neurologic outcome was associated with the medical risk factor of intracranial hemorrhage grade 3 or 4 or periventricular leukomalacia. Poor cognitive outcome was correlated with both medical and social risk factors; however, there was an association between poor cognitive outcome and lower gestational age (P<.05), regardless of the relationships of any other risk factors to cognitive outcome.ConclusionAlthough the incidence of cerebral palsy was low in these three groups, the high percentage of infants born at 24 and 25 weeks' gestation with cognitive deficits is concerning.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo study umbilical cord interleukin-6 levels and the occurrence of neonatal sepsis, congenital pneumonia, necrotizing enterocolitis, and grade II–IV intraventricular hemorrhage.MethodsUmbilical cord blood was collected from 133 preterm newborns. The study population was divided according to the presence or absence of neonatal complications. Interleukin-6 levels and clinical characteristics were compared by univariate and multivariate analyses.ResultsSixteen neonates had adverse outcomes, and 117 were unaffected. The median interleukin-6 level was significantly higher in affected than in unaffected infants (145 pg/mL versus 0 pg/mL,P= .002). Elevated interleukin-6 levels were associated independently with neonatal morbidityin multiple logistic regression modeling that included gestational age, birth weight, and antenatal steroid exposure.ConclusionUmbilical cord blood interleukin-6 levels are elevated in neonates who subsequently develop sepsis, congenital pneumonia, necrotizing enterocolitis, or grade II–IV intraventricular hemorrhage.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the effects of multiple courses of maternal betamethasone for fetal lung maturation on neonatal serum cortisol levels and clinical Cushing syndrome.MethodsSeventy-nine mother-infant pairs delivered between 24 and 36 weeks' gestation were enrolled in the study. They were grouped according to the number of courses of betamethasone received between 24 and 34 weeks' gestation for fetal lung maturation: those receiving no courses, one course, and two or more courses. Physical examinations were performed and serum glucose, electrolyte, and cortisol levels were measured on days 1 and 3 of life.ResultsFor those receiving multiple courses of betamethasone (n= 43), the mean (± standard error of the mean [SEM]) number of courses was 5.3 ± 0.4, with a mean (± SEM) total dose of 125.0 ± 10.7 mg. No neonates had findings suggestive of Cushing syndrome. Day 1 cortisol levels (pooled mean ± SEM) were 12.6 ± 2.4, 5.3 ± 3.2, and 4.4 ± 1.8 μg/dL in those receiving no courses, one course, and two or more courses, respectively (P= .03; no courses versus two or more courses,P= .03), but the differences were not significant when corrected for multiple variables. Differences among day 3 cortisol levels (pooled mean ± SEM) were not significant: 8.3 ± 1.6, 5.8 ± 1.4, and 5.8 ± 0.9 μg/dL in those receiving no courses, one course, and two or more courses, respectively. None of the neonates in the group receiving no courses of betamethasone had day 1 cortisol levels lower than normal, whereas 22% and 11% of the neonates receiving one and two or more courses, respectively, had day 1 levels lower than normal. On day 3, 15% of those receiving one course and 10% of those receiving two or more courses had serum cortisol levels lower than normal, whereas none of those who received no courses had a low cortisol level. Multivariate regression analysis could show no association between the number of courses or total dose of betamethasone and the day 1 or day 3 cortisol values. The day 1 cortisol level (log10) was most associated with the severity of respiratory distress syndrome (RDS) and day 3 cortisol level (log10) with race and severity of RDS. Only in neonates with absent or mild RDS did number of courses correlate with day 3 cortisol levels (log10), but this was a positive correlation.ConclusionSerum cortisol levels either were independent of the number of courses or total dose of corticosteroids given or, in a subpopulation, were associated with increasing levels with increasing doses, suggesting that there is no suppressive effect with repeated dosing.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the marginal cost-effectiveness of two strategies for preventing respiratory distress syndrome (RDS) resulting from preterm birth: 1) tocolysis with beta-mimetic agonists and treatment with corticosteroids (TREATALL), and 2) amniocentesis and testing for fetal lung maturity, with treatment based on test results (TESTALL), compared with no treatment.MethodsWe used a Markov decision analytic model to estimate the outcomes of each strategy, from a hospitalbased perspective. Probability variables were obtained from the literature, whereas cost variables came from the Beth Israel-Deaconess Medical Center. Sensitivity analysis was performed on all variables.ResultsThe most cost-effective strategy varied with the probability of RDS. TREATALL was the most cost-effective strategy above a probability of 17% (before 34 weeks' gestation), TESTALL was most cost-effective from 17% to 2% (34–36 weeks), and it was most cost-effective to use no treatment at probabilities less than 2% (after 36 weeks). TREATALL and TESTALL were both cost-saving compared with no treatment at probabilities of RDS above 2%. TREATALL was more highly favored as the costs of RDS and preterm birth increased, whereas TESTALL was more favored as the specificity of the test and the cost of maternal hospitalization increased.ConclusionAlthough testing for fetal lung maturity is useful in many clinical situations, the cost-effectiveness of such testing in the setting of idiopathic preterm labor from a tertiary medical center perspective depends primarily on the probability and costs of RDS and the costs of non-RDS-related morbidity. At our institution, such testing is costeffective between 34 and 36 weeks' gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify placental histopathology associated with absent and reversed end-diastolic flow demonstrated by umbilical artery (UA) Doppler velocimetry in fetal growth restriction (FGR).MethodsBetween January 1989 and June 1995, 64 consecutive, nonanomalous singletons at less than the tenth percentile for birth weight were admitted to the neonatal intensive care unit, with UA Doppler velocimetry obtained within 3 days of delivery; 54 of the 64 (84%) had placental histopathology. Umbilical artery Doppler wave forms were classified as having end-diastolic flow (n= 26), and either absent (n= 20) or reversed end-diastolic flow (n= 8). Blinded review of placental histology scored lesions in categories of intraplacental vaso-occlusion, uteroplacental vascular pathology, chronic inflammation, and coagulation.ResultsUsing cases of FGR with end-diastolic flow present as the control population, we found that absent end-diastolic flow cases had significantly more fetal stem vessels with medial hyperplasia and luminal obliteration, and cases of reversed end-diastolic flow had significantly more poorly vascularized terminal villi, villous stromal hemorrhage, “hemorrhagic endovasculitis,” and abnormally thin-walled fetal stem vessels (eachP<.005).ConclusionIn FGR, UA Doppler velocity wave forms do not demonstrate a continuum of placental lesions in which reversed end-diastolic flow reflects more severe placental histopathology than absent end-diastolic flow and enddiastolic flow present. As expected, absent end-diastolic flow cases had more occlusive lesions of the intraplacental vasculature. In reversed end-diastolic flow, lesions suggesting vascular remodeling and/or damage by pathologic conditions of intraplacental flow predominated.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundFetal heart rate (FHR) values in the averaged format that are provided by commercial computed cardiotocography analysis systems may be unsuitable for special analysis purposes.MethodI developed a communication software program to obtain any measured values of fetal monitors for individual analysis of computed cardiotocography.ExperienceThe software program was used to study the data continuity of beat-to-beat FHR values as an experiment for chaos theory and power spectrum analysis. The results indicated that the signal loss was recognized at a precision of 95%.ConclusionThe described method of digital communication with fetal monitors was found to be useful for individual purposes in the field of computed cardiotocography analysis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundTo describe the cross-sectional anatomy of the anal sphincter mechanism relevant to magnetic resonance imaging (MRI) and ultrasound cross-sectional images.MethodAxial, sagittal, and coronal 5-mm sections of female pelves were reviewed from six cadaver specimens (ages 24–72 years). Fetal anatomy was studied in plastinated histologic sections from 19 and 26 weeks' gestation. Images of the anal sphincter were obtained by MRI in six and by ultrasound using an exoanal technique in 12 nulliparous volunteers.ExperienceThe internal anal sphincter is clearly visible in anatomic sections central to the external sphincter and is visible in MRI and ultrasound images. The external anal sphincter can be subdivided into a subcutaneous and a deep portion. On anatomic sections and on MRI, the subcutaneous part shows as two parallel muscle strips in the axial plane; the deep portion presents with a characteristic tear-drop form in the section perpendicular to the axis of the anal canal. The puborectalis muscle and the external anal sphincter form a “double bump” in the sagittal section. The longitudinal muscle can be identified by its fiber orientation in anatomic sections but is not clearly visible in imaging studies.ConclusionThis information should make it possible to identify accurately anal sphincter anatomy in two-dimensional sectional images of the anal sphincter.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundThe paravaginal defect, present in more than three-quarters of patients with cystoceles, can be repaired by both the abdominal and vaginal approaches. The technical challenges of the vaginal paravaginal repair have militated against its widespread adoption by gynecologic surgeons.InstrumentCurrycombs can be used to facilitate suture management during vaginal paravaginal repair.ExperienceThe vaginal paravaginal repair using curry-combs was performed as part of pelvic repair surgery on 27 patients. Perioperative complications were minimal. A cystocele cure rate of 80% was achieved after a mean follow-up of 8 months.ConclusionThe use of currycombs during performance of the vaginal paravaginal repair facilitates suture management. The addition of this technique should help gynecologic surgeons to perform this somewhat daunting surgical procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Thromboembolic disease is a leading cause of maternal mortality in the United States. Recently, inherited resistance to activated protein C has been recognized as a major risk factor for thrombosis and has been demonstrated in 20–60% of patients with clinically evident thrombosis. The factor V Leiden mutation, which is readily detectable by molecular DNA techniques, is responsible for 90–95% of cases of activated protein C resistance. Because 5% of whites and 1% of blacks in the United States are heterozygous for the Leiden mutation, at least one group has suggested that screening of asymptomatic gravidas for the mutation should be considered. Therefore, we conducted a combined MEDLINE and bibliographic literature search for relevant data and evaluated screening for the factor V Leiden mutation in the context of well-elucidated desirable characteristics for a successful screening program. Based on this evaluation, we conclude that routine antenatal screening for the factor V Leiden mutation cannot be recommended at the present time.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID