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The NeoUpdates - Dec

The NeoUpdates - Dec

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Published by Dr Satish Mishra
This is a research bulletin on Neonatal, Perinatal & Pediatric Medicine.
This is a research bulletin on Neonatal, Perinatal & Pediatric Medicine.

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Published by: Dr Satish Mishra on Jan 08, 2010
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10/22/2012

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1 |Page 
Perinatal Medicine
Prior Adverse Pregnancy Outcome and the Risk of Stillbirth
 Authors analyzed a population-based cohort, from 1967 to 2005 from the Medical Birth Registry of Norway, to estimate whether a history of fetal growth restriction, abruptio placentae, preeclampsia, orlive preterm birth is associated with excess risk of stillbirth in subsequent pregnancy. Analysis revealed,after preterm births with gestational age 22–27, 28–32, and 33–36 weeks, odd of stillbirth were 5.7(95% CI 4.2–7.6), 2.6 (95% CI 2.1–3.3), and 1.7 (95% CI 1.5–1.9), respectively. Odds ratios of stillbirthsubsequent to pregnancies with SGA, preeclampsia, and abruptio placentae were 1.7 (95% CI 1.6–1.9),1.6 (95% CI 1.5–1.9), and 2.8 (95% CI 2.2–3.5), respectively, and increased with severity of theconditions. Gestational age below 33 weeks with preeclampsia or SGA carried 6–9 and 6–13 fold effectson later stillbirth, respectively. Men who fathered a pregnancy with preterm preeclampsia weresignificantly more likely to father a stillbirth in another woman (OR 2.4, 95% CI 1.1–5.5).
Svein R et al. Obstetrics & Gynecology 2009; 114:1259-70.
Decreased Regional Brain Volume and Cognitive Impairment in Preterm Children at Low Risk 
 Volumetric MRI evaluation of 20 preterm children who were
 
determined to be at low risk forneurodevelopmental deficits
 
and were born between 30 and 34 weeks’ gestational age
 
without majorneonatal morbidity or cerebral pathology in the
 
neonatal period and 22 matched, term subjects revealeddecreased regional cortical grey-matter (GM) and white-matter (WM) in
 
preterm children. Pretermchildren showed global and regional GM volume
 
reductions in several brain areas, including temporal andparietal
 
lobes and concomitant WM volume reductions in the same areas,
 
although only the left temporalregions achieved statistical
 
significance. Global intellectual performance in the preterm
 
group wassignificantly decreased compared with control subjects.
 
Neither behavioral nor emotional problems werefound in the
 
preterm group.
Soria-Pastor S 
 
et al. Pediatrics. 2009;124: e1161-e1170.
The NeoUpdatesThe NeoUpdatesThe NeoUpdatesThe NeoUpdates
Dec 15, 2009Volume 1 (Number 2)
A Monthly Electronic Bulletin on Neonatal and PerinatalA Monthly Electronic Bulletin on Neonatal and PerinatalA Monthly Electronic Bulletin on Neonatal and PerinatalA Monthly Electronic Bulletin on Neonatal and Perinatal
medicinemedicinemedicinemedicine
 
2 |Page 
The PREM score: a graphical tool for predicting survival in very preterm births
Based on data of 4838 preterm neonates (22-31 weeks’ gestation), Cole and colleagues developed alogistic regression model for prediction of survival to term for these neonates. They used gestation, birthweight for gestation and base deficit from umbilical cord blood for developing this tool. They found thatgestation was by far the most powerful predictor of survival to term, and as few as 5 extra days candouble the chance of survival. Weight for gestation also had a powerful but non-linear effect on survival,with weight between the median and 85
th
centile predicting the highest survival. Using this informationsurvival can be predicted almost as accurately before birth as after, although base deficit furtherimproves the prediction.This scoring system may not be useful for predicting the survival of individual neonate, but, can be usedto balance risk at entry into a controlled trial and to adjust for differences in “case mix” when assessingthe quality of perinatal care.
 Cole TJ et al. Arch Dis Child Fetal Neonatal Ed 2010;95:F14-F19.
 
Pregnancy Outcomes from the Pregnancy Registry of a Human Papillomavirus Type6/11/16/18 Vaccine
This postmarketing surveillance data-analysis of 517 pregnant women exposed to human papillomavirus(HPV) type 6/11/16/18 vaccine on pregnancy outcomes (ie, live births, abortions, fetal deaths, andcongenital anomalies) did not reveal any adverse effect. Overall rate of spontaneous abortions andmajor birth-defects were not greater than the unexposed population rates. However, although noadverse signals have been identified to date, the HPV6/11/16/18 vaccine is not recommended for use inpregnant women.
 Adrian D et al. Obstetrics & Gynecology 2009; 114(6):1170-1178.
Pregnancy and Infant Outcomes in the Clinical Trials of a Human PapillomavirusType 6/11/16/18 Vaccine: A Combined Analysis of Five RCTs
Combined analysis of the pregnancy outcomes for women enrolled in five phase III clinical studies of theprophylactic quadrivalent human papillomavirus 6/11/16/18 vaccine enrolling 20,551 women aged 15-45did not reveal any significant differences in the proportions of pregnancies resulting in live birth, fetalloss, or spontaneous abortion. However, currently vaccination is not recommended during pregnancy(pregnancy category B medication).
Suzanne MG et al. Obstetrics & Gynecology 2009; 114(6): 1179-1188.
 
3 |Page 
Neonatal Medicine
Chlorhexidine maternal-vaginal and neonate body wipes for prevention of earlyonset sepsis
Sepsis is one of the most common causes of early neonatal mortality. Use of vaginal chlorhexidine wipesduring labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis indeveloping countries. The PoPS trial team assessed the efficacy of chlorhexidine in early-onset neonatalsepsis and vertical transmission of group B streptococcus. In 8011 pregnant women were randomlyassigned to chlorhexidine vaginal wipes or external genitalia water wipes during active labour and their8129 newborn babies were assigned to full-body (intervention group) or foot (control group) washeswith chlorhexidine at birth. Primary outcome, the rate of early onset neonatal sepsis (within 72 h of delivery), was not different between the two groups [chlorhexidine 141 (3%) of 4072
vs 
control 148(4%) of 4057; p=065]. Rates of colonisation with group B streptococcus in newborn babies born tomothers in the chlorhexidine [217 (54%) of 401] and control groups [234 (55%) of 429] were notdifferent (efficacy −005%, 95% CI −95 to 79).
Cutlandet CL et al (the PoPS Trial Team). The Lancet 2009;374:1909-16.
Does skin cleansing with chlorhexidine affect skin condition, temperature andcolonization in hospitalized preterm low birth weight infants?
In a randomized clinical trial enrolling 60 stable preterm neonates admitted in a health facility, Sankar etal demonstrated that single skin cleansing with 0.25% chlorhexidine reduced axillary-skin colonization at24 h after the intervention. They monitored the temperature and skin condition score of the enrolledneonates and did not find any adverse affect on skin condition or temperature.
Sankar MJ et al. Perinatol. 2009;29:795-801.
Energy Expenditure for Breastfeeding and Bottle-Feeding Preterm Infants
In this study from Israel, authors demonstrated that there was no difference in resting energyexpenditure (REE) when infants were breast fed versus bottle-fed. Although, the duration of feeding
 
wassignificantly longer for breastfeeding than for bottle-feeding
 
(20.1±7.9 vs 7.8±2.9 minutes;
<.0001),longer feeding times
 
at the breast did not increase REE. Authors conjectured that it is
 
safe torecommend feeding at the breast for infants born at
 
>32 weeks when they can tolerate oral feeding.
Berger I et al. Pediatrics 2009; 124: 
e1149-e1152.
 

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