Factors Associated with Neonatal Hypoglycemia in Premature Twins and Singletons

AbstractTwin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix <40 and <20 mg%) was found in twins vs singletons (54% vs 32%, OR 2.49, CI 1.77-3.56; 19% vs 8%, OR 2.65, CI 1.59-4.19, respectively). Gestational age of 34-37 weeks increased hypoglycemia risk for the premature twins (77% vs 51%, OR 3.20 CI 1.49-6.88). Twin deliveries statistically differed from those of singletons in several perinatal characteristics. More twins were born by cesarean section (85% vs 55%, OR 4.15, CI 2.48-6.95), and the birth weight of twins was much lower related to prematures with BW < 1.0 kg (12% vs 6%, OR 2.06, CI 1.11-3.82) and SGA (20% vs 10%, OR 2.41, CI 1.46-3.98). The risk of twin deliveries was increased at 30-33 weeks gestational age (25% vs 15%, OR 1.84; CI 1.17-2.90). Twins were found to have higher rates of hospitalization (50% vs 40%, OR 1.52, CI 1.04-2.23) and showed an increased risk of cardiorespiratory resuscitation (51% vs 31%, OR 2.36, CI 1.61-3.47), hypothermia (11% vs 4%, OR 3.02, CI 2.333.91), BPD (25% vs 19%, OR 2.55, CI 1.10-5.91), and PVL (4% vs 1%, OR 4.08, CI 1.23-13.5). Mortality was found more often (not significant) in premature twins. The risk for intrapartum and early neonatal morbidity was however, mostly reduced in hypoglycemic twins, while it was comparable between smaller or smaller weight discordant twins and larger twins. Similarly, SGA twins, and smaller or smaller weight-discordant twins did not show increased hypoglycemia risk. In conclusion, our findings suggest that the multiple gestation per se is the single most important relative risk factor of hypoglycemia in premature twins.

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Fetal sex modifies the effect of maternal macronutrient intake on the incidence of small-for-gestational-age births: a prospective observational cohort study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy161 ◽

2018 ◽

Vol 108 (4) ◽

pp. 814-820 ◽

Cited By ~ 3

Author(s):

A Mukhopadhyay ◽

T Thomas ◽

R J Bosch ◽

P Dwarkanath ◽

A Thomas ◽

...

Keyword(s):

Cohort Study ◽

Gestational Age ◽

Small For Gestational Age ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Macronutrient Intake ◽

Fetal Sex ◽

Increased Risk ◽

Observational Cohort

Abstract Background Maternal macronutrient intake is likely to play a pivotal role in fetoplacental growth. Male fetuses grow faster and their growth is more responsive to maternal size. Objective We assessed the role of fetal sex in modifying the effect of maternal macronutrient intake on the risk of small-for-gestational-age (SGA) birth. Design This was a prospective, observational cohort study of 2035 births from an urban South Asian Indian population. Maternal intakes of total energy and macronutrients were recorded by validated food-frequency questionnaires. The interaction of trimester 1 macronutrient intake with fetal sex was tested on the outcome of SGA births. Results The prevalence of SGA was 28%. Trimester 1 macronutrient composition was high in carbohydrate and low in fat (means ± SDs—carbohydrate: 64.6% ± 5.1%; protein: 11.5% ± 1.1%; and fat: 23.9% ± 4.4% of energy). Higher carbohydrate and lower fat consumption were each associated with an increased risk of SGA [adjusted OR (AOR) per 5% of energy (95% CI): carbohydrate: 1.15 (1.01, 1.32); fat: 0.83 (0.71, 0.97)] specifically among male births (males: n = 1047; females: n = 988). Dietary intake of >70% of energy from carbohydrate was also associated with increased risk (AOR: 1.67; 95% CI: 1.00, 2.78), whereas >25% of energy from fat intake was associated with decreased risk (AOR: 0.61; 95% CI: 0.41, 0.90) of SGA in male births. Conclusions Higher carbohydrate and lower fat intakes early in pregnancy were associated with increased risk of male SGA births. Therefore, we speculate that fetal sex acts as a modifier of the role of maternal periconceptional nutrition in optimal fetoplacental growth.

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The role of transvaginal ultrasound in the management of a low-lying placenta

Fetal and Maternal Medicine Review ◽

10.1017/s0965539502000438 ◽

2002 ◽

Vol 13 (4) ◽

pp. 261-275

Author(s):

Bahauddin Sallout ◽

Lawrence Oppenheimer

Keyword(s):

Postpartum Haemorrhage ◽

Transvaginal Ultrasound ◽

Caesarean Section Rate ◽

Neonatal Morbidity ◽

Placenta Praevia ◽

Third Trimester ◽

Obstetric Haemorrhage ◽

Increased Risk ◽

Abruptio Placenta

Placenta praevia is an uncommon but dangerous and occasionally fatal condition. It increases maternal, fetal and neonatal morbidity and mortality. Placenta praevia is one of the leading causes of third-trimester bleeding and the incidence of both placenta praevia and placenta accreta is steadily increasing due to the rising caesarean section rate. At delivery, women with placenta praevia have an increased risk of abruptio placenta, caesarean delivery, fetal malpresentation, postpartum haemorrhage and disseminated intravascular coagulation. Massive obstetric haemorrhage is still a leading cause of pregnancy-related deaths, and placenta praevia/accreta remains one of the major predisposing factors.

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Sonographic Estimated Fetal Weight among Diabetics at ≥ 34 Weeks and Composite Neonatal Morbidity

American Journal of Perinatology Reports ◽

10.1055/s-0038-1660433 ◽

2018 ◽

Vol 08 (02) ◽

pp. e121-e127

Author(s):

Leen Al-Hafez ◽

Michael Pirics ◽

Suneet Chauhan

Keyword(s):

Retrospective Study ◽

Confidence Intervals ◽

Gestational Age ◽

Neonatal Morbidity ◽

Fetal Weight ◽

Inclusion Criteria ◽

Increased Risk ◽

Estimated Fetal Weight ◽

Singleton Pregnancies

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. Compared with women with diabetes with last SEFW at 10th to 90th percentile, those with estimate > 90th percentile for GA had a significantly higher rate of CNM (13 vs. 28%; OR, 2.65; 95% CI, 1.07–6.59). Among 109 diabetic women who labored, the rate of shoulder dystocia was significantly higher with SEFW at >90th percentile for GA than those at 10th to 90th percentile (25 vs. 2%; p = 0.002); the corresponding rate of CNM was 29 versus 10% (p = 0.02). Conclusion Among diabetic women with SEFW > 90th percentile for GA, CNM was significantly higher than in women with estimate at 10 to 90th percentile. Despite the increased risk of CNM, these newborns did not have long-term morbid sequela.

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Racial Disparities in Delivery Gestational Age among Twin Pregnancies

American Journal of Perinatology ◽

10.1055/s-0037-1603764 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1065-1071

Author(s):

Catherine Vladutiu ◽

Tracy Manuck ◽

Jacqueline Grant

Keyword(s):

Gestational Age ◽

Proportional Hazards ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Increased Risk ◽

Hydroxyprogesterone Caproate

Objective This study aims to estimate the association between maternal race and delivery gestational age among women with twin gestations. Study Design Secondary analysis of a prospective, randomized control trial of 17-α hydroxyprogesterone caproate versus placebo for preterm birth (PTB) prevention in twin gestations. Non-Hispanic (NH) black and whites were included. Demographic and antenatal characteristics were compared. The primary outcome was delivery gestational age. Secondary outcomes included a composite of major neonatal morbidity. Kaplan–Meier curves estimated survival probabilities for delivery gestational age by race. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI). Results A total of 535 women with twin gestations were included; 150 were NH black. NH blacks delivered earlier than NH whites (33.6 ± 4.8 weeks vs. 35.1 ± 3.5 weeks, p < 0.001). Differences in delivery gestational age between NH blacks and whites were consistent across gestation. In adjusted analyses, NH black race (HR: 1.24, 95% CI: 1.02–1.51), prior PTB (HR: 1.59, 95% CI: 1.15–2.19), and cerclage (HR: 3.90, 95% CI: 2.00–7.60) were associated with an increased risk of earlier delivery. Major neonatal morbidity was higher for NH blacks compared with NH whites (12.7 vs. 7.0%, p = 0.036). Conclusion NH blacks with twin gestations have an increased risk of early delivery and neonatal morbidity compared with NH whites.

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Thromboembolic Complications in Covid-19: From Clinical Scenario to Laboratory Evidence

Life ◽

10.3390/life11050395 ◽

2021 ◽

Vol 11 (5) ◽

pp. 395

Author(s):

Alberto Palazzuoli ◽

Michela Giustozzi ◽

Gaetano Ruocco ◽

Francesco Tramonte ◽

Edoardo Gronda ◽

...

Keyword(s):

Cardiovascular Complications ◽

Risk Category ◽

Moderate Risk ◽

Factors Associated ◽

Appropriate Treatment ◽

Increased Risk ◽

Recent Statement ◽

European Society Of Cardiology ◽

Prophylactic Anticoagulation

SARS-Cov-2 infection, a pandemic disease since March 2020, is associated with a high percentage of cardiovascular complications mainly of a thromboembolic (TE) nature. Although clinical patterns have been described for the assessment of patients with increased risk, many TE complications occur in patients with apparently moderate risk. Notably, a recent statement from the European Society of Cardiology (ESC) atherosclerosis and vascular biology working group pointed out the key role of vascular endothelium for the recruitment of inflammatory and thrombotic pathways responsible for both disseminated intravascular coagulation and cardiovascular complications. Therefore, a better understanding of the pathophysiological process linking infection to increased TE risk is needed in order to understand the pathways of this dangerous liaison and possibly interrupt it with appropriate treatment. In this review, we describe the histological lesions and the related blood coagulation mechanisms involved in COVID-19, we define the laboratory parameters and clinical risk factors associated with TE events, and propose a prophylactic anticoagulation treatment in relation to the risk category. Finally, we highlight the concept that a solid risk assessment based on prospective multi-center data would be the challenge for a more precise risk stratification and more appropriate treatment.

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Frequency of Neonatal Hypoglycemia in Large for Gestational Age Infants of Non-Diabetic Mothers in a Community Maternity Hospital

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.139 ◽

2006 ◽

Vol 49 (4) ◽

pp. 237-239 ◽

Cited By ~ 5

Author(s):

Nilgun Araz ◽

Mustafa Araz

Keyword(s):

Blood Glucose ◽

Gestational Age ◽

Maternity Hospital ◽

Large For Gestational Age ◽

Control Group ◽

Neonatal Hypoglycemia ◽

Glucose Levels ◽

Increased Risk ◽

Appropriate For Gestational Age ◽

Diabetic Mothers

Large for gestational age (LGA) infants are at increased risk for hypoglycemia. The aim of the study was to determine the frequency of neonatal hypoglycemia in LGA infants of non-diabetic mothers in a Community Maternity Hospital in Gaziantep, Turkey. Hospital records of 5229 infants of non-diabetic mothers were examined retrospectively. Newborns with birth weight more than 4000 g were defined as LGA. The control group consisted of 100 appropriate for gestational age (AGA) newborns. Capillary blood glucose was measured at the second hour of life. Glucose values lower than 40 mg/dL (2.2 mmol/L) were defined as hypoglycemia. Ninety-six (1.8%) of the 5229 infants were found to be LGA. The mean capillary glucose levels of the LGA newborns were significantly lower than those of the AGA newborns (54 mg/dL (3.0 mmol/L) vs. 95 mg/dL (5.2 mmol/L), p<0.0001). Neonatal hypoglycemia was established in 16 of 96 LGA infants (16.7%). In the control group hypoglycemia was absent. The rate of hypoglycemia in LGA infants was significantly higher than the rate in the AGA infants (p=0.0000). As hypoglycemia is not rare in LGA infants and can have serious consequences, blood glucose levels should be screened routinely in LGA infants.

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Prediction of preterm birth: the role cervical assessment by ultrasound and cervico-vaginal biomarkers

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1275 ◽

2020 ◽

Author(s):

Giuseppe Rizzo ◽

Ilenia Mappa Mappa ◽

Victoria Bitsadze ◽

Jamilya Khizroeva ◽

Alexander Makatsariya

Keyword(s):

Preterm Birth ◽

Neonatal Morbidity ◽

Cervical Length ◽

Fetal Fibronectin ◽

Neonatal Deaths ◽

A Value ◽

Increased Risk ◽

Asymptomatic Women

Preterm delivery (PTB) is one of the most common and serious complications of pregnancy. PTB accounts for approximately 70% of neonatal deaths and is a major cause of neonatal morbidity including respiratory distress syndrome, necrotising enterocolitis and long-term neurological disabilities. Prevention of PTB and its complications include identification among symptomatic women those at high risk of immediate delivery requiring prenatal corticosteroids administration. Transvaginal ultrasonographic evaluation of the cervical length (CL) is predictive of PTB and a value 15 mm identifies among symptomatic women approximately 70% of women who will deliver within one week. In the range of CL within 15 and 30 mm biomarkers n cervical-vaginal fluids (fetal fibronectin, phosphorylated insulin-like growth factor protein-1, placental alpha-microglobulin-, cytokines) and other ultrasonographic cervical variables (posterior cervical angle, elastography) improve the identification of women at risk, In asymptomatic women CL can be applied as screening and has been proposed as a universal screening during the second trimester in singleton gestations. The finding of a CL25mm is associated with an increased risk of subsequent PTB with a sensitivity between 30 and 60% that is improved with the combination of biomarkers. Asymptomatic women with a CL 25mm should be offered vaginal progesterone treatment for the prevention of preterm birth and neonatal morbidity. The role of cerclage and pessary is still controversial. In this review we discuss the evidence-based role of ultrasonographic cervical assessment and cervicovaginal biomarkers in the prediction of PTB in symptomatic and asymptomatic women

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The impact of placental pathology discordance in multiple gestation pregnancies on bronchopulmonary dysplasia-associated pulmonary hypertension

Pulmonary Circulation ◽

10.1177/2045894020910674 ◽

2020 ◽

Vol 10 (1) ◽

pp. 204589402091067

Author(s):

Andrew Franklin ◽

Sushmita Yallapragada ◽

Robert Birkett ◽

William Grobman ◽

Linda M. Ernst ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Small For Gestational Age ◽

Chronic Hypertension ◽

Multiple Gestation ◽

Placental Pathology ◽

Angiogenic Growth Factors ◽

Increased Risk ◽

The Impact

Bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) may either be concordant or discordant between multiple gestation births. Abnormal placental development, particularly maternal vascular malperfusion, may account for discordance in BPD-PH through fetal programming mechanisms. Maternal vascular malperfusion is a placental histologic lesion associated with intrauterine growth restriction and BPD-PH. We conducted a retrospective longitudinal cohort study of infants born <29 weeks gestation with available placental histology at Prentice Women's Hospital in Chicago from 2005–2012. The primary outcome was discordant BPD-PH associated with placental maternal vascular malperfusion. We secondarily assessed whether the risk of BPD-PH and placental lesions was different among infants of multiple (compared to singleton) gestations. The cohort consisted of 135 multiple gestation infants and 355 singletons. In a separate cohort of 39 singletons and 35 multiples, associations between 12 cytokines and angiogenic growth factors in cord blood plasma for biomarker discordance, maternal vascular malperfusion, and bronchopulmonary dysplasia were explored. Among multiples, discordant maternal vascular malperfusion was not associated with BPD-PH (OR = 1.9 (0.52, 6.9); p = 0.33) in infants exposed to placental maternal vascular malperfusion. However, singleton infants were more likely to develop BPD-PH (compared to multiples) after adjusting for mode of delivery, chorioamnionitis, chronic hypertension, placental abruption, small-for-gestational age birth weight, and gestational age (aOR = 2.7 (1.2, 5.8); p = 0.038). Singletons were more likely to be small-for-gestational age (11% vs 4%, p = 0.025) and have placental lesions compared to their multiple-gestation counterparts (96% vs 81%, p < 0.001), principally severe maternal vascular malperfusion (17% vs 4%, p < 0.001) and chronic inflammation (32% vs 11%, p < 0.001). Increased risk of BPD-PH in singleton pregnancies <29 weeks gestation compared to multiples may be related to increased frequency of these histologic lesions. Placental pathology in singleton and multiple gestation pregnancies may serve as an early biomarker to predict BPD-PH.

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Risk factors associated with retinopathy of prematurity among neonates in a tertiary care hospital in Nepal

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v5i1.18263 ◽

2017 ◽

Vol 5 (1) ◽

pp. 28-33

Author(s):

Jyoti Baba Shrestha ◽

Reena Yadav ◽

Jeevan Kumar Shrestha ◽

Laxman Shrestha ◽

Raman Prasad Sah

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Neonatal Intensive Care ◽

Multiple Gestation ◽

Factors Associated

Background: Retinopathy of prematurity is a vascular retinal disease that can cause blindness in premature new born babies. Several risk factors are associated with the incidence of ROP. Information and data on risk factors associated with ROP in context to Nepalese population is scarcely documented in literature.Objectives: The purpose of this study was to evaluate the risk factors of retinopathy of prematurity in premature infants admitted in the neonatal intensive care unit of Tribhuvan University Teaching Hospital.Methods: Neonates with gestational age of 36 weeks or less and birth weight of 2000 gram or less admitted to neonatal intensive care unit (NICU), during 2013 to 2015 were screened for retinopathy of prematurity. Risk factors and severity of retinopathy of prematurity were evaluated. The initial examination was carried out at 4-6 weeks after birth by indirect ophthalmoscope and retinopathy of prematurity positive and negative infants were compared subsequently. The Chisquare and independent t-tests were used for statistical analysis. A p value less than 0.05 was considered statistically signifi cant.Results: The incidence of retinopathy of prematurity was 22.6% and severe retinopathy of prematurity requiring treatment was observed in 3.2% of 93 neonates who had eye examinations. There was a signifi cant relationship between the occurrence of ROP and birth weight (p=0.000), gestational age (p=0.000), duration of oxygen therapy (p=0.009) and sepsis (p=0.002). However, insignifi cant relationship was observed between the occurrence of retinopathy of prematurity and gender, type of delivery, multiple gestation, premature rupture of foetal membrane, respiratory distress syndrome and hyperbilirubinaemia.Conclusion: The risk factors contributing to development of retinopathy of prematurity showed signifi cant relationship with immaturity, duration of oxygen supplementation and septicaemia.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016,page: 28-33

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