Perinatal Outcomes of a Pregnancy Complicated by Cancer, Including Neonatal Follow-Up After in Utero Exposure to Chemotherapy

Lead poisoning in a neonate is poorly defined, and limited data exists on appropriate follow-up and treatment of such infants. We are presenting the case of a newborn infant, who had a lead level of 63 mcg/dL. Treatment involved five days of intravenous chelation therapy. At discharge, no clinical sequelae of lead toxicity were found. However, due to the chronic nature of in utero exposure the infant requires close follow-up, in particular neurologic and developmental sequelae. Lead toxicity has many complications. Long-term complications include delays in growth and development. Furthermore, these complications may develop in children with minimal toxicity, let alone those with grossly abnormal values. Due to lack of data, perhaps it is worthwhile to screen those women of child-bearing age, who are of "high risk", for elevated blood lead levels to reduce the risk of in utero exposure.

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IN UTERO EXPOSURE TO THE HIROSHIMA ATOMIC BOMB

PEDIATRICS ◽

10.1542/peds.39.3.385 ◽

1967 ◽

Vol 39 (3) ◽

pp. 385-392

Author(s):

James W. Wood ◽

Kenneth G. Johnson ◽

Yoshiaki Omori

Keyword(s):

Early Childhood ◽

Mental Retardation ◽

Mortality Rate ◽

Atomic Bomb ◽

Adult Life ◽

In Utero ◽

In Utero Exposure ◽

Normal Children ◽

Small Head

A study was made by Miller in 1954 of children who were in utero and within 2,200 meters from the hypocenter at the time of the atomic bomb in Hiroshima. These earlier observations have with few exceptions been validated by this follow-up of the subjects at 20 years of age and the value and accuracy of clinical evaluation in early childhood is clearly indicated. The following conclusions are made. Both small head size (circumference minus 2 SD or more) and mental retardation are most closely related to (1) maternal exposure within 1,500 meters from the hypocenter, and (2) a gestational age of less than 15 weeks. The heads of infants with either small or normal circumferences at birth increase thereafter in circumference at the same rate and stop growing at the same age, thereby maintaining the same size relationships throughout childhood into adult life. Mortality in the mentally retarded group as a whole exceeds mortality in normal children. For the group of all subjects exposed within 1,500 meters the mortality rate is higher than for the subjects located beyond 1,500 meters.

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In utero exposure to diagnostic ultrasound: a 6-year follow-up.

Radiology ◽

10.1148/radiology.166.3.3277240 ◽

1988 ◽

Vol 166 (3) ◽

pp. 687-690 ◽

Cited By ~ 48

Author(s):

E A Lyons ◽

C Dyke ◽

M Toms ◽

M Cheang

Keyword(s):

Diagnostic Ultrasound ◽

In Utero ◽

In Utero Exposure

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The Antenatal and Postnatal Consequences of Antenatal Exposure to Prolonged Low Dose Indomethacin

Journal of Clinical Medicine ◽

10.3390/jcm10091851 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1851

Author(s):

Vera Donadono ◽

Nicky Manning ◽

Lawrence Impey

Keyword(s):

Preterm Birth ◽

Low Dose ◽

Ductus Arteriosus ◽

In Utero ◽

In Utero Exposure ◽

Neonatal Deaths ◽

Arterial Duct ◽

John Radcliffe Hospital ◽

Low Incidence

Despite its many clinical applications, indomethacin is seldom used in pregnancy, principally because of concerns regarding the potential for constriction of the arterial duct. The aim of this study was to document adverse antenatal effects and postnatal outcomes after in utero exposure to low-dose indomethacin. We studied a retrospective cohort of pregnancies between 2005 and 2016 at the John Radcliffe Hospital, Oxford, UK, in which mothers at extremely high risk of preterm birth were treated as prophylaxis with indomethacin 25 mg, 12 hourly, before 29 weeks. Antenatal effects on the arterial duct and postnatal outcomes were analysed. Overall, 198 fetuses had in utero follow-up, and 13 (6.6%) had ductal constriction, all within 9 days of starting treatment. No ductal constriction was seen in pregnancies when therapy was started before 20 weeks, and all effects were reversed after cessation of therapy. An analysis of postnatal complications was possible in 181 neonates. There were eight (4.4%) neonatal deaths, all but one associated with extreme preterm birth. Seven (5%) patent ductus arteriosus cases occurred in the 140 neonates delivered after 28 weeks who were alive at discharge. Postnatal complications were not more common in neonates in whom antenatal ductal constriction had been demonstrated. In conclusion, fetuses exposed to prolonged low dose indomethacin have a low incidence of in utero complications; these complications can be diagnosed with ultrasound and are reversible. Adverse postnatal events are related to gestation at birth and do not appear more common.

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