Neonatal mortality and morbidity in preterm infants born from assisted reproductive technologies

2012 ◽  
Vol 101 (8) ◽  
pp. 846-851 ◽  
Author(s):  
JC Picaud ◽  
S Chalies ◽  
C Combes ◽  
G Mercier ◽  
H Dechaud ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Mortality And Morbidity

scholarly journals Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023004 ◽  
Author(s):  
Lindsay L Richter ◽  
Joseph Ting ◽  
Giulia M Muraca ◽  
Anne Synnes ◽  
Kenneth I Lim ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Temporal Trends ◽  
Population Based ◽  
Washington State ◽  
Late Preterm ◽  
Population Based Study ◽  
Mortality And Morbidity ◽  
Late Preterm Infants ◽  
Spontaneous Labour

ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p<0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.

Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

2020 ◽  
Author(s):  
Amudha Jayanthi Anand ◽  
Karthik Sabapathy ◽  
Bhavani Sriram ◽  
Victor Samuel Rajadurai ◽  
Pratibha Keshav Agarwal
Keyword(s):  
Neonatal Mortality ◽  
Low Birthweight ◽  
Ductus Arteriosus ◽  
Multiple Pregnancy ◽  
Neonatal Morbidity ◽  
Reproductive Technologies ◽  
Multiple Births ◽  
Mortality And Morbidity ◽  
Group 2 ◽  
Group 1

Objective The aim of this study is to compare neonatal mortality and morbidity in multiple and singleton preterm/very low birthweight (PT/VLBW) multiethnic Asian infants. Study Design Cohort study of 676 singleton and 299 multiple PT/VLBW infants born between 2008 and 2012 at KK Women's and Children's Hospital, the largest tertiary perinatal center in Singapore with further stratification by gestational ages 23 to 25 (Group 1), 26 to 28 (Group 2), and ≥29 (Group 3) weeks. Outcome measures included predischarge mortality and major neonatal morbidity. Results Overall survival to discharge was comparable for singletons 611/676 (90%) and multiples 273/299 (91%). Use of assisted reproductive technologies (47 vs. 4%), antenatal steroids (80 vs. 68%), and delivery by cesarean section (84 vs. 62%) were significantly higher (p < 0.001) in multiples while pregnancy induced hypertension (8.7 vs. 31.6%, p < 0.001) and maternal chorioamnionitis (31 vs. 41%, p < 0.01) were seen less commonly compared with singleton pregnancies. Survival was comparable between singletons and multiples except for a lower survival in multiples in Group 2 (81.7 vs. 92.4%, p = 0.007). Major neonatal morbidities were comparable for multiples and singletons in the overall cohort. Presence of hemodynamically significant patent ductus arteriosus (HsPDA) requiring treatment (88.9 vs. 72.5%), air leaks (33 vs. 14.6%, p = 0.02), NEC (30 vs. 14.6%, p = 0.04), and composite morbidity (86 vs. 66%, p = 0.031) were significantly higher in multiples in Group 1. A significantly higher incidence of HsPDA (68.1 vs. 52.4%, p = 0.008) was also observed in multiples in Group 2. Multiple pregnancy was not an independent predictor of an adverse outcome on regression analysis (OR: 0.685, 95% confidence interval: 0.629–2.02) even in GA ≤25 weeks. Conclusion Neonatal mortality and morbidity were comparable in our cohort of PT/VLBW singletons and multiple births, but preterm multiple births ≤25 weeks had a higher incidence of neonatal morbidity. Key Points

Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity

2016 ◽  
Vol 175 ◽  
pp. 61-67.e4 ◽  
Author(s):  
Emilija Wilson ◽  
Rolf F. Maier ◽  
Mikael Norman ◽  
Bjoern Misselwitz ◽  
Elizabeth A. Howell ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Very Preterm Infants ◽  
Mortality And Morbidity ◽  
Very Preterm

Effects of perinatal, late foetal, and early embryonic insults on the cardiovascular phenotype in experimental animal models and humans

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 439-449 ◽  
Author(s):  
Theo Arthur Meister ◽  
Emrush Rexhaj ◽  
Stefano Flavio Rimoldi ◽  
Urs Scherrer ◽  
Claudio Sartori
Keyword(s):  
Animal Models ◽  
Experimental Animal ◽  
Genetic Factors ◽  
Assisted Reproductive Technologies ◽  
Disease Risk ◽  
Reproductive Technologies ◽  
Mortality And Morbidity ◽  
Experimental Animal Models ◽  
Experimental Animals ◽  
Underlying Mechanisms

Abstract. Cardiovascular diseases are the main cause of mortality and morbidity in Western countries, but the underlying mechanisms are still poorly understood. Genetic polymorphisms, once thought to represent a major determinant of cardiovascular risk, individually and collectively, only explain a tiny fraction of phenotypic variation and disease risk in humans. It is now clear that non-genetic factors, i.e., factors that modify gene activity without changing the DNA sequence and that are sensitive to the environment can cause important alterations of the cardiovascular phenotype in experimental animal models and humans. Here, we will review recent studies demonstrating that distinct pathological events during the perinatal (transient perinatal hypoxemia), late foetal (preeclampsia), and early embryonic (assisted reproductive technologies) periods induce profound alterations of the cardiovascular phenotype in humans and experimental animals. Moreover, we will provide evidence that epigenetic modifications are contributing importantly to this problem and are conferring the potential for its transmission to subsequent generations.

Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension

2021 ◽  
Author(s):  
Heather M. Weydig ◽  
Charles R. Rosenfeld ◽  
Mambarambath A. Jaleel ◽  
Patti J. Burchfield ◽  
Mackenzie S. Frost ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Neonatal Mortality ◽  
Preterm Infants ◽  
Mortality And Morbidity ◽  
Antenatal Steroids

scholarly journals OUTCOME OF PRETERM INFANTS AFTER DELIVERY ROOM CARDIOPULMONARY RESUSCITATION. A RETROSPECTIVE OBSERVATIONAL STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e19-e19
Author(s):  
Bishal Gautam ◽  
Sarah McKnight ◽  
Michael Miller ◽  
Bryan Richardson ◽  
Abrar Ahmed ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Chest Compression ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Bivariate Analysis ◽  
Care Hospital ◽  
Mortality And Morbidity

Abstract BACKGROUND Chest compression in the delivery room (CPR-DR) during neonatal resuscitation is considered as an extreme measure. When respiratory support alone is unable to establish circulatory transition, chest compression with or without epinephrine is necessary. The results of earlier studies have shown varied results in mortality and morbidity of preterm infants who received CPR-DR. OBJECTIVES To examine the relationship between need of CPR-DR in infants born between 23 and 32 weeks gestation and neonatal mortality and morbidity. DESIGN/METHODS This was a population-based cohort study of 23 0/7 to 32 6/7 weeks gestational age infants born at a Canadian tertiary care hospital between January 1, 2007 and December 31, 2016. Data were retrieved from the Neonatal-Perinatal database. Neonatal mortality and morbidities were examined between infants who did and did not need CPR-DR. RESULTS Of 1443 newborns meeting study criteria, 55 (3.8%) received CPR-DR. On bivariate analysis, outcome of infants requiring CPR-DR was associated with higher mortality (40% vs. 5.8%, p <0.001), intraventricular hemorrhage grade 3 or 4 (21.8% vs. 6.1%, p <0.001), patent ductus arteriosus (54.5% vs. 27.7%, p<0.001), bronchopulmonary dysplasia (35.4% vs. 19.6%, p=0.007), need of mechanical ventilation (90.9% vs. 61.1%, p<0.001) and sepsis (23.6% vs. 13.5%, p=0.034). However, in a multivariable logistic regression analysis controlling for predictor variables, CPR-DR was only associated with increased neonatal mortality (aOR=4.41 p<0.001, 95%CI [2.18, 8.92]). CONCLUSION While CPR-DR is associated with a high mortality rate in infants less than 32 weeks gestation, associated morbidities are largely predicted by other risk factors.

Outcomes of Very Preterm Infants Conceived with Assisted Reproductive Technologies

2021 ◽  
Author(s):  
David C. Fineman ◽  
Roberta L. Keller ◽  
Emin Maltepe ◽  
Paolo F. Rinaudo ◽  
Martina A. Steurer
Keyword(s):  
Preterm Infants ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Very Preterm Infants ◽  
Very Preterm

scholarly journals Sex-specific differences in HPA axis activity in VLBW preterm newborns

2021 ◽  
Author(s):  
Britt J van Keulen ◽  
Michelle Romijn ◽  
Bibian van der Voorn ◽  
Marita de Waard ◽  
Michaela F. Hartmann ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Very Low Birth Weight ◽  
Excretion Rate ◽  
Post Partum ◽  
Small Sample ◽  
Gas Chromatography Mass Spectrometry ◽  
Adrenocortical Function ◽  
Mortality And Morbidity ◽  
Cortisol Excretion

Objective Sex-specific differences in hypothalamic-pituitary-adrenal axis activity might explain why male preterm infants are at higher risk of neonatal mortality and morbidity than their female counterparts. We examined whether male and female preterm infants differed in cortisol production and metabolism at 10 days post-partum. Design and methods This prospective study included 36 preterm born infants (18 boys) with a very low birth weight (VLBW) (<1.500 gram). At 10 days postnatal age, urine was collected over a 4- to 6-hr period. Glucocorticoid metabolites were measured using gas chromatography-mass spectrometry. Main outcome measures were: (1) cortisol excretion rate, (2) sum of all glucocorticoid metabolites, as an index of corticosteroid excretion rate, and (3) ratio of 11-OH/11-OXO metabolites, as an estimate of 11β-hydroxysteroid dehydrogenase (11β-HSD) activity. Differences between sexes, including interaction with Score of Neonatal Acute Physiology Perinatal Extension-II (SNAPPE II), sepsis and bronchopulmonary dysplasia (BPD), were assessed. Results No differences between sexes were found for cortisol excretion rate, corticosteroid excretion rate or 11β-HSD activity. Interaction was observed between: sex and SNAPPE II score on 11β-HSD activity (p=0.04) and sex and BPD on cortisol excretion rate (p=0.04). Conclusion This study did not provide evidence for sex-specific differences in adrenocortical function in preterm VLBW infants on a group level. However, in an interaction model sex differences became manifest under stressful circumstances. These patterns might provide clues for the male disadvantage in neonatal mortality and morbidity following preterm birth. However, due to the small sample size, the data should be seen as hypothesis generating.

Re-imagining Reproduction: Unsettling Metaphors in the History of Imperial Science and Commercial Surrogacy in India

Somatechnics ◽  
2015 ◽  
Vol 5 (1) ◽  
pp. 88-103 ◽  
Author(s):  
Kalindi Vora
Keyword(s):  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
The Body ◽  
Body Parts ◽  
Colonial History ◽  
Women's Bodies ◽  
Commercial Surrogacy ◽  
Art Practices ◽  
History Of ◽  
Travel Industry

This paper provides an analysis of how cultural notions of the body and kinship conveyed through Western medical technologies and practices in Assisted Reproductive Technologies (ART) bring together India's colonial history and its economic development through outsourcing, globalisation and instrumentalised notions of the reproductive body in transnational commercial surrogacy. Essential to this industry is the concept of the disembodied uterus that has arisen in scientific and medical practice, which allows for the logic of the ‘gestational carrier’ as a functional role in ART practices, and therefore in transnational medical fertility travel to India. Highlighting the instrumentalisation of the uterus as an alienable component of a body and subject – and therefore of women's bodies in surrogacy – helps elucidate some of the material and political stakes that accompany the growth of the fertility travel industry in India, where histories of privilege and difference converge. I conclude that the metaphors we use to structure our understanding of bodies and body parts impact how we imagine appropriate roles for people and their bodies in ways that are still deeply entangled with imperial histories of science, and these histories shape the contemporary disparities found in access to medical and legal protections among participants in transnational surrogacy arrangements.

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