Aim
To assess whether maternal hypertensive disorders in pregnancies result in higher respiratory requirements, risk of chronic lung disease (CLD) and poorer neurodevelopmental outcome in <29‐week ...premature neonates.
Methods
This is a multicentre, retrospective cohort study, within a geographically defined area in Australia, served by a network of 10 neonatal intensive care units (NICUs), consisting of infants <29 weeks of gestational age who were admitted to NICUs between 1998 and 2004. Outcome measures included hospital survival, perinatal complications and functional disability at 2–3 years follow‐up.
Results
A total of 2549 mothers and infants were included in the study; 379 (14.9%) mothers had hypertensive disorders during pregnancy. Follow‐up data were obtained for 1473 (74.8%) infants at 2–3 years. Infants exposed to pre‐eclampsia had a higher need for supplemental surfactant therapy (odds ratio (OR): 2.004, 95% confidence interval (CI): 1.51–2.66), longer duration of mechanical ventilation (7.0 days vs. 4.0 days), were associated with a higher incidence of CLD (OR: 1.40, 95% CI: 1.12–1.76) and received post‐natal steroids for CLD (OR: 1.82, 95% CI: 1.43–2.31) and home oxygen (OR: 1.47, 95% CI: 1.11–1.95). Multivariable analysis showed that hypertensive disease of pregnancy was not significantly associated with the development of CLD in this cohort (OR: 1.103, 95% CI: 0.845–1.441). Multivariable analysis of long‐term neurodevelopmental data available for the 1473 follow‐up infants showed no significant difference in outcomes with or without exposure to maternal hypertensive disease.
Conclusion
Maternal hypertensive disease of pregnancy does not increase the risk of CLD or long‐term neurodevelopmental complications in infants born at <29 weeks of gestation.
Abstract Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. ...With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases – Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
Neonatal hypertension is an uncommon but important complication of intensive care management. The aims of this study were to identify in neonates with hypertension: antenatal and postnatal risk ...factors; aldosterone and renin levels; and report on outcome in early infancy. The study involved a retrospective review of neonates diagnosed with systemic hypertension from January 2001 to December 2005. Demographic data, risk factors, laboratory investigation, and follow-up data at 3-6 months of age were collected. Of the 2,572 newborn infants included, 34 (1.3%) had neonatal hypertension. Gestational age and birth weight and length were significantly lower in infants with hypertension. The median postnatal age at diagnosis of systemic hypertension was 5.0 days. Antenatal steroid administration, maternal hypertension, umbilical arterial catheter, postnatal acute renal failure, patent ductus arteriosus, indomethacin treatment and chronic lung disease were associated with the development of neonatal hypertension odds ratios (OR) 8.7, 3.8, 10.0, 51.8, 5.9, 5.7 and 7.7, respectively. Elevated aldosterone and renin levels occurred in 60% and 33% but had normalised in the majority by 6 months of age. The majority of infants do not require treatment for hypertension by 6 months of age.
To assess the effect of pregnancy-induced hypertensive disorders on the growth of the placenta on the short and long axes and neonatal outcomes.
A retrospective cohort study of gross and histological ...characteristics of placentas and the fetal outcomes of normotensive and hypertensive pregnancies over a three-year period from January 2009 to December 2011 at a tertiary teaching hospital in ACT, Australia.
Placentas and neonatal outcomes from 100 pregnancies complicated with pregnancy-induced hypertension/pre-eclampsia were studied and compared with 51 gestational age-matched placentas and neonatal outcomes from normotensive pregnancies. The median maternal age and smoking history were similar in the two groups (P = 0.894; P = 1.00, respectively). The median pre-pregnancy weight was significantly higher (P < 0.001) and primiparity more common (P = 0.001) in the study group. The median weight of the placenta was significantly lower (P < 0.001) and below the 10th centile (P < 0.001) in the study group. Both the long and short axes of the placental disc were significantly smaller in the study group (P = 0.002; P ≤ 0.001 respectively). Accelerated villous maturation, placental infarcts and decidual vessel vasculopathy were more common in the study group (P < 0.001). The median birthweight and the number of infants with birthweight and length below the 10th centile were significantly higher in the study group (P = 0.008; P < 0.001; P = 0.004, respectively).
This study demonstrates that pregnancy-induced hypertension significantly influences the growth and development of both the placenta and fetus.
Summary Objectives Recent development of serogroup B meningococcal (MenB) vaccines highlights the importance of pharyngeal carriage data, particularly in adolescents and young adults, to inform ...implementation strategies. We describe current UK carriage prevalence in this high risk population and compare methods of carriage detection. Methods In this multisite study, pharyngeal swabs were collected on 3–4 occasions over 6–12 months, from 1040 school and university students, aged 10–25 years. Meningococcal carriage was detected by standard culture combined with seroagglutination or PCR of cultured isolates, or by direct PCR from swab. The factor H binding protein (fHBP) variants present in meningococcal isolates were determined. Results Meningococcal serogroups B and Y were most common, with carriage up to 6.5% and 5.5% respectively, increasing throughout adolescence. Identification by seroagglutination was often unreliable, and the sensitivity of direct PCR detection was 66% compared to culture combined with PCR. Of MenB isolates, 89.1% had subfamily A variants of fHBP. The acquisition rate of MenB carriage was estimated at 2.8 per 1000 person-months. Conclusions If vaccination is to precede the adolescent rise in MenB carriage, these data suggest it should take place in early adolescence. Studies assessing vaccine impact should use molecular methods to detect carriage.
Aim
Sudden Infant Death Syndrome (SIDS) remains one of the largest causes of infant mortality worldwide, and despite widespread educational campaigns compliance to safe sleeping guidelines remains ...low in many areas. Hospital staff play a significant role in educating parents on safe sleeping recommendations and providing appropriate sleeping environments for infants. The aim of the study was to evaluate adherence to safe sleeping guidelines in a special care nursery (SCN) and general paediatric ward (GPW).
Methods
A prospective audit of sleeping environments in a SCN and GPW with data collected on 10 safe sleeping compliance rules, based on national and international guidelines.
Results
Two hundred eleven sleeping environments were observed (161 in SCN, 50 in GPW). Supine sleeping compliance was high in both wards (83% SCN, 82% GPW). Overall the median compliance score was significantly lower in the GPW (7, IQR = 6–7) compared to the SCN (8, IQR = 7–9) (Mann Whitney U test, P < 0.001). Lowest compliance rates were seen in respect to removing soft items from the crib and infant positioning within the crib.
Conclusions
Compliance with supine sleeping was high; however, nurses and parents may not be aware, or do not implement, the full suite of safe sleeping guidelines. Further research is required to determine specific reasons for poor compliance and on the effectiveness of educational programmes in improving hospital infant sleeping environments.
IntroductionHyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. ...Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP.MethodsA consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact.ResultsPopulation interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline (‘business as usual’ scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy weight was most effective in reducing HIP incidence (28.8% reduction by 2030; incidence=11.5, 95% CI 11.2 to 11.8). Scenarios exploring the effect of childhood weight status on entry to adulthood demonstrated significant impact in the selected outcome measure for glycemic regulation, insulin sensitivity in the short term and HIP in the long term.DiscussionPopulation-level weight reduction interventions will be necessary to ‘turn the tide’ on HIP. Weight reduction interventions targeting high-risk individuals, while beneficial for those individuals, did not significantly impact forecasted HIP incidence rates. The importance of maintaining interventions promoting healthy weight in childhood was demonstrated.
ObjectivesThe objective of this study is to evaluate whether there are differences in the long-term prognosis across various phenotypes of early arthritis (EA).MethodsThree EA cohorts (Reade, Etude ...et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) and Early Arthritis Clinic (EAC)) were analysed. Clinical data were collected up to 24 years. Hands and feet radiographs were scored according to the Sharp van der Heijde (SvdH) method. Latent class analysis was applied to determine the EA phenotypes at baseline. Each class received a label reflecting its most prominent features. Prognostic outcomes included Health Assessment Questionnaire (HAQ), Short Form 36 (SF36) and SvdH score. The association between class membership and outcomes over time was tested in multivariable models.ResultsIn total, 390 (Reade), 798 (ESPOIR) and 3991 (EAC) patients were analysed separately. Two classes with symmetrical polyarthritis emerged; one of these labelled as autoimmune inflammatory polyarthritis (AIPA), had high likelihood of acute phase reactants (APR) elevation and autoantibody positivity, while the other (mild-inflammatory polyarthritis; MIPA) had not. A third class had oligoarthritis of upper limbs (OAUL) and could be subdivided into autoimmune OAUL and mild-inflammatory OAUL. A fifth class had oligoarthritis of lower limbs. The SvdH scores were worse in patients with APR/autoantibodies (AIPA) than in those without (MIPA). No clinically meaningful differences across classes in HAQ or SF36 over time were found.ConclusionRadiographic progression over time primarily occurs in EA patients with APR/autoantibodies. The absence of these markers, however, does not necessarily translate into better long-term function and quality of life. Clinicians should not only aim at preventing joint damage, but look beyond structural progression in order to further improve the lives of people with EA.
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