Eileen Wang

A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infants

A multicenter prospective, randomized controlled trial was conducted to determine whether early use of platelet concentrates would reduce the incidence or extension of intracranial hemorrhage or both in sick preterm infants with thrombocytopenia. The effects on bleeding as reflected by the amount of blood product support administered and a shortened bleeding time were assessed as secondary outcomes. Premature infants with a platelet count < 150 x 10(9)/L within the first 72 hours of life were randomly assigned to receive either conventional therapy or conventional therapy plus platelet concentrates (10 ml/kg). The platelet count was maintained < 150 x 10(9)/L until day 7 of life by one to three platelet transfusions. In 22 (28%) of the 78 treated infants and 19 (26%) of the 74 control infants, either a new intracranial hemorrhage developed or an already-present one became more extensive (p = 0.73). Similar numbers of infants had each grade of intracranial hemorrhage on both initial and follow-up ultrasonography. Similar numbers of infants received fresh frozen plasma and packed red blood cells, but treated infants received less of both. The bleeding time was prolonged in the treated group before the infusion of platelet concentrates but subsequently shortened (mean difference, 79.0; 95% confidence interval, 73.1 to 84.9). Subanalysis of the control group showed that infants with platelet counts < 60 x 10(9)/L (n = 21) on at least one occasion received more fresh frozen plasma and packed red blood cells than did those with platelet counts > 60 x 10(9)/L.(ABSTRACT TRUNCATED AT 250 WORDS)

Can transabdominal ultrasound be used as a screening test for short cervical length

OBJECTIVE Universal transvaginal cervical length screening can be associated with a significant logistical burden. We hypothesized that there is a threshold cervical length measured by transabdominal ultrasound above which risk for short transvaginal cervical length is extremely low. STUDY DESIGN This prospective cohort study evaluated a consecutive series of women offered universal transvaginal cervical length screening during anatomy ultrasound. Transabdominal measurement of the cervix-obtained before and after voiding for each patient-was performed before transvaginal ultrasound. The study was powered to detect a transabdominal cervical length cutoff with 95% sensitivity (95% confidence interval, 90-99%) for transvaginal cervical length of ≤25 mm. RESULTS One thousand two hundred seventeen women were included in the analysis. Prevoid transabdominal cervical length ≤36 mm detects 96% of transvaginal cervical lengths ≤25 mm with 39% specificity. A prevoid transabdominal cervical length ≤35 mm detects 100% of transvaginal cervical lengths ≤20 mm with 41% specificity. Transabdominal images of the cervix could not be obtained in 6.2% of women prevoid and 17.9% of women postvoid. CONCLUSION Transabdominal cervical length screening successfully identifies women at very low risk for short transvaginal cervical length. Transabdominal screening may significantly reduce the burden of universal cervical length screening by allowing approximately 40% of women to avoid transvaginal ultrasound. To ensure high sensitivity of transabdominal screening, approximately 60% of patients will still require a transvaginal study.

In situ hybridization and translocation breakpoint mapping

In situ chromosomal hybridization of a probe for part of the lamda light chain constant region (Cλ) has demonstrated that the 22q11 breakpoints of chronic myelogenous leukemia (CML) t(9;22) and Burkit

Survival rates in extremely low birthweight infants depend on the denominator: avoiding potential for bias by specifying denominators

OBJECTIVE The objective of the study was to assess whether recent data reporting survival of preterm infants introduce a bias from the use of varying denominators. STUDY DESIGN We performed a systematic review of hospital survival of infants less than 1000 g or less than 28 weeks. Included publications specified the denominator used to calculate survival rates. RESULTS Of 111 eligible publications only 51 (46%) specified the denominators used to calculate survival rates: 6 used all births, 25 used live births, and 20 used neonatal intensive care unit admissions. Overall rates of survival to hospital discharge ranged widely: from 26.5% to 87.8%. Mean survival varied significantly by denominator: 45.0% (±11.6) using a denominator of all births, 60.7% (±13.2) using live births, or 71.6% (±12.1) using used neonatal intensive care unit admissions (P ≤ .009 or less for each of 3 comparisons). CONCLUSION Variations in reported rates of survival to discharge for extremely low-birthweight (<1000 g) and extremely low-gestational-age (<28 weeks) infants reflect in part a denominator bias that dramatically affects reported data.

Adnexal masses in pregnancy.

With the increased use and quality of ultrasound in pregnancy, adenxal masses are being encountered with greater frequency. Fortunately, most of such masses are benign and resolve on their own. However, complications such as ovarian torsion can occur. In addition, a malignancy can be present in a small minority of cases. In this article, we review the available literature on this subject to help guide the clinician in the diagnosis and management of adnexal masses in pregnancy.

Is Sonographic Assessment of Fetal Weight Influenced by Formula Selection

Objective. Several published formulas exist for the determination of estimated fetal weight (EFW), with limited data on their comparative accuracies. The aims of our study were to assess and compare the performance of different EFW formulas in predicting actual birth weight (BW) in an urban population. Methods. Patients with an EFW determined within 7 days of delivery were considered eligible for the study. Fourteen published formulas, derived from populations comparable to ours, were used to recalculate EFWs from the same initial measurements. The accuracy of the EFWs obtained from the different formulas were compared by percentage error methods using bias and precision and Bland‐Altman limits of agreement methods. Sensitivity and specificity for prediction of being small for gestational age (SGA) were calculated. Results. Eighty‐one fetuses were included in the study. Formula C of Hadlock et al [Hadlock C; log10 BW = 1.335 − 0.0034(abdominal circumference [AC])(femur length [FL]) + 0.0316(biparietal diameter) + 0.0457(AC) + 0.1623(FL); Am J Obstet Gynecol 1985; 151:333–337] had the best performance according to the bias and precision method. Bland‐Altman limits of agreement confirmed these results. Among the formulas, the sensitivity for detection of SGA ranged from 72% to 100%, and specificity was 41% to 88%. Hadlock C had the optimal sensitivity/specificity trade‐off for detection of SGA. Conclusions. Fourteen formulas showed considerable variation of bias and precision in our population as well as a wide range of sensitivities and specificities for SGA. The choice of the appropriate formula for EFW in a given population should be based on objective and explicit criteria. Consideration of bias and precision for the formula in the population being assessed is critical and may affect clinical care.

Two-dimensional sonographic placental measurements in the prediction of small-for-gestational-age infants

To determine the utility of two‐dimensional (2D) sonographic placental measurements in the prediction of small‐for‐gestational‐age (SGA) infants.

Performance of lecithin-sphingomyelin ratio as a reflex test for documenting fetal lung maturity in late preterm and term fetuses

Objective: To determine if infants delivered after immature or indeterminate TDx-FLM II testing and a mature reflex test are at increased risk for neonatal respiratory complications. Methods: The primary analysis compared neonatal respiratory morbidity (RDS or TTN) in 34–39-week fetuses delivered after either (i) mature TDx-FLM II testing, or (ii) indeterminate or immature TDx-FLM II and a positive reflex test (PG or L/S ratio). Results: Fifty patients delivered after mature TDx-FLM II, and 30 after immature or indeterminate TDx-FLM II with an L/S ≥2.0. Respiratory morbidity was significantly higher in the group delivered after mature reflex testing compared with mature TDx-FLM II (23% vs. 2%, p < 0.01). When PG was present, there were no cases of RDS or TTN. Conclusions: Utilizing L/S ratios as a reflex test to confirm lung maturity was associated with a high risk for respiratory morbidity, particularly when PG was not present.

Transabdominal ultrasonography as a screening test for second-trimester placenta previa.

OBJECTIVE: To determine the test characteristics of transabdominal ultrasonography as a screening test for second-trimester placenta previa. METHODS: This secondary analysis of a prospective cohort study evaluated the distance from the placental edge to the internal os (placenta–cervix distance) through both transabdominal and transvaginal ultrasonography during the anatomic survey. Patients were recruited in the Maternal-Fetal Medicine Ultrasound Unit at the Hospital of the University of Pennsylvania, an urban tertiary care center. Transabdominal placenta–cervix distance cutoffs with high sensitivity for detection of previa and low-lying placenta were identified, and test characteristics were calculated. Follow-up ultrasound data, pregnancy, and delivery outcomes for those with second-trimester previa or low-lying placenta were obtained. RESULTS: One thousand two hundred fourteen women were included in the analysis. A transabdominal placenta–cervix distance cutoff of 4.2 cm was 93.3% sensitive and 76.7% specific for detection of previa with a 99.8% negative predictive value at a screen-positive rate of 25.0%. A cutoff of 2.8 cm was 86.7% sensitive and 90.5% specific with a 99.6% negative predictive value at a screen-positive rate of 11.4%. Only 9.8% (four of 41) of previas and low-lying placentas persisted through delivery. CONCLUSION: Transabdominal ultrasonography is an effective screening test for second-trimester placenta previa. At centers not performing universal transvaginal ultrasonography at the time of the anatomic survey, evidence-based transabdominal placenta–cervix distance cutoffs can optimize the identification of patients who require further surveillance for previa. LEVEL OF EVIDENCE: II

Utility of a Single 3-Vessel View in the Evaluation of the Ventricular Outflow Tracts

Prenatal diagnosis of congenital heart disease can improve neonatal outcomes. The purpose of this study was to evaluate the utility of an isolated 3‐vessel view image in evaluating the ventricular outflow tracts.