Irit Schushan-Eisen

Clot formation of neonates tested by thromboelastography correlates with gestational age

Evaluation of clot formation in neonates is troublesome. Our aim was to investigate cord blood clot formation of pre-term versus full-term infants and adults, using rotating thromboelastogram (ROTEM), Pentafarm, Munich, Germany). ROTEM was investigated in cord blood of 184 full-term and 47 pre-term infants. Measurements of the clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) were obtained in order to asses reference values for this age group, and compare between full-term and pre-term neonates and compared to adult controls. For each infant demographic information and data regarding pregnancy and delivery were gathered. Infants were prospectively followed until discharge. CT and CFT were significantly shorter among pre-term and term infants as compared to adults [median CT: 185, 194, 293 seconds respectively, p pound0.001, CFT: 80, 76, 103 seconds respectively, p pound0.001). MCF was lower in pre-term and term as compared to adults (p pound0.001) with significantly lower values in pre-term as compared to full-term neonates (p=0.004). Clotting time and MCF correlated with gestational age (R=0.132, p=0.045, R= 0.259, p<0.001, respectively). No association was found between any ROTEM values and the occurrence of post-natal complications in infants of our study group. This is the first study assessing clot formation by ROTEM in pre-term infants. Clot formation parameters of term and premature infants correlated with gestational age. The predictive value of clot formation tests in neonates deserves further attention.

Delivery Room Breastfeeding for Prevention of Hypoglycaemia in Infants of Diabetic Mothers

Objective: To evaluate the effect of duration of early breastfeeding in the delivery room on blood glucose levels among term neonates of diabetic mothers. Methods: Mothers with gestational diabetes were encouraged to breastfeed their infants immediately after birth in the delivery room. The breastfeeding duration was recorded by the midwife. Results: The longer duration of breastfeeding subgroup (n = 39) demonstrated a lower rate of hypoglycaemia in the first 8 hours of life (< 40 mg/dl) compared to the shorter duration subgroup (n = 40), but this difference did not reach statistical significance (2.6% vs. 17.5% respectively, p = 0.057). Hypoglycaemia was mainly predicted by lower cord glucose for each decrease of 10 mg/dl (OR 2.11 [CI 1.1–4.03] p = 0.024. Conclusion: Longer duration of delivery room breastfeeding did not reduce the rate of hypoglycaemia, which was mainly influenced by lower cord blood glucose level.

The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia

To measure 3 intervals of time—induction of regional anesthesia to delivery (I–D), initial skin incision to delivery (S–D), and uterine incision to delivery (U–D)—in elective cesareans and to evaluate the impact of the duration of these 3 components on short‐term neonatal outcome.

Short-Term Neonatal Outcome among Term Infants after in utero Exposure to Serotonin Reuptake Inhibitors

Background: Serotonin reuptake inhibitor (SRI) medications are commonly in use during pregnancy. Objectives: To evaluate short-term neonatal clinical signs among infants exposed to intrauterine SRI medications, in order to estimate the need for postnatal monitoring and observation. Methods: Retrospective review of clinical data in medical files of term infants born to mothers who reported treatment with SRIs during pregnancy. Results: Out of 401 infants in the study group, 165 (41%) were reported to have at least 1 clinical symptom, including respiratory distress, jitteriness, restlessness, feeding difficulties, regurgitations, fever ≥38°C, a short cyanotic event and convulsions. In the symptomatic group, 70% exhibited mild symptoms, among them restlessness, jitteriness or feeding difficulties, while around 30% exhibited significant symptoms. Overall, 12% of the total cohort, mostly males (70%), presented significant clinical symptoms, but none had an urgent or life-threatening condition. Infants in the study group were shorter in length and had a higher rate of Apgar score <7 at 1 min, meconium-stained amniotic fluid and respiratory distress. Conclusions: Despite the high incidence of clinical signs among infants born to SRI-treated mothers, most of their symptoms were mild and self-limited. These infants should be observed while they are close to their mothers on the maternity ward for 48 h after birth.

Restrictive management of neonatal polycythemia.

Partial exchange transfusion (PET) is traditionally suggested as treatment for neonates diagnosed with polycythemia. Nevertheless, justification of this treatment is controversial. We evaluated the risk for short-term complications associated with a restrictive treatment protocol for neonatal polycythemia. A retrospective cross-sectional analytical study was conducted. Three treatment groups were defined and managed according to their degree of polycythemia, defined by capillary tube filled with venous blood and manually centrifuged hematocrit: group 1, hematocrit 65 to 69% and no special treatment was recommended; group 2, hematocrit 70 to 75% and intravenous fluids were given and feedings were withheld until hematocrit decreased to < 70%; and group 3, hematocrit ≥ 76% or symptomatic neonates and PET was recommended. During the study period, 190 neonates were diagnosed with polycythemia. The overall rate of short-term complications was 15% (28 neonates). Seizures, proven necrotizing enterocolitis, or thrombosis did not occur in any participating neonates. PET was performed in 31 (16%) neonates. The groups did not differ in their rate of early neonatal morbidities or length of hospitalization. Restrictive treatment for neonatal asymptomatic polycythemia is not associated with an increased risk of short-term complications.

Short-term morbidities and neurodevelopmental outcomes in preterm infants exposed to magnesium sulphate treatment.

The aim of the study is to examine whether baseline serum Mg concentration has an impact on short‐term and long‐term outcomes in preterm infants exposed antenatally to MgSO4.

Gestational weight gain and body mass indexes have an impact on the outcomes of diabetic mothers and infants

This study evaluated mothers with diabetes to determine whether prepregnancy body mass index (BMI), BMI on delivery or gestational weight gain (GWG) had the greatest impact on maternal and neonatal outcomes.

Meconium-Stained Amniotic Fluid and Hypoglycemia Among Term Newborn Infants

To evaluate whether meconium-stained amniotic fluid (MSAF) is a risk factor for neonatal hypoglycemia. Retrospective recording of medical charts of full-term infants born following observation of meconium-stained amniotic fluid to examine glucose levels in the first hours of life. Out of 803 infants of the study group, 68 (8.5%) had glucose levels lower than 47 mg/dl. Most (6.7%) had mild hypoglycemia, and 14 (1.8%) had moderate or severe hypoglycemia (1.4% and 0.4% respectively). No infant developed clinical signs clearly related to hypoglycemia. Low-risk infants born following meconium-stained amniotic fluid are not at increased risk for neonatal hypoglycemia.

Predictors for neonatal thrombocytopenia in infants of thrombocytopenic mothers during pregnancy.

Although maternal thrombocytopenia during pregnancy is common, its effect on neonatal platelets has not yet been fully evaluated.

Short-Term Outcome for Term and Near-Term Singleton Infants with Intrapartum Polyhydramnios

Objective: To evaluate rates of early short-term neonatal complications among term and near-term newborn infants with polyhydramnios. Methods: Retrospective data were collected on 788 term infants with prenatal diagnosis of polyhydramnios and 1,576 matched controls, including information on maternal condition and on infant perinatal complications. Results: The total rate of major congenital malformations among infants born to mothers with polyhydramnios was 2.3% compared to 0.13% for those with normal amniotic fluid index (p < 0.001). Infants in the study group were more likely to be born to diabetic mothers, were heavier and large for gestational age and were more likely to be delivered by cesarean section. Infants with polyhydramnios, but no major congenital malformations, are at increased risk for minor congenital malformations (4.2%) as well as for postnatal complications, such as respiratory distress (5.7%), cardiovascular manifestations (mainly delayed closure of the ductus arteriosus; 3.1%) and hypoglycemia (7%) compared to controls. Multivariate logistic regression revealed that polyhydramnios was associated only with postnatal respiratory distress and hypoglycemia. The severity of polyhydramnios was not associated with an increased rate of neonatal complications. Conclusion: Although infants with polyhydramnios, but no major congenital malformations, were found to have increased rates of respiratory distress and hypoglycemia, these clinical manifestations were mild and had little effect on the babies’ well-being and length of hospital stay.