Krista Jangaard

Fetal and neonatal outcomes of diabetic pregnancies.

OBJECTIVE: To estimate whether the incidences of adverse fetal and neonatal outcomes in infants of mothers with preexisting types 1 and 2 diabetes 1) differ from infants of nondiabetic mothers in Nova Scotia (NS); and 2) have changed between 1988 and 2002. METHODS: Population-based cohort study using the NS Atlee Perinatal Database, a well-validated source of standardized clinical information. RESULTS: A total of 516 infants of diabetic mothers and 150,589 infants of nondiabetic mothers from singleton pregnancies were studied. Infants of diabetic mothers had significantly higher rates of perinatal mortality (17.4/1,000 compared with 5.9/1,000, relative risk [RR] 3.01, 95% confidence interval [CI] 1.55–5.84), major congenital anomaly (9.1% compared with 3.1%, RR 2.97, 95% CI 2.25–3.90), and large for gestational age birth (LGA, more than 90th percentile weight for gestational age) (45.2% compared with 12.6%, RR 3.59, 95% CI 3.26–3.95) than infants of nondiabetic mothers. In infants of diabetic mothers, there was no improvement in perinatal mortality (23.4/1,000 in 1988–1995 compared with 11.5/1000 in 1996–2002, P=.340), incidence of LGA (48.0% in 1988–1995 compared with 42.3% in 1996–2002, P=.237), or rate of major congenital anomaly (8.2% in 1988–1995 compared with 10.0% in 1996–2002, P=.560). Diabetes remained an independent risk factor for LGA infants and major congenital anomaly after adjusting for possible confounders. CONCLUSION: Rates of adverse neonatal outcomes are 3–9 times greater in infants of diabetic mothers compared with those of nondiabetic mothers. There were no significant improvements in rates of perinatal mortality, congenital anomaly, or LGA birth in infants of diabetic mothers in 1996–2002 compared with 1988–95. LEVEL OF EVIDENCE: II-2

Neonatal outcomes with caesarean delivery at term

Objective: To estimate the impact of caesarean delivery on the incidence of selected neonatal outcomes. Patients and methods: A 15-year, population-based, cohort study (1988–2002) using the Nova Scotia Atlee Perinatal Database compared neonatal outcomes in term newborns born by spontaneous and assisted vaginal delivery, with newborns born by caesarean delivery, with and without labour, using multiple logistic regression. Results: From a total of 142 929 deliveries, there were 27 263 caesarean deliveries, 61% of which were performed in labour. Relative risks were adjusted for year of birth, maternal age, parity, smoking, maternal weight at delivery, hypertensive diseases, diabetes, previous caesarean delivery, use of regional anaesthesia, induction of labour, gestational age at delivery and large and small for gestational age, where significant. Caesarean delivery in labour, but not caesarean delivery without labour, had increased risks for depression at birth and neonatal respiratory conditions compared with spontaneous or assisted vaginal delivery. Compared with spontaneous vaginal delivery and assisted vaginal delivery, the risk of major neonatal birth trauma was decreased for infants after caesarean delivery with labour (odds ratio (OR) = 0.34, 95% CI 0.21 to 0.56 and OR = 0.07, 95% CI 0.04 to 0.11, respectively) and caesarean delivery without labour (OR = 0.20, 95% CI 0.08 to 0.52 and OR = 0.04, 95% CI 0.02 to 0.10, respectively). Conclusion: Caesarean delivery in labour, compared with vaginal delivery, is more likely to be associated with an increased risk for respiratory conditions and depression at birth than caesarean delivery without labour. Caesarean delivery appears protective against neonatal birth trauma, especially when performed without labour.

Outcomes in a Population of Healthy Term and Near-Term Infants With Serum Bilirubin Levels of ≥325 μmol/L (≥19 mg/dL) Who Were Born in Nova Scotia, Canada, Between 1994 and 2000

OBJECTIVE. The goal was to study the incidence of kernicterus, developmental delay, autism, cerebral palsy, and hearing loss in infants with peak total serum bilirubin levels of ≥325 μmol/L (≥19 mg/dL), compared with infants with less-severe or no hyperbilirubinemia, in a population of healthy term and late preterm infants. METHODS. Prospectively gathered, standardized, maternal and neonatal data for infants at ≥35 weeks of gestation who were born between January 1, 1994, and December 31, 2000, were extracted from the Nova Scotia Atlee Perinatal Database. Infants with Rh factor isoimmunization, significant congenital or chromosomal abnormalities, or severe peripartum asphyxia were excluded. Comparisons were made on the basis of peak total serum bilirubin levels. Diagnoses were obtained through data linkage with the Medical Services Insurance Database for office visits and the Canadian Institute for Health Information Database for hospital admissions. The registration file provided information allowing calculation of follow-up times, which were determined for each separate outcome. Follow-up periods ranged from 2 to 9 years, with the end point being the first time the diagnostic code was encountered in either database. Cox proportional-hazards regression analyses were used to examine the relationships between outcomes and total serum bilirubin levels. RESULTS. Of 61238 infants included in the study cohort, 4010 (6.7%) did not have linkage data, which left 56019 infants for analysis. There were no cases of kernicterus and no significant differences in rates of cerebral palsy, deafness, developmental delay, or visual abnormalities between the groups. There were suggestions of associations with attention-deficit disorder in the severe hyperbilirubinemia group and with autism in the combined moderate and severe hyperbilirubinemia group. CONCLUSIONS. There was no increase in adverse effects reported previously to be associated with bilirubin toxicity. Associations with developmental delay, attention-deficit disorder, and autism were observed.

Preterm Prelabour Rupture of Membranes: Effect of Latency on Neonatal and Maternal Outcomes

OBJECTIVES To compare risks of infection and prematurity-related outcomes according to latency periods among women with preterm prelabour rupture of membranes (PPROM). METHODS Women with PPROM occurring between 24+0 and 36+6 weeks of gestation were identified from a provincial population-based perinatal database in Nova Scotia. The primary outcomes included composite variables for serious maternal and neonatal infectious morbidity and neonatal prematurity-related morbidity. Logistic regression was used to quantify the relationship between latency period (< 24 hours, 24 hours to < 48 hours, 48 hours to < 7 days, and ≥ 7 days) and maternal and neonatal outcomes. Separate analyses were conducted for gestational age groups 24+0 to 33+6 weeks and 34+0 to 36+6 weeks. RESULTS There were 4329 women included in the cohort. The composite variables representing serious maternal or neonatal infectious morbidity were not significantly associated with latency for either gestational age group. For PPROM occurring at gestational ages of 24+0 to 33+6 weeks, the odds of neonatal prematurity-related morbidity were significantly decreased at the latency periods of 48 hours or more compared with < 24 hours latency. For PPROM at 34+0 to 36+6 weeks of gestation, the odds of prematurity-related morbidity at 48 hours to < 7 days latency was decreased compared with latencies < 24 hours (OR 0.4; 95% CI 0.2 to 0.8). CONCLUSION Postponing delivery following PPROM may contribute to less prematurity-related morbidity, even close to term, without putting mother or neonate at substantial risk for serious infectious morbidity. Generalization of these findings to other obstetric populations should be informed by the underlying risk of infection.

Neurodevelopmental and Respiratory Outcomes at 18 Months in Infants with Birth Weight<1250 Grams Who Received Early Inhaled Steroid(iB) Therapy

Neurodevelopmental and Respiratory Outcomes at 18 Months in Infants with Birth Weight<1250 Grams Who Received Early Inhaled Steroid(iB) Therapy

Patterns of Follow-up and Parental Education by Primary Care Physicians in the Era of Early Neonatal Discharge 648

Patterns of Follow-up and Parental Education by Primary Care Physicians in the Era of Early Neonatal Discharge 648