Vito D'Andrea

Neonatal outcome in hypertensive disorders of pregnancy.

BACKGROUND Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations. AIMS To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries. STUDY DESIGN The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls. SUBJECTS Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated. MEASURES Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed. RESULTS Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (<32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE, 37.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries. CONCLUSION Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE.

Ophthalmia neonatorum: what kind of prophylaxis?

Objective. Conjunctivitis during neonatal period occurs in 1–12% of all babies. Ophthalmia neonatorum is an acute muco-purulent conjunctivitis occurring in the first month of birth. It is essentially an infection acquired during vaginal delivery. The most frequent infectious agents involved in ophthalmia neonatorum are Chlamydia trachomatis and Neisseria gonorrhoeae. Methods. Topical ocular prophylaxis must be instituted early after birth. Recommended prophylactic regimen are: 1% nitrate solution; 1% tetracycline solution; 1% erythromycin solution; 2.5% povidone-iodine solution; and fusidic acid. Results. Evidence suggests better outcomes using 1% tetracycline solutions even if there is the risk of selecting drug resistant bacteria. However, even the widespread used nitrate solution can cause a chemical conjunctivitis, arguing against its widespread use. Conclusions. Fusidic acid is a relatively new promising therapy even if there are still few data about its use. None of the used regimens has the optimal risk-benefit profile to suggest a widespread use.

Neonatal outcomes in triplet pregnancies: assisted reproduction versus spontaneous conception

Abstract Aims: The purpose of this study is to compare neonatal outcomes of spontaneously conceived triplets with triplets conceived by assisted reproduction. Methods: This was a retrospective cohort study of all cases from assisted triplet pregnancies and controls from spontaneous triplet pregnancies. A total of 24 triplet pregnancies were studied: six spontaneous and 18 assisted. The following variables were evaluated in all newborns: prematurity, birth-weight, small for gestational age, birth-weight discordance, Apgar scores, major neonatal morbidity and perinatal mortality. Results: Gestational age (33±1 vs. 33±2 weeks) and birth-weight (1760±256 vs. 1907±452 g) were similar in spontaneous and assisted triplet pregnancies. There were no significant differences in the rates of small for gestational age, discordance, and major neonatal morbidity. In the assisted reproduction group only the following cases were recorded: 1 surgically treated patent ductus arteriosus, 1 feto-fetal transfusion syndrome, 2 grade II intraventricular hemorrhage, 1 Cri du Chat syndrome and 1 stillbirth with malformations. Conclusions: This study is unable to assess the influence of assisted reproduction on the neonatal outcomes of triplet pregnancies. However, the results suggest that the incidence of major neonatal morbidity, especially malformations, might increase due to assisted reproduction. This finding requires further confirmation.

Infants Born to Mothers With Anti-SSA/Ro Autoantibodies: Neonatal Outcome and Follow-up

Neonatal lupus syndrome is considered a model of passively acquired autoimmune disease. The first 10 newborns born to mothers with connective tissue disease and positive for anti-SSA/Ro antibodies enrolled in a follow-up program to evaluate the incidence of cardiac, hepatobiliary, hematologic, echoencephalographic, and cutaneous manifestations until 9 months of age are described in this study. No congenital heart block was observed, but only transient rhythm alterations were observed. In all, 1 infant showed typical neonatal lupus syndrome skin lesions at 3 months of age. During the neonatal period, echoencephalographic alterations were found more frequently, whereas at follow-up, hepatic and hematologic alterations were more often observed. In all, 1 baby showed persistent neutropenia. A standard program that enrolls all infants born to mothers with anti-SSA/Ro autoantibodies, who are at risk of developing neonatal lupus syndrome, should also include tests performed some time after birth, as a number of clinical manifestations might appear at a late stage.

Clinical examination and pulse oximetry as screening for congenital heart disease in low-risk newborn

Abstract Objective: To assess sensitivity, specificity, positive predictive value and negative predictive value of the cardiovascular physical examination (CPE) and of pulse oximetry in screening for congenital heart diseases (CHD) in asymptomatic newborn when prenatal ultrasound evaluation is negative for structural cardiac abnormalities. Methods: In this observational cohort study, 5750 asymptomatic newborns, admitted to nursery in a period of 2 years, underwent to CPE and determination of arterial oxygen saturation by pulse oxymetry between 48th and 72nd h of life. Results: Two hundred and ninty-eight newborns presented a suspected CPE; in 70% of cases, we found a transitional alteration and in only 17% of cases, the echocardiography examination performed for suspected CPE were completely negative. Three newborns were positive to pulse oximetry screening test but negative at CPE. After discharge, one case of critical CHD was diagnosed. Conclusions: An accurate CPE performed by trained and experienced pediatricians is indicative of important cardiac structural alteration in more than 25%. The association of CPE and pulse oximetry allows to further improve the diagnostic accuracy.

ABO hemolytic disease of the fetus and newborn: an iatrogenic complication of heterologous assisted reproductive technology-induced pregnancy.

BACKGROUND: ABO hemolytic disease of the fetus and newborn (ABO HDFN) may manifest itself in cases of mothers belonging to blood group O and newborns of groups A or B and more frequently in group A and less so in group B.

Is growth-discordance in twins a substantial risk factor in adverse neonatal outcomes?

To evaluate whether growth discordance is an independent risk factor in the neonatal outcome of the smaller twin, all medical records of twin pregnancies delivered between 26 and 41 weeks during a 5-year period (January 2004-December 2008) were reviewed. Among the 49 selected twins, weight discordance was 15-20% in 7 infants, 21-30% in 16 infants, 31-40% in 16 infants and > 40% in 10 infants. No significant differences between the four groups were found with regards to obstetric complications and neonatal disease. Occurrence of birthweight below the 10th percentile and rate of admission to the neonatal intensive care unit significantly increased as intra-pair birthweight difference increased (p = .03). The > 40% discordant group had a significantly lower gestational age (p = .03), lower birthweight (p = .007) and a significantly higher mortality rate (4/10 versus 3/39 p = .04) in comparison with the other discordant groups. Multiple logistic regression analysis showed that birthweight was the single independent and consistent factor associated with elevated risks of mortality. For every 250 g increase in birthweight, the risk for mortality decreased by about 84% [RR 0.16(CI 0.00-0.70)]. Gestational age was the most reliable predictor for major neonatal complications. For every 1-week increase in gestational age a significant decreased risk for all outcomes was found. Discordance alone should not be considered as a predictor for adverse neonatal outcome. Neonatal outcome in discordant twins appears to be related to gestational age and birthweight rather than to the degree of discordance.

Spontaneous neonatal pneumomediastinum: Radiological or clinical diagnosis?

Spontaneous neonatal pneumomediastinum (PNM) is associated with the aspiration of blood or meconium and birth-related trauma and it seems to be more frequent in post-term newborns. It is generally asymptomatic, but it is occasionally accompanied by mild tachypnoea. Only rarely, it requires oxygen therapy or develops into pneumothorax. To evaluate the relationship between the radiological and clinical diagnosis in this uncommon problem, from January 2005 to August 2009, 35 newborns with spontaneous PNM were enrolled in the study. Treatment protocol provides for execution of a chest X-ray, clinical check, SatO2 and heart rate monitoring. Clinical diagnosis was accomplished particularly early, within the first 24 h of life. Paraphonic and distant tones discovered by cardio-auscultatory exam disappeared within the following 72 h. A total of 28 newborns were asymptomatic (80%); seven were symptomatic (20%); five had transient tachypnoea of the newborn; two developed an RDS, with Silverman score ≥ 3 and required O2 therapy. It is necessary to affirm the importance of early diagnosis of this condition, carrying out careful monitoring of newborns at risk, to begin timely therapeutic treatments, as oxygen-therapy and to heighten alertness for complications, such as pneumothorax.

T-cell polarization: Potential serological markers in preterm and term infants

BACKGROUND The immaturity of immune system characterizes newborn infants. Possible serological markers of Th1 and Th2 immune response are the lymphocyte activation gene-3 (CD223) and soluble CD30, respectively (sCD30). AIMS The aim of our study was to evaluate the relationship between Th1 and Th2 immune response and gestational age (GA), comparing data in preterm and term neonates. STUDY DESIGN Cord blood from 20 preterm (GA: 33±2weeks, BW 1950±490g) and 20 term infants (GA: 38±1weeks, BW: 3177±330g) were tested for sCD30 and CD223 levels by ELISA. IFNγ levels produced by cord blood lymphocytes were also analyzed, both before and after stimulation with phytohaemagglutinin (PHA). RESULTS sCD30 resulted significantly higher in preterm neonates when compared with term neonates (60±7.6 vs 42.6±3.9U/ml p<0.05). CD223 was undetectable in preterm neonates while resulting at a level of 176.1±112.6ng/ml in term neonates. After stimulation with PHA, a significant increase in IFNγ levels was only observed in term neonates (326.6±72.7pg/ml p<0.05). CONCLUSIONS Our findings show that sCD30 is present and measurable in term and preterm infants, while CD223 is detectable only in term infants and that Th-cell polarization could also depend on gestational age. Our data suggest that a Th2 immune response seems predominant in preterm neonates.

444 Higher Rates of Birth Defects in Newborns After Icsi Pregnancy

The Assisted Reproductive Techniques (ART) have become a routine infertility treatment. International data suggest the high rates of multiple pregnancies, prematurity, low birth-weight, neonatal morbility/ mortality in ART conceived births. Correlation between ART pregnancy and birth defects is not well established yet. The aim of this study is to compare neonatal outcomes in ICSI-induced pregnancies vs IVFinduced pregnancies delivered at Romes Gemelli Hospital. We studied 322 infants conceived through assisted reproductive technology: 147 ICSI and 175 IVF. All newborns were evaluated for prenatal outcomes (maternal age, pregnancy complications) and neonatal outcomes (gestational age, birthweight, major neonatal diseases, congenital malformations). 32.2% were singletons,54.2% were twins and 14.6% were triplets. No significant differences were observed in prenatal outcomes, gestational age (35±2 vs 34±3) birthweight (2325±668 vs 2318±759) and major neonatal diseases (34.01% vs 27.42%) compared ICSI/IVF groups. A significant higher rate of malformations in ICSI-group was observed (11,5% vs 5,1% p < 0.03): 7 cases of heart defects(4.7%), one case of SNC defect (anencephaly), three cases of clubfoot, three cases of urinogenital defects and three cases of syndrome(2 Downs syndrome and 1 Larsen s syndrome). No differeces we observed in singleton, twins and triplets comparing ICSI/IVF groups. Our study suggests a significantly increased risk of congenital malformations in ART conceived births. The higher rate adverse neonatal outcomes and malformations in ICSI-group may be due to micromanipulation of gametes or unknown characteristics in the couples who undergo ICSItreatment.