Objective-Determine factors predicting outcome in newborns with gastroschisisMethods-Retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007. Prenatal ultrasound findings were available for 89/155 (57%) patients and were compared to final outcome. Both univariate and multiple regression analyses were used.Results-All patients survived to discharge home. The primary outcome measure was length of stay (LOS). Multiple regression identified four factors associated with LOS: 1) gestational age (p=0.004), 2) non-elective silo (p<0.001), 3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (p<0.001), and 4) non-GI anomaly (p=0.029). Non-GI anomalies occurred in 17/155 (11%) patients and tended to increase the risk of a non-elective silo or GI complication (59% vs. 39%, p=0.190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs. 3%, p=0.010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases.Conclusion-Prematurity, non-elective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.

Glucose turnover and glucose oxidation were quantified in six normal pregnant women serially throughout pregnancy, using [U-13C]glucose tracer in combination with open-circuit indirect respiratory calorimetry. Five normal nonpregnant women were studied for comparison. With advancing gestation and increase in maternal body weight, there was a proportionate increase in the rate of appearance (Ra) of glucose so that Ra expressed per kilogram body weight did not change from the first to third trimester. The tracer measured rate of glucose oxidation expressed per kilogram body weight also did not change significantly throughout pregnancy. Oxygen consumption (VO2) in pregnant subjects did not differ from that in nonpregnant subjects. However, the respiratory exchange ratio (RER) increased significantly during pregnancy (0.88 +/- 0.53 3rd trimester and 0.76 +/- 0.50 nonpregnant, P < 0.01). The estimated contribution of carbohydrate to VO2 measured by respiratory calorimetry was greater than that measured by the tracer method. This discrepancy became wider as the respiratory quotient increased in late pregnancy. These data suggest that maternal glucose metabolism adjusts throughout pregnancy to meet the increased demands of the conceptus. The discrepancy between tracer method and respiratory calorimetry was probably due to the contribution of (fetal) lipogenesis and (maternal) gluconeogenesis to RER.

The purpose of the review article is to determine if prolonged (≥48 hour) tocolytics with symptomatic preterm placenta previa improves perinatal outcome. OVID MEDLINE and Cochrane Databases were searched from January 1950 to January 2009. Odds ratio (OR) and 95% confidence intervals (CI) were calculated. We identified two retrospective studies ( N = 217) and one randomized clinical trial (RCT; N = 60), and they were analyzed separately. Results of the RCT indicated that pregnancy is prolonged for more than 7 days with continued tocolytics (OR 3.10, 95% CI 1.38 to 6.96) but combined results of two retrospective studies did not confirm the prolongation (OR 1.19, 95% CI 0.63 to 2.28). The RCT was inadequately compliant with Consolidated Standards of Reporting Trials statement. While awaiting an appropriately designed RCT to determine the duration of tocolytics with placenta previa and preterm labor, it should be limited to 48 hours.

We compared the extrauterine adaptation of preterm with term newborn infants, by sequentially measuring plasma catecholamine (CAT) levels at birth and during the first 24 h of life. Twenty-seven preterm appropriate-for-gestational-age (AGA) infants, less than 35 weeks gestation, were compared with 26 healthy near-term AGA infants. Modes of delivery and umbilical arterial pH (mean 7.28) did not differ. Infants with asphyxia, presumed sepsis or hypoglycemia were excluded. CAT (norepinephrine, epinephrine, dopamine) levels were measured by radioenzymatic assay in blood samples from maternal vein, cord vein, cord artery and blood samples obtained at 1, 2 and 24 h of postnatal age. At birth, the cord arterial CAT levels were significantly higher than maternal venous CAT levels in both groups of neonates. Plasma epinephrine levels (mean ± SD) at 1 and 2 h of postnatal age were significantly higher in preterm than in near-term newborns (0.98 ± 0.82 nmol/l vs. 0.30 ± 0.21 nmol/l at 1 h; 0.98 ± 0.68 nmol/l vs. 0.28 ± 0.29 nmol/l at 2 h; p < 0.05). The norepinephrine and dopamine measurements did not differ between the two groups studied at birth, 1, 2 and 24 h of postnatal age. These data indicate that the preterm infants (25-35 weeks gestation) are capable of mounting a catecholamine response at birth similar to near-term newborns. The persistent elevation of epinephrine in preterm infants at 1 and 2 h of life may be attributed to either slower clearance of epinephrine or continued stimulation during clinical care in the NICU.