531: Rates of neonatal morbidity and mortality following preterm premature rupture of membranes (PPROM) by gestational age at rupture vs. gestational age at delivery

Manuck, Tracy A.; Korgenski, Kent; Henry, Erick; Esplin, Sean; Silver, Bob M.; Varner, Michael W.

doi:10.1016/j.ajog.2010.10.550

Cited by 32 publications

(44 citation statements)

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“…For example, in a study of 8334 live singleton preterm births, the rate of hypoxic-ischaemic encephalopathy increased from 30.8 per 1000 births at 28–36 weeks gestation to 119.9 at <28 weeks. 10 …”

Section: Introductionmentioning

confidence: 99%

Tumour necrosis factor blockade after asphyxia in foetal sheep ameliorates cystic white matter injury

Lear

Davidson

et al. 2022

Brain

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Cystic white matter injury (WMI) is highly associated with severe neurodevelopmental disability and cerebral palsy in preterm infants, yet its pathogenesis remains poorly understood and there is no established treatment. In the present study we tested the hypothesis that slowly evolving cystic WMI after hypoxia-ischaemia is mediated by programmed necrosis initiated by tumour necrosis factor (TNF). TNF blockade was begun 3 days after hypoxia-ischaemia in order to target the tertiary phase of injury, when the majority of secondary cell death is thought to be complete. Chronically instrumented preterm fetal sheep (0.7 gestation) received 25 minutes of hypoxia-ischaemia induced by complete umbilical cord occlusion (UCO) or sham-UCO (controls, n = 10), followed by intracerebroventricular infusion of the soluble TNF inhibitor, Etanercept, at 3, 8 and 13 days after UCO (UCO-Etanercept, n = 9) or vehicle (UCO-vehicle, n = 9). Fetal brains were processed for histology at 21 days after UCO. UCO-vehicle was associated with a spectrum of macroscopic white matter degeneration, including white matter atrophy, ventriculomegaly and overt temporal lobe cystic WMI. Oligodendrocyte maturational arrest and impaired labelling of myelin proteins, characteristic of diffuse WMI, was observed in the parietal lobe and surrounding the cystic lesions in the temporal lobe. Etanercept markedly attenuated cystic WMI on the side of the intracerebroventricular infusion, with partial contralateral protection. Further, Etanercept improved oligodendrocyte maturation and labelling of myelin proteins in the temporal and parietal lobes. The present study shows that cystic WMI reflects late-onset tertiary cell death mediated by delayed neuroinflammation through the TNF pathway. Delayed TNF blockade markedly attenuated cystic WMI and restored oligodendrocyte maturation and deficits in myelin protein expression. These data suggest that delayed TNF blockade may represent a viable therapeutic strategy to reduce the risk of cystic and diffuse WMI and potentially cerebral palsy after preterm birth, with a surprisingly wide therapeutic window.

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Section: Introductionmentioning

confidence: 99%

Tumour necrosis factor blockade after asphyxia in foetal sheep ameliorates cystic white matter injury

Lear

Davidson

et al. 2022

Brain

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“…The second analysis stratified the previous model by gestational age (births occurring < 32 or ≥ 32 weeks’ gestation), since birth before 32 weeks’ gestation is a major contributor to morbidity and mortality. 5 , 69 The third analysis expanded the cohort to live births and stillbirths born at 20 weeks’ gestation or later, and compared SNM or perinatal mortality in the index birth admission and up to 27 days thereafter for newborns of immigrant and nonimmigrant females.…”

Section: Methodsmentioning

confidence: 99%

Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Jairam

Vigod

Siddiqi

et al. 2023

CMAJ

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Neonatal morbidity and mortality are important public health indicators used to monitor and evaluate neonatal health and quality of perinatal care. 1,2 The neonatal period, ranging from birth to 27 days thereafter, is the most vulnerable time for infant survival. 1 Around 75% of infant deaths occur during this period, largely from prematurity and other conditions that can often be prevented by timely obstetrical and neonatal care. 3,4 In high-income countries, improvements in health care have resulted in a decline in neonatal mortality, 5,6 including in Canada, where the rate is 3.6 deaths per 1000 live births. 7 Accordingly, research and public health surveillance has increasingly focused on severe neonatal morbidity (SNM), which refers to a newborn who has survived a severe complication during birth or the neonatal period. 1,8,9 Identifying newborns at high risk of SNM is crucial as it has serious implications for the surviving child and their family. 10,11 Limited research has examined SNM in high-income countries. 2,6,8,[12][13][14][15][16][17] Studies have primarily focused on deriving and validating the criteria to define SNM, 1,3,10 quantifying the prevalence of SNM and identifying risk factors in African, Asian and Latin American regions. 11,[18][19][20][21][22][23][24][25][26][27] Research is also lacking on a range of upstream social determinants of health inequity and their influence on SNM. 28,29 Living in a low-income area 12,[30][31][32][33][34][35] and being an

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“…When preeclampsia with severe features presents at term, the decision to proceed with delivery is easy, as the maternal/fetal/neonatal risk profile is clear. 15 Even between 34 and 37 weeks, the risk profile still leans strongly toward delivery. However, in cases where preeclampsia with severe features presents before 34 weeks, the risks of prematurity must be balanced with maternal and fetal risks associated with the disease itself.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Adverse Maternal Outcomes among Patients with Severe Preeclampsia Before 34 Weeks

Nisly,

Dillon,

Darling

et al. 2023

Am J Perinatol

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Objective: To characterize rates of maternal morbidity associated with early (<34 weeks) preeclampsia with severe features (esPREX), and to determine factors associated with developing these morbidities. Study Design: Retrospective cohort study of patients with esPREX at a single institution from 2013–2019. Inclusion criteria were admission between 23-34 weeks and diagnosis of preeclampsia with severe features. Maternal morbidity defined as death, sepsis, ICU admission, acute renal insufficiency(AKI), postpartum(PP) dilation and curation(D&C), PP hysterectomy, venous thromboembolism(VTE), PP hemorrhage(PPH), PP wound infection, PP endometritis, pelvic abscess, PP pneumonia, readmission, and/or need for blood transfusion. Death, ICU admission, VTE, AKI, PP hysterectomy, sepsis, and/or transfusion of >2 units were considered severe maternal morbidity(SMM). Simple statistics used to compare characteristics among patients experiencing any morbidity and those not. Poisson regression used to assess relative risks. Results: Of 260 patients included, 77(29.6%) experienced maternal morbidity and 16(6.2%) experienced SMM. PPH(n=46, 17.7%) was the most common morbidity, though 15(5.8%) patients were readmitted, 16(6.2%) needed a blood transfusion, and 14(5.4%) had AKI. Patients who experienced maternal morbidity were more likely to be advanced maternal age, have pre-existing diabetes, have multiparity, and deliver non-vaginally (all p<0.05). Diagnosis of pre-eclampsia < 28 weeks or longer latency from diagnosis to delivery were not associated with increased maternal morbidity. In regression models, the relative risk of maternal morbidity remained significant for twins(aRR 2.29;95%CI:1.59,3.30), and pre-existing diabetes(aOR 1.69;95%CI:1.09,2.63), while attempted vaginal delivery was protective (aOR 0.63;95%CI:0.42,0.94). Conclusion: In this cohort, more than 1 in 4 patients diagnosed with esPREX experienced maternal morbidity, while 1 in 16 patients experienced SMM. Twins and pre-gestational diabetes were associated with higher risk of morbidity, while attempted vaginal delivery was protective. These data may be helpful in promoting risk reduction and counseling patients diagnosed with esPREX.

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531: Rates of neonatal morbidity and mortality following preterm premature rupture of membranes (PPROM) by gestational age at rupture vs. gestational age at delivery

Cited by 32 publications

References 0 publications

Tumour necrosis factor blockade after asphyxia in foetal sheep ameliorates cystic white matter injury

Tumour necrosis factor blockade after asphyxia in foetal sheep ameliorates cystic white matter injury

Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Risk Factors for Adverse Maternal Outcomes among Patients with Severe Preeclampsia Before 34 Weeks

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