Impact of pre‐eclampsia in extremely premature infants: Population‐based study

Tokumasu, Hironobu; Tokumasu, Satoko; Kawakami, Koji

doi:10.1111/ped.12905

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…As maternal hypertension (MH) is a common reason for medically induced preterm birth, the survival of babies born following this complication has been examined in several studies, with conflicting results. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Although studies restricted to very preterm births (which, by design, condition on gestational age (GA) at birth) yield estimates that cannot be interpreted causally, [16][17][18][19][20] they are important for descriptive and predictive purposes.…”

Section: Introductionmentioning

confidence: 99%

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Gagliardi

Basso

2019

Pediatr Res

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BACKGROUND: To describe the association between maternal hypertension (chronic and gestational, MH) and mortality in very preterm singletons and twins, focusing on how estimates depend on gestational age (GA) and size at birth. METHODS: We estimated relative risks of in-hospital death in 12,320 singletons (MH: 22.4%) and 4381 twins (MH: 10.6%) born at 23-29 weeks in the Italian Neonatal Network (89 hospitals, 2008-2016). RESULTS: Babies with MH had higher GA and were more frequently small-for-gestational age (SGA), especially singletons. In crude analyses, MH was associated with lower mortality in singletons. In multivariable analyses, the effects of GA and size differed between twins and singletons with and without MH. The best-fitting models included continuous birth weight (rather than SGA) and were stratified by GA. In these models, MH was associated with lower mortality in singletons-but not twins-born after week 25. CONCLUSIONS: In this cohort of very preterm infants, the association between MH and mortality differed between singletons and twins and across strata of GA at birth. These estimates cannot be interpreted causally, but suggest that, from a descriptive/ predictive standpoint, singletons with MH born after week 25 have lower mortality than singletons born to women without MH.

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Section: Introductionmentioning

confidence: 99%

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Gagliardi

Basso

2019

Pediatr Res

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“…The NRNJ is a national database for clinical characteristics and morbidities of very-lowbirth-weight (VLBW) infants in Japan [14] . The data included 96% (72/75 as of 2008) of newborns from level 3 NICUs and from 7 level 2 NICUs [15] . Among the eligible EPT infants in this study, 91.4% (4,932/5,394) were born in level 3 NICUs.…”

Section: Selection Of Subjectsmentioning

confidence: 99%

“…Antenatal steroid use was defined as administration of any corticosteroid to accelerate fetal maturity with at least 1 dose. Clinical chorioamnionitis, premature rupture of membranes, and nonreassuring fetal heart rate were defined as previously described [15] .…”

Section: Definitionsmentioning

confidence: 99%

Neurodevelopment at 3 Years in Neonates Born by Vaginal Delivery versus Cesarean Section at <26 Weeks of Gestation: Retrospective Analysis of a Nationwide Registry in Japan

Kimura

Takeuchi²,

Imai³

et al. 2017

Neonatology

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Background: A high proportion of extremely preterm (EPT) infants are born by cesarean section (CS). However, whether the mode of delivery is related to long-term neurodevelopment in these infants is unclear. Objectives: This study aimed to determine whether the mode of delivery is associated with mortality and long-term outcomes in EPT infants. Methods: We analyzed data of the Neonatal Research Network in Japan (NRNJ), a population-based, nationwide registry. Inclusion criteria were neonates who were born between 2003 and 2012 with a gestational age <26 weeks. The primary composite outcome was death before 3 years or neurodevelopmental impairment (NDI) at 3 years. Confounder-adjusted odds ratios (OR) were estimated by logistic generalized linear mixed models, which accounted for clustering within hospitals. Results: 2,138 eligible infants (703 by vaginal delivery [VD] and 1,435 by CS) were identified for primary analysis. The composite outcome of death or NDI was not different between both groups (66.7% by VD and 62.7% by CS, p = 0.075). After multivariate analysis adjusting for confounders, we found that CS did not improve the composite outcome of death or NDI (OR = 0.839, 95% confidence interval = 0.816-1.328, p = 0.742). For secondary outcomes, mortality (OR = 0.824, p = 0.150), NDI (OR = 1.237, p = 0.165), and other neurodevelopmental outcomes were not different between the groups. Conclusions: Among neonates born at <26 weeks, CS does not improve mortality and neurodevelopmental outcomes at 3 years in the NRNJ cohort. However, because of several potential biases such as high rates of infants lost to follow-up, further evidence may be required.

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“…Antenatal steroid use was defined as administration of dexamethasone to accelerate fetal maturity with at least 1 dose (incomplete) or at least 4 doses (complete). Chorioamnionitis was defined based on histologic findings; where histology was not performed (only in-fants born in level I and II neonatal care units), the diagnosis was based on the previously described criteria 13 . Maternal hypertension and late-onset sepsis were defined based on previous studies 14 .…”

Section: Methodsmentioning

confidence: 99%

Survival until Discharge of Very-Low-Birth-Weight Infants in Two Croatian Perinatal Care Regions: A Retrospective Cohort Study of Time and Cause of Death

Kardum

Filipović‐Grčić

Müller

et al. 2019

ACC

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We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.

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Impact of pre‐eclampsia in extremely premature infants: Population‐based study

Abstract: Maternal pre-eclampsia is associated with poor prognosis in extremely premature infants. We also need to deliberate on the trade-off between the advantages of early rescue from pre-eclampsia and risk of prematurity.

Cited by 15 publications

References 26 publications

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Maternal hypertension and survival in singletons and twins born at 23–29 weeks: not just one answer…

Neurodevelopment at 3 Years in Neonates Born by Vaginal Delivery versus Cesarean Section at <26 Weeks of Gestation: Retrospective Analysis of a Nationwide Registry in Japan

Survival until Discharge of Very-Low-Birth-Weight Infants in Two Croatian Perinatal Care Regions: A Retrospective Cohort Study of Time and Cause of Death

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