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Study design
We implemented interventions to support early expression of colostrum and reliable delivery of resultant MOM to premature newborns. Statistical process control chart...
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Citations
... At 18 months of age, cognitive function, assessed by the Bayley Scales, was not associated with maternal PE. The authors concluded that hypertension during gestation could even be protective [10]. In agreement with our findings, two studies have described lower cognitive ability in childhood after PE: one study in 3-year old children born after PE and growth restriction at a median of 34.7 gestational weeks [6] and another in 2-year old infants born preterm before 32 gestational weeks to pre-eclamptic mothers [7]. ...
Objective
To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.
Methods
Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.
Results
The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.
Conclusion
Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.
... As a result, precise data regarding underlying maternal morbidity, classification of disease, maternal treatment strategies, prematurity and fetal growth restriction, and fetal monitoring are lacking. [4][5][6][7][8][9][10] Often literature on outcome after small-for-gestational-age (SGA) status at birth is referred to, but not all infants born SGA are also growth restricted and vice versa. [11][12][13] This study presents the long-term developmental outcome, including cognition, neurological, and motor and behavioral outcome, in a, from maternal admission onward, prospective cohort of children born after expectant management of early-onset hypertensive disor-ders of pregnancy. ...
The objective of the study was to describe neurodevelopmental outcome at the age of 4.5 years in 216 children, born after expectant management of severe early-onset hypertensive complications of pregnancy.
This was a prospective follow-up study until age 4.5 years from maternal admission onward. Developmental outcome measurements included child intelligence quotient and behavioral, motor, and neurological outcome. Abnormal composite outcome (perinatal mortality or abnormal developmental outcome) was studied in relation to gestational age (GA), birthweight (BW), and perinatal variables.
Fetal and neonatal mortality was 9% and 8%, respectively. Of the 178 survivors, 149 (84%) were seen for follow-up. Mean GA was 31.4 weeks and 90% were born growth restricted. Abnormal developmental outcome occurred in 20% and abnormal composite outcome in 37%.
Perinatal mortality or abnormal child development occurs in one third of pregnancies with early-onset and severe hypertensive complications and is highest in the lowest GA and BW ranges.
Importance
Although research suggests an association between hypertensive disorders of pregnancy (HDP) and autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders in offspring, consensus is lacking. Given the increasing prevalence of hypertension in pregnancy, it is important to examine the association of HDP with neurodevelopmental outcome.
Objective
To synthesize the published literature on the association between HDP and risk of neurodevelopmental disorders in offspring in a systematic review and meta-analysis.
Data Sources
On the basis of a preprepared protocol, a systematic search of PubMed, CINAHL, Embase, PsycINFO, and Web of Science was performed from inception through June 7, 2017, supplemented by hand searching of reference lists.
Study Selection
Two investigators independently reviewed titles, abstracts, and full-text articles. English-language cohort and case-control studies were included in which HDP and neurodevelopmental disorders were reported.
Data Extraction and Synthesis
Data extraction and quality appraisal were performed independently by 2 reviewers. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed throughout.
Main Outcomes and Measures
Random-effects meta-analyses of estimated pooled odds ratios (ORs) for HDP and ASD and for HDP and ADHD. Stand-alone estimates were reported for all other neurodevelopmental disorders.
Results
Of 1166 studies identified, 61 unique articles met inclusion criteria. Twenty studies reported estimates for ASD. Eleven of these (including 777 518 participants) reported adjusted estimates, with a pooled adjusted OR of 1.35 (95% CI, 1.11-1.64). Ten studies reported estimates for ADHD. Six of these (including 1 395 605 participants) reported adjusted estimates, with a pooled adjusted OR of 1.29 (95% CI, 1.22-1.36). Subgroup analyses according to type of exposure (ie, preeclampsia or other HDP) showed no statistically significant differences for ASD or ADHD. Thirty-one studies met inclusion criteria for all other neurodevelopmental disorders. Individual estimates reported for these were largely inconsistent, with few patterns of association observed.
Conclusions and Relevance
Exposure to HDP may be associated with an increase in the risk of ASD and ADHD. These findings highlight the need for greater pediatric surveillance of infants exposed to HDP to allow early intervention that may improve neurodevelopmental outcome.
Objective:
Pregnancy-induced hypertension (PIH) is associated with preterm delivery but its independent impact on neonatal outcomes remains unclear. We sought to systematically review and meta-analyze clinical outcomes of preterm infants <37 weeks' gestation born to mothers with and without PIH.
Study design:
Medline, Embase, PsychINFO and CINAHL were searched from January 2000 to October 2016. Studies with low-moderate risk of bias reporting neonatal outcomes based on PIH as primary exposure variable were included. Data were extracted independently by two co-authors.
Results:
PIH was associated with lower mortality (3 studies; adjusted odds ratio (aOR) 0.65; 95% confidence interval (CI) 0.54 to 0.79), lower severe retinopathy of prematurity (ROP) (2 studies; aOR 0.83; 0.72 to 0.96) and lower severe brain injury (2 studies; unadjusted OR (uOR) 0.57; 0.49 to 0.66). No association between PIH and short-term respiratory outcomes, bronchopulmonary dysplasia (BPD) or necrotizing enterocolitis (NEC) was identified. In subgroup analysis among infants <29 weeks' gestation, BPD odds were higher (3 studies; aOR 1.15; 1.06 to 1.26), whereas mortality lower (2 studies; aOR 0.73; 0.69 to 0.77). In subgroup analysis limited to severe PIH, odds of mortality (3 studies; uOR 2.36; 1.07 to 5.22) and invasive ventilation (3 studies; uOR 3.26; 1.11 to 9.61) were higher. In subgroup analysis limited to preeclampsia, odds of BPD (3 studies; uOR 1.21; 95% CI:1.03 to 1.43) and NEC were higher (3 studies; uOR 2.79; 95% CI:1.57 to 4.96).
Conclusion:
PIH was associated with reduced odds of mortality and ROP (all infants), but higher odds for BPD (<29 weeks' gestation). The paradoxical reduction in mortality may be due to survival bias and deserves further exploration in future studies.Journal of Perinatology advance online publication, 2 November 2017; doi:10.1038/jp.2017.162.
Aim:
To assess whether maternal hypertensive disorders in pregnancies result in higher respiratory requirements, risk of chronic lung disease (CLD) and poorer neurodevelopmental outcome in <29-week premature neonates.
Methods:
This is a multicentre, retrospective cohort study, within a geographically defined area in Australia, served by a network of 10 neonatal intensive care units (NICUs), consisting of infants <29 weeks of gestational age who were admitted to NICUs between 1998 and 2004. Outcome measures included hospital survival, perinatal complications and functional disability at 2-3 years follow-up.
Results:
A total of 2549 mothers and infants were included in the study; 379 (14.9%) mothers had hypertensive disorders during pregnancy. Follow-up data were obtained for 1473 (74.8%) infants at 2-3 years. Infants exposed to pre-eclampsia had a higher need for supplemental surfactant therapy (odds ratio (OR): 2.004, 95% confidence interval (CI): 1.51-2.66), longer duration of mechanical ventilation (7.0 days vs. 4.0 days), were associated with a higher incidence of CLD (OR: 1.40, 95% CI: 1.12-1.76) and received post-natal steroids for CLD (OR: 1.82, 95% CI: 1.43-2.31) and home oxygen (OR: 1.47, 95% CI: 1.11-1.95). Multivariable analysis showed that hypertensive disease of pregnancy was not significantly associated with the development of CLD in this cohort (OR: 1.103, 95% CI: 0.845-1.441). Multivariable analysis of long-term neurodevelopmental data available for the 1473 follow-up infants showed no significant difference in outcomes with or without exposure to maternal hypertensive disease.
Conclusion:
Maternal hypertensive disease of pregnancy does not increase the risk of CLD or long-term neurodevelopmental complications in infants born at <29 weeks of gestation.
Objective Preeclampsia is one of the top six causes of maternal mortality in the United States (US) and is associated with considerable perinatal morbidity and mortality. Evidence suggests the US incidence of preeclampsia has increased dramatically over the past two decades. This study aims to compile, summarize, and critique the literature on the health and economic burden of preeclampsia and early-onset preeclampsia.
Study Design We reviewed the literature for estimates of burden of preeclampsia and early-onset preeclampsia to both mother and child, summarized the evidence on economic and social burden, and highlighted current gaps in the literature.
Results No recent studies comprehensively assess the costs and health consequences of preeclampsia or early-onset preeclampsia for both mother and child. Where it exists, the literature suggests preeclampsia and early-onset preeclampsia cause numerous adverse health consequences, but these conditions currently lack effective treatment. The need for preterm delivery from early-onset preeclampsia suggests its costs are substantial: very (28–31 weeks) and extremely (<28 weeks) preterm birth cost approximately 40 and 100 times a term pregnancy, respectively.
Conclusion Given the severity of outcomes from preeclampsia, further research on its health and economic consequences is essential to inform policy and resource allocation decisions in health care.
Objective:
Preeclampsia leads to chronic intrauterine hypoxia by interfering with placental blood supply. The aim of this study was to investigate whether preeclampsia exposure has an influence on the central nervous system of infants, as monitored by amplitude integrated electroencephalography (aEEG).
Methods:
We recruited 52 infants with gestational age between 30 and 34 weeks. Twenty-seven infants were born to preeclamptic mothers, and 25 gestational age-matched infants whose mothers were healthy were enrolled as a control group. aEEG recordings were performed between 24 and 48 h of life using a cerebral function monitor (CFM) (Olympic Brainz monitor). Along with aEEG, middle cerebral artery (MCA) blood flow velocities (BFV) were measured using Doppler ultrasound.
Results:
The duration of quiet sleep was significantly shorter (P=0.001), and Burdjalov score was lower (P=0.04) in the preeclampsia group. However, there was no change in MCA BFV in this group.
Conclusions:
Preeclampsia altered cerebral electrical activity of premature infants born to preeclamptic mothers.
Objective: To investigate the relationship between postnatal growth of low-birth-weight (LBW) infants and different growth biomarkers including serum ghrelin, IGF-1 (reflecting anabolic activity and growth hormone sensitivity), and IL-6 (reflecting stress and inflammation). Methods: This prospective study included 80 infants recruited from the Outpatient Clinic of Suzan Mubarak Specialized Hospital of Pediatrics Cairo, Egypt. They were divided into two groups: group I, comprising 40 infants who had documented LBW; and group II, comprising 40 infants with average birth weight who served as controls. Serum ghrelin level, IL-6, and IGF-1 were measured at enrollment in the study and at the end of the sixth month. Results: At the onset of the study, serum ghrelin concentrations were significantly higher in infants who had LBW (group I) compared with infants who had normal birth weight (group II); P<0.001. During the follow-up period, serum levels of IGF-1 increased significantly (P<0.001). In contrast, IL-6 showed a significant decline (P<0.001) and was inversely correlated with IGF-1 (r=−0.5, P=0.003). Catch-up growth was associated with higher serum levels of ghrelin and IGF-1 and with lower serum levels of IL-6. Conclusion: Catch-up growth in LBW infants is characterized by an increase in the serum ghrelin level and IGF-1 levels with a simultaneous decrease in IL-6 levels. Efforts to optimally balance inflammatory and growth mediators may benefit somatic growth in LBW infants.
Intrauterine conditions may interfere with foetal brain development. We compared the neurodevelopmental outcome between infants <32 weeks gestational age after maternal preeclampsia or chorioamnionitis and controls.
Case-control study on infants with maternal preeclampsia, chorioamnionitis and controls (each n = 33) matched for gestational age. Neurodevelopment at 2 years was assessed with the Bayley Scales of Infant Development II.
A total of 99 infants were included with a median gestational age of 29 weeks (range 25-32). Median mental developmental index (MDI) was 96 in the control, 90 in the chorioamnionitis and 86 in the preeclampsia group. Preeclampsia infants had a lower MDI compared with the control group (univariate p = 0.021, multivariate p = 0.183) and with the chorioamnionitis group (univariate p = 0.242; multivariate p = 0.027). Median psychomotor index was 80.5 in the control, 80 in the preeclampsia and 85 in the chorioamnionitis group and was not different between these three groups (p > 0.05). Chorioamnionitis or preeclampsia exposure was not associated with major neurodevelopmental impairments (cerebral palsy, MDI<70, PDI<70).
The results of this preliminary study suggest that preeclampsia and chorioamnionitis play a relatively minor role among risk factors for adverse neurodevelopment outcome. Postnatal factors such as ventilation and bronchopulmonary dysplasia may have a greater impact on neurodevelopmental outcome.
