Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study

Gagliardi, Luigi; Rusconi, Franca; Frè, Monica Da; Mello, Giorgio; Carnielli, Virgilio P.; Lallo, Domenico Di; Montorsi, Francesco; Miniaci, Silvana; Corchia, Carlo; Cuttini, Marina

doi:10.1038/pr.2013.52

Cited by 86 publications

(107 citation statements)

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“…Although we and other authors 14,27,28 found a detrimental role played by hypertension on ROP, others showed a protective one. [29][30][31] A possible explanation for these discordant results lies in the data analysis.…”

Section: Figurecontrasting

confidence: 65%

“…If being SGA is both caused by hypertension/preeclampsia and associated with ROP, then adjusting for birth weight in studies analyzing the role of hypertensive disorders could give rise to a problem of "overadjustment." In fact, studies that investigate the role played by hypertension on ROP and correct-for-birth weight in their analysis find that hypertension is protective, [28][29][30] whereas others that do not adjust (eg, this study and refs 14,27,28) find the opposite.…”

Section: Figurementioning

confidence: 73%

“…14 In particular, we found that complications associated with infection/ inflammation (eg, spontaneous preterm labor) increased the risk for neurologic outcomes, whereas complications associated with placentation disorders (eg, hypertensive disorders of pregnancy) increased the risk for BPD, retinopathy of prematurity (ROP), and in-hospital mortality. This epidemiologic work followed an important study by McElrath et al,3 in which the authors, based on both clinical information and histologic and bacteriological data, suggested the clustering of pregnancy complications into 2 main groups: placentation disorders and intrauterine infection/inflammation.…”

Section: Resultsmentioning

confidence: 92%

“…Several recent reports have shown that maternal hypertensive disorders of pregnancy are associated with a higher risk for BPD 5,6,14,22 ; however, the underlying mechanism has only recently been clarified in experimental animal studies. Preeclampsia is characterized by maternal endothelial dysfunction that leads to hypertension, proteinuria, and other complications.…”

Section: Figurementioning

confidence: 99%

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Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: In very preterm infants, outcomes depend not only on the degree of immaturity, but also on the underlying pathologies that trigger preterm delivery. Studies that have addressed this issue have provided unclear results.WHAT THIS STUDY ADDS: Patterns of outcomes differ between maternal hypertension and chorioamnionitis: hypertension is associated with greater risks for bronchopulmonary dysplasia and retinopathy of prematurity, and lower risks for brain injury, necrotizing enterocolitis, early-onset sepsis. For mortality, the effect changes across gestational age weeks. abstract OBJECTIVES: We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects. METHODS:A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders. RESULTS:Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for earlyonset sepsis (OR, 0.25; 95% CI,, severe intraventricular hemorrhage (OR, 0.65; 95% CI, periventricular leukomalacia (OR, 0.70; 95% CI,, and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72).CONCLUSIONS: Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks. Pediatrics 2014;134:e154-e161 AUTHORS:

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Section: Figurecontrasting

confidence: 65%

Section: Figurementioning

confidence: 73%

Section: Resultsmentioning

confidence: 92%

Section: Figurementioning

confidence: 99%

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Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

et al. 2014

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“…Given the lack of antepartum evidence, the literature on therapeutic hypothermia does not allow consideration of whether or not antecedents in selected infants alters their response to treatment, yet underlying aetiologies commonly do influence outcome: smallpox and chickenpox have different prognoses despite similarities at presentation, and different causes of prematurity are associated with differing outcomes of birth at the same gestational age. 17,18 It has been observed that, among term-born infants selected for cooling, those with inflammatory placental histology 19 or reduced fetal movements 20 respond less well to therapeutic hypothermia. It seems likely that, as with other disease-associated outcomes, the antecedents of neonatal neurological abnormality will influence both long-term outcomes and response to therapies.…”

Section: How Antecedents Are Identifiedmentioning

confidence: 99%

Does aetiology of neonatal encephalopathy and hypoxic–ischaemic encephalopathy influence the outcome of treatment?

McIntyre

Badawi

Blair

et al. 2015

Develop Med Child Neuro

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HIE Hypoxic-ischaemic encephalopathyNeonatal encephalopathy, a clinical syndrome affecting term-born and late preterm newborn infants, increases the risk of perinatal death and long-term neurological morbidity, especially cerebral palsy. With the advent of therapeutic hypothermia, a treatment designed for hypoxic or ischaemic injury, associated mortality and morbidity rates have decreased. Unfortunately, only about one in eight neonates (95% confidence interval) who meet eligibility criteria for therapeutic cooling apparently benefit from the treatment. Studies of infants in representative populations indicate that neonatal encephalopathy is a potential result of a variety of antecedents and that asphyxial complications at birth account for only a small percentage of neonatal encephalopathy. In contrast, clinical case series suggest that a large proportion of neonatal encephalopathy is hypoxic or ischaemic, and trials of therapeutic hypothermia are specifically designed to include only infants exposed to hypoxia or ischaemia. This review addresses the differences, definitional and methodological, between infants studied and investigations undertaken, in population studies compared with cooling trials. It raises the question if there may be subgroups of infants with a clinical diagnosis of hypoxic-ischaemic encephalopathy (HIE) in whom the pathobiology of neonatal neurological depression is not fundamentally hypoxic or ischaemic and, therefore, for whom cooling may not be beneficial. In addition, it suggests approaches to future trials of cooling plus adjuvant therapy that may contribute to further improvement of care for these vulnerable neonates.Neonatal encephalopathy is a clinical syndrome of disordered neurological function occurring in the first days of life in term-born and late preterm neonates and is characterized by difficulty initiating and maintaining respiration, an abnormal level of consciousness, depression of tone and reflex responses, and often seizures. This symptom complex affects about 3 in every 1000 births, and is an important predictor of perinatal death and a major contributor to long-term adverse neurological outcomes, particularly cerebral palsy (CP). 1,2 Evidence from clinical and experimental studies agrees that some instances of neonatal encephalopathy are related to hypoxic-ischaemic injury, but the proportions of neonatal encephalopathy attributed to recent asphyxial events vary with the definitions used and the methodology of the investigations. Studies of infants in representative populations indicate that asphyxial complications at birth account for only a minority of neonatal encephalopathy. These population-based studies also identify other factors that contribute to increased risk of neonatal encephalopathy, such as intrauterine exposure to inflammation or fetal growth restriction, and note that some non-asphyxial factors can produce a clinical picture that closely mimics hypoxia-ischaemia. [3][4][5] In contrast, studies of neonatal cooling have approached this topic from the ...

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Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity

et al. 2017

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IMPORTANCE Studies report conflicting associations between preeclampsia and retinopathy of prematurity (ROP). This study provides explanations for the discrepancies to clarify the relationship between preeclampsia and ROP.OBJECTIVE To evaluate the association of maternal preeclampsia and risk of ROP among infants in an unrestricted birth cohort and a restricted subcohort of preterm, very low birth weight (P-VLBW) infants.

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Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study

Cited by 86 publications

References 43 publications

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

Association of Maternal Hypertension and Chorioamnionitis With Preterm Outcomes

Does aetiology of neonatal encephalopathy and hypoxic–ischaemic encephalopathy influence the outcome of treatment?

Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity

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