The Relation of Maternal Complications to Outcomes in Very Low Birthweight Infants in an Era of Changing Neonatal Care

Abstract

We examine the relation of key neonatal outcomes to pregnancy complications and to the use of antenatal steroids and investigate whether there is evidence of recent change in this relation. Complete information on pregnancy and neonatal course was available for 749 out of 949 singleton births without major congenital anomalies below 1501 g admitted to seven regional neonatal intensive care units between August 1, 1988 and June 30, 1991. Mortality was highest in infants born after labor with spontaneous rupture of fetal membranes of less than 24 hours duration (odds ratio [OR] = 1.6, 95% confidence interval [1.0, 2.6]). Spontaneous rupture of membranes of over 24 hours duration was associated with decreased risk of respiratory distress syndrome (OR = 0.42, [0.28, 0.64]) and decreased risk of patent ductus arteriosus (OR = 43, [0.28, 0.66]). Pregnancy induced hypertension was associated with increased risk of respiratory distress syndrome in those born at less than 20 weeks' gestation (OR = 6.0, [2.0, 17]). Labor with or without rupture of membranes of short duration was associated with increased risk of intraventricular hemorrhage (OR = 1.9, [1.2, 2.5]). These associations were not different in early versus late time periods of the study. Antenatal steroids were associated with dramatically reduced risk of mortality (OR = 0.20, [0.09, 0.50] ), respiratory distress syndrome (OR = 0.52, [0.32, 0.85]), and intraventricular hemorrhage (OR = 0.37, [0.21-0.65]).

Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia

“…The major advantages of these cohorts are the availability of medical records in order to retrospectively analyze the relationship between perinatal events and outcomes and the ability to follow the cohort participants as they age. Studies using this cohort have already been immensely informative (Palta et al 1990; Palta et al 1991; Palta et al 1994; Weinstein et al 1994; Palta et al 1996; Evans et al 1998; Palta et al 1998; Palta et al 1998; Palta et al 2000; Palta et al 2001; Hagen et al 2006; Palta et al 2007). We expect that the study of these participants will aid in our understanding of ventilatory control in humans with BPD and hope to see the support of similar cohorts in the future.…”

Properties ofR2 statistics for logistic regression

“…The Newborn Lung Project [16] enrolled all neonates born between 1 August 1988 and 30 June 1991 at admission to seven neonatal intensive care units in Wisconsin and Iowa. Birth weight (BW) was reported in grams, gestational age (GA) in weeks and RDS severity (RDS) in the ÿrst three days of life was scored 0-100 by an index developed for the project [17].…”

Pequenos para idade gestacional: fator de risco para mortalidade neonatal

“…Vários autores 5,22,25,27 mostram que o crescimento fetal intra-uterino retardado, que resulta em nascidos vivos considerados "pequenos para idade gestacional" (PIGs), constitui-se em importante fator de risco para a mortalidade neonatal . Por sua vez, os fatores de risco associados ao retardo do crescimento fetal intra-uterino são: pequeno ganho de peso materno durante a gestação, baixo peso materno anterior à gestação, baixa estatura da mãe, os quais são considerados como indicadores de possível presença de desnutrição materna 1,7 .…”