Perinatal risk factors for the occurrence of singleton apparently stillborn infants / 中国当代儿科杂志

OBJECTIVES@#To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.@*METHODS@#This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.@*RESULTS@#The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05).@*CONCLUSIONS@#Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.

Report of a case with twin anemia-polycythemia sequence and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize and review the clinical characteristics including clinical features, prenatal characteristics, diagnosis, treatments and short-term outcomes of the twin anemia-polycythemia sequence (TAPS) to improve the recognition of the disease.</p><p><b>METHOD</b>The clinical data of one case with twin anemia-polycythemia sequence and the reports of 15 cases seen in the past 5 years were reviewed and analyzed.</p><p><b>RESULT</b>There was an increasing number of reports of cases with TAPS. Prenatal manifestation: among the 16 cases, TAPS occurred in 13 cases naturally and in 3 cases occurred after laser treatment. Amniotic fluid volume showed no significant difference in 16 cases. Middle cerebral artery peak systolic velocity (MCA-PSV) > 1.5 multiples of the median (MoM) in the donor were 11/16 cases and 3/16 cases were not tested. MCA-PSV < 1.0 MoM in the recipient were seen in 10/16 cases and in 3/16 cases MCA-PSV was not tested. Hydrops fetalis was found in 6/16 cases. Intrauterine intervention: intrauterine blood transfusion was performed in 4/16 cases, fetoscopic laser occlusion of chorioangiopagus vessels was performed in 4/16 cases, umbilical cord occlusion selective feticide was done in 2/16 cases and intrauterine hemodilution in the recipient was performed in 1/16 case. Postnatal manifestation: average hemoglobin concentration in the anemic neonate was 95 g/L and in the polycythemic one was 208 g/L, intertwin Hb difference was > 80 g/L in 10/16 cases and < 80 g/L in 2/16 cases (after intrauterine laser treatment). Intertwin reticulocyte count ratio was > 1.7 in 5/16 cases and < 1.7 in 1/16 case (after intrauterine laser treatment). Postnatal treatment: 9/16 cases of donor had anemia, among them, 6/16 cases were given blood transfusions, 6/16 cases of recipient with hyperviscosity underwent partial exchange transfusions. Neurodevelopmental follow-up during neonatal period was normal in 11/16 cases, in our case, neurodevelopmental follow-up at the corrected gestational age 3 months was normal.</p><p><b>CONCLUSION</b>TAPS is a new atypical form of twin-twin transfusion syndrome (TTTS) that presents as a large intertwin hemoglobin difference with one twin developing anemia and the other developing polycythemia, without oligohydramnios-polyhydramnios sequence that is required for the diagnosis of TTTS. We suggest that routine doppler studies and MCA-PSV measurements should be performed during each follow-up visit in all uncomplicated monochorionic twin pregnancies, in order to find out the cases required intrauterine intervention to decrease neonatal mortality rates and improve the prognosis.</p>

Changes in MLS-BAEP in newborn piglets with hypoxic-ischemic brain damage during selective moderate head cooling therapy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of selective moderate head cooling therapy on maximum length sequences brainstem auditory evoked potential (MLS-BAEP) in newborn piglets with hypoxic-ischemic brain damage.</p><p><b>METHODS</b>Sixteen newborn piglets aged 5-7 day old were randomly divided into three groups: normothermic control (n=4), HI (n=6) and mild hypothermia-treated (n=6). HI was induced through temporary occlusion of both carotid arteries, followed by mechanical ventilation with low concentration of oxygen (FiO2=0.06) for 30 minutes. Mild hypothermia was induced by equipment via circulating water. MLS-BAER was recorded before HI and at 12 hours, 24 hours, 36 hours, 48 hours, 60 hours, 72 hours, 4 days, 7 days, 10 days, 13 days and 15 days after HI.</p><p><b>RESULTS</b>Compared with the normothermic control group, all latencies and intervals tended to increase significantly at 72 hours in the HI group and reached peak values on day 7. From day 10, all latencies and intervals tended to decrease, but apart from wave I latency, still differed significantly from those of the normothermic control group. MLS-BAER variables did not reach normal values until day 15. Ⅲ latency, Ⅰ-Ⅲ interval and Ⅰ-Ⅴ interval were significantly reduced in the hypothermia-treated group between 60 and 7 days after HI compared with the HI group (P<0.05). V latency and Ⅲ-Ⅴ interval in the hypothermia-treated group were also reduced compared with the HI group between 72 hours and 7 days after HI (P<0.05).</p><p><b>CONCLUSIONS</b>Both peripheral and central auditory systems are disturbed by HI, which shows as a significant increase in MLS-BAER variables (all latencies and intervals) in newborn piglets. Involvement in central brainstem auditory system reaches a peak on day 7 after injury. MLS-BAER variables still cannot reach to normal values until day 15. Selective moderate head cooling therapy can significantly reduce brainstem damage induced by HI.</p>

Clinical features and follow-up study of neonatal asymmetric crying facies / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and short-term outcomes of neonatal asymmetric crying facies (ACF), in order to improve recognition of the disease.</p><p><b>METHODS</b>The clinical data of 11 infants with ACF between January 2010 and February 2012 were retrospectively studied. Physical and neurological development were followed up at correct gestational age 44 weeks and 3 months.</p><p><b>RESULTS</b>Of the 11 infants with ACF, 4 had ipsilateral ear malformation, 2 had congenital heart disease and 1 had syndactyly and polydactyly. Of the 11 infants, 8 were male and 3 were female. Eight infants presented with lesions on the left side and 3 presented with lesions on the right. The fathers were aged over 35 in 8 cases and the mothers were over 30 in 7 cases. Eight mothers had a history of at least 3 pregnancies and 2 infants were born to mothers with diabetes mellitus. Physical index was below P10 in 1 case and 2 cases showed a low NBNA score and mild abnormal GMs (poor repertoire PR) during the writhing period at correct gestational age 44 weeks. Physical index was between P10-P90 and GM assessment during the fidgety period showed normal movements in all infants at correct gestational age 3 months, but they still had ACF.</p><p><b>CONCLUSIONS</b>ACF is associated with a high rate of other congenital malformations. The short-term outcomes of ACF infants are satisfactory, but long-term follow-up and interdisciplinary cooperation are necessary to improve prognosis.</p>

Amplitude integrated electroencephalography characteristics of normal preterm newborns: a multicenter clinical study / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the characteristics of amplitude integrated electroencephalography (aEEG) in preterm infants and changes of maturation with gestational age.</p><p><b>METHODS</b>aEEG monitoring was done within 3 days of age with domestically produced digital aEEG set (CFM3000). Duration of each recording was at least 4 hours. The continuity, sleep-wake cycle, voltage and bandwidth of all aEEG tracing were analyzed.</p><p><b>RESULTS</b>The percent of continuity background increased from 30% of 28 weeks to 85.7% of 36 weeks (χ(2) = 28.2, P = 0.026); the percent of mature sleep-wake cycle increased from 10% of 28 weeks to 100% of 36 weeks (χ(2) = 192.4, P < 0.01). Low bound voltage increased with gestational age, from (6.8 ± 1.7) µV (28 w) to 9.7 - 10.1 µV (35 - 36 w) (F = 11.4, P < 0.01). Bandwidth of the narrow band decreases gradually with gestational age, from 1.45 cm (28 w) to (0.86 ± 0.24) cm (36 w) (F = 8.731, P < 0.01). The correlation coefficient for continuity, sleep-wake cycle, low bound voltage and bandwidth of narrow band, and total scores were 0.32, 0.81, 0.38, 0.55 and 0.78 respectively (P < 0.05).</p><p><b>CONCLUSION</b>The older the gestational age of infants at birth, the more mature the aEEG pattern, manifested as increased continuity and sleep-wake cycle, the higher low bound voltage and more narrowed bandwidth with increased gestational age.</p>

Amplitude-integrated electroencephalographic monitoring in early diagnosis and neurological outcome prediction of term infants with hypoxic-ischemic encephalopathy / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the changes of the amplitude-integrated electroencephalography (aEEG) tracings within 6 hours after birth in term infants with hypoxic-ischemic encephalopathy (HIE) and explore the value of aEEG in early diagnosis and prediction of neurological outcome in term infants.</p><p><b>METHODS</b>From May 2003 to February 2005, 33 term infants with HIE at the Division of Neonatology, Pediatric Hospital of Fudan University were studied by aEEG within 6 hours after birth. The results of aEEG were categorized into three groups (normal, mildly abnormal and severely abnormal aEEG), while HIE was clinically classified into three grades (mild, moderate and severe) and the neurological outcomes at 18 months were assessed (normal, disabled and dead). The correlation between the results of aEEG, severity of HIE and neurological outcome at 18 months were analyzed, respectively. The values of aEEG on early diagnosis and neurological outcome prediction of HIE were analyzed.</p><p><b>RESULTS</b>Among the 33 term infants with HIE, 20 infants had normal aEEG (normal amplitude aEEG), 5 had mildly abnormal aEEG (4 with mildly abnormal amplitude aEEG, 1 with normal amplitude and seizure) and 8 had severely abnormal aEEG (2 with mildly abnormal aEEG and seizures, 4 with severely abnormal amplitude and 2 with severely abnormal amplitude and seizures), respectively. Seventeen infants (51.5%) had mild HIE, 19 moderate (27.3%) and 7 (21.2%) severe HIE, respectively. Twenty-five cases were followed up, which showed that 19 had normal neurological outcome, 1 had disability and 5 died. By CMH square analysis and Spearman rank correlation analysis, the results of aEEG classification were correlated with the severity of HIE and the neurological outcome of term infants. Abnormal aEEG could predict the severity of HIE in term infants with a sensitivity of 100%, specificity of 81.3%, positive predictive value of 85.0% and negative predictive value of 100%, respectively. Abnormal aEEG could predict the neurological outcome of term infants with HIE, which showed a sensitivity of 100%, specificity of 90.9%, positive predictive value of 93.3% and negative predictive value of 100%, respectively. Severely abnormal aEEG could predict the severe HIE in term infants with sensitivity of 96.2%, specificity of 100%, positive predictive value of 100% and negative predictive value of 87.5%, respectively. Severely abnormal aEEG could predict the neurological outcome of term infants with HIE, which showed sensitivity of 94.7%, specificity of 100%, positive predictive value of 100% and negative predictive value of 85.7%, respectively.</p><p><b>CONCLUSIONS</b>Monitoring with aEEG in term infants with HIE within 6 hours after birth could predict the severity of HIE and its neurological outcome at 18 months.</p>