Risk factors of neonatal asphyxia in twin pregnancy / 中华围产医学杂志

Objective:To investigate the incidence and risk factors of neonatal asphyxia in twin pregnancy.Methods:This study retrospectively recruited 2 035 women with twin pregnancy and their 4 070 twin neonates in the Obstetrics and Gynecology Hospital of Fudan University from January 2010 to December 2018. There were 211 cases suffered from neonatal asphyxia (asphyxia group) and 3 859 did not (non-asphyxia group). The demographic information of the women and their newborns and the incidence of perinatal complications were compared between the two groups by two independent samples t-test and Chi-square test. Multivariate logistic regression was used to analyze the risk factors of neonatal asphyxia in twin pregnancy. Results:The age of 2 035 women was (31.8±4.4) years old (17-52 years old). The gestational age of the twins at delivery was (35.2±2.2) weeks (25-40 weeks). There were 1 330 (65.4%) premature births, including 997 (49.0%) born at ≥34 weeks. Monochorionic diamniotic twin pregnancies accounted for 22.6% (460/2 035). The total incidence of neonatal asphyxia was 5.2% (211/4 070), 5.0% (102/2 035) in the first- and 5.4% (109/2 035) in the second-born twin infants, and the three figures were all decreased with the increase of gestational age ( χ2trend=1 601.965, 549.693 and 1 089.709, all P<0.001) as well as birth weight ( χ2trend=1 273.386, 437.906 and 848.007, all P<0.001). Univariate analysis showed that the asphyxia group had smaller gestational age and lower birth weight [(34.1±2.8) vs (35.3±2.1) weeks, t=6.279; (2 113.3±565.7) vs (2 339.6±478.7) g, t=5.700], but a higher ratio of male infants [58.3% (123/211) vs 48.5% (1 878/3 859), χ2=7.704], vaginal delivery [10.4% (22/211) vs 4.5% (173/3 859), χ2=15.493], monochorionic diamniotic twins [27.5% (58/211) vs 22.3% (862/3 859), χ2=7.714], special complications related to monochorionic diamniotic twin pregnancies [8.1% (17/211) vs 2.5% (95/3 859), χ2=23.403] and fetal distress [13.7% (29/211) vs 3.8% (148/3 859), χ2=47.222] than the non-asphyxia group (all P<0.05). After adjusting for the gestational age, birth weight and gender, multivariate logistic regression found that vaginal delivery ( OR=1.748, 95% CI: 1.069-2.861), special complications related to monochorionic diamniotic twin pregnancies ( OR=3.200, 95% CI: 2.056-4.982) and fetal distress ( OR=2.017, 95% CI: 1.073-3.791) were the risk factors for asphyxia in twin neonates (all P<0.05). Conclusions:The incidence of neonatal asphyxia is high in twins with small gestational age and low birth weight. Vaginal delivery, fetal distress and special complications related to monochorionic diamniotic twin pregnancies are the high-risk factors. Clinicians should be well prepared for resuscitation when encountering neonatal asphyxia.

Pregnancy outcome of fetal tethered cord diagnosed by MRI: analysis of 38 cases / 中华围产医学杂志

Objective:To evaluate the pregnancy outcomes of fetal tethered cord (TC) prenatally diagnosed by MRI.Methods:Clinical data of 38 fetuses diagnosed as having TC by MRI, including 36 singletons and two fetuses who were both one of dichorionic diamniotic twins, were retrospectively collected and analyzed in the Obstetrics and Gynecology Hospital of Fudan University from January 2015 to August 2019. According to whether conus medullaris was located above the bladder or reached the lower edge of the bladder, all cases were divided into high or low groups. Pregnancy outcomes were compared between the two groups using Fisher's exact test and Student's t-test. Results:(1) The gestational age at MRI was (25.5±4.7) weeks. Among the 38 cases, 14 (36.8%) were isolated TC, 24 (63.2%) were complicated by other anomalies. The meningocele was responsible for the most (39.5%, n=15). The results of the ultrasound were consistent with those of MRI in 24 cases (63.2%). While in the other 14 cases (36.8%), the ultrasound only showed vertebral body's abnormal morphology, after which further MRI examination revealed a tethered cord. (2) Twenty-nine women (76.3%) chose to terminate the pregnancy. One patient (2.6%) underwent fetal reduction at 23 gestational weeks (one normal twin was delivered prematurely), and one (2.6%) was lost to follow-up. Seven (18.4%) cases continued the pregnancies to delivery. The postnatal follow-up period was 8.1 months (4.0 to 54.9 months). Two infants without comorbidities showed normal growth and development. Another three cases underwent surgeries after birth, and two cases died in the neonatal period. (3) The average width of the medullary cone was (2.5±0.8) cm. There was no significant difference in the spinal cord width between the high [(2.5±0.8) cm, n=34] and low group [(2.7±1.1) cm, n=4]. Six pregnancies (17.6%) in the high group was continued to delivery, and one of the neonates died of severe hydrocephalus. One patient in the low group (1/4) was delivered, while the baby died of neonatal asphyxia. Conclusions:Fetuses with isolated TC are prone to have a good prognosis. Further study should focus on the relation between the high or low position of the conus medullaris and pregnancy outcomes.

The clinical analysis of pleural effusion associated with peripherally inserted central catheters in two neonates / 临床儿科杂志

Objective To explore the clinical characteristics of pleural effusion associated with peripherally inserted central catheters (PICCs) in neonates. Method The clinical data of pleural effusion caused by PICCs in two neonates were retrospectively analyzed. Results Both 2 cases were preterm female infants. Case 1 was delivered at 26+5 weeks, with a birth weight of 800 g. Dyspnea aggravated 8 hours after the PICC placement. Bedside chest radiograph indicated a large amount of pleural effusion on the right side. PICC was removed, puncture and drainage were performed, and pleural effusion was cured after 6 days of closed thoracic drainage. Case 2 was delivered at 29+3 weeks with a birth weight of 1240 g. Three days after placement of PICC, dyspnea became worse. Bedside chest radiograph showed bilateral pleural effusion, which was cured after PICC removal, puncture and drainage. According to the routine and biochemical indexes of pleural effusion, combined with the medical history, case 1 was consistent with the diagnosis of chylothorax and case 2 was considered as fluid exudation. Conclusion Neonatal PICC-associated pleural effusion is rare, but the etiology is varied and progress is rapid. Vigilance and active treatment is needed in clinic.

Analysis of related risk factors of neonatal resuscitation dififculty / 临床儿科杂志

Objective To analyze related risk factors in resuscitation difficulty in neonates.MethodsLive birth asphyxia neonates with gestational age≥28 weeks (1 minute Apgar score count of 0-7) were included during January 2011 to October 2015. After resuscitation, the neonates were divided into two groups by 5 minutes Apgar score, successful resuscitation group (Apgar score of 8-10) and poor resuscitation group (Apgar score of 0-7). The analysis of related risk factors was performed. Neonates with poor resuscitation assessed by 5 minutes Apgar were continued being resuscitated. After 20 minutes, these neonates were divided into successful resuscitation group (20 minutes Apgar 8-10) and poor resuscitation group (20 minutes Apgar 0-7). The related risk factors analysis was performed once again. ResultsA total of 743 neonates with asphyxia at one minute were included, among whom 130 cases were poor resuscitation and 613 cases were successful resuscitation at 5 minutes. There were obvious correlations of 5 minutes poor resuscitation with premature delivery, low birth weight, 1 minute Apgar score for 0?~?3, intrapartum infectious fever, abnormal placenta, vaginal bleeding during late pregnancy, twin transfusion syndrome, and fetal malformation (P all?

Clinical features of non-immune hydrops fetalis in neonates / 中华围产医学杂志

Objective To summarize the clinical characteristics of neonates with non-immune hydrops fetalis.Methods The clinical data of ten neonates with non-immune hydrops fetalis, who were admitted to the Department of Neonatology, Gynecology and Obstetrics Hospital of Fudan University between January 2012 and June 2014, were retrospectively studied.Prenatal characteristics, causes, clinical features and prognosis were explored and analyzed with descriptive statistical methods.Results (1) One of the ten neonates was diagnosed after birth presented with hydroderma and abdominal distension, and the rest ones were diagnosed antenatally.There were six males and four females, and eight premature and two term neonates with the average gestational age of (33.6±2.4) weeks and birth weight of(2 680±478) g.(2) The mean maternal age was (30.3 ±4.6) years.Two of the mothers had gestational diabetes mellitus and one had gestational diabetes mellitus complicating with hyperthyroidism.The blood types of all mothers were O and Rh(+).None of the mothers were tested for parvovirus B19 and no fetus was reported with abnormal chromosome karyotype in the five cases received fetal karyotype analysis.(3) The average gestational age at initial identification of hydrops fetalis by fetal ultrasound was (31.3 ± 2.4) weeks (25.1～37.0 weeks) among nine cases diagnosed prenatally.By ultrasound screening, there were seven cases with hydrothorax, six with seroperitoneum, five with polyhydramnios and four with hydroderm.(4) Two neonates had normal non-stress test results during labor, and eight were abnormal and suffered from severe neonatal asphyxia at birth and resuscitated by endotracheal intubation.Ten neonates had hydroderm, seven had hydrothorax, six had seroperitoneum and one had hydropericardium.One complicated with multiple malformations and one had chromosome abnormality.Four cases received thoracentesis and three had abdominal paracentesis after parturition.(5) Prognosis: One neonate survived and nine died among which six due to resuscitation failure in delivery room, two died one day after giving up treatment after one day, and one died due to treatment failure six months after birth.(6) The causes of hydrops fetalis were anemia (two cases) and congenital diaphragmatic hemangioma, recurrent atrial premature beat, Down's syndrome, congenital pulmonary lymphangiectasia, paroxysmal supraventricular tachycardia, placental chorioangioma, suspicious genetic syndrome and idiopathic (one for each).Conclusions The prognosis varies because of different etiology of non-immune hydrops fetalis.Neonates with hydrops fetalis might have a higher rate of asphyxia and mortality rate, and difficulties in resuscitation at birth.

The reference ranges of oxygen saturation and heart rate in healthy infants during the first ten minutes after birth / 临床儿科杂志

Objective To establish the reference ranges of preductal oxygen saturation (SpO2) and heart rate (HR) for healthy neonates in 10 minutes after birth. Methods SpO2 and HR recordings of 203 term neonates (vaginal group:n=97 and ce-sarean group:n=106) with regular respiratory pattern were evaluated. 10th-95th percentile charts of SpO2 and HR from 1 minute to 10 minutes after birth were drawn. Results The SpO2 of P10, P50 and P95 at 1 minute after birth was 62%, 71%and 85%respec-tively. The heart rate of P10, P50 and P95 at 1 minute after birth was 66 bpm, 98 bpm and 126 bpm respectively. The median time for SpO2 to reach 90%was 5 minutes. The rising trend of HR was evident during 1-5 minutes after birth, and then the HR leveled off. Conclusions The status of newborn can be assessed using the charts of SpO2 and HR combined with clinical manifestations. The oxygen intervention should be used with care to avoid damage caused by hyperoxemia and hypoxemia.