Intraamniotic digoxin administration versus intracardiac or funic potassium chloride administration to induce foetal demise before termination of pregnancy: a prospective study.

Different foeticide techniques and pharmacological agents have been used to achieve foetal asystole. This study aimed to compare the success of intraamniotic digoxin, intracardiac potassium chloride (KCl), and funic KCl in achieving foetal asystole and discuss procedural difficulties for physicians and clinical outcomes. This prospective observational study included 124 patients who received foeticide at 22-31 weeks of gestation. All procedures were performed transabdominally, and 1 mg of intraamniotic digoxin, funic KCl, or intracardiac KCl was administered. Procedure times, procedural difficulty scores, patient pain scores, decrease in haematocrit levels, induction and hospitalisation times, and the presence of chorioamnionitis were recorded. The foeticide success rates were 93.0, 95.1, and 97.5% for intraamniotic digoxin, intracardiac KCl, and funic KCl, respectively. Intraamniotic digoxin was associated with shorter procedure times, lower procedural difficulty scores, and lower patient pain scores (p < 0.001). Decreases in haematocrit, induction times, and chorioamnionitis were similar in all three procedures. Success rates and clinical results were similar for all three procedures. Foeticide with intra-amniotic digoxin has a high success rate, the procedure is easier to perform, and patients experience less procedural pain.IMPACT STATEMENTWhat is already known on this subject? Different foeticide techniques and pharmacological agents have been used to achieve foetal asystole. Pharmacological agents used in the foeticide procedure can be injected as intracardiac, funic, intrafetal, or intraamniotic, and the most commonly used are potassium chloride (KCl), digoxin, and lidocaine.What do the results of this study add? The success rates and clinical outcomes in achieving foetal asystole are similar for intracardiac KCl, funic KCl, and intra-amniotic digoxin procedures. Foeticide with intra-amniotic digoxin is less difficult to perform, and patients experience less pain associated with the procedure. All three techniques appear to be safe and have similar short-term obstetric outcomes.What are the implications of these findings for clinical practice and/or further research? Physicians may prefer foeticide with intra-amniotic digoxin as the procedure is technically simpler and has similar success rates to intracardiac or funic KCl administration. A prospective randomised study could better compare the advantages and limitations of the foeticide techniques.

Prenatal diagnosis and management of fetal supraventricular tachyarrhythmia and postnatal outcomes.

OBJECTIVE: We aimed to describe a single institutional experience managing tachyarrhythmic fetuses, to investigate the underlying pathological findings and to evaluate the postnatal follow-up results. METHOD: This retrospective study included 24 fetuses, treated and followed up with the diagnosis of supraventricular tachyarrhythmia between January 2014 and July 2020. Fetal tachyarrhythmia was evaluated by M mode and Doppler ultrasound. Patients were divided into two categories, fetuses with supraventricular tachycardia (SVT) and those with atrial flutter. Also, patients with SVT were subgrouped as short ventriculo-atrial (VA) SVT and long VA SVT. The presence of hydrops was recorded. Prenatal and postnatal data were all collected from hospital records. RESULTS: SVT and atrial flutter were diagnosed in 23 fetuses and in one fetus, respectively. Of the 23 fetuses with supraventricular tachycardia, 12 cases had short VA time interval and 11 had long VA time interval. Antiarrhythmic therapy was applied to 19 cases, but was not initiated in five cases. Thirteen cases responded to single antiarrhythmic drug. Seven (88%) out of 8 cases with short VA SVT without any sign of hydrops responded to digoxin as a single therapy. Six (67%) out of 9 cases with long VA SVT responded to single therapy. In 6 cases (including atrial flutter), combined antiarrhythmic drug was required. In only one fetus, SVT (long-VA) did not convert to sinus rhythm despite high dose combined antiarrhythmic therapy. Six fetuses (25%) had signs of hydrops. In hydrops cases, overall fetal and neonatal mortality rate was 33%. In the absence of hydrops the mortality rate was zero. Second or third line antiarrhythmic treatment options were required in 83% (5 cases) of hydropic fetuses, whereas in only 8% (one case) of non-hydropic cases. Only one fetus recurred. Maternal complications due to antiarrhythmic therapy developed in four cases. Postnatal antiarrhythmic therapy was required in seven cases. CONCLUSION: We found that in the absence of hydrops, all tachycardiac fetuses responded to treatment regardless of the treatment option. In cases with hydrops, mortality was not observed when anti-arrhythmic treatment was started before significant cardiac dysfunction and heart failure. The need for postnatal treatment was common among those with recurrent tachyarrhythmia under treatment, recurrent arrhythmia after discontinuation of fetal therapy, arrhythmia followed up without treatment in the late gestational period and arrhythmias such as Junctional ectopic tachycardia (JET) and Wolff-Parkinson-White syndrome (WPW) syndrome.

Foetal thoracic hypoplasia: concomitant anomalies and neonatal outcomes.

The aim of the current study was to determine the frequency of concomitant anomalies in foetal thoracic hypoplasia and the neonatal outcomes of these pregnancies. This retrospective study included 49 cases of foetal thoracic hypoplasia. All of the cases had skeletal system anomalies. Head and face anomalies (36.7%) were the second most frequent accompanying foetal anomaly, and the least common anomaly was genital system anomalies (4.1%). During the follow-ups, 52.6% (n = 10) of the newborns died in the first 24 h of life, 10.5% (n = 2) in the neonatal period and 36.8% (n = 7) in the infantile period.IMPACT STATEMENTWhat is already known on this subject? Foetal thoracic hypoplasias are lethal anomalies due to inadequate pulmonary development. Data on the other system anomalies that accompany foetuses with thoracic hypoplasia are quite limited in the literature. Moreover, even if the lethal course of thoracic hypoplasia is known, the information on how long newborns will survive is unclear.What do the results of this study add? In this study, most of the cases have additional anomalies, especially skeletal system and head-face anomalies. Approximately half of the newborns with thoracic hypoplasia die within the first 24 h.What are the implications of these findings for clinical practice and/or further research? When we need to consult a family considering the outcome of thoracic hypoplasia, this study can be guiding and helpful. On the other hand, the effects of additional anomalies on the prognosis of foetal and neonatal period are not clear. More studies are needed to better understand the prognosis of thoracic hypoplasias.

Simple Hematological Markers in Predicting the Severity of Transient Tachypnea of Newborn: New Wine in Old Bottles.

OBJECTIVES: To evaluate the validity of red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet mass index (PMI) of patients with transient tachypnea of the newborn (TTN), and to find out their roles in predicting severity of TTN. PATIENTS AND METHODS: In this prospective study, hematological parameters (RDW, PMI) and ratios (NLR, PLR) of 147 patients with TTN and 147 full-term healthy controls were evaluated and compared at birth and at 72nd h of life. PATIENT: s with TTN and 147 full-term healthy controls were evaluated and compared at birth and at 72nd hours of life. RESULTS: RDW and NLR were not only significantly higher in patients with TTN at birth (p = 0.001) and at 72nd hours of life (p: 0.001), but also were correlated with days of nasal continuous positive airway pressure therapy, duration of O2 therapy, TTN clinical scores, hospitalization and TTN duration. At a cut-off value of 2.40, NLR had a sensitivity of 82.5% and specificity of 77.5% to predict TTN, the most striking parameter at 72nd hours of life. RDW of 17.75 was also determined as the predictive cutoff value of TTN (sensitivity 72.5%; specificity 67.5%; area under the receiver-operating characteristic curve 0.80; p = 0.001). Multivariate analysis model adjusted for delivery, gestational age, male gender revealed that RDW and NLR were significantly and independently associated with TTN. CONCLUSION: RDW and NLR both at birth and at 72nd hours of life can be used as biomarkers to distinguish TTN patients from healthy newborns and to predict the severity of TTN.

Acute kidney injury in a single neonatal intensive care unit in Turkey.

BACKGROUND: Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity. METHODS: Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function. RESULTS: The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI. CONCLUSIONS: Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

Healthcare-associated infections in a Neonatal Intensive Care Unit in Turkey.

OBJECTIVE: To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit. DESIGN: Prospective, cohort. SETTING: A 38-bed, teaching, referral, neonatal intensive-care unit. PARTICIPANTS: All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. METHODS: The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. RESULTS: The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. CONCLUSIONS: Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.