Corticoterapia prenatal y morbimortalidad del prematuro tardío: estudio prospectivo / Antenatal corticosteroid therapy and late preterm infant morbidity and mortality

INTRODUCCIÓN: Se define al prematuro tardío como al recién nacido de 34 a 36 semanas de gestación. Este grupo presenta mayor riesgo de complicaciones que los nacidos a término. Sin embargo, son pocas las intervenciones que se realizan para reducir esta mayor morbimortalidad. La administración prenatal de corticoides podría ser una medida preventiva eficaz. OBJETIVO: Describir la morbilidad asociada a la prematuridad tardía y determinar si existen diferencias en los prematuros tardíos que recibieron corticoides prenatales. PACIENTES Y MÉTODOS: Estudio observacional prospectivo de los prematuros tardíos nacidos en un hospital terciario desde octubre de 2011 a octubre de 2012. Se clasificaron en 2 grupos, según hubiesen o no recibido corticoides prenatales, y se compararon las tasas de morbimortalidad entre los 2 grupos. RESULTADOS: La tasa de prematuridad global fue del 8,04%, de los cuales el 74,4% (n = 247) fueron prematuros tardíos. Precisaron ingreso el 63,2% (n = 156), suponiendo el 17% del total de ingresados y el 20,6% de los ingresos en la unidad de cuidados intensivos neonatales. Recibieron corticoides prenatales el 29,6% (n = 73). La incidencia de ingreso en neonatología y cuidados intensivos neonatales, la presencia de taquipnea transitoria, hipoglucemia, intolerancia digestiva, ictericia, asistencia respiratoria en forma de presión positiva continua en la vía respiratoria nasal, oxigenoterapia, sueroterapia y fototerapia fueron significativamente superiores (p < 0,05) en el grupo que no recibió corticoides prenatales. CONCLUSIONES: La morbilidad de los prematuros tardíos de nuestro medio es significativamente inferior en los que recibieron corticoides prenatales, por lo que podría ser útil prolongar su administración más allá de las 34 semanas

INTRODUCTION: Late preterm infants (34-36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure. OBJECTIVE: The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids. PATIENTS AND METHODS: A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared. RESULTS: There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P < .05) in the late preterm group that did not receive antenatal steroids. CONCLUSIONS: Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth

[Antenatal corticosteroid therapy and late preterm infant morbidity and mortality]. / Corticoterapia prenatal y morbimortalidad del prematuro tardío: estudio prospectivo.

INTRODUCTION: Late preterm infants (34-36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure. OBJECTIVE: The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids. PATIENTS AND METHODS: A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared. RESULTS: There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P<.05) in the late preterm group that did not receive antenatal steroids. CONCLUSIONS: Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth.

Accidente cerebrovascular en el recién nacido a término / Cerebral stroke in the term newborn

Los accidentes cerebrovasculares (ACV) constituyen una patología relativamente frecuente en el periodo perinatal. Últimamente, los factores protrombóticos están adquiriendo especial protagonismo como favorecedores de los ACV, y pueden presentarse hasta en el 68% de los casos. La ecografía cerebral constituye la primera prueba de imagen diagnóstica, y la resonancia magnética (RM) es la prueba de elección. Se realiza una revisión de la casuística en un hospital de tercer nivel y se presentan los 2 casos de ACV neonatal en los que se constató una trombofilia hereditaria. De los 7 casos de ACV neonatal encontrados durante el periodo 2006-2011, sólo el 28% presentaba anomalías focales en el estudio ecográfico inicial, confirmándose posteriormente una lesión hemorrágica por RM craneal. Todos los ACV isquémicos presentaron ecografías cerebrales iniciales normales. Por ello, se destaca la conveniencia de realizar una RM craneal en todo neonato con sintomatología-semiología neurológica focal, aun cuando la ecografía inicial no muestre alteraciones. Asimismo, ante la sospecha de una etiología vascular se debe descartar la existencia de anomalías protrombóticas (AU)

Cerebral stroke (CS) is a relatively common pathology in the perinatal period. Recently, prothrombotic factors are acquiring special protagonism and can be present in up to 68% of cases. Cranial sonography is the first diagnostic option, but the MRI is the gold standard technique. We carry out a review of casuistry in a third level hospital and we present two cases of perinatal stroke where it was found hereditary thrombophilia. Only 28% showed focal injuries in first ultrasound study, subsequently confirming hemorrhagic lesion by cranial MRI. All ischemic CS presented normal initial cranial ultrasound. For this reason, we would like to emphasise the desirability of realization of cranial MRI in neonates with focal neurological symptoms or signs, even when the first cranial ultrasound does not show alterations. In the same way, when vascular ethiology is suspected, a screening of prothrombotic factors should be studied (AU)

Understanding factors influencing request for a repeat termination of pregnancy.

OBJECTIVE: To assess factors influencing request for a termination of pregnancy (TOP). DESIGN: A questionnaire based, prospective study of 150 women requesting a TOP. This questionnaire contained a modified version of the Edinburgh Postnatal Depression Scale (EPDS). SUBJECTS: Of the 150 women requesting a TOP, 100 were seeking a TOP for the first time and the remaining 50 had at least one TOP in the past. RESULTS: Forty-five percent of women requesting termination of the first pregnancy were under the age of 20, 62% earned less than 10,000 Pounds per year and 12% did not use any form of contraception. Ninety-eight percent knew about emergency contraception but only 3% used it. The repeat termination group were older (only 24% under the age of 20). Fifty-five percent earned less than 10,000 Pounds per year, 15% did not use any contraception, 92% knew about emergency contraception but only 10% used it. Both groups were highly satisfied with the counselling, explanation about the procedure and future contraception advice. However, about 60% of women in both groups had suffered from mild to moderate depression as a consequence of termination. CONCLUSION: This study confirms the need for easy availability of emergency contraception and emphasises the importance of education about contraception in general.