Follow-up of infants with congenital cytomegalovirus and normal fetal imaging.

OBJECTIVE: To evaluate the outcome of infants with congenital cytomegalovirus (CMV) infection and normal fetal imaging. DESIGN: Retrospective cohort study. SETTING: Tertiary paediatric medical centre. PATIENTS: 98 infants born to mothers with primary CMV infection in the first and second trimesters (diagnosed by positive amniotic fluid findings) and normal fetal imaging. METHODS: Initial evaluation included confirmatory urine culture, complete blood count, liver and kidney function tests, funduscopy, brain ultrasound and hearing test. Follow-up included periodic neurological and developmental evaluation, hearing tests until age 5 and Bayley-III Developmental Scale (in some patients). MAIN OUTCOME MEASURES: The presence and rate of sequelae of congenital CMV. RESULTS: 52 (53.1%) infants received early antiviral treatment for central nervous system symptoms or signs, mainly lenticulostriatal vasculopathy on postnatal ultrasonography (88.5%). Sensorineural hearing loss was found on first examination in 16 infants (25 ears), of whom 10 also had cranial ultrasound findings; another five with late-onset hearing loss were also treated. The median follow-up time was 32 (12-83) months. Most infants with moderate and severe hearing loss were infected in the first trimester (10 vs 2, p=0.053). At the last assessment, eight children (10 ears) still had hearing loss, including two with bilateral loss who underwent a cochlear implant. The mean Bayley-III score was 102.6±10.3 (range 85-127). All 98 children attended regular educational institutions. CONCLUSIONS: Congenital CMV infection acquired from primary maternal infection with normal fetal imaging is associated with a high rate of subtle signs and symptoms after birth. Overall, intermediate-term outcome is good with a low rate of sequelae.

Birth trauma--risk factors and short-term neonatal outcome.

OBJECTIVE: The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. We aimed to identify risk factors for BT and to evaluate the effect of BT on short-term neonatal outcome. METHODS: A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity. RESULTS: Of the 118 280 singleton full-term newborns delivered during the study period, 2874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95% CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95% CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 versus 2.7 d, p = 0.001), were more likely to be admitted to the NICU (3.9% versus 1.9%, p < 0.001), and had a higher rate of jaundice (11.9% versus 7.1%, p < 0.001) and neurological morbidity (4.7% versus 2.3%, p < 0.001). CONCLUSION: Instrumental delivery appears to be responsible for most cases of neonatal BT.

Role of fetal length in the prediction of fetal weight.

OBJECTIVES: The purpose of this study was to compare the accuracy of routine fetal biometric indices in the prediction of fetal length and to determine whether more accurate sonographic measures of fetal length can improve the accuracy of fetal weight estimation. METHODS: The accuracy of the common sonographic fetal biometric indices for predicting fetal length was determined using 3689 sonographic weight estimations performed within 3 days before delivery. The fetal length at the time of the sonographic examination was assumed to be equal to the neonatal length, which is routinely measured within 24 hours of delivery. Two new regression models for fetal weight estimation, one with and one without fetal length as an independent variable, were generated to determine the potential contribution of more accurate predictors of fetal length to the accuracy of fetal weight estimation. RESULTS: Abdominal circumference was a significantly more accurate predictor of fetal length (r = 0.732) compared with femur length (r = 0.712), biparietal diameter (r = 0.644), and head circumference (r = 0.661; P < .05), although each of these biometric indices explained only about 50% of the variance in fetal length (R(2) = 0.423-0.548). The addition of fetal length as an independent variable to a birth weight prediction model significantly improved the model's correlation with birth weight(r = 0.917 versus 0.903; P = .006), systematic error (0.2% versus 0.6%; P < .001), random error (6.7% versus 7.5%; P < .001), mean absolute percent error, and the proportion of estimations within 5% and 10% of birth weight. CONCLUSIONS: The correlation between routine biometric indices and fetal length is limited. Identification of new fetal sonographic biometric indices with greater predictive accuracy for fetal length may improve the accuracy of fetal weight estimation.

Monthly number of preterm births and environmental physical activity.

UNLABELLED: Recent studies have reported links between external physical factors and human homeostasis. OBJECTIVE: to determine whether the monthly values of specific physical environmental factors are associated with the monthly number of preterm births in a major medical center in Israel. METHODS: The sample included 1006 infants weighing less than 1500g born live to 774 mothers during 96 consecutive months (1995-2002) at a tertiary medical center in Israel. Monthly values of indices of solar, cosmic ray, and geomagnetic activity for the same period were obtained from national data monitoring facilities in the United States of America, Russia, and Finland. The findings were statistically correlated with the monthly number of preterm births. RESULTS: The number of preterm births correlated with the month of the year (1-12), with a progressive rise in the number of infants born as the year progressed (p = .02). The monthly number of preterm births showed a significant and direct correlation with solar activity indices (r = .32, p = .0016), and a significant and inverse correlation with cosmic ray activity indices (r = -0.3, p = .008). The relation was significant only for singelton births and for the whole group of preterm newborns, but not for multiple pregnancies. CONCLUSION: Our findings suggest that solar and cosmic ray activity may play a role in the timing of premature labor, however in multiple pregnancies additional factors are dominant.