Background: The efficacy and safety of repeat doses ofprenatal corticosteroids remains uncertain. Our aim was to establish whether repeat prenatal corticosteroids given to women at risk of preterm birth can reduce neo...Background: The efficacy and safety of repeat doses ofprenatal corticosteroids remains uncertain. Our aim was to establish whether repeat prenatal corticosteroids given to women at risk of preterm birth can reduce neonatal morbidity without harm. Methods: In this hospital-basedstudy, 982 women who remained at risk of preterm birth at less than 32 weeks’ gestation, 7 or more days after receiving a first course of prenatal corticosteroids,were randomly assigned to receive a repeat intramuscular dose of either 11.4 mg betamethasone (as Celestone Chronodose), or saline placebo. This was repeated every week the woman remained undelivered, at less than 32 weeks’ gestation, and at risk of preterm birth. Primary outcomes were occurrence and severity of neonatal respiratory distress syndrome, use and duration of oxygen and mechanical ventilation, and weight, length, and head circumference at birth and hospital discharge. Statistical analyses were on an intention to treat basis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN48656428. Findings:Fewer babies exposed to repeat corticosteroids had respiratory distress syndrome (33%vs 41%; relative risk 0.82,95%CI 0.71-0.95, P=0.01) and fewer had severe lung disease(12%vs 20%; relative risk 0.60, 95%CI 0.46-0.79,P=0.0003) than those in the placebo group. In keeping with these benefits, babies exposed to repeat corticosteroids needed less oxygen therapy (P=0.03), and shorter duration of mechanical ventilation (P=0.01). Mean weight,length, and head circumference at birth and hospital discharge did not differ between treatment groups. Z-scores for weight (P=0.04) and head circumference (P=0.03) at birth were lower in the babies who received repeat corticosteroids although at the time of hospital discharge Z-scores did not differ between treatment groups (P=0.29 for weight, P=0.48 for head circumference). Interpretation:Exposure to repeat doses of antenatal corticosteroids reduces neonatal morbidity. Pending long-term outcome results, the short-term benefits for the babies in our study support the use of repeat doses of corticosteroids in women who remain at risk of very preterm birth 7 or more days after an initial course.展开更多
We describe 7 Polynesian babies with a unique severe form of holocarboxylase synthetase deficiency characterized by antenatal growth retardation, subependymal cysts, only partial response to biotin, and a poor outcome.
Objective: To report the antenatal detection rate in a consecutive series of l iveborn infants with atrioventricular septal defect (AVSD). Design: Review and a nalysis of referrals for detailed fetal echocardiography ...Objective: To report the antenatal detection rate in a consecutive series of l iveborn infants with atrioventricular septal defect (AVSD). Design: Review and a nalysis of referrals for detailed fetal echocardiography and postnatal diagnosis of AVSD. Setting: Tertiary referral centre for congenital heart disease centre with data prospectively collected between 1996 to 2001. Results: 92 consecutivel y liveborn infants with AVSDs were identified of which 27 (29%) were detected b y routine obstetric antenatal ultrasound. The antenatal diagnosis rate was worse for liveborn infants with trisomy 21(12 of 49(25%) v 15 of 43 (35%) chromosom ally normal children) and for infants with AVSD without other structural heart d isease (18 of 74 (24%) v 9 of 18 (50%) infants with associated structural hear t disease). Conclusion: Despite the potential ability of fetal ultrasound to det ect AVSDs, the antenatal diagnosis rate is poor. This is particularly true for i nfants with trisomy 21 and is of importance when counselling parents with an app arently normal fetal ultrasound scan.展开更多
neonatal tumors with an incidence of approximately 1:30,000. There are few large single-center series and even fewer describing both their antenatal and postnatal course. We report the outcome of all fetuses investiga...neonatal tumors with an incidence of approximately 1:30,000. There are few large single-center series and even fewer describing both their antenatal and postnatal course. We report the outcome of all fetuses investigated at a tertiary fetal medicine center with this diagnosis. Method: Demographic details were obtained from a prospectively maintained database. Patient records were examined for additional data including antenatal and postnatal interventions. Data were described as median (range). Results: Forty-one SCTs were diagnosed antenatally during the period 1993 to 2004. Twelve were excluded from subsequent analysis (single antenatal visit or attending for second opinion [n = 6] and termination of pregnancy [n = 6]). Twelve underwent fetal intervention (laser vessel ablation [n = 4],alcohol sclerosis [n = 3],cyst drainage [n = 2],amniodrainage [n = 2],vesicoamniotic shunt [n = 1]) for fetal hydrops and polyhydramnios to aid in delivery and to prevent obstructive uropathy developing in the fetus. Of these,3 died in utero and 9 survived to be born (median gestational age,33 weeks [27-37 weeks]). A further 3 died in the neonatal period. There are 6 long-term survivors (50% ) from this group. Seventeen infants,without intervention,were born at median gestational age 38weeks (26-40weeks). One infant with severe cardiac anomalies died on the day of birth. All surviving infants had definitive excisional surgery at a median of 2 days (1-16 days). Current median follow-up of survivors is 39 months (8-86 months). There have been no recurrences. One child has mild constipation,and 3 are awaiting cosmetic revision of their scars. Conclusions: The overall survival of antenatally diagnosed SCT is approximately 77% ,with the development of hydrops and others requiring in utero intervention carrying a poor prognosis. Otherwise,the outcome after surgical excision is excellent.展开更多
Although antenatal infection is thought to play an important role in the path ogenesis of preterm labor and neonatal diseases, the exact mechanisms are largel y unknown. We sought to clarify the relationship between a...Although antenatal infection is thought to play an important role in the path ogenesis of preterm labor and neonatal diseases, the exact mechanisms are largel y unknown. We sought to clarify the relationship between antenatal infection and intrauterine and neonatal inflammation. Samples were obtained from 41 preterm i nfants of < 33 wk gestation delivered to 36 mothers and analyzed for the presenc e of 16s ribosomal RNA (16s rRNA) genes using PCR and for the proinflammatory cy tokines IL- 6 and IL- 8. In 16 (44% )motherbaby pairings, at least one sample was found to be positive for the presence of 16s rRNA genes. All but one of the positive samples were from mothers presenting with preterm prelabor rupture of membranes (pPROM) or in spontaneous idiopathic preterm labor. A strong associati on was found between the presence of 16s rRNA genes and chorioamnionitis and wit h funisitis. A marked increase in IL- 6 and IL- 8 was noted in all tissues pos itive for 16s rRNA genes, including placenta, fetal membranes, cord blood serum, and, where samples were available, in bronchoalveolar lavage fluid (BAL) and in amniotic fluid. Interestingly, gastric fluid was always positive for 16s rRNA g enes if any other intrauterine or BAL sample was positive, suggesting that this sample may provide an alternative to amniotic fluid to identify antenatal infect ion. In conclusion, we have found that microbial genes are particularly prevalen t in pPROM and spontaneous preterm labor groups and that their presence is stron gly associated with a marked intrauterine inflammatory response.展开更多
Background: Antenatal betamethasone treatment is widely used for the prevention of neonatal respiratory distress syndrome in preterm infants and substantially reduces neonatal mortality and morbidity. Fetal exposure t...Background: Antenatal betamethasone treatment is widely used for the prevention of neonatal respiratory distress syndrome in preterm infants and substantially reduces neonatal mortality and morbidity. Fetal exposure to excess glucocorticoids has been proposed as one of the core mechanisms of the fetal origins of adult disease hypothesis. We assessed whether antenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome affects cardiovascular risk factors at 30 years of age. Methods: We followed up at age 30 years 534 individuals whose mothers participated in a doubleblind, placebo-controlled, randomised trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. Mothers received two doses of betamethasone or placebo given by intramuscular injection 24 h apart. Follow-up assessments included anthropometry; measurement of blood pressure, blood lipids (after overnight fasting), and early morning cortisol levels; and a 75 g oral glucose tolerance test. Findings: There were no differences between those exposed to betamethasone and to placebo in body size, blood lipids, blood pressure, plasma cortisol, prevalence of diabetes, or history of cardiovascular disease. After a 75 g oral glucose tolerance test, participants exposed to betamethasone had higher plasma insulin concentrations at 30 min (60.5 vs 52.0 mIU/L; ratio of geometric means 1.16 95%CI 1.03 to 1.31 , p=0.02) and lower glucose concentrations at 120 min (4.8 vs 5.1 mmol/L; difference -0.26 mmol/L -0.53 to 0.00 , p=0.05) than did those exposed to placebo. Interpretation: Antenatal exposure to betamethasone might result in insulin resistance in adult offspring, but has no clinical effect on cardiovascular risk factors at 30 years of age. Thus, obstetricians should continue to use a single course of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome.展开更多
Thyroid hormone is essential for normal brain development including structures critical for visual processing. While chick and rodent models have demonstrated abnormal visual development following prenatal thyroid hor...Thyroid hormone is essential for normal brain development including structures critical for visual processing. While chick and rodent models have demonstrated abnormal visual development following prenatal thyroid hormone loss, comparable data do not exist in the human. To determine whether human infants with intrauterine and early postnatal thyroid hormone insufficiencies have compromised visual abilities, we investigated contrast sensitivity and visual acuity development in 13 infant offspring of women with hypothyroidism during pregnancy (HYPO), 16 preterm infants born between 32 and 35 weeks gestation, 12 infants with congenital hypothyroidism (CH), and 20 typically developing infants. All were assessed with the sweep visual evoked potential technique at 3, 4.5, and 6 months (corrected) age. Results showed significantly reduced contrast sensitivity but normal visual acuity in HYPO and CH groups relative to controls (p < 0.003 and p < 0.05 respectively). Stratification of the HYPO group into subgroups based on maternal TSH levels during the first half of pregnancy revealed lower contrast sensitivities for infants whose mothers’TSH values were above than below the median (p < 0.05). In the CH group, those with an absent thyroid gland and/or a newborn TSH value above 200 mIU/L had lower contrast sensitivities than did those with other etiologies or TSH levels below 100 mIU/L (p< 0.05). There were no significant effects involving the preterm group. These results indicate that thyroid hormone is important for human visual development.展开更多
文摘Background: The efficacy and safety of repeat doses ofprenatal corticosteroids remains uncertain. Our aim was to establish whether repeat prenatal corticosteroids given to women at risk of preterm birth can reduce neonatal morbidity without harm. Methods: In this hospital-basedstudy, 982 women who remained at risk of preterm birth at less than 32 weeks’ gestation, 7 or more days after receiving a first course of prenatal corticosteroids,were randomly assigned to receive a repeat intramuscular dose of either 11.4 mg betamethasone (as Celestone Chronodose), or saline placebo. This was repeated every week the woman remained undelivered, at less than 32 weeks’ gestation, and at risk of preterm birth. Primary outcomes were occurrence and severity of neonatal respiratory distress syndrome, use and duration of oxygen and mechanical ventilation, and weight, length, and head circumference at birth and hospital discharge. Statistical analyses were on an intention to treat basis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN48656428. Findings:Fewer babies exposed to repeat corticosteroids had respiratory distress syndrome (33%vs 41%; relative risk 0.82,95%CI 0.71-0.95, P=0.01) and fewer had severe lung disease(12%vs 20%; relative risk 0.60, 95%CI 0.46-0.79,P=0.0003) than those in the placebo group. In keeping with these benefits, babies exposed to repeat corticosteroids needed less oxygen therapy (P=0.03), and shorter duration of mechanical ventilation (P=0.01). Mean weight,length, and head circumference at birth and hospital discharge did not differ between treatment groups. Z-scores for weight (P=0.04) and head circumference (P=0.03) at birth were lower in the babies who received repeat corticosteroids although at the time of hospital discharge Z-scores did not differ between treatment groups (P=0.29 for weight, P=0.48 for head circumference). Interpretation:Exposure to repeat doses of antenatal corticosteroids reduces neonatal morbidity. Pending long-term outcome results, the short-term benefits for the babies in our study support the use of repeat doses of corticosteroids in women who remain at risk of very preterm birth 7 or more days after an initial course.
文摘We describe 7 Polynesian babies with a unique severe form of holocarboxylase synthetase deficiency characterized by antenatal growth retardation, subependymal cysts, only partial response to biotin, and a poor outcome.
文摘Objective: To report the antenatal detection rate in a consecutive series of l iveborn infants with atrioventricular septal defect (AVSD). Design: Review and a nalysis of referrals for detailed fetal echocardiography and postnatal diagnosis of AVSD. Setting: Tertiary referral centre for congenital heart disease centre with data prospectively collected between 1996 to 2001. Results: 92 consecutivel y liveborn infants with AVSDs were identified of which 27 (29%) were detected b y routine obstetric antenatal ultrasound. The antenatal diagnosis rate was worse for liveborn infants with trisomy 21(12 of 49(25%) v 15 of 43 (35%) chromosom ally normal children) and for infants with AVSD without other structural heart d isease (18 of 74 (24%) v 9 of 18 (50%) infants with associated structural hear t disease). Conclusion: Despite the potential ability of fetal ultrasound to det ect AVSDs, the antenatal diagnosis rate is poor. This is particularly true for i nfants with trisomy 21 and is of importance when counselling parents with an app arently normal fetal ultrasound scan.
文摘neonatal tumors with an incidence of approximately 1:30,000. There are few large single-center series and even fewer describing both their antenatal and postnatal course. We report the outcome of all fetuses investigated at a tertiary fetal medicine center with this diagnosis. Method: Demographic details were obtained from a prospectively maintained database. Patient records were examined for additional data including antenatal and postnatal interventions. Data were described as median (range). Results: Forty-one SCTs were diagnosed antenatally during the period 1993 to 2004. Twelve were excluded from subsequent analysis (single antenatal visit or attending for second opinion [n = 6] and termination of pregnancy [n = 6]). Twelve underwent fetal intervention (laser vessel ablation [n = 4],alcohol sclerosis [n = 3],cyst drainage [n = 2],amniodrainage [n = 2],vesicoamniotic shunt [n = 1]) for fetal hydrops and polyhydramnios to aid in delivery and to prevent obstructive uropathy developing in the fetus. Of these,3 died in utero and 9 survived to be born (median gestational age,33 weeks [27-37 weeks]). A further 3 died in the neonatal period. There are 6 long-term survivors (50% ) from this group. Seventeen infants,without intervention,were born at median gestational age 38weeks (26-40weeks). One infant with severe cardiac anomalies died on the day of birth. All surviving infants had definitive excisional surgery at a median of 2 days (1-16 days). Current median follow-up of survivors is 39 months (8-86 months). There have been no recurrences. One child has mild constipation,and 3 are awaiting cosmetic revision of their scars. Conclusions: The overall survival of antenatally diagnosed SCT is approximately 77% ,with the development of hydrops and others requiring in utero intervention carrying a poor prognosis. Otherwise,the outcome after surgical excision is excellent.
文摘Although antenatal infection is thought to play an important role in the path ogenesis of preterm labor and neonatal diseases, the exact mechanisms are largel y unknown. We sought to clarify the relationship between antenatal infection and intrauterine and neonatal inflammation. Samples were obtained from 41 preterm i nfants of < 33 wk gestation delivered to 36 mothers and analyzed for the presenc e of 16s ribosomal RNA (16s rRNA) genes using PCR and for the proinflammatory cy tokines IL- 6 and IL- 8. In 16 (44% )motherbaby pairings, at least one sample was found to be positive for the presence of 16s rRNA genes. All but one of the positive samples were from mothers presenting with preterm prelabor rupture of membranes (pPROM) or in spontaneous idiopathic preterm labor. A strong associati on was found between the presence of 16s rRNA genes and chorioamnionitis and wit h funisitis. A marked increase in IL- 6 and IL- 8 was noted in all tissues pos itive for 16s rRNA genes, including placenta, fetal membranes, cord blood serum, and, where samples were available, in bronchoalveolar lavage fluid (BAL) and in amniotic fluid. Interestingly, gastric fluid was always positive for 16s rRNA g enes if any other intrauterine or BAL sample was positive, suggesting that this sample may provide an alternative to amniotic fluid to identify antenatal infect ion. In conclusion, we have found that microbial genes are particularly prevalen t in pPROM and spontaneous preterm labor groups and that their presence is stron gly associated with a marked intrauterine inflammatory response.
文摘Background: Antenatal betamethasone treatment is widely used for the prevention of neonatal respiratory distress syndrome in preterm infants and substantially reduces neonatal mortality and morbidity. Fetal exposure to excess glucocorticoids has been proposed as one of the core mechanisms of the fetal origins of adult disease hypothesis. We assessed whether antenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome affects cardiovascular risk factors at 30 years of age. Methods: We followed up at age 30 years 534 individuals whose mothers participated in a doubleblind, placebo-controlled, randomised trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. Mothers received two doses of betamethasone or placebo given by intramuscular injection 24 h apart. Follow-up assessments included anthropometry; measurement of blood pressure, blood lipids (after overnight fasting), and early morning cortisol levels; and a 75 g oral glucose tolerance test. Findings: There were no differences between those exposed to betamethasone and to placebo in body size, blood lipids, blood pressure, plasma cortisol, prevalence of diabetes, or history of cardiovascular disease. After a 75 g oral glucose tolerance test, participants exposed to betamethasone had higher plasma insulin concentrations at 30 min (60.5 vs 52.0 mIU/L; ratio of geometric means 1.16 95%CI 1.03 to 1.31 , p=0.02) and lower glucose concentrations at 120 min (4.8 vs 5.1 mmol/L; difference -0.26 mmol/L -0.53 to 0.00 , p=0.05) than did those exposed to placebo. Interpretation: Antenatal exposure to betamethasone might result in insulin resistance in adult offspring, but has no clinical effect on cardiovascular risk factors at 30 years of age. Thus, obstetricians should continue to use a single course of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome.
文摘Thyroid hormone is essential for normal brain development including structures critical for visual processing. While chick and rodent models have demonstrated abnormal visual development following prenatal thyroid hormone loss, comparable data do not exist in the human. To determine whether human infants with intrauterine and early postnatal thyroid hormone insufficiencies have compromised visual abilities, we investigated contrast sensitivity and visual acuity development in 13 infant offspring of women with hypothyroidism during pregnancy (HYPO), 16 preterm infants born between 32 and 35 weeks gestation, 12 infants with congenital hypothyroidism (CH), and 20 typically developing infants. All were assessed with the sweep visual evoked potential technique at 3, 4.5, and 6 months (corrected) age. Results showed significantly reduced contrast sensitivity but normal visual acuity in HYPO and CH groups relative to controls (p < 0.003 and p < 0.05 respectively). Stratification of the HYPO group into subgroups based on maternal TSH levels during the first half of pregnancy revealed lower contrast sensitivities for infants whose mothers’TSH values were above than below the median (p < 0.05). In the CH group, those with an absent thyroid gland and/or a newborn TSH value above 200 mIU/L had lower contrast sensitivities than did those with other etiologies or TSH levels below 100 mIU/L (p< 0.05). There were no significant effects involving the preterm group. These results indicate that thyroid hormone is important for human visual development.
