Amniotic Fluid Infection in Preterm Pregnancies with Intact Membranes

Peer reviewe

Oxidative stress - Related spontaneous preterm delivery challenges in causality determination, prevention and novel strategies in reduction of the sequelae

Spontaneous preterm birth (PTB) is one of the major complications of pregnancy and the main cause of neonatal mortality and morbidity. Despite the efforts devoted to the understanding of this obstetrical syndrome and improved medical care, there has been a tendency for the PTB rate to increase in the last decades globally. The costs of the screening for spontaneous PTB, its management, and treatment of the sequelae represent a major burden to the health service economy of high-income countries. In this scenario, it has been widely acknowledged that oxidative stress (OS) plays an important role in the pathogenicity of human disease in wide range of areas of medicine. There is an emerging evidence that an imbalance between pro-and-antioxidants may be associated with spontaneous PTB. However, there are still many controversies on the mechanisms by which OS are involved in the pathogenesis of prematurity. Moreover, the crucial question whether the OS is the cause or consequence of the disease is yet to be answered. The purpose of this article is to briefly summarize the current knowledge and controversies on oxidative stress-related spontaneous PTB and to give a critical approach on future perspectives on this topic as a classical example of translational medicine. Placenta-mediated pregnancy adverse outcome associated with OS leading to iatrogenic PTB (e.g. pre-eclampsia, intrauterine growth restriction, gestational diabetes) will not be discussed.Peer reviewe

Neurocognitive outcome in young adults born late-preterm

Aim This study examined whether late-preterm birth (34+0 to 36+6wks+d gestational age) was associated with neurocognitive deficit in young adulthood, and whether small for gestational age (SGA) birth amplified any adversity. Method Participants derived from the prospective regional cohort study, the Arvo Ylppö Longitudinal Study (n=786; 398 females, 388 males) (mean age 25y 4mo, SD 8mo), born 1985 to 1986 late-preterm (n=119; 21 SGA, <−2 SD) and at term (37+0 to 41+6wks+d; n=667; 28 SGA) underwent tests of intelligence, executive functioning, attention, and memory, and reported their education. Results Those born late-preterm scored −3.71 (95% confidence interval [CI] −6.71 to −0.72) and −3.11 (95% CI −6.01 to −0.22) points lower on Full-scale and Verbal IQ than peers born at term. Compared with those born at term and appropriate for gestational age (≥−2 to <2 SD) Full-scale, Verbal, and Performance IQ scores of those born late-preterm and SGA were −9.45 to −11.84 points lower. After adjustments, differences were rendered non-significant, except that scores in Full-scale and Performance IQ remained lower among those born late-preterm and SGA. Interpretation Late-preterm birth, per se, may not increase the risk of poorer neurocognitive functioning in adulthood. But the double burden of being born late-preterm and SGA seems to increase this risk

Caffeine is a respiratory stimulant without effect on sleep in the short-term in late-preterm infants

Publisher Copyright: © 2021, The Author(s).Background Caffeine is widely used in preterm infants for apnea control. It has no effect on sleep in the only existing polysomnographic study including ten preterm infants Behavioral and polygraphic studies have conflicting results. Methods We studied 21 late-preterm infants at a median gestational age of 36 weeks. Polysomnography was performed twice, at baseline on day 1 and on the day after the onset of caffeine treatment (20 mg/kg loading and 5 mg/kg morning maintenance dose). Results Caffeine acted short term as a breathing stimulant with reduction of apneas, improved baseline SpO(2) (p < 0.001), and decreased 95 percentile of end-tidal carbon dioxide level (p < 0.01). It also increased arousal frequency to SpO(2) desaturations of more than 5% (p < 0.001). Caffeine did not affect sleep stage distribution, sleep efficiency, frequency of sleep stage transitions, appearance of REM periods, or the high number of spontaneous arousals. The median spontaneous arousal count was 18 per hour at baseline, and 16 per hour during caffeine treatment (p = 0.88). Conclusions In late-preterm infants, caffeine has a clear short-term respiratory stimulant effect, and it increases the arousal frequency to hypoxia. However, caffeine does not appear to act as a central nervous system stimulant, and it has no acute effect on sleep quality. Impact Effects of caffeine on sleep in preterm infants has previously been investigated with only one full polysomnographic study including ten preterm infants. The study showed no effect. The current study shows that caffeine acts short term as a respiratory stimulant and increases arousal frequency to hypoxia. Although a potent central nervous system (CNS) stimulant in adults, caffeine does not seem to have similar acute CNS effect in late-preterm infants. The onset of caffeine treatment has no short-term effect on sleep stage distribution, sleep efficiency, frequency of sleep stage transitions, appearance of REM periods, or the high number of spontaneous arousals.Peer reviewe

Supplemental Oxygen Treats Periodic Breathing without Effects on Sleep in Late-Preterm Infants

Background: The effect of supplemental oxygen on sleep has not been studied in preterm infants. Methods: We studied 18 stable late-preterm infants with observed periodic breathing at a median gestational age of 36 weeks. Polysomnography was performed on room air and on 25% oxygen-enriched ambient air. Results: Supplemental oxygen did not affect sleep stage distribution, sleep efficiency, the frequency of sleep stage transitions, the appearance of rapid-eye movement (REM) sleep periods, or the high number of spontaneous arousals. The percentage in periodic breathing out of total sleep time decreased from 10% (interquartile range [IQR] 5-9%) on room air to 1% (IQR 0-3%) (p < 0.001) on supplemental oxygen. Also, the number of central apneas decreased from 48 (IQR 32-68) to 23 (IRQ 15-32) per hour (p < 0.001), and the number of oxygen desaturations of a minimum 3% from 38 (IQR 29-74) to 10 (IQR 5-24) per hour (p < 0.001). On room air in non-REM sleep, the median end-tidal carbon dioxide values were systematically lower during periodic breathing at 5.1 (IQR 4.6-6.4) kPa than during stable breathing at 5.5 (4.9-5.9) kPa (p < 0.0001). Conclusions: In late-preterm infants, supplemental oxygen effectively reduces periodic breathing and the number of oxygen desaturations while having no significant effect on sleep. The results support the importance of carotid body over-reactivity on the genesis of periodic breathing in preterm infants.Peer reviewe

Childhood cognitive ability and physical activity in young adulthood

Objective: Childhood cognitive ability is associated with lifestyle in adulthood, including self-reported physical activity (PA). We examined whether childhood cognitive ability is associated with objectively-measured PA and sedentary time (ST) in young adulthood. Methods: Participants of the Arvo Ylppö Longitudinal Study (n=500) underwent tests of general reasoning, visuo-motor integration, verbal competence and language comprehension at the age of 56 months yielding a general intelligence factor score; at the age of 25 years they wore omnidirectional accelerometers for 9 days (Range=4-10 days) measuring overall daily PA (counts per minute, cpm), ST and light and moderate-to-vigorous PA (MVPA) (minutes), and completed a questionnaire on occupational, commuting, leisure-time conditioning and non-conditioning PA. Results: After adjustment for sex, age, BMI-for-age SD score at 56 months and mean of valid minutes of measurement period for PA, per each one SD increase in the childhood general intelligence factor score, overall daily PA decreased by -8.99 CPM/day, ST increased by 14.93 minutes/day, time spent in light PA decreased by -14.39 minutes/day, and the odds per each level increase in physical demandingness of the work and in time spent in non-conditioning leisure-time PA decreased by 38% and 31%, respectively (p-values<0.04). These associations were mediated via higher young adulthood level of education. Conclusions: In contrast to expected, in this cohort of young adults with high variability in PA, of whom many were still studying, higher childhood cognitive ability was associated with more objectively-measured and self-reported physical inactivity. Whether these findings persist beyond young adulthood is a subject of further studies

Tekoäly vastasyntyneiden tehohoidossa

Vertaisarvioitu. English summary. Teema : tekoäly lääketieteessä.Sähköisessä muodossa oleva lääketieteellinen tieto lisääntyy jatkuvasti, ja erityisesti tehohoidossa olevien potilaiden hoidosta pystytään integroitujen mittalaitteiden ansiosta muodostamaan potilastietojärjestelmiin yhä kattavampi kuva. Yhdistämällä nämä tiedot terveydenhuollon rekistereihin ja hyödyntämällä viime vuosikymmenellä huomattavasti kehittynyttä suurten tietomassojen analysointia on mahdollista kehittää malleja, jotka pystyvät koneoppimisen avulla ennustamaan komplikaatioita ja arvioimaan potilaan ennustetta. Tällaiset mallit pystyvät analysoimaan valtavaa määrää muuttujia ja niiden ajallisia yhteyksiä. Niiden läpinäkyvyys on kuitenkin usein heikko, ja kliinikon on vaikea seurata, miten lopputulokseen on päästy. Kun algoritmeja tarjotaan yhä enemmän ratkaisuiksi kliinisiin ongelmiin, lääkärien tulee ymmärtää mallien rajoitukset ja toisaalta niiden tarjoamat mahdollisuudet.Peer reviewe

Artificiell intelligens i neonatalvård

English summar

Maternal vitamin D status, gestational diabetes and infant birth size

Background: Maternal vitamin D status has been associated with both gestational diabetes mellitus (GDM) and fetal growth restriction, however, the evidence is inconsistent. In Finland, maternal vitamin D status has improved considerably due to national health policies. Our objective was to compare maternal 25-hydroxy vitamin D concentrations [25(OH)D] between mothers with and without GDM, and to investigate if an association existed between maternal vitamin D concentration and infant birth size. Methods: This cross-sectional study included 723 mother-child pairs. Mothers were of Caucasian origin, and infants were born at term with normal birth weight. GDM diagnosis and birth size were obtained from medical records. Maternal 25(OH)D was determined on average at 11 weeks of gestation in pregnancy and in umbilical cord blood (UCB) at birth. Results: GDM was observed in 81 of the 723 women (11%). Of the study population, 97% were vitamin D sufficient [25(OH)D >= 50 nmol/L]. There was no difference in pregnancy 25(OH)D concentration between GDM and non-GDM mothers (82 vs 82 nmol/L, P = 0.99). Regression analysis confirmed no association between oral glucose tolerance test results and maternal 25(OH)D (P > 0.53). Regarding the birth size, mothers with optimal pregnancy 25(OH)D (>= 80 nmol/L) had heavier newborns than those with suboptimal pregnancy 25(OH)D (P = 0.010). However, mothers with optimal UCB 25(OH) D had newborns with smaller head circumference than those with suboptimal 25(OH)D (P = 0.003), which was further confirmed as a linear association (P = 0.024). Conclusions: Maternal vitamin D concentration was similar in mothers with and without GDM in a mostly vitamin D sufficient population. Associations between maternal vitamin D status and birth size were inconsistent. A sufficient maternal vitamin D status, specified as 25(OH)D above 50 nmol/L, may be a threshold above which the physiological requirements of pregnancy are achieved.Peer reviewe

Reduction of inflammation by high-dose methylprednisolone does not attenuate oxidative stress in children undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair

Objective Corticosteroids attenuate inflammatory reaction in pediatric heart surgery. Inflammation is a source of free oxygen radicals. Children with a cyanotic heart defect are prone to increased radical stress during heart surgery. We hypothesized that high-dose methylprednisolone reduces inflammatory reaction and thereby also oxidative stress in infants with a univentricular heart defect undergoing bidirectional Glenn procedure. Design A double-blind, placebo-controlled, randomized clinical trial. Setting Operation theatre and pediatric intensive care unit of a university hospital. Participants Twenty-nine infants undergoing bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair. Interventions After anesthesia induction, the patients received intravenously either 30 mg/kg of methylprednisolone (n=15) or the same volume of saline as placebo (n=14). Measurements and Main Results Plasma interleukin-6, interleukin-8 and interleukin-10 (biomarkers of inflammation) as well as 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative stress) were measured at four different time points: preoperatively, during CPB, after protamine administration, and six hours postoperatively. The study parameters did not differ between the study groups preoperatively. Methylprednisolone reduced the pro-inflammatory cytokines interleukin-6 and interleukin-8 and increased the anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced inflammation, there were no differences in 8-hydroxydeoxyguanosine between the methylprednisolone and placebo groups. Conclusions Pro-inflammatory reaction and increase in free radical stress were not interrelated during congenital heart surgery in cyanotic infants with a univentricular heart defect undergoing bidirectional Glenn procedure. High-dose methylprednisolone was ineffective in attenuating free radical stress.Peer reviewe