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Median Birthweight (median + birthweight)
Selected AbstractsTransient hyperthyroidism of hyperemesis gravidarumBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002Jackie Y.L. Tan Objective To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum. Design Prospective observational study. Setting Hospital inpatient gynaecological ward. Population Women admitted with hyperemesis gravidarum and found to have hyperthyroidism. Methods Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation. Main outcome measures Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes). Results Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of >5% of their pre-pregnancy weight was lower compared with those of women who did not (P= 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile. Conclusions In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism. [source] Developmental assessment of preterm infants at 2 years: validity of parent reportsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2008Samantha Johnson PhD CPsychol Parental questionnaires are inexpensive alternatives to standardized testing for outcome measurement. The Parent Report of Children's Abilities has previously been revised (PARCA-R) and validated for use with very-preterm infants at 2 years of age. This study revalidated the PARCA-R for assessing cognition in a larger and more inclusive sample of preterm infants. One hundred and sixty-four children (82 males, 82 females) of <32 weeks' gestation (median 29wks, interquartile range [IQR] 28-30wks); and median birthweight 1200g (IQR 925-1463g) were evaluated using the Mental Development Index (MDI) of the Bayley Scales of Infant Development - 2nd edition (BSID-II) at 2 years' corrected age. Parents completed the PARCA-R questionnaire. Significant correlations between PARCA-R Parent Report Composite (PRC) scores and MDI scores (r=0.77, 95% confidence interval [CI] 0.69-0.82, p<0.01) demonstrated concurrent validity. A receiver operating characteristic-determined PRC cut-off of <44 had optimal discriminatory power (area under curve 0.92) for identifying MDI <70, with 85% sensitivity (95% CI 0.58-0.96), 87% specificity (95% CI 0.81-0.92), 98% negative predictive value (95% CI 0.95-1), and 37% positive predictive value (95% CI 0.22-0.54). The PARCA-R has good concurrent validity and diagnostic utility for identifying cognitive delay in very-preterm infants at 2 years of age. It is useful for outcome measurement, developmental screening, and facilitating parental involvement at folow-up. [source] Differences between European birthweight standards: impact on classification of ,small for gestational age'DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2006K Hemming PhD We describe a quantitative and comparative review of a selection of European birthweight standards for gestational age for singletons, to enable appropriate choices to be made for clinical and research use. Differences between median values at term across standards in 10 regions and misclassification of 'small for gestational age'(SGA), were studied. Sex and parity differences, exclusion criteria, and methods of construction were considered. There was wide variation between countries in exclusion criteria, methods of calculating standards, and median birthweight at term. The lightest standards (e.g. France's medians are 255g lower than Norway's medians) were associated with fewer exclusion criteria. Up to 20% of the population used in the construction of the Scottish standard would be classified as SGA using the Norwegian standard. Substantial misclassification of SGA is possible. Assumptions about variation used in the construction of some standards were not justified. It is not possible to conclude that there are real differences in birthweight standards between European countries. Country-based standards control for some population features but add misclassification due to the differing ways in which standards are derived. Standards should be chosen to reflect clinical or research need. If standards stratified by sex or parity are not available, adjustments should be made. In multinational studies, comparisons should be made between results using both a common standard and country-based standards. [source] Pregnancy outcome in Type 1 diabetes mellitus treated with insulin lispro (Humalog)DIABETIC MEDICINE, Issue 1 2003E. A. Masson Abstract Aims The use of insulin lispro in pregnancy has not been systematically investigated despite its increasing use. Pooled data from seven centres with experience in the use of insulin lispro were accumulated to evaluate pregnancy outcome in women with Type 1 diabetes. Methods Seven units with specialist obstetric diabetes services were recruited to describe their total experience with insulin lispro in pregnancy. Outcomes with respect to the rate of miscarriage, congenital abnormality, perinatal mortality and maternal parameters were recorded in a standardized format. Results Outcomes on 71 babies from 76 pregnancies were documented. There were six (7.8%) early miscarriages. All 71 babies were liveborn with a mean gestational age of 37.2 weeks, and median birthweight of 3230 g. Seven babies weighed > 4 kg. There were four congenital abnormalities (5.6%). There was a 72% increase in the mean insulin dose (0.75,1.29 IU/kg per day). Maternal glycaemic control improved throughout pregnancy. No women developed retinopathy de novo during pregnancy and six with established retinopathy required laser therapy during pregnancy. Conclusions The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy. [source] Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unitJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2008Jimmy KF Lee Background: An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies. Setting: Neonatal Intensive Care Unit, Kuala Terengganu Hospital. Aim: To review the patient characteristics and the risk factors for septicaemia in the first outbreak. Methods: Retrospective review of records and in the first outbreak a case,control analysis with 23 matched controls for risk factors for septicaemia. Results: In the first outbreak, median birthweight was 1670 g (range 860,3760) and median gestational age was 32 weeks (range 27,41). There were 32 episodes of septicaemia, and five and two patients had two and three episodes, respectively. The mortality rate was 6.3% per septicaemic episode. Multiple logistic regression showed the presence of a prior long line was associated with first septicaemic episode (OR 7.07, 95% CI 1.37,36.47 with P = 0.019) but not prior assisted ventilation. The organism was isolated from the water of an oxygen humidifier in the delivery room, three ventilator water traps and one humidifier water trap in the neonatal unit. In the second outbreak, six episodes of septicaemia occurred in five neonates with median birthweight 2060 g and median gestational age 32.5 weeks. The organism was isolated from two ventilator water traps. Conclusion: These two outbreaks of Burkholderia cepacia subsided with general infection control measures. The sources of these two outbreaks were not identified. [source] Maternal and neonatal outcomes in 54 triplet pregnancies managed in an Australian tertiary centreAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2004Andrea BARKEHALL-THOMAS Abstract Background:, To provide current data on maternal and neonatal outcomes in triplet pregnancies in an Australian population. Methods:, Retrospective case note review of all triplet pregnancies managed within a single Australian tertiary centre. Results:, Fifty-four sets of triplets were managed from January 1996 to October 2002. A total of 59% resulted from the use of assisted reproductive technologies. The median gestation at delivery was 32.5 weeks (range: 21,36 weeks); 14% delivered prior to 28 weeks and 43% delivered before 32 weeks. Preterm labour and preterm rupture of membranes were the most common antenatal complications occurring in 57 and 22% of pregnancies, respectively. A total of 93% of pregnancies were delivered by Caesarean section and 37% of mothers experienced at least one post-partum complication. A total of 96% of neonates were liveborn, with a median birthweight of 1644 g (range: 165,2888 g). The two most common neonatal complications were jaundice and hypoglycaemia in 52 and 43% of liveborn neonates, respectively. A total of 28% of neonates were below the 10th centile for gestational age and sex. A total of 8% of neonates demonstrated congenital anomalies. The perinatal mortality at a gestational age of 20,24 weeks was 100%, 22% at 25,28 weeks and zero for those babies born at 29 weeks or beyond. Conclusion:, Assisted reproductive technologies contribute significantly to the incidence of triplet pregnancies. Gestational age at delivery and perinatal mortality is comparable to published international data. Triplets born in a tertiary centre beyond 28 weeks gestation have a very favourable prognosis in the newborn period. [source] Implementation of a nation-wide automated auditory brainstem response hearing screening programme in neonatal intensive care unitsACTA PAEDIATRICA, Issue 3 2003HLM van Straaten Aim: As part of a future national neonatal hearing screening programme in the Netherlands, automated auditory brainstem response (AABR) hearing screening was implemented in seven neonatal intensive care units (NICUs). The objective was to evaluate key outcomes of this programme: participation rate, first stage success rate, pass/referral rates, rescreening compliance, diagnostic referral rates, age of first diagnostic evaluation and prevalence of congenital hearing loss (CHL). Methods: This prospective cohort study collected data on 2513 survivors. NICU graduates with one or more risk factors according to the Joint Committee on Infant Hearing were included in a two-stage AABR hearing screening programme. Conventional ABR was used to establish a diagnosis of CHL. Results: A total of 2513 newborns enrolled in the programme with a median gestational age of 31.6 (range 24,43) wk and a median birthweight of 1450 (range 510,4820) g. In 25 (1%) cases parents refused screening. Four out of 2513 newborns were initially lost; 2484 newborns have been tested initially. A final 98% participation rate (2465/2513) was obtained for the whole programme. After a median postmenstrual age at the first test of 33.7 (range 27,54) wk, a pass rate of 2284/2484 (92%) resulted at the first stage. The rescreening compliance after the first test was 92% (184/200). A referral rate for diagnostic ABR of 3.1% (77/2484) resulted. Of the 77 referrals 14 (18.2%) had normal screening thresholds, 15 (19.5%) had unilateral CHL and 48 (62.3%) had bilateral CHL. The prevalence of unilateral CHL was 0.6% (15/2484) and of bilateral CHL 1.9% (48/2484). Conclusion: A financially supported two-stage AABR hearing screening programme can be successfully incorporated in NICU centres and detects a high prevalence of CHL in NICU graduates. Neonatal hearing screening should be part of standard clinical practice in all NICU infants. [source] Knee-heel length measurements in preterm infants: evaluation of a simple electronically equipped instrumentACTA PAEDIATRICA, Issue 2 2003E Engström Aim: To compare and evaluate a mini-knemometer with a simple and inexpensive electronic caliper with regard to precision, handling error (technical error) and estimation of growth velocity. Methods: Thirty-five prematurely born infants, with a median gestational age of 29 (range 24,33) wk and a median birthweight of 960 (range 480,2480) g, were measured on 409 different occasions with both instruments. On each occasion, five independent readings were made. Results: There was no significant difference in precision between the two instruments, when measuring growth velocity over a 4 wk period (median 0.41, range 0.10,0.59 mm d,1). The handling error in this study, calculated as the mean standard deviation, was 0.36 (SD 0.18, coefficient of variation 0.38%) mm for the simple electronic caliper and 0.59 mm for the mini-knemometer. Short-term growth was detectable within 2 d when growth velocity was normal. Conclusion: Longitudinal measurement of lower leg length is a gentle and useful complementary method for assessing growth in preterm infants. An inexpensive electronic caliper is well suited for routine use in clinical practice, with measurements taken once or twice a week. [source] | ||||||||||||||||||||||