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Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (31 July 2022) | Viewed by 12969

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Special Issue Editor

Dr. Roxana Elena Bohiltea

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Guest Editor

Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
Interests: preterm delivery; PPROM; combined tocolytic therapy; iatrogenic preterm delivery; perinatal outcome; maternal nutrition; preterm birth management; ultrasound and preterm delivery; genomics of preterm birth; ultrasound assessment
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Special Issue Information

Dear Colleagues,

As we all know, despite the huge advances achieved in genomics and proteomics, immunology, ultrasonography, pharmacology, and other fields put in the service of the prevention of preterm birth, the incidence of this pathology has remained unchanged over the last few decades. This pathology represents a continuous challenge for both obstetricians and neonatologists due to the limitations in terms of its prediction. This requires the establishment of a personalized strategy and clear therapeutic directions, which take into account the mechanisms underlying this condition. Preterm birth is caused by preterm labor, preterm pre-labor rupture of membranes (PPROM), cervical insufficiency, and iatrogenic preterm delivery due to pregnancy or maternal complications. Premature newborns have a higher morbidity and mortality rate than full-term infants. Analysis of this problem has highlighted the importance of the projection of fetal development in utero, continuing with the neonatal period, childhood, and even adulthood. The risk of complications due to preterm delivery is inversely proportional to gestational age and birth weight, but there are certainly many other factors that influence prognosis. Among numerous short-term complications, neonatal sepsis is a common cause of death, and it is associated with an increased probability of poor neurodevelopmental outcomes and growth impairment. The same consequences are due to respiratory distress, neonatal hypoxia, or cerebral hemorrhage; the results of postnatal care are significantly conditioned by the prophylactic methods applied by the obstetrician. Pending the emergence of more effective prevention methods, obstetrics can repolarize its attention to the needs of neonatology in a joint interdisciplinary effort to improve the prognosis of premature newborns. In this sense, the decrease in iatrogenic prematurity, prolongation of pregnancies with PPROM, screening and treatment of infections in pregnancy, and the combination of different tocolytics addressed to different pathogenic causes can facilitate the effort of neonatology and improve short- and long-term neonatal prognosis. The complexity of complications due to prematurity requires a special interdisciplinary approach capable of ensuring the long-term active monitoring of these newborns. The development of guidelines is an imperative goal on the border between obstetrics and neonatology, in order to improve the survival rate and reduce the developmental sequelae of the fragile premature newborns.

Dr. Roxana Elena Bohiltea
Guest Editor

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Keywords

preterm delivery
PPROM
combined tocolytic therapy
preterm birth management
iatrogenic preterm delivery
perinatal outcome
perinatal mortality
neonatal sepsis

Published Papers (5 papers)

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Research

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10 pages, 866 KiB

Open AccessArticle

Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO₂) with Perinatal Factors in Preterm Neonates: A Single Centre Study

by Melinda Matyas, Mihaela Iancu, Monica Hasmasanu, Anca Man and Gabriela Zaharie

J. Clin. Med. 2022, 11(12), 3546; https://doi.org/10.3390/jcm11123546 - 20 Jun 2022

Viewed by 1611

Abstract

(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO₂) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the blood oxygen saturation. We investigated the effect of perinatal factors on cerebral oxygenation of preterm newborns. (2) Methods: We conducted a longitudinal study with 48 preterm newborns <34 weeks of gestation who underwent NIRS registration during the first 72 h of life. crSaO₂ was measured and cFTOE was calculated foreach patient. (3) Results: One-way ANOVA showed no significant main effect of IVH severity on crSaO₂ and cFTOE (p > 0.05); there was a tendency toward statistical significance concerning the difference between the means of crSaO₂ (p = 0.083) and cFTOE (p = 0.098). Patients with intraventricular haemorrhage (IVH) had a lower mean of crSaO₂ and a higher mean of cFTOE (59.67 ± 10.37% vs. 64.92 ± 10.16% for crSaO₂; 0.37 ± 0.11 vs. 0.32 ± 0.11 for cFTOE) compared to those with no IVH. Significantly lower values of crSaO₂ and higher values of cFTOE were found in neonates receiving inotropic treatment (p < 0.0001). Episodes of apnoea also proved to influence the cerebral oxygen saturation of the study group (p = 0.0026). No significant association between the maternal hypertension treatment and the cerebral oxygenation of preterms was found. (4) Conclusions: This study showed a decreased cerebral oxygen saturation of preterms with IVH, inotrope support and apnoea episodes. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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10 pages, 386 KiB

Open AccessArticle

Antenatal Betamethasone Every 12 Hours in Imminent Preterm Labour

by Natalia Saldaña-García, María Gracia Espinosa-Fernández, Jose David Martínez-Pajares, Elías Tapia-Moreno, María Moreno-Samos, Celia Cuenca-Marín, Francisca Rius-Díaz and Tomás Sánchez-Tamayo

J. Clin. Med. 2022, 11(5), 1227; https://doi.org/10.3390/jcm11051227 - 24 Feb 2022

Cited by 1 | Viewed by 2410

Abstract

Background: Benefits of antenatal corticosteroids have been established for preterm infants who have received the full course. In imminent preterm labours there is no time to administer the second dose 24 h later. Objective: To determine whether the administration of two doses of betamethasone in a 12 h interval is equivalent to the effects of a full maturation. Methods: We performed a retrospective cohort study including preterm infants ≤34 weeks gestational age at birth and ≤1500 g, admitted to an NICU IIIC level in a tertiary hospital from 2015 to 2020. The population was divided into two cohorts: complete maturation (CM) (two doses of betamethasone 24 h apart), or advanced maturation (AM) (two doses of betamethasone 12 h apart). The primary outcomes were mortality or survival with severe morbidities. The presence of respiratory distress syndrome and other morbidities of prematurity were determined. These variables were analysed in the neonates under 28 weeks gestational age cohort. Neurodevelopment at 2 years was evaluated with the validated Ages and Stages Questionnaires^®, Third Edition (ASQ^®-3). Multiple regression analyses were performed and adjusted for confounding factors. Results: A total of 275 preterm neonates were included. Serious outcomes did not show differences between cohorts, no increased incidence of morbidity was found in AM. A lower percentage of hypotension during the first week (p = 0.04), a tendency towards lower maximum FiO₂ (p = 0.14) and to a shorter mechanical ventilation time (p = 0.14) were observed for the AM cohort. Similar results were found in the subgroup of neonates under 28 weeks gestational age. There were no differences in cerebral palsy or sensory deficits at 24 months of corrected age, although the AM cohort showed a trend towards better scores on the ASQ3 scale. Conclusions: Administration of betamethasone every 12 h showed similar results to the traditional pattern with respect to mortality and severe morbidities. No deleterious neurodevelopmental effects were found at 24 months of corrected age. Earlier administration of betamethasone at 12 h after the first dose would be an alternative in imminent preterm delivery. Further studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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11 pages, 13981 KiB

Open AccessArticle

The Strategy against Iatrogenic Prematurity Due to True Umbilical Knot: From Prenatal Diagnosis Challenges to the Favorable Fetal Outcome

by Roxana Elena Bohiltea, Valentin-Nicolae Varlas, Vlad Dima, Ana-Maria Iordache, Teodor Salmen, Bianca-Margareta Mihai, Alexia Teodora Bohiltea, Emilia Maria Vladareanu, Ioniță Ducu and Corina Grigoriu

J. Clin. Med. 2022, 11(3), 818; https://doi.org/10.3390/jcm11030818 - 3 Feb 2022

Cited by 6 | Viewed by 2500

Abstract

True umbilical knot (TUK), although not a commonly encountered pathology, hasan important psychological burden on the mother and obstetrician. It has an extremely low prenatal ultrasound diagnosis rate, despite its adverse perinatal outcomes when unknown. We conducted a retrospective observational analytical study on a 7-year period (2015–2021), including all pregnancies overseen by a single fetal-maternal medicine specialist for monitoring and delivery. We analyzed the prenatal detection rate and correlations between prenatal diagnosis of TUK and pregnancy outcome in terms of associated maternal and fetal factors, time and mode of delivery, fetal weight at birth, maternal level of stress, and iatrogenic prematurity. We compared our results with an electronic search of the literature to study the relationship between TUK and prematurity. We prenatally diagnosed 16 TUKs, and there were two false positives and two undiagnosed knots. All of those women had birth at term. The main finding of the review was a small number of studies that included enough cases for analysis. The prematurity rate due to TUK is 14.2%, significantly increased compared to the general population. An umbilical artery flow velocimetry notch in twin pregnancies complicated by TUK was an important ultrasonographic finding. We consider intrauterine fetal death exceptional, and the main adverse neonatal outcome is due to iatrogenic prematurity caused by maternal anxiety of knowing the prenatal diagnosis and mode of delivery. The elective method for diagnosis should be the second-trimester ultrasound scan using three-dimensional (3D) reconstruction and cesarean delivery for a good neonatal outcome. Pregnant women should be counseled to understand the implications of iatrogenic prematurity, especially respiratory distress syndrome, to ensure these infants are delivered at term. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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12 pages, 858 KiB

Open AccessArticle

Expectant Management of PPROM Improves Neonatal Outcome—A Retrospective Study of 562 Patients

by Roxana Elena Bohilțea, Ana Maria Cioca, Vlad Dima, Ioniță Ducu, Corina Grigoriu, Valentin Varlas and Florentina Furtunescu

J. Clin. Med. 2022, 11(1), 214; https://doi.org/10.3390/jcm11010214 - 31 Dec 2021

Cited by 2 | Viewed by 2319

Abstract

Prelabor preterm rupture of the membranes (PPROM) refers to the rupture of the membranes before 37 weeks, but also before the onset of labor. Approximately 3% of pregnancies are complicated by PPROM, which is an important cause of neonatal morbidity and mortality. The aim of the study is to demonstrate the benefit of expectant management in PPROM, compared to immediate birth, defined in our study as birth in the first 48 h. We analyzed 562 pregnancies with PPROM by gestational age groups and short-term morbidities. Material and methods: We conducted a retrospective observational analytical study, which included women with PPROM between 24 + 0 and 36 + 6 weeks. We divided the cohort into gestational age groups: group 1 gestational age (GA) between 24 and 27, group 2 GA between 28 and 31, group 3 GA between 32 and 34, group 4 GA > 35 weeks. In each group, we analyzed the benefit of the latency period (established in our study as delivery after 48 h of hospitalization) in terms of short-term neonatal complications. Result: The latency period brought a significant benefit starting with GA greater than 28 weeks; therefore, in the group with GA between 28–31, the complications were significantly statistically lower, mentioning respiratory distress syndrome (no latency 100% vs. latency 85.1%) and admission to the neonatal intensive care unit (no latency 89.7% vs. latency 70.2%). In group 3, with GA between 32–34, we reached statistical significance in terms of respiratory distress syndrome (no latency 61.8% vs. latency 39%), hypoxia (no latency 50% vs. latency 31.7%) and admission to the neonatal intensive care unit (no latency 70.2% vs. latency 47.4%). Conclusion: Expectant management of pregnancies with PPROM can bring a real benefit in terms of the incidence of complications in premature infants, but this benefit depends most on the gestational age at which the membranes ruptured and the medical conduct put into practice during the latency period. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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Review

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17 pages, 1222 KiB

Open AccessReview

Respiratory Follow Up of the Premature Neonates—Rationale and Practical Issues

by Raluca Daniela Bogdan, Roxana Elena Bohiltea and Adrian Ioan Toma

J. Clin. Med. 2022, 11(6), 1746; https://doi.org/10.3390/jcm11061746 - 21 Mar 2022

Cited by 5 | Viewed by 2823

Abstract

The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm—before 37 weeks of gestation—and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood—this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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