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Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
In this open, randomized, multicenter trial involving extremely-low-birth-weight preterm infants, the use of a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity.
Journal Article
Association of blood pressure control with atrial and ventricular ectopy in SPRINT
BackgroundPrevious epidemiological studies demonstrated that premature atrial contractions (PACs) and premature ventricular contractions (PVCs) detected by single 12-lead ECGs can predict incident cardiovascular disease and death. The determinants of cardiac ectopy remain unknown, with some evidence that hypertension may contribute.ObjectiveTo determine if intensive blood pressure (BP) control reduces the incidence of cardiac ectopy.MethodsWe performed a post-hoc analysis of the Systolic Blood Pressure Intervention trial, which randomised hypertensive participants to standard treatment (BP target <140 mm Hg) or intensive treatment (<120 mm Hg) with ECGs obtained at baseline, 2 years, 4 years and 5 years. The primary outcomes were incidence of ectopy (PACs or PVCs) as coded by Minnesota ECG classification, censoring for pacing, atrioventricular block, pre-excitation or atrial fibrillation/flutter. We performed Cox proportional hazards regression to determine the association of treatment group with outcomes.ResultsThe analysis cohort comprised 3910 participants randomised to standard treatment and 3911 to intensive treatment, of whom 452 had ectopy on baseline ECG. After excluding those with baseline ectopy, there was no significant difference in the incidence of ectopy (incidence rate ratio 0.93 (95% CI 0.81 to 1.05)). There was no significant association between treatment group and ectopy incidence, with an unadjusted Cox HR of 0.93 (95% CI 0.82 to 1.07), and HR of 1 (95% CI 0.81 to 1.25) after adjusting for covariates.ConclusionIntensive BP control did not reduce the incidence of cardiac ectopy in patients with hypertension. Given the variable nature of PAC and PVC burden, further studies with continuous monitoring or more frequent sampling in larger populations are warranted.
Journal Article
The moment you were born : a story for you and your premature baby
Parents find ways to bond with their premature babies in the Neonatal Intensive Care Unit (NICU).
Book
Preterm Birth
The increasing prevalence of preterm birth in the United States is a complex public health problem that requires multifaceted solutions. Preterm birth is a cluster of problems with a set of overlapping factors of influence. Its causes may include individual-level behavioral and psychosocial factors, sociodemographic and neighborhood characteristics, environmental exposure, medical conditions, infertility treatments, and biological factors. Many of these factors co-occur, particularly in those who are socioeconomically disadvantaged or who are members of racial and ethnic minority groups.
While advances in perinatal and neonatal care have improved survival for preterm infants, those infants who do survive have a greater risk than infants born at term for developmental disabilities, health problems, and poor growth. The birth of a preterm infant can also bring considerable emotional and economic costs to families and have implications for public-sector services, such as health insurance, educational, and other social support systems.
Preterm Birth assesses the problem with respect to both its causes and outcomes. This book addresses the need for research involving clinical, basic, behavioral, and social science disciplines. By defining and addressing the health and economic consequences of premature birth, this book will be of particular interest to health care professionals, public health officials, policy makers, professional associations and clinical, basic, behavioral, and social science researchers.
eBook
Antenatal Betamethasone for Women at Risk for Late Preterm Delivery
In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications.
Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation.
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The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data
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and the belief that at a threshold of . . .
Journal Article
Juniper : the girl who was born too soon
\"Juniper French was born four months early, at 23 weeks gestation. She weighed 1 pound, 4 ounces, and her twiggy body was the length of a Barbie doll. Her head was smaller than a tennis ball, her skin was nearly translucent, and through her chest you could see her flickering heart. Babies like Juniper, born at the edge of viability, trigger the question: Which is the greater act of love--to save her, or to let her go? Kelley and Thomas French chose to fight for Juniper's life, and this is their incredible tale. In one exquisite memoir, the authors explore the border between what is possible and what is right. They marvel at the science that conceived and sustained their daughter and the love that made the difference. They probe the bond between a mother and a baby, between a husband and a wife. They trace the journey of their family from its fragile beginning to the miraculous survival of their now thriving daughter.\" -- Dust jacket.
Book
Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia
In this trial involving fetuses with severe left congenital diaphragmatic hernia, fetoscopic endoluminal tracheal occlusion at 27 to 29 weeks of gestation significantly increased survival to discharge, but it resulted in an increased incidence of preterm, prelabor rupture of membranes and preterm birth.
Journal Article