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      Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction

      , , , ,
      American Journal of Obstetrics and Gynecology
      Elsevier BV

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          Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?

          To determine if perinatal morbidity and mortality differ in growth-retarded, small for gestational age (SGA), premature infants and appropriate for gestational age (AGA) infants. All consecutive, singleton, nondiabetic, preterm pregnancies delivered over a 15-year period were analyzed. Infants were categorized as SGA (at or below the tenth percentile) or AGA (11th to the 89th percentiles), then stratified by birth weight and gestational age categories. Perinatal morbidity and mortality were examined. We studied 4183 preterm deliveries, 1012 of them SGA and 3171 of them AGA. Overall, we found significantly higher rates of fetal and neonatal death in the SGA group. Stratification by gestational age revealed significantly higher rates of neonatal death for the SGA group compared with the AGA group in each gestational age category. Overall, comparison also revealed significantly higher rates of fetal heart rate abnormality in the SGA group but no difference in neonatal sepsis, birth trauma, cesarean delivery, hyaline membrane disease, or congenital anomalies. Growth-retarded premature infants have a significantly higher risk of morbidity and mortality, both before and after delivery, than do appropriately grown infants.
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            Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.

            The relationship between antenatal steroids, delivery mode, and early-onset intraventricular hemorrhage was examined in very-low-birth-weight infants. A total of 505 preterm infants (birth weight 600 to 1250 gm) were enrolled in a multicenter, prospectively randomized, controlled trial evaluating the efficacy of postnatal indomethacin to prevent intraventricular hemorrhage. All infants had echoencephalography between 5 and 11 hours of life. Seventy-three infants had intraventricular hemorrhage within the first 5 to 11 hours (mean age at echoencephalography 7.5 hours). Four hundred thirty-two infants did not have early intraventricular hemorrhage. There was less antenatal steroid treatment (19% vs 32%, p = 0.03) and more vaginal deliveries (71% vs 45%, p < 0.0001) in the group with early intraventricular hemorrhage. Of 152 infants who received antenatal steroids, those delivered by cesarean section had significantly less early-onset intraventricular hemorrhage than did those delivered vaginally (4% vs 17%, p = 0.02). Of the 353 not exposed to antenatal steroids, 10% of infants delivered by cesarean section and 22% delivered vaginally had early intraventricular hemorrhage (p = 0.003). These data are the first to suggest that both antenatal steroids and cesarean section delivery have an important and independent role in lowering the risk of early-onset intraventricular hemorrhage.
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              Lecithin-sphingomyelin ratios in amniotic fluid in normal and abnormal pregnancy.

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                Author and article information

                Journal
                American Journal of Obstetrics and Gynecology
                American Journal of Obstetrics and Gynecology
                Elsevier BV
                00029378
                January 2000
                January 2000
                : 182
                : 1
                : 198-206
                Article
                10.1016/S0002-9378(00)70513-8
                10649179
                744ee8eb-c90e-460b-851a-2435bc5cf99d
                © 2000

                http://www.elsevier.com/tdm/userlicense/1.0/

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