Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: a systematic review

Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery.  The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched.  Last search was 5 th August 2016.  Studies were included if they reported gestational age, IQ measure and the ages assessed.  The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472).  Two independent reviewers assessed the studies.  Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included.  For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing.  Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion:  Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks).  This should be considered when discussing timing of delivery.  For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores

N2O emission from grass-clover swards is largely unaffected by recently fixed N2

The contribution of biologically fixed dinitrogen (N2) to the nitrous oxide (N2O) production in grasslands is unknown. To assess the contribution of recently fixed N2 as a source of N2O and the transfer of fixed N from clover to companion grass, mixtures of white clover and perennial ryegrass were incubated for 14 days in a 15N2-enriched atmosphere (0.4 atom% excess). Immediately after labelling, half of the grass-clover pots were sampled for N2 fixation determination, whereas the remaining half were examined for emission of 15N labelled N2O for another eight days using a static chamber method. Biological N2 fixation measured in grass-clover shoots and roots as well as in soil constituted 342, 38 and 67 mg N m-2 d-1 at 16, 26 and 36 weeks after emergence, respectively. The drop in N2 fixation was most likely due to a severe aphid attack on the clover component. Transfer of recently fixed N from clover to companion grass was detected at 26 and 36 weeks after emergence and amounted to 0.7 ± 0.1 mg N m-2 d-1, which represented 1.7 ± 0.3 % of the N accumulated in grass shoots during the labelling period. Total N2O emission was 91, 416 and 259 μg N2O-N m-2 d-1 at 16, 26 and 36 weeks after emergence, respectively. Only 3.2 ± 0.5 ppm of the recently fixed N2 was emitted as N2O on a daily basis, thus recently fixed N released via easily degradable clover residues appears to be a minor source of N2O

A new formulation of oral viscous budesonide in treating of paediatric eosinophilic oesophagitis: a pilot study

OBJECTIVES: Oral viscous budesonide is a recent therapeutic option for eosinophilic oesophagitis (EoE) compared with dietary restriction and inhaled steroids. This single-centre, open-label, not blinded study aims to evaluate the efficacy and safety of a new, preprepared oral viscous budesonide suspension (PVB) in children and adolescents with EoE. METHODS: We treated 36 children with PVB (29 boys; median age 12 years) with EoE diagnosed according to European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines. Patients <150 and >150 cm height received 2 and 4 mg PVB daily, respectively, for 12 weeks. Upper gastrointestinal endoscopy was performed at baseline, after 12 weeks of therapy and 24 weeks after the end of therapy. Baseline and post-treatment scores were calculated for symptoms, endoscopy, and histology. Serum cortisol was performed at baseline, 12, and 36 weeks. RESULTS: At the end of PVB trial, endoscopy showed macroscopic remission in 32 patients (88.9%), whereas at histology median pre- and post-treatment peak eosinophil count/high power field (HPF) markedly decreased from 42.2 (range: 15-100) to 2.9 (range: 0-30); moreover, mean symptom and histology scores impressively improved compared with baseline (P < 0.01). At 24 weeks after the end of PVB therapy, endoscopy showed oesophageal relapse in 21 patients (58.3%), whereas 15 (41.7%) were still in remission. Seven children (19.4%) with positive multichannel intraluminal impedance-pH were treated also with proton pump inhibitors. No significant difference between pre-/post-treatment morning cortisol levels occurred. CONCLUSIONS: The new PVB suspension presented in the present study is effective and safe for treating children with proven EoE. Larger placebo-controlled clinical trials would provide more information about dosing, efficacy, and long-term safety of this formulation, specifically designed for the oesophagus

Factors invoved in onset and recovery from postnatal depression

Background: A wide variety of psychosocial variables have been implicated in the onset and recovery from postnatal depression. A number of these factors were examined on a representative sample of pregnant Maltese women attending St Luke's Hospital. Method: A random sample of 239 pregnant women were interviewed at booking using a detailed sociodemographic history, the Revised Version of the Clinical Interview Schedule (CIS-R) and Maltese translation of the Edinburgh Postnatal Depression Scale (EPDS). The CIS-R was again administered over the phone at 36 weeks and the EPDS sent by post. At eight weeks postpartum, the CIS-R, modified version of the Social Maladjustment Schedule and the EPDS were again administered to 95.8% of women. Results: Onset of depression in the postpartum was not predicted by depressive symptomatology during pregnancy, marital status, level of education, planning of pregnancy, woman's, partner's or family's reaction to pregnancy and marital adjustment. However being primiparous and employed during pregnancy were significantly associated with postnatal depression. In contrast, depressed women who remained depressed postnatally had a past personal psychiatry history and significantly higher scores on the CISR recorded at 36 weeks gestation. Limitation: The number of women examined in the study yielded a small number of depressed women, for which the results are limited in value. The sample is that of Maltese women booking in at the antenatal clinic, thus excluding women who present late, close to delivery date. The follow up period was limited to eight weeks postpartum only, excluding those who develop depressive episodes after 8 weeks. Conclusions: Some cases of postpartum depression may be traced back to pregnancy while others do not seem to be predictable during pregnancy further contributing evidence to the view that the prenatal period may be a separate entity from the postnatal period with regards to depressive illness.peer-reviewe

Compression shorts reduce prenatal pelvic and low back pain: a prospective quasi-experimental controlled study

Background Common prenatal ailments negatively impact performance of activities of daily living and it has been proposed that the use of dynamic elastomeric fabric orthoses, more commonly referred to as compression garments, during pregnancy might aid in the reduction of pain from these ailments, allowing for improved functional capacity. However, the effectiveness of such garments in this context has not been established. This study aims to determine whether compression shorts are effective and thermally safe in the prevention and management of prenatal pelvic and low back pain (LBP). Method A prospective quasi-experimental controlled study using parallel groups without random allocation was conducted, involving 55 childbearing women (gestational weeks 16–31) recruited from hospital and community-based maternity care providers. The compression shorts group (SG) wore SRC Pregnancy Shorts in addition to receiving usual care. The comparison group (CG) received usual care alone. Primary outcome measures—Numeric Pain Rating Scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ) and secondary measures Pelvic Floor Impact Questionnaire - 7 (PFIQ-7) and SF-36 Short Form Health Survey—were assessed fortnightly over 6-weeks for both groups. The compression SG self-assessed daily their body temperatures to monitor thermal impact. Data analysis involved descriptive analyses of the primary and secondary outcome measures scores by group and time-point, and multivariable linear regressions to assess between-group differences in change scores at 6-weeks from baseline while controlling for baseline factors. Results After controlling for baseline scores, gestational weeks and parity, statistically significant differences in NPRS and RMDQ change scores between groups were in favour of the compression SG. At 6-weeks, mean (SD) NPRS change scores in the compression SG and CG were significantly different, at −0.38 (2.21) and 2.82 (2.68), respectively, p = 0.003. Mean (SD) RMDQ change scores in the compression SG and CG were also significantly different, at 0.46 (3.05) and 3.64 (3.32), respectively, p = 0.009. A total of 883 (99.7%) of the reported daily self-assessed body temperatures ranged between 35.4 and 38.0 °C when wearing the compression shorts. At 6-weeks, mean (SD) PFIQ-7 and SF-36 change scores in the compression SG and CG were not significantly different. Conclusion Compression shorts are effective and thermally safe for prenatal management of pelvic and LBP. Registration Trial registration was not required (Australian Government Department of Health Therapeutic Goods Administration (TGA), 2018)

Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth.

OBJECTIVE: To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. DESIGN: Multicentre prospective cohort study. SETTING: Ten European centres offering prenatal screening for toxoplasmosis. POPULATION: Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks. METHODS: Comparison of infected and uninfected births, adjusted for parity and country of birth. MAIN OUTCOME MEASURES: Differences in gestational age at birth, birthweight and birthweight centile. RESULTS: Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile. CONCLUSION: Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth

Peripartum patient with epigastric pain

A 44-year-old female, gravida 2, para 1, abortus 1, presented to the emergency department with epigastric pain, vomiting and nosebleed at 36 weeks gestation. She had right upper quadrant tenderness and was hypertensive at 138/90 mmHg. Laboratory studies demonstrated decreased platelets of 122 k/mcL, Hb of 11.2 g/dL and RBC of 3.48 M/mcL, elevated AST of 371 U/L and ALT of 522 U/L, and proteinuria of 13 mg/dL

Myomectomy as a pregnancy-preserving option in the carefully selected patient

Objectives: To present the indications for myomectomy during pregnancy and to discuss complications possibly related and unrelated to the procedure. Method and Results: A 33-year-old patient at 18 weeks of gestation underwent removal of a 1,570-gram symptomatic fundic myoma. Histologically the patient had a leiomyomatous neoplasm of uncertain malignant potential. The pregnancy was continued under sequential observation with magnetic resonance imaging and ultrasound. At 36 weeks of gestation a healthy girl with an upper extremity limb defect was born via cesarean section. Follow-up of the mother and the child was uneventful. Conclusions: Certain known risk factors in pregnant women with myomas can predispose to complications during pregnancy. Women with such risk factors or women who have failed medical therapy should be offered the option of undergoing myomectomy as a pregnancy-preserving procedure. Copyright (C) 2002 S. Karger AG, Basel

Cocoon viability and evidence for delayed hatching by the earthworm Lumbricus terrestris in a laboratory-based study.

Clitellate Lumbricus terrestris, obtained from 5 commercial suppliers (A-E) and also field collected (F) - grassland in Preston, Lancashire, UK, were kept under controlled environmental conditions (15 °C and 24 h darkness) in a sterilised loam soil and surface-fed with horse manure. Survival, biomass and cocoon production was monitored every 4 weeks over 1 y. Collected cocoons were maintained in water-filled Petri dishes on filter paper. Time to hatch and cocoon viability was recorded over a 2 y period. Cocoon production ranged from 15.1 – 32.2 ind.-1 y-1. Cocoon production was initially low followed by a period of high production (12-36 weeks) and then fell (36-52 weeks). Time for cocoon hatching ranged from 132-731 days. Hatching success after 2 years was 58–90% across treatments, with a total viability (including cocoons dissected after the 2 year period) of 88-94%. Evidence of 2 distinct hatching peaks was recorded, separated by a period of approximately 12 months in treatments of most of the commercially obtained earthworms. Cocoon incubation periods are in excess of those previously recorded under similar laboratory conditions (e.g. 90–280 days). Furthermore, viability is also higher than previously recorded (e.g. 67.9–83%). These differences are mainly attributable to the extended length of cocoon observation. Origin, age, unknown pre-treatment (in A-E) and experimental conditions (e.g. a constant temperature regime) may have influenced incubation times. However, it is suggested that asynchronous and delayed hatching within cohorts and ability for cocoons to remain viable for extended periods allows this K-selected species to maximise reproductive potential. This proposed “bet-hedging” strategy is worthy of further laboratory and field-based investigation