Neonatal outcome in early term and late term pregnancy

Background: Full-term neonates born between 37- and 41-weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies has pointed toward increased NICU admissions and morbidity associated with births (37-38 weeks) compared with term neonates (39-41 weeks). The objective of this study was to compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service. Methods: Retrospective observational population-based 2 year birth cohort study at Department of Obstetrics and Gynecology GSVM Medical College, Kanpur. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU, or neonatology service admissions were extracted from individual medical records.  Gestational age of early term (37 0/7-38 6/7 weeks) verses term (39 0/7-4 10/7 weeks). Admission to the NICU or neonatology service. Results: There were 17,132 live births during the 2 year period, of which 13679 had a gestational age between 37 and 41 weeks. Of all live births, 6204 (45.3%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycaemia (29.9% verses 14.7%), NICU or neonatology service admission (20.9% vs12.05 %), need for respiratory support (36.8% verses 29.9%), treatment with intravenous antibiotics [39.4% verses 25. Delivery by caesarean section was common among early-term births (45.9%)]. Conclusions: Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources

Stereopsis following surgery in children with congenital and developmental cataracts:A systematic review and meta-analysis

We estimated the proportion of children with stereopsis following surgery in congenital and developmental cataracts by systematic review and meta-analysis and also considered the factors influencing stereopsis, such as intervention age and presence of strabismus. Stereopsis is directly related to quality of life, and investigating its levels following cataract surgery in children may help decide the right time to intervene, particularly in the context of brain plasticity. We conducted a systematic literature search using Scopus, PubMed, and Web of Science and found 25 case series, 3 cohorts, and 3 clinical trial studies from 1/1/1995 to 31/12/2020. Study-specific proportions of stereopsis from 923 children were pooled using a random-effects model, and stratified analyses were conducted based on intervention age and pre-existing strabismus as a confounder. We appraised the risk of bias using tools published by National Institutes of Health and evaluated publication bias with funnel plots and the Egger test. The pooled proportions of stereopsis based on 8 unilateral and 6 bilateral congenital cataract studies were 0.37 (95% CIs: [0.24, 0.53]) and 0.45 (95% CIs: [0.24,0.68]) when patients with preexisting strabismus were excluded as a confounder. When the intervention age was ≤6 months, proportions in unilateral congenital cataract group significantly increased to 0.52 (95% CIs: [0.37, 0.66]; P = 0.49) compared to 0.26 (95% CIs: [0.14, 0.44]; P = 0.16) otherwise. A similar increase in proportions was found when intervention age ≤4 months. In both unilateral and bilateral congenital cataract groups, proportions increased significantly when the confounder was excluded. Overall, proportions in bilateral congenital cataracts were significantly greater than unilateral cases (irrespective of confounder). Eight unilateral and 5 bilateral developmental cataract studies resulted in pooled proportions of 0.62 (95% CIs: [0.27, 0.88] and 0.82 (95% CIs: [0.4, 0.97]), respectively. Although proportions for bilateral developmental cataracts were greater than unilateral cataracts (irrespective of confounder), results were not statistically significant. Finally, proportions in unilateral developmental cataracts were significantly greater than unilateral congenital cataracts (Z = 7.413, P = 6.173694e−14). We conclude that surgical intervention within first 4–6 months can significantly affect postoperative outcomes in unilateral congenital cataracts. Analysis of existing data does not show a significant effect of intervention age on stereopsis outcomes for developmental cataracts