Risk factors, predictive markers and prevention strategies for intrauterine fetal death. An integrative review

According to World Health Organization (WHO), fetal death is defined as the death of the fetus prior to its complete expulsion, independent of the duration of pregnancy, thus only ascribing the term stillbirth to fetal deaths in the case of pregnancies after 28 weeks of gestation. The great progress of perinatology care is reflected in a significant reduction in the rate of stillbirths, especially in well-developed countries, with approximately 98% of stillbirth cases now occurring in poor and developing countries. Stillbirth powerfully impacts both the patient and the practitioner. Because nearly half of stillbirth cases result from apparently uncomplicated pregnancies, we considered it critical to review the known predictive markers for intrauterine fetal death. In both preterm and term infants, perinatal mortality is increased in fetuses small for their gestational age, and this risk grows proportionally with the severity of the fetal growth restriction. A protracted first stage of labor has not been associated with an increased risk of perinatal mortality and morbidity, but a prolonged second stage of labor has been associated with mortality and neonatal morbidity characterized by sepsis, seizures, and hypoxic-ischemic encephalopathy. Ultrasound examination of the placenta and the umbilical cord is essential for appropriate pregnancy monitoring. Various findings from ultrasound examination have been related to variable adverse perinatal outcomes, including intrauterine fetal death. After reviewing the evidence for predictors of intrauterine fetal death, we offer a general strategy for reducing the likelihood of stillbirths

Determining the Effect of Circadian Lighting on Premature Infants’ DNA Methylation

Background Evidence shows that premature infants in the NICU experiencing stress in the areas of parental detachment, pain, and exposure to noxious stimuli undergo DNA methylation (Montirosso & Provenzi, 2015). These epigenetic changes cause long-term effects similar to PTSD. Purpose The purpose of this study is to determine the effects of evidence-based low-stress nursing care including circadian lighting on premature infants’ DNA methylation levels at SLC6A4 alleles. Methods The study will be conducted in 3 phases with infants admitted to the level III NICU. The anticipated number of participants is 150 to 200. The first phase includes obtaining a baseline oral swab for DNA in the control group. Phase two begins with evidence-based nursing care. Focus of care will be to reduce pain by low-stress nursing care. After 50 infants’ data are collected, phase three will begin with circadian lighting. The initial swab will be obtained before 2 days of age. The second will be obtained 24 hours before discharge. The baseline swab shows the levels of methylation due to maternal stress passed to the infant. This compares methylation levels from hospitalization to those inherited from mom. Implications Circadian Lighting, which changes morning, evening, and night helps create a 24- hour cycle with calming light tones to aid in creating their circadian rhythm (Linander et al., 2020). Bright light exposure at night causes DNA methylation changes (Fonken & Nelson, 2016). Environmental lighting affects biological processes and sleep states (Miriam & Ariagno, 2000). Cycled lighting decreases length of hospital stay and increased weight gain (Miriam & Ariagno, 2000). Current research demonstrates stressful events cause DNA changes in premature infants (Montirosso et al., 2016; Montirosso & Provenzi, 2015). This research provides low-stress interventions to infants mitigating DNA changes. DNA methylation is significant to understand the impact of nursing care