Late Prematurity: A Systematic Review

Objective this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects. Sources the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. Data synthesis numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. Conclusions numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. 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Natural History Of Monochorionic Diamniotic Twin Pregnancies With And Without Twin-twin Transfusion Syndrome [história Natural Das Gestações Gemelares Monocoriônicas Diamnióticas Com E Sem Transfusão Feto-fetal]

Purpose: to evaluate the evolution of monochorionic-diamniotic twin pregnancies with and without the twin-twin transfusion syndrome (TTTS), followed up in an expectant way. Methods: retrospective study in which the pregnancies with and without TTTS and with mild (Quintero's stage I) and severe (Quintero's stages II, III, IV and V) disease manifestations were compared according to extreme preterm delivery, neurological impairment and the twins' nursery discharge. The extreme preterm twins who had had TTTS, or not, were compared whether they had or not neurological impairment. The X 2 or Fisher's exact test were used. Results: among 149 monochorionic-diamniotic twin pregnancies, 15 presented TTTS, 11 (11/15 - 73.3%) in the severe form and 4 (4/15 - 26.7%) at stage I. The extreme preterm delivery was more frequent (p<0.001) in the cases with the disease (11/15 - 73.3%) than in the cases without it (25/134 - 18.7%), and more common (p=0.033) in severe (10/11 - 91.1%) than in mild cases (1/4 - 25.0%). Neurological impairment in at least one twin was more frequent in cases with (5/8 - 62.5%) than in cases without (9/134 - 6.7%) the disease (p<0.001). Nursery discharge of at least one twin was more common (p<0.001) in cases without (132/134 - 98.5%) than in cases with the disease (8/15 - 53.0%). Neurological impairment in at least one of the twins was more frequent (p=0.04) in the severe (5/5 - 100%) than in the mild (1/4 - 25%) form of the disease. Nursery discharge of both twins was more common (p=0.004) at stage I (4/4 - 100%), than in the severe form of the disease (1/11 - 9.0%). Among the 47 extreme preterm twins, the neurological impairment was more frequent (p=0.001) among the ones who had (6/6 - 100%), than among those who did not have TTTS (11/41 - 26.8%). Conclusions: cases with twin-twin transfusion syndrome, followed up in an expectant way have bad perinatal prognosis, with high neonatal mortality and high rates of neurological arrest among the survivors.316273278Bermúdez, C., Becerra, C.H., Bornick, P.W., Allen, M.H., Arroyo, J., Quintero, R.A., Placental types and twin-twin transfusion syndrome (2002) Am J Obstet Gynecol, 187 (2), pp. 489-94de Paepe, M.E., Dekoninck, P., Friedman, R.M., Vascular distribution patterns in monochorionic twin placentas (2005) Placenta, 26 (6), pp. 471-5Lewi, L., Jani, J., Cannie, M., Robyr, R., Ville, Y., Hecher, K., Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: Is there more than meets the eye? 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Fetal Genotyping For Platelets Antigens: A Precise Tool For Alloimmune Thrombocytopenia: Case Report And Literature Review

Maternal-fetal alloimmune thrombocytopenia complicates about 0.1% of all pregnancies and is associated with major fetal and neonatal morbidity and mortality, especially spontaneous central nervous system bleeding leading to death and neurological handicaps. Successful prevention and treatment depend on the identification of at-risk possible carriers of anti-platelet antibodies. Case report: We report a case of a mother with a previous child that developed neonatal hemorrhage; HPA-5b anti-platelet antibodies were detected post-natally. During the next pregnancy, fetal genotyping confirmed the presence of HPA-5b antigen; she was treated with weekly intravenous human immunoglobulin and oral prednisone. Pregnancy evolved without remarkable features and a full-term baby was delivered, with normal platelet counts. 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Qualidade da silagem de grãos de milho com adição de soja crua e parâmetros de digestibilidade parcial e total em bovinos Quality of high moisture corn grain silage with addition of raw soybean grains and parameters of partial and total digestibility in cattle

Avaliou-se a qualidade da silagem de grãos úmidos de milho com adição de soja crua, por meio de medidas de digestibilidade parcial e total em bovinos. Foram utilizados três animais mestiços Nelore x Red Angus, implantados com cânulas ruminal e duodenal. O delineamento experimental foi o quadrado latino 3x3, com os seguintes tratamentos: SGM66= 60% de volumoso, 26,6% de silagem de grãos de milho e 13,4% de farelo de soja e milho moído; SGM33= 60% de volumoso, 13,4% de silagem de grãos de milho e 26,6% de farelo de soja e milho moído, e GMS= 60% de volumoso e 40% de farelo de soja e milho moído. A digestão e a digestibilidade da matéria seca não foram influenciadas pela inclusão de SGM na dieta. A dieta SGM66 aumentou a digestibilidade de matéria seca no intestino em relação à dieta GMS. Não houve efeito da inclusão da silagem de grãos na digestão e na digestibilidade das frações fibra em detergente ácido e fibra em detergente neutro da ração, bem como no fluxo ruminal e intestinal do amido. A SGM66 melhorou a digestibilidade total da proteína bruta, mas não mostrou efeito sobre a digestibilidade total da matéria seca, da fibra e do amido e sobre o ambiente ruminal no que se refere à acidez e à concentração de amônia.<br>The quality of high moisture corn grain silage with addition of raw soybean grains was evaluated by measures of partial and total digestibilities in cattle. Three crossbred Nelore x Red Angus steers averaging 305kg of live weigth and fitted with ruminal and duodenal cannulas were used. The experimental design was a 3x3 Latin square, and the steers received the following treatments: HMGS66 = 60% roughage, 26.6% high moisture grain silage, and 13.4% soybean meal and ground corn; HMGS33 = 60% roughage, 13.4% high moisture grain silage, and 26.6% soybean meal and ground corn; and GC = 60% roughage and 40% soybean meal and ground corn. The digestion and digestibility of dry matter was not influenced by the inclusion of HMGS in the diet. HMGS66 increased intestinal dry matter digestibility in relation to GC. The inclusion of high moisture corn grain silage did not affect acid detergent fiber and neutral detergent fiber digestions and digestibilities. The diet did not affect total intake of starch, as well ruminal and intestinal flow of starch. HMGS66 improved total digestibility of crude protein, but did not show effect on total digestibilities of dry matter, fiber, starch, and pH and ammonia concentration in the rumen