Is intracytoplasmic sperm injection (ICSI) associated with higher incidence of congenital anomalies? A single center prospective controlled study in Egypt.

OBJECTIVE: To compare the incidence of congenital anomalies by ultrasound in intracytoplasmic sperm injection (ICSI) pregnancies and in spontaneous pregnancies with correlation to the neonatal outcome. METHODS: This is a prospective comparative study carried out in Kasr Al Aini Hospital Cairo University from January 2010 to December 2012, comparing 739 pregnant women conceived through ICSI and 843 pregnant women conceived spontaneously as regard to incidence of congenital anomalies, multiple pregnancy, preterm labor, cesarean section and neonatal outcome. RESULTS: The number of anomalies diagnosed by antenatal ultrasound in ICSI group was 14 (1.62%) while in spontaneous group was 13 (1.51%). The number of anomalies detected by postnatal examination in ICSI group was 20 (2.31%) while in spontaneous group was 16 (1.86%) (Odds ratio [OR] 1.438; 95% confidence interval [CI] 0.739-2.796). ICSI group was associated with higher incidence of twins 12.7% (p < 0.001), preterm labor 3.8% (p 0.022), preterm premature rupture of membranes 4.6% (p 0.001), cesarean section 74.1% (p < 0.001) and neonatal deaths 10.4% (p < 0.001). CONCLUSION: ICSI was associated with higher incidence of multiple pregnancy and cesarean section, with no difference in the incidence of congenital anomalies compared to spontaneous conception

Is intracytoplasmic sperm injection (ICSI) associated with higher incidence of congenital anomalies? A single center prospective controlled study in Egypt.

OBJECTIVE: To compare the incidence of congenital anomalies by ultrasound in intracytoplasmic sperm injection (ICSI) pregnancies and in spontaneous pregnancies with correlation to the neonatal outcome. METHODS: This is a prospective comparative study carried out in Kasr Al Aini Hospital Cairo University from January 2010 to December 2012, comparing 739 pregnant women conceived through ICSI and 843 pregnant women conceived spontaneously as regard to incidence of congenital anomalies, multiple pregnancy, preterm labor, cesarean section and neonatal outcome. RESULTS: The number of anomalies diagnosed by antenatal ultrasound in ICSI group was 14 (1.62%) while in spontaneous group was 13 (1.51%). The number of anomalies detected by postnatal examination in ICSI group was 20 (2.31%) while in spontaneous group was 16 (1.86%) (Odds ratio [OR] 1.438; 95% confidence interval [CI] 0.739-2.796). ICSI group was associated with higher incidence of twins 12.7% (p < 0.001), preterm labor 3.8% (p 0.022), preterm premature rupture of membranes 4.6% (p 0.001), cesarean section 74.1% (p < 0.001) and neonatal deaths 10.4% (p < 0.001). CONCLUSION: ICSI was associated with higher incidence of multiple pregnancy and cesarean section, with no difference in the incidence of congenital anomalies compared to spontaneous conception

Impact of balanced versus unbalanced fluid resuscitation on clinical outcomes in critically ill children: protocol for a systematic review and meta-analysis

Abstract Background Isotonic crystalloid fluid bolus therapy is used in critically ill children to restore or maintain hemodynamic stability. However, the ideal choice of crystalloid remains to be determined. The most easily available and most frequently used crystalloid is 0.9% saline, an unbalanced crystalloid, that has been associated with hyperchloremic metabolic acidosis and acute kidney injury (AKI). Balanced fluids such as Ringer’s lactate (RL) were developed to be closer to the composition of serum. However, they are more expensive and less readily available than 0.9% saline. Few trials have found RL to be associated with more favorable outcomes, but pediatric data is limited and inconsistent. The objective of the present systematic review is to review existing literature to determine the effect of balanced versus unbalanced fluid bolus therapy on metabolic acidosis in critically ill children. Methods Using the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines, we will conduct a systematic review to retrieve all controlled trials and observational studies comparing balanced and unbalanced resuscitative fluids in critically ill children from age 28 days to 18 years old in any resuscitation settings. Search strategy was developed in collaboration with an experienced clinical research librarian. The primary outcome is the incidence and/or time to resolution of metabolic acidosis. Secondary outcomes included the incidence of hyperchloremia, AKI, duration of renal replacement therapy, vasopressors, mechanical ventilation, total volume of rehydration needed per day, extracorporeal membrane oxygenation, and length of stay and mortality. Study screening, inclusion, data extraction, and assessment of risk of bias will be performed independently by two authors. We intend to perform a meta-analysis with studies that are compatible on the basis of population and outcomes. Discussion Isotonic crystalloid fluid bolus therapy is a ubiquitous treatment in resuscitation of critically ill pediatric patients and yet there is no clear recommendation to support the choice of balanced versus unbalanced fluid. The present review will summarize current available data in the literature and assess whether recommendations can be generated regarding the choice of crystalloids or otherwise identify knowledge gaps which will open the door to a large-scale randomized controlled trial (RCT)