Gender disparities in neonatal outcome of near-term preterm births following preterm premature...
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199 ACUTE BIRTH ASPHYXIA AND NEONATAL HEMATOLOGIC INJURY JEFFREY PHELAN 1 , CORTNEY KIRKRNDALL 2 , LISA KORST 3 , GILBERT MARTIN 4 , 1 Citrus Valley Medical Center, OB/GYN, West Covina, California, 2 Childbirth Injury Prevention Foundation, Pasadena, California, 3 USC Keck School of Medicine, OB/GYN, Los Angeles, California, 4 Citrus Valley Medical Center, Neonatology, West Covina, California OBJECTIVE: To examine the relationship between acute birth asphyxia and hematologic injury among neonates with permanent neurologic impairment. STUDY DESIGN: Study cases were from the population defined in a prior publication (J. Matern. Fet-Med 1999;8:101). Acute birth asphyxia was defined as a sudden, rapid, and sustained deterioration of the FHR that lasted until delivery from a previously normal and reactive FHR pattern or a bradycardia on admission to the hospital. Hematologic injury as defined in a prior publication (Obstet. Gynecol. 2002;99:688) were as follows: nucleated red blood cells (NRBC) count R26 per 100 white blood cells (%); platelet count %100,000 per mm within 5 days of birth in the absence infection or a thrombocytopenic syndrome. RESULTS: Of our original 47 study cases,45 cases had sufficient hematologic data for evaluation. Using the aforementioned hematologic injury criteria in our study population,hematologic injury occurred in 4/45 (8.9%) of these acutely asphyxiated neonates. CONCLUSION: When applied to neonates with well-defined acute birth asphyxia, the presence of hematologic injury using these criteria is minimal. 200 GENDER DISPARITIES IN NEONATAL OUTCOME OF NEAR-TERM PRETERM BIRTHS FOLLOWING PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM): DO THEY EXIST? PATRICK RAMSEY 1 , JOELLE LIEMAN 1 , 1 University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, Alabama OBJECTIVE: To evaluate and compare gender-specific neonatal morbidity rates among near-term preterm births following PPROM. STUDY DESIGN: We reviewed maternal and neonatal records of all cases of confirmed PPROM R 24 wks that resulted in delivery between 32 0/7 and 36 6/7 wks at our institution between 8/98 and 08/00. Cases involving multifetal gestation, fetal anomalies, and hypertensive disorders were excluded. Standard PPROM management included the administration of antibiotics, betametha- sone for those pregnancies !32 wks, weekly vaginal pool PG testing at 32 0/7 wks, and expectant management with labor induction with confirmed positive vaginal pool PG test or at R34 wks gestation. Composite major neonatal morbidity was defined as any of the following: IVH, RDS, BPD, NEC, PDA, ROP, intubation, sepsis, seizure, bowel perforation, meningitis, pneumonia, or primary pulmonary hypertension. Composite minor morbidity was defined as any of the following: hyperbilirubinemia, transient tachypnea of the newborn, or metabolic disturbances. RESULTS: Of the 430 PPROM cases which occurred over the study interval, 289 (67%) were R 32 wks gestation: 32 wk (n=38), 33 wk (n=41), 34 wk (n=58), 35 wk (n=47), and 36 wk (n=105). 49% of the delivered infants were female. Within each gestational age week group, latency duration, birthweight, and infant race, were similar between the female and male infant groups. The composite major neonatal morbidity rates were similar between female and male infants within each gestational age wk group: 32 wk (18 vs 38%, p=0.3), 33 wk (6 vs 21%, p=0.4), 34 wk (4 vs 7%, p=1.0), 35 wk (4 vs 4%, p=1.0), and 36 wk (2 vs 4%, p=0.6). Composite minor neonatal morbidity rates were also similar between female and male infants within each gestational age wk group: 32 wk (96 vs 100%, p=1.0), 33 wk (94 vs 83%, p=0.4), 34 wk (82 vs 77%, p=0.8), 35 wk (48 vs 50%, p=1.0), and 36 wk (40 vs 37%, p=0.8). CONCLUSION: Neonatal outcomes are similar between female and male infants which result from near-term preterm birth following PPROM. 201 POSTNATAL INFLAMMATORY RAT MODEL FOR CEREBRAL PALSY: TOO DIFFERENT FROM HUMAN ROBIN ROBERSON 1 , JADE WOODARD 1 , LAURA TOSO 1 , DANIEL ABEBE 1 , SARAH POGGI 1 , CATHERINE SPONG 1 , 1 NIH, NICHD, NIAAA, Unit on Perinatal Developmental Neurobiology, Bethesda, Maryland OBJECTIVE: Cerebral Palsy (CP) is a non–progressive life long condition characterized by spasticity, motor impairment and demyelinization in brain regions controlling movement and posture. In humans,CP may originate from inflammation during the 2nd & 3rd trimesters of gestation when pre- oligodendrocytes (Pre-OL), the myelin producing cells, are most vulnerable to an inflammatory insult. We studied a rat postnatal CP model to evaluate injury that would correlate with presence of Pre-OL in human pregnancy. STUDY DESIGN: On postnatal (P) days 2, 3, 4, 5, 6, pups were injected SQ daily with LPS (lipopolysaccharide) (n=7; 30, 30, 60, 60, 120 ug/Kg) or saline (control, n=7). Neonatal tests for motor and cognitive developmental mile- stones were on P 0-22. Adult offspring (8-12 wks) performed beam walking and rotarod for motor activity. White matter damage (WMD) was assessed with immunohistochemical Pre-OL markers (CNP and PLP) at P 22 and 12 wks. Statistical analysis included Mann-Whitney U and ANOVA. RESULTS: LPS treated animals performed negative geotaxis (P=.009) and surface righting (P=.01) earlier than controls. No differences observed for eye opening, rooting, cliff aversion, forelimb placing, forelimb grasp, ear twitch, activity, air righting, auditory startle and weight. Adult LPS treated offspring performed better in tests of motor control: rotarod (P=.01) and beam walking (P=.02). Pre-OL markers were altered in LPS animals at both P22 (CNP and PLP increased in LPS animals, P=.01 and P!.001 respectively) and 12 weeks (CNP and PLP decreased in LPS pups, P=.0001 and P=.03 respectively). CONCLUSION: Neonatal exposure to LPS induced WMD in the brain, accelerated neurodevelopment and motor tasks in adulthood. These are similar to findings from a postnatal hypoxic model (Zhang et al J Neurobiol 2005) suggesting that in the rodent, targeting the Pre-OL does not result in a CP phenotype. Further studies are needed to refine the timing of inflammatory mediated-injury in animal models for CP. 202 IMPACT OF THE FEDERAL BORN ALIVE INFANT PROTECTION ACT: A COST- EFFECTIVENESS ANALYSIS MYA SENDOWSKI 1 , AARON CAUGHEY 2 , ELEANOR DREY 2 , ALMA MARTINEZ 1 , SARAH LITTLE 2 , J. C. PARTRIDGE 1 , 1 University of California, San Francisco, Pediatrics, San Francisco, California, 2 University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California OBJECTIVE: To examine the theoretical effects of enforcement of the federal Born Alive Infant Protection Act (BAIPA), if live born fetuses are to be routinely resuscitated at lower gestational ages 20-24 weeks. STUDY DESIGN: We designed a decision analytic model to compare current practice of individualized resuscitation decisions to the proposed policy of resuscitating all live born potentially viable immature fetuses (20-24 wks GA) whether born after preterm delivery or elective termination of pregnancy. We used a theoretical cohort based on the U.S. population. Primary outcomes examined were maternal quality-adjusted life years (QALYs), the number of severely or moderately injured neonatal survivors and costs. RESULTS: Maternal quality-of-life outcomes were worse in both preterm birth and termination of pregnancy when all 20-24 wks GA infants are resuscitated (Table). Costs per pregnancy increased from $10,562 to $21,402 for premature births and from $1080 to $1870 for termination of pregnancy. The incremental cost-effectiveness comparison reveals that the baseline policy dominates the new policy as it has lower costs and better outcomes. In addition, the new policy would lead to 49 moderately or severely disabled infants but only 30 unaffected infants. CONCLUSION: Enforced resuscitation of all neonates born at 20-24 weeks’ gestation increases costs of perinatal care and worsens maternal outcomes. Selective individualized to resuscitation of extremely immature infants, espe- cially after elective termination, appears a better policy. Proposals to mandate resuscitation of live born severely immature infants would not be effective in improving health care costs nor maternal quality of life. Total QALYs Total costs PTD - BAIPA 13,6687.6 $123,403,932 PTD - current policy 13,7015.7 $60,900,492 Inremental comparison -328.1 $62,503,440 TAB - BAIPA 339,387.1 $24,310,000 TAB - current policy 339,467.7 $14,040,000 Incremental comparison ÿ80.6 $10,270,000 S66 SMFM Abstracts
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Transcript of Gender disparities in neonatal outcome of near-term preterm births following preterm premature...
199 ACUTE BIRTH ASPHYXIA AND NEONATAL HEMATOLOGIC INJURY JEFFREYPHELAN1, CORTNEY KIRKRNDALL2, LISA KORST3, GILBERT MARTIN4, 1CitrusValley Medical Center, OB/GYN, West Covina, California, 2ChildbirthInjury Prevention Foundation, Pasadena, California, 3USC Keck School ofMedicine, OB/GYN, Los Angeles, California, 4Citrus Valley MedicalCenter, Neonatology, West Covina, California
OBJECTIVE: To examine the relationship between acute birth asphyxia andhematologic injury among neonates with permanent neurologic impairment.
STUDY DESIGN: Study cases were from the population defined in a priorpublication (J. Matern. Fet-Med 1999;8:101). Acute birth asphyxia wasdefined as a sudden, rapid, and sustained deterioration of the FHR thatlasted until delivery from a previously normal and reactive FHR pattern or abradycardia on admission to the hospital. Hematologic injury as defined in aprior publication (Obstet. Gynecol. 2002;99:688) were as follows: nucleatedred blood cells (NRBC) count R26 per 100 white blood cells (%); plateletcount %100,000 per mm within 5 days of birth in the absence infection or athrombocytopenic syndrome.
RESULTS: Of our original 47 study cases,45 cases had sufficient hematologicdata for evaluation. Using the aforementioned hematologic injury criteria inour study population,hematologic injury occurred in 4/45 (8.9%) of theseacutely asphyxiated neonates.
CONCLUSION: When applied to neonates with well-defined acute birthasphyxia, the presence of hematologic injury using these criteria is minimal.
200 GENDER DISPARITIES IN NEONATAL OUTCOME OF NEAR-TERM PRETERM BIRTHSFOLLOWING PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM): DO THEYEXIST? PATRICK RAMSEY1, JOELLE LIEMAN1, 1University of Alabama atBirmingham, Obstetrics/Gynecology, Birmingham, Alabama
OBJECTIVE: To evaluate and compare gender-specific neonatal morbidityrates among near-term preterm births following PPROM.
STUDY DESIGN: We reviewed maternal and neonatal records of all cases ofconfirmed PPROM R 24 wks that resulted in delivery between 32 0/7 and 366/7 wks at our institution between 8/98 and 08/00. Cases involving multifetalgestation, fetal anomalies, and hypertensive disorders were excluded. StandardPPROM management included the administration of antibiotics, betametha-sone for those pregnancies !32 wks, weekly vaginal pool PG testing at 32 0/7wks, and expectant management with labor induction with confirmed positivevaginal pool PG test or at R34 wks gestation. Composite major neonatalmorbidity was defined as any of the following: IVH, RDS, BPD, NEC, PDA,ROP, intubation, sepsis, seizure, bowel perforation, meningitis, pneumonia, orprimary pulmonary hypertension. Composite minor morbidity was defined asany of the following: hyperbilirubinemia, transient tachypnea of the newborn,or metabolic disturbances.
RESULTS: Of the 430 PPROM cases which occurred over the study interval,289 (67%) were R 32 wks gestation: 32 wk (n=38), 33 wk (n=41), 34 wk(n=58), 35 wk (n=47), and 36 wk (n=105). 49% of the delivered infants werefemale. Within each gestational age week group, latency duration, birthweight,and infant race, were similar between the female and male infant groups. Thecomposite major neonatal morbidity rates were similar between female andmale infants within each gestational age wk group: 32 wk (18 vs 38%, p=0.3),33 wk (6 vs 21%, p=0.4), 34 wk (4 vs 7%, p=1.0), 35 wk (4 vs 4%, p=1.0),and 36 wk (2 vs 4%, p=0.6). Composite minor neonatal morbidity rates werealso similar between female and male infants within each gestational age wkgroup: 32 wk (96 vs 100%, p=1.0), 33 wk (94 vs 83%, p=0.4), 34 wk (82 vs77%, p=0.8), 35 wk (48 vs 50%, p=1.0), and 36 wk (40 vs 37%, p=0.8).
CONCLUSION: Neonatal outcomes are similar between female and maleinfants which result from near-term preterm birth following PPROM.
201 POSTNATAL INFLAMMATORY RAT MODEL FOR CEREBRAL PALSY: TOO DIFFERENTFROM HUMAN ROBIN ROBERSON1, JADE WOODARD1, LAURA TOSO1, DANIELABEBE1, SARAH POGGI1, CATHERINE SPONG1, 1NIH, NICHD, NIAAA, Uniton Perinatal Developmental Neurobiology, Bethesda, Maryland
OBJECTIVE: Cerebral Palsy (CP) is a non–progressive life long conditioncharacterized by spasticity, motor impairment and demyelinization in brainregions controlling movement and posture. In humans,CP may originate frominflammation during the 2nd & 3rd trimesters of gestation when pre-oligodendrocytes (Pre-OL), the myelin producing cells, are most vulnerableto an inflammatory insult. We studied a rat postnatal CP model to evaluateinjury that would correlate with presence of Pre-OL in human pregnancy.
STUDY DESIGN: On postnatal (P) days 2, 3, 4, 5, 6, pups were injected SQdaily with LPS (lipopolysaccharide) (n=7; 30, 30, 60, 60, 120 ug/Kg) or saline(control, n=7). Neonatal tests for motor and cognitive developmental mile-stones were on P 0-22. Adult offspring (8-12 wks) performed beam walkingand rotarod for motor activity. White matter damage (WMD) was assessedwith immunohistochemical Pre-OL markers (CNP and PLP) at P 22 and 12wks. Statistical analysis included Mann-Whitney U and ANOVA.
RESULTS: LPS treated animals performed negative geotaxis (P=.009) andsurface righting (P=.01) earlier than controls. No differences observed for eyeopening, rooting, cliff aversion, forelimb placing, forelimb grasp, ear twitch,activity, air righting, auditory startle and weight. Adult LPS treated offspringperformed better in tests of motor control: rotarod (P=.01) and beam walking(P=.02). Pre-OL markers were altered in LPS animals at both P22 (CNP andPLP increased in LPS animals, P=.01 and P!.001 respectively) and 12 weeks(CNP and PLP decreased in LPS pups, P=.0001 and P=.03 respectively).
CONCLUSION: Neonatal exposure to LPS induced WMD in the brain,accelerated neurodevelopment and motor tasks in adulthood. These are similarto findings from a postnatal hypoxic model (Zhang et al J Neurobiol 2005)suggesting that in the rodent, targeting the Pre-OL does not result in a CPphenotype. Further studies are needed to refine the timing of inflammatorymediated-injury in animal models for CP.
202 IMPACT OF THE FEDERAL BORN ALIVE INFANT PROTECTION ACT: A COST-EFFECTIVENESS ANALYSIS MYA SENDOWSKI1, AARON CAUGHEY2, ELEANORDREY2, ALMA MARTINEZ1, SARAH LITTLE2, J. C. PARTRIDGE1, 1University ofCalifornia, San Francisco, Pediatrics, San Francisco, California, 2Universityof California, San Francisco, Obstetrics, Gynecology and ReproductiveSciences, San Francisco, California
OBJECTIVE: To examine the theoretical effects of enforcement of the federalBorn Alive Infant Protection Act (BAIPA), if live born fetuses are to beroutinely resuscitated at lower gestational ages 20-24 weeks.
STUDY DESIGN: We designed a decision analytic model to compare currentpractice of individualized resuscitation decisions to the proposed policy ofresuscitating all live born potentially viable immature fetuses (20-24 wks GA)whether born after preterm delivery or elective termination of pregnancy. Weused a theoretical cohort based on the U.S. population. Primary outcomesexamined were maternal quality-adjusted life years (QALYs), the number ofseverely or moderately injured neonatal survivors and costs.
RESULTS: Maternal quality-of-life outcomes were worse in both pretermbirth and termination of pregnancy when all 20-24 wks GA infants areresuscitated (Table). Costs per pregnancy increased from $10,562 to $21,402for premature births and from $1080 to $1870 for termination of pregnancy.The incremental cost-effectiveness comparison reveals that the baseline policydominates the new policy as it has lower costs and better outcomes. Inaddition, the new policy would lead to 49 moderately or severely disabledinfants but only 30 unaffected infants.
CONCLUSION: Enforced resuscitation of all neonates born at 20-24 weeks’gestation increases costs of perinatal care and worsens maternal outcomes.Selective individualized to resuscitation of extremely immature infants, espe-cially after elective termination, appears a better policy. Proposals to mandateresuscitation of live born severely immature infants would not be effective inimproving health care costs nor maternal quality of life.
Total QALYs Total costs
PTD - BAIPA 13,6687.6 $123,403,932PTD - current policy 13,7015.7 $60,900,492Inremental comparison -328.1 $62,503,440TAB - BAIPA 339,387.1 $24,310,000TAB - current policy 339,467.7 $14,040,000Incremental comparison �80.6 $10,270,000
S66 SMFM Abstracts
