Objective: To determine an appropriate cutoff value to differentiate physiologic and pathologic birth weight discordance, to determine the prevalence of birth weight discordance ≥ 25% among twin pregnancies in differ...Objective: To determine an appropriate cutoff value to differentiate physiologic and pathologic birth weight discordance, to determine the prevalence of birth weight discordance ≥ 25% among twin pregnancies in different sub-populations, and to examine its clinical significance. Study design: Historical cohort study of 147,262 twin sets registered in the United States between 1995 and 1997. Results: The prevalence of birth weight discordance ≥ 25% among twin pregnancies was 8.6% . The prevalence of birth weight discordance ≥ 25% was significantly decreased with increasing total twin birth weight deciles, was more frequently found in twins with discordant gender (9.1% ) than in those twins with concordant gender (8.3% ) and in mothers whose age was 30 years or older (9.1% ) than those of younger mothers (8.1% ). Birth weight discordance ≥ 25% was associated with earlier gestational age at delivery (35.0 weeks versus 36.0 weeks) and higher neonatal mortality (5.4% versus 2.3% ) as compared to twins with lower birth weight discordance. Conclusions: The prevalence of birth weight discordance ≥ 25% among twin pregnancies was 8.6% , which is associated with lower gestational age at delivery and higher neonatal mortality rates, and may represent a pathologic process.展开更多
A neonatal death certificate was introduced in France in 1997. It provides detailed data on the causes of death and the characteristics of newborn, birth and parents. Our aim was to describe the new results of this ce...A neonatal death certificate was introduced in France in 1997. It provides detailed data on the causes of death and the characteristics of newborn, birth and parents. Our aim was to describe the new results of this certificate. Method. -All deaths in 1999 in the first 27 days of life were included (N = 2036). Certificates were analysed using the usual process, especially following the International Classification of Diseases. Results. -The neonatal death certificate was used for 87% of deaths. The proportion of documented items was 96% for gestational age and birthweight, 87% for maternal age and parity and 70% for maternal occupation. Almost three quarters of the deaths occurred in the first 6 days (36.9% in the first 24 hours and 35.1% between one and six days). 30.5% of the died infants were born before 27 weeks of gestation and 36.5% between 27 and 36 weeks. A shift in medical care was observed at 26 weeks, with an increase in caesarean sections before labour and newborn referrals. In all, 63.3% of neonatal deaths were due to perinatal conditions, and 27.9% to congenital anomalies. The proportion of deaths explained by congenital anomalies was higher for longer gestational age: 14% of deaths between 25 and 28 weeks of gestation vs 38 to 43% between 33 and 42 weeks. Conclusion. -The neonatal death certificate was well accepted; however the data on detailed causes of death and parent’ s characteristics were insufficient. Analysis of the circumstances and the causes of death is facilitated with the neonatal death certificate and it will be developped in the future.展开更多
The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. The population- based US “ matched multiple birth" database (1...The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. The population- based US “ matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC)- modes of delivery (MOD) on neonatal mortality (< 28 days after birth). Births at < 32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesar- ean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40% , but this reached significance at BWD ≥ 40% ; VV pairs had a 1.6- fold (95% CI 1.1- 2.2) increased NMR compared with CC. In twins with BWD < 40% , MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesar- ean- cesarean delivery.展开更多
We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33...We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33 institutions. Competing risks methodology was used to determine simultaneous risk and associated incremental risk factors for death, initial and subsequent left ventricular outflow tract procedures, and arch reinterventions. Overall survival was 59%at 16 years after study entry but improved with successive birth cohort. In general, risk factors for death in each of the competing risks analyses included lower birth weight, younger age at study entry, type B interrupted aortic arch, and major associated cardiac anomalies. Of 453 patients who had interrupted aortic arch repair, after 16 years 33%had died and 28%had undergone an arch reintervention. Reintervention was more likely for those who had truncus arteriosus repair, interrupted aortic arch repair by a method other than direct anastomosis with patch augmentation, and the use of polytetrafluoroethylene as either an interposition graft or a patch. From study entry, competing risks after 16 years showed that 28%had died and 34%had undergone an initial left ventricular outflow tract procedure. Initial left ventricular outflow tract procedure was more likely for those with single ventricle, type B interrupted aortic arch, bicuspid aortic valve, or anomalous right subclavian artery. Among those who had undergone an initial left ventricular out-flow tract procedure, after 16 years 37%had died and 28%had undergone a second procedure. Anatomic features affect mortality and initial left ventricular outflow tract procedures, whereas characteristics of the arch repair affect arch reintervention.展开更多
文摘Objective: To determine an appropriate cutoff value to differentiate physiologic and pathologic birth weight discordance, to determine the prevalence of birth weight discordance ≥ 25% among twin pregnancies in different sub-populations, and to examine its clinical significance. Study design: Historical cohort study of 147,262 twin sets registered in the United States between 1995 and 1997. Results: The prevalence of birth weight discordance ≥ 25% among twin pregnancies was 8.6% . The prevalence of birth weight discordance ≥ 25% was significantly decreased with increasing total twin birth weight deciles, was more frequently found in twins with discordant gender (9.1% ) than in those twins with concordant gender (8.3% ) and in mothers whose age was 30 years or older (9.1% ) than those of younger mothers (8.1% ). Birth weight discordance ≥ 25% was associated with earlier gestational age at delivery (35.0 weeks versus 36.0 weeks) and higher neonatal mortality (5.4% versus 2.3% ) as compared to twins with lower birth weight discordance. Conclusions: The prevalence of birth weight discordance ≥ 25% among twin pregnancies was 8.6% , which is associated with lower gestational age at delivery and higher neonatal mortality rates, and may represent a pathologic process.
文摘A neonatal death certificate was introduced in France in 1997. It provides detailed data on the causes of death and the characteristics of newborn, birth and parents. Our aim was to describe the new results of this certificate. Method. -All deaths in 1999 in the first 27 days of life were included (N = 2036). Certificates were analysed using the usual process, especially following the International Classification of Diseases. Results. -The neonatal death certificate was used for 87% of deaths. The proportion of documented items was 96% for gestational age and birthweight, 87% for maternal age and parity and 70% for maternal occupation. Almost three quarters of the deaths occurred in the first 6 days (36.9% in the first 24 hours and 35.1% between one and six days). 30.5% of the died infants were born before 27 weeks of gestation and 36.5% between 27 and 36 weeks. A shift in medical care was observed at 26 weeks, with an increase in caesarean sections before labour and newborn referrals. In all, 63.3% of neonatal deaths were due to perinatal conditions, and 27.9% to congenital anomalies. The proportion of deaths explained by congenital anomalies was higher for longer gestational age: 14% of deaths between 25 and 28 weeks of gestation vs 38 to 43% between 33 and 42 weeks. Conclusion. -The neonatal death certificate was well accepted; however the data on detailed causes of death and parent’ s characteristics were insufficient. Analysis of the circumstances and the causes of death is facilitated with the neonatal death certificate and it will be developped in the future.
文摘The purpose of this study was to examine if neonatal mortality rates (NMR) based on birth weight discordance (BWD) differ based on mode of delivery. The population- based US “ matched multiple birth" database (1995 to 1998) was used to examine the effect of vaginal/vaginal (VV) and cesarean/cesarean (CC)- modes of delivery (MOD) on neonatal mortality (< 28 days after birth). Births at < 32 weeks, congenital malformations, chromosomal anomalies, and discordant MOD (vaginal/cesar- ean) were excluded. The association between MOD (with CC as the reference) and neonatal mortality was expressed as relative risks (RR) with 95% CI, derived from logistic regression models. The NMR increased with increasing degrees of BWD regardless of mode of delivery. CC was associated with decreased NMR when BWD was between 20% and 40% , but this reached significance at BWD ≥ 40% ; VV pairs had a 1.6- fold (95% CI 1.1- 2.2) increased NMR compared with CC. In twins with BWD < 40% , MOD has no effect on NMR. Beyond or equal to 40% discordance, there was lower NMR with cesar- ean- cesarean delivery.
文摘We sought to determine the prevalence of outcomes and associated patient and management factors for neonates with interrupted aortic arch. From 1987 to 1997, a total of 472 neonates were enrolled prospectively from 33 institutions. Competing risks methodology was used to determine simultaneous risk and associated incremental risk factors for death, initial and subsequent left ventricular outflow tract procedures, and arch reinterventions. Overall survival was 59%at 16 years after study entry but improved with successive birth cohort. In general, risk factors for death in each of the competing risks analyses included lower birth weight, younger age at study entry, type B interrupted aortic arch, and major associated cardiac anomalies. Of 453 patients who had interrupted aortic arch repair, after 16 years 33%had died and 28%had undergone an arch reintervention. Reintervention was more likely for those who had truncus arteriosus repair, interrupted aortic arch repair by a method other than direct anastomosis with patch augmentation, and the use of polytetrafluoroethylene as either an interposition graft or a patch. From study entry, competing risks after 16 years showed that 28%had died and 34%had undergone an initial left ventricular outflow tract procedure. Initial left ventricular outflow tract procedure was more likely for those with single ventricle, type B interrupted aortic arch, bicuspid aortic valve, or anomalous right subclavian artery. Among those who had undergone an initial left ventricular out-flow tract procedure, after 16 years 37%had died and 28%had undergone a second procedure. Anatomic features affect mortality and initial left ventricular outflow tract procedures, whereas characteristics of the arch repair affect arch reintervention.
