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Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. Key Points

Objective This study aimed to the assess risk of respiratory morbidity in neonates born to women with gestational diabetes mellitus (GDM) delivered after labor compared with those delivered without exposure to labor. Study Design This is a secondary analysis of a prospective single-center cohort study of singleton pregnancies complicated by GDM. Neonates who were liveborn and delivered at ≥34 weeks' gestation were included. The primary outcome was respiratory morbidity defined as respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN) resulting in neonatal intensive care unit (NICU) admission. Neonates born after labor (either spontaneous or induced) were compared with those delivered by cesarean delivery without labor. Associations between labor and neonatal morbidities were estimated using logistic regression. Covariates were adjusted for if they differed significantly between neonates exposed to and not exposed to labor (p Results Of the 581 neonates meeting study inclusion criteria, 23.2% delivered without exposure to labor. Those who did and did not experience labor delivered at similar gestational ages (38.6 vs. 38.4 weeks). Thirty-six neonates (6.2%) developed RDS or TTN and were admitted to the NICU. Exposure to labor was associated with a lower frequency of respiratory morbidity requiring admission to NICU, 4.9% (22/446) versus 10.4% (14/135) (p = 0.04). After adjusting for parity, body mass index, birth weight, gestational weight gain more than Institute of Medicine guidelines, race, and exposure to labor were associated with an adjusted odds ratio of 0.41 (95% confidence interval: 0.18–0.89). Conclusion Exposure to labor was associated with decreased odds of respiratory morbidity in neonates born to mothers with GDM. Limiting elective cesarean in this population can reduce health care costs and optimize neonatal health. Key Points

Objective The optimal noninvasive ventilation (NIV) modality in the treatment of transient tachypnea of the newborn (TTN) is still unknown. The aim of this study was to compare nasal continuous positive airway pressure (NCPAP) versus bi-level CPAP in the treatment of TTN. Study Design This was a prospective randomized study that was conducted in a tertiary level neonatal intensive care unit of Zekai Tahir Burak Women's Health Education and Research Hospital during the 1-year period between April 2017 and March 2018. The study included infants at ≥34 gestational weeks and birth weight ≥2,000 g who were diagnosed with TTN. The patients were randomized to either NCPAP or bi-level CPAP groups as initial respiratory support. The primary outcome was the rate of NIV failure. Results A total of 151 infants were incorporated into the study. The intubation rate was significantly higher in the NCPAP group (15/75) compared with the bi-level CPAP group (6/76) (p = 0.032). There was a significant decrease in the level of pCO2 at the 12 (60.7 ± 6.7 vs. 66.3 ± 8.8, p = 0.017) and 24 (50 ± 8 vs. 53 ± 10, p = 0.028) hours of NIV in the bi-level CPAP group compared with the NCPAP group. Duration of NIV, total respiratory support, hospital stay, and the incidence of pneumothorax were similar between the groups. Conclusion Bi-level CPAP reduced the rate of NIV failure and pCO2 levels at the 12 and 24 hours in late preterm and term infants with a diagnosis of TTN. Key Points

OBJECTIVE Lung ultrasonography (LUS) is a useful method for diagnosis of lung diseases such as respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax in the neonatal period. LUS has become an important tool in the diagnosis and follow-up of lung diseases. LUS is easy to apply at the bedside and is a practical and low-cost method for diagnosing pneumonia. STUDY DESIGN This study was conducted in neonatal intensive care unit of Dr. Sami Ulus Obstetrics, Children's Health and Diseases Training and Research Hospital. From September 2019 to April 2020, 50 patients who were diagnosed with viral pneumonia were included in the study. Also, 24 patients with sepsis-related respiratory failure were included in the study as a control group. LUS was performed at the bedside three times, by a single expert, once each before treatment for diagnosis, on discharge, and after discharge in outpatient clinic control. RESULTS Before treatment, LUS findings were lung consolidation with air bronchograms (50/50), pleural line abnormalities (35/50), B-pattern (25/50), disappearance of lung sliding (21/50), lung pulse (5/50), and pleural effusion (9/50). During discharge, we found significant changes: lung consolidation with air bronchograms (6/50), pleural line abnormalities (7/50), B-pattern (12/50), and pleural effusion (1/50) (p

Objective Transient tachypnea of the newborn (TTN), a common neonatal respiratory morbidity, is associated with failure of adequate clearance of fetal lung fluid. Glucocorticoids have an important role in lung maturity and the mechanisms of lung fluid clearance. The aim of this study is to assess the association between umbilical cord cortisol levels and transient TTN in late preterm and term neonates delivered by elective cesarean section (CS). Study Design A case-control study of 37 newborns diagnosed with TTN (cases) was compared with 40 healthy newborns (controls). All infants were delivered by elective CS without labor. Umbilical cord cortisol levels were measured using enzyme-linked immunosorbent assay. Results Mean cord cortisol levels were significantly lower in cases than controls (131.36 vs. 233.32 nmol/L, p = 0.0001; odds ratio [OR] = 3.7; 95% confidence interval [CI]: 1.40–9.53), respectively. Cord serum cortisol correlated inversely with the duration of tachypnea and the respiratory rate (r = − 0.678 and −0.535, respectively). Conclusion Umbilical cord cortisol levels are significantly lower in newborns with transient TTN, and lower cortisol levels are associated with an increased respiratory rate and longer duration of admission. Antenatal glucocorticoids can be recommended for late preterm delivered by CS. Key Points

Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis.We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS.Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN.The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN.· Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..

Objective Nulliparous obese women are at increased risk of labor induction and cesarean delivery (CD). We sought to determine whether the combination of a transvaginal Foley balloon plus misoprostol prostaglandin E1 (PGE1) is superior to misoprostol alone in reducing the risk for CD. Study Design We undertook a multicenter, open-label, comparative-effectiveness randomized clinical trial of nulliparous obese women with unfavorable cervix (Bishop's score ≤ 6) undergoing labor induction from January 2016 to June 2018 at three tertiary centers. Those at 6, further management was deferred to treating physicians. Primary outcome was the rate of CD. Secondary maternal outcomes included duration of induction-to-delivery interval, occurrence of tachysystole, clinical chorioamnionitis, need for operative vaginal delivery, as well as a composite of maternal morbidity (postpartum endometritis, surgical-site infection, venous thromboembolism, need for transfusion, intensive care unit admission, and maternal death). Secondary neonatal outcomes included need for neonatal intensive care unit admission, transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, culture-proven sepsis, neonatal seizures, and a composite of neonatal morbidity (Apgar's score ≤7 at 5 minutes, umbilical artery cord pH ≤7.10, birth injury, perinatal death). With the rate of CD rate being 53% at Children's Memorial Herman Hospital among nulliparous obese women who underwent induction of labor at ≥32 weeks and met our inclusion criteria; 250 women (125 women per group) were required to answer the study question. All analyses were by intention to treat. Results Of the 236 women randomized, 113 (48%) were allocated to group 1 (combined Foley and PGE1) and 123 (52%) to group 2 (PGE1 alone). The rate of CD was similar between the groups (45 vs. 43%, p = 0.84, relative risk [RR]: 1.03, 95% CI: 0.75–1.42). There was no difference in the occurrence of tachysystole that resulted in fetal heart rate abnormalities between the groups (8.8 vs. 16.2%, p = 0.09, RR: 0.54, 95% CI: 0.27–1.11). The total duration of the induction-to-delivery interval was also similar between the groups (24.8 ± 13.8 vs. 24.5 ± 14.0 hours, p = 0.87) regardless of the mode of delivery. No differences were seen in the indications for CD and secondary maternal or neonatal outcomes. Conclusion In this trial of nulliparous obese women undergoing labor induction, cervical ripening with combined Foley balloon and PGE1 resulted in similar CD rates than ripening with vaginal PGE1 alone. Key Points

Diabetes complicates 6 to 7% of all pregnancies in the United States. Poor glycemic control is associated with multiple immediate and long-term adverse effects on both the mother and fetus. Although uniformity exists in the antenatal management of this disease, there is a paucity of evidence-based studies upon which to dictate the optimal time of delivery among affected women. The potential risks of delayed neonatal pulmonary maturation including respiratory distress syndrome and transient tachypnea of the newborn associated with early delivery must be balanced with the increased incidence of fetal demise, overgrowth, and birth injury related to diabetes in late gestations. Even among diabetic women with optimal glycemic control, the risk of stillbirth in the third trimester is considerably higher than their normal counterparts. The current paradigm of delaying delivery to 39 weeks in women with controlled and uncomplicated diabetes has been challenged by recent evidence advocating delivery by 38 weeks to improve perinatal outcomes. However, additional well-designed and adequately powered prospective studies are needed to better understand the short- and long-term implications of the optimal timing of delivery in this high-risk population. This article reviews the most current literature regarding the optimal timing of delivery in pregnancies complicated by diabetes mellitus and gestational diabetes mellitus.

Objective To assess effects of neonatal transport on transient tachypnea of the newborn (TTN) in outborn term neonates. Study Design This retrospective cohort study included 66 term neonates diagnosed with TTN and transported to the Osaka Women's and Children's Hospital neonatal intensive care unit between January 2003 and March 2018. A multivariate logistic regression analysis identified perinatal and neonatal transport factors associated with adverse short-term outcomes defined as mechanical ventilation >48 hours, continuous positive airway pressure >72 hours, pulmonary hemorrhage, and requirement for inhaled nitric oxide, thoracentesis, or surfactant replacement therapy. Results A lower gestational age (GA) (37.7 [37.2, 38.3] vs. 39.6 [37.8, 40.3] weeks, p = 0.002), longer time to neonatal transport (10.0 [4.3, 25.5] vs. 5.5 [2.7, 9.7] hours, p = 0.01), and higher respiratory rates during transport (70 [60, 85] vs. 60 [55, 78.8] breaths/min, p = 0.04) were significantly associated with adverse short-term outcomes. After adjusting for GA, sex, cesarean section, and time to neonatal transport, GA (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.24–0.87) and time to neonatal transport (OR, 1.07; 95% CI, 1.01–1.13) were significantly associated with adverse outcomes. Conclusion Short-term adverse prognosis of TTN is strongly associated with a lower GA and longer time between birth and neonatal transport.

Objective The objective of this study was to measure knowledge and practice variation in late preterm steroid use. Study Design Electronic survey of American College of Obstetricians and Gynecologists (ACOG) members about data supporting the ACOG/Society for Maternal-Fetal Medicine (SMFM) recommendations and practice when caring for women with anticipated late preterm birth (PTB), 340/7 to 366/7 weeks. Results Of 352 administered surveys, we obtained 193 completed responses (55%); 82.5% were generalist obstetrician-gynecologists (OB/GYNs), and 42% cared for women with anticipated late PTB at least weekly. Most believed that late preterm steroids provided benefit by reducing respiratory distress syndrome (93%), transient tachypnea of the newborn (83%), and neonatal intensive care unit admission (82%). More than half administered late preterm steroids to women with multiple gestations (73%), and pregestational diabetes (55–80%) depending on glycemic control. OB/GYNs administered steroids to insulin-dependent and poorly controlled diabetics more often than MFMs (75 vs. 46% and 59 vs. 37% respectively, p Conclusion Most providers are administering late preterm steroids to all women, even those populations who have been excluded from previous trials. Despite widespread use, providers believe more research is needed to optimize management.

Background and Objective Mechanical ventilation (MV) can induce oxidative stress, which plays a critical role in pulmonary injury in intubated neonates. Ischemia-modified albumin (IMA)—a variant of human serum albumin—is a novel biomarker of myocardial ischemia that occurs due to reactive oxygen species during ischemic insult. This study aimed to investigate IMA production due to oxidative stress induced during MV in neonates. Materials and Methods This study included 17 neonates that were ventilated using synchronized intermittent mechanical ventilation (SIMV; SIMV group) and 20 neonates ventilated using continuous positive airway pressure (CPAP; CPAP group). Blood samples were collected from each neonate during ventilation support and following cessation of ventilation support. Total antioxidant capacity (TAC) and total oxidant status (TOS) were measured using the Erel method. IMA was measured via an enzyme-linked immunosorbent assay kit (Cusabio Biotech Co., Ltd., Wuhan, China). The oxidant stress index (OSI) was calculated as OSI = TOS/TAC. Statistical analysis was performed using SPSS v.18.0 (SPSS Inc., Chicago, IL) for Windows. Results Among the neonates included in the study, mean gestational age was 34.7 ± 3.8 weeks, mean birth weight was 2,553 ± 904 g, and 54% were premature. There were not any significant differences in mean gestational age or birth weight between the SIMV and CPAP groups. Among the neonates in both the groups, mean IMA, TOS, and OSI levels were significantly higher during ventilation support (102.2 ± 9.3 IU mL–1, 15.5 ± 1.3 µmol H2O2 equivalent L–1, and 0.85 ± 0.22 arbitrary units [ABU], respectively), as compared with following cessation of ventilation support (82.9 ± 11.9 IU mL–1, 13.4 ± 1.3 µmol H2O2 equivalent L–1, and 0.64 ± 0.14 ABU, respectively) (p = 0.001). Among all the neonates in the study, mean TAC was significantly lower during ventilation support than the postventilation support (1.82 ± 0.28 mmol 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid [Trolox] equivalent L–1 vs. 2.16 ± 0.31 mmol Trolox equivalent L–1) (p = 0.001). There were no significant differences in mean TAC, OSI, or IMA levels between the SIMV and CPAP groups. The mean TOS level during ventilation support and the mean difference in TOS between during and postventilation support was significantly greater in the CPAP group than in the SIMV group. There were no significant relationships between the mean TOS, TAC, OSI, or IMA levels, and gestational age of the neonates. Conclusion SIMV and CPAP activated the oxidative stress and increased the IMA level in neonates; therefore, measurement of IMA and oxidant markers may be useful in the follow-up of lung injury in neonates due to ventilation support. Additional prospective studies are needed to compare the effects of various ventilation methods on oxidative stress and the IMA level in neonates.

Objective This study aims to determine whether preterm infants who are small for gestational age (SGA) are more likely to have respiratory distress syndrome (RDS) compared with appropriate-for-gestational-age infants. Methods Secondary analysis of a multicenter trial evaluating magnesium for neuroprotection. Nonanomalous, singleton gestations delivered between 22 0/7 and 36 6/7 weeks were included. Large-for-gestational-age infants were excluded. We performed a nested case–control study. Cases were infants with RDS; controls were infants without RDS. The sample size estimates revealed 779 subjects/group were needed to achieve a 80% power to demonstrate a 1/3 difference in RDS. We fit a multivariable logistic regression model to adjust for confounders. We assessed the association of SGA with RDS and a composite adverse respiratory and neonatal outcome. Results Overall, 947 cases and 920 controls were included. The groups differed by gestational age at delivery, antibiotic exposure, mode of delivery, infant gender, and birth weight. SGA was not associated with RDS (adjusted odds ratio [aOR]: 1.07, 95% confidence interval [CI]: 0.48–2.38) or the composite respiratory (aOR: 0.87, 95% CI: 0.37–2.04) or adverse neonatal outcome (aOR: 0.65, 95% CI: 0.27–1.54). RDS and the composite respiratory outcome were most associated with earlier gestational age at delivery, cesarean delivery, and male gender. Conclusion SGA is not associated with RDS or other adverse respiratory and neonatal composites.

We sought to determine the effect of neonatal transport on the incidence of adverse events of transient tachypnea of the newborn (TTN) in term neonates. A retrospective study was performed of neonates who had TTN and were admitted to Neonatal Intensive Care Unit (NICU) of Sami Ulus Maternity, Children's Education and Research Hospital by land-based transport. Data from 208 newborns with TTN were evaluated, and clinical and laboratory findings were compared between patients who were transported from within the city (group 1) or from outside of the city (group 2). In the present study, long-distance land-based neonatal transport increased the adverse effects of TTN in newborns. Arterial blood gas parameters of the neonates in both groups before transport were similar, and these parameters and Downes' scores were comparable in both groups, implying that patients from outside the city had greater respiratory insufficiency than those from inside the city at admission to NICU. Respiratory support in the NICU and pulmonary air leak syndrome ratios were found to be significantly higher in the group from outside the city. Long-distance land-based transport in neonates with TTN increases the severity of illness. Furthermore, adverse events and the outcome of such infants depend on the effectiveness of the neonatal transport system.

The appropriate time and the optimal mode of delivery of twins are still controversial. We assessed the effect of gestational age and the mode of elective delivery of twins on the occurrence of neonatal respiratory morbidity (NRM) and of maternal morbidity. This study included twins born beyond 35 weeks' gestation. NRM was defined as respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). Additionally, maternal complications related to the different modes of delivery were taken into account. Of 711 twin pregnancies (1422 liveborn neonates) included, 74 (5.2%) experienced NRM. Maternal age > 25 years, delivery at an earlier gestational age, and delivery by emergency cesarean section maintained statistical significance with NRM. From the maternal point of view, increased length of hospitalization ( P = 0.045) and the need for postoperative antibiotics ( P = 0.0065) were significantly higher following an emergency cesarean section than after an elective cesarean birth. The risk of NRM in twins born beyond 37 weeks' gestation is rather low. We suggest considering elective cesarean delivery at completion of 37 weeks. This can be performed safely in regard to NRM, the trade-off being reduced maternal morbidity associated with elective cesarean delivery.

Transient tachypnea of the newborn (TTN) is a common respiratory problem in newborns. This study aims to determine if cesarean delivery (CD) is a risk factor for TTN, and if labor prior to CD decreases this risk. A linked data set consisting of Arizona birth certificates (1994 to 1998) and infants enrolled in a high-risk perinatal program provided 800 TTN cases and 800 controls, stratified by year. The relationships of CD and labor to TTN were examined using logistic regression. CD was associated with an increased risk of TTN, whether it was accompanied by labor (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.62 to 4.45) or not accompanied by labor (OR 2.88; 95% CI 2.01 to 4.13), even after adjusting for confounding variables. Labor did not affect the development of TTN, nor did it modify the association of CD with increased risk for TTN. CD is a risk factor for TTN. Labor prior to CD is not protective for TTN.

This study aims to determine the impact of meconium-stained amniotic fluid (MSAF) in low-risk pregnancies at term on pregnancy outcome.A retrospective cohort study of women with MSAF during labor who delivered in a tertiary hospital at 37 to 41(+6) weeks of gestation (2007-2013). Exclusion criteria included: multiple gestations, noncephalic presentation, fetal structural/chromosomal anomalies, hypertensive disorders, diabetes, oligohydramnios, or small for gestational age. Pregnancy outcome of women with MSAF (N = 4,893) was compared with a control group of women without MSAF (N = 39,651). Neonatal respiratory morbidity was defined as the presence of any of the following: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, or need for ventilatory support.Overall, 10.9% of low-risk pregnancies at term were diagnosed with MSAF. Compared with the controls, women with MSAF had higher rates of nulliparity, gestational age at delivery ≥ 41 weeks, induction of labor, nonreassuring fetal heart rate, and operative deliveries. In multivariate analysis MSAF was associated with operative delivery (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.63-2.09; p 0.001), cesarean section (OR, 1.48; 95% CI, 1.31-1.69; p 0.001), respiratory morbidity (OR, 4.74; 95% CI, 3.87-5.82; p 0.001), and increased risk for short-term neonatal morbidity.MSAF is associated with a higher rate of adverse perinatal outcome even in low-risk pregnancies at term.

This study aims to evaluate impact of respiratory and other neonatal comorbidities on neurodevelopmental outcome in late preterm infants (LPT).Retrospective study of LPT infants (34 (0/7)-36 (6/7) weeks' gestation) discharged from the New York University Langone Medical Center neonatal intensive care unit, during January 2006 to December 2010 and received follow-up care up to 2 years of age. Neonatal morbidities were correlated with neurodevelopmental outcomes and assessed by performance on the Mullen Scales of Early Learning during three developmental follow-up visits.A total of 99 LPT completed neurodevelopmental assessment up to 2 years of age. Infants with diagnosis of moderate-to-severe respiratory distress syndrome showed a significantly lower performance in the visual reception on the second (p0.01) and third visit (p=0.02), as well as lower performance in the receptive language (visit 2, p=0.02; visit 3, p0.01). A diagnosis of persistent pulmonary hypertension was found to be associated with significantly lower performance in the visual reception at all visits (p0.01; p=0.02; p=0.02) and in the receptive language on the second and third visit (p=0.03; p=0.02). Combined respiratory morbidities were also associated with lower developmental scores in fine motor (visit 2, p0.01; visit 3, p=0.04) as well as expressive language (visit 3, p=0.02).LPT with significant respiratory morbidities are at higher risk for long-term developmental delays, mainly affecting cognitive developmental domains.

Transient tachypnea of the neonate (TTN) is the commonest neonatal respiratory disorder. Given TTN physiopathology, continuous positive airway pressure (CPAP) could be indicated for its treatment, but no data are available. Our aim is to clarify if CPAP might reduce the TTN burden of care.Retrospective multicenter cohort study enrolling 42 full-term TTN babies treated with CPAP and 40 with oxygen supplementation.CPAP-treated infants show shorter intensive care unit stay (CPAP, 2.5 ± 2 vs. Oxygen, 4.4 ± 2.6 days; adjβ, -2.1 [95% confidence interval (CI): -3.1; -1]); p 0.001) and lower maximal oxygen fraction (adjβ, -4.7 [95% CI: -7.7; -1.7]; p = 0.003). Air leak incidence was similar between the groups (adjOR, 0.36 [95% CI: 0.1; 1.1); p = 0.08). Patients' comfort as per EDIN score was also unchanged. Given the shorter length of intensive care, the use of CPAP for treating TTN would spare on average around 7,000 Euros/infant.CPAP seems a useful therapeutics for TTN, as it may reduce the burden of care without increasing air leaks or patients' discomfort.

The purpose of this study was to identify risk factors and to characterize infants with transient tachypnea of the newborn (TTN). A total of 67 newborns with TTN, born at gestational age (GA)>or=35 weeks, were studied. Newborns delivered before and after each study case served as controls. Mean GA was lower and cesarean section (CS) rate was higher in the TTN group (38.2+/-2.3 versus 39.5+/-1.4 weeks, p

The objective of this study is to identify risk factors for meconium aspiration syndrome (MAS) in newborns born through meconium-stained amniotic fluid (MSAF). From May 27, 1994 to June 9, 1997 maternal and neonatal data were prospectively collected on all infants born through MSAF. Development of MAS was the primary outcome. Using bivariate and logistic regression analysis we identified risk factors for MAS. There were 8,967 births during this period: 7.9% (708 of 8,967) were delivered through MSAF. Respiratory symptoms developed in 6.8% (48 of 708) of births. Of these, 50% (24 of 48) were excluded due to the diagnosis of transient tachypnea of the newborn (17), respiratory distress syndrome (4), group B streptococcus pneumonia (1), congenital cytomegalic inclusion disease (1), and supraventricular tachycardia (1). Of the 24 infants with respiratory symptoms consistent with MAS, 45.8% (11 of 24) required ventilatory support, one required extracorporeal-membrane oxygenation. Bivariate analysis identified six risk factors ( p

The aim of the article is to evaluate ischemia-modified albumin (IMA) levels in infants with transient tachypnea of the newborn (TTN) and to find out its relation to the disease severity. Patients andInfants with 37 weeks of gestation, without any respiratory and cardiac symptoms and without any maternal health problems, and diagnosed as TTN were allocated as the study group. Patients with obvious retractions, grunting, hypercarbia (Pco 2 60 mm Hg) or hypoxia (oxygen saturation 88% with Fio 2 of 0.60) were managed with nasal continuous positive airway pressure (CPAP). During the postnatal 0 to 24 hours, blood samples were collected in 2 mL for IMA.A total of 47 patients were diagnosed TTN, and allocated as the study group. Of the 47 patients, 43 patients without respiratory symptoms were enrolled as the control group. IMA levels in TTN were found to be significantly higher (p 0.05). In addition, IMA levels were significantly increased in the nasal CPAP group versus supplemental oxygen therapy groups (p 0.05). IMA levels were determined to be significantly higher in the 3 days of oxygen therapy group (p 0.05). IMA levels with a cutoff point of 0.87 ABSU, sensitivity of 81.1% and specificity of 69.8% predicted TTN (area under the curve [AUC] = 0.85; p 0.05). IMA levels with 0.98 ABSU, 78% sensitivity, and 86% specificity indicated the prediction of CPAP requirement (AUC = 0.86; p 0.05).IMA levels were significantly higher in infants with diagnosed TTN. Therefore, IMA may be used as a new marker for predicting TTN and disease severity.

To determine etiology of neonatal intensive care unit (NICU) admission and acute morbidities in late preterm (LPT) neonates.Neonates admitted at New York University Langone Medical Center's NICU were grouped as follows: period 1: all LPT neonates with gestational age between 34(0)/(7) and 36(6)/(7) weeks and born between January 2006 and June 2007; period 2: all term neonates born between January 2007 and June 2008. Neonatal and maternal data were collected from both the groups and compared.Thirty-three percent of LPT births were admitted to the NICU, compared with 7% of term births (p0.05). LPT neonates had an increased incidence of low birth weight, hypoglycemia, hypothermia, and hyperbilirubinemia as an admission diagnosis (p0.001). The overall incidence of respiratory distress syndrome (RDS) was 9%, 4%, 3%, 0.7%, 0.2% and 0% in 34-week, 35-week, 36-week, 37-week, 38- to 39-week, and 40-week gestational age neonates (p0. 001).There was an increased incidence of RDS and persistent pulmonary hypertension, along with an increased need for surfactant replacement therapy, continuous positive airway pressure, and ventilator support in the LPT group when compared with the term neonates (p0.001).LPT neonates are at increased risk for hypothermia, hypoglycemia, hyperbilirubinemia, and respiratory morbidity requiring increased respiratory support when compared with term neonates.

We attempted to clarify the renal physiologic response to arginine vasopressin (AVP) in the 12 sick neonates: three with respiratory distress syndrome (RDS), three with meconium aspiration syndrome, two with transient tachypnea of the newborn, two with neonatal asphyxia, and two low birthweight infants during the first 2 days of life. Plasma atrial natriuretic factor (ANF), urinary AVP, osmolality, free water clearance and creatinine clearance (Ccr) were measured at 8 to 16 hours of life (stage 1) and 24 to 32 hours of life (stage 2). Urinary AVP was expressed as the ratio of AVP to Ccr (urine AVP/Ccr). These subjects were divided into two groups: group A represented five infants with a urine AVP/Ccr ratio of 2000 or higher and group B, seven infants with a ratio of less than 2000 at stage 1. Hyponatremia occurred in two infants of group A at stage 2. Number of infants on mechanical ventilation was four in group A and one in group B. There were no significant differences in gestational age, birthweight, Apgar scores at 1 and 5 minutes, blood gas pH and mean arterial blood pressure between groups A and B. A good correlation was observed between logarithm of urine AVP/Ccr ratio and urinary osmolality (p < 0.01). A negative correlation was observed between logarithm of urine AVP/Ccr ratio and free water clearance (p < 0.01). Body weight of infants of group A at stage 2 was greater than at stage 1 (p < 0.05). Higher plasma ANF concentrations were observed in infants of group A at stage 2 when compared with those at stage 1 (p < 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)