Search

OBJECTIVE: To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). DESIGN: Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. SETTING: Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS: 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). INTERVENTIONS: Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME MEASURES: Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months. RESULTS: Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. CONCLUSION: Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22-36 months in infants with moderate or severe HIE.

Objective: To determine the associations between lid and conjunctival injuries (LACI), non‐fatal strangulation (NFS) and domestic family violence (DFV) in non‐sexual assault. Methods: The present study involves an analysis of LACI in a clinical audit of 85 sequential non‐sexual assault presentations. Results: LACI was present in 26.9% of non‐sexual assault cases, and 47.4% of LACI patients also experienced NFS. LACI was sustained in the context of DFV in 62.9% of cases. Females made up 69.2% of LACI patients, with those between 14 and 29 years most at risk. Children were present in 12.8% of cases, 78.2% of perpetrators were male and 44.9% of patients had previously been assaulted by the same perpetrator. Conclusions: LACI is frequently associated with NFS and/or DFV. Since NFS increases future homicide attempts and events more than sixfold, LACI is an important signal about a patient's homicide risk, expanding the dimensions of the care needed. Those experiencing LACI during an assault also need to be referred for comprehensive eye examination as soon as possible. With consent, systematic forensic photography of LACI enables its assessment and documentation, which assists the legal process. These conclusions should drive legislative consideration and reform, plus expanded education for clinicians and police. [ABSTRACT FROM AUTHOR]

Aim: To explore frontline health professionals' current understanding of non‐fatal strangulation and their need for and support for a comprehensive education and screening package to support health delivery. Design: A descriptive mixed‐method approach was chosen to analyse responses to an anonymous, online survey consisting of ten Likert scale, open‐ended and five demographic questions. 103 frontline health professionals (nurses, doctors, paramedics, midwives) participated in this study. Methods: Content analysis of the Likert scale and open‐ended questions describing the subjective experiences and perceptions of the participants was undertaken along with percentage and frequency counts of the rated Likert responses. Results: The findings identified that 51.1% of health professionals do not ask about strangulation routinely and that 59% of health professionals reported receiving no formal education or professional development on NFS to enhance their knowledge or inform clinical practice. No health professionals identified mild traumatic brain injury as a consequence or sign of strangulation, nor did they identify an understanding that 50% of people may have no visible injuries after being strangled. Health professionals also do not routinely document the different agencies referred to or involved in supporting the person who experienced NFS. Conclusion: Findings suggest that frontline health professionals lack the confidence, skills and education needed to meet medical obligations to their patients and to fulfil their duty to 'do no harm'. Frontline health professionals would welcome a comprehensive education and screening package to guide recognition and response to non‐fatal strangulation in their clinical settings. Where and on Whom Will the Research Have an Impact?: The purpose of the study was to understand and explore health professionals' knowledge about non‐fatal strangulation so that improved education around better screening, and management of trauma‐focused care to people who have been subjected to non‐fatal strangulation could occur. No Patient or Public Contribution: This review contains no patient or public contribution since it examines health professionals' knowledge of identifying non‐fatal strangulation and the screening and assessment tools used in clinical practice. [ABSTRACT FROM AUTHOR]

This study explores the effects of bodily states on emotions based on embodied cognition theories of conceptual metaphor and feelings‐as‐information theory. Specifically, it investigates how physical suffocation induced by mask‐wearing affects perceptions of emotional suffocation related to one's romantic relationship and financial situation. In this quantitative online experiment, we employed a convenience sampling method through a crowdsourcing platform. Adult participants (N = 180, 25 years or older and involved in a romantic relationship) were randomly assigned to three conditions: wearing COVID‐19 masks properly, wearing masks on their chins, or not wearing masks. After completing a puzzle meant to prolong mask‐wear, participants filled out digital questionnaires assessing their experiences of physical and psychological distress. The results supported our proposed mechanisms, revealing that increased feeling of physical suffocation while wearing masks properly, compared to the other conditions, was linked to heightened feelings of financial and romantic distress, supporting the conceptual metaphor account. This link was partially mediated by elevated state anxiety, aligning with the feelings‐as‐information theory. This study demonstrates how bodily experiences can impact emotional states, and highlights the complex interplay between everyday behaviours like mask‐wearing and emotions. [ABSTRACT FROM AUTHOR]

Each year millions of females develop serious mental illnesses (SMI), which are major risk factors for suicides. Using the Web-Based Injury Statistics Query and Reporting System (WISQARS) for the years 2000, 2010 and 2020, we found in 2020 9,428 females (almost 190/week) committed suicide, losing 328,653 years off potential life before age 80 years. There were pronounced increases in female suicides from 2000 to 2020 across all racial and ethnic groups. The greatest number of suicides were in non-Hispanic white females, but the highest rate of suicides was in non-Hispanic American Indians /Alaska Natives, and in females 15–24 years of age. The West had the highest female suicide rates, with methods used to commit suicides varying by census regions and race and ethnicity. Suffocation to commit suicide increased for most racial and ethnic groups and poisonings decreased for most groups between 2000 and 2020, These underscore the need for targeted primary prevention of suicides for females based on age, geographic location and method of suicide, to mitigate female suicides improved access (e.g. geographically and financially) to mental health care services is essential. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Perinatal asphyxia is the main risk factor for mortality and morbidity in neonates and neurological disorders in survived infants. We compared the neonatal and maternal 25 (OH) vitamin D levels in neonates with/without asphyxia. MATERIALS AND METHODS: This cross-sectional research was done on 229 neonates (including 158 neonates [69%] without asphyxia [control group] and 71 neonates [31%] with asphyxia [case group]) from 2020 to 2023 using the available sampling method. 25 (OH) Vit D levels in mothers and neonates were assessed and compared in the 2 groups. The data collection instrument was a researcher-made checklist, containing the maternal and neonatal characteristics and laboratory evaluations. Data were analyzed by SPSS 23 using the t-test. RESULTS: The mean maternal 25 (OH) Vit D levels in the case and control groups were 16.34±11.87 and 22.80±12.67 ng/mL, respectively. The mean neonatal 25 (OH) Vit D levels in the case and control groups were respectively 12.13±8.62 and 19.55±11.62 ng/mL (P = 0.002). The case group showed severer maternal and neonatal 25 (OH) Vit D deficiency (P = 0.000) compared to the control group. CONCLUSIONS: Neonatal and maternal 25 (OH) Vit D deficiency can increase the risk of perinatal asphyxia. Therefore, administration of 25 (OH) Vit D supplements to pregnant mothers may reduce the incidence of asphyxia. [ABSTRACT FROM AUTHOR]

Introduction: Hypoxic-ischemic encephalopathy (HIE), a consequence of perinatal asphyxia, is a major cause of pediatric mortality and morbidity, often leading to neurological conditions like cerebral palsy, mental retardation, and epilepsy. This study aimed to assess the presence or absence of a lactate peak on MR spectroscopy (MRS) in relation to HIE severity and neurodevelopmental outcomes in asphyxiated neonates. Objectives: To examine the trend of brain lactate peaks in asphyxiated neonates over the first 3 months and its relationship with neurodevelopmental outcomes at 6 months. The study also sought to determine the correlation between HIE severity at birth and brain lactate peaks observed on MRS. Methods: This prospective observational clinical study was conducted at Dr. S. N. Medical College, Jodhpur, India, in the Department of Pediatrics and Radiology, following IEC approval. The study spanned December 2020 to May 2021. A total of 89 full-term neonates with clinical HIE were stabilized and underwent MRI with MRS. Repeat MRI/MRS was performed after 4-6 weeks if a lactate peak was initially present. Neurodevelopmental outcomes were assessed using the Hammersmith Infant Neurological Examination (HINE) score at 6-7 months. Results: Of the 89 neonates, 49 (55.1%) showed a lactate peak on the first MRS. Follow-up MRS at a mean age of 67.41±7.91 days showed persistent lactate peaks in 12 (31.5%) of these neonates. In total, 79 neonates completed neurodevelopmental follow-up; 22 (53.65%) with an initial lactate peak exhibited developmental delays. Conclusion: Lactate detected on neonatal MRS often persists until 2-3 months in asphyxiated neonates, correlating with poor neurodevelopmental outcomes, growth, and head circumference. Routine MRS alongside MRI is recommended for all asphyxiated neonates to assess and monitor lactate levels. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Birth asphyxia is a major cause of neonatal mortality and neurological morbidity. This study was aimed to determine biochemical (sodium, potassium, and calcium) abnormalities and their correlation across different severities of perinatal asphyxia in term neonates. Methods: This observational analytical study was conducted in term neonates with perinatal asphyxia admitted at the neonatal intensive care unit of a tertiary care centre for a period of 18 months. Blood collection was done at baseline, 24 hours, and 48 hours of treatment to evaluate electrolyte abnormalities. The abnormality in serum electrolytes was correlated across different stages of hypoxic ischaemic encephalopathy (HIE) as per severity and at different time intervals. Results: A total of 74 neonates were included in the study and classified into HIE stage 1 (n = 37), stage 2 (n = 18), and stage 3 (n = 19). At baseline, hyponatremia, hyperkalaemia, and hypocalaemia were observed in 36.5% (n = 27), 20.3% (n = 15), and 10.8% (n = 8), respectively. The difference between mean serum sodium (p: 0.007), potassium (P: 0.004), and calcium levels (p: 0.001) at baseline in stage 1 and stage 3 was statistically significant. The degree of hyponatremia and hyperkalaemia was more and statistically significant as per increasing severity of HIE. All the deaths (n = 6.8.1%) belonged to stage 3 of HIE. Conclusion: The degree of hyponatremia, hypocalaemia, and hyperkalaemia in the asphyxiated newborns correlated with the severity of birth asphyxia. The mortality rate was greater in asphyxiated neonates with severe HIE and electrolyte abnormality. Effective perinatal care and meticulous management of dyselectrolytemia are crucial for improving neonatal outcomes. [ABSTRACT FROM AUTHOR]

Asphyxia is a critical condition characterized by inadequate oxygen supply to the body. Post mortem diagnostics of asphyxia present significant challenges in forensic pathology, particularly when there are equivocal signs during autopsy or uncertain circumstantial data. The identification of biochemical biomarkers that indicate asphyxia has emerged as a promising area of research, as these markers can provide vital insights into the physiological changes occurring at the cellular level during asphyxiation. We performed a review of the scientific literature on the search engines Pubmed and Scopus in order to assess the state of the art on this topic. The aim of this study is to analyze which are the most promising markers and methods in the post mortem diagnosis of asphyxia. The literature review highlighted the great potential that molecular investigations can have in the analysis of this type of death, especially considering that hypoxia determines strong biochemical alterations in response to cellular stress. These changes are marked by specific biochemical alterations, which can be detected through various advanced technologies and methodologies, including mass spectrometry, immunohistochemistry, and metabolomic profiling. The review evidenced a combination of markers that can be used for diagnostic purposes in various cases, including mechanical asphyxia, carbon monoxide (CO) poisoning, perinatal asphyxia, and drowning analysis. However, we highlight that, to date, there are still no standard protocols for forensic biochemistry in asphyxia. By scrutinizing the reliability of identified biomarkers and their potential to reshape forensic investigative practices, this research aims to elucidate the critical role that post mortem biochemical analysis can play in diagnosing asphyxia, ultimately contributing to a more nuanced understanding of death-related scenarios and the development of standardized protocols in forensic examinations. [ABSTRACT FROM AUTHOR]

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ~10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ~1 infant dies unexpectedly during sleep very week. Of these SUID, ~25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep--Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began. [ABSTRACT FROM AUTHOR]

Massive hemoptysis (MH) is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of massive hemoptysis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. MH is a rare but deadly condition. It is defined clinically as any bleeding from the tracheobronchial tree that compromises respiratory or circulatory function. The bronchial artery system is the primary source in the majority of cases of MH. The most common cause is tuberculosis worldwide, but bronchiectasis, bronchogenic carcinoma, and mycetoma are more common causes in the U.S. Patients with MH require rapid assessment and management, as decompensation can be rapid. Patients with altered mental status, inability to clear their sections, respiratory distress, or hemodynamic compromise require emergent airway intervention. The imaging modality of choice is computed tomography angiography with pulmonary arterial phase contrast. A reasonable order or sequence of management includes initial stabilization; assessment for the need for airway intervention; reversal of any coagulopathy; advanced imaging; and emergent consultation of pulmonary, cardiothoracic surgery, and interventional radiology. Ongoing resuscitation including blood products may be required in some patients with MH until definitive hemostasis is achieved. An understanding of MH can assist emergency clinicians in diagnosing and managing this dangerous disease. Providing a prompt evaluation, obtaining intravenous access, pursuing advanced imaging, providing reversal of coagulopathy, supporting hemodynamics, and appropriate consultation are key interventions in MH. [ABSTRACT FROM AUTHOR]

Background: Oxidative stress-related diseases in newborns arise from pro-oxidant/antioxidant imbalance in both term and preterm neonates. Pro-oxidant/antioxidant imbalance has shown to be present in different pathological conditions such as hypoxic ischemic encephalopathy (HIE), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and patent ductus arteriosus (PDA). Methods and Results: We performed a narrative review according to the most recent available literature (2012–2024), using Scopus and PubMed as electronic databases. Many observational and experimental studies in vitro and in vivo have evaluated the effectiveness of antioxidant therapies such as melatonin, erythropoietin (EPO), allopurinol, N-acetylcisteine (NAS), and nitric oxide synthase (NOS) inhibitors in these diseases. Perinatal asphyxia is one of the most important causes of mortality and morbidity in term and near-term newborns. Therapeutic hypothermia (TH) is the gold standard treatment for neonates with moderate-severe perinatal asphyxia, resulting in a reduction in the mortality and neurodevelopmental disability rates. Conclusions: According to the most recent literature and clinical trials, melatonin, allopurinol, NAS, NOS inhibitors, magnesium sulfate, and stem cells stand out as promising as both adjuvants and future probable alternatives to TH in the treatment of HIE. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Super-absorbent polymers (SAPs) possess the ability to absorb large amounts of water and are widely used in medical settings. Commonly used in vomit bags to contain fluids, reduce spillage, and enhance bedside hygiene, SAPs are generally regarded as safe and non-toxic. However, we report a tragic incident where the accidental ingestion of SAPs led to fatal asphyxiation, highlighting a critical safety concern. Case presentation: A 76-year-old female suffering from advanced Alzheimer's dementia was brought to the emergency department following a fall with cervical trauma. Following a complaint of nausea, she was given a vomit bag containing a sachet of approximately 9 g of SAP. Thirty minutes later, she was found deceased in the waiting area, with a grayish, half-hardened gel blocking her oropharynx and remnants of a chewed SAP sachet. Pathological analysis confirmed death by asphyxiation caused by the SAP expanding in her oropharynx upon contact with saliva. Conclusions: This case emphasizes the potential dangers of SAPs when accidentally ingested and it is imperative that such products are kept out of reach of vulnerable populations. In cases of airway obstruction, there are no specific treatments available. Laryngoscopy may be impossible, necessitating the prompt consideration of an emergency tracheotomy. Experimental data suggest the use of an aerosol of warm alkaline hydrogen peroxide solution to dissolve these obstructive foreign bodies, but further studies are needed to validate its use in emergency situations. [ABSTRACT FROM AUTHOR]

Introduction: A significant factor in neonatal mortality and morbidity is birth asphyxia. Signs of asphyxia are linked to about 23% of the 4 million newborn fatalities and 8% of all deaths worldwide that occur in children under the age of 5 each year. Aims: Trans-cranial Doppler evaluation of neonates with birth asphyxia. Correlation between Doppler study findings with clinical outcome Materials & Methods: Sample size was 50, study design was Prospective study. Period of study: from 1st may 2021 to 31st July 2022 and study area: Burdwan medical college & hospital Result: In our study, 44 (88.0%) patients had Whether First Breath Required Stimulation The value of z is 7.6. The value of p is < .00001. The result is significant at p < .05. In our study, 38 (76.0%) patients had Presence of Birth Complication. The value of z is 5.2. The value of p is < .00001. The result is significant at p < .05. In our study, 43 (86.0%) patients had Presence of Birth Complication The value of z is 7.2. The value of p is < .00001. The result is significant at p < .05. Conclusion: We concluded that it has been demonstrated that ultrasonography can be used to evaluate a new born who has asphyxia. The clinical outcome of a neonate receiving hypoxic-ischemic insults is positively connected with the resistant indices of the middle cerebral artery and anterior cerebral artery. Bad clinical outcomes are associated with both extremely high and low RI values. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder dystocia is a severe obstetric emergency that can cause substantial neonatal and maternal complications. This study aims to assess the performed obstetric maneuvers and their frequency, success, and association with maternal and neonatal complication rates. Material and methods: The study population was collected among all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352) by searching for ICD‐10 codes for shoulder dystocia, brachial plexus injury and clavicle fracture. Shoulder dystocia cases (n = 537) were identified by reviewing the medical records. Shoulder dystocia cases treated with one or two maneuvers were compared with those treated with at least three. Medical records of a matched control group constituting of 566 parturients without any of the forementioned ICD‐10 codes were also scrutinized. Results: Using the four most common obstetric maneuvers (McRoberts maneuver, suprapubic pressure, rotational maneuvers, the delivery of the posterior arm) significantly increased during the study period with individual success rates of 61.0%, 71.9%, 68.1% and 84.8%, respectively. Concurrently, the rate of brachial plexus injury and combined neonatal morbidity significantly declined from 50% to 24.2% (p = 0.02) and from 91.4% to 48.5% (p < 0.001). Approximately 75% of shoulder dystocia cases treated with maneuvers were resolved by the McRoberts maneuver and/or suprapubic pressure, but each of the four most performed maneuvers significantly increased the cumulative success rate individually and statistically (p < 0.001). The rates of brachial plexus injury and combined neonatal morbidity were at their highest (52.9% and 97.8%) when none of the maneuvers were performed and at their lowest when two maneuvers were performed (43.0% and 65.4%). The increasing number (≥3) of maneuvers did not affect the combined maternal or neonatal morbidity or brachial plexus injury but increased the risk for third‐ or fourth‐degree lacerations (odds ratio 2.91, 95% confidence interval 1.17 to 7.24). Conclusions: The increased use of obstetric maneuvers during the study period was associated with decreasing rates of neonatal complications; conversely, the lack of obstetric maneuvers was associated with the highest rate of neonatal complications. These emphasize the importance of education, maneuver training and urgently performing shoulder dystocia maneuvers according to the international protocol guidelines. [ABSTRACT FROM AUTHOR]

Strangulation by ligature is often homicidal and is mainly diagnosed through the detection of a ligature mark on the neck. We describe the unusual appearance of a ligature mark in a woman who was strangled and thrown into a river, where she lay for one month. On her neck, there was an irregular horizontal tear, associated with superficial ecchymosis and deep structures' haemorrhage. We made a comparison with literature cases of unusual features of the ligature mark. The ligature mark appearance can be influenced by post-mortem modifications, effects of concealment methods, cut injuries and neck tightening resulting in decapitation. Drowning victims could show injuries similar to those resulting from hanging/strangulation. We found just a few cases of water immersion after strangulation and no cases of a ligature mark presenting like a loss of substance. We tried to explain the unusual appearance of the ligature mark in our case: the skin at the ligature mark lost the superficial layer and underwent dehydration, so soaking and maceration have been accelerated and produced the appearance of loss of substance. Finally, the study led to the distinction from other sources of traumatic action and the definition of the cause of death. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate how the cumulative expulsion interval, litter size, and birth order influence the characteristics of newborn piglets from hyperprolific sows, as well as their intake of colostrum. Analysis was conducted on the temporal aspects of parturition in 254 sows, including 3920 piglets. Newborn piglet characteristics examined encompassed delivery time, birth order, birth status, umbilical cord rupture, meconium staining, delivery ease, birth weight, blood oxygen saturation, and heart rate. From the raw data, colostrum intake, birth interval, and cumulative birth interval of each piglet were computed. Piglets were sorted based on the cumulative expulsion interval into nine categories: 0–30, 31–60, 61–90, 91–120, 121–150, 151–180, 181–210, 211–240, and >240 min. Litter sizes were categorized into three groups: 10–13, 14–17, and ≥18 piglets per litter. The birth-order ranking referred to the piglet's position within a litter and was categorized into four quartiles: 1, 2, 3, and 4. On average, the expulsion interval, cumulative expulsion interval, and colostrum consumption were 14.8 ± 21.8 min, 138.6 ± 155.7 min, and 407.6 ± 162.1 g, respectively. In litters with ≥18 piglets, the percentage of piglets with inadequate colostrum intake (<300 g) was higher compared to litters with 10–13 piglets (33.1 % vs. 12.9 %, P < 0.001) and 14–17 piglets (23.9 %, P < 0.001). The occurrence of stillbirths in the fourth quartile of the litter was higher than in the first (16.0 % vs. 2.2 %, P < 0.001), second (4.0 %, P < 0.001), and third (7.8 %, P < 0.001) quartiles. Among litters with ≥18 piglets, those born in the third quartile exhibited lower colostrum consumption compared to those born in the first quartile (346.0 ± 9.9 vs. 391.4 ± 8.6 g, P = 0.028). Colostrum intake decreased with longer cumulative expulsion intervals, evident from a notable decline starting at 90 min post-farrowing compared to piglets born within the first 30 min (P = 0.004). Interestingly, colostrum consumption exhibited a negative correlation with the cumulative expulsion interval (P < 0.001), but not with individual piglet expulsion intervals (P = 0.460). Piglets born with meconium staining were most prevalent among those with a cumulative expulsion interval of >240 min. In summary, both the cumulative expulsion interval and birth-order ranking significantly impact the physiological characteristics of newborn piglets and their colostrum intake. Colostrum consumption decreases and newborn piglet characteristics change with higher cumulative expulsion intervals. Identifying piglets at high risk of hypoxia and implementing appropriate treatments and management strategies within an optimal timeframe could aid pig producers in reducing pre-weaning mortality among piglets born to hyperprolific sows. • The analysis was conducted on the parturition timing of 3920 piglets. • Colostrum intake decreased with longer cumulative expulsion intervals. • Meconium staining was most prevalent in piglets with expulsion intervals of >240 min. • Birth assistance in litters of ≥18 piglets was lower than in smaller litters. • The incidence of umbilical rupture in the fourth quartile was higher than in the first. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursing Effect / Etkili Hemşirelik Dergisi is the property of Dokuz Eylul Universitesi Hemsirelik Fakultesi Elektronik Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gestational diabetes mellitus (GDM) is the main cause of hyperglycemia in pregnancy and is related to complications throughout the gestational and post-partum period. Objectives: To analyze the pregnancy outcomes related to the occurrence of GDM in women and their offspring. Methods: Third-trimester pregnant women were interviewed and monitored until childbirth. The diagnosis of GDM, blood glucose ≥ 92 mg/dL, was defined by the criteria of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Results: A total of 138 women participated, and there were 136 births (due to 2 fetal losses); 23 (16.7%) were diagnosed with GDM. The risk of complications during childbirth was higher among pregnant women with GDM (RR 3.40; 95%CI 1.65–7.00), as was the occurrence of cesarean birth (RR 1.9; 95%CI 1.46–2.59). The occurrence of preterm birth did not show a significant difference between GDM/non-GDM groups. There was a non-significant association in adjusted analyses of macrosomia (birth weight ≥ 4000 g) among newborns born to mothers with GDM (RR 1.27; 95%CI 0.67–2.38). For newborns born to pregnant women with GDM, there was a higher risk for the following outcomes: large for gestational age (LGA) (3.29 95%CI 1.62–6.64), low Apgar (4.98 95%CI 2.32–10.69), and birth asphyxia (9.51 95%CI 3.42–26.48). Conclusions: The findings reinforce that GDM is an important risk factor for adverse pregnancy outcomes for women and their offspring. [ABSTRACT FROM AUTHOR]