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Peles G, Paz-Levy D, Wainstock T, Goldbart A, Kluwgant D, Sheiner E. Pediatric respiratory hospitalizations in small for gestational age neonates born at term. Pediatr Pulmonol 2022; 57:754-760. [PMID: 34931470 DOI: 10.1002/ppul.25797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigates the risk for long-term respiratory hospitalizations of offspring born small for gestational age (SGA) at term. STUDY DESIGN A retrospective population-based cohort analysis was performed to examine the risk of long-term respiratory hospitalizations between SGA compared to appropriate for gestational age (AGA) newborns. The analysis included all term singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations, multiple gestation, cases of perinatal mortality and large for gestational age (LGA) were excluded. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence up to the age of 18 years, and a Cox hazards regression model was used to control for confounders. RESULTS During the study period 216,671 deliveries met the inclusion criteria; of them 4.8% (n = 10,450) were diagnosed as SGA neonates. During the follow-up period, the rate of hospitalization due to respiratory morbidity was significantly higher in the SGA group as compared to the AGA group (5.2% vs. 4.7%, OR = 1.13, 95% confidence interval [CI] = 1.03-1.24, p = 0.011). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the SGA group (log-rank p = 0.026). In the Cox hazards regression model, controlled for relevant clinical confounders, SGA was found to be an independent risk factor for long-term pediatric respiratory morbidity (adjusted hazard ratio [HR] = 1.1, 95% CI = 1.001-1.19, p = 0.049). CONCLUSION Being delivered SGA at term is an independent long-term risk factor for pediatric respiratory hospitalization.
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Affiliation(s)
- Galia Peles
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvora Kluwgant
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Joyce and Irving Goldman Medical School, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Paz-Levy D, Walfisch A, Wainstock T, Landau D, Sheiner E. 696: Meconium stained amniotic fluid exposure is associated with a lower rate of offspring's infectious morbidity. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Paz-Levy D, Weintraub AY, Reuven Y, Yohay Z, Idan I, Elharar D, Yohay D. Prevalence and risk factors for urinary tract infection following stress urinary incontinence surgery with two midurethral sling procedures. Int J Gynaecol Obstet 2018; 143:333-338. [PMID: 30229894 DOI: 10.1002/ijgo.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/21/2018] [Accepted: 09/17/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare prevalence and risk factors for urinary tract infection (UTI) following midurethral sling surgery with either the GYNECARE ABBREVO Continence System (Ethicon, Somerville, NJ, USA) or a standard transobturator. METHODS A retrospective cohort study was conducted among women who underwent midurethral sling surgery to treat stress urinary incontinence at a single tertiary hospital in Israel between January 1, 2014, and August 11, 2015. Data were retrieved from medical records. The diagnosis of UTI was based on a positive urine culture result. RESULTS Of 178 patients included, 30 (16.9%) underwent the ABBREVO procedure and 148 (83.1%) underwent the standard transobturator procedure. The mean ± SD BMI at the time of surgery was 28.1 ± 4.5 for the standard transobturator procedures and 30.7 ± 15.2 for the ABBREVO procedures. Women who underwent the ABBREVO procedure had an increased duration of hospitalization (P=0.004), and higher rates of concomitant anterior colporrhaphy procedures (P=0.009) and concomitant hysterectomy (P=0.009). Only 38 (21.3%) women developed UTIs within 12 months of surgery (seven in the ABBREVO procedure group and 31 in the standard transobturator procedure group). No statistically significant between-group differences were found for the risk of UTI or for urinary tract adverse events, such as recurrent UTI and the need for rehospitalization. CONCLUSIONS The two procedures were comparable in terms of prevalence and risk factors for UTI during the postoperative period.
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Affiliation(s)
- Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yonatan Reuven
- Division of Community Health, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Weintraub AY, Reuven Y, Paz-Levy D, Yohay Z, Idan I, Elharar D, Glinter H, Tzur T, Yohay D. Prevalence and risk factors for urinary tract infection up to one year following midurethral sling incontinence surgery. Eur J Obstet Gynecol Reprod Biol 2018; 222:146-150. [PMID: 29408746 DOI: 10.1016/j.ejogrb.2018.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the prevalence and risk factors of urinary tract infection (UTI) one year following sub-midurethral sling (SMUS) incontinence surgery in a university affiliated medical center in southern Israel. METHODS A retrospective cohort study was conducted to identify and characterize patients who suffered UTI within a year following SMUS surgery. The study population comprised of all patients who underwent a SMUS surgery between the years 2014 and 2015. Demographic and clinical data were retrieved from the patients' medical records, and a comparison between patients with and without a positive urine culture was performed. RESULTS During the study period, there were 178 SMUS surgeries. Urine culture positive UTI was noted in 21% (38 patients) within the first year following surgery. The mean age and BMI of patients complicated with UTI was 64.8 and 29.1, respectively. The most common pathogen found in urine culture was E. coli that accounted for 55% of all UTIs. When comparing patients with and without UTI, no significant difference was noted in the pre- and intra-operative characteristics. However, duration of hospitalization and readmissions in the first year following surgery, were significantly associated with the risk of UTI (p < 0.026 and p < 0.003, respectively). CONCLUSIONS Approximately one in every five women undergoing a SMUS operation in our population will suffer from UTI within a year from surgery. A significant association was found between the duration of hospitalization and readmissions in the first postoperative year and suffering from UTI.
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Affiliation(s)
- Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Yonatan Reuven
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Zehava Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Inbal Idan
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Debi Elharar
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Hannah Glinter
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
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Paz-Levy D, Schreiber L, Erez O, Goshen S, Richardson J, Drunov VI, Staretz Chacham O, Shany E. Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates. PLoS One 2017. [PMID: 28644831 PMCID: PMC5482430 DOI: 10.1371/journal.pone.0179481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Placental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns. OBJECTIVE To determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival. PATIENTS AND METHODS This prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics. RESULTS Twenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007). CONCLUSIONS Depressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome.
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Affiliation(s)
- Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev Beer Sheva, Israel
| | | | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev Beer Sheva, Israel
- * E-mail:
| | - Sharon Goshen
- Department of Epidemiology, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Neonatology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Justin Richardson
- Department of Neonatology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - VIadimir Drunov
- Department of Pathology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orna Staretz Chacham
- Department of Neonatology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eilon Shany
- Department of Neonatology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Paz-Levy D, Sheiner E, Wainstock T, Landau D, Walfisch A. 597: Early term deliveries and long-term endocrine and metabolic morbidity of the offspring. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paz-Levy D, Yohay D, Neymeyer J, Hizkiyahu R, Weintraub AY. Native tissue repair for central compartment prolapse: a narrative review. Int Urogynecol J 2016; 28:181-189. [PMID: 27209309 DOI: 10.1007/s00192-016-3032-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
Central descent due to a level 1 defect is a main component in pelvic organ prolapse (POP) reconstructive surgery, whether for symptomatic apical prolapse or for the prolapse repair of other compartments. A recent growth in the rate of native tissue repair procedures for POP, following the US Food and Drug Administration (FDA) warnings regarding the safety and efficacy of synthetic meshes, requires a re-evaluation of these procedures. The safety, efficacy, and determination of the optimal surgical approach should be the center of attention. Functional outcome measures and patient-centered results have lately gained importance and received focus. A comprehensive literature review was performed to evaluate objective and subjective outcomes of apical prolapse native tissue repair, with a special focus on studies reporting impact on patients' functional outcomes, quality of life, and satisfaction. We performed a MEDLINE search for articles in the English language by using the following key words: apical prolapse, sacrospinous ligament fixation, uterosacral ligament suspension, sacral colpopexy, McCall culdoplasty, iliococcygeus vaginal fixation, and functional outcomes. We reviewed references as well. Despite a prominent shortage of studies reporting standardized prospective outcomes for native tissue repair interventions, we noted a high rate of safety and efficacy, with a low complication rate for most procedures and low recurrence or re-treatment rates. The objective and subjective results of different procedures are reviewed. Functional outcomes of native tissue repair procedures have not been studied sufficiently, though existing data present those procedures as favorable and not categorically inferior to sacrocolpopexy. Apical compartment prolapse repair using native tissue is not a compromise. Functional outcomes of native tissue repair procedures are favorable, have a high rate of success, improve women's quality of life (QoL), and result in high rates of patient satisfaction. This subject requires further long-term, standardized prospective studies following the International Continence Society/International Urogynecologists Association guidelines for surgical outcomes report, with the focus on patient-centered functional outcomes.
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Affiliation(s)
- Dorit Paz-Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joerg Neymeyer
- Department of Urology, Charitè University, Berlin, Germany
| | - Ranit Hizkiyahu
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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