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Treatment of Carbon Monoxide Poisoning
Published in David G. Penney, Carbon Monoxide, 2019
The fetus is particularly vulnerable to the effects of CO, which readily crosses the placenta and is even more tightly bound to fetal hemoglobin. The fetus also reaches higher peak COHb levels than does the mother. Fetuses that survive a significant CO poisoning may be left with limb malformation, hypotonia, areflexia, persistent seizures, mental and motor disability, and microcephaly (Ginsberg and Myers, 1974, 1976). The only prospective, multicenter study of acute CO poisoning in pregnancy recently reported adverse outcomes in 60% of children whose mothers suffered severe CO toxicity. Of those babies born to mothers with mild to moderate CO exposure, normal physical exams and neurobehavioral development were reported (Koren et al., 1991). Since CO elimination from the fetus is prolonged (7-10 h), it is generally accepted that HBO therapy is useful at lower maternal COHb levels than would be acted upon in the nongravid patient. In addition, surface O2 therapy should be extended to four to five times the normal duration. Although controversial, HBO has been reported to be safe in pregnancy (Brown et al., 1992), despite theoretical dangers of fetal hyper-oxia in animal models (Ferm, 1964; Fujikura, 1964; Miller et al., 1971). A recent report of 44 women undergoing HBO during pregnancy for CO exposure suggests that HBO is safe and should be considered, although miscarriages did occur, and 6 patients were lost to follow-up (Elkaharrat et al., 1991). It should be noted that HBO was implicated in the induction of labor in 1 pregnant patient; however, the pregnancy was near term when the CO exposure occurred (Farrow et al., 1991). Indications for HBO therapy in the pregnant patient are as follows: Maternal COHb level > 15-20% at any time during the exposure.Any neurological signs or symptoms.Evidence of fetal distress (fetal tachycardia, decreased beat-to-beat variability, late decelerations).If maternal neurologic symptoms or fetal distress persist 12 h after initial therapy, additional HBO treatments may be necessary.
Adverse neonatal outcomes in relation to ambient temperatures at birth: A nationwide survey in Taiwan
Published in Archives of Environmental & Occupational Health, 2018
Yi-Hao Weng, Chun-Yuh Yang, Ya-Wen Chiu
The statistical analyses were conducted using a commercially available program (SPSS 19.0 for Windows, SPSS, Chicago, IL, USA). We first applied a chi-squared test to determine whether ambient temperatures were associated with neonatal birth outcomes, including congenital anomalies, neonatal death, sex at birth, Apgar score (< 7 vs 7–10), delivery mode (Cesarean section vs vaginal delivery), gestational age, and birth weight. Further, we selected potential confounders, including birth region (northern vs southern), obstetric complications (maternal fever at delivery [> 38°C], meconium in the amniotic fluid, premature rupture of membrane [> 12 h], placental abruption, placenta previa, massive bleeding, seizure at delivery, precipitating delivery [< 3 h], breech presentation/malpresentation, cord prolapse, prolonged labor, dysfunctional labor, fetal distress, and complications of anesthesia), pregnancy-related disorders (maternal anemia, diabetes, pregnancy-induced hypertension, toxemia), parity, birth year, and maternal ethnicity, a priori and included them in the analytic model. A log-binomial model (generalized linear model with a log link and the binomial distribution for the error term) was used to estimate the risk of adverse neonatal outcomes in relation to ambient temperature after adjusting for confounders.18,19 Factors associated with ambient temperature in the univariate analysis were used as confounders for the log-binomial analysis. Absolute risk difference and 95% confidence intervals (CI) were expressed after adjusting the control variables. Statistical significance was set at p < .05 based on a two-sided calculation.