7th March 2014, Volume 127 Number 1390

Risk of first venous thromboembolism in pregnant women in hospital

It is know that admission to hospital increases the risk of venous thromboembolism. This report investigates the situation with respect to pregnant women. This cohort study derives data from over 200,000 pregnant women in England.

Exposure to the risk was evaluated in those admitted to hospital during pregnancy, but not for delivery or thromboembolism. The researchers report an 18-fold increase in those admitted to hospital compared with those not admitted. The increased rate was sustained during 28 days after discharge (6-fold).

BMJ 2013;347:f6099.

Mitral-valve repair versus replacement for severe ischemic mitral regurgitation

Ischemic mitral regurgitation is a consequence of adverse left ventricular remodelling after myocardial injury or infarction. Medical treatment of the regurgitation and its consequences is often unsatisfactory.

Consequently surgical intervention is often indicated. The options are repair or replacement of the damaged valve. Studies suggest that repair has a lower perioperative mortality risk whereas valve replacement provides a better long-term correction with a lower risk of recurrence.

This report is of a trial in which 251 such patients were randomised to receive valve repair or replacement. The researchers’ conclusions were that there were “no significant difference in left ventricular reverse remodelling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes.”

N Engl J Med 2014;370:23–32.

Dextrose gel for neonatal hypoglycaemia

Neonatal hypoglycaemia is important because it is a common disorder, which is associated with brain injury and poor neurodevelopmental outcome. Treatment options include feeding with frequent blood tests, intravenous glucose in severe cases and the use of 40% dextrose gel administered into the buccal mucosa.

This report concerns a trial comparing feeding alone or feeding plus the use of the gel. 237 babies were considered to be of risk of hypoglycaemia because of the known risk factors—maternal diabetes or obesity, being preterm, or being small or large at birth.

The 237 babies were randomised to receive 200 mg/kg of 40% dextrose gel or placebo gel massaged into their buccal mucosa and were encouraged to feed. Treatment with the dextrose gel was found to reduce treatment failure significantly and the researchers suggest that buccal dextrose gel should be considered for first line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 hours after birth.

Lancet 2013;382:2077–83.