Perinatal Asphyxia Research Articles

Additive interaction between birth asphyxia and febrile seizures on autism spectrum disorder: a population-based study

BackgroundAutism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder that can significantly impact an individual’s ability to socially integrate and adapt. It’s crucial to identify key factors associated with ASD. Recent studies link both birth asphyxia (BA) and febrile seizures (FS) separately to higher ASD prevalence. However, investigations into the interplay of BA and FS and its relationship with ASD are yet to be conducted. The present study mainly focuses on exploring the interactive effect between BA and FS in the context of ASD.MethodsUtilizing a multi-stage stratified cluster sampling, we initially recruited 84,934 Shanghai children aged 3–12 years old from June 2014 to June 2015, ultimately including 74,251 post-exclusion criteria. A logistic regression model was conducted to estimate the interaction effect after controlling for pertinent covariates. The attributable proportion (AP), the relative excess risk due to interaction (RERI), the synergy index (SI), and multiplicative-scale interaction were computed to determine the interaction effect.ResultsAmong a total of 74,251 children, 192 (0.26%) were diagnosed with ASD. The adjusted odds ratio for ASD in children with BA alone was 3.82 (95% confidence interval [CI] 2.42–6.02), for FS alone 3.06 (95%CI 1.48–6.31), and for comorbid BA and FS 21.18 (95%CI 9.10–49.30), versus children without BA or FS. The additive interaction between BA and FS showed statistical significance (P < 0.001), whereas the multiplicative interaction was statistically insignificant (P > 0.05).LimitationsThis study can only demonstrate the relationship between the interaction of BA and FS with ASD but cannot prove causation. Animal brain experimentation is necessary to unravel its neural mechanisms. A larger sample size, ongoing monitoring, and detailed FS classification are needed for confirming BA-FS interaction in ASD.ConclusionIn this extensive cross-sectional study, both BA and FS were significantly linked to ASD. The coexistence of these factors was associated with an additive increase in ASD prevalence, surpassing the cumulative risk of each individual factor.

Cardiac Troponin I as an Early Prognostic Indicator in Asphyxiated Neonates

Background: Myocardial damage, estimated to occur in 28%–73% of asphyxiated neonates, 1 is a major cause of mortality in perinatal asphyxia, and survivors can show significant myocardial morbidity as well. 2 Study Setting and Design: This study is a hospital-based prospective cohort study, done at the pediatrics department of a tertiary care hospital in northern India, from December 2020 to June 2022. Materials and Methods: 40 asphyxiated neonates with an APGAR score of &lt;7 at 1 minute of life, as per the WHO–Neonatal Perinatal Database, were included in the study. They were graded as hypoxic ischemic encephalopathy (HIE) I (mild), II (moderate), and III (severe) based on Sarnat and Sarnat staging. The blood samples at 0 and 6 hours of life were taken for studying successive changes in the values of high-sensitivity cardiac troponin I (hs-cTnI) and creatinine phospho-kinase-myocardium-bound (CPK-MB). These were compared with various parameters such as electrocardiograph (ECG) findings, 2D-ECHO abnormalities, HIE severity, and outcome. Results: Among the two biomarkers that were assessed, hs-cTnI had the highest diagnostic value for detecting myocardial injury and was corelated with the severity of HIE and higher chances of death. Conclusion: The troponin I levels, in contrast to CPK-MB levels, were significantly associated with the outcome of the patient, implying that asphyxiated babies with elevated troponin I levels have a poorer prognosis and a higher mortality rate.

Clinical-functional correlation with brain volumetry in severe perinatal asphyxia: a case report

BackgroundHypoxic-ischemic encephalopathy (HIE) appears in neurological conditions where some brain areas are likely to be injured, such as deep grey matter, basal ganglia area, and white matter subcortical periventricular áreas. Moreover, modeling these brain areas in a newborn is challenging due to significant variability in the intensities associated with HIE conditions. This paper aims to evaluate functional measurements and 3D machine learning models of a given HIE case by correlating the affected brain areas with the pathophysiology and clinical neurodevelopmental.Case presentationA comprehensive analysis of a term infant with perinatal asphyxia using longitudinal 3D brain information from Machine Learning Models is presented. The clinical analysis revealed the perinatal asphyxia diagnosis with APGAR <5 at 5 and 10 minutes, umbilical arterial pH of 7.0 BE of -21.2 mmol / L), neonatal seizures, and invasive ventilation mechanics. Therapeutic interventions: physical, occupational, and language neurodevelopmental therapies. Epilepsy treatment: vagus nerve stimulation, levetiracetam, and phenobarbital. Furthermore, the 3D analysis showed how the volume decreases due to age, exhibiting an increasing asymmetry between hemispheres. The results of the basal ganglia area showed that thalamus asymmetry, caudate, and putamen increase over time while globus pallidus decreases. Clinical outcomes: spastic cerebral palsy, microcephaly, treatment-refractory epilepsy.ConclusionsSlight changes in the basal ganglia and cerebellum require 3D volumetry for detection, as standard MRI examinations cannot fully reveal their complex shape variations. Quantifying these subtle neurodevelopmental changes helps in understanding their clinical implications. Besides, neurophysiological evaluations can boost neuroplasticity in children with neurological sequelae by stimulating new neuronal connections.

Clinical analysis of complete uterine rupture during pregnancy

BackgroundUterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture.MethodsData from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People’s Hospital between January 2015 and December 2022 were analyzed retrospectively.ResultsIn total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1–40+3 weeks), and the average bleeding volume was 1896.97 ml (200–6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%).ConclusionsThe site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.

Fetal Outcome in Younger Age Pregnant Female; A Tertiary Care Hospital

Background: The efficacy of Caesarean section in managing breech births surpasses that of a vaginal birth. Risk factors associated with breech presentation include prematurity,recurrent pregnancies, uterine anomalies, and fetal abnormalities. this study aimed toassess fetal outcomes in younger age pregnant female.Materials and Methods:This cross-sectional study was performed in Department of Obstetrics and Gynecology at Mardan Medical Complex, Mardan. The study conducted in 12 months duration from January to December 2020. All data including patients' history,and clinical tests were collected through designed proforma. All recruited patients and fetal were monitor. All data were analyzed through Microsoft excel 2016.Results: Fetal outcomes revealed that out of the total cases, 53.6% found in age group 18-25 years and 46.4% in age 26-33 years. Apgar scores found low in 17.8%, low birth weight fetus observed in 17.8%, birth asphyxia in 32.9%, brachial plexus in 12.5%, andfetal distress in 11.4%.Conclusion: This study highlights that fetal birth issues including low birth weight, birth asphyxia, brachial plexus, and detal distress are common here in our region. It is a crucial to take additional precautions, including vigilant labor monitoring and thorough preparation for infant resuscitation, to mitigate these issues within our local Khyber Pakhtunkhwa community. Awareness of the risks associated with each option can aid in personalized decision-making regarding breech delivery, adding value to the decision-making process. Therefore, the choice of delivery method for breech presentations should be informed by the findings of this study.

Induction of labor in term pregnancies with isolated polyhydramnios: Is it beneficial or harmful?

To compare rates of adverse pregnancy outcomes in term pregnancies complicated by polyhydramnios between women who had induction of labor (IOB) versus women who had expectant management. This multicenter retrospective study included term pregnancies complicated by isolated polyhydramnios. Patients who underwent IOB were compared with those who had expectant management. The primary outcome was defined as a composite adverse maternal outcome, and secondary outcomes were various maternal and neonatal adverse outcomes. Univariate analyses were followed by multivariate logistic regression. A total of 865 pregnancies with term isolated polyhydramnios were included: 169 patients underwent IOB (19.5%), while 696 had expectant management and developed spontaneous onset of labor (80.5%). Women who underwent IOB had significantly higher rates of composite adverse maternal outcome (23.1% vs 9.8%, P < 0.01), prolonged hospital stay, perineal tear grade 3/4, intrapartum cesarean, postpartum hemorrhage, blood products transfusion, and neonatal asphyxia compared with expectant management. While the perinatal fetal death rate was similar between the groups (0.6% vs 0.6%, P = 0.98), the timing of the loss was different. Four women in the expectant management group had a stillbirth, while in the induction group one case of intrapartum fetal death occurred due to uterine rupture. Multivariate analyses revealed that IOB was associated with a higher rate of composite adverse maternal outcome (adjusted odds ratio, 2.22 [95% CI, 1.28-3.83]; P < 0.01). IOB in women with term isolated polyhydramnios is associated with higher rates of adverse maternal outcomes in comparison to expectant management. Further research is needed to determine the optimal approach for the management of isolated polyhydramnios at term.

Use of ABGA Parameters as predictive tool for Evaluation Of Outcomes Of Perinatal Asphyxia in Term And Preterm Newborns from central India: A Prospective Observational Study

Background: Perinatal asphyxia (PNA) is one of the three major cause of morbidity and mortality in India. ABG analysis may help to predict outcome of babies with Perinatal asphyxia. Aim of study was to identify Arterial blood gas analysis parameter as a predictor of outcome of newborns with perinatal asphyxia.Methods: We included 144 newborns, with perinatal asphyxia who were born in our tertiary health care centre during March 2021 to September 2022. Extremely low birth weight babies and any baby with major congenital malformation were excluded from study. Babies were resuscitated in delivery room, then shifted immediately to NICU, stabilised and sample for arterial blood gas analysis (ABGA) was taken within first hour of life, then the babies were intervened accordingly. The outcomes were analyzed, correlated with the initial ABGA and compared among the study group.Conclusion: We found that pH and HCO3 are better markers in predicting the outcome of perinatal asphyxiain newborns. HCO3 had the highest specificity (99.18%) followed by pH (97.54%). Discharge was higher withHCO3(mmol/L) &gt;10 while death was significantly higher in HCO3(mmol/L)&lt;10.This study gives an advantageover other studies conducted on cord blood sampling at birth as resuscitation of the baby is of more priority than sampling for the outcome while the amount of time taken for result and interpretation is the same. Along with the APGAR score, Arterial blood gas analysis within one hour can be used as a better predictive tool for outcome in newborns with perinatal asphyxia.

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi.

Neonatal deaths and stillbirths are significant public health concerns in Pakistan, with an estimated stillbirth rate of 43 per 1,000 births and a neonatal mortality rate of 46 deaths per 1,000 live births. Limited access to obstetric care, poor health seeking behaviors and lack of quality healthcare are the leading root causes for stillbirths and neonatal deaths. Rehri Goth, a coastal slum in Karachi, faces even greater challenges due to extreme poverty, and inadequate infrastructure. This study aims to investigate the causes and pathways leading to stillbirths and neonatal deaths in Rehri Goth to develop effective maternal and child health interventions. A mixed-method cohort study was nested with the implementation of large maternal, neonatal and child health program, captured all stillbirths and neonatal death during the period of May 2014 till June 2018. The Verbal and Social Autopsy (VASA) tool (WHO 2016) was used to collect primary data from all death events to determine the causes as well as the pathways. Interviews were conducted both retrospectively and prospectively with mothers and caregivers. Two trained physicians reviewed the VASA form and the medical records (if available) and coded the cause of death blinded to each other. Descriptive analysis was used to categorize stillbirth and neonatal mortality data into high- and low-mortality clusters, followed by chi-square tests to explore associations between categories, and concluded with a qualitative analysis. Out of 421 events captured, complete VASA interviews were conducted for 317 cases. The leading causes of antepartum stillbirths were pregnancy-induced hypertension (22.4%) and maternal infections (13.4%), while obstructed labor was the primary cause of intrapartum stillbirths (38.3%). Neonatal deaths were primarily caused by perinatal asphyxia (36.1%) and preterm birth complications (27.8%). The qualitative analysis on a subset of 40 death events showed that health system (62.5%) and community factors (37.5%) contributing to adverse outcomes, such as delayed referrals, poor triage systems, suboptimal quality of care, and delayed care-seeking behaviors. The study provides an opportunity to understand the causes of stillbirths and neonatal deaths in one of the impoverished slums of Karachi. The data segregation by clusters as well as triangulation with qualitative analysis highlight the needs of evidence-based strategies for maternal and child health interventions in disadvantaged communities.

RENAL DYSFUNCTION IN PRETERM INFANTS WITH PERINATAL PATHOLOGY: RISK FACTORS, SENSITIVITY AND SPECIFICITY OF LABORATORY MARKERS OF DAMAGE

RENAL DYSFUNCTION IN PRETERM INFANTS WITH PERINATAL PATHOLOGY: RISK FACTORS, SENSITIVITY AND SPECIFICITY OF LABORATORY MARKERS OF DAMAGE

The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor

The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future. This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor. This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.

Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia

BackgroundDespite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it’s contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH).MethodsA hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05.ResultsThe magnitude of neonatal death was 14.2% (95% CI: 0.099–0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die.ConclusionThe prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.

Risk factors of delayed developmental milestones among infants attending RCH clinics in Dodoma region. A cross-sectional studydoma region

Background: Delayed Developmental Milestones are defined as slow to attain typical developmental milestones in one or more developmental areas. This study aimed to assess risk factors of delayed developmental milestones among infants in the Dodoma Region. Methods: We conducted a health facility-based cross-sectional descriptive study using the pathways developmental screening tool. A total of 262 mothers with their children were enrolled, the study population were all neonates delivered at the study sites during the study period. Three data collection methods were utilized to obtain information for this study: observation, interviewer-administered questionnaires, and documentary review. Ethical approval was obtained from the Ethical Review Board of the University of Dodoma SAS version 9.4 was used for data analysis. The association between developmental status and factors was assessed with Chi-square and binomial logistic regression. Results: Notably, infants born with birth asphyxia were more likely three times to develop delayed developmental milestones as opposed to those without birth asphyxia [adjusted risk ratio =3.22, 95%, [1.97, 5.46], probability value= &lt;.0001]. Birth weight was significantly associated with delayed developmental milestones; infants who were born with a birth weight of ≥4000gm had more risk of developing delayed developmental milestones compared to those with a birth weight of 2500-3999gm [adjusted risk ratio 0.48, 95%, [0.26, 0.92], probability value = 0.0256]. Regarding mode of delivery, the risk of developing delayed developmental milestones was less among infants born via caesarean section compared to those who were born via spontaneous vaginal delivery [adjusted risk ratio 0.47[0.18, 0.99], probability value = 0.0461]. Conclusion: Delayed developmental milestones are a burden in developing countries. The risk factors are known, and they are based on the individual to the community level; birth asphyxia was identified as a possible risk factor that has been reported in many studies and has an impact on children's development.

Risk factors for infection and outcomes in infants with neonatal encephalopathy: a cohort study

BackgroundTo determine the association between early infection risk factors and short-term outcomes in infants with neonatal encephalopathy following perinatal asphyxia (NE).MethodsA retrospective population-based cohort study utilizing the National Neonatal Research Database that included infants with NE admitted to neonatal units in England and Wales, Jan 2008–Feb 2018. Exposure: one or more of rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics. Primary outcome: death or nasogastric feeds/nil by mouth (NG/NBM) at discharge. Secondary outcomes: organ dysfunction; length of stay; intraventricular hemorrhage; antiseizure medications use.Results998 (13.7%) out of 7265 NE infants had exposure to early infection risk factors. Primary outcome (20.3% vs. 23.1%, OR 0.87 (95% CI 0.71–1.08), p = 0.22), death (12.8% vs. 14.0%, p = 0.32) and NG/NBM (17.4% vs. 19.9%. p = 0.07) did not differ between the exposed and unexposed group. Time to full sucking feeds (OR 0.81 (0.69–0.95)), duration (OR 0.82 (0.71–0.95)) and the number of antiseizure medications (OR 0.84 (0.72–0.98)) were lower in exposed than unexposed infants after adjusting for confounders. Therapeutic hypothermia did not alter the results.ConclusionsInfants with NE exposed to risk factors for early-onset infection did not have worse short-term adverse outcomes.ImpactRisk factors for early-onset neonatal infection, including rupture of membranes >18 h, maternal group B streptococcus colonization, chorioamnionitis, maternal pyrexia or antepartum antibiotics, were not associated with death or short-term morbidity after cooling for NE.Despite exposure to risk factors for early-onset neonatal infection, infants with NE reached oral feeds earlier and needed fewer anti-seizure medications for a shorter duration than infants with NE but without such risk factors.This study supports current provision of therapeutic hypothermia for infants with NE and any risk factors for early-onset neonatal infection.

Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia

BackgroundBirth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and...

Development, Validation and Clinical Utility of a Risk Prediction Model for Maternal and Neonatal Adverse Outcomes in Pregnant Women with Hypothyroidism.

This study aimed to create, verify and assess the clinical utility of a prediction model for maternal and neonatal adverse outcomes in pregnant women with hypothyroidism. A prediction model was developed, and its accuracy was tested using data from a retrospective cohort. The study focused exclusively on female patients diagnosed with hypothyroidism who were admitted to a tertiary hospital. The development and validation cohort comprised individuals who gave birth between 1 October 2020 and 31 December 2022. The primary outcome was a combination of crucial maternal and newborn problems (eg premature births, abortions and neonatal asphyxia). The prediction model was developed using logistic regression. Evaluation of the model's performance was conducted based on its ability to discriminate, calibrate and provide clinical value. In total, nine variables were chosen to develop the predictive model for adverse maternal and neonatal outcomes during pregnancy with hypothyroidism. The area under the curve of the model for predicting maternal adverse outcomes was 0.845, and that for predicting neonatal adverse outcomes was 0.685. The calibration plots showed good agreement between the nomogram predictions and the actual observations in both the training and validation cohorts. Furthermore, decision curve analysis suggested that the nomograms were clinically useful and had good discriminative power to identify high-risk mother-infant cases. Two models to predict the risk probability of maternal and neonatal adverse outcomes in pregnant women with hypothyroidism were developed and verified to assist physicians in evaluating maternal and neonatal adverse outcomes throughout pregnancy with hypothyroidism and to facilitate decision-making regarding therapy.

Admission Cardiotocography and Neonatal Outcomes at a Tertiary Health Facility in Southwestern Nigeria

Background: Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. Objective: This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility. Materials and Methods: A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P &lt; 0.05. Results: The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P &lt; 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery. Conclusion: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological.

Fetal Outcome among Women with Postdate Pregnancy

OBJECTIVE: The study aimed to determine the mode of delivery and fetal outcome among women with postdated pregnancies. METHODOLOGY: This cross-sectional study was conducted from July to December 2020 in the Department of Gynecology, Hayatabad Medical Complex, Peshawar. A total of 287 women with postdated pregnancies (beyond 41 weeks) were selected through a convenient sampling technique for the study and followed to detect expected fetal outcomes. All women of age 20-45 with no signs of labor onset and cepahlic presentation of singleton pregnancy were included, while women with retained placenta detected by ultrasound, women with a medical disorder like coagulopathies (Haemophilia, Von Willebrand disease, Thrombocytopenia, DIC, Protein S deficiency, Protein C deficiency) detected by the specific investigation were excluded from the study. Data was analyzed using SPSS version 20. RESULTS: The mean age of the sample was 30.5 years, with a standard deviation of 6.1 years. The mean parity of the sample was 2.1±1.5. The mean BMI of the sample was 26.1±3.8kg/m2. On follow-up, fetal distress in 16%, macrosomia in 18.5%, birth asphyxia in 18.1%, meconium aspiration in 8.4% and NICU admission in 9.1%. None of the neonates died in this study. CONCLUSION: Postdated pregnancy carries a high risk of fetal distress, macrosomia and birth asphyxia. We recommend more large-scale surveys as well as trials to determine the efficacy of induction before pregnancy enters the postdate period and reduce the morbidity and mortality due to postdate pregnancies. KEYWORDS: Postdate Pregnancy, Meconium Aspiration, Birth Asphyxia, Fetal Distress, Intrauterine Growth Restriction, Macrosomia

Factors Influencing Neonatal Health Conditions in Zambia: A Systematic Literature Review

Neonatal mortalities and health outcomes among infants are serious health conditions facing public health practice in Zambia and hindering the attainment of SDG 3 and target 3.2 by 2030. To address the problem of neonatal mortalities and health conditions in Zambia and inform relevant intervention, the present systematic literature review aimed to investigate the factors influencing neonatal mortalities and health conditions in Zambia. Methodology: A systematic literature review was done in order to assess factors influencing neonatal disorders in Zambia to document findings other researchers in Zambia had reported. The search strategies involved reviewing literature from Zambia using Google scholar and PubMed data bases. Selection of studies considered as eligible by this systematic literature review tool three steps namely topics only, abstracts and full articles. A CASP systematic review checklist 2018 tool was used to appraise included studies validity, results and relevance of results to the local situation. Findings of the articles selected for inclusion on the study were analyzed thematically based on themes generated from the study objective and presented in a narrative form. A data extraction table utilized and included among others a critical appraisal section for the included studies. Findings: On the prevalence of neonatal mortalities and health conditions among newborns in Zambia, the present systematic literature review found that in Zambia, neonatal mortalities and health disorders are a very serious public health problem among new borns in the nation and that majority of Zambian neonates die in a span of seven days after birth in with the rural regions which are underdeveloped bearing the brunt of these neonatal deaths and health conditions. The health conditions among Zambian neonates include respiratory syncytial virus, sepsis, premature births and respiratory dysfunctions among others. Regarding the factors influencing neonatal disorders among newborns in Zambia, the review found that in Zambia, neonatal mortalities and health conditions are caused by several factors namely neonatal sepsis, intrauterine infections, birth asphyxia, bacterial infections, premature deliveries and low-birth weight as the main factors while others include but are not limited to maternal level of education, being a male infant, severe intrapartum incidents respiratory syncytial virus, twin pregnancies and placental abruption. The study therefore concludes that neonatal mortalities and disorders are very prevalent among Zambian newborns with neonatal sepsis and low birth weight being some of the key causes of these health outcomes.

Evaluation of Psychomotor Development in Children Treated with Therapeutic Hypothermia

Introduction. Perinatal asphyxia is a common neonatal problem. It remains a leading cause of neonatal morbidity and mortality and plays a major role in motor and intellectual developmental deficits in children. Complications of cerebral hypoxia in asphyxiated newborns can be treated with therapeutic hypothermia. The treatment involves moderate cooling of the newborn to minimize the consequences of hypoxia. Aim. To evaluate psychomotor development and detect impairments and deficits in motor functions, perception, speech, manual functions and social contacts in children treated with therapeutic hypothermia. Material and Methods. The study was carried out on a group of 27 children treated with therapeutic hypothermia. The data involved an analysis of medical records and the results of psychomotor development evaluation using the Munich Functional Development Diagnostics scale. Results. We found no significant delay in the developmental age of the children for walking. The mean developmental age for this area was 30.56 months (SD=8.42 months), for fine motor skills, speaking, independence and social skills were similar. The mean developmental age for understanding speech was 28.76 months (SD=7.92 months). The mean developmental age for cognitive skills was 27.73 months (Me=28 months). The speech development was slightly delayed for their age (x̅=3.2 months, SD=1.09 months). Conclusions. Children aged up to 1 year showed normal psychomotor development. Small deficits in cognitive processes and social skills were identified in children in the second and third years of life. The greatest developmental delays were identified in children in the fourth, fifth and sixth years of life. (JNNN 2024;13(1):9–16)

Incidence and development of validated mortality prediction model among asphyxiated neonates admitted to neonatal intensive care unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia, 2021: retrospective follow-up study

IntroductionPerinatal asphyxia is failure to maintain normal breathing at birth. World Health Organization indicates that perinatal asphyxia is the third major cause of neonatal mortality in developing countries accounting for 23% of neonatal deaths every year. At global and national level efforts have done to reduce neonatal mortality, however fatalities from asphyxia remains high in Ethiopia (24%). And there are no sufficient studies to show incidence and prediction of mortality among asphyxiated neonates. Developing validated risk prediction model is one of the crucial strategies to improve neonatal outcomes with asphyxia. Therefore, this study will help to screen asphyxiated neonate at high-risk for mortality during admission by easily accessible predictors. This study aimed to determine the incidence and develop validated Mortality Prediction model among asphyxiated neonates admitted to the Neonatal Intensive Care Unit at Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.MethodRetrospective follow-up study was conducted at Felege-Hiwot Comprehensive Specialized Hospital from September 1, 2017, to March 31, 2021. Simple random sampling was used to select 774 neonates, and 738 were reviewed. Since was data Secondary, it was collected by checklist. After the description of the data by table and graph, Univariable with p-value < 0.25, and stepwise multivariable analysis with p-value < 0.05 were done to develop final reduced prediction model by likelihood ratio test. To improve clinical utility, we developed a simplified risk score to classify asphyxiated neonates at high or low-risk of mortality. The accuracy of the model was evaluated using area under curve, and calibration plot. To measures all accuracy internal validation using bootstrapping technique were assessed. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities.ResultIncidence of neonatal mortality with asphyxia was 27.2% (95% CI: 24.1, 30.6). Rural residence, bad obstetric history, amniotic fluid status, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck were identified in the final risk prediction score. The area under the curve for mortality using 7 predictors was 0.78 (95% CI 0.74 to 0.82). With ≥ 7 cutoffs the sensitivity and specificity of risk prediction score were 0.64 and 0.82 respectively.Conclusion and recommendationIncidence of neonatal mortality with asphyxia was high. The risk prediction score had good discrimination power built by rural residence, bad obstetric history, stained amniotic fluid, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck. Thus, using this score chart and improve neonatal and maternal service reduce mortality among asphyxiated neonates.