Early Identification Of Neonates Research Articles

Implementing Explainable Machine Learning Models for Practical Prediction of Early Neonatal Hypoglycemia.

Hypoglycemia is a common metabolic disorder that occurs in the neonatal period. Early identification of neonates at risk of developing hypoglycemia can optimize therapeutic strategies in neonatal care. This study aims to develop a machine learning model and implement a predictive application to assist clinicians in accurately predicting the risk of neonatal hypoglycemia within four hours after birth. Our retrospective study analyzed data from neonates born ≥35 weeks gestational age and admitted to the well-baby nursery between 1 January 2011 and 31 August 2021. We collected electronic medical records of 2687 neonates from a tertiary medical center in Southern Taiwan. Using 12 clinically relevant features, we evaluated nine machine learning approaches to build the predictive models. We selected the models with the highest area under the receiver operating characteristic curve (AUC) for integration into our hospital information system (HIS). The top three AUC values for the early neonatal hypoglycemia prediction models were 0.739 for Stacking, 0.732 for Random Forest and 0.732 for Voting. Random Forest is considered the best model because it has a relatively high AUC and shows no significant overfitting (accuracy of 0.658, sensitivity of 0.682, specificity of 0.649, F1 score of 0.517 and precision of 0.417). The best model was incorporated in the web-based application integrated into the hospital information system. Shapley Additive Explanation (SHAP) values indicated mode of delivery, gestational age, multiparity, respiratory distress, and birth weight < 2500 gm as the top five predictors of neonatal hypoglycemia. The implementation of our machine learning model provides an effective tool that assists clinicians in accurately identifying at-risk neonates for early neonatal hypoglycemia, thereby allowing timely interventions and treatments.

MiR-126 and miR-146a as Melatonin-Responsive Biomarkers for Neonatal Brain Ischemia

Despite advances in obstetric and neonatal care, challenges remain in early identification of neonates with encephalopathy due to hypoxia-ischemia who are undergoing therapeutic hypothermia. Therefore, there is a deep search for biomarkers that can identify brain injury. The aims of this study were to investigate the serum and brain expressions of two potential biomarkers, miR-126/miR-146a, in a preclinical model of hypoxia-ischemia (HI)–induced brain injury, and to explore their modulation during melatonin treatment. Seven-day-old rats were subjected to permanent ligation of the right carotid artery followed by 2.5 h hypoxia (HI). Melatonin (15 mg/kg) was administered 5 min after HI. Serum and brain samples were collected 1, 6 and 24 h after HI. Results show that HI caused a significant increase in the circulating levels of both miR-126 and miR-146a during the early phase of ischemic brain damage development (i.e. 1 h), with a parallel and opposite pattern in the ischemic cerebral cortex. These effects are not observed 24 h later. Treatment with melatonin restored the HI-induced effects on miR-126/miR-146a expressions, both in the cerebral cortex and in serum. We conclude that miR-126/miR-146a are promising biomarkers of HI injury and demonstrate an associated change in concentration following melatonin treatment.

Risk factors and early markers for echovirus type 11 associated haemorrhage-hepatitis syndrome in neonates, a retrospective cohort study.

Echovirus type 11(E-11) can cause fatal haemorrhage-hepatitis syndrome in neonates. This study aims to investigate clinical risk factors and early markers of E-11 associated neonatal haemorrhage-hepatitis syndrome. This is a multicentre retrospective cohort study of 105 neonates with E-11 infection in China. Patients with haemorrhage-hepatitis syndrome (the severe group) were compared with those with mild disease. Clinical risk factors and early markers of haemorrhage-hepatitis syndrome were analysed. In addition, cytokine analysis were performed in selective patients to explore the immune responses. In addition to prematurity, low birth weight, premature rupture of fetal membrane, total parenteral nutrition (PN) (OR, 28.7; 95% CI, 2.8-295.1) and partial PN (OR, 12.9; 95% CI, 2.2-77.5) prior to the onset of disease were identified as risk factors of developing haemorrhage-hepatitis syndrome. Progressive decrease in haemoglobin levels (per 10 g/L; OR, 1.5; 95% CI, 1.1-2.0) and platelet (PLT) < 140 × 10⁹/L at early stage of illness (OR, 17.7; 95% CI, 1.4-221.5) were associated with the development of haemorrhage-hepatitis syndrome. Immunological workup revealed significantly increased interferon-inducible protein-10(IP-10) (P < 0.0005) but decreased IFN-α (P < 0.05) in peripheral blood in severe patients compared with the mild cases. PN may potentiate the development of E-11 associated haemorrhage-hepatitis syndrome. Early onset of thrombocytopenia and decreased haemoglobin could be helpful in early identification of neonates with the disease. The low level of IFN-α and elevated expression of IP-10 may promote the progression of haemorrhage-hepatitis syndrome.

A neonate with acquired long QT from placental transfer of medications

Long QT Syndrome (LQTS) can present in the neonate with bradycardia and AV block and confers significant risk for life threatening ventricular arrhythmias. We report a case of a neonate presenting with complex bradyarrhythmias secondary to acquired LQTS after maternal overdose of QT-prolonging medications (haloperidol and sertraline). When the mother was brought in to the delivery center unconscious, fetal bradycardia was noted and the baby was emergently delivered prematurely. The newborn’s initial ECG showed bradycardia with AV node conduction block, rate related His-Purkinje conduction aberration with varying QRS morphology and a QTc &gt;600 ms. She continued to be bradycardic through her first day of life with echocardiogram showing mild cardiac dysfunction. With the elimination of the offending medication from her circulation, the infant’s rate and function abnormalities resolved and QTc normalized. Both haloperidol and sertraline are known to be strong suppressors of the HERG potassium channel that plays an important role in myocardial repolarization and both medications can cross the placenta. Maternal overdose can cause transient QT-prolonging effect similar to that of inherited LQTS type 2. Given the high risk for sudden death in affected newborns, reporting this case is aimed to raise the awareness of acquired LQTS by placental transfer of medication. Early identification of neonates at risk should prompt ECG testing. If long QT is identified, the newborn should be closely monitored with care to avoid any further QT prolonging medications or conditions, until the toxic medication effect resolves.

Risk Factors of Neonatal Jaundice at Al Kadhimiya Pediatrics Hospital in Baghdad, Iraq

Jaundice is the most common condition that requires medical attention in newborns. Jaundice is observed during the 1st wk after birth in approximately 60% of term infants and 80% of preterm infants. Early identification of neonates at great risk of Neonatal Hyperbilirubinemia is of paramount importance in preventing brain damage.Objectives: to investigate the prevalence and risk factors associated with neonatal jaundice at Al Kadhimiya pediatrics hospital.Materials and Methods: A cross sectional study was conducted at Al Kadhimiya pediatrics hospital. Data collection took place from 8th February 2015 -10th May 2015. Sample size was (160) neonates who were diagnosed with neonatal hyperbilirubinemia. At date of data gathering, a questionnaire developed by the researchers based on literatures review was completed. Verbal Consent to participate in the study was obtained from all parents. Total serum bilirubin was measured using venous sampling. P value

Vaginal Delivery and Low Gestational Age are Key Risk Factors for Hypernatremia in Neonates&lt;32 Weeks

Preterm neonates frequently experience hypernatremia (plasma sodium concentrations >145 mmol/l), which is associated with clinical complications, such as intraventricular hemorrhage. In this single center retrospective observational study, the following 7 risk factors for hypernatremia were analyzed in very low gestational age (VLGA, below 32 weeks) neonates: gestational age (GA), delivery mode (DM; vaginal or caesarian section), sex, birth weight, small for GA, multiple birth, and antenatal corticosteroids. Machine learning (ML) approaches were applied to obtain probabilities for hypernatremia. 824 VLGA neonates were included (median GA 29.4 weeks, median birth weight 1170 g, caesarean section 83%). 38% of neonates experienced hypernatremia. Maximal sodium concentration of 144 mmol/l (interquartile range 142-147) was observed 52 hours (41-65) after birth. ML identified vaginal delivery and GA as key risk factors for hypernatremia. The risk of hypernatremia increased with lower GA from 22% for GA ≥ 31-32 weeks to 46% for GA < 31 weeks and 60% for GA < 27 weeks. A linear relationship between maximal sodium concentrations and GA was found, showing decreases of 0.29 mmol/l per increasing week GA in neonates with vaginal delivery and 0.49 mmol/l/week after cesarean section. Sex, multiple birth and antenatal corticosteroids were not associated hypernatremia. VLGA neonates with vaginal delivery and low GA have the highest risk for hypernatremia. Early identification of neonates at risk and early intervention may prevent extreme sodium excursions and associated clinical complications. Bei Frühgeborenen tritt häufig eine Hypernatriämie (Natrium im Plasma > 145 mmol/l) auf, welche mit klinischen Komplikationen wie Hirnblutungen assoziiert ist. Diese retrospektive Beobachtungsstudie untersuchte folgenden 7 Risikofaktoren für Hypernatriämie bei Neugeborenen mit sehr niedrigem Gestationsalter (VLGA, unter 32 Wochen): Gestationsalter (GA), Entbindungsmodus (DM) (vaginal oder Kaiserschnitt), Geschlecht, Geburtsgewicht, klein für GA, Mehrlingsgeburt und pränatale Lungenreife. Durch maschinelles Lernen (ML) wurden Risikofaktoren für Hypernatriämie analysiert. 824 VLGA-Neugeborene wurden eingeschlossen (GA Median 29,4 Wochen, Geburtsgewicht Median 1170 g, Kaiserschnitt 83%). 38% der Neugeborenen zeigten eine Hypernatriämie. Die maximale Natriumkonzentration von 144 mmol/l (Interquartilbereich 142-147) wurde 52 Stunden (41-65) nach der Geburt beobachtet. ML identifizierte vaginale Geburt und GA als Hauptrisikofaktoren für Hypernatriämie. Die Häufigkeit stieg mit niedrigerem GA von 22% für GA ≥31-32 Wochen auf 46% für GA <31 Wochen und 60% für GA <27 Wochen. Es bestand eine lineare Beziehung zwischen maximalem Natrium und GA (bei vaginaler Geburt Abnahme von 0,29mmol/l pro zunehmender Woche GA; bei Kaiserschnitt Abnahme von 0,49mmol/l pro Woche GA). Geschlecht, Mehrlingsgeburt und Lungenreife waren nicht mit erhöhtem Risiko einer Hypernatriämie assoziiert. VLGA-Neugeborene mit vaginaler Entbindung und niedrigem GA haben das höchste Risiko für Hypernatriämie. Frühes Identifizieren von Risikopatienten und frühe Intervention könnten extreme Natriumexkursionen und damit verbundene klinische Komplikationen verhindern.

Can we delineate brain injury in full-term neonates using serum biomarkers?

ABSTRACT OBJECTIVE: Early identification of neonates at risk of neurological impairment is particularly important for the bedside clinician. Clinical value of S100b and neuron-specific enolase in neonates has not been yet established. We investigated their kinetics and possible early clinical utility in neonatal encephalopathy (NE). STUDY DESIGN: 36 full-term neonates (13 with moderate/severe encephalopathy, 11 with mild encephalopathy, 12 controls) were enrolled and studied prospectively. Serum S100b and neuron-specific enolase (NSE) were measured serially on days(d) 1, 3, 9 and 18 of life. Brain MRI and long-term neurodevelopmental outcome were also assessed. RESULT: Neonates with moderate/severe encephalopathy had significantly increased S100b (d1) and NSE levels (d1, d3, d9) compared to controls. Neuron-specific enolase significantly correlated with the degree of encephalopathy, and a cutoff of 38.8 μg/l (d1) accurately predicted moderate/severe encephalopathy. S100b (d1) cutoff points of 1.6 μg/l and 11.4 μg/l prognosticated severe encephalopathy and death/cerebral palsy, respectively. Both biomarkers correlated well with neuroimaging and Bayley-III scores. CONCLUSION: Combined clinical, laboratory, imaging and neurodevelopmental data indicate that serum S100b and NSE can be useful biomarkers for the diagnosis and prognosis of neonatal brain injury, providing useful information to the bedside clinician.

Diagnostic Accuracy of Clinical Tool 'STOPS' and Serum Procalcitonin for Optimizing Antibiotic Therapy in Neonates Born at ≥ 28 Weeks of Gestation with Neonatal Sepsis.

BackgroundAntibiotic therapy is initiated in neonates on suspicion of sepsis. Optimizing therapy is a felt need of clinicians as prolonged injudicious use increases mortality and morbidity risk.ObjectiveTo evaluate the diagnostic accuracy of clinical tool 'STOPS' and serum procalcitonin (PCT) for identifying neonates with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) and early discontinuation in those with no sepsis.MethodsThe study had a prospective analytical design conducted at a tertiary care hospital. Consecutively admitted neonates with suspected EONS or LONS were enrolled. The 'STOPS' tool comprising sensorium, temperature, oxygenation, perfusion, skin color, and blood sugar was applied at 6 and 12 hours of enrollment. Serum PCT was sent at 12 hr. The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) were estimated.ResultsThe study enrolled 380 neonates, of which 330 were given antibiotics for EONS and 50 for LONS. Temperature disturbance in the EONS group at 12 hr showed a PPV of 100% and a PLR of 9.1 (7.7 – 18). Perfusion assessment at 12 hr had a PPV of 77% and PLR of 8.25 (2.3 – 29). Skin color assessment at 12 hr had a PPV of 100% and PLR of 13.5 (9.7 – 27). The diagnostic accuracy of PCT in the EONS group was unremarkable. In the LONS group, skin color at 12 hr had a PPV of 100% and PLR of 11.2 (8.6 – 19.5). The diagnostic accuracy of PCT in the LONS group showed a PPV of 82% and PLR of 7 (1.7 – 29).ConclusionIdentifying abnormal STOPS parameters was superior to PCT alone in EONS and as good as PCT in LONS. The 'STOPS' tool allows early identification of neonates with no sepsis, thereby optimizing antibiotic use.

Predicting neonatal respiratory distress syndrome and hypoglycaemia prior to discharge: Leveraging health administrative data and machine learning

ObjectivesA major challenge for hospitals and clinicians is the early identification of neonates at risk of developing adverse conditions. We develop a model based on routinely collected administrative data, which accurately predicts two common disorders among early term and preterm (<39 weeks) neonates prior to discharge.Study design.The data included all inpatient live births born prior to 39 weeks (n = 154,755) occurring in the Australian state of Queensland between January 2009 and December 2015. Predictor variables included all maternal data captured in administrative records from the beginning of gestation up to, and including, the delivery, as well as neonatal data recorded at the delivery. Gradient boosted trees were used to predict neonatal respiratory distress syndrome and hypoglycaemia prior to discharge, with model performance benchmarked against a logistic regression models. ResultsThe gradient boosted trees model achieved very high discrimination for respiratory distress syndrome [AUC = 0.923, 95% CI (0.917, 0.928)] and good discrimination for hypoglycaemia [AUC = 0.832, 95% CI (0.827, 0.837)] in the validation data, as well as outperforming the logistic regression models. ConclusionOur study suggests that routinely collected health data have the potential to play an important role in assisting clinicians to identify neonates at risk of developing selected disorders shortly after birth. Despite achieving high levels of discrimination, many issues remain before such models can be implemented in practice, which we discuss in relation to our findings.

Utility of cord blood bilirubin as a predictors of significant neonatal Hyperbilirubinemia in healthy term neonate

Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 &amp; 72 hours was done to predict significant hyperbilirubinemia.Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level &gt;3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (&gt;3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin &gt;17mg/dl at the end of 72 hours with cord blood bilirubin &gt;3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin &gt;3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.

Development, evaluation and validation of a screening tool for late onset bacteremia in neonates \u2013 a pilot study

BackgroundClinical and laboratory parameters can aid in the early identification of neonates at risk for bacteremia before clinical deterioration occurs. However, current prediction models have poor diagnostic capabilities. The objective of this study was to develop, evaluate and validate a screening tool for late onset (> 72 h post admission) neonatal bacteremia using common laboratory and clinical parameters; and determine its predictive value in the identification of bacteremia.MethodsA retrospective chart review of neonates admitted to a neonatal intensive care unit (NICU) between March 1, 2012 and January 14, 2015 and a prospective evaluation of all neonates admitted between January 15, 2015 and March 30, 2015 were completed. Neonates with late-onset bacteremia (> 72 h after NICU admission) were eligible for inclusion in the bacteremic cohort. Bacteremic patients were matched to non-infected controls on several demographic parameters. A Pearson’s Correlation matrix was completed to identify independent variables significantly associated with infection (p < 0.05, univariate analysis). Significant parameters were analyzed using iterative binary logistic regression to identify the simplest significant model (p < 0.05). The predictive value of the model was assessed and the optimal probability cut-off for bacteremia was determined using a Receiver Operating Characteristic curve.ResultsMaximum blood glucose, heart rate, neutrophils and bands were identified as the best predictors of bacteremia in a significant binary logistic regression model. The model’s sensitivity, specificity and accuracy were 90, 80 and 85%, respectively, with a false positive rate of 20% and a false negative rate of 9.7%. At the study bacteremia prevalence rate of 51%, the positive predictive value, negative predictive value and negative post-test probability were 82, 89 and 11%, respectively.ConclusionThe model developed in the current study is superior to currently published neonatal bacteremia screening tools. Validation of the tool in a historic data set of neonates from our institution will be completed.

Update on the current management of newborns with neonatal encephalopathy

Hypoxic-ischemic encephalopathy is a subtype of neonatal encephalopathy and a major contributor to global neonatal morbidity and mortality. Despite advances in obstetric and neonatal care there are still challenges in accurate determination of etiology of neonatal encephalopathy. Thus, identification of intrapartum risk factors and comprehensive evaluation of the neonate is important to determine the etiology and severity of neonatal encephalopathy. In developed countries, therapeutic hypothermia as a standard of care therapy for neonates with hypoxic-ischemic encephalopathy has proven to decrease incidence of death and neurodevelopmental disabilities, including cerebral palsy in surviving children. Advances in neuroimaging, brain monitoring modalities, and biomarkers of brain injury have improved the ability to diagnose, monitor, and treat newborns with encephalopathy. However, challenges remain in early identification of neonates at risk for hypoxic-ischemic brain injury, and determination of the timing and extent of brain injury. Using imaging studies such as Neonatal MRI and MR spectroscopy have proven to be most useful in predicting outcomes in infants with encephalopathy within the first week of life, although comprehensive neurodevelopmental assessments still remains the gold standard for determining long term outcomes. Future studies are needed to identify other newborns with encephalopathy that might benefit from therapeutic hypothermia and to determine the efficacy of other adjunctive neuroprotective strategies. This review focuses on newer evidence and advances in diagnoses and management of infants with neonatal encephalopathy, including novel therapies, as well as prognostication of outcomes to childhood.

Postoperative Abdominal NIRS Values Predict Low Cardiac Output Syndrome in Neonates.

The development of low cardiac output syndrome (LCOS) after cardiopulmonary bypass (CPB) occurs in up to 25% of neonates and is associated with increased morbidity. Invasive cardiac output monitors such as pulmonary artery catheters have limited availability and are costly. Near-infrared spectroscopy (NIRS) is a noninvasive tool for monitoring regional oxygenation in neonates in the cardiac intensive care unit (CICU). We hypothesize that anterior abdominal NIRS may aid in the early identification of LCOS after cardiac surgery. Prospective observational study from October 2013 to October 2014 of all neonates with congenital heart disease admitted to the CICU following CPB. Abdominal NIRS values were continuously recorded upon CICU admission and for the subsequent 24-hour period. The primary outcome was the development of LCOS. Low cardiac output syndrome was defined as the presence of metabolic lactic acidosis (pH < 7.3 and lactate > 4) or addition of a new vasoactive agent or a vasoactive inotropic score > 15. Autoregressive time series models were constructed for each patient based on the continuously recorded NIRS values, and patients were stratified by development of LCOS. Twenty-seven neonates met inclusion criteria, of whom 11 developed LCOS. Neonates who developed LCOS had lower constant NIRS values (49% vs. 66%, P < .001). Constant NIRS values less than 58% best predicted development of LCOS with a sensitivity of 100% and specificity of 69%. Lower constant anterior abdominal NIRS values in the early postoperative period may allow early identification of neonates at risk for LCOS.

Hepatitis B and HIV co-infection in pregnant women: indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting.

Sub-Saharan Africa is endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections. HBV/HIV co-infection in women of reproductive age is of clinical and public health importance because these women constitute a significant reservoir for horizontal and perinatal HBV transmission. Childhood HBV vaccination from 6 weeks of age protects most children against chronic HBV infection. However, infants born to HBV/HIV co-infected women are more likely to be infected perinatally, with an increased risk of chronic hepatitis, than infants born to HBV mono-infected women. The aim of our study was to establish the prevalence of HBV infection and HBV/HIV co-infection in pregnant women in KwaZulu-Natal, South Africa, to inform antenatal HBV screening and childhood immunisation policies in South Africa. Stored plasma specimens obtained from 570 pregnant women were tested for hepatitis B surface antigen (HBsAg) and HBV infectivity, as characterised by the presence of hepatitis B e antigen (HBeAg) and/or HBV DNA load. The antenatal HIV prevalence and HBsAg prevalence in this study were 41.6% and 5.3% (95% confidence interval (CI) 3.4 - 7.1), respectively. Overall, 3.1% (95% CI 1.7 - 4.6) of pregnant women were HBV/HIV co-infected, with HBeAg positivity and the HBV DNA load being significantly higher in co-infected women. We report a 5.3% HBV prevalence and a 3.1% HBV/HIV co-infection prevalence in pregnant women from this HIV-endemic region. Routine antenatal HBV screening will allow early identification of neonates who require HBV active-passive immunoprophylaxis at birth. This strategy, together with antenatal antiretrovirals, will reduce the risk of perinatal HBV transmission, especially in high-risk HBV/ HIV co-infected pregnant women.

The prognostic value of amplitude-integrated electroencephalography in neonates with hypoxic-ischemic encephalopathy

Diagnosis of perinatal hypoxic-ischemic encephalopathy (HIE) and early prediction neurological outcome is important and difficult. The aim of this study was to determine the prognostic value of amplitude-integrated electroencephalography (aEEG) for abnormal neurodevelopment outcome in a neonate with HIE. A total of 90 neonates > 32 gestational age (GA) with HIE were enrolled prospectively. All neonates with HIE were categorized into three grades according to the Sarnat and Sarnat clinical scoring system (mild HIE, moderate HIE and severe HIE). aEEG traces were recorded with a cerebral function monitor (CFM) during the first 72 h of life. The neurodevelopment outcome was assessed at 12 months of age of corrected gestational age. The pattern of aEEG correlated with the severity of HIE (p < 0.0001) and subsequent neurodevelopment outcome (p < 0.001). We found that aEEG background patterns exhibited superior prediction of abnormal outcomes at 12 months of age (sensitivity of 91.7% and specificity of 94.3%, positive predictive value of 78.6% and negative predictive value of 98.1%) when compared to aEEG seizure (sensitivity of 94% and specificity of 48%, positive predictive value of 57% and a negative predictive value of 92%). Electroclinical dissociation seizure was detected in 28% of the neonates with HIE. Our results confirm that aEEG is simple and accurate bedside diagnostic method for assessing extension of hypoxic-ischemic brain damage and early identification of neonates with perinatal HIE who are at high risk of neurodevelopmental impairment.

342: Severity of antenatal hydronephrosis as a predictor of urologic anomalies after birth

a predictor of urologic anomalies after birth Ravi de Roo, Emily Kleinrouweler, Tonny Bouts, Ben Mol, Eva Pajkrt Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, Emma Childrens Hospital, Academic Medical Center, Department of Pediatric Nephrology, Amsterdam, Netherlands OBJECTIVE: When antenatal hydronephrosis (ANH, defined as anteroposterior pelvic diameter (APPD) 5-7mm) is diagnosed at the 20 weeks anomaly scan, (inter-)national guidelines recommend follow-up at 30 weeks. Fetuses with APPD 10mm are referred for postnatal work up. To evaluate the usefulness of these guidelines, we estimated the prognostic value of degree of ANH at the 20 and 30 weeks scan for postnatal urologic anomalies, surgery and solitary functioning kidney in our center. STUDY DESIGN: We performed a historical cohort study of all fetuses with isolated ANH 5mm at the 20 weeks anomaly scan diagnosed between 2000 and 2009 at the Academic Medical Center. Cases were identified from the hospital owned prenatal database. Data of the 30 weeks follow-up scan were collected from the same database and findings of postnatal nephrologic examination of the infants from pediatric medical records. Logistic regression analyses were performed to study the association between degree of ANH at the 20 and 30 weeks scan and urologic anomalies after birth, need for surgical intervention, and disorders resulting in a solitary functioning kidney. RESULTS: We identified 332 cases, of which 290 (87%) had complete data available for the 30 weeks scan and, when indicated, postnatal examination. In 192/290 cases (66%), APPD had normalized at the 30 weeks scan. Of the 98 cases with APPD 10mm at 30 weeks, 50/98 (51%) were diagnosed with urological abnormalities after birth. Of these 50 cases, surgical intervention was required in 26 (52%) and 12 (24%) ended up with a solitary functioning kidney. The odds of urologic anomalies, the need for surgery, and the occurrence of solitary functioning kidney all increased with the severity of ANH at the 20 as well as the 30 weeks scan (all p 0.001). CONCLUSION: Screening for ANH at the 20 weeks scan allows early identification of neonates with urologic anomalies. Most cases of ANH at 20 weeks will have normalized at 30 weeks, thus the current criteria are on the safe side. However, the consequences of a urologic anomaly are such that guidelines should not be changed. 343 Small-for-gestational age, cesarean delivery for non-reassuring fetal heart status and composite neonatal morbidity Eugene Chang, Scott Sullivan, Suneet Chauhan, Adam Sandlin, Joshua Dahlke, Elena Igwe, Everett Magann, Kristi Anderson, Alfred Abuhamad Medical University of South Carolina, Department of Obstetrics and Gynecology, Charleston, SC, Medical University of South Carolina, Obstetrics & Gynecology, Charleston, SC, Eastern Virginia Medical School, Department of Obstetrics and Gynecology, Norfolk, VA, University of Arkansas for Medical Sciences, Department of Obstetrics & Gynecology, Little Rock, AR, Naval Medical Center Portsmouth, Department of Obstetrics and Gynecology, Portsmouth, VA, Temple University Hospital, Department of Obstetrics and Gynecology, Philadelphia, PA, Mississippi progestogen trial, Naval Medical Center Portsmouth, Department of Obstetrics and Gynecology, Portsmouth, VA OBJECTIVE: The ACOG practice bulletin on intrauterine growth restriction (IUGR), states that these pregnancies are at increased risk of cesarean delivery for non-reassuring fetal status (CD NRFS) but does not specify the rate or the risk factors. The aim of the secondary analysis of our retrospective study was to determine the rate and risk factors for CD NRFS for women in labor, and composite neonatal morbidity (CNM). STUDY DESIGN: All non-anomalous singletons with a sonographic exam before 22 weeks and small-for-gestational age (SGA; birth weight 10% for GA using Alexander nomogram) that delivered at four centers in 2009 were identified. If IUGR was suspected antenatally, SGA was considered detected and undetected otherwise. CNM included thrombocytopenia, RDS, proven sepsis, grade III/IV IVH, seizure, or death. Mann-Whitney test and multi-variable logistic regression models were used and odds ratio (OR), with 95% confidence intervals (CI) were calculated. RESULTS: At 4 centers, in 2009, there were 11,487 births and 8% (929) were SGA that met the inclusion criteria. Of the 731 (78%) women who labored, the rate of CD NRFS was 22% (160). Significant risk factors for CD NRFS are listed below. The binomial multi-variable stepwise regression model yielded a Cox and Snell R2 of 0.165 (p .005). Compared to SGA who delivered vaginally, the CNM was www.AJOG.org Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging Poster Session II

Bilateral loss of cortical somatosensory evoked potential at birth predicts cerebral palsy in term and near-term newborns

Bilateral loss of cortical somatosensory evoked potential (SEP) is considered the single best indicator of adverse outcome in acute encephalopathy of adult patients and older children. This study determines whether the presence or absence of the neonatal cortical SEP can predict cerebral palsy at two years in survivors of neonatal encephalopathy scored according to Sarnat criteria. We also compare SEPs with visual evoked potentials (VEPs), the EEG and neonatal neurological status. Fifty-nine neonates admitted to the neonatal intensive care unit had SEP, VEP and EEG recordings analysed according to the presence ( n = 37, 63%) or absence ( n = 22, 37%) of neonatal encephalopathy (score ≥ 1). Cortical SEP was always present in the perinatal period in those surviving without major neurological disability, while it was bilaterally absent in all but one patient with a subsequent diagnosis of cerebral palsy. Multivariate analysis using the logistic regression model showed that bilateral loss of cortical SEP and Sarnat Score correctly classified the neurological outcome in all patients. Bilateral absence of cortical SEP indicates early identification of neonates at risk of cerebral palsy indicating that EPs have a clinical role in the workup of neonatal encephalopathy.

On a possible early identification procedure for babies at high risk for autistic spectrum disorder

A hypothesis for a method that may make possible the early identification of neonates at high risk for later development of autistic spectrum disorder (ASD) is set forth. The method is a test of the assertion that unusually high testosterone concentrations in amniotic fluid (TECAFs) are predictive of later ASD diagnoses. The statistical distribution of TECAFS, obtained in the 14-20th week of pregnancy, is used to determine the critical TECAF value above which the highest 2% lie and thus identify the babies at high risk for later ASD syndromes. From presently available data a single numerical value cannot be obtained. However, a critical value calculated from the mean TECAF value of a group of gender identified amniotic fluid samples, which are all assayed by the same technique, and multiples of the standard deviation (SD) of the TECAFs of that group, leads to an estimate of the critical TECAF value. We estimate that this critical value is equal to the mean plus 2.6 times the standard deviation, (m+2.6 SD), of the set of measurements. A rough calculation of the number of neonates that would be needed for a test of this method is discussed.

La piel como expresión de alteraciones neurológicas en el recién nacido

The skin is involved in many different genetic syndromes and diseases with multiple organ involvement. Neurodevelopmental disorders appear in many of these entities and knowledge of these cutaneous alterations may provide clues to their diagnosis. Recognizing these skin disorders in the newborn allows early identification of neonates with a biological risk of epilepsy and motor and/or cognitive disorders and enables them to be followed up. This helps to plan the management of these patients and, in many entities, to predict their natural history and provide genetic counseling to the family. This review examines the cutaneous signs that may provide important clues in the neonate that help to identify entities that carry a risk of neurodevelopmental disorders in the neonate.

New Methods for Neonatal Drug Screening

After completing this article, readers should be able to: 1. Describe perinatal and neonatal complications of maternal use of cocaine, alcohol, opiates, and barbiturates in pregnancy. 2. List established cutoffs of conventional immunoassays of urine for common substances of abuse. 3. List the advantages of using meconium testing for substances of abuse. 4. Describe the role of fatty acid ethyl esters in detecting prenatal alcohol exposure. Maternal substance use during pregnancy can have direct consequences on both the developing fetus and the mother and is a significant public health concern. The prevalence of gestational use of drugs of abuse varies, depending on the study population and method of detection, but it generally ranges from 1% to 15%. (1) One of the largest epidemiologic studies conducted in the United States documented that although most pregnant women decrease the use of substances as the pregnancy progresses, a significant proportion of them remain regular users, even in the third trimester (eg, ethanol [13%], cannabis [9.3%], cocaine [10%], and heroin [1%]). (2) Various perinatal and neonatal complications can result from prenatal exposure to common drugs of abuse. (3) The use of cocaine during pregnancy is associated with increased risks of preterm labor, intrauterine growth retardation, and neurobehavioral abnormalities. Heavy alcohol use during pregnancy leads to fetal alcohol spectrum disorder, which is characterized by an array of congenital malformations, central nervous system abnormalities, and neurodevelopmental deficits. Neonates exposed to opiates, alcohol, and barbiturates in utero are at risk of developing neonatal abstinence syndrome, which is characterized by irritability, gastrointestinal dysfunction, respiratory distress, and other nonspecific symptoms. (1) Data in the literature conflict regarding adverse events in the immediate postnatal period that can be attributed to prenatal exposure to other illicit drugs. Thus, early identification of neonates in whom substance exposure is suspected is important for appropriate treatment intervention and …