Early Preterm Neonates Research Articles

Clinical Outcome Profile Of Early Preterm Neonates In A NICU At Tertiary Care Center

Clinical Outcome Profile Of Early Preterm Neonates In A NICU At Tertiary Care Center

Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later

Surfactant administration may be needed in late preterm through full-term neonates, but the pathophysiology of their respiratory failure can be different from that of early preterm neonates. The lung ultrasonography score (LUS) is accurate to guide surfactant replacement in early preterm neonates, but to our knowledge, it has not yet been studied in the late preterm through full-term neonatal population. To assess whether LUS is equally accurate to predict surfactant need in late preterm through full-term neonates as in early preterm neonates. This prospective, international, multicenter diagnostic study was performed between December 2022 and November 2023 in tertiary academic neonatal intensive care units in France, Italy, Spain, and the US. Late preterm through full-term neonates (≥34 weeks' gestation) with respiratory failure early after birth were enrolled. Point-of-care lung ultrasonography to calculate the neonatal LUS (range, 0-18, with higher scores indicating worse aeration), which was registered in dedicated research databases and unavailable for clinical decision-making. The main outcomes were the area under the curve (AUC) in receiver operating characteristic analysis and derived accuracy variables, considering LUS as a replacement for other tests (ie, highest global accuracy) and as a triage test (ie, highest sensitivity). Sample size was calculated to assess noninferiority of LUS to predict surfactant need in the study population compared with neonates born more prematurely. Correlations of LUS with the ratio of hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) to fraction of inspired oxygen (FiO2) and with the oxygen saturation index (OSI) were assessed. A total of 157 neonates (96 [61.1%] male) were enrolled and underwent lung ultrasonography at a median of 3 hours (IQR, 2-7 hours) of life; 32 (20.4%) needed surfactant administration (pretest probability, 20%). The AUC was 0.87 (95% CI, 0.81-0.92). The highest global accuracy and sensitivity were reached for LUS values higher than 8 or 4 or lower, respectively. Subgroup analysis gave similar diagnostic accuracy in neonates born late preterm (AUC, 0.89; 95% CI, 0.81-0.97; n = 111) and early term and later (AUC, 0.84; 95% CI, 0.73-0.96; n = 46). After adjusting for gestational age, LUS was significantly correlated with SpO2:FiO2 (adjusted β, -10.4; 95% CI, -14.0 to -6.7; P < .001) and OSI (adjusted β, 0.2; 95% CI, 0.1-0.3; P < .001). In this diagnostic study of late preterm through full-term neonates with respiratory failure early after birth, LUS accuracy to predict surfactant need was not inferior to that observed in earlier preterm neonates. An LUS higher than 8 was associated with highest global accuracy (replacement test), suggesting that it can be used to guide surfactant administration. An LUS value of 4 or lower was associated with the highest sensitivity (triage test), suggesting it is unlikely for this population to need surfactant.

Frequency of Intraventricular Haemorrhage (IVH) in Early Preterm Neonates Born at DHQ Teaching Hospital Gujranwala

Objective: The reported frequency of intraventricular hemorrhage in preterm neonates varied greatly. We determined the frequency of IVH in premature neonates in the pediatric unit of DHQ Hospital Gujranwala. Materials &amp; Methods: This cross-sectional study involved 282 very low birth weight neonates (birth weight &lt;1500 gm.) delivered very preterm (gestational age &lt;32 weeks). These neonates were assessed for intraventricular hemorrhage which was diagnosed on cranial ultrasound performed on 3rd day of life. The frequency of IVH was compared across various attributing factors i.e., gestational age at delivery, gender, birth weight, mode of delivery, and maternal antenatal steroids. Results: The mean gestational age at delivery was 27.5±2.3 weeks while the mean birth weight was 1120.5±190.2 grams. 172 (61.0%) neonates were delivered vaginally while C-section was performed in 110 (39.0%) cases. 263 (93.3%) mothers received antenatal steroids. Intraventricular hemorrhage was diagnosed in 64 (22.7%) early preterm neonates. The frequency of IVH increased significantly with increasing prematurity; 24-27 weeks vs. 28-31 weeks (28.9% vs. 17.0%; p-value=0.017), decreasing birth weight; &lt;1 kg vs. ?1kg (31.8% vs. 18.6%; p-value=0.014) and lack of antenatal steroids (52.6% vs. 20.5%; p-value=0.001). Conclusion: The intraventricular hemorrhage was observed in 22.7% of early preterm neonates which advocates routine screening of preterm neonates for IVH so that timely identification and anticipated management may improve the outcome of such neonates. We also identified increasing prematurity, decreasing birth weight, and lack of antenatal steroids as potential attributing factors that can be used for risk stratification and management planning of such cases.

Prevalence and Risk Factors of Apnea in Preterm Neonates Admitted to the French Medical Institute for Mothers and Children Hospital in Kabul City: An Analytic Cross-Sectional Study

Introduction: Prematurity is one of the leading causes of neonatal death in Afghanistan and complicates many serious problems including apnea. Although recurrent and prolong apnea of prematurity (AOP) may be directly or indirectly associated with significant adverse outcomes, there isn’t enough scientific information regarding the prevalence and risk factors of this problem in Afghanistan, therefore, this study is performed to obtain such information. Objective: To determine the prevalence rate and risk factors for apnea of prematurity in neonates admitted to the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital, Kabul City. Patients and Methods: This analytic cross-sectional study was conducted at the Neonatal Intensive Care Unit of the French Medical Institute for Mothers and Children Hospital in Kabul City, Afghanistan. The study participants were preterm neonates. Statistical analysis was performed by SPSS 24. Results: 75 preterm newborns were enrolled in this study and the apnea of prematurity were developed in 48% of them. Extremely low birth weight preterm neonates had a 71.4% prevalence rate of such apnea, while in very low birth weight and low birth weight the rates were 47.4% and 36.4% respectively. Based on gestational age, the prevalence rates of apnea in the early and moderate preterm neonates were 55.6% and 52.8% respectively, whilst also in late preterm neonates it was 42.8%. The apnea of prematurity appeared more prevalent in boys (54.3%) than girls (45.7%). The preterm neonates in the apnea group versus the non-apnea group had the mean birth weight of (1233.33 ± 235.25g vs 1333.46 ± 274.44g, 90%CI= -198 _ -1.4), mean maternal age of (24.78 ± 3.68y vs 26.62 ± 4.58y, 90%CI= -3.44_-0.23) and RR of anemia (2.2, P=0.05). Conclusion: The overall prevalence rate of AOP in preterm neonates was 48% and the highest rates were seen within extremely low birth weight and early preterm neonates. The lower neonatal birth weight, neonatal anemia and younger maternal age were found to be the risk factors for apnea of prematurity.

Racial and ethnic disparities in respiratory morbidity among early preterm neonates exposed to antenatal corticosteroids

Racial and ethnic disparities in respiratory morbidity among early preterm neonates exposed to antenatal corticosteroids

Impact of Prematurity on the Buccal Epithelial Cells of the Neonates via Wnt/Beta-Catenin Signaling Pathway and Apoptosis.

Understanding the reflections of prematurity is necessary for the management of neonatal complications. We focused on the impact of prematurity and related "maternal risk factors/obstetric complications" on buccal cells of the neonates via evaluation of the Wnt/β-catenin signaling pathway and apoptosis. This study consisted of "early preterm neonates (EPN) (≤34th gestational week [gw]) (n = 36)," "late preterm neonates (LPN) (34th- < 37th gw) (n = 46)," and "term neonates (control) (≥37th gw) (n = 56)." Cohort was also subclassified according to the presence of maternal risk factors, obstetric complications, and neonatal complications. Wnt/β-catenin signaling and caspase-3 activation pathways were studied immunocytochemically. Wnt/β-catenin signaling positivity was statistically more frequent at buccal smears of the EPN and LPN groups compared with controls (p < 0.001). The cutoff for gestational age at delivery in receiver operating characteristic curve with the best balance of sensitivity (67.4%) and specificity (67.3%) was 35.8th gw for determining the reduction of Wnt/β-catenin signaling positivity (p < 0.001). The study demonstrated that obstetric complications significantly affected the activity of signaling, while maternal risk factors do not have any effect on Wnt/β-catenin signaling pathway (p = 0.003 and p = 0.828, respectively). This study also demonstrated a significant relationship between Wnt/β-catenin signaling pathway and the presence of neonatal complications (p = 0.015). Dynamic characteristics of buccal cells are influenced by prematurity and related obstetric and neonatal problems. Buccal smear is a good tool to investigate the impact of prematurity and obstetric problems on perinatal outcome. · Neonatal buccal cells are affected by prematurity and related obstetric/neonatal problems.. · 35.8th gw is critical for determining the reduction of Wnt/β-catenin signaling positivity.. · Obstetric and neonatal complications significantly related to Wnt/β-catenin signaling activity..

Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing.

To determine the factors associated with neonatal hypoglycemia among neonates exposed to antenatal corticosteroid (ACS). A retrospective study conducted during 2017-2019 at a tertiary-care center including all neonates delivered between 24 and 34weeks of gestation after ACS administration. The primary outcome was neonatal hypoglycemia (<40mg/dl). Overall, 362 early preterm neonates, including 205singletons and 157 twins, were exposed to ACS before delivery and constituted the study group. Of them, 275 (76.0%) were exposed to a single ACS course and 87 (24.0%) to an additional rescue ACS course. Neonatal hypoglycemia occurred in 84 (23.2%) neonates. The incidence of neonatal hypoglycemia was significantly higher in those delivered between 24 and 48h after ACS administration compared with those delivered outside this time interval (10/25, 40.0% vs 74/337, 21.9%; P=0.049). In multivariate analysis, after adjusting for neonatal birth weight and gestational age, delivery within 24-48h after ACS administration was the only independent risk factor associated with neonatal hypoglycemia (adjusted odds ratio 2.41, 95% confidence interval 1.03-5.68; P=0.044). Neonatal hypoglycemia occurred in over one-fifth of those exposed to ACS, and was independently associated with delivery between 24 and 48h after ACS administration.

A study of correlation of foot length and new Ballard score in determining the gestational age of newborns

Background: Gestational age (GA) estimation plays a vital role in obstetric, perinatal and neonatal care. Foot length (FL) measurement can serve as a simple, easy and cost effective parameter for estimating GA. The aim of this study was to determine correlation between foot length of new born and GA by new Ballard score and forming a percentile chart if a positive correlation was found.Methods: GA assessment of newborns born in our hospital was done by new Ballard score within 24 hours of life. FL was measured using vernier caliper. Neonates were classified as pre term, term and post term and also grouped as small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA).Results: FL measurement was strongly correlating with GA assessment by new Ballard score, with overall correlation coefficient r=0.897 (p&lt;0.001). FL increased as GA increased. Strong positive correlation was seen in pre term and term newborns. The cut-off foot lengths for identifying preterm and early preterm neonates were 73.14 mm (diagnostic accuracy 88.4%) and 68.49 mm (diagnostic accuracy 95.3%), respectively.Conclusions: Strong positive correlation of foot length with GA by new Ballard score was obtained and a percentile chart of foot length for each GA was formed, with mean and standard deviation. This can serve as a simple and quick tool, requiring less expertise for GA assessment.

Impact of preterm birth on the cellular characteristics of neonatal buccal cells.

To demonstrate the impact of preterm birth on the cytological, cytomorphometrical, and nuclear parameters of neonatal buccal smears. This study consisted of Early Preterm Neonates (EPN; ≤34th gestational week [gw]; n=36), Late Preterm Neonates (LPN; 34th to <37th gw; n=46), and Term Neonates (control; ≥37th gw; n=56). Cytological evaluation and buccal cytome assay were performed using Papanicolaou and Feulgen methods, respectively. Cytological evaluation demonstrated that smear background was cleaner (P<.05) and there were less macrophages in the control group (P<.001). Cyto-morphometric analysis showed that the measurements of nuclear diameter, nuclear area, and nucleus-to-cytoplasm ratio were higher in the preterm (EPN and LPN) versus the control groups (P=.016, P<.001, and P<.001, respectively). We also demonstrated that staining intensity of the nucleus and cytoplasm were less intense in the EPN and LPN groups (P<.001). There was no statistically significant difference between the EPN and LPN groups for any parameters (P>.05). Buccal cytome assay showed that nuclear buds were more prevalent in term newborns compared to preterm neonates (P<.001). Morphological and cytological properties of neonatal buccal cells are influenced by preterm birth status, and buccal smears may be used as a tool to detect biological markers of neonatal health problems.

894 Antenatal steroids in diabetic mothers and neonatal hypoglycemia: a retrospective cohort study

Neonatal hypoglycemia is a complication of antenatal corticosteroid (ACS) administration. Pregnant women with diabetes are both at risk for hypoglycemia and preterm delivery, and diabetes is known to be associated with delayed fetal lung maturity. Our aim is to identify if ACS administration increases the risk of hypoglycemia in infants of diabetic mothers. We conducted a retrospective cohort study of the preterm deliveries in diabetic and non-diabetic women from January 2018 to September 2019. We included non-anomalous singleton gestations with liveborn deliveries between (28 0/7 – 33 6/7 weeks) who received ACS. Our diabetic cohort included pre-gestational and gestational diabetic mothers. We excluded multifetal pregnancies, deliveries (< 28 and ≥ 34 weeks), fetal genetic and structural abnormalities and stillbirths. Baseline demographics, including the number of steroid doses administered and the time of administration prior to delivery were compared between our primary exposure groups, diabetics vs. non-diabetics (Tables 1, 2). The primary outcome was neonatal hypoglycemia (< 40 mg/dL) within the first 48 hours of life. Associations between categorical variables were tested using pearson’s chi-square test. A total of 212 eligible patients were included (Diabetic: n=33, Non-diabetic: n=179), all of whom received ACS for threatened preterm delivery. Of all the patients who received ACS, neonates of diabetic mothers demonstrated a higher rate of neonatal hypoglycemia after birth (39.4% vs. 19.6%). There was a significant association between ACS exposure and neonatal hypoglycemia (p= 0.01). The dosing of steroids (full vs partial course, rescue dose) was not a determinant factor in developing neonatal hypoglycemia (NH); neither was the timing of steroid administration prior to delivery. Diabetes is an independent factor for NH in early preterm neonates who received ACS. The number of ACS courses and the timing of administration did not influence the risk of developing neonatal hypoglycaemia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparative study of total serum bilirubin levels measured via blood vs skin in neonates

ObjectiveThe aim was to compare between total bilirubin levels measured via blood vs skin in neonates.BackgroundNeonatal jaundice is a common clinical problem. total serum bilirubin (TSB) with transcutaneous bilirubin (TCB) measurement can be used for evaluating bilirubin levels in neonates.Patients and methodsThis cross-sectional study was conducted on 200 jaundiced neonates with indirect hyperbilirubinemia, in the neonatal intensive care unit of Menoufia University Hospital, and they were randomly divided into three groups: group 1 (n = 100) included full-term neonates with gestational age ranged from 37 to 42 weeks; group 2 (n = 35) included late preterm neonates with gestational age ranged from 34 to 36 weeks; and group 3 (n = 65) included early preterm neonates with gestational age ranged from 30 to 33 weeks. Complete blood count with reticulocyte count was obtained along with TSB, Rhesus factor, and ABO blood groups for both mothers and neonates.ResultsThere was a strong positive significant correlation between TSB and TCB, but the correlation decreased as both levels advanced [Pearson correlation (r)=0.983]. The correlation was better in full tem with TSB-TCB difference of 1.88 ± 0.39 in comparison with late and early preterm, which was 2.27 ± 1.99 and 2.55 ± 0.64, respectively. There was a strong positive correlation between TSB and TCB regarding weight, gestational age, and postnatal ages, with Pearson correlation of 0.08, 0.404, and 0.505, respectively, for TSB and 0.477, 0.489, and 0.558, respectively, for TCB. TSB always overestimates TCB.ConclusionTCB is a reliable method in screening of neonatal jaundice in full-term babies, reducing the need for TSB, which is expensive and invasive. Reliability is lesser for the preterm.

Maternal antepartum antibiotic administration and patterns of bacterial resistance in early preterm neonates

Objective The objective of this study was to determine the relationship between maternal antepartum antibiotic administration and antibiotic resistance patterns in preterm neonates admitted to the neonatal intensive care unit (NICU). Methods This was a retrospective cohort study of women and their preterm neonates delivered at a single tertiary care center over a 5-year period. Women and neonates were included if they delivered between 23 weeks 0 days and 28 weeks 6 days of gestation and neonates were admitted to the NICU. Subjects were excluded if there was incomplete antibiotic administration data or incomplete laboratory or bacterial culture data for either mothers or neonates. Data collected from maternal and neonatal charts included the type, duration, and total number of antibiotics administered to subjects, neonatal culture results within the first 7 days of life, and bacterial antibiotic resistance information. Women with neonates that cultured positive for bacteria demonstrating antibiotic resistance were compared to those whose neonates did not have antibiotic-resistant bacteria. Results 79 women with 90 neonates met inclusion criteria. Of the 79 women, 71 (89.9%) received at least 1 antibiotic antepartum. 14 neonatal bacterial isolates were resistant to at least 1 antibiotic. Antibiotic-resistant bacteria were present in 11 neonates; 3 neonates had more than 1 resistant bacteria cultured. The most common resistant bacteria cultured were Coagulase-negative Staphylococcus (6/14, 42.9%), S. aureus (3/14, 21.4%), and E. coli (2/14, 14.3%). Enterobacter spp (2) and Klebsiella pneumoniae (1) made up the remainder. Of the 11 neonates with resistant bacteria isolated, 10 of their mothers received antibiotics antepartum. Neonates with antibiotic-resistant bacterial isolates were more likely to be born at lower gestational ages (24.6 vs 25.9 weeks, p = .013) and have lower mean birth weights (679.5 vs 849.3 g, p = .009) than those without resistant bacteria. In 8 of 11 (73%) neonates with resistant bacteria, the mother received an antibiotic to which the bacteria cultured were resistant: 6 coagulase-negative Staphylococcus, 1 MRSA, and 1 S. aureus. Conclusions Although preterm neonates are often treated for presumed sepsis, they infrequently have positive bacterial cultures. In this study, those that had positive bacterial cultures for resistant bacteria were born at earlier gestational ages and had lower birth weights. These bacteria cultured in neonates are likely to be resistant to antibiotics received by mothers in the antepartum period. Careful selection of maternal and neonatal antibiotics in the preterm setting with consideration for local antibiotic resistance patterns is suggested.

The Impact of Mode of Delivery on Early Preterm Morbidity and Mortality [32K

INTRODUCTION: Whether the mode of delivery for early preterm infants influences the risk of adverse outcomes is an ongoing topic of debate. This study aims to determine whether cesarean delivery is independently associated with improved early preterm neonatal morbidity or mortality. METHODS: This is a retrospective cohort study of preterm deliveries at 22.0–29.0 weeks gestation between 2010 and 2015, excluding multiple gestations, intrauterine fetal demise, and induction terminations. The primary outcome was a neonatal morbidity composite (apgar &lt;5 at 5 min, prolonged ventilation &gt;28 days, IVH, NEC, coagulopathy, discharged on home ventilator support, or discharged with enteric feeding tube). The secondary outcome was neonatal death. Outcomes were compared between patients who underwent cesarean vs vaginal delivery. Patients were first matched for ethnicity (black v. other). Propensity scores were estimated utilizing logistic regression models adjusting for small for gestational age, gestational at delivery, and nulliparity. IRB approval was granted through Washington University. RESULTS: Of the 273 (56.9%) early preterm deliveries, 125 (45.8%) were cesarean deliveries and 148 (54.2%) were vaginal deliveries. After matching, there were 115 patients in each group. In vertex fetuses, there was no significant difference in neonatal mortality within 24 hours (aOR 1.48 CI 0.56, 3.90) or within 28 days of delivery (aOR 0.71 CI 0.27, 1.90) by mode of delivery. There was no difference in composite neonatal morbidity. CONCLUSION: In this propensity score analysis, the risk of neonatal death or neonatal morbidity was not significantly improved among early preterm neonates delivered by cesarean versus vaginal delivery.

Maternal antepartum antibiotic administration and patterns of bacterial resistance in early preterm neonates

Maternal antepartum antibiotic administration and patterns of bacterial resistance in early preterm neonates

Clinical profile of acute kidney injury in neonatal sepsis and perinatal asphyxia using nRIFLE and modified KDIGO criteria

Background: Newborn babies with sepsis and perinatal asphyxia form a high-risk group for developing neonatal acute kidney injury (nAKI). The diagnosis and staging of nAKI is challenging and has several limitations. Objective: The objectives of this study were to estimate the hospital-based incidence of nAKI in septic and asphyxiated neonates, describe their clinical profile and outcome, and compare the two classifications – neonatal risk, injury, failure, loss, and end-stage renal disease (nRIFLE) and neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria for their agreement. Materials and Methods: Consecutive neonates who fulfilled the diagnosis of sepsis or perinatal asphyxia were included in this prospective cohort study. Urine output was monitored 6 hourly by diaper weight and serum creatinine every 48 h or earlier if required. The clinical profile and outcome of neonates who developed AKI were studied, and AKI was staged using both nRIFLE and KDIGO criteria. Chi-square test was used to test the association of risk factors with AKI, Pearson’s Chi-square and Kappa statistics were used to compare the two staging criteria. Results: Of 90 neonates enrolled, the incidence of AKI in sepsis was 145/1000 neonates and perinatal asphyxia was 464/1000 neonates. AKI was maximally observed in the early preterm neonates (45.4%) and very low birth weight neonates (36.36%). Oliguria was present in a majority of the neonates with nAKI but varied according to the classification system used. nAKI was significantly associated with high mortality (54.2%) (p&lt;0.01) which increased with decreasing gestation and birth weight and increasing severity of nAKI. On comparing KDIGO and nRIFLE criteria, there was a poor agreement between the two. Conclusion: AKI is a common occurrence in septic and asphyxiated neonates and portends poor outcomes. Although studies have evaluated nRIFLE and KDIGO individually, larger studies comparing the two criteria are required to improve early diagnosis and accurate staging of neonatal AKI.

The origin of amniotic fluid monocytes/macrophages in women with intra-amniotic inflammation or infection.

Background Monocytes, after neutrophils, are the most abundant white blood cells found in the amniotic cavity of women with intra-amniotic inflammation/infection. However, the origin of such cells has not been fully investigated. Herein, we determined (1) the origin of amniotic fluid monocytes/macrophages from women with intra-amniotic inflammation/infection, (2) the relationship between the origin of amniotic fluid monocytes/macrophages and preterm or term delivery and (3) the localization of monocytes/macrophages in the placental tissues. Methods Amniotic fluid samples (n = 16) were collected from women with suspected intra-amniotic inflammation or infection. Amniotic fluid monocytes/macrophages were purified by fluorescence-activated cell sorting, and DNA fingerprinting was performed. Blinded placental histopathological evaluations were conducted. Immunohistochemistry was performed to detect CD14+ monocytes/macrophages in the placental tissues. Results DNA fingerprinting revealed that (1) 56.25% (9/16) of amniotic fluid samples had mostly fetal monocytes/macrophages, (2) 37.5% (6/16) had predominantly maternal monocytes/macrophages and (3) one sample (6.25% [1/16]) had a mixture of fetal and maternal monocytes/macrophages. (4) Most samples with predominantly fetal monocytes/macrophages were from women who delivered early preterm neonates (77.8% [7/9]), whereas all samples with mostly maternal monocytes/macrophages or a mixture of both were from women who delivered term or late preterm neonates (100% [7/7]). (5) Most of the women included in this study presented acute maternal and fetal inflammatory responses in the placenta (85.7% [12/14]). (6) Women who had mostly fetal monocytes/macrophages in amniotic fluid had abundant CD14+ cells in the umbilical cord and chorionic plate, whereas women with mostly maternal amniotic fluid monocytes/macrophages had abundant CD14+ cells in the chorioamniotic membranes. Conclusion Amniotic fluid monocytes/macrophages can be of either fetal or maternal origin, or a mixture of both, in women with intra-amniotic inflammation or infection. These immune cells could be derived from the fetal and maternal vasculature of the placenta.

Periventricular Hemorrhage in Term and Late Preterm Neonates: Risk Factors and Outcomes

Background: Periventricular hemorrhage (PVH) is common in early preterm neonates but much less common in term and late preterm neonates. The aim of this study was to identify the risk factors and outcomes of PVH in term and late preterm neonates in a tertiary care center in Upper Egypt. Methods: A total of 33 term and late preterm (≥ 34 weeks of gestation) neonates (18 females and 15 males) admitted at the neonatal intensive care unit (NICU) of Sohag University Hospital and diagnosed with PVH from January 2016 to October 2018 were included in this prospective study. The neonates with major congenital malformation of the nervous system were excluded. The risk factors for PVH were ascertained, and the diagnosis was confirmed by transcranial ultrasound, computed tomography or magnetic resonance imaging. The outcomes were assessed at discharge time and the age of 6 months. Results: ThePVH was diagnosed in 5.9% of the neonates. The median of age was 12 days (age range: 2-28 days) at presentation, and convulsions were the most frequent presentations followed by poor suckling and pallor. The risk factors for PVH included prolonged prothrombin time, thrombocytopenia, non-administration of vitamin K, and prolonged labor in 54.5%, 30 %, 30 %, and 27.3% of the cases, respectively. Moreover, 26 (78.7 %) cases were discharged with good conditions, and 7 (21.2 %) subjects died in the NICU. The investigation of the patients’ follow-up at the age of 6 months revealed neurological impairments in 36 % of the survivors. Grade IV and III PVH had mortality rates of 66.67% and 18.75%, respectively (P=0.009). Neurodevelopmental impairments were more frequent in Grade III and IV (P=0.002). Conclusion: The incidence of PVH was 5.9% among term and late preterm neonates admitted to our NICU. Coagulation disorders and prolonged labor were the leading risk factors. Most patients had favorable outcomes, and one-third of the cases had neurodevelopmental impairments. In addition, mortality was reported in one-fifth of the neonates. Severe grades of PVH had the worst outcomes.

Risk Factors for Neonatal Hypoglycemia Following Exposure to Antenatal Corticosteroids [14D

INTRODUCTION: To quantify the influence of maternal and neonate characteristics on risk of neonatal hypoglycemia in pregnancies exposed to antenatal steroids (ANCS). METHODS: We performed a retrospective cohort study utilizing a 2013-2017 dataset created from electronic medical records (EPIC) of all mothers who delivered early (<34) and late preterm (34 to <37 weeks) at the University of Cincinnati, linked to neonatal data through 1 week postdelivery. Maternal and neonatal characteristics were compared between preterm neonates exposed to ANCS experiencing hypoglycemia and those with normal glycemic levels. Multivariate logistic regression estimated the relative risk of these factors on the risk of neonatal hypoglycemia following preterm ANCS. RESULTS: 1,210 mother-neonate pairs were included. Hypoglycemia, defined as neonatal BG of <40 mg/dL in the first week of life, was present in 24.0% of early preterm births (PTBs) and 24.4% of late PTBs exposed to ANCS. The factor most strongly associated with neonatal hypoglycemia was maternal hyperglycemia (BG ≥180mg/dL) on the day of or day prior to delivery. This association was stronger in late PTBs (adjusted relative risk [adjRR] 4.49; 95% CI 1.50, 13.40) than early PTBs (adjRR 1.91; 95% CI 1.07, 3.41). CONCLUSION: The presence of maternal hyperglycemia proximate to time of delivery (0-1 days prior to birth) is the most predictive factor for neonatal hypoglycemia, with magnitude of risk higher in late preterm compared to early preterm neonates This information demonstrates the importance of maternal glycemic control near the time of delivery after exposure to ANCS.

Influence of assisted reproductive technologies on maternal and neonatal outcomes in early preterm deliveries

IntroductionCompared to spontaneous conception (SC), pregnancies conceived through assisted reproductive technologies (ART) carry worse pregnancy and neonatal outcomes. Evidences focused on preterm births are limited. Early preterm delivery is a critical situation for medical management and parental counselling. The aim of this study was to analyze if ART procedures influenced pregnancy and neonatal outcomes in singleton pregnancies with early preterm delivery. Material and methodsThis was a retrospective case control study. The population consisted of all consecutive early preterm deliveries occurred at Careggi University Hospital in Florence (Italy) between 2010 and 2017. Cases were considered patients who conceived though ART, including intra cytoplasmic sperm injection (ICSI), in vitro fertilization and embryo transfer (IVF-ET), intra uterine insemination (IUI) and ovarian stimulation. Controls were patients who conceived in the natural way.Main outcomes of the study were: birth weight, umbilical artery pH, Apgar score at 1 and 5 min, gestational age at delivery and mode of delivery.Secondary outcomes were: spontaneous preterm labor initiation, gestational diabetes mellitus, intrauterine growth restriction (IUGR), cholestasis of pregnancy, intra uterine fetal demise (IUFD), placenta previa, fetal malformations, pregnancy induced hypertensive (PIH) disorders (gestational hypertension, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome) and postpartum hysterectomy.Shapiro-Wilk test was used to check the normality of the data; Mann-Whitney test was used to compare two continuous variables not-normally distributed. Multiple and binomial logistic regression analyses were used to adjust the results of the statistical analysis for potential confounding factors. The analysis for the main outcomes was performed for all deliveries and then repeated for spontaneous deliveries, separately. ResultsSeventy-one patients had ART and 640 SC. We found no differences in birthweight, umbilical artery pH, Apgar at 1 and 5 min and gestational age at delivery between ART and SC groups. C-section rate, placenta previa and PIH disorders were higher in the ART group. The higher prevalence of C-sections in the ART group was not statistically significant after adjusting for age and parity in the whole population but resulted significantly different when analyzing the subgroup of patients with spontaneous initiation of labor. ConclusionsFetal outcomes seem to be equal between ART and SC in early preterm neonates ; C-section rate and pregnancy complications such as placenta previa and PIH disorders seem to be higher in the ART group. These information should be part of the family counselling in these cases. We suggest that clinicians, after management of preterm delivery had been properly addressed, should not apply different management in ART compared to SC pregnancies.

Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital.

Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates. The study was prospective cross-sectional in design. Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses. Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95-61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40-721.84] were retained as significant predictors of IVH in the multivariate logistic regression model. The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.