Fifth Minute Of Life Research Articles

Сравнительная характеристика перинатальных исходов у женщин с семейной средиземноморской лихорадкой и в контроле

The aim of the study is to compare the reproductive outcome of women with familial Mediterranean fever (FMF) and a control sample. An observational cohort study compares the outcomes in 251 women with FMF to 312 without FMF. A study of perinatal outcomes showed that weight, height and neonatal status assessment at birth were comparable in both groups. The average body weight of the newborn was 2800±500g in the FMF group and 2770±580g in the control group (p≤0,05), the average height was 48±2,5cm and 49±3,0cm (p≤0,001), respectively. Apgar score in the first and fifth minutes of life: 7,6±0,6 and 7,7±0,7 points, (p≤0,05) and 8,4±0,2 and 8,7±0,5 points, (p≤0,01) respectively. Fetal distress was detected in 2,0% in group 1 and in 2,5% in group 2; CDF – 1,6% and 2,6, PS – 31,5% versus 45,5% (p≤0,001); postpartum hemorrhage – 0% and 0.8%; maternal mortality – 0% and 0%, respectively. Perinatal outcomes were comparable in patients with Familial Mediterranean fever and control group.

Прогнозування ризику розвитку бронхолегеневої дисплазії в передчасно народжених дітей

Bronchopulmonary dysplasia (BPD) is one of the most frequent outcomes of prematurity. Relatively late diagnosis and development of formidable complications that can affect the quality of life in adulthood, determine the need for early BPD prognosis for the timely appointment of effective therapy. Purpose - identification of informatively significant clinical and anamnestic risk factors of BPD based on retrospective analysis and mathematical model creation for the prediction of chronic respiratory disease risk development in prematurely born children. Materials and methods. A retrospective analysis of the medical histories of 280 prematurely born children who were treated in neonatal units was conducted. With the help of sequential Wald analysis, 53 clinical and anamnestic indicators were analyzed, for each of them the relative risk (RR) and diagnostic coefficient (DC) were calculated. Results. Significant, prognostically unfavorable factors for BPD development are gestational age ≤28 weeks (RR=20.30); birthweight ≤1500 g (RR=3.08); duration of non-invasive combined respiratory support over 18 days (RR=3.74); Apgar score 1-3 at the first minute (RR=4.69) and 4-6 at the fifth minute of life (RR=4.19); newborn anemia (RR=3.12); invasive artificial lung ventilation for more than 13 days (RR=5.12). The probability of BPD increases substantially with the presence of retinopathy of the II and III degrees (RR=16.4 and RR=10.15, respectively). Interestingly, breastfeeding markedly prevented BPD development (RR=0.29). Furthermore, a mathematical model is represented to determine BLD development prediction and to diagnose this disease. Conclusions. High validity indicators and ease of use of the mathematical model for the BPD development prediction in prematurely born children make it possible to recommend it in the practice of neonatologists and pediatricians. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Predictive Value of Sflt-1/Plgf Ratio for Occurrence of Preeclampsia in Singleton Pregnancies: A Retrospective Study

Introduction: Preeclampsia is multisystem disorder of pregnancy, characterized by endothelial and placental dysfunction. It is classified as an early onset (which occurs < 34 weeks) and late onset (which occurs ≥ 34 weeks). There is an increase of level of antiangiogenic factor of soluble form similar to tyrosine kinase 1 (sFlt-1) and decrease of level of proangiogenic placental growth factor (PlGF) at preeclampsia. High ratio sFlt-1/PlGF is connected to occurrence of preeclampsia. Materials and Methods: There was a retrospective study of the Clinic for Gynecology and Obstetrics of the University Clinical Center of Republic of Srpska (KGA UKC RS), which was implemented in period January 1st, 2020 – December 31st, 2021 and which included 224 patients hospitalized at the Department of Perinatology for suspected preeclampsia development, from 26+0 weeks of gestation until birth. One of the key criteria for the inclusion of patients in the study is the use of the sFlt-1/PlGF ratio as a marker for the onset of preeclampsia, and the determination of protein values in 24-hour urine (biuret). The antenatal state of the fetus was also monitored by ultrasound measurement of the flow resistance ratio (Ri) through the middle cerebral artery and the umbilical artery (C/U), as well as the values of the newborn’s Apgar score in the first and fifth minute of life (AS 1 and 5). The patients included in the study were divided into two groups according to gestational age: group 1 (<33+6 NG) and group 2 (≥34NG). For the purposes of the research, data from patient protocol books for the specified period, as well as corresponding data from the Clinical Information System (KIS), were used. Results: Calculated values for cut off 38 for group 1 are: NPV= 76.9%, PPV=72.0%, sensitivity=85.7%, specificity=58.8%, and for group 2 are: NPV= 89 ,1%, PPV=40.8%, sensitivity=72.1%, specificity=68.5%. For cut off 85, the calculated values for group 1 are: NPV= 82.4%, PPV=85.7%, sensitivity=85.7%, specificity=82.4%, and for group 2 they are: NPV= 84.9 %, PPV=70.4%, sensitivity=44.2%, specificity=94.4%. For cutt off 110, the calculated values for group 1 are: NPV= 77.8%, PPV=85%, sensitivity=81%, specificity=82.4%, and for group 2 they are: NPV= 83.5 %, PPV=72.7%, sensitivity=37.2%, specificity=95.8%. The measured value of protein in 24h urine (biuret) in comparison with the measured values of the sFlt-1/PlGF ratio have statistical significance for predicting the onset of preeclampsia. Statistical data processing obtained by examining the measured values of the sFlt-1/PlGF ratio and the antenatal and natal condition of the fetus (C/U and AS 1 and 5) showed statistical significance, except for C/U for group 2, where p=0.32. Conclusion: Determination of the sFlt-1/PlGF ratio as well as biuret and monitoring of the antenatal and postnatal state of the fetus significantly contributes to the timely diagnostic of preeclampsia, which impacts reducing the incidence of undesirable outcomes for the mother and the fetus.

Features of platelet and plasma hemostasis in premature infants with hemorrhagic disorders

The research revealed features of platelet and plasma hemostasis indicators in children born before 32 weeks with hemorrhagic disorders in the early neonatal period, a method for predicting the development of intraventricular hemorrhage was developed.Material and methods. 132 premature newborns were examined, a detailed clinical blood test, a coagulogram with the determination of: activated partial thromboplastin time, prothrombin time, thrombin time, prothrombin index, fibrinogen content, D-dimer were performed on 1–3 days of life. The main group consisted of 58 children with hemorrhagic disorders, the comparison group included 74 children without hemorrhagic disorders.Results. Risk factors for the formation of hemorrhagic disorders in the early neonatal period were established: a lower gestational age of the child, lower Apgar scores at the end of the first and fifth minutes of life, the need for the introduction of an exogenous surfactant, and the use of higher concentrations of oxygen-air mixture during respiratory therapy. The features of hemostasis indicators in deep-premature newborns with hemorrhagic disorders in the early neonatal period were revealed: a lower number of platelets in the blood and higher platelet granularity, higher activated partial thromboplastin time, and a decrease in the prothrombin index. Based on the data obtained, a new method for predicting the formation of intraventricular hemorrhage in deeply premature newborns is proposed based on determining the concentration of total Ca2+ in the blood and the average concentration of platelet components. The results of this study can be used in intensive care units for newborns. Conclusion. The implementation of the obtained results in practice will help timely assess the state of hemostasis in deeply premature newborns to predict the development of intraventricular hemorrhages in the early neonatal period.

Influence of overweight and obesity on perinatal outcomes in assisted reproduction: a retrospective cohort study

BackgroundIn spontaneous pregnancies, maternal weight and gestational diabetes are independent risk factors for macrosomia and large-for-gestational-age newborns. Furthermore, maternal body mass index (BMI) of ≥25 kg/m2 is associated with worse neonatal vitality, classified as an Apgar score of < 7 at the fifth minute of life. However, few studies have evaluated the influence of BMI on perinatal outcomes in pregnancies resulting from assisted reproduction. Therefore, this study aimed to analyze whether the perinatal outcomes of assisted reproduction are influenced by BMI.MethodsThis was a retrospective cohort study performed at a reproductive medicine center. Patients undergoing assisted reproduction (2013–2020) were divided into three groups according to their BMI (kg/m2): group 1, < 25; group 2, 25–29.9, and group 3, ≥30. In total, 1753 in vitro fertilization embryo transfer cycles were analyzed. Data were expressed as mean ± standard deviation or frequency (%). The analysis of variance and chi-square test were performed for comparison. To determine the participants and number of cycles for these analyses, generalized estimating equations were used, considering p < 0.05.ResultsIn groups 1, 2, and 3, the rates of live birth were 33.5, 32.3, and 29.9% (p = 0.668); preeclampsia were 2.9, 6.1, and 6.3% (p = 0.268); small-for-gestational-age newborns were 23, 23.2, and 21.7% (p = 0.965); macrosomia were 1.9, 0.9, and 2.7% (p = 0.708); Apgar score > 7 at the fifth minute were 97.6, 98.2, and 100% (p = 0.616); and preterm birth were 29.6, 30.1, and 35.1% (p = 0.970), respectively.ConclusionsIn conclusion, although the three groups had similar perinatal outcomes in this study, the study population was too small for conclusive results. The higher the BMI, the lower the chances of clinically relevant LBR and the higher the chances of premature labor and preeclampsia.

Alobar holoprosencephaly with cebocephaly in a neonate: A rare case report from Northern Tanzania.

Introduction and importanceHoloprosencephaly is a rare brain malformation consisting of impaired midline cleavage of the embryonic forebrain presenting with variable features of craniofacial dysmorphism. It affects 1 in 10,000 live births occurring more in females than males. We present a case of alobar HPE and aim to raise awareness on the importance of early prenatal detection and counselling.Case presentationWe present a case of 3200-gram female baby, born by spontaneous vaginal delivery with APGAR scores of 5 and 6 in the first and fifth minute of life respectively. On admission, the baby was lethargic, had central and peripheral cyanosis, hypothermic with temperature of 32.1 °C, respiratory rate of 65 breaths/min, heart rate of 135 beats/min and oxygen saturation of 94% with an oropharyngeal airway and on oxygen support via a face mask. She had microcephaly, hypotelorism, and a small nose with a single imperforate nostril. She was diagnosed to have alobar holoprosencephaly with cebocephaly. A computed tomography scan of the brain revealed a cephalohematoma in the vertex and an intranasal soft tissue density lesion blocking the entrance measuring approximately 10 × 8.5 mm. Absence of the corpus callosum and septum pellucidum with a resulting monoventricle formed from the lateral ventricles, the fusion of the thalami and a sizeable arachnoid cyst involving the left cerebellar hemisphere were evident. She was started on IV antibiotics and IV fluids. Non-invasive airway management was opted for by the ENT team based on the condition of the baby. She succumbed to death 6 days post admission due to severe respiratory failure.Clinical discussionThe types of HPE are alobar, semi lobar, lobar and interhemispheric variants. Alobar HPE is the most severe form and is incompatible with life. Clinical presentation entails facial dysmorphism with features of hypotelorism, microcephaly and a blind ended nostril. Alobar and semilobar HPE can reliably be diagnosed with ultrasound during the first and second trimesters of pregnancy. Absence of choroid plexus and fused cortex are pathognomonic characteristic on ultrasound and CT scan respectively.ConclusionAlobar holoprosencephaly is a rare brain malformation which is incompatible with life.Prenatal ultrasound screening of the foetus brain is essential and reliable in making a diagnosis. Absence of the “butterfly” sign in the foetal brain ultrasonography should raise a high index of suspicion for brain malformation with unfavourable outcome. Legal medical termination of pregnancy may serve as an early intervention.

Возможности ранней диагностики гипоксического повреждения головного мозга у доношенных новорожденных

The aim of the research. To create a technology for early diagnosis of hypoxic brain damage in full-term newborns. Material and methods. A retrospective analysis of birth histories and cytokine levels in 89 newborns in 2017-2020 was carried out at the premises of perinatal centres in Chita. A total of two study groups were outlined: group 1 included 39 newborns with chronic hypoxia; group 2 included 50 newborns with birth asphyxia. The levels of interleukins (IL-1β, IL-4, IL-6, IL-8, IL-10), TNF-α and NSE in the of umbilical cord blood serum were measured via the immunoenzymatic method. Statistical processing of the results was carried out using the IBM SPSS Statistics Version 25.0 soft ware package (International Business Machines Corporation, USA). Results. The structure of the trained neural network included 6 input neurons refl ecting the level of relevant interleukins (IL-1β, IL-4, IL-6 and IL-8) and the Apgar score at the end of the first and fifth minutes. The percentage of incorrect predictions of the obtained neural network was 17.4 %. Conclusion. A complex approach based on integration of the Apgar score at the end of the first and fifth minutes of life and the level of the cytokines IL-1β, IL-4, IL-6 and IL-8 in umbilical cord blood in the structure of the neural network allows the diagnosis of hypoxic brain damage development with an accuracy of 82.6 %. Application of this technology in clinical practice will make it possible to timely diagnose the pathology of the central nervous system and reduce the frequency of adverse neurological outcomes.

The Comparison of Three Assessment Scales in a Neonatal Unit in Poland

Abstract The aim of this study was to analyse the relationship between the following three assessments: the Neonatal Behavioral Assessment Scale (NBAS), the Alberta Infant Motor Scale (AIMS), and the General Movement Assessment (GMA). 29 patients from the neonatal unit of the Gynecology and Obstetrics Clinical Hospital were examined. The study was conducted between feedings by a person properly trained in the use of the NBAS, the AIMS, and the GMA. The average postmenstrual age of the examined newborns was 35.6 weeks. The average week of gestation was the 29th, the average birth weight was 1469 g, and the Median Apgar score in the fifth minute of life was 7. A relationship was found between the AIMS and the NBAS. It was concluded that the Neonatal Behavioral Assessment Scale and the Alberta Infant Motor Scale may be used to determine the motor development of preterm infants. Moreover, it is advisable to use more than one assessment method in order to adjust the intervention.

Pregnancy planning in women with diabetes mellitus type 2

BACKGROUND: The increase in the incidence of type 2 diabetes mellitus worldwide and the improvement in the quality of diabetic and obstetric care lead to an increase in the number of pregnant women with type 2 diabetes mellitus. The incidence of obstetric and perinatal adverse outcomes in women with type 2 diabetes mellitus is often higher than in women with type 1 diabetes. In the world literature, there are few works on the effect of pregnancy planning on the course and outcome of pregnancy in women with type 2 diabetes mellitus.&#x0D; AIM: The aim of this study was to evaluate the role of pregnancy planning in patients with type 2 diabetes mellitus in improvement of pregnancy and birth outcomes.&#x0D; MATERIALS AND METHODS: We retro- and prospectively analyzed the course and outcome of pregnancy in 124 women with type 2 diabetes mellitus, who were observed in the Diabetes Mellitus and Pregnancy Center of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott for the period from 2010 to 2019. The study included 34 women with type 2 diabetes mellitus at the stage of pregnancy planning and 90 women during pregnancy. All patients underwent a general clinical examination, carbohydrate metabolism correction, training at the School of Diabetes Mellitus in the principles of rational nutrition, self-control of glycemia and insulin therapy. Diabetes compensation was assessed by the level of glycated hemoglobin, determined using a method certified in accordance with the National Glycogemoglobin Standartization Program and standardized in accordance with the reference values adopted in the Diabetes Control and Complications Trial, as well as by the level of glycemia (self-control at least four times a day). We also assessed the severity of vascular complications of type 2 diabetes mellitus before and during pregnancy, and identified and treated comorbidities. To assess the degree of obesity, the criteria of the World Health Organization and the pregravid body mass index calculated by the Quetelet formula were used. The severity of preeclampsia was assessed in accordance with federal clinical guidelines. Ultrasound examination of the fetus with Doppler blood flow in the vessels of the fetoplacental complex was performed using a Voluson E6 ultrasound system (GE Healthcare, USA). For the timely diagnosis of diabetic fetopathy and fetal cardiomyopathy, dynamic fetometry and echocardiography were conducted. In addition, cardiotocography was performed for antenatal assessment of the fetus from the 30th week of pregnancy. After delivery, a neonatologist assessed the condition of the newborn using the Apgar scale at the first and fifth minutes of life, and then the assessment was carried out in the early neonatal period.&#x0D; RESULTS: In the group of women who received pregravid training, the course and outcomes of pregnancy were significantly better: the frequency of preeclampsia was lower (14.7%) compared to the group of women with an unplanned pregnancy (40.0%); there was no severe preeclampsia compared to the same women (13.3%). The number of preterm births was significantly lower (14.7%) in the group of women with planned pregnancy compared to the group of women without pregravid preparation (37.8%). In addition, in the group of women planning pregnancy, there were no fetal congenital malformations, neonatal hypoglycemic conditions, hypertrophic cardiomyopathy; in the group of women with an unplanned pregnancy, these parameters being found to amount to 6.7%, 24.4% and 6.7%, respectively. There was no perinatal mortality in the group of women with a planned pregnancy; however, this parameter was shown to be 3.3% in the group of women with an unplanned pregnancy.&#x0D; CONCLUSIONS: Pregnancy planning in patients with type 2 diabetes mellitus can significantly improve the course of pregnancy and childbirth outcomes.

The Effect of Asphyxia on Neonatal Death: A Meta-Analysis

Background: Asphyxia is the second leading cau­se of in the world. The indi­ca­tor for the diagnosis of in newborns is the (Appearance, Pulse, Grimace, Acti­vi­ty, and Respiration) score. at the fifth minute of life correlated with the deg­ree. This study aimed to estimate how great the effect of on based on the results of some previous studies. Subjects and Method: This was a systematic and meta-analysis study. The articles used in this study were obtained from several databases in­clud­­­ing PubMed, Science Direct, and Google Scho­lar. The articles used in this study were ar­ticles that have been published from 2010-2020. The article was searched by considering the eli­gi­bi­l­ity criteria defined using the PICO model. The po­pulation of this study was with inter­ven­tion in the form of asphyxia, comparison, name­ly non-asphyxia, and outcome in the form of death. These articles were collected for 1 month. The keywords were neonatal AND as­phy­­xia OR APGAR score AND mortality, death asphyxia OR mortality as­phy­xia AND cross sectional. The articles included in this study were full-text articles with a cross-sectional study design. The articles were collected using PRISMA flow diagrams. The articles were ana­lyzed using the Review Manager 5.3 application. Results: 6 articles were reviewed in this study. This study showed that increas­­ed the risk of (aOR= 3.52; 95% CI= 1.05 to 11.82; p=0.040). Conclusion: Asphyxia increases the risk of neo­n­a­tal death. Keywords: Asphyxia, score, mor­tality, Correspondence: Silvalia Rahma Pratiwi. Masters Program in Public Health, Univeritas Sebelas Maret. Jl. Ir. Su­ta­mi 36A, Surakarta 57126, Central Java. Email: sil­­valiarahmapratiwi@gmail.com Journal of Maternal and Child Health (2020), 05(04): 413-421 https://doi.org/10.26911/thejmch.2020.05.04.08

Cesarean Section in Low Birth Weight Babies: An Original Research

The high prevalence of high-risk pregnancies, which can lead to premature delivery, contributes to an increasein the rates of preterm and low-birth weight (LBW) infants, with an increase in the number of cesareandeliveries. This study was done to access maternal variables and their associations with cesarean deliveries ofLBW newborns. A retrospective study was conducted by reviewing the medical records of pregnant womenwho underwent cesarean sections for the delivery of LBW infants (weight, ?1500 and 35 weeks at delivery,and 50.8% attended less than eight prenatal consultations. Hypertensive syndrome (23.8%) was the mainindication for cesarean delivery. Among the newborns, 58.3% had an Apgar score of 7 in the first minuteof life, 79.3% had a score of 9 in the fifth minute of life, and 54.3% were females. Conclusions: Severalmaternal variables such as primiparity, education level, number of prenatal consultations, and presence ofmaternal hypertensive syndrome had a statistically significant association with the occurrence of cesareansections for the delivery of LBW infants.

Perfil e resultados perinatais de gestantes com sí­ndrome hipertensiva do Sul do Brasil

Objetivou-se analisar o perfil e resultados perinatais de gestantes de alto risco com Sí­ndrome Hipertensiva. Trata-se de um estudo epidemiológico, observacional e retrospectivo, com abordagem quantitativa. Foram utilizados dados secundários de 471 gestantes de alto risco e com Sí­ndrome Hipertensiva da cidade de Sarandi/PR e posteriormente acompanhadas pelo ambulatório e realização do parto no hospital de referência, no perí­odo de 2012 a 2016, com partos realizados até 2017. As variáveis independentes foram constituí­das pela Sí­ndrome Hipertensiva, classificada em: hipertensão crônica, pré-eclâmpsia/eclâmpsia, pré-eclâmpsia sobreposta í hipertensão crônica, também conhecida como doença hipertensiva especí­fica da gestação (DHEG). As variáveis desfechos foram: prematuridade, baixo peso ao nascer, Apgar &lt;7 no 1º e 5º minutos, óbito fetal, óbito neonatal e parto cesárea. Os dados foram submetidos aos testes Qui-quadrado e Teste Exato de Fisher. Todas as discussões foram realizadas em ní­vel de 5% de significância (p&lt;0,05) e intervalo de confiança de 95%. A Sí­ndrome hipertensiva gestacional associa-se diretamente a prematuridade, o desenvolvimento de Apgar inferior a sete no quinto minuto de vida, o baixo peso ao nascer, a morte fetal e ao parto cesárea.

Awareness towards an increasing concern during pregnancy: maternal and perinatal outcomes of women with cancer

Increased incidence of cancer in women of childbearing age and improvements on treatment for preserving fertility have led to higher frequency of pregnancy during or after cancer treatment. This study aimed to describe maternal and perinatal outcomes associated with cancer and pregnancy and, as a secondary analysis, to compare outcomes of women with active disease and with remission before pregnancy. We performed a retrospective study of women followed up at a referral center owing to a history of cancer or cancer diagnosed during pregnancy. Data on sociodemographic information, obstetrical history, types of neoplasia, treatments offered, antenatal follow-up, and maternal and perinatal outcomes were retrieved from medical chart review. A descriptive analysis was performed and a comparison among women with active and nonactive disease was performed using Student t-test and chi-square test. A total of 66 women were included in a 5-year period. The most frequent types of cancer were breast (33%), hematologic (21%), brain (11%), cervical (9%), and ovarian (5%) cancers. There were 39 participants (59%) who had active disease and 26 who received oncological treatment during pregnancy, and 23 (34.8%) had a vaginal delivery. There were 4 women who needed intensive care unit admission postpartum. A total of 18 (29.5%) deliveries were at term, most newborns (59%) with adequate weight for gestational age and only 1 had Apgar score lower than 7 in the fifth minute of life. There was 1 stillbirth. The active invasive cancer during pregnancy group showed a higher rate of preterm birth and lower birthweight with significant statistical difference (P=.03 and P<.01, respectively). Breast cancer was the most frequent type of cancer in our cohort. Most deliveries were preterm, with adequate birthweight. Women with active cancer are more likely to have a preterm childbirth and newborns with lower birthweight.

Evaluation of cord blood alkaline phosphatase as a predictor of hyperbilirubinemia in Egyptian neonates

Background/aim Hyperbilirubinemia is a major cause of neonatal morbidity. It affects nearly 60% of term and 80% of preterm neonates during the first week of life. Early prediction of hyperbilirubinemia will help in early discharge and prevent hospitalization of babies and mothers for longer periods. The aim of this study was to verify whether the cord alkaline phosphatase (ALP) levels can predict the development of neonatal hyperbilirubinemia. Participants and methods This prospective study was conducted at Alglaa Teaching Hospital from June 2016 to May 2018. A total of 200 healthy term and late preterm neonates meeting the inclusion criteria were enrolled in this study (gestational age >35 weeks of either sex, from any mode of delivery, and Apgar score ≥7 at first and fifth minutes of life). After birth, cord blood was collected for the estimation of cord blood ALP and serum total bilirubin. Results The incidence of clinical jaundice in our study was 50.54% (94 cases). Only 28.72% (27 cases) of them required treatment. There is a significant association between cord blood ALP levels and the development of hyperbilirubinemia requiring treatment. Receiver operating characteristic curve analysis demonstrates that ALP level of the cord blood greater than 342 IU/l was the most appropriate cutoff value for predicting significant jaundice (that needs treatment). It was associated with 91.07% sensitivity and specificity 61.54%. The area under the curve was 0.791, indicating the high significance and the usefulness of this assay in predicting significant jaundice requiring medication. Conclusion This study concludes that cord blood ALP levels reliably predict the occurrence of pathological hyperbilirubinemia requiring therapy as defined by the current operational guidelines.

Тактика прогнозування акушерських та перинатальних ускладнень у жінок, які народжують уперше

The objective: to develop and introduce tactics of forecasting of obstetric and perinatal complications at the primapara. Materials and methods. The material, allowing to construct classifications for creation of prognostic screening programs of obstetric and perinatal complications at primapara, were the courses of pregnancy given clinical-statistical research, labors, a condition of a fetus and the newborn at 400 primapara. The method of the step-by-step discriminant analysis for which carrying out actual data of clinical-statistical research about prevalence of gestational, patrimonial and perinatal complications at the primapara in interrelation with complex of studied factors are used is the basis for forecasting of possible complications. Results. A method of the step-by-step discriminant analysis were selected the most significant criteria of the forecast (parity; body height; age; age of menarche of the woman; duration of gestation at debut of placental dysfunction; an average assessment on Fisher; a mark assessment of detseleration on a cardiotocogram; concentration - -fetoprotein, chorionic Gonadotropinum, placental lactogen, a theelol, Progesteronum at the end of the III trimester of pregnancy; the systolodiastolic relation in 36-40 weeks; an assessment of the newborn on a scale Apgar on the first and fifth minutes of life of risk of realization and development of obstetric and perinatal complications in the primapara. Discriminant functions which with probability from 59.6 to 92.88% allow to define risk of realization of placental dysfunction, developments of anomalies of patrimonial activity and fetus distress at first labor are constructed. Conclusion. The results received by us allow to recommend the developed algorithm for introduction in practical health care. Key words: pregnancy, labors, complications, forecasting.

Influência do Apgar baixo na primeira triagem auditiva do neonato

Introdução: Diversos são os indicadores de risco para deficiência auditiva. O índice de Apgar, quando menor que quatro no primeiro minuto e/ou menor que seis no quinto minuto de vida, é considerado um indicador de risco para surdez. Tais valores estão associados à ocorrência de asfixia, que é uma das causas mais comuns de lesão e morte celular e, desta forma, algum dano ao sistema auditivo pode ocorrer. Objetivo: Verificar a influência do indicador de risco para deficiência auditiva, Apgar baixo, na primeira avaliação auditiva do neonato. Métodos: Estudo clínico transversal, realizado em hospital público no período de janeiro de 2012 a dezembro de 2016. Os neonatos realizaram a avaliação audiológica por meio do exame de emissões otoacústicas evocadas por estímulo transiente (EOE-t). A relação entre Apgar baixo e “falha” nas EOE-t foi analisada por regressão logística simples. Resultados: Foram avaliados 6.301 neonatos, desses 15,82% (n=996) tinham indicadores de risco para deficiência auditiva e 6,57% (n=415) obtiveram Apgar baixo. Apresentaram falha no exame de EOE-t, uni ou bilateral, 6,5% (n=415) dos neonatos triados. Outros indicadores de risco aumentaram as chances de “falha” na EOE-t, porém o Apgar baixo, isoladamente, aumentou as chances de “falha” em neonatos com peso ao nascimento maior que 1.500 g (OR: 1,58; p=0,02) e sem hemorragia peri-intraventricular (OR: 1,56; p=0,01). Conclusão: O índice de Apgar baixo foi o principal causador de "falha” na primeira avaliação auditiva dentre os neonatos com peso maior de 1.500 g e sem hemorragia peri-intraventricular.

The Correlation between HIV/AIDS Positive Pregnant Mother with Infant APGAR Score in RSD dr. Soebandi Jember

Human Immunodeficiency Virus (HIV) is a virus that decreased immunity and a set symptoms of diseases called Acquired Immune Deficiency Syndrome (AIDS). One of the major risk factors for HIV transmission is perinatal transmission about 2.8% during pregnancy, delivery, and postpartum. HIV positive mothers have a potential to give birth infants with low APGAR. APGAR Score was used as a reference to determine asphyxia in the first and fifth minutes of life. The purpose of this research were to determine the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score and to determine the other factors that affect the infant APGAR Score in RSD dr. Soebandi Jember. This research used observational analytic survey method with cross sectional design using medical record of HIV positive and negative pregnant women from August 2014-July 2017 in RSD dr. Soebandi Jember as a subject that qualify the inclusion and exclusion criteria. This research used case group sampling technique by total sampling and control group by simple random sampling each 52 samples. Test result of the correlation between HIV/AIDS positive pregnant mother with infant APGAR Score using Chi-Square test obtained p value=1.000 (OR=1.13) that means there was no significant correlation. Test result of the correlation between the other factors that affect infant APGAR Score concluded that there were no significant correlation.&#x0D; Keywords: pregnant mother, HIV/AIDS, APGAR Score, infant

Identification of risk factors in infants participating in a Follow-up program

ABSTRACT Purpose: to identify the main health risk factors of infants participating in a follow-up program. Methods: a longitudinal prospective study conducted with 540 high-risk infants observed in the follow-up clinic of the Hospital Materno Infantil in Goiânia in the State of Goiás, Brazil. All biological data of the infants from birth, prenatal, and postnatal periods were collected through assessment sessions with their mothers and medical chart reviews. Data were analyzed through binary logistic regression to identify the highest-risk variables for the infants’ health. Results: in a predictive analysis, the findings showed that neonatal risk was statistically associated with a lower Apgar score at the fifth minute of life, male infants, and longer hospital stay. Infants with increased neonatal risk were more likely to show alterations identified in cranial ultrasound examinations. Moreover, the longer hospital stay was related to mixed breastfeeding after discharge. Conclusion: the main risk factors for the health of high-risk infants in the follow-up program were: low Apgar score at the fifth minute; male sex; longer hospital stay; alterations detected in transfontanellar ultrasound; and mixed feeding after discharge.

Factors associated with preventable infant death: a multiple logistic regression.

ABSTRACTOBJECTIVETo identify and analyze factors associated with preventable child deaths.METHODSThis analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models.RESULTSApproximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women.CONCLUSIONSThe following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

PROGNOSIS OF RENAL DYSFUNCTIONIN TERM NEWBORNS WITH PATHOLOGICAL COURSE OF EARLNEONATAL ADAPTATION

Newborns getting treatment in the intensive care units constitute a high risk group concerning formation of renal dysfunction which serious sign is acutekidney injury. Objective: to develop a mathematical model toprognosticate renal dysfunction of term newborns considering degree of severity of pathological course of early neonatal adaptation. Materials and methods. A retrospective study was carried out including the analysis of risk factors ofrenal dysfunction in 80 term newborns with signs of perinatal pathology of different degree of severity with further step-by-step discriminant analysis of indexed factors (mother’s age ≥ 35 years, presence/absence ofchronic pathology of the urinary system, gestational pyelonephritis in mother, assessment of acute adaptation of a newborn by Apgar scale at the end of the first and fifth minute of life, presence/absence of arterial hypotension syndrome, assessment by NTISS, levels of diuresis by the hour and serum creatinine in a newborn). Results of the study. Coordinates of centroids by the main functions obtained by the findings of discriminant analysis for children without renal dysfunction were the following: F 1 =4,84; F =-0,36; for children with mild disorders – F 1 =0,42; F 2 2 =0,60; for children with moderate disorders – F 1 =-1,94; F =0,51; and for children with severe disorders – F 1 2 =-3,31; F =-0,75. Conclusion. The suggested mathematical model 2 to prognosticate disorders of the renal functional state in sick newborns enables to predict development of severe renal dysfunction to within 75,0%, moderate degree – 80,0%, mild degree – 85,0%, absence of renal dysfunction – 100,0%.