Incidence Of RDS Research Articles

A Cohort Study of Serum 25-Hydroxyvitamin D Levels and Lung Disease in Preterm Infants

Objectives: To analyze the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and lung diseases (wet lung, RDS, BPD, pneumothorax) in preterm infants. Methods: Preterm infants (corrected gestational age <37 weeks) hospitalized in the neonatology department of Yan'an University Hospital from January 2023 to December 2023 were selected as the study subjects, and their clinical data and 25-hydroxyvitamin D [25(OH)D] levels in the first 24 h of life were collected (by the random number table method to avoid selection bias) in a retrospective cohort study with the basis of the Serum 25(OH)D level was used to categorize preterm infants into high vitamin D and low vitamin D groups, and to compare the incidence of lung diseases in preterm infants in the 2 groups. Results: A total of 414 preterm infants were selected, and 237 preterm infants were finally included for analysis. The mean serum 25(OH)D level in preterm infants within 24 hours of birth was 16.97 ng/mL. 140 cases in the low-vitamin D group had a serum 25(OH)D level of (11.88± 2.74) ng/mL. 97 cases in the high-vitamin D group had a serum 25(OH)D level of (24.31± 7.52) ng/mL; the rate of births in the fall in the low-vitamin D group was was significantly higher than that of the high-vitamin D group (P<0.05), the utilization rate of lung surface active substance was higher than that of the high-vitamin D group (P<0.05), and the incidence of RDS and BPD was significantly higher than that of the high-vitamin D group (P<0.05). Univariate logistic regression analysis suggested that season of birth, serum 25(OH)D level, 5 min Apgar score and prenatal hormone use were associated with pulmonary complications in preterm infants (P<0.05). Multifactorial logistic regression analysis showed that higher serum 25(OH)D levels reduced the risk of pulmonary complications in preterm infants, which was statistically significant (B=-0.056, RR= 0.946, 95% CI: 0.910-0.984, P=0.006); higher 5-min Apgar scores had a lower incidence of pulmonary complications in preterm infants, which was statistical significance (B=-0.722, RR= 0.486, 95% CI: 0.281~0.840, P=0.010); prenatal use of hormones will reduce the risk of pulmonary complications in preterm infants (B=-0.763, RR= 0.466, 95% CI: 0.261~0.833, P=0.010). Conclusion: Low vitamin D levels at birth in preterm infants may increase the incidence of RDS and BPD.

Effects of hypertensive disorders of pregnancy on the complications in very low birth weight neonates

ABSTRACT Objective This study was designed to investigate the effects of hypertensive disorders of pregnancy (HDP) on the complications in very low birth weight (VLBW) neonates. Methods We retrospectively included VLBW neonates (<37 weeks) who were delivered by HDP pregnant women with a body weight of < 1,500 g (HDP group) hospitalized in our hospital between January 2016 and July 2021. Gestational age matched VLBW neonates delivered by pregnant women with a normal blood pressure, with a proportion of 1:1 to the HDP group in number, served as normal control. Results Then we compared the peripartum data and major complications between HDP group and control. The body weight, prelabor rupture of membrane (PROM), maternal age, cesarean section rate, fetal distress, small for gestational age (SGA), mechanical ventilation, RDS, necrotizing enterocolitis (NEC) (≥2 stage), Apgar score at 1 min, and mortality in HDP group showed statistical differences compared with those of the control (all p < 0.05). To compare the major complications among HDP subgroups, we classified the VLBW neonates of the HDP group into three subgroups including gestational hypertension group (n = 72), pre-eclampsia (PE) group (n = 222), and eclampsia group (n = 14), which showed significant differences in the fetal distress, Apgar score at 1 min, SGA, ventilation, RDS and NEC (≥2 stage) among these subgroups (all p < 0.05). Multivariate regression analysis showed that eclampsia and PE were the independent risk factors for SGA and NEC, respectively. Conclusion HDP was associated with increased incidence of neonatal asphyxia, fatal distress, SGA, mechanical ventilation, RDS, NEC and mortality. Besides, eclampsia and PE were independent risk factors for SGA and NEC.

Hospitalisations and fatality due to respiratory diseases according to a national database in Brazil: a longitudinal study

BackgroundRespiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the...

A RIGOROUS EXAMINATION OF THE APPROPRIATENESS AND CONSEQUENCES OF DEFERRED CORD CLAMPING IN PRETERM BABIES

The timing of umbilical cord clamping is a pivotal decision in neonatal care, especially for preterm babies. Recent discussions have pivoted around the merits and drawbacks of Delayed Cord Clamping (DCC) compared to Immediate Cord Clamping (ICC). This study aimed to assess and contrast the implications of DCC versus ICC on clinical, respiratory, developmental, and maternal outcomes among preterm neonates. A multicentric, forward-looking, cross-sectional investigation was executed. The study encompassed 350 preterm neonates from various centers. They were categorically split: 175 underwent DCC, while the other 175 experienced ICC. Diverse outcomes, spanning clinical to maternal, were meticulously evaluated. DCC neonates demonstrated elevated early post-birth hemoglobin and hematocrit measurements. The DCC group reported reduced polycythemia occurrences, diminished transfusion necessities, and lesser demands for cardiovascular interventions. Regarding respiratory metrics, the DCC faction showed a decreased incidence of RDS. Neurodevelopmental indicators, such as cognitive and motor capabilities, were more pronounced in the DCC segment. The DCC group manifested reduced neonatal mortality rates and fewer sepsis cases. Maternally, post-delivery hemorrhage was comparable between groups, yet the DCC set displayed heightened satisfaction and a more pronounced initiation and continuity in breastfeeding. The evidence suggests that DCC may present multiple benefits over ICC for preterm neonates in terms of health and developmental outcomes. This underscores the potential of DCC as an integral component of best practices in neonatal care for premature babies.

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies.

This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021. This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded. A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus. The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA. Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

The Use of Antenatal Dexamethasone in Late Preterm and Term Pregnancies to Improve Neonatal Morbidity and Mortality: A Systematic Review and Meta-Analysis.

There are no acceptable worldwide recommendations regarding the use of dexamethasone in late-preterm newborns delivered either vaginally or via cesarean section and term gestation that are performed via cesarean section. The present study aims to compare the effectiveness of antenatal intramuscular dexamethasone versus placebo/no-treatment in reducing neonatal respiratory complications in high-risk for imminent preterm birth in late preterm pregnancies and term pregnancies undergoing elective cesarean section. The PubMed, Scopus, and Cochrane Library databases were searched to assess the effectiveness of dexamethasone during late preterm and term gestation. The last literature search was performed on March 20th, 2022. Randomized controlled trials compared antenatal dexamethasone administration with placebo or no treatment. The outcomes of interest were: the incidence of Respiratory Distress Syndrome; Transient Tachypnea of the Newborn, Neonatal Intensive Care Unit admissions; and the need for ventilatory support or mechanical ventilation.A standardized data form and three independent investigators performed the data extraction. Ten RCTs fulfilled our inclusion criteria. No statistically significant difference was found regarding all of the outcomes in the 34th-36th gestational week group. In the >37th gestational week group, a statistically significant difference was found regarding the incidence of RDS [RR (95% CI); p-value: 0.56 (0.36, 0.87); 0.01], TTN [RR (95% CI); p-value: 0.54 (0.42, 0.71); <0.00001], need for ventilatory support [RR (95% CI); p-value: 0.71 (0.52, 0.96); 0.03] and need for mechanical ventilation [RR (95% CI); p-value: 0.56 (0.33, 0.95); 0.03]. To conclude, the antenatal administration of dexamethasone can be considered to prevent neonatal complications and reduce perinatal morbidity in term pregnancies.

MATERNAL AND PERINATAL OUTCOMES WITH ANTENATAL CORTICOSTEROID ADMINISTRATION IN PRETERM DELIVERIES AT GOVERNMENT DISTRICT HOSPITAL, NANDYAL- AN OBSERVATIONAL STUDY

MATERNAL AND PERINATAL OUTCOMES WITH ANTENATAL CORTICOSTEROID ADMINISTRATION IN PRETERM DELIVERIES AT GOVERNMENT DISTRICT HOSPITAL, NANDYAL- AN OBSERVATIONAL STUDY

INCIDENCE AND ETIOLOGY OF RESPRATORY DISTRESS IN LOW BIRTH WEIGHT NEONATES BORN IN RURAL TERTIARY CARE CENTRE.

Background : To Study The Incidence And Etiology Of Respratory Distress In Low Birth Weight Neonates Born In Rural Tertiary Care Centre. Methods: This is a prospective observational study. It was carried out in neonatal division of department Of pediatrics MMIMSR, Mullana. The study included 200 low birth weight neonates born during the study period. Results: Out of 200 neonates 63 had respiratory distress. The incidence of respiratory distress in index study was 31.5%. According to weight distribution the incidence of respiratory distress among neonates with 1.5kg to 2.499kg was 27.6% , 1kg to &lt;1.5kg was 57.1% and &lt;1kg was 100%. According to gestation the incidence of respiratory distress among term was 29.8% and preterm was 33.6%. The most common cause of respiratory distress was transient tachypnea of newborn(33.8%) followed by hyaline membrane disease(24.1%), sepsis(17.7%), apnea(9.6%), CVS disorder(6.4%). Conclusion: Low birth weight and preterm deliveries are at higher risk for morbidity during and after the birth. Early antenatal care will greatly reduce the incidence of respiratory distress syndrome in neonates. The incidence increases as birth weight and gestation decreases in neonates Due to recent medical advances and skilled clinical practice the incidence of RDS has decreased. Transient tachypnea of newborn remains the main etiology of respiratory distress in neonates.

Rare Disease Patients as Potential Organ Donors

BackgroundRare diseases (RDs) are a heterogeneous group of pathologies, which, when present in a donor, with their anatomic or functional deficiencies, may put the recipient at risk. The aim of our work is to analyze the incidence of RDs in our donors to support transplant experts in the evaluation of these organs. MethodsWe retrospectively assessed the incidence of RDs in donors from July 2017 to June 2019, along with the risk attributed, the number of transplanted organs, and the follow-up results of the recipients. ResultsOver a 24-month period, we had 19 donors with RDs. Of those, the organs of 4 donors were rejected before the risk assessment, the organs of 4 other donors were deemed an unacceptable risk, the organs of 4 more donors were rejected by transplant centers, and the organs of 7 donors were accepted with 16 organs ultimately transplanted (2 hearts, 3 livers, and 11 kidneys). Three of the recipients died of causes not related to the RDs. Thirteen of the recipients are still alive with a functioning organ with an average follow-up of 9 months. ConclusionsAlthough the evaluation of the results is influenced by the limited follow-up period, the use of donors with RDs has proved safe. One of the critical issues encountered in the evaluation process was the impossibility of carrying out genetic and histologic investigations for each organ in urgency. Moreover, the heterogeneity of RDs and the lack of solid literature data require, for the purpose of assessing the level of risk, a specific assessment of individual cases. To overcome these limitations, a group of experts was set up at the Superior Health Council, who drafted a reference document, which allowed for the assessment of the suitability and risk level of donors with the most frequent RDs.

Maternal hypertension, preeclampsia, and risk of neonatal respiratory disorders in a large-prospective cohort study

Possible impact of maternal hypertension and preeclampsia on neonatal respiratory disorders was unknown. We investigated the association of maternal hypertension and preeclampsia with neonatal respiratory disorders in preterm and full-term newborns. In this study, we used a large Chinese population-based study which includes 185,687 singleton livebirths with gestational weeks between 28 and 42weeks. The "exposure" was maternal hypertension and preeclampsia. The outcome was neonatal respiratory disorders including neonatal respiratory distress syndrome (NRDS), pneumonia and low Apgar scores. Logistic regression was used to examine the association between the maternal hypertensive disorders and the risk for neonatal respiratory disorders. We further evaluated the association in preterm and full-term infants. As a result, the incidence of neonatal RDS, pneumonia, and low Apgar score in hypertensive group was higher than that in normotensive group. Preeclampsia was associated with RDS [(adjusted relative risk (aRR): 1.85, 95% confidence interval (CI): 1.22-3.05)]. Both maternal hypertension and preeclampsia increased risks for neonatal pneumonia (aRR: 1.79, 95%CI: 1.48-2.17; aRR: 1.81, 95%CI: 1.36-2.40, respectively), for low Apgar score at 1min (aRR: 1.20, 95%CI: 1.13-1.27; aRR: 1.53, 95%CI: 1.41-1.67, respectively), and for low Apgar score at 5min (aRR: 1.30, 95%CI: 1.17-1.45; aRR: 1.70, 95%CI: 1.46-1.99, respectively). The risk for neonatal respiratory disorders increased with severity of maternal hypertension. The observed associations were present in both full-term and preterm birth. Maternal hypertension and preeclampsia are risk factors for neonatal respiratory disorders in full-term and preterm newborns.

Morbidity profile and immediate outcome of low birth weight neonates in a rural tertiary care hospital of Gujarat, India

Background: Low birth weight (LBW) has been defined as a birth weight of &lt;2.5 kilogram regardless of gestational age. In India, every 3rd born child is of LBW. LBW is associated with increased neonatal mortality and morbidity, compromised growth and cognitive development.Methods: This is a retrospective cohort study using previously collected data from January 2015 to December 2015.Results: Out of 1238 live births, 485 (39.17%) were LBW. 456(94.01%) were LBW weighing &gt;1500 grams (LBW), 22(4.53%) were VLBW, and 07(1.44%) were ELBW. 361(74.43%) were LBW2 (birth weight ≥2000 - &lt;2500 grams), 95(19.58%) were LBW1 (birth weight ≥1500 - &lt;2000 grams). 289(59.58%) of LBW neonates were full term. SNCU admission is significantly higher in LBW neonates (25.8% vs 9.61%). Morbidities were higher in LBW neonates compared to normal birth weight neonates. Difference was more significant in incidence of sepsis (3.72% vs 0.83%), RDS (2.19% vs 0%), TTN (5.48% vs 2.36%), hypoglycemia (1.31% vs 0%), feed intolerance (1.09% vs 0%) and risk of major congenital malformation (1.97% vs 0.27%). Need for respiratory support was 4.82% in LBW vs 2.36% in normal birth weight neonates. Morbidities were significantly higher in VLBW and ELBW neonates. Immediate poor outcome was in 3.92% in LBW neonates, while it was 0.56% in normal weight neonates. Poor immediate outcome was 1.11% in LBW2, 2.10% in LBW1, 10% in VLBW1, 41.66% IN VLBW2, and 100% in ELBW.Conclusions: LBW neonates are at higher risk of morbidities and mortalities. The major determinant for mortality in LBW babies is the birth weight. The best option to prevent LBW is by improving maternal health. Improvement of perinatal and neonatal services in government sector and public private partnership model of free neonatal care can help to achieve the INAP goal of NMR &lt;10 by 2030.

Intrauterine Growth Restriction in the Triad: Understanding Outcomes Associated with Differential Management of Severe Early IUGR

Objective:&#x0D; Preterm delivery of growth restricted (IUGR) fetuses prior to 32 wks is rarely indicated, occurring in &lt;1.9% of all pregnancies. We sought to determine if delaying delivery until non-reassuring fetal heart tracing (NRFT) increases adverse outcomes.&#x0D; Materials and Methods:&#x0D; This is a cohort of pregnant women with IUGR identified prior to 32wks. Serial fetal growth and umbilical artery Doppler (UAD) were assessed. Two groups were compared: those delivered for abnormal UAD studies and those delivered for non-reassuring fetal heart tracing (NRFHT). Fetuses with absent (AEDF) or reversed end diastolic flow (REDF) were placed on continuous monitoring until delivery. Maternal comorbidities, delivery indications, and neonatal outcomes were compared between the 2 groups. T-test and Chi-square were performed where appropriate.&#x0D; Results:&#x0D; 43 singleton gestations with IUGR were identified at &lt;32 weeks gestation from 2012-2015. Pregnancies were excluded for multiple gestation or when delivered for maternal deterioration. Mean GA at diagnosis 24.7 +/-3.1wks (range 18-30.3wks). 30 delivered for abnormal UAD and 13 for NRFT. Pregnancy characteristics were similar between groups. Those women who progressed to urgent delivery due to NRFT were more likely to undergo cesarean (CD) than SVD (p=0.01). 83.9% of both groups were delivered via CD and were significantly smaller compared to those able to be born via SVD (p=0.026). Women with HTN, preeclampsia or GHTN were also more likely to undergo CD than SVD (p=0.04). Expectant management for abnormal UAD did not decrease requirement for CPR at delivery or incidence of IVH, RDS, or death. Although not statistically significant, the length of stay was 50.9 days in those delivered for Doppler while 61.2 days in the group delivered emergently (p=0.23); see Table 1.&#x0D; Conclusion:&#x0D; Expectant management for fetal growth restriction and waiting to deliver until there was NRFT does not appear to decrease neonatal morbidity/mortality, increases risk for emergency CD, and may increase length of stay in NICU.

Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth <37 weeks of gestation or not. Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%; P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%; P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length < 25 mm.

Study of respiratory distress syndrome in newborn with special reference to the role of bubble CPAP in its management

Background: Respiratory distress syndrome is the most important cause of morbidity and mortality in preterm neonates. Intermittent positive pressure ventilation with surfactant therapy was standard treatment of RDS. IIPV is invasive, costly and requires expertise. It is not a viable option for many of the resource limited SNCU set ups of our country. Trials have showed that CPAP is noninvasive, easy to use, safe and effective. This study was done to find out effectiveness of CPAP in RDS, and also to find CPAP failure factors.Methods: This was a prospective observational study, carried out at SNCU of Dhiraj hospital, Piparia, Vadodara district, Gujarat, India form February 2014 to March 2015. Neonates with diagnosis of respiratory distress syndrome were included in this study.Results: Total 57 (42 inborn and 15 out born) cases of RDS were analyzed in this study. Incidence of RDS was 3.68% of live births. 5(8.8%) settled down with low flow oxygen only. 24 (42.1%) successfully treated with CPAP only. 15 (26.3%) were treated with CPAP and surfactant. 13 (22.8%) were CPAP failure cases which required ventilator support. The variables significantly associated with failure of CPAP were: no exposure to antenatal steroids (p value of 0.025), grade 3-4 RDS on CXR (p value of 0.03), PDA (p value of 0.0264), sepsis/pneumonia (p value of &lt;0.001) and Silverman Anderson score of ≥7 at admission (p value of 0.001). 3 (5.3%) went on DAMA. 5 (8.8%) expired and 49 (85.9%) were discharged. 4 out of 5 (80%) death occurred in very preterm group. 4 (80%) of death occurred in neonates whose mothers did not receive any dose of antenatal steroid. There was no mortality in neonates who were in need of surfactant and received within 6 hours of life. 75% of neonates having sepsis and asphyxia both along with RDS expired.Conclusions: Bubble CPAP is safe and very effective in low resource settings. CPAP failure is significantly associated with no antenatal steroids, grade 3 to 4 x-ray changes of RDS, Silverman Anderson score of ≥7 at beginning of CPAP, presence of significant PDA and association of sepsis/pneumonia.

Early Onset Severe IUGR: Waiting to Deliver Does Not Appear to Improve Outcome and May Be Harmful [35R

INTRODUCTION: Preterm delivery of IUGR fetuses prior to 32 wks is rarely indicated, occurring in &lt; 1.9% of all pregnancies. We sought to determine if delaying delivery until non-reassuring fetal heart tracing (NRFT) increases adverse outcomes. METHODS: In a cohort of IUGR &lt; 32 wks, two groups were compared: those delivered for abnormal UAD studies and those delivered for NRFT. Fetuses with persistent absent (AEDF) or reversed end diastolic flow (REDF) were placed on continuous monitoring until delivery. Pregnancies were excluded when delivered for maternal deterioration. T-test and Chi-square were performed where appropriate. RESULTS: 43 singletons with IUGR &lt; 32 weeks gestation and abnormal UAD from 2012-2015. Mean GA at diagnosis 24.7 +/-3.1 wks (range 18-30.3 wks). 30 delivered for abnormal UAD and 13 for NRFT. Pregnancy characteristics were similar between groups. Women progressing to urgent delivery due to NRFT were more likely to undergo cesarean (CD) than SVD (p=0.01). 83.9% of both groups were delivered via CD and were significantly smaller compared to those able to be born via SVD (p=0.026). Women with HTN, preeclampsia or GHTN were also more likely to undergo CD than SVD (p=0.04). Expectant management until NRFT of abnormal UAD did not decrease requirement for CPR at delivery or incidence of IVH, RDS, or death. Length of stay was 50.9 days in those delivered for Doppler while 61.2 days in the group delivered emergently (p=0.23). CONCLUSION: Waiting to deliver until there was NRFT does not appear to decrease neonatal morbidity/mortality, increases risk for emergency CD, and may increase length of stay in NICU.

Morbidities and survival outcome of admitted low birth weight neonates in non-teaching district hospital SNCU

Background: 0.8% of India’s health care spending is for universalization of SNCU. The working status of a non-medical college SNCU is still far from satisfaction in relation to manpower, availability, maintenance and utilization of equipment’s. There are very few studies on outcome of morbities in non-teaching hospital SNCU and no studies analysing on morbities of LBW neonates in such SNCU with multiple deficiencies. LBW comprises 30% of SNCU admissions, half of perinatal and 1/3 rd of neonatal deaths. Methods: A retrospective study analyzing morbities and survival outcome of admitted LBW neonates in SNCU of district hospital Madikeri, Kodagu District, Karnataka, India from October 2014 to October 2015. 224 LBW neonates were grouped as per birth weight (<1 kg, 1-1.499 kg, 1.5-1.99 kg, 2-2.499 kg and maturity at birth (<28 weeks, 28-34 weeks, 34-37 weeks, Term). Intrauterine growth charts used to note birth weight for period of gestation and further classified into preterm, and term IUGR. Morbidities and survival outcomes followed until discharge were analyzed by descriptive and analytic statistics with respect to maturity, birth weight and IUGR . Results: 28.61% of SNCU admissions were LBW. 79.46% of LBW babies were preterm. 8.93%, 37.1%, 33.48% and 20.54% babies were <28 weeks, 28-34 weeks, 34-37 weeks and term neonates. 1.7%, 24.6%, 43.75%, and 29.99% weighed <1 kg, 1-1.499 kg, 1.5-1.99 kg and 2-2.499 kg. Incidence of RDS was 20.09%, Meconium aspiration syndrome was 4.46%, Neonatal sepsis 16.1%, Birth asphyxia 11.61%, Neonatal jaundice 7.59%, Apnoea 2.71%, hypoglyceamia 1.34%, hypothermia 1.79%, Refusal to feed 2.71%, congenital anomalies 1.34%. Discharge, deaths, referrals and LAMA for <1 kg (25%, 25%, 25%, 25%), for 1-1.499 kg (47.27%, 25.45%, 14.54%, 12.73%), for 1.5-1.99 kg (80.61%, 5.1%, 11.22%, 3.06%), for 2-2.499 kg (76.12%, 1.49%, 13.43%, 8.9%). Prevalence of IUGR in admitted LBW neonates was 43.75%. Early preterm <34 weeks were LBW AGA babies and late preterm 34-37 weeks were LBW SGA babies (P value-<0.001). Correlation between ELBW, VLBW and LBW neonates and its relation to deaths and discharge were highly significant (P value -<0.001), LAMA was significant (P value -<0.05). 70.08% cases were successfully discharged, 12.59% referred to tertiary care, 7.59% LAMA. 9.38% babies died. LBW constituted 47.72% of total SNCU deaths. Conclusions: Morbidity and survival outcome of LBW neonates is directly proportional to birth weight and gestational age. Though a low resource non-teaching hospital unit with deficiencies in manpower and functioning equipment’s 70.08% of LBW babies were successfully discharged. FBNC units are contributing enormously to bring down neonatal death rates.

Late preterm births: a retrospective analysis of the morbidity risk stratified for gestational age.

PurposeLate-preterm births are considered functionally mature but, several line of evidences suggest that, compared with term neonates, they have a higher risk of complications. The aim of this study was to compare the incidence of maior clinical complications of late preterm infants born in our division, compared to those born at term.MethodsWe retrospectively analysed late preterm deliveries occurred in a twenty-months period. Late preterms were divided in 3 sub-groups according to gestational age at delivery: 34 0/6 , 35 0/6 , 36 0/6 weeks of gestation. The incidence of maior clinical complications was evaluated. Statistical analysis was performed by using the Z- test.ResultsAmong term deliveries 17.24% were admitted to the neonatal intensive care unit and 69.01% presented one major adverse outcome: 25.35% jaundice, 25.35% hypoglycemia , 11.26% RDS , 4.22% intraventricular hemorrhage (IVH), 4,22% anemia. The incidence of IVH was significantly higher only at 340/6 weeks of gestation compared to term infants. The incidence of anemia and RDS was significantly higher at 34 0/6 and 35 0/6 weeks of gestation, but it was not significantly different at 36 weeks of gestation, compared to full-term infants. Finally, the incidence of hypoglycemia and jaundice results significantly higher in all the 3 sub groups of late preterms, compared to full term infants.ConclusionsResults demostrated an increased risk of morbidity in the late preterm period. Results also showed that the gestational age at delivery of late preterms can influence the risk of adverse neonatal outcomes.

Http://www.omicsgroup.org/journals/pulmonary-agenesis-with-dextrocardia-and-hypertrophic-cardiomyopathy-first-case-report-2167-0897.1000141.php?aid=26283

Background: Last two decades have witnessed a steady improvement in the quality of perinatal care in India. Better understanding of the pathophysiology and newer treatment strategies like antenatal steroid, surfactant use, newer modes of ventilation and stringent aseptic measures have contributed to the improved survival of very low birth weight babies. Methods: In a prospective cohort study conducted in a tertiary care center over two years period (October 2011- September 2013), 744 VLBW babies (birth weight <1500 g) were assessed for gestational age, maturity, maternal risk factors and administration of antenatal steroids. Morbidities like birth asphyxia, sepsis, jaundice, respiratory distress syndrome, intraventricular haemorrhage, necrotisingenterocolitis, apnoea, pulmonary haemorrhage and patent ductusarteriosus were noted. Screening for retinopathy of prematurity and hearing impairment was done. Outcome in terms of survival till discharge was recorded. Results: Out of 744 VLBW babies, 496 (66.67%) survived till discharge. Maternal risk factors associated with birth of VLBW babies were primiparity (58.06%), poor socio economic status (40.86%), multiple gestations (36.83%), PROM (26.34%), hypertension (13.44%) and under nutrition (12.36%). Jaundice (43.31%), apnoea (26.34%), birth asphyxia (20.43%), RDS (19.89%) and sepsis (18.82%) were found to be significant morbidities. Mortality was higher among males (20.43%) than females (12.9%). None below 27 weeks of gestation and birth weight of 800 g survived. RDS was the main cause of death (46.15%) followed by birth asphyxia (23%), sepsis (19.2%) and IVH (11.5%). Antenatal steroid improved the survival (72.9%) and reduced the incidence of RDS, NEC and IVH. ROP was detected in 30.49% VLBW babies. 33.3 % of the survivors failed in the initial hearing screening. Conclusions: Higher birth weight, gestational age, female sex and antenatal steroids improved survival amongst VLBW babies. Antenatal steroids reduced incidence of RDS, NEC and IVH when preterm delivery was inevitable. Judicial use of supplemental oxygen and blood products prevent development of ROP.

Perinatal Outcome of Monochorionic Twins With Selective IUGR Compared With Uncomplicated Monochorionic Twins

To evaluate the perinatal outcome of MC twins with selective IUGR (sIUGR). A prospective study, which included three groups of MC twins: Group A, uncomplicated MC twin pregnancies (n = 91); group B, sIUGR with normal umbilical artery Doppler (n = 19); and group C, sIUGR with abnormal (absence or reversed EDV) umbilical artery Doppler (n = 18). The latter were routinely hospitalized in the high-risk ward under strict surveillance. Neonatal outcome of fetuses complicated with sIUGR and normal Doppler was similar to controls. Neonates born to pregnancies complicated by sIUGR and abnormal Doppler had significantly increased incidence of CNS findings, RDS, NEC, sepsis, and neonatal death compared to controls. Adverse outcome in this group was independently associated only with gestational age at birth. The perinatal outcomes of MC twins complicated with sIUGR and normal Doppler are similar to uncomplicated MC pregnancies. MC twins with sIUGR and abnormal Doppler have reasonable outcomes, yet significantly more neonatal complications compared to non-complicated MC twins.

Outcome Following Surgical Closure of Patent Ductus Arteriosus in Very Low Birth Weight Infants in Neonatal Intensive Care Unit

PurposeThe aims of this study were to determine the factors affecting the outcome of patent ductus arteriosus ligation in very low birth weight infants (VLBWI) and demonstrate the safety of PDA ligation in VLBWI performed in the neonatal intensive care unit (NICU).Materials and MethodsFrom October 1994 to July 2006, medical records of 94 VLBWI weighing < 1,500 g who underwent PDA ligation in the NICU of Samsung Medical Center were reviewed retrospectively. Factors affecting the final outcome of PDA ligation were evaluated by dividing the infants into 3 groups according to mortality and major morbidities as follows: mortality group (Mo), major morbidity group (Mb), and no major morbidity group (NM).ResultsIn the Mo group, birth weight was significantly lower and the preoperative mean FiO2 and mean dopamine dose were significantly higher than those in the other 2 groups. There was no significant difference in gestational age, incidence of RDS, number of courses of indomethacin, surgery-related factors, including weight and age at surgery, perioperative vital signs, and complications after surgery between the 3 groups. During surgery in the NICU, there were no significant hemodynamic instability or serious acute complications.ConclusionThe factors affecting the outcome of surgery in VLBWI are not the factors related to surgery but the preoperative conditions related to the underlying prematurity. PDA ligation of VLBWI performed in the NICU is safe without serious complications.