Incidence Of Respiratory Distress Research Articles

Assessment of Initial Morbidity Patterns in Late Preterm Infants Relative to Those at Term

The purpose of this research was to assess the patterns of morbidity and mortality in late preterm neonates—that is, neonates born before 37 weeks of gestation. Preterm births are a major contributing factor to many deaths in children under five, with a larger percentage of deaths occurring during the neonatal era. The study was a prospective observational cohort study carried out at DDU Hospital in New Delhi in the neonatal intensive care unit of the pediatrics department. While term neonates had a mean gestation distribution of 38.64 weeks, late preterm newborns had a mean distribution of 35.39 weeks. The distribution of mean birth weight was 2.35 (±0.48) and 3.04 (±0.43) kg. Males were seen often in both research groups. The distribution of hypoglycemia among the study groups showed a significant difference, with late preterm infants having a higher incidence of the condition. The rate of post-resuscitation care varied significantly as well, with late preterm infants needing greater attention. A statistically significant increase was observed in the incidence of respiratory distress in late preterm newborns. Compared to the other group, late preterm infants had a higher prevalence of jaundice and sepsis. The study finds that compared to term newborns, late preterm infants had a higher risk of morbidity. To have a better understanding of these children's neonatal outcomes, more research is required.

Association of History of Diabetes and Hypertension with Clinical Findings and Length of Hospital Stay in COVID-19 Patients

Background: Coronavirus disease 2019 (COVID-19) has become one of the most serious diseases worldwide. The contagiousness of the virus and its unexpectedly rapid spread in different communities have raised many concerns. Objectives: This study investigated the association of clinical findings and hospital stay length of COVID-19 patients with diabetes and hypertension history in Garmsar Hospital. Methods: This cross-sectional study assessed COVID-19 patients admitted to Motamedi Hospital, Garmsar, Iran. Data were recorded in Minitab V17 software and analyzed through analysis of variance (ANOVA). Pearson's and Spearman's correlation coefficients were also computed for quantitative and qualitative variables, respectively. Results: The mean age was significantly higher in the group with underlying diseases than in the control group. The proportion of CRP-positive cases was higher in the hypertensive group than in the diabetes + hypertensive group, but it was not statistically significant. The rate of shortness of breath, length of hospital stay, and mortality were lower in the control group than in the group with underlying diseases, but this difference was not statistically significant. Conclusions: Although the incidence of respiratory distress, the length of hospital stay, and the mortality rate were lower in the control group than in the group with diabetes + hypertension, there was no significant association between these conditions and the risk of death and the length of hospital stay due to COVID-19.

Evaluation of etiology and clinical spectrum of respiratory distress in neonates admitted in tertiary care NICU

Background: Neonatal period is defined as up to first 28 days of life and further divided into very early (birth to <24 h), early (birth to <7 days), and late neonatal period (7 days to <28 days). Neonatal period is the most vulnerable period of human life as it accounts for very high morbidities and mortalities and most of these are preventable. India contributes to one-fifth of global live births and more than a quarter of neonatal deaths. Respiratory distress is most common cause of NICU admission Aim of current study was to determine the etiology of respiratory distress in neonates presenting in NICU, clinical spectrum of respiratory problems in neonates having respiratory distress and the management of respiratory distress. Methods: The present study was a prospective, observational, comparative study. This study was conducted from January 2019 to October 2019 at Mata Channan Devi hospital Janakpuri, New Delhi. 80 patients were included in this study. Results: In our study 93.75% cases of respiratory distress was of respiratory origin, while 3.75% was due to cardiac cause and 2.5% was central nervous system due to birth asphyxia and in our study group most common clinical finding of respiratory distress was tachypnea found in 97.5% of patients. Result showed, overall incidence of respiratory distress among in borns was 10.34%. In our study TTNB was most common cause of respiratory distress among new born. Conclusions: There was no significant difference of incidence in male and female babies. The etiology varies with gestational age. In spite of all advances in primary maternal care, delivery and early new born care respiratory distress is still the most common cause of morbidity and NICU admission in newborn babies.

A retrospective cohort study on effects of antenatal steroids on respiratory morbidity for term elective caesarean sections in South Asian women

Background Respiratory distress (RD) is higher among newborns born by caesarean section (CS) compared to vaginal delivery. Royal College of Obstetricians and Gynaecologists recommend steroid administration for CS prior to 39 weeks. Effectiveness of steroids for neonatal RD at term is inconclusive. The racial differences are yet to be studied. Methods A single center retrospective cohort study was conducted in Colombo, Sri Lanka from December 2016 to February 2019. All mothers delivered by CS between 37+0 and 38+6 weeks were included. Mothers with severe maternal hypertension, fetal rhesus sensitization, intrauterine infection, multiple pregnancies and who received steroids at a prior gestation were excluded. Cohort was subdivided according to administration of intramuscular dexamethasone prior to CS. Primary outcomes measured were RD, admissions to neonatal intensive care unit (NICU) and special care baby unit (SCBU). Neonatal infections and maternal duration of hospital stay were recorded as secondary outcome measures. Results 560 patients were included. 23.2% of patients received antenatal corticosteroids. Incidence of RD, NICU admissions and SCBU admissions in the study cohort was 10%, 0.9%, and 2.7% respectively. Relative risk for developing RD in the steroid group compared to non-steroid group was 2.67 (95CI 1.64-4.35). 4.6% of the steroid group and 3.3% of the non-steroid group needed to be admitted to the NICU/SCBU (p=0.464). A significantly higher number of babies in the steroid group needed IV antibiotics. The average number of days the mothers were admitted to the hospital was 2.45 days (SD+/- 1.424) for steroid group and 1.4 days (SD+/- 0.856) for the non-steroid group (p < 0.001). Conclusions There is a significant increase in the respiratory morbidity in the dexamethasone administered south Asian mothers at term prior to CS. However, this effect has no clinical significance since the admissions to NICU and SCBU were not significantly different.

Efficacy and Safety of Corticosteroids' Administration for Pulmonary Immaturity in Anticipated Preterm Delivery.

Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. The scope of this narrative review was to synthesize available evidence on the efficacy and safety of corticosteroids' administration during antenatal period, in cases of anticipated preterm delivery. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24- hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised.

Fetal Outcome in Cesarean Versus Normal Deliveries in Pregnancy with Meconium-stained Liquor: A Cross-sectional Study.

Intrauterine meconium passage in near term or term fetuses has been associated with feto-maternal stress factors and/or infection and is contributing to the increased rate of cesarean section. This study aimed to evaluate effect of mode of delivery on fetal outcome in pregnancy with meconium-stained liquor. A cross sectional study was done in 2019 at a tertiary care center. Data was collected from women in labor, in whom meconium was seen after rupture of membrane. Out of these, 115 cases, who underwent cesarean delivery for meconium-stained liquor were enrolled in one group; while in another group 115 cases who delivered vaginally were enrolled and the fetal outcome was compared in between these two groups. Out of 230 cases, most participants were from 21 to 25 years age group. Most of patients were primigravida accounting for 63%, and with mean gestational age of 39.4 weeks. Low Apgar score at one and 5 minutes, percentage of respiratory distress, perinatal asphyxia, need of bag and mask ventilation as mode of resuscitation were associated more with vaginal deliveries. Incidence of Neonatal Intensive Care Unit admission, meconium aspiration syndrome, and neonatal death were seen more in vaginal delivery in comparison to cesarean delivery. There was no much difference in Apgar score at 5 minutes in either mode of delivery. Incidence of respiratory distress, perinatal asphyxia, Neonatal Intensive Care Unit admission, meconium aspiration syndrome and neonatal death were higher in vaginal delivery. Fetal morbidity and mortality were seen more in moderate to thick meconium-stained liquor.

Respiratory Distress in Full and Post Term Neonates: Prevalence, Etiologies and Outcomes in a Tertiary Health Center in Yaoundé

Introduction: Respiratory pathologies are top listed amongst neonatal morbidities. Our objective was to describe the clinical features, causes and treatment of respiratory distress (RD) in full and post term neonates in a tertiary health center in Yaoundé, the Essos Hospital Centre (EHC). Patients and Method: This was a retrospective study. Full/post term neonates with RD from January 2017-December 2018 were included. Main parameters: incidence of RD, etiologies, risk factors for severity and mortality. Results: We included 186 neonates among 2312 newborn babies. The RD prevalence rate was 8%. Sex ratio of 2.15 was favoring male, median gestational age of 38 weeks. Clinical signs of RD were dominated by a Silverman score above 4/10 in 64%. Main etiologies were pneumonia (44%), followed by transient tachypnea (35.4). Perinatal asphyxia (OR = 9.412, P = 0.005) and cyanosis (OR = 6.509; P 0.001) were worsening RD, while caesarian section was protective (OR = 0.412; P = 0.050). Mortality rate (MR) was 10.4%. Therapeutic measures briefly consisted in oxygen therapy for 98.9% of patients and probabilistic antibiotic therapy. Conclusion: Neonatal pneumonia was the preeminent etiology of RD in this population; the MR was high.

Incidence of respiratory distress and its predictors among neonates admitted to the neonatal intensive care unit, Black Lion Specialized Hospital, Addis Ababa, Ethiopia.

Although respiratory distress is one of the major causes of neonatal morbidity and mortality throughout the globe, it is a particularly serious concern for nations like Ethiopia that have significant resource limitations. Additionally, few studies have looked at neonatal respiratory distress and its predictors in developing countries, and thus we sought to investigate this issue in neonates who were admitted to the Neonatal Intensive Care Unit at Black Lion Specialized Hospital, Ethiopia. An institution-based retrospective follow-up study was conducted with 571 neonates from January 2013 to March 2018. Data were collected by reviewing patients' charts using a systematic sampling technique with a pretested checklist. The data was then entered using Epi-data 4.2 and analyzed with STATA 14. Median time, Kaplan-Meier survival estimation curves, and log-rank tests were then computed. Bivariable and multivariable Gompertz parametric hazard models were fitted to detect the determinants of respiratory distress. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with reported p-values < 0.05 were considered statistically significant. The proportion of neonates with respiratory distress among those admitted to the Black Lion Specialized Hospital neonatal intensive care unit was 42.9% (95%CI: 39.3-46.1%) The incidence rate was 8.1/100 (95%CI: 7.3, 8.9). Significant predictors of respiratory distress in neonates included being male [Adjusted hazard ratio (HR): 2.4 (95%CI: 1.1, 3.1)], born via caesarean section [AHR: 1.9 (95%CI: 1.6, 2.3)], home delivery [AHR: 2.9 (95%CI: 1.5, 5,2)], maternal diabetes mellitus (AHR: 2.3 (95%CI: 1.4, 3.6)), preterm birth [AHR: 2.9 (95%CI: 1.6, 5.1)], and having an Apgar score of less than 7 [AHR: 3.1 (95%CI: 1.8, 5.0)]. In this study, the proportion of respiratory distress (RD) was high. Preterm birth, delivery by caesarean section, Apgar score < 7, sepsis, maternal diabetes mellitus, and home delivery were all significant predictors of this condition. Based on our findings this would likely include encouraging more hospital births, better control of diabetes in pregnancy, improved neonatal resuscitation and addressing ways to decrease the need for frequent caesarean sections.

Fetal Intrapericardial Teratomas: An Update

Fetal intrapericardial teratomas are rare and benign cardiac tumors. By comprehensive literature retrieval of the pertinent articles published since 2000, 49 articles with 61 cases of intrapericadial teratomas were recruited into this study. The intrapericardial teratomas were found during pregnancy in 55 cases (fetal group), while the tumors were detected until neonatal period in 6 cases (neonatal group). In the fetal group, 15 cases were critical with fetal/neonatal respiratory distress or cardiac tamponade. Antenatal treatments including centesis, shunt placement, open fetal surgery and the ex utero intrapartum treatment were required in 24 (43.6%) fetal cases. Postnatal intubation was required in 19 cases with 18 of them having immediate intubation after birth. Postnatal tumor resection was performed in 41 (95.3%) cases. In neonatal group, 4 neonates had respiratory distress and/or cardiac tamponade. Neonatal intubation was required in 1 (16.7%) patient. Surgical tumor resection was performed in all 6 patients. A comparison between the fetal and neonatal groups revealed that the fetal group was associated with higher refractory effusions while the neonatal group had a higher incidence of respiratory distress. Although the all cause death rate was higher in the fetal group than in the neonatal (25.5 vs. 0%), but lack of a statistical significance. Antenatal treatments for fetal intrapericardial teratomas are feasible but carry higher risks in comparison to neonatal cases.

Etiological serotype and genotype distributions and clinical characteristics of group B streptococcus-inducing invasive disease among infants in South China

BackgroundGroup B streptococcus (GBS)-induced invasive disease is a major cause of illness and death among infants aged under 90 days in China; however, invasive GBS infection remains unknown in China. We aimed to describe the serotype and genotype distributions of early-onset disease (EOD) and late-onset disease (LOD), and to show the clinical correlations among various GBS serotypes and genotypes obtained from infants with invasive GBS infections.MethodsBetween June 1, 2016 and June 1, 2018, 84 GBS strains were collected from patients younger than 90 days at seven Chinese hospitals. Clinical data were retrospectively reviewed. GBS serotyping was conducted and multi-locus sequence typing was performed.ResultsSerotypes Ia, Ib, II, III, and V were detected. Serotype III (60.71%) was the most common, followed by Ia (16.67%) and Ib (14.29%). Intrapartum temperature ≥ 37.5 °C, chorioamnionitis, and mortality were noted in 28.57, 42.86, and 28.57% of patients with serotype Ia, respectively, and these rates were higher than those in patients with serotypes Ib and III (P = 0.041, P = 0.031, and P = 0.023, respectively). The incidence of respiratory distress was lower (P = 0.039) while that of purulent meningitis was higher (P = 0.026) in the serotype III group. Eighteen sequence types were detected among isolates, and ST17 [42.86% (36/84)] was the most prevalent.ConclusionsGBS isolates belonging to serotypes Ia, Ib, and III are common in southern mainland China, and ST17 is highly prevalent. Differences were found in the clinical manifestations of invasive GBS disease induced by serotypes Ia and III.

Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial

Background Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered via C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth. Objective To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS). Design/methods In a single center, randomized parallel clinical trial, vigorous term neonates delivered via scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS via Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life. Results Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%, p = .93), mean RS duration (4.08 versus 4.39 min; p = .71), frequency of admission to the NICU (5% in both groups; p = .95) and mean length of stay (0.14 versus 0.28 days; p = .42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation (p = .02) as well as heart rate (p = .004). Conclusions Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life.

Neonatal outcome in pregnancies complicated by gestational diabetes mellitus: a hospital based study

Background: Gestational diabetes mellitus (GDM) is amongst the most common medical complications of pregnancy associated with adverse maternal and perinatal outcomes. The prevalence of GDM is increasing worldwide especially in India with increasing obesity and lifestyle and dietary changes. Hence this study was undertaken to study the prevalence of GDM and to evaluate its neonatal outcomes.Methods: This was a prospective study. During the study period, 205 pregnant women between 24 to 28 weeks of gestation were screened for GDM using 75 g oral glucose tolerance test (OGTT) and were diagnosed to have GDM based on WHO criteria. Risk factors for GDM, maternal and neonatal outcomes were studied.Results: The prevalence of GDM in the study population was 7.8%. Prevalence of GDM cases was significantly associated with body mass index (BMI) &gt;25 kg/m2, family history of diabetes, previous macrosomia/large for gestational age (LGA) baby and past history of GDM with p &lt;0.001 and with multiparity (p = 0.024). Maternal age &gt;25 years was not statistically associated with prevalence of GDM (p = 0.358). Incidence of pre-eclampsia and polyhydramnios were significantly higher among GDM cases. Operative delivery and assisted (forceps) delivery had strongly significant association with GDM (p &lt;0.001). GDM cases were significantly associated with higher birth weight (&gt;3.5 kg) in the neonates (p &lt;0.001). Hypoglycemia was the most common complication noted in neonates of GDM women. Incidence of respiratory distress, transient tachypnea of the newborn (TTN), polycythemia and neonatal hyperbilirubinemia were also significantly more common among neonates born to GDM women.Conclusions: BMI &gt;25 kg/m2, family history of diabetes, past GDM and previous LGA baby were important risk factors for GDM. The study emphasizes the need to screen all pregnant women for GDM, so that timely diagnosis and intervention will reduce both maternal and perinatal complications.

Effect of endotracheal suctioning just after birth in non-vigorous infants born through meconium stained amniotic fluid: A randomized controlled trial

BackgroundDepressed neonates born through meconium stained amniotic fluid (MSAF) are at high risk for developing meconium aspiration syndrome (MAS). Benefits and risk of endotracheal suctioning in non-vigorous infants at birth, though widely practiced till recent have not been established. ObjectivesTo evaluate effect of endotracheal suctioning at birth on incidence of MAS, its severity and outcome among non-vigorous MSAF born infants. MethodsThis randomized open level trial was conducted over one year period at a tertiary care teaching hospital. 155 non-vigorous infants (vigour assessed within 5–10s of birth) were randomized to receive either endotracheal (ET) suctioning just after birth (n=76) or no-endotracheal suction (n=79). Subsequent resuscitation was performed as per neonatal resuscitation guideline. All infants were admitted for subsequent care and monitoring. Antenatal, intrapartum, and neonatal details; respiratory support; complications, hospital stay and outcome were recorded. ResultsIncidence of respiratory distress due to MAS (with consistent chest radiology) was 41.3% and 57.1% [OR=0.53(0.28to 1.01); p=0.052], while non-MAS respiratory distress was 33.3% and 27.3% [OR=1.69(0.81 to 3.54); p=0.17] in ET suction and no-ET suction group, respectively. Severity of MAS in ET suction vs. no-ET suction group were mild:16.1%(5/31)vs15.9%(7/44); moderate:61.3%(19/31)vs65.9%(29/44) and severe:22.6%(7/31)vs18.2% (8/44). Respiratory support requirement including mechanical ventilation; its duration, and mortality were similar in both groups, however, hospital stay was shorter in ET suction group (9.91±3.22vs. 11.17±3.73days; mean diff:−1.26(−3.36 to −0.17); p=0.024). ConclusionsEndotracheal suctioning at birth in non-vigorous infants born through MSAF tends to decrease the incidence of MAS and duration of hospital stay, however, overall incidence of respiratory distress and mortality remain unchanged.

Outcome of neonates born through Meconium stained amniotic fluid in tertiary health care centre

Background: Meconium Aspiraion Syndrome (MAS) is an important cause of morbidity and mortality among newborns in the developing world. Meconium stained amniotic fluid (MSAF) occurs in approximately 13% of all live births.Methods: This was a prospective observational study to assess the risk factors related with MSAF deliveries and MAS. All the details regarding mode of delivery, APGAR score (AS), birth weight, fetal distress, maternal age, any maternal illness, gestational age, clinical course, outcome was recorded and evaluated.Results: In the present study total of 100 babies born through MSAF were included of which the incidence of respiratory distress was noted in 62% (62 babies).Conclusions: Appropriate monitoring of respiratory distress at birth and assessing the high-risk cases will surely help in reducing the morbidity and mortality in vigorous babies born through MSAF.

Prophylactic Methylxanthines for Preventing Extubation Failure in the Preterm Neonates with the Gestational Age of ≤30 Weeks: A Randomized Controlled Trial

Background: Preterm neonates are at a high risk of respiratory depression at birth. Incidence of respiratory distress is reported in 60-80% of the neonates born with the gestational age of less than 28 weeks and 15-30% of the neonates with the gestational age of less than 32-34 weeks. The present study aimed to compare the incidence and risk of failed extubation in using caffeine and aminophylline in the preterm neonates with the gestational age of ≤30 weeks in the periextubation period.Methods: This single-centered, parallel, open-label, randomized controlled trial was conducted in a tertiary care referral hospital in India during June 2014-2016. Neonates with the gestational age of ≤30 weeks who were intubated for a minimum of 24 hours were enrolled in the study. Neonates with major anomalies, heart disease, and sepsis were excluded from the study. After the random allocation of the infants to treatment with the standard dose of caffeine citrate and aminophylline methylxanthine, intubation continued for seven consecutive days with or without non-invasive ventilatory support. As the primary objective, the incidence and risk of failed extubation were assessed. Secondary objective of the research was to compare the relative incidence of acute adverse effects, persistent apnea, and the associated morbidities.Results: Neonates treated by caffeine were at a higher risk of extubation failure (1.09 times) adjusted with birth weight (31.5% versus 21.4%; RR=1.09; 95% CI: 0.81-1.46; P=0.55), which was not statistically significant. In addition, risk of apnea within seven days and after seven days of methylxanthine therapy was 1.57 (95% CI: 0.95-2.61) and 1.10 (95% CI: 0.95-2.61) times higher in the neonates with caffeine treatment. Also, rate of tachycardia was high in the neonates treated by aminophylline, which was statistically significant (RR=0.27; 95% CI: 0.13-0.56; P<0.001). Duration of non-invasive ventilator support, length of admission in the neonatal intensive care unit, O2 requirement at discharge, death before hospital discharge, and the associated morbidities were similar between the groups.Conclusion: According to the results, the incidence and risk of extubation failure were clinically high in the caffeine-treated neonates. However, aminophylline administration could continue as a prophylactic agent in developing countries under medical supervision.

Acute Respiratory Distress and Its Risk Factors among Neonates Admitted in a Tertiary Care Center of Western Nepal

Background: Neonatal period is defined as a period from birth to under 4 weeks (&lt;28 days) of age. It is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra uterine existence. The term Respiratory distress (RD) is used to indicate signs &amp; symptoms of abnormal respiratory pattern.&#x0D; Methods: All neonates admitted in neonatal intensive care unit of Nepalgunj Medical College, Kohalpur with respiratory distress were included. Same number of age and sex matched controls without RD were selected.&#x0D; Results: The NICU based hospital incidence of RD was 9.1% with male: female ratio 1.4:1 The Most Common etiology was neonatal sepsis (51.6%), followed by hyaline membrane disease (17.8%), TTN (12.7%), meconium aspiration syndrome (6%), birth asphyxia (5.08%), tracheoesophageal fistula (2%) and pneumothorax (2%). Newborns with poor APGAR score requiring resuscitation were more likely to develop RD (p=0.025). Newborns with birth weight &lt;2.5 kg and &gt;4 kg were 2 times likely to develop RD as compared to control group (p&lt;0.012). There was 7 times higher risk of developing MAS when a baby was born through thick MSL as compared to control group (P&lt;0.022). Inadequate ANC visit significantly increased RD in newborns (p&lt;0.001). Babies born to mother with PROM for more than 18 hours were 5.5 times likely to develop RD (p&lt;0.001) whereas those born to mother who had any source of infection were about 6 times at risk of developing respiratory distress than control group (p=0.007).&#x0D; Conclusion: Certain measures that could be taken to reduce the number of RD are: 1. discouraging early marriage and teenage pregnancy. 2. Increasing awareness regarding temporary and permanent contraceptive measures. 3. Promoting education of girls. 4. Increasing coverage of ANC visit in rural areas and 5. formulating integrated plan and policies from the Government level.

Canine Brachycephaly Is Associated with a Retrotransposon-Mediated Missplicing of SMOC2

SummaryIn morphological terms, “form” is used to describe an object’s shape and size. In dogs, facial form is stunningly diverse. Facial retrusion, the proximodistal shortening of the snout and widening of the hard palate is common to brachycephalic dogs and is a welfare concern, as the incidence of respiratory distress and ocular trauma observed in this class of dogs is highly correlated with their skull form. Progress to identify the molecular underpinnings of facial retrusion is limited to association of a missense mutation in BMP3 among small brachycephalic dogs. Here, we used morphometrics of skull isosurfaces derived from 374 pedigree and mixed-breed dogs to dissect the genetics of skull form. Through deconvolution of facial forms, we identified quantitative trait loci that are responsible for canine facial shapes and sizes. Our novel insights include recognition that the FGF4 retrogene insertion, previously associated with appendicular chondrodysplasia, also reduces neurocranium size. Focusing on facial shape, we resolved a quantitative trait locus on canine chromosome 1 to a 188-kb critical interval that encompasses SMOC2. An intronic, transposable element within SMOC2 promotes the utilization of cryptic splice sites, causing its incorporation into transcripts, and drastically reduces SMOC2 gene expression in brachycephalic dogs. SMOC2 disruption affects the facial skeleton in a dose-dependent manner. The size effects of the associated SMOC2 haplotype are profound, accounting for 36% of facial length variation in the dogs we tested. Our data bring new focus to SMOC2 by highlighting its clinical implications in both human and veterinary medicine.

Respiratory distress in vigorous babies born through meconium stained amniotic fluid: incidence, onset, risk factors and predictors at birth

Background: One in every seven pregnancies ends with meconium-stained amniotic fluid (MSAF). MSAF can be harmful to the newborn with short and long-term sequelae. This study was aimed to find out the incidence, predictors, onset and severity of respiratory distress among vigorous babies born through meconium stained amniotic fluid which may or may not be evident at birth.Methods: It is a prospective observational study. One hundred forty-one neonates were studied. Data was collected on perinatal risk factors, clinical course and development of respiratory distress. Significance of the perinatal risk factors were identified by fisher’s exact test (p-value) and score based on odds ratio was assigned for significant risk factors. Results: This study included one hundred and forty-one vigorous babies born through meconium stained amniotic fluid, of which 36.9% (52) babies developed respiratory distress. Of the 52 babies who developed respiratory distress 19.23%(10 babies) developed meconium aspiration syndrome (MAS). In our study, it was observed factors like caesarean section and thick meconium increased risk of respiratory distress in the neonates born through meconium stained amniotic fluid who were vigorous.Conclusions: The incidence of respiratory distress in vigorous babies born through meconium stained liquor in this study was observed to be 36.9% (52 babies). 98.07% (51 babies) developed respiratory distress at birth or within one hour of life. All the babies who developed MAS had mild or moderate form of MAS. None of the babies required assisted ventilation. Risk factors like thick meconium, caesarean section showed significant increase in the incidence of respiratory distress. Therefore intrapartum monitoring and timely intervention can prevent the complications of MAS.

T-piece or self inflating bag for positive pressure ventilation during delivery room resuscitation: An RCT

ObjectiveTo compare the duration of positive pressure ventilation (PPV) during delivery room resuscitation in neonates resuscitated with self-inflating bag (SIB) and T-piece resuscitator (TPR). DesignRandomized control trial. SettingDelivery room and neonatal intensive care unit of a tertiary care center in northern India. PatientsConsecutively born neonates more than 26 weeks of gestation requiring PPV at birth. InterventionEligible neonates were randomized to two groups, SIB and TPR. Outcome measuresDuration of PPV, intubation rates in delivery room, incidence of respiratory distress, need for mechanical ventilation during first 48h and its duration, need for surfactant replacement therapy and mortality during NICU stay. ResultsFifty neonates received PPV with a SIB and 40 received PPV with a TPR. The mean (SD) birth weight and gestational age of neonates in SIB and TPR groups were 2264 (872) and 2065 (814)g; 35.1 (3.6) and 34.3 (3.7) weeks, respectively. The median (IQR) duration of PPV in delivery room was significantly less in TPR group as compared to SIB; 30 (30–60)s vs. 60 (30–90)s, respectively; (p<0.001). A higher proportion of neonates required delivery room intubation in SIB group as compared to TPR group (34% vs. 15%, p=0.04). In the TPR group, a higher proportion of neonates could be resuscitated with room air only (72.5% vs. 38%, p=0.001). Other outcomes were comparable in the two groups. Similar findings were observed in neonates <34 weeks, except that fewer neonates resuscitated with TPR required invasive ventilation (31.6% vs. 77.8%, p=0.008). ConclusionUse of TPR during delivery room resuscitation resulted in shorter duration of PPV and lesser rates of intubation as compared to SIB. More infants in this group could be resuscitated with room air only (CTRI/2010/091/002946).

Differences between late preterm and term neonates admitted to neonatal intensive care unit a two-year retrospective study

Introduction: Late preterm neonates have been defined as those born between 34 completed weeks to 3 6 weeks and 6 days of gestation. Late preterm neonates though bear close resemblance to full-term neonates in appearance and birth weights; are a special group because they are still physiologically immature and vulnerable. Despite the increase in their numbers, there is limited data concerning problems of late preterm neonates in India. The objective of this study is to compare morbidities of late preterm neonates with term neonates. Study design: Retrospective study conducted at a Level 3 NICU of a tertiary care hospital in Mumbai between Oct 2011 to Sep 2 0 1 3 . Late preterm neonates formed the cases and equal number of matched term neonates formed the controls. Maternal risk factors and neonatal morbidities were compared among the two groups. Results: Late preterm neonates formed a major share of preterm births. Significantly more number of late preterm neonates had the maternal risk factors (as defined) and also required more NICU admissions. Late preterm neonates had lower birth weights compared to term neonates. There was a statistically significant difference in the incidence of respiratory distress consequently requiring more ventilator support in late preterm neonates. Average length of NICU stay was more for late preterm neonates. Conclusion: Late preterm neonates have more neonatal morbidities compared to term neonates.