Low Birth Weight Newborns Research Articles

Association of newborn low birth weight and the diet quality of their mothers during pregnancy: A case control study in El Jadida province

BACKGROUND: Healthy eating habits among mothers both before and throughout pregnancy are beneficial for their own well-being, the fetus and the child in adulthood. OBJECTIVE: Our aim was to study the link between the quality of the diet of parturients and the birth weight of newborns. METHODS: The diversity scores (DDS) and dietary variety scores (DVS) were used to assess the quality of the diet, and the mean adequacy ratio (MAR) and the nutrient adequacy ratio were calculated and compared in 200 parturients (Controls) who gave birth to normal-weight (NW) newborns and 200 parturients (Cases) who gave birth to low birth weight (LBW) newborns. RESULTS: Mean DDS was 7.01±1.36 in controls and 4.55±1.60 in cases. The mean DVS was 13.31±3.28 in controls vs 8.11±4.60 in the cases (P < 0.001). The MAR index of controls 0.84±0.004 was higher compared to cases 0.70±0.004. The lowest NAR values are found for calcium (0.60±0.02 vs 0.34±0.01), iron (0.66±0.01 vs 0.50±0.01), folates (0.68±0.011 vs 0.48±0.009) in controls and cases respectively. CONCLUSIONS: The diets of women with LBW newborns do not meet the basic nutritional needs for a successful pregnancy and childbirth.

Association of Placental Pathology with Physical and Neuronal Development of Infants: A Narrative Review and Reclassification of the Literature by the Consensus Statement of the Amsterdam Placental Workshop Group.

The placenta is the largest fetal organ, which connects the mother to the fetus and supports most aspects of organogenesis through the transport of nutrients and gases. However, further studies are needed to assess placental pathology as a reliable predictor of long-term physical growth or neural development in newborns. The Consensus Statement of the Amsterdam Placental Workshop Group (APWGCS) on the sampling and definition of placental lesions has resulted in diagnostic uniformity in describing the most common pathological lesions of the placenta and contributed to the international standardization of descriptions of placental pathology. In this narrative review, we reclassified descriptions of placental pathology from previously published papers according to the APWGCS criteria and comparatively assessed the relationship with infantile physical and/or neural development. After reclassification and reevaluation, placental pathology of maternal vascular malperfusion, one of the APWGCS criteria, emerged as a promising candidate as a universal predictor of negative infantile neurodevelopmental outcomes, not only in term and preterm deliveries but also in high-risk groups of very low birthweight newborns. However, there are few studies that examined placental pathology according to the full categories of APWGCS and also included low-risk general infants. It is necessary to incorporate the assessment of placental pathology utilizing APWGCS in the design of future birth cohort studies as well as in follow-up investigations of high-risk infants.

Risk factors for acute kidney injury in very-low birth weight newborns: a systematic review with meta-analysis.

This study aims to analyze the main risk factors for acute kidney injury in the subgroup of very-low birth weight newborns, using the diagnosing criteria of the Kidney Disease Improving Global Outcomes (KDIGO) or the Acute Kidney Injury Network (AKIN). A systematic review of the literature was performed on the EMBASE® and PubMed® platforms. Studies that evaluated the risk factors for developing AKI in VLBW newborns were included. For the meta-analysis, we only included the risk factors that were associated with AKI in the univariate analysis of at least two studies. After an initial screening, abstract readings, and full-text readings, 10 articles were included in the systematic review and 9 in the meta-analysis. The incidence of AKI varied from 11.6 to 55.8%. All the studies have performed multivariate analysis, and the risk factors that appeared most were PDA and hemodynamic instability (use of inotropes or hypotension), sepsis, and invasive mechanical ventilation. After the meta-analysis, only cesarian delivery did not show an increased risk of AKI, all the other variables remained as important risk factors. Moreover, in our meta-analysis, we found a pooled increased risk of death in newborns with AKI almost 7 times. Conclusion: AKI in VLBW has several risk factors and must be seen as a multifactorial disease. The most common risk factors were PDA, hemodynamic instability, sepsis, and invasive mechanical ventilation. What is known: • Acute kidney injury is associated with worst outcomes in all ages. It´s prevention can help diminish mortality. What is new: • A synthesis of the main risk factors associated with AKI in very low birth weight newborns.

COVID-19 and Pregnancy Complications: Meta-analysis and Systematic Review

Introduction:: Although the number of studies conducted among pregnant women with coronavirus (COVID-19) is increasing rapidly, most of the studies are small-scale. Accordingly, data on the relationship between COVID-19 and pregnancy are limited. In addition, there is limited information about which complications COVID-19 causes in pregnant women compared to the normal population, and at what rates. This meta-analysis aimed to examine the data of studies and meta-analyses on pregnancies with COVID-19, and to determine the complication rates caused by COVID-19 in pregnancies. Methods: Clinical, observational, or cohort studies published (or epub ahead of print) between January 2020 and December 2021 in any language were scanned in PubMed and Google Scholar. While scanning, the combinations of the terms “COVID-19”, “SARS-CoV-2”, “coronavirus”, “pregnancy”, “PROM”, or “preterm birth” were used. Results: A total of 52 articles and data on 11088 pregnant women were included in the meta-analysis after the screening of 6166 studies. In addition, data belonging to 10 meta-analyses were examined in order to obtain additional information. In the studies covered by this meta-analysis, the rate of premature rupture of membranes was found in 16.8%; preterm birth in 10.3%; low birth weight newborns in 9.2%; maternal or fetal mortality in 3.0%, and other adverse outcomes (fetal distress or abnormal APGAR score, abortion, etc.) in 17.5%. The vertical contamination rate was found to be 2.1%. Conclusion: The findings obtained in this meta-analysis show that COVID-19 significantly increases the maternal or fetal mortality rate in pregnant women and has a negative effect on the preterm birth rate. According to the data we have obtained, COVID-19 also causes the development of some complications, such as fetal distress. The findings also show that COVID-19 is transmitted vertically at a rate of around 2% during pregnancy.

استكشاف عوامل الخطر والنتائج للأطفال الذين يولدون بوزن منخفض في وحدة العناية المركزة للأطفال الرضع في مستشفى مصراتة - تحليل استرجاعي (2022)

Objective: To examine the characteristics and outcomes of low-birth-weight (LBW) newborns admitted to the NICU at Misurata Teaching Hospital in 2022, and to identify key factors influencing their survival. Patient’s and methods: a retrospective descriptive study included 199 LBW newborns (<2.5kg) admitted to the NICU during the study period. Data were collected from medical records and analyzed using descriptive statistics. Results: Maternal factors: Mothers aged 30-35 years had the highest mortality burden. Clear amniotic fluid was associated with the highest death rate, despite being the most common finding. Gestational age showed a clear inverse relationship with survival, with mortality reaching 100% for infants born before 28 weeks. Low APGAR scores were a significant predictor of mortality. RDS and sepsis were the most common diagnoses, with RDS having the highest mortality rate. Elective caesarean section had the lowest mortality rate, while normal vaginal delivery and urgent C-section had higher rates. Cephalic presentation, though most common, had a higher mortality rate than breech presentation. Conclusion: LBW newborns in Misurata Teaching Hospital faced a complex interplay of maternal, neonatal, and delivery-related factors influencing their survival. Further investigation into maternal factors and individualized delivery management is warranted to improve the prognosis of LBW newborns in this population.

Epigenetic modifications in the ferroptosis pathway in cord blood cells from newborns of smoking mothers and their influence on fetal growth

Maternal smoking during pregnancy increases oxidative stress and decreases antioxidant capacity in newborns. Uncontrolled oxidative stress plays a role in fetal development disorders and in adverse perinatal outcomes. In order to identify molecular pathways involved in low fetal growth, epigenetic modifications in newborns of smoking and non-smoking mothers were examined. Low birth weight newborns of mothers who smoked more than 10 cigarettes per day during the first trimester of pregnancy and normal birth weight newborns of mothers who did not smoke during pregnancy were included in the study. DNA was extracted from umbilical cord blood of term newborns. 125 differentially methylated regions were identified by MeDIP-Seq. Functional analysis revealed several pathways, such as ferroptosis, that were enriched in differentially methylated genes after prenatal smoke exposure. GPX4 and PCBP1 were found to be hypermethylated and associated with low fetal growth. These epigenetic modifications in ferroptosis pathway genes in newborns of smoking mothers can potentially contribute to intrauterine growth restriction through the induction of cell death via lipid peroxidation of cell membranes. The identification of epigenetic modifications in the ferroptosis pathway sheds light on the potential mechanisms underlying the pathophysiology of low birth weight in infants born to smoking mothers.

Extremely low birth weight (ELBW) neonates for emergency surgery- A challenge for the Anesthesiologist: A case series

Background: Extremely Low Birth Weight (ELBW) newborns, defined as those with a birth weight of 1000 grams or less, present challenging anesthetic scenarios. Emergency surgeries in these infants elevate their vulnerability to various complications. Case Presentation: We present a case series involving 5 ELBW neonates who underwent emergency surgery. Three of them were at a post-conceptual age (PCA) of ≥ 33 weeks and underwent procedures for congenital birth defects, including esophageal atresia, ileal atresia, and gastroschisis. The remaining two neonates, with a PCA of 29-30 weeks, underwent surgery for necrotizing enterocolitis (NEC). Conclusion: The compromised physiology resulting from distinct disease processes and the underdeveloped systems of ELBW preterm neonates necessitate focused care and strategic anesthesia. This approach is crucial to mitigate morbidity and mortality risks in such vulnerable patients.

Correlations of Aflatoxin Exposure from Cooking Oil and Dietary Foods During Pregnancy with Birth Weight and Gestational Age at Birth in Guangxi, China.

Cooking oil and dietary foods are easily contaminated by aflatoxins (AFs) in Guangxi, China where low birth weight and preterm birth were prevalent. However, there are no data on AF exposure in pregnant women or their impact on newborn birth outcomes. This study aims to measure the levels and correlations of AFs in cooking oil, estimated dietary intake (EDI) of AFs in dietary foods, and serum AFB1 albumin adducts (AFB1-alb) with newborn birthweight and gestational age at birth. A prospective study was conducted among 126 pregnant women in Guangxi, China. All recruited women were interviewed for demographic data and behavior and obstetric information and then followed up until giving birth. AF measurements were obtained from cooking oil, dietary foods, maternal serum, and cord blood and the correlations of AF levels with newborn birthweight and gestational age at birth were tested using correlation analysis. The median EDI of AFs in cooking oil was 2.61 ng/kg.bw/day and in dietary foods 2.95 ng/kg.bw/day. High positive correlations among EDI of aflatoxin B1 (AFB1) from cooking oil and dietary foods were found (r > 0.7). Low positive correlations of AFB1-alb in maternal serum and cord blood and both EDI of AFB1 in both cooking oil and dietary foods were shown (r ≈0.3). Significant correlations between AF levels in both cooking oil and dietary foods with birth weight were found, but very low negative correlations (r = - 0.244 ~ -0.285). AFB1 levels in foods, maternal serum and cord blood levels were high in pregnant women with newborn low birth weight and preterm birth. The EDIs of AFB1 from both cooking oil and dietary foods were significantly correlated with AFB1-alb in maternal serum and cord blood. Negative correlations of AFs from cooking oils and foods with newborn birth weight should be paid more attention.

Short-Term Outcomes of Early Oral Colostrum Administration in VLBW Neonates: An Open-Label Randomized Controlled Trial.

Oropharyngeal colostrum priming (OCP) has been proposed as a potential nutritional option for very low birth weight (VLBW) newborns. This study aimed to determine short-term outcomes of early oral colostrum administration in VLBW neonates. This open-label randomized controlled trial was conducted on VLBW neonates admitted to Mahdieh Hospital, Tehran, Iran, between February and December 2022. According to the protocol, all eligible neonates were randomized evenly to the intervention group, which received oral colostrum (OC), and the control group, which received no OC. Finally, short-term outcomes of early OC administration were compared between groups using the independent-samples t test, chi-square, and Fisher exact tests. Of 80 randomized neonates, 37 and 39 from the intervention and control groups entered the final analysis, respectively. Neonates in the intervention and control groups did not significantly differ in terms of peripherally inserted central catheter (PICC) infection (P = 0.728), sepsis (P = 0.904), necrotizing enterocolitis (NEC) (P > 0.999), intraventricular hemorrhage (IVH) (P = 0.141), retinopathy of prematurity (ROP) (P = 0.923), and bronchopulmonary dysplasia (BPD) (P = 0.633). Furthermore, there was no significant difference between groups considering the time to reach 120 cc/kg feeds (P = 0.557), time to reach birth weight (P = 0.157), length of hospitalization (P = 0.532), and mortality rate (P = 0.628). The results of our study revealed that despite safety, early OC administration did not improve any of the short-term outcomes in VLBW neonates.

Duration of residence and offspring birth weight among foreign-born mothers in Spain: a cross-sectional study.

Duration of residence has been used to monitor changes in the health of a foreign-born population in a destination country. This study assesses whether the mother's duration of residence influences the relationship between maternal origin and birth weight. We conducted a cross-sectional study using Spanish census microdata (2011) linked to Vital Statistics (2011-15). Linear and multinomial logistic regression models were used to estimate birth weight differences between children born to foreign-born mothers by duration of residence and those born to natives. Maternal countries of origin were classified according to the Human Development Index (HDI). Our findings revealed significant differences in birth weight of 109683 births from both foreign- and native-born mothers. Overall, in descriptive statistics, compared with Spanish mothers, foreign-born mothers gave birth more frequently to high-birth weight (HBW) newborns (8.4% vs. 5.3%, respectively) and less frequently to low-birth weight (LBW) newborns (4.8% vs. 5.1%). According to the model's estimations, the risk of giving birth to HBW babies remains relatively high in foreign-born mothers. Especially, mothers from very high-HDI countries experienced changes in the RRR of HBW (1.59-1.28) and LBW (0.58-0.89) after spending over 10 years in Spain. Foreign-born mothers residing in Spain are at increased risk of delivering a HBW child regardless of their duration of residence. In fact, given the long-term health consequences associated with HBW, our results highlight the need to improve prenatal care in the foreign-born population.

A study to evaluate the antenatal profile of mothers and the neonatal outcome in first 72 hours of life in VLBW babies at a tertiary care hospital

Low birth weight (LBW) is well-defined as a birth weight of < 2500 g, as per the WHO. Internationally, it is predictable that 15–20% of all births, or >20 million children yearly, are low birth weight. In developing countries, explanation for an inconsistent encumbrance of LBW; over 95% of the Globally LBW newborns are intuitive in developing countries. Low birth weight is a foremost public health problem in developing countries including India.To know the antenatal profile of the mother (which includes mother's age, height, weight, body mass index, parity) and the immediate neonatal outcome in VLBW (999-1500 g) babies at a tertiary care hospital. To assess correlation between antenatal care profile of mother and weight of the baby.A Hospital-based descriptive ambispective longitudinal study was conducted among 120 patients at Department of Pediatrics of tertiary care Hospital during February 2021 – August 2021.Among the study participants, 109(90.8%) were admitted within first day of birth. Only 1.7% cases were admitted after 3 days of birth due to complications. Among the patients, 52% died, while 4% DOR. Out of total, 44% and 16% were Discharged and DAMA, respectively.Prevention of very low birth weight of a newborn is the best way of promoting better health for babies and it can be achieved by giving adequate care to the females since early childhood and adolescence by promoting better nutrition and health care.

Hospital-Level NICU Capacity, Utilization, and 30-Day Outcomes in Texas

Risk-adjusted neonatal intensive care unit (NICU) utilization and outcomes vary markedly across regions and hospitals. The causes of this variation are poorly understood. To assess the association of hospital-level NICU bed capacity with utilization and outcomes in newborn cohorts with differing levels of health risk. This population-based retrospective cohort study included all Medicaid-insured live births in Texas from 2010 to 2014 using linked vital records and maternal and newborn claims data. Participants were Medicaid-insured singleton live births (LBs) with birth weights of at least 400 g and gestational ages between 22 and 44 weeks. Newborns were grouped into 3 cohorts: very low birth weight (VLBW; <1500 g), late preterm (LPT; 34-36 weeks' gestation), and nonpreterm newborns (NPT; ≥37 weeks' gestation). Data analysis was conducted from January 2022 to October 2023. Hospital NICU capacity measured as reported NICU beds/100 LBs, adjusted (ie, allocated) for transfers. NICU admissions and special care days; inpatient mortality and 30-day postdischarge adverse events (ie, mortality, emergency department visit, admission, observation stay). The overall cohort of 874 280 single LBs included 9938 VLBW (5054 [50.9%] female; mean [SD] birth weight, 1028.9 [289.6] g; mean [SD] gestational age, 27.6 [2.6] wk), 63 160 LPT (33 684 [53.3%] female; mean [SD] birth weight, 2664.0 [409.4] g; mean [SD] gestational age, 35.4 [0.8] wk), and 801 182 NPT (407 977 [50.9%] female; mean [SD] birth weight, 3318.7 [383.4] g; mean [SD] gestational age, 38.9 [1.0] wk) LBs. Median (IQR) NICU capacity was 0.84 (0.57-1.30) allocated beds/100 LB/year. For VLBW newborns, NICU capacity was not associated with the risk of NICU admission or number of special care days. For LPT newborns, birth in hospitals with the highest compared with the lowest category of capacity was associated with a 17% higher risk of NICU admission (adjusted risk ratio [aRR], 1.17; 95% CI, 1.01-1.33). For NPT newborns, risk of NICU admission was 55% higher (aRR, 1.55; 95% CI, 1.22-1.97) in the highest- vs the lowest-capacity hospitals. The number of special care days for LPT and NPT newborns was 21% (aRR, 1.21; 95% CI,1.08-1.36) and 37% (aRR, 1.37; 95% CI, 1.08-1.74) higher in the highest vs lowest capacity hospitals, respectively. Among LPT and NPT newborns, NICU capacity was associated with higher inpatient mortality and 30-day postdischarge adverse events. In this cohort study of Medicaid-insured newborns in Texas, greater hospital NICU bed supply was associated with increased NICU utilization in newborns born LPT and NPT. Higher capacity was not associated with lower risk of adverse events. These findings raise important questions about how the NICU is used for newborns with lower risk.

Level of exposure to aflatoxins during pregnancy and its association with adverse birth outcomes in Africa: a meta-analysis

Abstract Background Aflatoxins are various poisonous carcinogens and mutagens produced by Aspergillus species. Exposure to aflatoxins during pregnancy results in adverse birth outcomes. This meta-analysis was carried out to determine the estimates of how much aflatoxin is harmful to the pregnancy and its outcome, including birthweight, birth length, low birthweight (LBW), small for gestational age (SGA), stunting, poverty, food insecurity, income, pesticides and stillbirth, in an African context. Methods Both published and unpublished studies in Africa were searched on MEDLINE, PubMed, Embase, SCOPUS, Web of Science and Google Scholar. Stata version 18.2 software was used for cleaning and analysis. The prevalence with a 95% confidence interval (CI) was estimated using the random effects model and a forest plot was used to present the findings. In addition, the heterogeneity of the study was assessed using Cochrane I2 statistics and publication bias was assessed using Egger's intercept and funnel plot. Results This review included 28 studies with a total of 6283 pregnant women and newborns. The analysis showed the overall level of exposure to aflatoxins was 64% (95% CI 48 to 78, τ2=0.66, I2=99.34%, p=0.001). In the subgroup analysis by publication year, the highest level of exposure to aflatoxins (82% [95% CI 69 to 92]) was observed among studies published from 2020 to 2023. This study also found that exposure to aflatoxins during pregnancy had an association with prematurity, LBW, SGA and stillbirth. Conclusions The data analysed in this study indicated that three of every five pregnant women had exposure to aflatoxins in Africa. Moreover, pregnant women exposed to aflatoxins had a higher likelihood of having a LBW and SGA newborn. Thus governments and all stakeholders should initiate policies that mitigate the toxicity of aflatoxins in pregnant women, foetuses and newborns.

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia.

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.

Survival benefits of the wait-and-grow approach in small babies (≤2000 g) requiring heart surgery

ObjectiveThe best approach to minimize the observed higher mortality of newborn infants with low birth weight who require congenital heart surgery is unclear. This retrospective study was designed to review outcomes of newborn infants weighing <2000 g who have undergone cardiovascular surgery to identify patient parameters and clinical strategies for care associated with higher survival. MethodsA retrospective chart review of 103 patients who underwent cardiovascular surgery from 2010 to 2021 who were identified as having low birth weight (≤2000 g). Patients who underwent only patent ductus arteriosus ligation or weighing >3500 g at surgery were excluded. ResultsMedian age was 24 days and weight at the time of surgery was 1920 g. Twenty-six (25%) operative mortalities were recorded. Median follow-up period was 2.7 years. The 1- and 3-year overall Kaplan-Meier survival estimate was 72.4% ± 4.5% and 69.1% ± 4.6%. The 1-year survival of patients who had a weight increase >300 g from birth to surgery was far superior to the survival of those who did not achieve such a weight gain (81.4% ± 5.6% vs 64.0% ± 6.7%; log-rank P = .04). By multivariable Cox-hazard regression analysis, the independent predictor of 1-year mortality was genetic syndrome (hazard ratio, 3.54; 95% CI, 1.67-7.82; P < .001), whereas following a strategy of increasing weight from birth to surgery resulted in lower mortality (hazard ratio, 0.49; 95% CI, 0.24-0.90; P = .02). ConclusionsA strategy of wait and grow for newborn infants with very low birth weight requiring heart surgery results in better survival than immediate surgery provided that the patient's condition allows for this waiting period.

Pathogen-wise Clinical Profile, Outcome and Antibiotic Sensitivity Profile of Septic Newborns in Level III Neonatal Intensive Care Unit of a Tertiary Teaching Hospital: A Retrospective Study

Introduction: Culture positive sepsis remains to be a leading cause of death in Neonatal Intensive Care Unit (NICU) mainly among preterm and low birth weight newborns. The objective was to analyze the initial signs of sepsis, antibiotic sensitivity, and outcome of septic newborns in NICU. Methods: The demographic data, initial clinical features at suspicion of sepsis, diagnosis, laboratory abnormalities, pathogen isolated and antibiotic sensitivity patterns of the septic neonates, and their outcome were documented from their case records. Results: A total of 161 culture positive septic newborns, 76.4% were preterm and 54 died of sepsis (33.54%). Early and late onset sepsis was seen in 56 and 109 neonates, respectively. The initial clinical findings at suspicion of sepsis which had a statistical significance were tachycardia in Escherichia coli and Pseudomonas sepsis, hyperglycemia in Burkholderia, fever in Candida, sclerema in Klebsiella pneumoniae (KP), and seizures in E. coli sepsis. The cerebrospinal fluid culture positive newborns commonly presented with apnea, poor perfusion, and lethargy. Raised C reactive protein was seen in a higher proportion of newborns with Candida (60%) sepsis and E. coli (50%) sepsis. Severe thrombocytopenia was seen in 53%–62% newborns with gram-negative and fungal sepsis. Metabolic acidosis was seen in all gram-negative sepsis neonates, particularly in &gt;80% cases of Klebsiella and Candida sepsis. Mortality was highest and statistically significant in KP (55.4%) and Citrobacter koseri (55.6%) sepsis ( p = .004). The statistically significant risk factors for mortality included neonates with raised C Reactive Protein (CRP). Most of the gram-negative pathogens were sensitive to colistin and aminoglycosides and resistant to carbapenems. Conclusion: Observing the initial clinical features at suspicion of sepsis may help predicting the likely pathogen awaiting the final blood/CSF culture report and knowing the antibiotic sensitivity profile of commonly isolated organisms in our NICU helps in the selection of a rational empirical antibiotic.

Introduction of complementary feeding and associated factors in preterm and low birthweight newborns: a prospective cohort study

This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.

Third stage of the kangaroo method: exclusive breastfeeding and growth of preterm and/or low birth weight newborns.

To evaluate the rates of exclusive breastfeeding (EBF) and growth of preterm and/or low birth weight newborns during the third stage of the Kangaroo Method (TSKM), at discharge. Retrospective study in a reference public maternity hospital between Jan/2014 and Dec/2017, including the preterm (less than 37 weeks) and/or low birth weight (less than 2500 g) newborn infants. Information was collected from medical records. Statistics analysis was done in SPSS software. 482 infants were included and followed up at the TSKM ambulatory. The average gestational age was 33 weeks (variation: 24-39 weeks) and birth weight, 1715g (variation: 455-2830 g). EBF occurred in 336 (70.1%) infants at hospital discharge, and in 291 (60.4%) at TSKM discharge. Each additional day of hospital stay increased the chance of infant formula (IF) use by 9.3% at hospital discharge and by 10.3% at TSKM discharge. Staying in the Kangaroo Neonatal Intermediate Care Unit (KNICU) favored EBF at hospital discharge and TSKM discharge (p<0.001). Not performing the kangaroo position increased the chance formula administration to the newborn infant at hospital discharge by 11%. Weight gain and head circumference growth were higher in infants using formula (p<0.001). The length of hospital stay and not performing the kangaroo position favored the use of infant formula at hospital and TSKM discharge. Staying in the KNICU favored exclusive breastfeeding at hospital and TSKM discharge. Weight gain and HC growth were higher in newborns receiving infant formula.

Mortality Risk Assessment by SNAP-II and SNAPPE-II among Very Low Birth Weight Newborns- An Observational Study

Introduction: Very Low Birth Weight (VLBW) babies are those with a birth weight of less than 1500 gm and require special care, attention, and resources. However, despite all efforts, their mortality rate remains high. Proper assessment of these neonates is crucial to identify high-risk cases and take early steps to reduce mortality. In addition to technical advances in neonatal care, severity scores have been developed to predict neonatal mortality. Richardson developed the Score for Neonatal Acute Physiology (SNAP-II) and SNAP with Perinatal Extension (SNAPPE-II) as scoring systems for predicting mortality in the Neonatal Intensive Care Unit (NICU). Aim: To assess the usefulness of SNAP-II and SNAPPE-II as predictors of mortality in VLBW neonates. Materials and Methods: This was an observational cross-sectional study involving 145 VLBW neonates admitted to the NICU of North Bengal Medical College and Hospital (NBMCH) from May 2019 to April 2020. Relevant data were collected to assess the mortality risk scores SNAP-II and SNAPPE-II. The outcome of discharge or death was recorded. Data entry was performed using MS excel and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The relationship between newborn survival and SNAP-II or SNAPPE-II final scores was determined using the Mann- Whitney U test, and the relationship between survival and various SNAP-II and SNAPPE-II score categories was determined using Fisher’s-Exact Test. A p-value of less than 0.05 was considered statistically significant. An ROC curve was generated to determine the best cutoff score for predicting mortality. Results: The mean scores of SNAP-II and SNAPPE-II were higher in babies who expired compared to those who survived. The mean (±SD) SNAP-II scores were 8.96 (±13.865) for survived newborns and 41.08 (±23.174) for expired newborns. The mean (±SD) SNAPPE-II scores were 20.01 (±14.54) for survived newborns and 48.85 (±25.02) for expired newborns. The optimal cutoff values for SNAP-II and SNAPPE-II in predicting mortality were 31.5 and 36, respectively. The sensitivity and specificity of SNAP-II were 83.0% and 89.1%, while for SNAPPE-II they were 69.8% and 89.1%, respectively. Conclusion: The mean SNAP-II and SNAPPE-II scores were higher among expired VLBW neonates compared to those who survived. A SNAP-II score of 31.5 and SNAPPE-II score of 36 were associated with higher mortality, indicating that both scores are effective predictors of mortality regardless of Gestational Ages (GA) and birth weight.

Risk Factors and Complications in Premature and Low Birth Weight Newborns

General objective: To develop a literature review that allows the analysis of risk factors and complications in preterm and low birth weight infants. Method: The literature review took as a reference the Scielo database, which largely had articles published with thematic axes related to the topic under analysis, and other databases and journals that met the index of relationship with the topic under review were also taken. Although they were to a lesser extent, they were included in the review. Result: In the review and analysis of the studies, it was found that prematurity and low birth weight increase vulnerability to various complications, mainly the immaturity of the organs and systems of the body is a key factor. The lungs, central nervous system, and other organs may not have fully developed, increasing the risk of breathing problems, infections, and difficulties in thermal regulation. Lack of time in the womb can also affect the development of the immune system, leaving them more susceptible to disease. Conclusion: Preterm and low birth weight newborns face a number of challenges that require comprehensive, specialized care. Understanding these risk factors and complications is essential to providing the necessary care and improving the prospects of these little fighters from the beginning of their lives.