Low Weight Neonates Research Articles

Lung Ultrasound Score Predicts the Extravascular Lung Water Content in Low-Birth-Weight Neonates with Patent Ductus Arteriosus.

BackgroundPatent ductus arteriosus (PDA) is a common congenital cardiac abnormality in premature infants. In low-birth-weight infants weighing less than 2500 g, if the PDA continues to open, abnormal circulation hemodynamics and pulmonary edema may occur. This study aimed to investigate the role of lung ultrasound score in the assessment of pulmonary edema in low-weight neonates with PDA.Material/MethodsTwo hundred and twenty-one neonates with low birth weight were selected as the subjects, children with PDA as the observation group, and children with closed ductus arteriosus as the control group. On the fourth postnatal day, lung ultrasound examination and 6-segment lung ultrasound scoring were performed.ResultsAll 221 infants (94 in the observation group, 127 controls) underwent ultrasound examinations of the lungs. Intergroup differences in gestational age, birth weight, length of hospital stay, and left ventricular ejection fraction were not statistically significant. There was a significant difference in lung ultrasound score (t=0.005, P=0.000) and aortic root ratio to left atrial (t=0.085, P=0.000), which was negatively correlated with gestational age (r=−0.235, P=0.000) and positively correlated with PDA diameter (r=0.261, P=0.011).ConclusionsLow-birth-weight children often have PDA. Its continued opening changes the circulation hemodynamics in children. Lung ultrasound score can semi-quantitatively evaluate the extravascular lung water content, identifying the need to intervene and follow up the hemodynamic significance of PDA over time.

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

Neonatal Encephalopathies: A Clinical Perspective.

Seizures are the most acute evident manifestation of central nervous system dysfunction in neonates. The incidence is higher in very low weight neonates, about 58/100 live births, as opposed to full-term infants, estimated about 3.5/100 live births. Neonatal seizures represent the clinical manifestation of a non-specific disorder of cortical cerebral dysfunction, which could lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment of each clinical scenario. The diagnosis and its management are further complicated as most neonatal seizures may have very subtle or no clinical changes and the diagnosis may be just based on EEG findings, so-called subclinical. The treatment is dependent on the etiology, but early and opportune intervention can prevent further brain damage and improve prognosis. Although early identification and treatment are essential, the diagnosis of neonatal seizures can be further complicated by the clinical presentations, possible etiologies, and treatments. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.

DOZ047.30: First year risk factors of mortality and morbidity in esophageal atresia with tracheo-esophageal fistula: data from a population-based national register

Abstract Objectives and Study The aim of our study is to assess the risk factor of mortality and morbidity in a large population-based registry in a population of type III/C esophageal atresia (EA). Methods Under the umbrella of the national plan for rare disease, a population based register was set up in 2008 recording the data of all the live newborns with EA in France. Based on the registry data, survival and morbidity at 1 year were studied. Morbidity was approached by calculating the rate of full oral autonomy and the hospital length of stay during the first year. Multivariate analysis was performed via multinomial logistic regression to evaluate independent predictors of overall survival and morbidity items among all significant category variables identified on univariate analysis. Results A total of 1008 patients with type III EA were extracted from the national database born from January first 2008 till 31 December 2014. Mean birth weight was 2610 g (2060 to 3075). Right lateral thoracotomy was used in 93% of cases and primary anastomosis was possible in 95% of cases. Associated abnormalities were present in 53% of patients, VACTERL in 19%, and CHARGE syndrome in 3%. Mortality at 3 months was at 5% and at one year at 6% and was correlated to prenatal diagnosis (odd ratio (OR):2.96 (1.08 to 8.08)), low birth weight (OR: 0.52 (0.38 to 0.72)), and heart defect (OR: 6.09 (1.96 to 18.89)). Length of hospitalization was correlated to birth weight (OR: 0.83 (0.61–1.13)), the difficulty of the anastomosis (OR: 1.59 (0.71–3.55)) and associated abnormalities (OR: 1.93(0.65–5.68)), the prenatal diagnosis is correlated only to the rate of full oral autonomy and not with the length of hospitalization. Conclusions Surgical procedure or difficulties did not seem to affect survival in this group of patients. In addition to the continuous need to improve care of low weight neonates, our results clearly identify that efforts should be focused on the small group of EA with prenatal diagnosis and/or severe cardiac malformation to reduce even more mortality and morbidity in EA patients.

Clinical Analysis on the Effectiveness of Conservative Compression Suture Technique to Conserve Fertility on Pernicious Placenta Previa

Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.

LncRNA HOXD-AS1 promotes preeclampsia progression via MAPK pathway.

To investigate the role of HOXD-AS1 in preeclampsia and its underlying mechanism. A total of 50 preeclampsia primiparas and 34 normal pregnancies admitted in our hospital from July 2015 to July 2017 were selected as the study group and control group, respectively. Age, body weight, blood pressure, 24-h urinary protein and neonatal weight were compared between the two groups. HOXD-AS1 expression in the placenta tissues was detected by quantitative Real-time PCR (qRT-PCR). Preeclampsia patients were further assigned into high and low expression group according to their HOXD-AS1 expressions. The relationship between HOXD-AS1 expression and blood pressure, 24-h urinary protein and neonatal weight in preeclampsia patients were analyzed. For in vitro experiments, transfection efficacy of pcDNA-HOXD-AS1 and si-HOXD-AS1 were detected by qRT-PCR. Proliferative and colony formation abilities in BeWo and Wish cells were detected by CCK-8 and colony formation assay, respectively. Moreover, protein expressions of p-p38, p-JNK, and p-ERK were detected by Western blot. The systolic blood pressure, diastolic blood pressure and urinary protein in preeclampsia patients were higher than those of normal pregnancies. However, neonatal weight in preeclampsia patients was lower than that of normal pregnancies. HOXD-AS1 expressions were gradually increased in normal pregnancies, patients with late onset preeclampsia and patients with early onset preeclampsia sequentially. Additionally, higher levels of systolic pressure, diastolic pressure and 24-h urinary protein, as well as lower neonatal weight, were observed in preeclampsia patients with high expression of HOXD-AS1 than those with low expression. In vitro results demonstrated that proliferative and colony formation abilities in trophoblasts were elevated after HOXD-AS1 knockdown. Western blot data illustrated that protein expressions of p-p38 and p-JNK were decreased, while p-ERK expression was increased after overexpression of HOXD-AS1 in trophoblasts. HOXD-AS1 participates in the development and progression of preeclampsia by regulating trophoblast proliferation via the MAPK pathway.

RF45 LOW BIRTH WEIGHT NEONATES AND CHD: IS CARDIAC SURGERY ASSOCIATED WITH WORSE OUTCOME?

Background and Aim: Congenital heart diseases often occur in low birth weight and preterm neonates. The aim of our study was to investigate the relationship between different strata of low weight at surgery and outcomes, and between gestational age and outcomes of cardiac surgery in low weight neonates treated at our institution. Methods: We retrospectively reviewed hospital records of neonates treated from January 2007 to November 2017. Inclusion criteria were body weight ≤ 2500 g at time of surgery for congenital heart disease, excluding isolated ductus arteriosus closure and pacemaker implantation. The outcomes investigated were 30-days and late mortality, major complications and need for reintervention. 84 patients met our criteria. Results: There were 10 early deaths; overall survival was 73% (23 pts died). 35 patients (42%) had major complications. 19 (23%) patients needed a reintervention. Weight at surgery, gestational age, type of operation and single or biventricular physiology did not influence neither mortality (early or late) nor morbidity (reintervention or complication). Mortality was significantly higher when extra-corporeal circulation was used (P &lt; 0,01); this can be related with more severe diagnosis and type of surgery. Conclusions: Despite the common thought that low weight and prematurity are associated with increased mortality, according to our results surgery for congenital heart diseases can be performed on low weight and preterm neonates with acceptable outcomes.

Early BCG Vaccination, Hospitalizations, and Hospital Deaths: Analysis of a Secondary Outcome in 3 Randomized Trials from Guinea-Bissau.

This study was performed to examine the effects of early BCG vaccination on the risk, cause, and severity of infant hospitalizations. The analysis included 3 trials randomizing low-weight neonates to early BCG vaccination (intervention) versus no BCG vaccination (usual practice in low-weight neonates, control), with hospitalizations as secondary outcome. Hospitalization data were collected at the pediatric ward of the National Hospital. Effects of BCG vaccination on hospitalization risk were assessed in Cox models providing overall and major disease-group incidence rate ratios (IRRs). Severity was assessed by means of in-hospital case-fatality rates and compared by group as cohort study risk ratios (RRs). Among 6583 infants (3297 in BCG group, 3286 controls), there were 908 infant hospitalizations (450 BCG, 458 controls) and 135 in-hospital deaths (56 BCG, 79 controls). The neonatal (28 days), 6-week, and infant (1-year) BCG versus control hospitalization IRRs were 0.97 (95% confidence interval [CI], .72-1.31), 0.95 (.73-1.24), and 0.96 (.84-1.10). Corresponding BCG versus control case-fatality rate RRs were 0.58 (95% CI, .35-.94), 0.56 (.35-.90), and 0.72 (.53-.99). BCG vaccination tended to reduce neonatal and infant sepsis hospitalization rates (IRR, 0.75 [95% CI, .50-1.13] and 0.78 [.55-1.11], respectively), and it reduced the neonatal in-hospital sepsis mortality rate (RR, 0.46; 95% CI, .22-.98). There were no confirmed hospitalizations for tuberculosis. BCG vaccination did not affect hospitalization rates but reduced in-hospital mortality rates significantly, primarily by preventing fatal cases of sepsis. The observed beneficial effects of BCG on the in-hospital mortality rate were entirely nonspecific. NCT00146302, NCT00168610, and NCT00625482.

Intraosseous (IO) access in neonate with birth weight 2300 g in cardiorespiratory arrest, a challenge in pre-hospital emergency care

Introduction: Obtaining vascular access in a low-weight neonate requires knowledge, experience, special materials and proper control of the scene. Attention in the pre-hospital setting is an important challenge faced by health professionals working in this field.

Short Term Outcomes in Extremely Low Birth Weight Neonates Receiving Caffeine & Indomethacin

Background Numerous studies have now shown that caffeine is no longer just limited to the treatment of apnea of prematurity. There are several short term benefits such as decreased incidence of patent ductus arteriosus (PDA) and bronchopulmonary dysplasia (BPD), lower mechanical ventilation days, and better neurodevelopmental outcome at 18-21 months with the use of early caffeine in Extremely Low Birth Weight (ELBW) neonates. Whether PDA should be treated medically or surgically is an ongoing debate, but morbidities …

High Frequency Ventilation and Risk of Hyperventilation in the Very and Extremely Low Birth Weight Neonate during Interfacility Transport

Purpose Our pediatric/neonatal critical care transport team provides high frequency ventilation (HFV) during interfacility transport utilizing the Bronchotron or TXP-2D (Percussionaire Corp., Sagle Idaho). Preliminary review of Very and Extremely Low Birth Weight (VLBW/ELBW) neonates who received HFV and were transported by our team revealed frequent episodes of hypocarbia (pCO2 < 35 mmHg). The objective of this study was to identify potential risk factors for hyperventilation in VLBW/ELBW neonates receiving HFV on transport. Methods A retrospective cohort of neonates …

Outcomes of the Arterial Switch Operation in ≤2.5-kg Neonates

Although low birth weight is a known risk factor for mortality in congenital heart lesions and may consequently delay surgical repair, outcomes in low-weight neonates undergoing the arterial switch operation (ASO) have not been well described. Our objective was to assess the safety of this procedure in infants weighing ≤2.5 kg at the time of surgery. We retrospectively analyzed outcomes for all neonates undergoing the ASO at our institution from 2005 to 2015. Our primary outcome of interest was major morbidity or operative mortality, assessed as a composite outcome. From 2005 to 2015, 217 neonates underwent the ASO, with 31 (14%) weighing ≤2.5 kg at the date of surgery, and 8 weighing <2.0 kg. Neonates weighing ≤2.5 kg were more likely to be premature than those weighing >2.5 kg, but there was no difference in the age at operation between these groups. Overall, 32 infants experienced a major morbidity or mortality, including 37.5% (n = 3) weighing <2.0 kg, 8.7% (n = 2) weighing 2.0-2.5 kg, and 14.5% (n = 7) weighing >2.5 kg (P = 0.141). One infant weighing <2.0 kg (1.1 kg) and 4 infants weighing >2.5 kg died. In multivariable models, odds of major morbidity or mortality were significantly higher for infants weighing <2 kg compared with infants weighing >2.5 kg (odds ratio 3.93, 95% confidence interval 1.04-14.85, P = 0.044), but there was no difference between infants weighing 2.0-2.5 kg and those weighing >2.5 kg (P = 0.225). The ASO can be performed safely in 2.0- to 2.5-kg neonates and yields results comparable with higher weight infants. Imposed delays for corrective surgery may not be necessary for these low-weight infants with transposition of the great arteries.

Early BCG-Denmark and Neonatal Mortality Among Infants Weighing

BCG vaccine may reduce overall mortality by increasing resistance to nontuberculosis infections. In 2 randomized trials in Guinea-Bissau of early BCG-Denmark (Statens Serum Institut) given to low-weight (LW) neonates (<2500 g at inclusion) to reduce infant mortality rates, we observed a very beneficial effect in the neonatal period. We therefore conducted the present trial to test whether early BCG-Denmark reduces neonatal mortality by 45%. We also conducted a meta-analysis of the 3 BCG-Denmark trials. In 2008-2013, we randomized LW neonates to "early BCG-Denmark" (intervention group; n = 2083) or "control" (local policy for LW and no BCG-Denmark; n = 2089) at discharge from the maternity ward or at first contact with the health center. The infants were randomized (1:1) without blinding in blocks of 24. Data was analyzed in Cox hazards models providing mortality rate ratios (MRRs). We had prespecified an analysis censoring follow-up at oral poliovirus vaccine campaigns. Early administration of BCG-Denmark was associated with a nonsignificant reduction in neonatal mortality rate (MRR, 0.70; 95% confidence interval [CI], .47-1.04) and a 34% reduction (0.66; .44-1.00) when censoring for oral poliovirus vaccine campaigns. There was no reduction in mortality rate for noninfectious diseases, but a 43% reduction in infectious disease mortality rate (MRR, 0.57; 95% CI, .35-.93). A meta-analysis of 3 BCG trials showed that early BCG-Denmark reduced mortality by 38% (MRR, 0.62; 95% CI, .46-.83) within the neonatal period and 16% (0.84; .71-1.00) by age 12 months. Early administration of BCG-Denmark in LW infants is associated with major reductions in mortality rate. It is important that all LW infants receive early BCG in areas with high neonatal mortality rates. NCT00625482.

Comparing Pregnancy Outcomes in Obese Diabetic and Obese Non Diabetic Women - A Retrospective Study [33C

INTRODUCTION: The purpose of this study was to compare the pregnancy outcomes between obese pregnant women with and without diabetes. METHODS: Data from labor and delivery records gathered between 1/1/2010 and 9/1/2013 were studied. Women with BMI greater than 40 and with either gestational or type I diabetes mellitus (DM) were included and separated into two groups: Obese with DM (Group 1) and Obese without DM (Group 2). RESULTS: Compared to group 2: 23% of Group 1 delivered prematurely vs 14% (P &lt; .05). Group 1 had cesarean deliveries 94% of the time vs 55% (P &lt; .05). NICU admissions occurred in 14% of Group 1 vs 8% (P &lt; .05) Neonates had a lower neonatal weight (3409 g ± 811 vs 3270 g ± 703 P &lt; .05), slightly lower Apgar scores (7.0 ± 2.0 vs 7.4 ± 1.6) and neonatal pH (7.23 ± 0.9 vs 7.26 ± 0.18) compared to Group 2. 14 % of Group 1 patients developed preeclampsia vs 8% (P &lt; .05). There was no significant difference in intrauterine fetal demise rates or shoulder dystocia rates between the two groups. CONCLUSION: In our study, women who are obese with DM had a higher risk of undergoing a cesarean section, delivering prematurely, developing preeclampsia, having a NICU admission, low fetal weight, low Apgar scores, and pH compared with obese women with no DM. This highlights the importance of recognizing and treating both obesity and DM in pregnancy as it has a large impact in both maternal and neonatal morbidity, as well as healthcare cost.

Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review

ObjetivesMelanoma is one of the most frequent malignancies during gestation. However, oncological and perinatal management is still challenging. Our first objective is to describe the cases of pregnancy-associated melanoma (PAM) diagnosed in our centre between January-2004 and May-2015. Secondly, to perform a systematic review of the published articles analysing the maternal-perinatal outcomes of patients diagnosed with PAM. Design, population and methodsObstetrical, oncological and perinatal variables were recorded in the case series. For the systematic review we include all published articles assessing the obstetric and neonatal outcomes in PAM cases in Pubmed, Web of Knowledge and Cochrane Library. The search was restricted to articles published in English, between January-2004 and May-2015. Study characteristics, oncological and maternal-perinatal variables were recorded in the systematic review. ResultsTwo patients were found: the first case presents a newly diagnosed metastatic melanoma at 26-weeks of gestation with fatal maternal and neonatal outcome. The second case presents a patient with metastatic melanoma who got pregnant during her treatment. For the systematic review we found 25 articles, providing data from 489 patients. Maternal-perinatal outcomes, including termination of pregnancy rates, vary depending on the country, gestational age and tumour stage at diagnosis. PAM is usually detected at advanced stages, even with metastasis affecting the placenta and the foetus. ConclusionsWhen diagnosed at early stages, melanoma does not seem to alter the evolution of gestation, whereas patients with advanced stages of melanoma frequently deliver prematurely, by caesarean section, with lower neonatal weight, higher neonatal morbidity and mortality rates.

Evaluation of Initial Respiratory Support Strategies in VLBW Neonates with RDS.

Non-invasive ventilation (NIV) has brought about a significant change in care and treatment of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates. The present study was designed and conducted to evaluate different strategies of initial respiratory support (IRS) in VLBW neonates hospitalized in the neonatal intensive care unit (NICU). This prospective study was conducted over three years (March 21, 2011 to March 20, 2014). Each eligible VLBW baby with RDS diagnosis received a specific IRS, including room air (RA), oxygen therapy (O2 RX), n.CPAP, NIPPV, MV ± SURF, based on clinical evaluation; then, the next strategies were selected based on the disease progression. Obtained data was entered in SPSS and the groups were compared for disease consequences or death. Then, contributing factors to the failure of NIV strategies, and the need for endotracheal mechanical ventilation (eMV) were determined. In total, 499 neonates were included in the study. The mean birth weight was 1,125 ± 254 g and the gestational age was 29.2 ± 2.5 weeks. The IRS included: RA = 43, O2.RX = 60, n.CPAP/NIPPV = 219, INSURE = 83 and MV ± SURF = 177. In terms of the need for IRS upgrading during hospitalization, neonates not on mechanical ventilation (64.5%) were divided into three groups. In 45.3% of cases, the IRS did not change (Never upgrading); in 24.5% of cases, the level of IRS increased but there was no need for eMV in the first three days of life (Specific); in 24.8% of cases, there was need for eMV within the first three days of life (Absolute) and during hospitalization (after the first three days of life) 5.3% of cases were in need of eMV (General). In terms of correlation between the effective variables in IRS upgrading, univariable analyses showed that low gestational age, low birth weight, multiple pregnancy, maternal disease, low one-minute Apgar score, and need for surfactant therapy had significant correlation, and multivariable analysis showed that low gestational age, low birth weight and maternal disease were risk factors independently correlated to IRS upgrading, CLD and death. Early use of NIV in preterm neonates with mild to moderate respiratory distress and spontaneous breathing significantly reduced the need for intubation, surfactant, mechanical ventilation and thereby pulmonary and non-pulmonary complications and neonatal mortality.

IVF outcomes in average- and poor-prognosis infertile women according to the number of embryos transferred

Outcome measures of IVF success, which account for effectiveness of IVF and perinatal outcome risks, have recently been described. The association between number of embryos transferred in average and poor-prognosis IVF patients, and the chances of having good or poor IVF and perinatal outcomes, was investigated. Good IVF and perinatal outcome was defined as the birth of a live, term, normal-weight infant (≥2500 g). Poor IVF and perinatal outcome was defined as no live birth or birth of a very low weight neonate (<1500 g) or severe prematurity (birth at <32 weeks gestation). Each neonate was analysed as a separate outcome. A total of 713 IVF cycles in 504 average and poor-prognosis patients from January 2010 to December 2013 were identified. The odds of having good IVF and perinatal outcomes increased by 28% for each additional embryo transferred. The odds of poor IVF and perinatal outcome decreased by 32% with an additional embryo transferred. The likelihood of live birth with good perinatal outcome in average- and poor-prognosis patients after IVF increases with additional embryos being transferred. These data add to recently reported evidence in favour of multiple embryo transfer in older women and those with average or poor IVF prognosis.

Modelación de la evolución de neonatos con bajo peso al nacer, atendidos en el Hospital Universitario del Valle, durante el período 2002 a 2010: Estudio de Cohorte

Objetivo: Esta investigación tuvo como objetivos observar relaciones y encontrar grupos de neonatos que muestren un comportamiento similar con respecto a las variables de crecimiento físico, morbilidad e intervención y modelar la evolución del peso del neonato con bajo peso al nacer a través del tiempo. Materiales y Métodos: Se analizó una muestra de historias clínicas de 159 neonatos prematuros nacidos en el Hospital Universitario del Valle (HUV), entre febrero de 2002 y noviembre de 2010, que pertenecen al programa de seguimiento de alto riesgo y canguro del HUV. Se realizó un análisis de correspondencias y un análisis de conglomerados y en segunda instancia, se ajustó un modelo de coeficientes aleatorios. Resultados: Se encontraron dos grupos bien definidos de neonatos, los que presentan extremo bajo peso y los que presentan bajo peso y muy bajo peso al nacer. Las curvas estimadas a partir del modelo ajustado, muestran pesos un poco más altos para los neonatos con control prenatal. Conclusiones: El tener un modelo que permita estimar la curva de evolución del peso de cada neonato que nace con bajo peso en el HUV, resulta de gran ventaja para los pediatras, ya que permite observar que tan variable es ésta frente a la curva del peso medio esperado.

Application of Pattern Recognition Techniques to the Classification of Full-Term and Preterm Infant Cry

Scientific and clinical advances in perinatology and neonatology have enhanced the chances of survival of preterm and very low weight neonates. Infant cry analysis is a suitable noninvasive complementary tool to assess the neurologic state of infants particularly important in the case of preterm neonates. This article aims at exploiting differences between full-term and preterm infant cry with robust automatic acoustical analysis and data mining techniques. Twenty-two acoustical parameters are estimated in more than 3000 cry units from cry recordings of 28 full-term and 10 preterm newborns. Feature extraction is performed through the BioVoice dedicated software tool, developed at the Biomedical Engineering Lab, University of Firenze, Italy. Classification and pattern recognition is based on genetic algorithms for the selection of the best attributes. Training is performed comparing four classifiers: Logistic Curve, Multilayer Perceptron, Support Vector Machine, and Random Forest and three different testing options: full training set, 10-fold cross-validation, and 66% split. Results show that the best feature set is made up by 10 parameters capable to assess differences between preterm and full-term newborns with about 87% of accuracy. Best results are obtained with the Random Forest method (receiver operating characteristic area, 0.94). These 10 cry features might convey important additional information to assist the clinical specialist in the diagnosis and follow-up of possible delays or disorders in the neurologic development due to premature birth in this extremely vulnerable population of patients. The proposed approach is a first step toward an automatic infant cry recognition system for fast and proper identification of risk in preterm babies.

Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

We report our current-era results after placement of a modified Blalock-Taussig shunt (mBTS) as the first surgery in the multistage palliation strategy of neonates born with single ventricle (SV) anomalies associated with restrictive pulmonary blood flow. Between 2002 and 2012, 174 neonates with SV underwent mBTS. Competing risks analysis modeled events after mBTS (death or transplantation, transition to Glenn) and subsequently after Glenn (death or transplantation, transition to Fontan) and examined risk factors affecting outcomes. Competing risks analysis showed that 2 years after mBTS 27% of patients had died or received transplantation and 73% had undergone Glenn. Five years after Glenn, 6% had died, 73% had undergone Fontan, and 21% were alive awaiting Fontan. Overall survival 8 years after mBTS was 68%. On multivariable analysis, risk factors for mortality were increased shunt size to weight ratio (hazard ratio [HR]:1.2 per 0.1 ratio increase [1.0 to 1.4], p = 0.015), postoperative extracorporeal membrane oxygenation (HR: 4.0 [2.2 to 7.4], p < 0.001), chromosomal and extracardiac malformations (HR: 2.5 [1.3 to 5.0], p = 0.008), cardiopulmonary bypass use (HR: 2.5 [1.3 to 4.5], p = 0.004), and underlying pulmonary atresia with intact ventricular septum (PAIVS) or atrial isomerism (HR: 2.1 [1.1 to 4.2], p = 0.035). Palliation outcomes with mBTS in SV patients trail behind the generally improved results of congenital heart surgery. Several anatomic and patient-related factors continue to affect survival. Mortality is high in low weight neonates in whom a balance between overcirculation due to large shunt and low pulmonary blood flow and risk of occlusion due to small shunt is difficult to attain. Patients with chromosomal and extracardiac malformations, atrial isomerism, and PAIVS continue to be the most challenging and are associated with higher hospital and interstage mortality.