Low 5-minute Apgar Score Research Articles

Optimizing Delivery Timing in Pregnant Patients With Chronic Hypertension at Term

OBJECTIVE: To estimate the optimal timing of delivery among pregnant patients with chronic hypertension at term. METHODS: We performed a population-based retrospective cohort study including all nonanomalous singleton term (37–42 weeks of gestation) births in the United States from 2014 to 2018 among patients with chronic hypertension, excluding those with superimposed preeclampsia, eclampsia, and pregestational diabetes. The rates of stillbirth, infant death (within 1 year of life), and neonatal morbidity were compared at each week of term pregnancy. Neonatal morbidity was defined as a composite of neonatal intensive care unit admission, ventilation for 6 hours or longer, low 5-minute Apgar score (3 or lower), and seizures. To estimate the optimal delivery timing among pregnant patients with chronic hypertension, the risk of delivery at each week (ie, the rate of infant death or neonatal morbidity) was compared with the risk of expectant management (ie, the rate of stillbirth over that week plus rate of infant death or neonatal morbidity in the subsequent week) for an additional week. Subgroup analyses were performed for pregnancies complicated by fetal growth restriction and among non-Hispanic Black patients with chronic hypertension. RESULTS: Among pregnant patients with chronic hypertension at term (N=227,977), the rate of stillbirth (per 10,000 ongoing pregnancies) overall increased with gestational age and was lowest at 38 weeks (6.5, 95% CI, 5.4–7.7). The rates of infant death and neonatal morbidity were lowest at 40 weeks (18.0/10,000 live births, 95% CI, 13.7–23.6) and 39 weeks (637/10,000 live births, 95% CI, 619–654), respectively. The risk of delivery (per 10,000 pregnancies) was higher at 38 weeks of gestation (815, 95% CI, 793–836) compared with the composite risk of expectant management for an additional week (657.7, 95% CI, 640–676); however, at 39 weeks, the risk of delivery was lower (651, 95% CI, 633–670) compared with the composite risk of expectant management for an additional week (750, 95% CI, 720–781). CONCLUSION: Among patients with chronic hypertension, delivery at 39 weeks of gestation provides the optimal balance between absolute rates of infant death or neonatal morbidity and stillbirth. This finding is consistent for non-Hispanic Black patients with chronic hypertension and for those pregnancies complicated by fetal growth restriction. This is consistent with current practice guidelines.

Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants

BackgroundThe objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).MethodThe data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.ConclusionMaternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.

EVALUATING PERINATAL OUTCOMES IN HIGH-RISK PREGNANCIES USING THE MODIFIED COOPLAND’S SCORING SYSTEM AT A TERTIARY HOSPITAL

This study aims to thoroughly assess perinatal mortality rates, Apgar scores, birth weights, and neonatal complications within the first-week post-birth among high-risk pregnancies. Methods: During a prospective cohort study at Jinnah Postgraduate Medical Centre, Karachi, from October 2023 to May 2024, we evaluated outcomes in 664 high-risk pregnant women using systematic random sampling. Participants, with singleton pregnancies of 24 weeks or more gestation, were stratified by risk level. Data included demographic details, socioeconomic status, BMI, and pregnancy history. Maternal outcomes, such as mode of delivery and postpartum haemorrhage requiring transfusion, and perinatal outcomes, including birth weight and APGAR scores, were assessed. Statistical analysis emphasized odds ratios, with p < 0.05 considered significant. Ethical approval was obtained, and all participants provided informed consent. Results: This prospective cohort study at Jinnah Postgraduate Medical Centre from October 2023 to May 2024 involved 664 high-risk pregnant women categorized by standard risk scoring. Participants were predominantly low-risk (65.77%), followed by moderate-risk (19.88%) and high-risk (14.35%). Key findings included increased rates of cesarean sections, postpartum haemorrhage, premature births, low birth weight, adverse APGAR scores, NICU admissions, and perinatal mortality with escalating risk levels. Statistical analyses revealed significant associations and elevated odds ratios for adverse outcomes among higher-risk groups, underscoring the importance of risk assessment in managing maternal and perinatal health outcomes. Conclusion: Our study highlights the urgent importance of identifying and effectively managing high-risk pregnancies. We discovered that these pregnancies are associated with significantly elevated risks of complications such as Cesarean deliveries, postpartum haemorrhage, preterm births, low birth weights, low 5-minute APGAR scores, NICU admissions, and perinatal mortality. Implementing a straightforward, non-invasive risk-scoring system can facilitate early detection of high-risk cases, enabling timely and tailored interventions that can greatly improve outcomes for both mothers and infants.

Neonatal outcomes in women with Multiple Sclerosis – Influence of disease activity: A Danish nationwide cohort study

BackgroundMaternal Multiple Sclerosis (MS) has been associated with an increased risk of adverse birth outcomes. We hypothesized that active disease during conception and pregnancy plays an important role in this context, which this study aims to address. MethodsWe used the Danish registers to conduct a nationwide cohort study. Information on maternal disease activity during pregnancy was retrieved using proxies from the linked registers (hospitalization, magnetic resonance imaging of the brain, and use of systemic corticosteroids during pregnancy). Neonates, exposed in utero to maternal disease activity constituted the exposed cohort and the unexposed cohort constituted neonates without in utero exposure to maternal disease activity. The examined outcomes were preterm birth, small for gestational age, low 5-minute Apgar score, and major congenital anomalies. In logistic regression models we estimated the odds ratios (OR) with adjustment for confounders such as maternal age, comorbidities, parity, smoking, calendar year of birth, and disease-modifying treatment. ResultsAmong the study population of 2492 children of mothers with MS we identified 273 (11 %) neonates exposed to maternal disease activity during pregnancy, and 2219 (89 %) neonates without exposure to disease activity. The adjusted odds ratios (aOR) for preterm birth, small for gestational age, low 5-minute Apgar score, and major congenital anomalies among children born to women with disease activity during pregnancy were 0.92 (95 % confidence interval (95 % CI) 0.53–1.60), aOR 1.19 (95 % CI 0.62–2.26), aOR 2.57 (95 % CI 0.93–7.15) and aOR 0.93 (95 % CI 0.48–1.83), respectively. ConclusionsWomen with MS having disease activity during pregnancy did not have a statistically significantly increased risk of adverse neonatal outcomes compared to women with MS without disease activity, which is overall reassuring results. We believe, that this will be useful knowledge for patients and clinicians in planning a pregnancy and preparing a birth plan.

Perinatal outcomes and sinopharm BBIBP-CorV vaccination during pregnancy

BackgroundAfter the outbreak of COVID-19, a huge part of the health care services was dedicated to preventing and treating this disease. In case of COVID-19 infection, severe COVID-19 is reported more in pregnant individuals. Afterward, Vaccination against SARS-CoV-2 became a hot topic due to known effects in preventing severe COVID-19 during pregnancy.Vaccination of pregnant individuals started in August 2021 with the Sinopharm vaccine in Iran. The aim of current study was to determine the incidence of perinatal outcomes in women who were vaccinated during pregnancy.MethodThis retrospective cohort study included 129,488 singleton births from March 21, 2021, until March 21, 2022, in Tehran, Iran.The data was obtained from the Iranian Maternal and Neonatal (IMaN) Network and the Maternal Vaccination Registry.Adverse perinatal outcomes investigated in this study include preterm birth, extremely preterm birth, low birth weight, very low birth weight, intrauterine growth restriction, stillbirth, neonatal intensive care unit admission, congenital anomaly, neonatal death and low 5-minute Apgar score. The risk of all perinatal outcomes was evaluated using multiple logistic regression. The analysis was done using STATA version 14.ResultsOf all 129,488 singleton births included in this study, 17,485 (13.5%) were vaccinated against SARS-CoV-2 (all with Sinopharm (BBIBP-CorV)). The exposure to the Sinopharm vaccine during pregnancy caused a significant decrease in the incidence of preterm birth (P =0.006, OR=0.91 [95% CI, 0.85 to 0.97]), extremely preterm birth (P =<0.001,OR=0.55 [95% CI, 0.45 to 0.66]), and stillbirth (P =<0.001, OR=0.60 [95% CI, 0.47 to 0.76]). Exposure to vaccination during the first trimester was associated with an increased risk of preterm birth (P =0.01, OR=1.27 [95% CI, 1.04 to 1.55])Maternal vaccination during pregnancy was not associated with an increased risk of other adverse perinatal outcomes included in this study.ConclusionThe finding of this population-based study indicated no adverse pregnancy outcome due to vaccination with the Sinopharm vaccine during the second and third trimesters of pregnancy. Overall risk of adverse pregnancy outcomes were lower in the vaccinated individuals compared to the unvaccinated group. Also, vaccination during the first trimester was associated with an increased risk of preterm birth.

Correlation Between APGAR Scores and the Incidence of Hyperbilirubinemia in Neonates at Wangaya Regional General Hospital, Denpasar

Background: Hyperbilirubinemia is defined as total serum bilirubin level at ≥ 5 mg/dl. In Indonesia, the prevalence of jaundice is 13,7-85%. One of the risk factors for hyperbilirubinemia in neonates is babies born with a history of asphyxia. The diagnosis of asphyxia can be enforced by the APGAR scoring system. This study aims to determine the relationship between APGAR values and the incidence of hyperbilirubinemia in neonates treated at Wangaya Regional General Hospital.&#x0D; Methods: This research is an analytic observational study using a cross-sectional approach, which was carried out in April-May 2022. The sample was taken by consecutive sampling. Bivariate analysis was performed using the chi-square test. Confounding variables will be controlled by design and by analysis. Influential risk factors were analyzed multivariate with logistic regression. Data were analyzed with SPSS software.&#x0D; Results: From 84 samples, 67, 9% had hyperbilirubinemia. The 1-minute APGAR score (P = 0,017, OR = 8,373, 95% CI; 1,468 – 47,738) and the 5-minute APGAR score (P = 0,034, OR =8,680, 95% CI; 1,172 – 64, 293) had significant correlation with the incidence of hyperbilirubinemia in neonates treated at Wangaya Regional General Hospital.&#x0D; Conclusion: Low APGAR scores have a significant correlation with the incidence of hyperbilirubinemia in neonates treated at Wangaya Regional General Hospital. The factor that most influences the incidence of hyperbilirubinemia is the 1-minute APGAR score. Neonates born with a low 1-minute APGAR score are 8,3 times at risk of experiencing hyperbilirubinemia.

Perinatal Outcomes of Newborns of COVID-19-Infected Pregnant Women: An Updated Systematic Review and Meta-Analysis.

In this systematic review and meta-analysis, we aimed to review the characteristics and outcomes of the newborns of Coronavirus disease 2019 (COVID-19) infected pregnant women. We conducted an online bibliographic search using the following electronic databases: MEDLINE via PubMed, Scopus, Web of Science, and Cochrane Central. Studies were deemed eligible if they recruited newborns from mothers with confirmed COVID-19 and reported the perinatal outcomes of neonatal COVID-19 cases. A total of 20 studies were included. Neonates born to mothers with positive COVID-19 results have been shown to have significantly lower birth weights (mean difference, MD = -48.54 g, p = 0.04), increased risks of fetal distress (odds ratio, OR = 1.76, p < 0.00001), respiratory distress (OR = 1.96, p = 0.006), premature birth (OR = 2.08, p < 0.00001), neonatal death (OR = 2.20, p = 0.004), and a lower 5-minute Apgar score (OR = 1.44, p = 0.02). Additionally, they were more likely to be admitted to the neonatal intensive care unit (NICU) (OR = 2.25, p = 0.007) and test positive for COVID-19 themselves (OR = 9.88, p = 0.03). However, other parameters, such as risks for malformations, mechanical ventilation, hypoglycemia, and sepsis, appeared to be comparable between the two groups. Maternal infection with COVID-19 during pregnancy is associated with several neonatal outcomes, some of which are adverse and others that do not show significant deviation from norms. While our meta-analysis clearly illustrates heightened risks associated with premature birth, reduced neonatal weight, and other challenges, it also emphasizes that not all neonatal outcomes can be directly attributed to maternal SARS-CoV-2 infection.

Clinical and Laboratory Characteristics and Associated Factors to Mortality in Neonates with Birth Asphyxia: A Prospective Observational Study

Aims: To describe the clinical and laboratory characteristics and to investigate associated factors with mortality of birth asphyxia. Methods: This was a prospective observational study conducted on a total of 120 asphyxiated neonates admitted to the Neonatal Intensive Care Unit (NICU). Results: Severe asphyxia was observed in 33.3%, and moderate asphyxia in 66.7% of the cases. The mortality rate was 19.2%. The common clinical features: apnea/gasping (45.8%), hypothermia (37.5%), lethargy (33.0%). The serious clinical signs: abnormal heart rate (15.8%), gastrointestinal bleeding (13.3%), oliguria and anuria (17.5%). The laboratory findings showed hypoglycemia (30.8%), elevated SGOT (45.0%), serum creatinine &gt; 133 µmol/l (31.7%), hyponatremia (35.0%), hypocalcemia (65.8%), elevated lactate &gt; 5mmol/l (53.6%). The factors that increased the risk of mortality in neonatal asphyxia were Apgar score at 5 min ≤ 5, seizure/coma, need for mechanical ventilation, serum creatinine &gt; 133 µmol/l, liver injury, and lactate ≥ 5 mmol/l. Conclusion: The mortality rate is still high, and elevated serum creatinine, elevated liver enzymes, elevated lactate, and low 5-minute Apgar scores increase the risk of death in asphyxiated neonates. Key words: birth asphyxia, mortality, risk factors, neonates.

Preterm infants with positive conjunctival swab culture: risk factors and association with late-onset sepsis-a retrospective cohort study.

Purulent conjunctival discharge in hospitalized preterm infants may indicate conjunctivitis and warrant treatment. The purpose of this study was to examine the relationship between positive conjunctival swab (CS) culture and late-onset sepsis (LOS) in preterm infants. A retrospective cohort study was conducted to determine the relationship between positive CS culture growth results (CSP) obtained in preterm infants ≤34 weeks' gestation and the development of LOS within 120 h of obtaining CS compared with those who had negative CS culture results (CSN). Electronic medical records were reviewed from January 2015 until December 2019 for preterm infants presenting with purulent conjunctival discharge and underwent CS culture testing due to suspected conjunctivitis. Of the 234 CS cultures obtained during the study period, 145 (61.9%) were CSP compared to 89 (38.1%) CSN cultures. Gram-negative organisms accounted for 70% of all CSP cultures, with the remaining 30% being Gram-positive. Patients with CSP were smaller, younger, had lower 1-minute APGAR scores, and required respiratory support more frequently than those with CSN. Infants with CSP received antibiotics for longer periods, both topically and systemically. Infants who developed LOS were more likely to require invasive ventilation (adjusted odds ratio, 33.5; 95% CI, 2.52-446.5, p = 0.008). The incidence of LOS between the two groups was similar, with 6.2% observed in the CSP group compared to 3.4% in the CSN group (p = 0.543). Similarly, the rates of bacteremia were similar in both groups. Of the CSP patients who were presented with bacteremia, four out of seven (57%) exhibited bacteremia caused by the same organism found in their CS cultures. Similarly, within the entire cohort, respiratory cultures were performed on nine intubated patients within two weeks of obtaining CS cultures. Of these, in the CSP group, five out of six (83%) showed an organism identical to that found in the CS cultures. The study found a significant proportion of positive CS cultures in preterm infants, with distinct patient characteristics and treatment compared to negative cultures. While the incidence of LOS was not significantly different between the two groups, some CSP patients demonstrated bacteremia with the same CS organism, suggesting a possible connection between conjunctival or respiratory colonization and bacteremia.

Prevalence and Risk Factors for Tube-Feeding at Discharge in Infants following Early Congenital Heart Disease Surgery: A Single-Center Cohort Study.

Oral feeding difficulty is common in infants after congenital heart disease (CHD) surgical repair and is associated with prolonged hospital stay and increased risk for tube-feeding at discharge (TF). The current understanding of the enteropathogenesis of oral feeding difficulty in infants requiring CHD surgery is limited. To determine the prevalence and risk factors for TF following CHD surgery in early infancy. This was a 6-year single-center retrospective cohort study (2016-2021) of infants under 6 months who had CHD surgery. Infants required TF were compared with infants who reached independent oral feeding (IOF). Of the final sample of 128 infants, 24 (18.8%) infants required TF at discharge. The risk factors for TF in univariate analysis include low birth weight, low 5-minute Apgar score, admitted at birth, risk adjustment in congenital heart surgery categories IV to VI, presence of genetic diagnosis, use of Prostin, higher pre- and postsurgery respiratory support, lower weight at surgery, lower presurgery oral feeding, higher presurgery milk calory, delayed postsurgery enteral and oral feeding, higher pre- and postsurgery gastroesophageal reflux disease (GERD), need for swallow study, abnormal brain magnetic resonance imaging (p < 0.05). In the multivariate analysis, only admitted at birth, higher presurgery milk calories, and GERD were significant risk factors for TF. TF had significantly longer hospital stay (72 vs. 17 days) and lower weight gain at discharge (z-score: -3.59 vs. -1.94) compared with IOF (p < 0.05). The prevalence of TF at discharge in our study is comparable to previous studies. Infants with CHD admitted at birth, received higher presurgery milk calories, and clinical GERD are significant risk factors for TF. Mitigating the effects of identified risk factors for TF will have significant impact on the quality of life for these infants and their families and may reduce health care cost. · Oral feeding difficulty in infants after congenital heart disease surgical repair is common.. · Such infants require prolonged hospital stay and higher risk for tube-feeding at discharge.. · Identifying modifiable risk factors associated with tube-feeding can enhance clinical outcomes..

Risk Factors for Prolonged Intertwin Delivery Interval and Associated Maternal and Second Twin Morbidity.

This work aimed to identify possible risk factors and the morbidity associated with prolonged intertwin delivery interval (IDI). A retrospective cohort study at a single tertiary care center. Women with twin gestations who reached the second stage of labor between January 2010 and December 2019 were included in the study. Demographic and clinical characteristics were compared between short IDI (≤15 minutes) and prolonged IDI (>15 minutes). The primary outcome was the rate of 5-minute Apgar score ≤ 7. A total of 461 women were included; 312 of whom were in the short IDI group and 149 were in the prolonged IDI group. Rates of 5-minute Apgar score ≤ 7 and neonatal acidemia were significantly higher in the prolonged IDI group (3.5 vs. 9.7%, p = 0.008; 4.3 vs. 15.7%, p = 0.01, respectively). Vaginal delivery was less likely to occur in the prolonged IDI group (75.8 vs. 93.3%). Placental abruption and hemoglobin drop ≥ 3 g/dL were more prevalent in the prolonged IDI group (4 vs. 1%, p = 0.03; 39.1 vs. 24.7%, p = 0.01, respectively). In the multivariate analysis, age ≥ 30 years (adjusted odds ratio [aOR]: 1.76, p = 0.01), nulliparity (aOR: 1.66, p = 0.03), and birth weight ratio ≥ 1.2 (aOR: 1.92, p < 0.05) were associated with prolonged IDI. Prolonged IDI is associated with an increased risk for neonatal acidemia and low 5-minute Apgar score, and with an increased rate of cesarean delivery, placental abruption, and hemoglobin drop ≥ 3 g/dL. Advanced maternal age, nulliparity, and twin birth weight ratio ≥ 1.2 are associated with prolonged IDI. · Prolonged was found to be associated with higher neonatal acidemia and lower 5-minute Apgar score.. · Prolonged IDI is also associated with increased rate of cesarean delivery, placental abruption, and blood loss.. · Advanced maternal age, birth weight discordancy, and nulliparity were associated with prolonged IDI..

Maternal and Neonatal Outcomes of Twin Pregnant Women With Anemia.

The aim of this study was to investigate the prevalence of anemia in twin pregnancies and the influence of anemia on maternal and neonatal outcomes. This retrospective study included twin pregnant women who delivered in a tertiary hospital in China from January 2018 to December 2018. Patients were divided by WHO criteria (hemoglobin <11.0 g/dL): the anemic and nonanemic groups. Patients with anemia were further classified as recovered or unrecovered subgroup after oral iron therapy. Maternal and neonatal outcomes in women carrying twins were compared using Student's t test and the chi-squared test or the Fisher exact test. Univariable and multivariable logistic regression models were used to determine the association of maternal and neonatal characteristics with anemia. Linear regression analysis was used to estimate mean birth weight and gestational week. The prevalence of anemia was 42.6% (182/427) in twin pregnancies. The anemic group had higher rates of low 1-minute Apgar score (4.4% vs. 1.8%, p = .028), perinatal death (1.9% vs. 0.2%, p = .012) and neonatal intensive care unit (NICU) admission (27.2% vs. 20.2%, p = .017; adjusted OR, 1.478; 95% CI [1.07, 2.044]). The recovered subgroup had lower NICU admission rate (13.5% vs. 30.3%, p = .006; OR, 0.388; 95% CI [0.186, 0.809]), higher gestational week and birth weight (β, 0.954 week; 95% CI [0.114, 1.794] and β, 171.01 g; 95% CI [9.894, 332.126] respectively). The prevalence of anemia in twin gestation is high. Anemia is associated with adverse neonatal outcomes, and correction of anemia significantly improved the pregnancy outcomes.

Neurocutaneous Syndromes, Perinatal Factors, and the Risk of Childhood Cancer in Sweden

Neurocutaneous syndromes are associated with cancer predisposition and sometimes associated with perinatal factors. A better understanding of the association between neurocutaneous syndromes, perinatal factors, and childhood cancer is key for earlier cancer detection. To evaluate the association of neurocutaneous syndromes and perinatal factors with childhood cancer risk in a cohort of Swedish children. In this nationwide cohort study, all children and adolescents up to age 20 years, from 1973 to 2015, were identified through the Swedish National Medical Birth Register (MBR), provided they had information on both biological parents. Analyses were conducted from April 2021 through May 2023. Diagnoses of neurocutaneous syndromes were obtained from the MBR, National Patient Register, and Cause of Death register. Perinatal factors (birth weight, gestational age, birth weight by gestational age, 5-minute Apgar score, and head circumference) were obtained from the MBR. Childhood cancer risk (<20 years at diagnosis; identified from the National Cancer Register), including leukemia, lymphoma, and central nervous system (CNS) tumors. Among 4 173 108 included children (2 143 133 [51.4%] male, median [IQR] follow-up 20 [9.7-20] years), 1783 had neurofibromatosis type 1 (NF1), 444 tuberous sclerosis, 63 von Hippel-Lindau disease, and 39 ataxia-telangiectasia. An increased cancer risk was observed among children with any neurocutaneous syndrome (HR, 34.9; 95% CI, 30.8-39.6) and was particularly pronounced for CNS tumors (HR, 111.7; 95% CI, 96.8-128.8), except among children with ataxia-telangiectasia, where the increased risk was associated with lymphomas (HR, 233.1; 95% CI, 75.0-724.1). Leukemia risk was increased only among children with NF1 (HR, 4.1; 95% CI, 1.7-9.8). Several perinatal factors, including high birth weight, being born large for gestational age, preterm birth, low 5-minute Apgar score, and large head circumference had lesser associations with childhood cancer. Adjusting for neurocutaneous syndromes did not affect these associations. In this nationwide cohort study, neurocutaneous syndromes were associated with an increased risk of childhood cancer, especially CNS tumors. Several perinatal factors had lesser associations with childhood cancer, independently of the presence of neurocutaneous syndromes. Other biological mechanisms likely underlie the association between perinatal factors and childhood cancer.

Profiles and Outcomes of Women with Gestational Diabetes Mellitus in the United States.

Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.

Pregnancy, Delivery, and Neonatal Outcomes Associated With Maternal Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is associated with adverse health-related outcomes. However, pregnancy and neonatal outcomes among women with OCD have been sparsely studied. To evaluate associations of maternal OCD with pregnancy, delivery, and neonatal outcomes. Two register-based cohort studies in Sweden and British Columbia (BC), Canada, included all singleton births at 22 weeks or more of gestation between January 1, 1999 (Sweden), or April 1, 2000 (BC), and December 31, 2019. Statistical analyses were conducted between August 1, 2022, and February 14, 2023. Maternal OCD diagnosis recorded before childbirth and use of serotonin reuptake inhibitors (SRIs) during pregnancy. Pregnancy and delivery outcomes examined were gestational diabetes, preeclampsia, maternal infection, antepartum hemorrhage or placental abruption, premature rupture of membranes, induction of labor, mode of delivery, and postpartum hemorrhage. Neonatal outcomes included perinatal death, preterm birth, small for gestational age, low birth weight (<2500 g), low 5-minute Apgar score, neonatal hypoglycemia, neonatal jaundice, neonatal respiratory distress, neonatal infections, and congenital malformations. Multivariable Poisson log-linear regressions estimated crude and adjusted risk ratios (aRRs). In the Swedish cohort, sister and cousin analyses were performed to account for familial confounding. In the Swedish cohort, 8312 pregnancies in women with OCD (mean [SD] age at delivery, 30.2 [5.1] years) were compared with 2 137 348 pregnancies in unexposed women (mean [SD] age at delivery, 30.2 [5.1] years). In the BC cohort, 2341 pregnancies in women with OCD (mean [SD] age at delivery, 31.0 [5.4] years) were compared with 821 759 pregnancies in unexposed women (mean [SD] age at delivery, 31.3 [5.5] years). In Sweden, maternal OCD was associated with increased risks of gestational diabetes (aRR, 1.40; 95% CI, 1.19-1.65) and elective cesarean delivery (aRR, 1.39; 95% CI, 1.30-1.49), as well as preeclampsia (aRR, 1.14; 95% CI, 1.01-1.29), induction of labor (aRR, 1.12; 95% CI, 1.06-1.18), emergency cesarean delivery (aRR, 1.16; 95% CI, 1.08-1.25), and postpartum hemorrhage (aRR, 1.13; 95% CI, 1.04-1.22). In BC, only emergency cesarean delivery (aRR, 1.15; 95% CI, 1.01-1.31) and antepartum hemorrhage or placental abruption (aRR, 1.48; 95% CI, 1.03-2.14) were associated with significantly higher risk. In both cohorts, offspring of women with OCD were at elevated risk of low Apgar score at 5 minutes (Sweden: aRR, 1.62; 95% CI, 1.42-1.85; BC: aRR, 2.30; 95% CI, 1.74-3.04), as well as preterm birth (Sweden: aRR, 1.33; 95% CI, 1.21-1.45; BC: aRR, 1.58; 95% CI, 1.32-1.87), low birth weight (Sweden: aRR, 1.28; 95% CI, 1.14-1.44; BC: aRR, 1.40; 95% CI, 1.07-1.82), and neonatal respiratory distress (Sweden: aRR, 1.63; 95% CI, 1.49-1.79; BC: aRR, 1.47; 95% CI, 1.20-1.80). Women with OCD taking SRIs during pregnancy had an overall increased risk of these outcomes, compared with those not taking SRIs. However, women with OCD not taking SRIs still had increased risks compared with women without OCD. Sister and cousin analyses showed that at least some of the associations were not influenced by familial confounding. These cohort studies suggest that maternal OCD was associated with an increased risk of adverse pregnancy, delivery, and neonatal outcomes. Improved collaboration between psychiatry and obstetric services and improved maternal and neonatal care for women with OCD and their children is warranted.

Decreasing Percentage of Infants With Very Low 5-Minute Apgar Scores at a Safety-Net Level III NICU.

Low 5-minute Apgar scores predict mortality and may be associated with poor neurologic outcomes. Our percentage of infants with low 5-minute Apgar scores was higher than the national average (2.4%). Therefore, we aimed to decrease the percentage of infants with Apgar scores <4 at 5 minutes from a mean of 5.12% to <2.4% and decrease the percentage of infants receiving chest compressions (CCs) before intubation from 21% to <5%. We completed 4 plan-do-study-act (PDSA) cycles from April 2015 through November 2018, including providing 24-hour advanced practice provider coverage (PDSA 1), initiating advanced practice provider-led delivery room scenarios for residents and education to secure the airway before CCs (PDSA 2), developing "Go Bags" with supplies (PDSA 3), and performing multidisciplinary mock codes (PDSA 4). We used a statistical process control p-chart to evaluate our primary outcome measure of the percentage of infants with 5-minute Apgar scores <4 from January 2012 through September 2021. The percent of infants with Apgar scores <4 at 5 minutes decreased from 5.12% in the baseline and intervention period to 2.16% in the sustainment period. We detected special cause with 8 points below the centerline. Infants born in the baseline period were 7.9 times more likely to receive CCs before intubation than in the intervention and sustainment periods (P = .002). We decreased the percentage of infants with 5-minute Apgar scores <4 and the percentage of infants receiving chest compressions before intubation. Ultimately, rigorous education and team collaboration through frequent multidisciplinary team mock codes were critical to our success.

C.3 Development and validation of a prediction model for perinatal arterial ischemic stroke in term neonates

Background: Perinatal arterial ischemic stroke (PAIS) is a focal brain injury in term neonates, identified postnatally but presumed to occur around birth. Early risk detection and targeted treatments are limited. We developed and validated a diagnostic risk prediction model from common clinical factors to predict a term neonate’s probability of PAIS. Methods: A diagnostic prediction model was developed using multivariable logistic regression. Common pregnancy, delivery, and neonatal clinical factors were collected across four registries. Variable selection was based on peer-reviewed literature. Participant inclusion criteria were term birth and no underlying predisposition to stroke. The primary outcome was discriminative accuracy of the model predicting PAIS, measured by the concordance (C-) statistic. Results: 2571 participants (527 cases, 2044 controls) were eligible for analysis. Nine variables were included in the model – maternal age, tobacco exposure, recreational drug exposure, pre-eclampsia, chorioamnionitis, maternal fever, emergency c-section, low 5-minute Apgar score, and sex – to predict the risk of PAIS in a term neonate. This model demonstrated good discrimination between cases and controls (C-statistic 0.73) and model fit (Hosmer-Lemeshow p=0.20). Conclusions: Clinical variables can be used to develop and internally validate a model of PAIS risk prediction. Identifying high-risk neonates for early screening and treatment could reduce lifelong morbidity.

Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease.

Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.

Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management

Elective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated with elective induction of labor. To examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management. A systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022. This systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management. Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO. Maternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia. Of the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management. In this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.

Incidence of Retinopathy of Prematurity in Neonates with Neonatal Sepsis.

One of the most important complications of premature birth is retinopathy of prematurity (ROP). Sepsis may increase the incidence of this complication. The aim of this study is to compare the incidence of ROP in neonates with and without sepsis. In a retrospective case-control study, preterm infants admitted to the neonatal intensive care unit (NICU) of Ghaem hospital from 2014 to 2022 were examined. The case group consisted of 155 preterm infants with definite sepsis (positive blood culture and clinical signs of sepsis) and the control group included 145 preterm infants without sepsis whose maternal and neonatal characteristics were collected; they were examined by a retinologist and evaluated for ROP at 32 weeks or four weeks after birth. Finally, we used the chi-square and the t test to compare the two groups. Out of 155 preterm infants with sepsis, 70% and out of 145 preterm infants without sepsis, 58% had ROP (P=0.023). Also, low birth weight, low initial Apgar score and low 5-minute Apgar score were significantly associated with ROP (P<0.05). Based on the results of this study, sepsis is a serious risk factor for ROP. We can reduce its incidence and complication by preventing sepsis in premature infants.