Infants Mean Gestational Age Research Articles

The effect of participation education on maternal role adaptation in mothers with premature infants in the neonatal intensive care unit.

The birth of a premature infant, hospitalization, and separation from the family cause disruption on maternal role adaption. This study was conducted with the aim of investigating the effect of participation education on maternal role adaption in mothers of premature infants hospitalized in the neonatal intensive care unit. This semiexperimental study was conducted with the participation of 129 eligible mothers with premature infants into three groups of 43 (face-to-face education, virtual education, and control). Data collection was done using a checklist measuring adaptation to the maternal role. Data were analyzed by descriptive statistical and multiple linear regression tests at a significance level of P < 0.05. The mean age of mothers was 30.8 years, the mean gestational age of infants was 31.7 weeks, the mean birth weight was 1781.4 g, and the most common (84.5%) reason for hospitalization of infants was respiratory distress. Multiple linear regression analysis showed that the total score of maternal role adaptation at the time of discharge was significantly different in the two groups of virtual education (134.362 ± 0.925) (P < 0.001) and face-to-face education (132.421 ± 0.928) (P = 0.005) with the control group (128.286 ± 0.924). The implementation of educational programs is a suitable solution to improve maternal role adaption. Therefore, it is recommended that managers and healthcare planners consider codified and regular educational programs in order to increase the ability of mothers, in order to adapt to the maternal role.

Morbidity and mortality among infants of diabetic mothers admitted to a neonatal care unit in Karbala pediatric teaching hospital.

This study aimed to determine the morbidity and mortality patterns among infants of diabetic mothers admitted to the neonatal care unit in Karbala pediatric teaching hospital. The study enrolled fifty diabetic infants (pregestational and gestational) admitted to the ward from the 1st of October 2013 to the 30th of January 2014. Data on delivery mode, gestational age, birth weight, other associated morbidities, investigation results, therapy, length of hospital stay, and outcome were collected and compared to infants of non-diabetic mothers admitted during the same period. A retrospective analysis of maternal data was performed. 62% of infants were born to mothers with gestational diabetes, and 38% were born to mothers with pre-gestational diabetes. 86% were born by caesarian section, of which 35% were by emergency cesarean section. The mean gestational age of infants of diabetic mothers was 37w1d±1.88, and 29 (64%) had macrosomia. The most typical morbidities were hypoglycemia (significantly higher in infants of diabetic mothers (IDMs) than infants of non-diabetic mothers) and hyperbilirubinemia in 36 (72%) and 24 (48%), respectively. There was no difference in morbidity patterns between infants of pregestational and gestational diabetic mothers except for macrosomia, and transient tachypnea of newborns was higher in gestational diabetes. The mortality rate was not significantly higher in IDMs. Diabetes during pregnancy has a serious effect on neonates and their mothers. The commenced morbidities in IDMs were hypoglycemia, macrosomia, and hyperbilirubinemia, so strict control of blood glucose level during pregnancy and education of diabetic women is essential before and during gestation.

Assessment of Nurses' Performance Regarding Infant Sleep Position on Sudden Infant Death Syndrome at Neonatal Intensive Care Units

Background: Sudden infant death syndrome (SIDS) is the sudden unexplained death of an infant during sleep. It is the most common cause of post neonatal mortality. Aim: This study aimed to assess nurses' performance regarding infant sleep position on sudden infant death syndrome at Neonatal Intensive Care Units (NICUs). Design: A descriptive research design was used to conduct this study. Settings: This study was carried out at NICUs in Helwan General Hospital affiliated to Ministry of health and Mustafa Hassan Pediatric Hospital affiliated to Fayoum University Hospitals. Sample: A convenience sample of seventy nurses who providing care for preterm and low birth weight infants admitted to NICUs in the previous mentioned settings. Tools: Two tools were used for data collection; 1st tool: A structured interview questionnaire sheet consists of two parts: Part (1) to assess characteristics of studied sample, Part (2) to assess nurses' knowledge regarding infant sleep position on SIDS, 2nd tool: Observational checklist to assess nurses' practice regarding infant sleep position on SIDS. Results: The mean age of studied nurses was 25.47±4.26 years and the mean gestational age of infants was 32.43±2.71 weeks, 55.7% of the studied nurses had unsatisfactory level of knowledge regarding infant sleep position on SIDS. Also, the study proved that, 58.6% of studied nurses had incompetent level of practice regarding infant sleep positions at NICUs. Conclusion: It can be concluded that, more than half of the studied nurses had unsatisfactory total level of knowledge regarding infant sleep position on SIDS and more than half of them had incompetent practice. Additionally, there were statistically significant differences between nurses’ total level of knowledge and their characteristics namely educational qualifications (P =0.033) and attendance of previous educational courses about the infant sleeping position at the NICUs (P =0.005), while there were highly statistically significant differences between nurses’ total level of practice and their years of experience at NICUs (P&lt;0.001).Recommendations: Continuous training program for nurses to improve their performance regarding infant sleep position on sudden infant death syndrome.

A study of the prevalence and severity of retinopathy of prematurity in East of Iran during 2015–2017: A descriptive cross-sectional study

IntroductionRetinopathy of prematurity (ROP) is a retinal vascular disease in preterm infants, which can cause partial defects in visual acuity or lead to serious defects including retinal detachment and blindness. In most cases, ROP can be prevented and treated if detected early. In this study, the prevalence of ROP and some factors affecting the severity of this disease have been examined. MethodThis cross-sectional study was implemented on 253 premature infants referred to Khatam-Al-Anbia hospital in Mashhad in 2015–2017 period for ROP screening. The sampling was performed using census method. The data-gathering tool was a demographic questionnaire and a checklist for recording the stage of the disease, follow-up and treatment of the patients. ResultsThe sample consisted of 104 female infants (41.1%) and 149 male infants (58.9%). The mean gestational age of infants was 32.1 ± 2.9 weeks and the mean birth weight was 1697.2 ± 566.5 g. Of the sample, 112 (44.3%) had some degrees of ROP and only 1.98% were in need of treatment. In the first examination, the severity of retinopathy in both eyes of infants was the highest in infants with gestational age of less than 32 weeks, and the lowest in infants older than 34 weeks (P < 0.001). There was a significant correlation between ROP severity and gestational age (p ≥ 0.001). The severity of retinopathy in natural pregnancy was also lower than assisted reproduction techniques (P < 0.001). In this study, there was no significant relationship between ROP severity and gender (p ≥ 0.10). ConclusionIn general, the prevalence of ROP in our sample was relatively high. Considering that the severity of ROP was found to be related to the gestational age of infants, and since early diagnosis is the key to ROP treatment, it is suggested to administer ROP screening for all infants with a gestational age of less than 34 weeks or premature infants born by assisted reproduction techniques.

Evaluation and modification of French screening guidelines for retinopathy of prematurity

To evaluate the current French screening guidelines for retinopathy of prematurity (ROP) and to suggest modifications to it. In this multicentric retrospective, noncomparative, interventional case series we included infants with a gestational age (GA) ≤32 weeks who were screened for ROP by fundus examination between 2011 and 2018. Main Outcome Measures were the presence of ROP and the need for treatment. A total of 2246 children with a mean GA of 28.9 ± 2.0 weeks and mean birth weight (BW) of 1141.1 ± 332.0 g were screened. Retinopathy of prematurity (ROP) was found in 683 infants (30.4%), of whom 145 (6.5%) had type 2 ROP and 58 (2.6%) had type 1 ROP. Mean GA of infants with type 1 ROP needing treatment was 25.9 + 1.5 weeks (range: 23.6-30) and mean BW was 774.1 ± 173.7 g (range: 540-1400). Both GA and BW had an impact on the development of type 1 and 2 ROP. None of the infants needing treatment had a GA of 31 weeks or more. None of the children needed treatment before 33 weeks of postmenstrual age (PMA) or 6 weeks of postnatal age (PNA). It seems possible to decrease the screening of premature infants to ≤31 weeks of GA and to start screening at 31 weeks PMA for infants having a GA < 26 weeks and at 6 weeks PNA for more mature children.

A Review of Very-Low-Birth-Weight Infants Admitted to the Kangaroo Mother Care Unit in Johannesburg, South Africa

BackgroundKangaroo Mother Care (KMC) is a widely implemented intervention developed as an alternative form of care in low- and middle-income countries (LMICs) for neonates. The implementation of KMC has significantly reduced morbidity and mortality in very-low-birth-weight infants (VLBWIs).AimTo describe the maternal and neonatal characteristics and clinical outcomes in VLBWIs who received KMC at a tertiary hospital.MethodsThis is a retrospective descriptive study of 981 VLBWIs admitted at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a six-year period (January 1, 2014, to December 31, 2019).ResultsThe mean gestational age of infants admitted to the unit was 29.6 weeks (standard deviation (SD): 2.4), with a mean birth weight of 1185 g (SD: 205.6). The average duration of admission in the neonatal unit was 37 days. The mean rate of weight gain was 37.6 g/kg/day (SD: 57.6). The majority of infants were breastfed (61.4%). In our study, the prevalences of the complications of prematurity were as follows: respiratory distress syndrome (RDS), 84.2%; late-onset sepsis (LOS), 26.1%; and retinopathy of prematurity (ROP), 10.6%. The mortality rate was 3.1%. Maternal comorbidities include human immunodeficiency virus (HIV) (26.4%), syphilis (2.9%) and gestational hypertension (33.7%). The antenatal clinic attendance rate was good (84.7%).ConclusionKMC is a cost-effective alternative to conventional care for VLBWIs in limited-resource countries, with evidence of increased weight gain, less rates of complications of prematurity and low overall mortality. The provision of KMC facilities is urgently required in LMICs.

Association of Maternal SARS-CoV-2 Infection in Pregnancy With Neonatal Outcomes

The outcomes of newborn infants of women testing positive for SARS-CoV-2 in pregnancy is unclear. To evaluate neonatal outcomes in relation to maternal SARS-CoV-2 test positivity in pregnancy. Nationwide, prospective cohort study based on linkage of the Swedish Pregnancy Register, the Neonatal Quality Register, and the Register for Communicable Diseases. Ninety-two percent of all live births in Sweden between March 11, 2020, and January 31, 2021, were investigated for neonatal outcomes by March 8, 2021. Infants with malformations were excluded. Infants of women who tested positive for SARS-CoV-2 were matched, directly and using propensity scores, on maternal characteristics with up to 4 comparator infants. Maternal test positivity for SARS-CoV-2 in pregnancy. In-hospital mortality; neonatal resuscitation; admission for neonatal care; respiratory, circulatory, neurologic, infectious, gastrointestinal, metabolic, and hematologic disorders and their treatments; length of hospital stay; breastfeeding; and infant test positivity for SARS-CoV-2. Of 88 159 infants (49.0% girls), 2323 (1.6%) were delivered by mothers who tested positive for SARS-CoV-2. The mean gestational age of infants of SARS-CoV-2-positive mothers was 39.2 (SD, 2.2) weeks vs 39.6 (SD, 1.8) weeks for comparator infants, and the proportions of preterm infants (gestational age <37 weeks) were 205/2323 (8.8%) among infants of SARS-CoV-2-positive mothers and 4719/85 836 (5.5%) among comparator infants. After matching on maternal characteristics, maternal SARS-CoV-2 test positivity was significantly associated with admission for neonatal care (11.7% vs 8.4%; odds ratio [OR], 1.47; 95% CI, 1.26-1.70) and with neonatal morbidities such as respiratory distress syndrome (1.2% vs 0.5%; OR, 2.40; 95% CI, 1.50-3.84), any neonatal respiratory disorder (2.8% vs 2.0%; OR, 1.42; 95% CI, 1.07-1.90), and hyperbilirubinemia (3.6% vs 2.5%; OR, 1.47; 95% CI, 1.13-1.90). Mortality (0.30% vs 0.12%; OR, 2.55; 95% CI, 0.99-6.57), breastfeeding rates at discharge (94.4% vs 95.1%; OR, 0.84; 95% CI, 0.67-1.05), and length of stay in neonatal care (median, 6 days in both groups; difference, 0 days; 95% CI, -2 to 7 days) did not differ significantly between the groups. Twenty-one infants (0.90%) of SARS-CoV-2-positive mothers tested positive for SARS-CoV-2 in the neonatal period; 12 did not have neonatal morbidity, 9 had diagnoses with unclear relation to SARS-CoV-2, and none had congenital pneumonia. In a nationwide cohort of infants in Sweden, maternal SARS-CoV-2 infection in pregnancy was significantly associated with small increases in some neonatal morbidities. Given the small numbers of events for many of the outcomes and the large number of statistical comparisons, the findings should be interpreted as exploratory.

Frequency and Prognosis of Hydrops Fetalis: A 10-Year Single-Center Experience.

Objective:The study aims to evaluate the etiological distribution and prognosis of newborn infants with hydrops fetalis (HF).Methods:All infants born in our hospital within the past 10 years and hospitalized with the diagnosis of HF were included in this retrospective descriptive study. Demographic characteristics, etiological distributions, treatment interventions, and prognosis information of the infants were recorded retrospectively. Infants with incomplete data were excluded from the study.Results:The mean gestational age of infants with HF was 33.6±3.1 weeks, and the mean birth weight was 2444±792 grams. Of the HF cases, 90.5% were born by cesarean section and the prenatal diagnosis rate was 42.9%. About 57.1% of the infants were intubated during resuscitation at birth in the delivery room. In the NICU, 81% of the cases were intubated and 71.4% received surfactant treatment. The most common HF findings were ascites (81%) and subcutaneous edema (81%). The most common interventional procedures were paracentesis (81%) and thoracentesis (52.4%). Exchange transfusion was performed in 2 cases (9.5%) due to immune HF. The mortality rate in the study group was 52.4%. Considering the etiological distribution of HF cases in the study group, three cases were diagnosed with immune HF (14.3%) and 18 cases with non-immune hydrops fetalis (NIHF) (85.7%). The underlying cause in immune HF cases was rhesus incompatibility. In cases with NIHF, idiopathic (23.8%) and cardiovascular diseases were the most common etiologies. A significant relationship was found between delivery room management and mortality. While the need for intubation in delivery room was significantly higher in non-survivors, the frequency of applying only positive pressure ventilation in the delivery room was significantly higher in survivors. While the rate of survival was 66.7% in immune HF cases, it was 44.4% in NIHF cases.Conclusion:The risk of perinatal mortality in infants with HF is high depending on the underlying cause. In this study, it was determined that HF mostly developed for non-immune reasons, prenatal diagnosis and follow-up were insufficient and the interventions performed in the delivery room were an important factor in predicting mortality in the follow-up of neonates with HF.

Risk factors for fungal infection in extremely low birthweight infants registered in the Korean neonatal network from 2013 to 2015: Male sex and hypotension.

In Korea, improvement in the survival rates of extremely low birthweight (<1,000g) infants has led to neonatal infection, especially fungal infection (FI), in the neonatal intensive care unit. The purpose of this study was to determine the risk factors for FI by analyzing the incidence of FI in extremely low birthweight infants in Korea. Data from 5,320 very low birthweight (<1,500g) infants registered from 2013 to 2015 in the Korean Neonatal Network were analyzed. The infants were divided into two groups based on the presence or absence of FI. Among infants, 1,524 with gestational ages of <27weeks and birthweights of <1,000g were included. The incidence of FI was 7.3% (111/1,524) and mortality of the infants with FI was 40% (44/111). The mean gestational age of infants with FI was 24.8±1.0weeks, which was significantly lower than those without FI. After logistic regression, being male, and having hypotension within 7days of birth were independent risk factors for FI. Moreover, hypotension was strongly associated with mortality in FI. Adverse outcomes such as severe bronchopulmonary dysplasia, bacteremia, and abnormal hearing test occurred more frequently in infants with FI than non-FI. As male sex and hypotension within 7days of birth increased the risk of developing FI in infants with gestational ages of <27weeks and birthweights of <1,000g, preventive strategies to reduce the incidence of FI are required for infants with risk factors for the development of FI.

Gestational and Previous Diabetes in Pregnancy: Perinatal Results

Objective: Evaluating the association between gestational diabetes and fetal/maternal complications such as poor obstetric outcomes. Methods: Historical cohort comprising patients from the High-Risk Service of Federal University of Juiz de Fora (UFJF,) who were diagnosed with diabetes (exposed), as well as patients from the Low-Risk Service of UFJF (non-exposed). Data generated through anamnesis, physical examination and medical conduct, as well as data of newborns such as fetal weight, ICU admission and fetal/neonatal death), were collected and stored in the Epi Info software (version 6.0); p &lt; 0.05. Results: 176 patients treated in the aforementioned services, 108 diabetic, and 68 non-diabetics, were investigated in the current study. In total, 92 (52.2%) of them were diagnosed with Gestational Diabetes Mellitus (GDM); 6 had DM type 1 (3.4%) and 10 had DM type 2 (5.6%). Therefore, 68 patients (38.6%) presented normal glucose metabolism. The mean age of the patients was 30.27 ± 6.77 years, the mean number of births was 1.06 ± 1.20. Macrosomia was diagnosed in 6.81% (n = 6) of the cases; it was associated with maternal glycemia (p &lt; 0.05). D- and F-class pregnant women, who had been previously diagnosed with diabetes, presented lower fetal weight than other pregnant women (p = 0.03). Treatment was based on diet, insulin or metformin, whenever necessary. Fasting glycemia levels decreased throughout the gestational trimesters. Eighteen (10.2%) preterm fetuses were identified; 12 were born from diabetic mothers and 6 were born from non-diabetic ones (p = 0.01; X2 = 10.51). All infants hospitalized in the neonatal ICU (n = 10) were born from diabetic mothers; their mean gestational age was 36.28 + 2.9 weeks, whereas the mean gestational age of infants who were not hospitalized in the ICU was 38.31 ± 1.5 (p = 0.005; T = 12.58). Cesarean section was the most common way of delivery adopted for diabetic pregnant women (p = 0.04). Conclusion: Based on the results, gestational diabetes (GDM) is a predisposing factor to fetal macrosomia, prematurity, and hospitalization in neonatal ICUs. Pregnant women subjected to proper glycemic control in the current study presented lower complication rates in comparison to other studies in the literature.

A Randomized Trial of Baby Triple P for Preterm Infants: Child Outcomes at 2 Years of Corrected Age

To determine the efficacy of a hospital-based intervention that transitions into existing community support, in enhancing developmental outcomes at 2years of corrected age in infants born at less than 32weeks. In total, 323 families of 384 infants born <32weeks were randomized to receive intervention or care-as-usual. The intervention teaches parents coping skills, partner support, and effective parenting strategies over 4 hospital-based and 4 home-phone sessions. At 2years of corrected age maternally reported child behavior was assessed by the Infant and Toddler Social Emotional Adjustment Scale. Observed child behavior was coded with the Revised Family Observation Schedule. Cognitive, language, and motor skills were assessed with the Bayley Scales of Infant and Toddler Development III. Mean gestational age of infants was 28.5weeks (SD=2.1), and mothers' mean age was 30.6years (SD=5.8). A total of 162 families (n=196 infants) were allocated to intervention and 161 families (n=188 infants) received care-as-usual. There was no significant adjusted difference between treatment groups on dysregulation (0.2; 95% CI -2.5 to 3.0, P=.9) externalizing (0.3; 95% CI -1.6 to 2.2, P=.8), internalizing (-1.5; 95% CI -4.3 to 1.3, P=.3), observed aversive (0.00; -0.04 to 0.04, P=.9), or nonaversive behavior (-0.01; 95% CI -0.05 to 0.03, P=.7). Intervention children scored significantly higher on cognition (3.5; 95% CI 0.2-6.8, P=.04) and motor skill (5.5; 95% CI 2.5-8.4, P<.001), and approached significance on language (3.8; 95% CI -0.3 to 7.9, P=.07). Baby Triple P for Preterm Infants increases cognitive and motor skills but does not impact behavior. The results are evidence that hospital-based interventions can improve some developmental outcomes for infants <32weeks. ACTRN12612000194864.

Macular morphology following unilateral bevacizumab injection for retinopathy of prematurity: an OCT study

This retrospective case series assessed the influence of unilateral intravitreal bevacizumab (IVB) for unilateral type 1 retinopathy of prematurity (ROP) on macular thickness and foveal development. Seven infants with unilateral type 1 ROP were treated with intravitreal bevacizumab 0.625mg/0.025ml in one eye only. To determine whether macular thickness and fovea structural development were affected by treatment, spectral domain optical coherence tomography was performed on both treated and untreated eyes. The mean gestational age of infants was 25.3±0.3weeks; the mean birth weight, 776±17.6g. Treatment was given at a mean postmenstrual age of 37.2±0.4weeks. Foveal development was normal in 3 (43%) treated versus 5 (71%) untreated eyes. The mean central foveal thickness for treated and untreated eyes was 270.1μm±19.6 and 253.0μm±27.2 respectively (P=0.15). There was small but nonsignificant difference in foveal development and thickness in eyes treated with intravitreal bevacizumab compared to fellow eyes. This study generates important data to test the hypothesis that foveal thickness is greater in unilateral type 1 ROP eyes treated with IVB compared to untreated fellow eyes.

The clinical comparative study of preterm respiratory distress syndrome and transient tachypnea of newborn

To completely compare the risk factors, respiratory therapies and complications between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) in preterm infants. Data were collected from preterm infants in Department of NICU, Peking University Third Hospital from January, 2013 to December, 2013. Components of clinical variables, including perinatal risk factors, ventilation therapies, pulmonary surfactant (PS) therapy, blood gas analysis and complications, were retrospectively analyzed. χ² test or Fisher's test or t test were used. Ninety-nine preterm infants mean gestational age was (31.9 ± 2.2) weeks and birth weight was (1 661 ± 501) g . Sixty-nine infants were diagnosed with TTN and 30 were diagnosed with RDS. There were significant differences in gestational age ((29.5 ± 2.5) vs. (32.0 ± 3.2) weeks, t = 6.046, P = 0.002), birth weight ((1 115 ± 415) vs. (1 660 ± 531) g, t = 5.916, P = 0.001). Nine cases in the RDS group had Apgar score ≤ 7 while four cases in the TTN group had Apgar score ≤ 7 (P = 0.001). Fourteen cases in RDS group were born through C-section while 55 cases of TTN group were born through C-section (P = 0.025). During 0-2 hours after birth, pH (7.25 ± 0.09 vs. 7.30 ± 0.01, t = -2.144, P = 0.046) was significantly lower in the RDS group. PaO₂((55 ± 20) vs. (41 ± 2) mmHg, 1 mmHg = 0.133 kPa, t = 2.963, P = 0.001) and oxigination index (OI) ((149 ± 58) vs.(100 ± 9) mmHg, t = 3.379, P = 0.003) were significantly lower in the TTN group. In the RDS group, all cases received PS therapy. Twenty-five cases received mechanical ventilation and five cases received noninvasive ventilation. In the TTN group, 12 cases received PS therapy. Forty-four cases received noninvasive ventilation and 25 cases received oxygen inhalation. The cases developing complications, including ventilator associated pneumonia (14(46.7%) vs.4(5.8%), P = 0.038), patent ductus arteriosus (19(63.3%) vs. 9(13.0%), P = 0.025), intraventricular hemorrhage (9(30.0%) vs. 2(2.9%), P = 0.041), bronchopulmonary dysplasia (12(40.0%) vs. 5(7.2%), P = 0.019), were significantly more in the RDS group. RDS and TTN are common causes leading to early dyspnea in preterm infants. Preterm infants with RDS are characterized by younger gestational age, lower birth weight, severer acidosis and more complications. Preterm infants with TTN show lower hypoxemia and OI.

DİYABETİK ANNE BEBEKLERİNİN YENİDOĞAN DÖNEMİ SORUNLARI

Objectives: Diabetes is a disease that effects fetal development during pregnancy and leads metabolic disorders in newborns. In this study, we aimed to evaluate the problems of infants of diabetic mothers and to determine risk factors of mothers during pregnancy. Material and Methods: The morbidity rates of 31 infants of diabetic mothers who were born and followed in neonatal intensive unit between January 2013 and December 2013 at Gaziosmanpasa University and demographic properties of mothers were retrospectively evaluated. Results: A total of 31 infants were included. The incidence of insulin dependent diabetes mellitus was %22,6 and the incidence of gestational diabetes was 77,4%. Mothers’ mean age was 32,6±7,9 years and HbA1c level was 5,4±1 (4,2-10,2). The mean gestational age of infants was 37,5±1,5 weeks and the mean birth weight of infants was 3322,5± 695,8 g. Macrosomia was present in 32.2% of infants. Hypoglycemia was present in 9,7% of infants, hypocalcemia was seen 3.2%, polycytemia was seen 6.5%, anemia was seen 6.5%, thrombocytopenia was seen 9.2%, hyperbilirubinemia was seen 41.9%, respiratory distress syndrome was seen 12.9%, congenital anomaly was seen 3.7% of all infants. There was no correlation between HbA1c levels of mothers and hypoglycemia, hypocalcemia, anemia and respiratory distress syndrome. Conclusion: Many complications may be prevented with appropriate management, obstetric care and neonatal management in infants of diabetic mother. It is possible to reduce morbidities with the identification of gestational diabetes and metabolic control of hyperglycemia, the determination of risk factors, the close contact between the diabetic mother and her infant in the first hours of delivery and the close follow-up of infants of diabetic mothers with rooming-in who do not need neonatal intensive care unit care.

A national survey of admission practices for late preterm infants in England.

BackgroundInfants born at 34+0 to 36+6 weeks gestation are defined as ‘late preterm’ infants. It is not clear whether these babies can be managed on the postnatal ward (PNW) or routinely need to be admitted to the neonatal unit after birth.AimTo conduct a national survey of admission practice for late preterm and low birth weight infants directly to the PNW after birth in England.MethodsAll neonatal units were identified from the Standardised Electronic Neonatal Database (SEND). Individual units were contacted and data collected on their admission practice.ResultsAll 180 neonatal units in England responded. 49, 84 and 47 Units were Special Care Units (SCUs), Local Neonatal Units (LNUs) and Neonatal Intensive Care Units (NICUs) respectively. 161 units (89%) had written guidelines in relation to direct PNW admission for late preterm infants.The mean gestational age of infants admitted directly to the PNW was significantly lower in LNUs compared to SCUs and NICUs compared to LNUs. Mean birth weight limit for direct PNW admission was significantly lower in NICUs compared to SCUs.72 units had PNW nursery nurses. There was no significant difference in gestational age or birth weight limit for direct PNW admission in the presence of PNW nursery nurses.ConclusionsAdmission practices of late preterm infants directly to the PNW varies according to designation of neonatal unit in England. Further studies are needed to establish the factors influencing these differences.

Pulmonary hypertension in extremely low birth weight infants: characteristics and outcomes

To determine the characteristics and outcomes of pulmonary arterial hypertension (PAH) in extremely low birth weight (ELBW) infants. A retrospective case-control study of all ELBW infants admitted to a level III neonatal intensive care unit (NICU) between January 1, 2003 and December 31, 2010. During the study period, 450 ELBW infants were admitted. 6.4% (29/450) were diagnosed with PAH and were matched to 26 controls. The mean gestational age of infants with PAH and their controls were similar [24.5 ± 1.3 vs. 24.9 ± 1.8 weeks (P=0.26)]; however the cases were smaller at birth than were controls [640.7 ± 119.5 vs. 727.0 ± 184.5 g (P=0.04)]. The diagnosis of PAH was made at a mean postnatal age of 131.8 ± 53.7 days. Infants with PAH had a higher rate of intrauterine exposure to illicit maternal drug use [12/29 (41%) vs. 1/25 (4%); P=0.001], a longer duration of initial mechanical ventilation [74.9 ± 28.3 vs. 59.1 ± 27.8 days; P=0.04)], a higher incidence of severe BPD [23/29 (79%) vs. 13/26 (50%); P=0.02], and a greater NICU mortality rate [12/29 (41%) vs. 4/26 (15%); P=0.04]. PAH in ELBW infants is associated with maternal illicit drug use in pregnancy, longer exposure to mechanical ventilation, severe bronchopulmonary dysplasia and a significant increase in early mortality.

Normal values of cerebral blood flow velocities in neonates

There was used color Doppler ultrasonography (cD-USI), allowing simultaneous examination of parenchymal and vascular cerebral structures. The evaluation of blood flow velocities in cerebral arteries is important in the assessment of cerebral circulation in hypoxic-ischaemic and haemorrhagic brain damage in neonates. The aim of this study was to estimate normal values of cerebral blood flow velocities (CBFV) and Doppler indices--pulsatility index (PI) and resistance index (RI)--in the anterior cerebral artery (ACA) during the first days of life in infants. CBFV, PI and RI were obtained during the first week of life with cD-US in 70 infants divided in four groups of gestational age (GA): < or =28 gestational weeks (GW); 29-32 GW; 33-36 GW; and > or =37 GW. Infants with congenital malformations, severe perinatal asphyxia, cerebral haemorrhagic lesion, DAP or severe hypotension were excluded. The mean GA of infants was 34.5 +/- 5.5 GW (range 26-40 GW) and the mean birth weight (BW) was 2540 +/- 950 g (range 750-4000 g). In the 1st group of 10 infants, < or =28 GW, the mean BW was 950 +/- 110 g and values of RI were 0.59 +/- 0.10 and PI 1.06 +/- 0.080. In the 2nd group of 20 infants, 29-32 GW, the mean BW was 1350 +/- 290 g and values of RI were 0.60 +/- 0.10 and PI 1.10 +/- 0.15. In the 3rd group of 20 infants, 33-36 GW, the mean BW was 1950 +/- 750 g and values of RI were 0.63 +/- 0.08 and PI 1.15 +/- 0.30. In the 4th group of 20 infants, > or =37 GW, the mean BW was 3540 +/- 950 g and values of RI were 0.65 +/- 0.05 and PI 1.18 +/- 0.35. Values of CBFV progressively increase with GA and BW due to progressive increase of cardiac output, blood pressure and closing of ductus arteriosus. Values of RI and PI gradually increase with GA and BW as a result of progressive maturation and opening of vascular cerebral bed with a reduction of the cerebrovascular resistance.

PREGNANCY DURING CHRONIC HEMODIALYSIS: A SINGLE DIALYSIS-UNIT EXPERIENCE WITH FIVE CASES

Background: Pregnancy is uncommon in women with end-stage renal disease (ESRD) requiring chronic dialysis. An increasing number of successful pregnancies in women in hemodialytic treatment have been recently reported but few institutions experienced more than one or two cases of pregnancy. Methods: Between 1988–1998 five pregnancies in patients receiving hemodialysis were observed in our center. Medical records of these patients were reviewed. Results: At the conception the mean age was 27 years. One patient started dialysis after conception. All patients received bicarbonate dialysis. Three patients were dialyzed six times per week, the other two patients three-four times per week. The dry weight was increased progressively; on average of 1.2 ± 0.5 kg in the first trimester and of 0.5 kg per week since the second trimester. The predialysis BUN was maintained between 50–100 mg/dL (17.85–35,70 mmol/L) during the pregnancy. Four patients were treated with erythropoietin to maintain hematocrit between 30–35%. Erythropoietin related—complications were not observed. Polyhydramnios was observed in all cases. All deliveries occurred before term. The mean gestational age of infants was 28.6 ± 4 weeks. Four out of five pregnancies resulted in liveborn infants. Two infants had an Apgar score of zero. All neonates were of low birth weight (1431 ± 738 g) with percentile of birth weight in the normal range. No one was small for date. Conclusion: A successful pregnancy is possible in women on chronic dialysis. Prematurity occurs frequently as well as low weight birth leading to increased perinatal morbidity and mortality.

Can circumcision prevent recurrent urinary tract infections in hospitalized infants?

Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia--a large academic medical center with a tertiary Level III NICU--to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants. The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: A1 <37 weeks with a single UTI and A2 <37 weeks with more than one UTI. In groups A1 and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram-negative organisms and Staphylococcus species. Mean gestational age (GA) in groups A1 and A2 were similar (29 +/- 2 weeks, and 29 +/- 4 weeks); however, mean GA of infants with Candida UTI was 27 +/- 2 weeks, and for bacterial UTI, 30 +/- 3 weeks (p<0.01). None of the premature infants in the study had a recurrent UTI once a circumcision was performed. Premature uncircumcised males had an increased risk for UTI (Odds Ratio=11.1, 95% CI, 3.3-28.9, p<0.001). Circumcision appears beneficial in reducing the risk for recurrent UTI in these infants.

Pica Practices of Pregnant Women are Associated with Lower Maternal Hemoglobin Level at Delivery

Objective To determine the prevalence of pica during pregnancy, maternal hemoglobin levels at delivery, and the association of pica with 2 adverse pregnancy outcomes: low birth weight and preterm birth. Design A retrospective cohort study was conducted using eligible subjects (n=281) from a cross-sectional survey (n=366). Subjects/setting Mothers aged 16 to 30 years with infants younger than 1 year of age who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interviewed at 4 WIC clinics in Houston and Prairie View, Tex. Medical records from 31 hospitals were abstracted. Main outcome measures Maternal hemoglobin levels at delivery, mean birth weight, and mean gestational age were compared for women who reported pica and women who did not. Statistical analyses χ 2 Tests, orthogonal t tests, analysis of variance, and regression analysis were used to test the relationships among study variables. Results Pica prevalence categorized by substance was as follows: ice, 53.7%; ice and freezer frost, 14.6%; other substances such as baking soda, baking powder, cornstarch, laundry starch, baby powder, clay, or dirt, 8.2%; and no pica, 23.5%. Women in all 3 pica groups had lower hemoglobin levels (mean±standard deviation, 114±12 g/L, 110±13 g/L, and 113±12 g/L, respectively) at delivery than women who did not report pica (118±11 g/L) ( P<.01 for all pica groups vs no pica). There were no differences in mean birth weight or mean gestational age of infants born to women from the 3 pica groups and the No Pica group. Applications The findings suggest that pica practices are associated with significantly lower maternal hemoglobin levels at delivery but are not associated with pregnancy outcomes. Dietitians should ask pregnant women with anemia about pica and should counsel women who report pica regarding the health risks associated with it. J Am Diet Assoc. 1998; 98:293-296.