Minutes Of Life Research Articles

Criteria for predicting early neonatal adaptation of newborns in women who had COVID-19 infection during pregnancy

Objective of the study: to investigate the possibility of predicting the early neonatal adaptation of newborns based on clinical and instrumental data that assesses the status of pregnant woman with COVID-19 infection and the fetus.Materials and methods. The participants of the study were 58 pregnant women with a diagnosis of COVID-19 (group A) and 40 women with a physiological course of pregnancy (group B), as well as their newborns. In addition to the analysis of standard examinations results, perinatal consequences for the mother and the fetus/newborn, the association between the saturation level (SрO2) in the pregnant woman, the short-term heart rate variability (STV) according to cardiotocography data of the fetus and the assessment of the newborn according to the Apgar scale was studied.Results. The SрO2 level was 95% or more in 87.9% of infected pregnant women, in 12.06% it was 90–94% (critical for pregnant women). 10.3% of pregnant women needed intensive therapy and respiratory support, 69% of women had inflammatory changes in the chest organs (pneumonia, etc.). Cardiotocography showed a significant difference in the type of basal heart rate between the groups (χ2 = 14.9055, p = 0,00058) and STV (7.78 ± 2.56 vs 8.39 ± 2.03 ms) in groups A and B, respectively (U = 687, p = 0.00022). The Apgar scale index in groups A and B was 6.48 ± 2.39 and 8.05 ± 0.54 points, respectively (χ2 = 21.933, df = 4). 20% of newborns in group B had 7 points in the first minute, 80% had 8 points or more. 51.85% of newborns in group A had scored 7 points or less (F = 0.00246, p < 0.05, odds ratio 4.308, 95% CI 1.681 – 11.037). 10.34% of newborns required intensive care, 5.17% – administration of surfactant, 1.72% – artificial lung ventilation. Regression analysis showed that the Apgar scale indicator at the first minute of life in newborns in group A depends on the SрO2 level of the pregnant woman (Y = 0.89X1 – 79.19), as well as on the STV (Y = 0.89X1 + 0.028X2 – 79.53), where Y is the score on the Apgar scale, X1 is the SрO2 in a pregnant woman, X2 is the STV.Conclusions. Assessment of the hypoxemia degree in pregnant women with COVID-19 infection and the cardiotocographic assessment of the fetus state require special attention: there is a direct association between these indicators and the assessment of the newborn according to the Apgar scale, which allows predicting the course of the period of early neonatal adaptation. It is recommended that these newborns be classified as a risk group with a violation of the adaptation period and possible long-term consequences.

Early Biomarkers in the Prediction of Later Functional Impairment in Preterm Children With Cerebral Palsy

BackgroundTo identify early biomarkers that could predict later functional capabilities in preterm children with later cerebral palsy (CP). MethodsData from 968 preterm children with later CP were extracted from the Canadian Cerebral Palsy Registry. One hundred eighty-two infants were born before 27 weeks of gestation, 461 infants were born between 27 and 33 weeks, and 325 infants were born between 34 and 37 weeks. Univariate and chi-square analyses were conducted to measure the association between early objective biomarkers and later mobility status defined as Gross Motor Function Classification System (GMFCS) levels IV and V as well as tube feeding dependence. ResultsUnivariate analysis suggested no significant association between GMFCS levels IV and V or impaired feeding status and bilateral white matter injury on magnetic resonance imaging, high-grade intraventricular hemorrhage on head ultrasound, chorioamnionitis, a birth weight of 1000 to 1500 g or <1000 g, as well as an Apgar score of ≤5 at five minutes of life. Similar results were found for gestational age <28 weeks at birth. Only a significant association between GMFCS levels IV and V and a cord or first hour of life pH of ≤7 was reported (mobility status: odds ratio [OR] 1.95, 95% confidence interval [CI] 1.09 to 3.57) and feeding status: OR 2.23, CI 0.97 to 4.65)]. ConclusionsPrediction of functional outcomes based on specific early biomarkers appears hard to obtain in children with CP born preterm in contrast to those born at term. The complications and causal pathways inherent to prematurity may contribute to making prognostication less determinant.

Non-Invasive High Frequency Oscillatory Ventilation versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short binasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. Any effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma. Objective To investigate the effectiveness of nasal high frequency oscillatory ventilation in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome. Methods This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout six months. Results In the current study, there was a significant decrease in FiO2 needs in nHFOV group vs. nCPAP group, the median (IQR) (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), but non significant difference in RDS according to total Silverman score in nHFOV group vs. nCPAP group with median (IQR) total Silverman score (4 (4 to 5)vs. 4 (3 to 6) respectively, P-value= 0.474). Conclusion Using nHFOV is better than nCPAP in decreasing the need of FiO2.

Prevalence of bradycardia in 4876 newborns in the first minute after birth and association with positive pressure ventilation: a population-based cross-sectional study

ObjectiveTo determine the prevalence of bradycardia in the first minute after birth and association with positive pressure ventilation (PPV).MethodA population-based cross-sectional study was conducted from June 2019 to December 2021...

Seizures in Asphyxiated Term Newborns Based on Admission Thompson Score at the Women and Newborn Hospital, University Teaching Hospitals in Lusaka, Zambia.

Purpose: The main purpose of the study was to investigate seizures in asphyxiated term neonates based on the admission Thompson score at the University of Zambia, Women and New-born Neonatal Intensive Care Unit. Methodology: A cross-sectional descriptive study design was used to conduct the study between (May 2022 to April 2023) in the Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital for Women and Newborns in Lusaka Zambia. Stratified sampling was used to collect 217 files of neonates born at the tertiary facility as well as those referred from other centres with Apgar scores of ≤ 7 at one and five minutes of life. A structured questionnaire was used to collect data from medical records, the Thompson score (TS) was assessed on admission and details of neonatal seizures were analyzed using chi-square, fisher’s exact test and multivariable logistic regression. Findings: On admission, TS assessment was conducted on all 217 neonates of which 169 (77.9 %) neonates were classified with mild HIE,45 (20.9 %) moderate and 3(1.4 %) with severe HIE. Most neonates (77.4%) presented with seizures on admission. Results of the chi-square and fisher's exact tests showed that Thompson's score on admission was significantly associated with seizure occurrence (p=0.001). On multivariable binary logistic regression neonates with moderate HIE had over 10 times more odds of seizure occurrence compared to neonates with a mild HIE score (aOR=10.6, CI=2.32, 48.1, p=0.002). A unique contribution to theory, practice, and policy: The study concluded that seizures were present in all categories of HIE, the majority of who were classified with moderate HIE based on the Thompson score. Therefore, improving the quality of intrapartum care at the Women and Newborn Hospital can significantly reduce the occurrence of asphyxia and its complication.

Cardiac Troponin I as an Early Prognostic Indicator in Asphyxiated Neonates

Background Myocardial damage, estimated to occur in 28%–73% of asphyxiated neonates, 1 is a major cause of mortality in perinatal asphyxia, and survivors can show significant myocardial morbidity as well. 2 Study Setting and Design This study is a hospital-based prospective cohort study, done at the pediatrics department of a tertiary care hospital in northern India, from December 2020 to June 2022. Materials and Methods 40 asphyxiated neonates with an APGAR score of &lt;7 at 1 minute of life, as per the WHO–Neonatal Perinatal Database, were included in the study. They were graded as hypoxic ischemic encephalopathy (HIE) I (mild), II (moderate), and III (severe) based on Sarnat and Sarnat staging. The blood samples at 0 and 6 hours of life were taken for studying successive changes in the values of high-sensitivity cardiac troponin I (hs-cTnI) and creatinine phospho-kinase-myocardium-bound (CPK-MB). These were compared with various parameters such as electrocardiograph (ECG) findings, 2D-ECHO abnormalities, HIE severity, and outcome. Results Among the two biomarkers that were assessed, hs-cTnI had the highest diagnostic value for detecting myocardial injury and was corelated with the severity of HIE and higher chances of death. Conclusion The troponin I levels, in contrast to CPK-MB levels, were significantly associated with the outcome of the patient, implying that asphyxiated babies with elevated troponin I levels have a poorer prognosis and a higher mortality rate.

Prenatal Stress as a Risk Factor for Maternal–Foetal Morbidity: A Longitudinal Study

Pregnancy is one of the most complex periods in a woman’s life, not only because of the biological changes involved but also because of the psychological aspects. Stress during pregnancy refers to the concerns and distress that arise during pregnancy and that can be assessed by means of psychological and physiological scales. The aim of this study was to analyse prenatal stress and to evaluate its consequences on the health of both the mother and the foetus. A descriptive longitudinal study was carried out on a sample of 398 pregnant women being followed up during their entire pregnancy, who gave birth at the Punta de Europa University Hospital in Algeciras (Spain) between September 2021 and August 2023. The Prenatal Distress Questionnaire (PDQ) was used, as well as serum cortisol levels in each trimester of pregnancy and birth experience using the Childbirth Experience Questionnaire in its validated Spanish version, CEQ-E. Demographic and obstetric variables were included. One of the main findings was that experiencing more stress in late pregnancy had a negative impact on obstetric outcomes. Women who had higher levels of prenatal distress had higher blood cortisol levels and increased risk of having a caesarean section at delivery. A significant negative correlation was also found between stress and Apgar test values in the first minute of life. It is concluded that interventions promoted by the health system that provide comprehensive prenatal care contribute to decreased stress as perceived by these pregnant women, thus reducing the risk of maternal and foetal morbidity.

Меконий (первородный кал): происхождение, состав, диагностический потенциал

The literature review substantiates the necessity of diagnosing and forecasting the outcomes of adverse perinatal exposures. A critical analysis of existing approaches was conducted. A conjecture is made about the diagnostic potential of the first stool, which is a unique source for gathering information about intrauterine development of a fetus. Given that meconium can be non-invasively collected from the first minutes of life, its study is particularly valuable for identifying perinatal risks in ill and preterm newborns. The authors justify its diagnostic value of meconium analysis for determining risk groups for intrauterine infections, poisoning with high-density metals, and even genetic and surgical pathologies of the gastrointestinal tract. All this promotes the refinement of diagnostic and treatment algorithms for various perinatal period diseases.

Prevalence of Perinatal Asphyxia Using Apgar Scores and Cord Blood pH and the Relationship between the Two Methods: A Study of FMC Umuahia.

Perinatal asphyxia contributes significantly to neonatal morbidity and mortality. It occurs worldwide, and the Apgar score is the most widely used method of diagnosis. Recently, umbilical cord arterial pH has been reported as the most objective way to assess fetal acidosis at birth as it predicts the adverse outcome of perinatal asphyxia. It is imperative to establish the concordance between these two diagnostic methods to reinforce the practicality of the Apgar score as the preferred diagnostic tool for perinatal asphyxia in developing nations, such as Nigeria. To determine the prevalence of perinatal asphyxia by using the Apgar score and arterial cord blood pH and the relationships between these methods at the Federal Medical Center (FMC), Umuahia. This cross-sectional study enrolled 245-term newborns. Perinatal asphyxia was diagnosed using both Apgar scoring and arterial cord blood pH measurements. Data obtained were analyzed using SPSS version 20 and a P value < 0.05 was considered significant. Perinatal asphyxia was reported in 33.1% and 31.4% by using the Apgar score and arterial cord blood pH, respectively. There was a moderate agreement between the two methods for diagnosing perinatal asphyxia (κ = 0.44), and no statistically significant difference was observed in the prevalence of perinatal asphyxia between these methods (McNemar's χ2 = 0.27, P = 0.699). Furthermore, a strong positive correlation was observed between the Apgar score at 1 and 5 minutes of life and arterial cord blood pH (rs = 0.87, P ≤ 0.001 and rs = 0.80, P ≤ 0.001 respectively). The prevalence of perinatal asphyxia by the two methods was high, and there was no significant difference between both methods of assessing perinatal asphyxia. Thus, the diagnosis of perinatal asphyxia can effectively be made using either the Apgar score or arterial cord blood pH, affirming the practicality and reliability of the Apgar score in resource-limited healthcare settings.

Сравнительная характеристика перинатальных исходов у женщин с семейной средиземноморской лихорадкой и в контроле

The aim of the study is to compare the reproductive outcome of women with familial Mediterranean fever (FMF) and a control sample. An observational cohort study compares the outcomes in 251 women with FMF to 312 without FMF. A study of perinatal outcomes showed that weight, height and neonatal status assessment at birth were comparable in both groups. The average body weight of the newborn was 2800±500g in the FMF group and 2770±580g in the control group (p≤0,05), the average height was 48±2,5cm and 49±3,0cm (p≤0,001), respectively. Apgar score in the first and fifth minutes of life: 7,6±0,6 and 7,7±0,7 points, (p≤0,05) and 8,4±0,2 and 8,7±0,5 points, (p≤0,01) respectively. Fetal distress was detected in 2,0% in group 1 and in 2,5% in group 2; CDF – 1,6% and 2,6, PS – 31,5% versus 45,5% (p≤0,001); postpartum hemorrhage – 0% and 0.8%; maternal mortality – 0% and 0%, respectively. Perinatal outcomes were comparable in patients with Familial Mediterranean fever and control group.

Assessing the Effectiveness of the Combined Apgar Scoring System in Predicting the Short-Term Outcomes of Newborns

Background: Many clinicians have used the Apgar scoring system to evaluate newborn babies at the first minutes of birth. Expanded and combined Apgar have been introduced due to the interventions done for babies in the first minutes of life. This study evaluates the predicting values of combined Apgar scores in short-term neonatal outcomes. Methods: A diagnostic test was conducted on alive preterm and term babies without major anomalies between October 2021 and August 2022. Infants with congenital heart disease, congenital metabolic disorders, and those transferred to another hospital were excluded. Demographic data, feeding volume, conventional, expanded, and combined Apgar scores were assessed at 5 minutes of birth and recorded. The area under the receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of the combined Apgar score to predict short-term outcomes (need to admission, duration of hospitalization, and oral feeding progression). Results: Of 599 babies (339 boys and 260 girls) with a mean gestational age of 35.3 ± 3.8 weeks (25 - 42 weeks), 280 (46.7%) babies were admitted. As the average Apgar score decreased, progression to full oral feeding was associated with longer delay. The area under the ROC curve for the Combined Apgar score was 80% and 55% in correlation with the need for admission and duration of hospitalization, respectively. Conclusions: This study showed that the 5th-minute combined Apgar score is a good predictor of the need for admission and oral feeding progression but does not seem suitable for predicting the duration of hospitalization.

Implantable automatic defibrillators and their deactivation, a necessary conversation. Literature review

The use of implantable cardioverter-defibrillators (ICDs) has been on the rise. Patients using ICDs inevitably transit towards the end of life at some point, including some who develop terminal illnesses. In this context, it is relevant to discuss and evaluate the deactivation of these devices with the aim of addressing patients' comfort and avoiding shocks during the end-of-life phase. There are multiple communicational and operational barriers when considering ICDs deactivation. Firstly, many patients have not discussed this issue with their physicians despite international guidelines recommending such discussions before device installation. Secondly, there is a significant lack of knowledge among patients, family members, and even doctors about the benefits of ICDs, as well as the deactivation process and ethics considerations, which leads them to believe that immediate death will occur, considering it as euthanasia or assisted suicide. Finally, the management of hospice patients or end-of-life ICDs users is poorly standardized, with low rates of deactivation, resulting in shocks in the last minutes of life, which can cause marked distress to patients and families. It is necessary to address these barriers and discuss these issues with patients to inform and educate them about the functioning of their devices, with the ultimate goal of enabling informed and shared decision-making for patient well-being.

Long-term trends in the incidence and management of shoulder dystocia in a tertiary obstetric unit in Hong Kong.

Because there have been changes in the management of macrosomic pregnancies and shoulder dystocia in the past decade, this study was conducted to compare the incidences of shoulder dystocia and perinatal outcomes between the periods of 2000-2009 and 2010-2019. This retrospective study was conducted in a tertiary obstetric unit. All cases of shoulder dystocia were identified using the hospital's electronic database. The incidences, maternal and fetal characteristics, obstetric management methods, and perinatal outcomes were compared between the two study periods. The overall incidence of shoulder dystocia decreased from 0.23% (134/58 326) in 2000-2009 to 0.16% (108/65 683) in 2010-2019 (P=0.009), mainly because of the overall decline in the proportion of babies with macrosomia (from 3.3% to 2.3%; P<0.001). The improved success rates of the McRoberts' manoeuvre (from 31.3% to 47.2%; P=0.012) and posterior arm extraction (from 52.9% to 92.3%; P=0.042) allowed a greater proportion of affected babies to be delivered within 2 minutes (from 59.0% to 79.6%; P=0.003). These changes led to a significant reduction in the proportion of fetuses with low Apgar scores: <5 at 1 minute of life (from 13.4% to 5.6%; P=0.042) and <7 at 5 minutes of life (from 11.9% to 4.6%; P=0.045). More proactive management of macrosomic pregnancies and enhanced training in the acute management of shoulder dystocia led to significant improvements in shoulder dystocia incidence and perinatal outcomes from 2000-2009 to 2010-2019.

Retrospective evaluation of labor induction with scar uterus at the university hospital of Rennes

ObjectiveThe aim of the study was a retrospective evaluation of labor induction in women with one previous cesarean section. The primary outcome was the mode of delivery. We also studied the severe maternal and neonatal morbidity and identify some prediction factors of vaginal delivery after labor induction after one previous cesarean section. Study designThis was a retrospective observational monocentric study performed over the period from January 1st, 2016 to April 30th, 2020 at the university hospital of Rennes. Were included women with scar uterus because of one previous cesarean section with a viable singleton fetus in cephalic presentation and an induction of labor for medical reason, at term. Multivariate logistic regression analysis was used to analyze prediction of vaginal delivery after labor induction after one previous cesarean section. We also studied maternal (included uterine rupture, loss of blood, obstetrical injury of anus sphincter) and neonatal (APGAR score, arterial umbilical pH after 1 minute of life and eventual admission to neonatal unit) morbidity. We used a stepwise multivariate logistic regression model to select variables for multivariate analysis. The model with the lowest Akaike Index Criteria was chosen. ResultsThe study enrolled 353 women with scar uterus: 121 women were induced by balloon catheter, 57 by osmotic cervical dilatators, 91 by oxytocin alone, 84 by amniotomy. Vaginal delivery rate was 47,9%. There was 45% of vaginal delivery in the group with Bishop < 6 before induction of labor versus 62% in the group with Bishop ≥ 6. There was no statistically significative difference in neonatal and maternal severe morbidities between vaginal delivery and cesarean section: 4,5% of severe maternal morbidities (n = 16). Among their, we highlighted 7 uterine ruptures (3,8%). We observed also 3% of postpartum severe hemorrhage in vaginal delivery group (n = 5) against 1,6% in cesarian section group (n = 3) with no statistical significant difference (p = 0,632). Regarding to the obstetric perineal tears and lacerations we noticed 1,2% of OASIS 3 (n = 2) and 0,6% of OASIS 4 (n = 1). Severe neonatal morbidities were comparable by mode of delivery without significant difference: APGAR score at 5 min was similar (p = 1), as well as arterial umbilical pH after 1 min. (p = 0.719) and admissions to a neonatal unit (p = 1). Two variables were statistically associated with vaginal delivery after labor induction in women with scar uterus: Bishop score ≥ 6 (OR = 0,44; 95%CI: 0,25–0,81) and/or previous vaginal delivery after cesarean section (OR = 0,17; 95%CI: 0,08–0,35). ConclusionWith 47,9% of vaginal delivery after labor induction in women with scar uterus, only 3.8% (n = 7/353) of uterine ruptures, less than 1% APGAR < 7 at 5 min (n = 3/353), induction on scar uterus should be consider in obstetrical practice. Bishop score ≥ 6 and/or previous vaginal delivery after cesarean section are associated to vaginal delivery after labor induction.

Contributing factors of birth asphyxia in Thailand: a case–control study

BackgroundBirth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia.MethodsA case–control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software.ResultsThe odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal–fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia.ConclusionBirth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

Quality improvement initiative to impact Golden Hour timeliness using a dedicated delivery team.

Golden Hour (GH) care impacts immediate and long-term outcomes for premature infants. We hypothesized that creation of a dedicated delivery team, the Stork Team, would improve delivery of GH care. A GH quality improvement initiative was created for infants born at <32 weeks and implemented in July 2018. Data were collected from GH checklists and the electronic medical record. Following Stork Team implementation there was special cause variation noted in the minute of life (MOL) for administration of dextrose containing fluids and antibiotics. Dextrose containing fluid time improved from 111 to 67 MOL, with an increase in the percentage of patients receiving fluids by 60 MOL. Antibiotic administration improved from 180 to 82.5 MOL. GH checklist completion increased from 77% to 98% and time to isolette closure improved from 88 to 62 MOL. Implementation of the Stork Team was associated with improvements in timeliness of GH care.

Increase in Newborns Ventilated Within the First Minute of Life and Reduced Mortality After Clinical Data-Guided Simulation Training.

Birth asphyxia-related deaths is a major global concern. Rapid initiation of ventilation within the "Golden Minute" is important for intact survival but reported to be challenging, especially in low-/middle-income countries. Helping Babies Breathe (HBB) is a simulation-based training program for newborn resuscitation. The aim of this HBB quality improvement (QI) intervention was to decrease time from birth to ventilation and document potential changes in perinatal outcomes. Prospective observational QI study in a rural Tanzanian hospital, October 1, 2017, to August 31, 2021, first-year baseline, second-year QI/simulation intervention, and 2-year postintervention. Trained research assistants observed wide-ranging information from all births (N = 12,938). The intervention included monthly targeted HBB simulation training addressing documented gaps in clinical care, clinical debriefings, and feedback meetings. During the QI/simulation intervention, 68.5% nonbreathing newborns were ventilated within 60 seconds after birth compared with 15.8% during baseline and 42.2% and 28.9% during the 2 postintervention years ( P < 0.001). Time to first ventilation decreased from median 101 (quartiles 72-150) to 55 (45-67) seconds ( P < 0.001), before increasing to 67 (49-97) and 85 (57-133) seconds after intervention. More nonbreathing newborns were ventilated in the intervention period (12.9%) compared with baseline (8.5%) and the postintervention years (10.6% and 9.4%) ( P < 0.001). Assumed fresh stillborns decreased significantly from baseline to intervention (3.2%-0.7%) ( P = 0.013). This QI study demonstrates an increase in nonbreathing newborns being ventilated within the Golden Minute and a significant reduction in fresh stillborns after introduction of an HBB QI/simulation intervention. Improvements are partially reversed after intervention, highlighting the need for continuous simulation-based training and research into QI efforts essential for sustainable changes.

Прогнозування ризику розвитку бронхолегеневої дисплазії в передчасно народжених дітей

Bronchopulmonary dysplasia (BPD) is one of the most frequent outcomes of prematurity. Relatively late diagnosis and development of formidable complications that can affect the quality of life in adulthood, determine the need for early BPD prognosis for the timely appointment of effective therapy. Purpose - identification of informatively significant clinical and anamnestic risk factors of BPD based on retrospective analysis and mathematical model creation for the prediction of chronic respiratory disease risk development in prematurely born children. Materials and methods. A retrospective analysis of the medical histories of 280 prematurely born children who were treated in neonatal units was conducted. With the help of sequential Wald analysis, 53 clinical and anamnestic indicators were analyzed, for each of them the relative risk (RR) and diagnostic coefficient (DC) were calculated. Results. Significant, prognostically unfavorable factors for BPD development are gestational age ≤28 weeks (RR=20.30); birthweight ≤1500 g (RR=3.08); duration of non-invasive combined respiratory support over 18 days (RR=3.74); Apgar score 1-3 at the first minute (RR=4.69) and 4-6 at the fifth minute of life (RR=4.19); newborn anemia (RR=3.12); invasive artificial lung ventilation for more than 13 days (RR=5.12). The probability of BPD increases substantially with the presence of retinopathy of the II and III degrees (RR=16.4 and RR=10.15, respectively). Interestingly, breastfeeding markedly prevented BPD development (RR=0.29). Furthermore, a mathematical model is represented to determine BLD development prediction and to diagnose this disease. Conclusions. High validity indicators and ease of use of the mathematical model for the BPD development prediction in prematurely born children make it possible to recommend it in the practice of neonatologists and pediatricians. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

The effectiveness of sitting position during second stage of labor among primiparae on maternal and neonatal outcomes

Background: There is longstanding debate concerning the most advantageous labor positions. Lithotomy position is the most common position used in tertiary settings, but the sitting position has been recommended more recently. Labor position in the second stage of labor affects maternal and neonatal outcomes. Therefore, the current study aims to compare the effectiveness of lithotomy and sitting positions during the second stage of labor on maternal and neonatal outcomes using a quasi-experimental design with purposeful sampling.Methods: Sample size: 120 low-risk primiparae, divided equally in sitting and lithotomy positions. Setting: Labor and delivery unit at King Abdulaziz University Hospital (KAUH), Jeddah. Sampling: Data collected over six months, from January to June 2020. Tool: A structured, five-part questionnaire. Data analysis: Chi-square test with post hoc Bonferroni test to examine significant differences between the two groups, using SPSS version 24.0.Results: Significant positive effects of sitting position are observed in reduced episiotomy rate and newborn transfer to the intensive care unit, shortened second stage of labor, improved mode of delivery, newborn arterial cord PH, Apgar score at one and five minutes of life, and maternal satisfaction (p-value &lt; .05).Conclusions: The sitting position during the second stage of labor has more positive effects than the lithotomy position for maternal and neonatal outcomes. Recommendation: Women should have the right to be educated about the benefits of the sitting position during the second stage of labor.

Predictive Value of Sflt-1/Plgf Ratio for Occurrence of Preeclampsia in Singleton Pregnancies: A Retrospective Study

Introduction: Preeclampsia is multisystem disorder of pregnancy, characterized by endothelial and placental dysfunction. It is classified as an early onset (which occurs &lt; 34 weeks) and late onset (which occurs ≥ 34 weeks). There is an increase of level of antiangiogenic factor of soluble form similar to tyrosine kinase 1 (sFlt-1) and decrease of level of proangiogenic placental growth factor (PlGF) at preeclampsia. High ratio sFlt-1/PlGF is connected to occurrence of preeclampsia. Materials and Methods: There was a retrospective study of the Clinic for Gynecology and Obstetrics of the University Clinical Center of Republic of Srpska (KGA UKC RS), which was implemented in period January 1st, 2020 – December 31st, 2021 and which included 224 patients hospitalized at the Department of Perinatology for suspected preeclampsia development, from 26+0 weeks of gestation until birth. One of the key criteria for the inclusion of patients in the study is the use of the sFlt-1/PlGF ratio as a marker for the onset of preeclampsia, and the determination of protein values in 24-hour urine (biuret). The antenatal state of the fetus was also monitored by ultrasound measurement of the flow resistance ratio (Ri) through the middle cerebral artery and the umbilical artery (C/U), as well as the values of the newborn’s Apgar score in the first and fifth minute of life (AS 1 and 5). The patients included in the study were divided into two groups according to gestational age: group 1 (&lt;33+6 NG) and group 2 (≥34NG). For the purposes of the research, data from patient protocol books for the specified period, as well as corresponding data from the Clinical Information System (KIS), were used. Results: Calculated values for cut off 38 for group 1 are: NPV= 76.9%, PPV=72.0%, sensitivity=85.7%, specificity=58.8%, and for group 2 are: NPV= 89 ,1%, PPV=40.8%, sensitivity=72.1%, specificity=68.5%. For cut off 85, the calculated values for group 1 are: NPV= 82.4%, PPV=85.7%, sensitivity=85.7%, specificity=82.4%, and for group 2 they are: NPV= 84.9 %, PPV=70.4%, sensitivity=44.2%, specificity=94.4%. For cutt off 110, the calculated values for group 1 are: NPV= 77.8%, PPV=85%, sensitivity=81%, specificity=82.4%, and for group 2 they are: NPV= 83.5 %, PPV=72.7%, sensitivity=37.2%, specificity=95.8%. The measured value of protein in 24h urine (biuret) in comparison with the measured values of the sFlt-1/PlGF ratio have statistical significance for predicting the onset of preeclampsia. Statistical data processing obtained by examining the measured values of the sFlt-1/PlGF ratio and the antenatal and natal condition of the fetus (C/U and AS 1 and 5) showed statistical significance, except for C/U for group 2, where p=0.32. Conclusion: Determination of the sFlt-1/PlGF ratio as well as biuret and monitoring of the antenatal and postnatal state of the fetus significantly contributes to the timely diagnostic of preeclampsia, which impacts reducing the incidence of undesirable outcomes for the mother and the fetus.