Mortality In Neonatal Intensive Care Unit Research Articles

Contemporary prenatal diagnosis of congenital heart disease in a regional perinatal center lacking onsite pediatric cardiac surgery: obstetrical and neonatal outcomes.

Determine obstetrical and neonatal outcomes in neonates with major CHD delivered at a level IV neonatal intensive care units (NICU) center lacking onsite pediatric cardiac surgery. A 10- year retrospective review of all neonates admitted to our level IV NICU, with CHD between January 1st, 2011 and December 31st, 2021. Births and NICU charts were cross queried with those from our perinatal center which include pediatric cardiology records. Terminations and stillbirths were excluded. A total of 285 neonates with major CHD and 78 withminor defects were included. In the major CHD group, 82.8 % had an isolated cardiac anomaly and 17.2 % had an extracardiac anomaly. Type of extracardiac anomaly had noimpact on neonatal survival. Prenatal diagnosis of aneuploidy did not impact survival in major CHD. Truncus arteriosus had the highest NICU mortality at 34.0 % followed by hypoplastic left heart syndrome (HLHS) at 31.6 %. Double outlet right ventricle with transposition of the great vessels and interrupted aortic arch (both types) had a 25 % mortality. Neonates with truncus arteriosus and total anomalous pulmonary venous returns were likely to have 5-min Apgar score<7. Transfer rate of neonates with major CHD for cardiac surgery was 58.6 %. Of those 81.5 % were discharged home, 14.3 % expired before discharge, and 1 % were transferred elsewhere post-operatively for higher level of care. Neonates with major CHD can deliver safely at a level IV NICU lacking onsite pediatric cardiac surgery. Our neonatal mortality was high for HLHS and truncus arteriosus, however comparable to other centers with proximate pediatric cardiac surgery.

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Understanding the impact of workload and regional differences on these rates is crucial for improving outcomes. This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities. Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates. This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with two rather than one neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates. Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

Mortality Risk in US Neonatal Intensive Care Unit Infants by Birth Size Classifications Comparing Three Growth Curves

Introduction: Three widely referenced growth curves classify infant birth anthropometric measurements as small (SGA), appropriate (AGA), or large (LGA) for gestational age (GA) differently. We assessed how these differences in assignment affect the identification and prediction of neonatal intensive care unit (NICU) mortality risk in US preterm infants. Methods: Birth data of infants admitted to NICUs from the Pediatrix Clinical Data Warehouse (2013–2018) were analyzed. Birth weight, length, and head circumference of 46,724 singleton infants (24–32 weeks GA) were classified as SGA, AGA, or LGA using the Olsen, Fenton, and INTERGROWTH-21st curves. NICU mortality risk based on birth size classification was analyzed using unadjusted and adjusted logistic regression stratified by GA. Results: Odds of mortality were increased with SGA classification at all GAs, size measurements, and curve sets, compared with AGA infants. LGA classification for weight was associated with lower mortality risk at 24 weeks GA and higher risk at 30 weeks GA. Odds of mortality did not differ significantly across curve sets. Classification of size at birth alone had relatively low predictive ability to identify mortality risk, with unadjusted AUCs near 0.5 for all analyses. Conclusion: There were no significant differences across curve sets in predicting mortality. Classification of size at birth is a relatively imprecise method to identify infants at risk for NICU mortality.

Prevalence of Preterm Birth and Perinatal Outcomes in a Tertiary Hospital in Malaysia.

Background Preterm birth (PTB) is defined as neonates that are born alive>22 weeks of gestation and <37 weeks of gestation. Because of the immaturity of different organ systems, 14.84 million newborns worldwide are born prematurely, which is the largest contributing factor to mortality and morbidity. Although studies have been conducted in this field, the magnitude of PTB is a major issue in most developing countries including Malaysia. Objective To assess the prevalence of PTB and the perinatal outcome among women delivered in a tertiary university hospital in Malaysia. Methods This was a cross-sectional study evaluating all singleton live births weighing>500g and delivered at>22+1weeks of gestation between January 2015 and December 2019 in Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Data were collected from the hospital's recorded birth registry. The primary outcome was the PTB rate. Data were entered and analysed using Statistical Product and Service Solutions (SPSS) (version 28.0; IBM SPSS Statistics for Windows, Armonk, NY). Results A total of 26,022 singleton live births were reported for the period 2015-2019. PTB rates showed a sharp 6% decrease from 2015 to 2016, after which the trend was inconsistent until 2019. The risk of preterm babies being admitted to the neonatal intensive care unit (NICU) or the ward compared to the risk of neonatal mortality increases for babies of identified sex, delivered via caesarean, and with a birth weight between 2 and 3 kgs. Babies born at a gestational age between 22+1and 33+6have a higher risk of neonatal mortality compared to late preterm babies. Conclusions The PTB incidence trend was inconsistent from 2015 to 2019 in a tertiary university hospital in Malaysia, with a far higher prevalence compared to national data. The high NICU admission and mortality rates among preterm infants mean urgent strategies and policies are needed to improve perinatal outcomes.

Risk factors and trends in neonatal mortality in NICU in a tertiary care hospital in India

Introduction: The most vulnerable period of human life is neonatal period, which accounts for most of the morbidities and mortalities. Most of them are preventable with adequate health-care facilities. Objectives: The aim of the study was to determine the trends of neonatal mortality and identify the risk factors, most of which are preventable and measure the progress of health-care services. Methods: A retrospective study was conducted in neonatal intensive care unit (NICU) of Al-Ameen Children Hospital (AMCH) Vijayapura, Karnataka, India. Data were extracted from paper medical records at AMCH of a period of 1 year and digitized. Data obtained included age, sex and birth weight, place of delivery, morbidity profile, mortality profile, diagnosis, and period of stay in NICU. Results: A total of 648 neonates were admitted in NICU during the study period of 1-year duration, between January and December 2021. A total of 382 (58.9%) infants were discharged on recovery, 65 (10.3%) were referred due to unavailability of advanced surgical intervention, 39 (6%) were discharged against medical advice, 162 (25%) died due to various reasons. Male neonatal deaths outnumbered female neonates (56.8%). Among the total neonatal deaths, 82 (50.6%) were preterm neonates, 73 (45.1%) were term neonates and 7 (4.3%) were post-term neonates. It was noticed that among neonatal deaths, 87 (54.3%) babies were out-born and 75 (46.2%) babies were inborn. In this study, it was noticed that the mortality percentage of the neonate falling in the category of 1.5–1.9 kg was high compared to other categories. In our study, respiratory distress syndrome was the main cause of mortality accounting for 19.1% (31 cases) of total cases and prematurity was the most common risk factor. Conclusion: Improving the standard of antenatal care and encouraging deliveries in institutions having good NICU facility and early identification of risk factors help to reduce the mortality and its complications.

Resting-State Functional Magnetic Resonance Imaging Network Association With Mortality, Epilepsy, Cognition, and Motor Two-Year Outcomes in Suspected Severe Neonatal Acute Brain Injury

Background and ObjectivesIn acute brain injury of neonates, resting-state functional magnetic resonance imaging (MRI) (RS) showed incremental association with consciousness, mortality, cognitive and motor development, and epilepsy, with correction for multiple comparisons, at six months postgestation in neonates with suspected acute brain injury (ABI). However, there are relatively few developmental milestones at six months to benchmark against, thus, we extended this cohort study to evaluate two-year outcomes. MethodsIn 40 consecutive neonates with ABI and RS, ordinal scores of resting-state networks; MRI, magnetic resonance spectroscopy, and electroencephalography; and up to 42-month outcomes of mortality, general and motor development, Pediatric Cerebral Performance Category Scale (PCPC), and epilepsy informed associations between tests and outcomes. ResultsMean gestational age was 37.8 weeks, 68% were male, and 60% had hypoxic-ischemic encephalopathy. Three died in-hospital, four at six to 42 months, and five were lost to follow-up. Associations included basal ganglia network with PCPC (P = 0.0003), all-mortality (P = 0.005), and motor (P = 0.0004); language/frontoparietal network with developmental delay (P = 0.009), PCPC (P = 0.006), and all-mortality (P = 0.01); default mode network with developmental delay (P = 0.003), PCPC (P = 0.004), neonatal intensive care unit mortality (P = 0.01), and motor (P = 0.009); RS seizure onset zone with epilepsy (P = 0.01); and anatomic MRI with epilepsy (P = 0.01). ConclusionFor the first time, at any age, resting state functional MRI in ABI is associated with long-term epilepsy and RSNs predicted mortality in neonates. Severity of RSN abnormality was associated with incrementally worsened neurodevelopment including cognition, language, and motor function over two years.

Profile of neonatal candidiasis in tertiary neonatal intensive care unit: A report from a developing country.

Systemic candidiasis is an important nosocomial infection in neonatal intensive care units. The objective of this study was to identify the change in the profile of neonatal candidiasis in a tertiary neonatal intensive care unit (NICU) in eastern India in recent times. It was a retrospective review of case records from 2014 to 2019 from a tertiary NICU of eastern India. Data of the fungal sepsis, demographic details, risk factors of fungal sepsis and mortality were collected from 103 neonates. One hundred and three neonates had blood culture positive for fungal species of which 91 (88.3%) infants weighed ≥1500 g and 66 (64%) infants were term. There was significant higher incidence of candidiasis among outborn (Relative risk of outborn 18.84, 95% CI 10.74-33.05). Prolonged antibiotic usage (>14 days), meropenem usage (>5 days), central catheterization (>5 days), invasive mechanical ventilation (>5 days), surgical intervention were found in 64 (62.1%), 46 (44.6%), 31(30.0%), 40 (38.8%) and 39 (37.8%) infants. Non albicans candida (NAC) was isolated as the predominant species (82/103, 79.6%). Resistance to both of fluconazole and amphotericin B were found in 19 (18.4%) babies. Presence of NAC infection and resistance to both amphotericin B and fluconazole were independent predictors of candida associated mortality in NICU. Neonatal candidiasis is found among outborn infants with higher birth weight and gestational age. NAC species are predominant organisms with resistance to common antifungal drugs.

Thromboelastometry and prediction of in-hospital mortality in neonates with sepsis.

This study aimed at evaluating the role of rotational thromboelastometry (ROTEM) assays in the prediction of in-hospital mortality of neonates with sepsis. Over a 6-year period, 129 neonates with confirmed sepsis, hospitalized in our neonatal intensive care unit (NICU) were included in the study. Demographics, clinical, and laboratory data were recorded at the sepsis onset and ROTEM assays were performed. Modified neonatal multiple organ dysfunction (NEOMOD) and neonatal sequential organ failure assessment (nSOFA) were calculated simultaneously. Mortality during in-hospital stay was the main outcome measure. In-hospital mortality was associated with patient intense hypocoagulability expressed by lower ROTEM MCF in the INTEM assay. The INTEM MCF demonstrated the best prognostic performance for NICU mortality in septic neonates among the other ROTEM parameters but without statistical significance (area under the curve [AUC] = 0.731; 95% confidence interval [CI]: 0.593-0.869). Our results indicate that ROTEM INTEM MCF parameter has good predictive capacity for in-hospital mortality of septic neonates, similar to that of modified NEOMOD score, nSOFA score, and platelet count, highlighting the integral role of coagulation in sepsis pathophysiology. Hence, ROTEM could serve as a valuable monitoring tool to identify neonates at risk.

Neighborhood Deprivation and Association With Neonatal Intensive Care Unit Mortality and Morbidity for Extremely Premature Infants

Socioeconomic status affects pregnancy and neurodevelopment, but its association with hospital outcomes among premature infants is unknown. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses US Census Bureau data on income, educational level, employment, and housing quality. To determine whether ADI is associated with neonatal intensive care unit (NICU) mortality and morbidity in extremely premature infants. This retrospective cohort study was performed at 4 level IV NICUs in the US Northeast, Mid-Atlantic, Midwest, and South regions. Non-Hispanic White and Black infants with gestational age of less than 29 weeks and born between January 1, 2012, and December 31, 2020, were included in the analysis. Addresses were converted to census blocks, identified by Federal Information Processing Series codes, to link residences to national ADI percentiles. ADI, race, birth weight, sex, and outborn status. In the primary outcome, the association between ADI and NICU mortality was analyzed using bayesian logistic regression adjusted for race, birth weight, outborn status, and sex. Risk factors were considered significant if the 95% credible intervals excluded zero. In the secondary outcome, the association between ADI and NICU morbidities, including late-onset sepsis, necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH), were also analyzed. A total of 2765 infants with a mean (SD) gestational age of 25.6 (1.7) weeks and mean (SD) birth weight of 805 (241) g were included in the analysis. Of these, 1391 (50.3%) were boys, 1325 (47.9%) reported Black maternal race, 498 (18.0%) died before NICU discharge, 692 (25.0%) developed sepsis or NEC, and 353 (12.8%) had severe IVH. In univariate analysis, higher median ADI was found among Black compared with White infants (77 [IQR, 45-93] vs 57 [IQR, 32-77]; P < .001), those who died before NICU discharge vs survived (71 [IQR, 45-89] vs 64 [IQR, 36-86]), those with late-onset sepsis or NEC vs those without (68 [IQR, 41-88] vs 64 [IQR, 35-86]), and those with severe IVH vs those without (69 [IQR, 44-90] vs 64 [IQR, 36-86]). In a multivariable bayesian logistic regression model, lower birth weight, higher ADI, and male sex were risk factors for mortality (95% credible intervals excluded zero), while Black race and outborn status were not. The ADI was also identified as a risk factor for sepsis or NEC and severe IVH. The findings of this cohort study of extremely preterm infants admitted to 4 NICUs in different US geographic regions suggest that ADI was a risk factor for mortality and morbidity after adjusting for multiple covariates.

Addition of platelet-lymphocyte ratio to risk factors to improve the early prediction of acute kidney injury and mortality in critically ill neonates.

To determine whether early neutrophil, lymphocyte, and platelet ratio (NLPR), neutrophillymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), calculated based on easily available parameters in complete blood count, are associated with the development of acute kidney injury (AKI) and mortality during neonatal intensive care unit (NICU) stay, and to evaluate whether these ratios could act as a predictor of AKI and mortality in neonates. The pooled data of 442 critically ill neonates from our previously published prospective observational studies of urinary biomarkers were analyzed. Complete blood count (CBC) was measured on NICU admission. The clinical outcomes included AKI developed during the first 7 days after admission and NICU mortality. Of the neonates, 49 developed AKI and 35 died. The association of the PLR, but not NLPR and NLR, with AKI and mortality remained significant after adjustment for potential confounders including birth weight and illness severity as assessed by the score for neonatal acute physiology (SNAP). The area under the curve (AUC) of the PLR for predicting AKI and mortality was 0.62 (P=0.008) and 0.63 (P=0.010), respectively, with additional predictive value when combined with other perinatal risk factors. The combination of PLR with birth weight, SNAP, and serum creatinine (SCr) had an AUC of 0.78 (P<0.001) in predicting AKI, and its combination with birth weight and SNAP had an AUC of 0.79 (P<0.001) in predicting mortality. Low PLR on admission is associated with increased risk for AKI and NICU mortality. Although the PLR alone is not predictive of AKI and mortally, it adds predictive value to other risk factors for AKI prediction in critically ill neonates.

Value of red cell distribution width-to-platelet ratio as a predictor for morbidity and mortality in neonatal intensive care unit.

Scoring neonatal acute physiology is significant for improving the survival rate of neonates in neonatal intensive care units (NICU). Red blood cell distribution width to platelet ratio (RPR) has been used to evaluate physiology of multiple diseases. However, the value of RPR as a predictor for morbidity and mortality in NICU remains unclear. The score for neonatal acute physiology and perinatal extension II (SNAPE-II) was used to evaluate the physiology and separate neonates into Mild (n = 45), Moderate (n = 45) and Severe (n = 45) groups. White blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) in cord blood were examine. Spearman's correlation and receiver operating characteristic analysis were performed to demonstrated the correlations of these indicators. There was a positive correlation between the SNAPE-II scores and RPR in neonates in NICU. The WBC, PCT and CRP levels increased with the upregulation of SNAPE-II scores in neonates in NICU and there were positive correlations between RPR and WBC, PCT and CRP, respectively. RPR could be used as a supplementary predictor for the evaluation of neonatal morbidity and mortality in NICU beside SNAPE-II.

The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies.

In the current study, we aimed to evaluate the effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancy. The perinatal outcome data of 11,366 patients who gave birth between 2015 and 2020 were evaluated retrospectively. Patients were subgrouped according to their age as control group (C) (20-29years), late advanced maternal age group (30-34years), advanced maternal age group (35-39years), and very advanced maternal age group (≥40years). Multinomial logistic regression analyses were performed to test the possible independent role ofmaternal age as a risk factor for adverse pregnancy outcomes. Statistically significant difference was observed between the control group and the other groups in terms of preterm delivery, preeclampsia, gestational diabetes mellitus (GDM), small gestational age (SGA), large gestational age (LGA), premature rupture of membranes (PROM), high birth weight (HBW), and perinatal mortality rates (p<0.05). An increased risk of the need for neonatal intensive care unit (NICU) and perinatal mortality was observed in groups over 35years old. Age poses a risk in terms of preterm delivery, preeclampsia, LGA, GDM, and HBW in the groups over 30years of maternal age. The rates of PROM, NICU, and perinatal mortality increase in addition to those perinatal results in the groups above 35years of maternal age.

Evaluation of Neonatal Intensive Care Unit Mortality

Objective: To evaluate neonatal intensive care unit (NICU) deaths in one of the largest obstetrics centers in Turkey in order to determine the causes of death in this high-risk group. Materials and Methods: We retrospectively analyzed all NICU deaths occurring between 2013 and 2018. The study included infants born alive at 22 weeks of gestation or older. Results: Of 102374 babies born in our hospital, 14768 infants (14.4%) were admitted to the NICU and 957 (6.48%) of those infants died before discharge. The most common causes of death were extreme prematurity or extremely low birth weight (31.5%), lethal anomalies (13.1%), and sepsis (8.2%). At younger gestational ages, causes associated with extreme prematurity and complications of prematurity were most common, while the death rate due to perinatal asphyxia and genetic or structural anomalies increased at older gestational ages. Conclusion: The causes of NICU deaths are multifactorial and vary with gestational age. Efforts to reduce NICU mortality should include preventing or delaying preterm delivery and identifying the most appropriate treatment modalities that may reduce the risk of respiratory distress, intracranial hemorrhage, necrotizing enterocolitis, and sepsis. In more mature infants, the main goal should be to prevent and treat perinatal asphyxia and determine the most appropriate treatment modalities for non-lethal anomalies.

SNAPPE II Score as a Predictor of Neonatal Mortality in NICU at a Tertiary Care Hospital in Pakistan.

IntroductionThe concept of illness severity scoring has been around for long and is currently being utilized in many neonatal intensive care unit (NICU). Scoring systems that help to quantify mortality risks on the basis of clinical conditions not only help in estimating prognosis, but also help clinicians in making decisions particularly in situations presenting with dilemmas. This study aims to determine SNAPPE-II (Score for Neonatal Acute Physiology-Perinatal Extension) score as a predictor of neonatal mortality in NICU at a tertiary care hospital in Pakistan.MethodologyIt was a longitudinal cohort study. The study was conducted at a neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH) Karachi, Pakistan. All neonates were included who were born in AKUH and who needed respiratory support in NICU.ResultsA total of 333 newborns were enrolled for this study. Out of those 30 (9.1%) neonates expired while 298 (90.9%) survived. Area Under the Receiver operative curve was calculated to obtain the SNAPPE-II score’s diagnostic discrimination ability. Area under the curve (AUC) was 80.2±4.6% which corresponds to a moderate diagnostic accuracy for the prediction of neonatal mortality. The 95% CI for this was between 71.1-89.2%. SNAPPE-II category III (>40) was found to be the strongest predictor of mortality, with a sensitivity of 40% and a specificity of 98.7%.ConclusionThe SNAPPE-II scoring system, we conclude, might be a valuable technique for predicting newborn death in resource-constrained NICUs.

1136. Effect of Weekly Antibiotic Rounds as a Core Strategy of the Antimicrobial Stewardship Program on Antibiotic Utilization in a Terciary-care Neonatal Intensive Care Unit, Medellin, Colombia

BackgroundAntibiotics are among the most prescribed drugs in the neonatal intensive care unit (NICU), but frequently are used inappropriately exposing preterm neonates to additional harm. Antibiotic stewardship programs (ASP) have demonstrated impact on antibiotic use in the hospital setting, but implementation in neonatal units is challenging. We sought to determine the effects of weekly antibiotic rounds on overall antibiotic consumption in the NICU. MethodsSingle-center, retrospective observational study. In November 2014, we implemented weekly antibiotic rounds in a 60-bed tertiary-care NICU, led by a pediatric infectious disease physician. Antibiotic therapy decisions were made in collaboration with neonatologists. Data collected included the proportion of patients receiving antibiotics, irrespective of the indication. Multimodal ASP was implemented hospital-wide in 2015. Antibiotic consumption was measured with days of therapy (DOT). Data on costs and in-hospital mortality were obtained from pharmacy and hospital records. ResultsFrom November 2014 to December 2020, we evaluated 13609 neonates admitted to the NICU during rounds. Of those, 3607 (27%) were receiving at least one antibiotic. Overall, the proportion of patients with antibiotics decreased from 31% to 19% during the study period (p< 0.001). In 2017, an outbreak of neonatal necrotizing enterocolitis (NEC) occurred. Specific countermeasures as well as reinforcement of ASP were implemented. Despite Antibiotic usage by DOT increased in 2017 driven by empiric treatment with piperacillin tazobactam in patients with NEC, overall antibiotic consumption decreased from 254.4 DOT/1000 patient days (PD) to 162.4 DOT/1000 PD (Figure 1). Annual costs from antibiotic prescriptions were US&23,161 in 2015 and decreased to US&12.046 in 2020 saving over US&3,800/year (fig 2a). During the study period, we did not observe an increase in crude in-hospital mortality rate (Figure 2b). Primary Y axis indicates the proportion of patients with at least one antibiotic prescription during rounds. Secondary Y axis indicates antibiotic consumption by days of therapy metrics.Antibiotic prescription costs and NICU mortality rates during study period A. Annual antibiotic prescription costs; B. NICU mortality rateConclusionWeekly antibiotic rounds led to a significant decrease in antibiotic utilization in our NICU. This strategy is relatively simple and low-cost, saves hospital resources and has a large impact on antibiotic use. Hence, its implementation is encouraged as part of successful antimicrobial stewardship programs. Disclosures All Authors: No reported disclosures

Machine Learning Algorithms to Predict Mortality of Neonates on Mechanical Intubation for Respiratory Failure.

Background: Early identification of critically ill neonates with poor outcomes can optimize therapeutic strategies. We aimed to examine whether machine learning (ML) methods can improve mortality prediction for neonatal intensive care unit (NICU) patients on intubation for respiratory failure. Methods: A total of 1734 neonates with respiratory failure were randomly divided into training (70%, n = 1214) and test (30%, n = 520) sets. The primary outcome was the probability of NICU mortality. The areas under the receiver operating characteristic curves (AUCs) of several ML algorithms were compared with those of the conventional neonatal illness severity scoring systems including the NTISS and SNAPPE-II. Results: For NICU mortality, the random forest (RF) model showed the highest AUC (0.939 (0.921–0.958)) for the prediction of neonates with respiratory failure, and the bagged classification and regression tree model demonstrated the next best results (0.915 (0.891–0.939)). The AUCs of both models were significantly better than the traditional NTISS (0.836 (0.800–0.871)) and SNAPPE-II scores (0.805 (0.766–0.843)). The superior performances were confirmed by higher accuracy and F1 score and better calibration, and the superior and net benefit was confirmed by decision curve analysis. In addition, Shapley additive explanation (SHAP) values were utilized to explain the RF prediction model. Conclusions: Machine learning algorithms increase the accuracy and predictive ability for mortality of neonates with respiratory failure compared with conventional neonatal illness severity scores. The RF model is suitable for clinical use in the NICU, and clinicians can gain insights and have better communication with families in advance.

Immediate Bacille Calmette-Guérin Vaccination to Neonates Requiring Perinatal Treatment at the Maternity Ward in Guinea-Bissau: A Randomized Controlled Trial.

Randomized controlled trials (RCTs) indicate that bacille Calmette-Guérin (BCG) vaccination provides broad beneficial "nonspecific" protection against infections. We investigated the effect on in-hospital mortality of providing BCG immediately upon admission to a neonatal intensive care unit (NICU), rather than BCG-at-discharge. The pretrial NICU mortality was 13% and we hypothesized that BCG would reduce mortality by 40%. Parallel-group, open-label RCT was initiated in 2013 in Guinea-Bissau. Neonatal intensive care unit-admitted neonates were randomized 1:1 to BCG + oral polio vaccine (OPV) immediately (intervention) versus BCG + OPV at hospital discharge (control; usual practice). The trial was discontinued due to decreasing in-hospital mortality and major NICU restructuring. We assessed overall and disease-specific mortality by randomization allocation in cox proportional hazards models providing mortality rate ratios (MRRs). We recruited 3353 neonates, and the overall mortality was 3.1% (52 of 1676) for BCG-vaccinated neonates versus 3.3% (55 of 1677) for controls (MRR = 0.94; 0.64-1.36). For noninfectious causes of death, the MRR was 1.20 (0.70-2.07), and there tended to be fewer deaths from infections in the BCG group (N = 14) than among controls (N = 21) (MRR = 0.65; 0.33-1.28). Providing BCG + OPV to frail neonates was safe and might protect against fatal infection in the immediate newborn period. Deaths due to prematurity and perinatal complications were unaffected by BCG.

FETAL OUTCOME AFTER CAESAREAN SECTION PERFORMED FOR FETAL DISTRESS BASED ON ABNORMAL CARDIOTOCOGRAPHY

Objective: To determine the fetal outcome of Caesarean Sections (CS) performed for abnormal Cardiotocography (CTG)&#x0D; Material and Methods: This retrospective data review was conducted in Gynaecology and Obstetrics unit B of Lady Reading Hospital Peshawar from June 2015 till June 2016 after approval from the hospital ethical committee, using a non-probability convenient sampling technique. The hospital record of 234 patients who had CS for fetal distress was reviewed. Patients with singleton and term gestation, who had CS for fetal distress diagnosed based on abnormal Cardiotocography were included in the study. The fetal outcome was noted in terms of Apgar score at 5 minutes, admission to neonatal intensive care unit (NICU), and perinatal mortality. Fetal blood sampling (FBS) and postnatal analysis of fetal arterial blood gases and PH were not carried out in any patient because of non-availability. The results are expressed in frequencies and percentages, shown in tables and figures.&#x0D; Results: In one year, a total of 1255 C-sections were performed. Amongst these, 234 (18.64%) patients fulfilling inclusion criteria were enrolled. Babies delivered with 5 minutes Apgar score of 7 or above were 166 (70.94%). Twenty-one (8.97%) babies were admitted to NICU and perinatal mortality was 6 (2.54%). &#x0D; Conclusion&#x0D; Out of 234 patients who underwent CS due to abnormal CTG, more than 2/3rd of patients had normal babies with an Apgar score of 7 or more, which indicates that abnormal CTG alone should not be used as an indication for CS&#x0D; Keywords: Fetal Distress, CTG, Caesarean section

An Analysis of Five years Neonatal Mortality in NICU of a Tertiary Care Hospital of Rawalpindi 2014-2019

Objective: This study was done to find out the main causes and magnitude of neonatal mortality in the neonatal intensive care unit (NICU) of Benazir Bhutto Hospital, Rawalpindi over a period of five years.Material and Methods: A hospital-based cross-sectional study was done from June 2014 to July 2019. The registration book of admitted neonates was reviewed by using a checklist to collect data. Data was analyzed in SPSS 24 for descriptive and bi-variate analysis applying the chi-square test and presented in text, frequencies, tables, and percentages.Results: The study assessed a total of 24,459 neonates admitted to the NICU at Benazir Bhutto Hospital over a span of five years (June 2014 to July 2019). The mean birth weight was 2432 grams ± 740 g (range: Between 800 and 6000 g). Male neonates accounted for 59.8% with male to female ratio of 1.5:1. 67.5% male neonates and 32.5% female neonates expired. Overall 19,832 neonates (81.1%) were discharged, while 4636 (18.9%) died, making a Neonatal Mortality Rate of 18.9% (189 per 1000 admissions). 86.21% of these deaths were early neonatal that occurred in the first week of life. The causes of death were pre-maturity/ low birth weight (LBW), suspected sepsis, birth asphyxia, neonatal jaundice, and meconium aspiration syndrome, accounting for 32%, 31%, 30%, 4%, and 3% respectively.Conclusion: In our NICU the neonatal mortality is high with prematurity/low birth weight (LBW), birth asphyxia (BA), neonatal jaundice (NNJ), and meconium aspiration syndrome (MAS) accounting for most of the deaths. These deaths are largely preventable with better antenatal, perinatal, and neonatal care.

Mortality, morbidity and clinical care in a referral neonatal intensive care unit in Haiti

Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.