Transfer To Neonatal Intensive Care Unit Research Articles

Development and validation of a prenatal predictive nomogram for the risk of NICU admission in infants born to Chinese mothers over 35 years of age: a retrospective cohort study.

The rising number of women giving birth at advanced maternal age has posed significant challenges in obstetric care in recent years, resulting in increased incidence of neonatal transfer to the Neonatal Intensive Care Unit (NICU). Therefore, identifying fetuses requiring NICU transfer before delivery is essential for guiding targeted preventive measures. This study aims to construct and validate a nomogram for predicting the prenatal risk of NICU admission in neonates born to mothers over 35 years of age. Clinical data of 4218 mothers aged ≥ 35 years who gave birth at the Department of Obstetrics of the Second Hospital of Shandong University between January 1, 2017 and December 31, 2021 were reviewed. Independent predictors were identified by multivariable logistic regression, and a predictive nomogram was subsequently constructed for the risk of neonatal NICU admission. Multivariate logistic regression demonstrated that the method of prenatal screening, number of implanted embryos, preterm premature rupture of the membranes, preeclampsia, HELLP syndrome, fetal distress, premature birth, and cause of preterm birth are independent predictors of neonatal NICU admission. Analysis of the nomogram decision curve based on these 8 independent predictors showed that the prediction model has good net benefit and clinical utility. The nomogram demonstrates favorable performance in predicting the risk of neonatal NICU transfer after delivery by mothers older than 35 years. The model serves as an accurate and effective tool for clinicians to predict NICU admission in a timely manner.

Effect of extended precision nursing on neurobehavioral function and pregnancy outcome in patients with threatened abortion.

This study aimed to assess the impact of continuous precision nursing on neurobehavioral function and pregnancy outcomes in patients experiencing threatened abortion. A total of 130 patients with early threatened abortion admitted to our hospital between October 2020 and January 2023 were selected and categorized into 2 groups based on intervention methods. The control group received routine nursing intervention, whereas the observation group received continuous precision nursing intervention. Changes in affective status scores, SF-36 scores, knowledge mastery scores, and satisfaction scores in the neurobehavioral function test before and after intervention were recorded in both groups. Additionally, pregnancy outcomes, obstetric adverse reaction rates, and neonatal conditions were documented. Following intervention, scores for tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment gradually decreased in both groups, with significantly lower scores observed in the observation group compared to the control group (P < .05). SF-36 scores in 8 dimensions, including physical functioning, role-physical, bodily pain, and overall health rating, showed a gradual increase in both groups, with the observation group scoring higher than the control group (P < .05). Knowledge mastery and satisfaction scores also increased significantly after intervention, with the observation group surpassing the control group (P < .05). The observation group exhibited lower rates of abortion and premature birth, along with a higher rate of full-term pregnancy compared to the control group, with statistically significant differences (P < .05). Furthermore, the observation group displayed lower rates of adverse reactions and low birth weight infants, with significant differences compared to the control group (P < .05). No significant differences were observed in neonatal mortality and neonatal intensive care unit transfer rates between the observation and control groups (P > .05). Continuous precision nursing contributes to improved pregnancy outcomes for patients with threatened miscarriage within the first 12 weeks of pregnancy. This comprehensive care approach is associated with enhanced knowledge retention, protection of neurological function, and an overall improvement in quality of life.

Perinatal Outcome: A Comparative Study between Emergency and Elective Caesarean Section at A Tertiary Care Hospital

Introduction: Caesarean delivery is the most commonly performed lifesaving procedure in obstetrics. Caesarean section can be done in emergency and elective basis. There has been rising trend of caesarean section over the last few decades. Both the caesarean sections are associated with fetal risks than vaginal delivery.&#x0D; Objectives: To assess and compare the perinatal outcomes of emergency and elective caesarean sections.&#x0D; Methods: It was a cross-sectional comparative study done in Civil Service Hospital of Nepal over the period of one year starting from January 2021 to December 2021. All the patients who underwent caesarean section during the study period were taken into study. Data regarding perinatal outcomes were analysed by SPSS software.&#x0D; Results: During the study period, there were 1349 total deliveries. Caesarean sections accounted for 52.2% (n=705) of all deliveries. There were a total of 373 (52.9%) emergency CS and 332 (47.1%) elective CS. Most common indications of emergency and elective caesarean section were fetal distress and previous caesarean section respectively.Out of 713 new-born’s, 26 (6.9%) were preterm in emergency CS, 4 (2.1%) in elective group which was statistically significant (X2 &lt;0.001). Regarding APGAR score, need of resuscitation, nursery admission, respiratory distress syndrome, and neonatal intensive care unit transfer, neonates delivered by emergency basis had more number of babies than elective. However, there was no significant difference. There was one early neonatal death in the study period.&#x0D; Conclusion: Caesarean section is in rising trend of late. However, timely decision making skills can certainly lead to better perinatal outcome in caesarean sections.

The Feasibility and Impact of a Postresuscitation Care Protocol in the Well Baby Nursery.

The objective of this study is to determine if a postresuscitation care (PRC) protocol in the well baby nursery (WBN) would improve identification of infants requiring neonatal intensive care unit (NICU) admission. This is a retrospective and prospective cohort study of a PRC protocol in 765 WBN admissions after delivery room (DR) resuscitation with continuous positive airway pressure and/or positive pressure ventilation. After protocol initiation, NICU transfers during the birth hospitalization increased significantly (11.17 vs. 16.08%, p < 0.05). There was no difference in incidence of NICU transfer (5.99 vs. 7.29%, pre-PRC vs. PRC, p = 0.47) during the first 4 hours of life during protocol administration. Respiratory distress was the most common indication for NICU transfer in both cohorts (7.90 vs. 11.81%, p = 0.09, pre-PRC vs. PRC). Noninvasive positive pressure and/or high-flow nasal cannula (5.72 vs. 9.55%, p = 0.06, pre-PRC vs. PRC) were routinely administered in the NICU to transferred infants. After apparent recovery from DR resuscitation, WBN admissions experience significant risk of complications requiring NICU transfer, supporting Neonatal Resuscitation Program recommendation for enhanced monitoring. In our study, we demonstrated the feasibility of standardized PRC protocol in the WBN. NICU transfers increased after initiation of a PRC protocol; however, further studies are needed to confirm possible benefits of this PRC protocol in improving identification of infants requiring a higher level of care. · A PRC protocol in WBN is feasible and associated with increased NICU transfer.. · Despite initial apparent recovery, delayed presentation of respiratory distress is a frequent morbidity.. · Increased surveillance as recommended by Neonatal Resuscitation Program is indicated in this population..

Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019.

BackgroundThere is little research on how financial incentives and penalties impact national cesarean section rates. In January 2018, Georgia introduced a national cesarean section reduction policy, which imposes a financial penalty on hospitals that do not meet their reduction targets. The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes.MethodsWe included women who gave birth from 2017 to 2019 registered in the Georgian Birth Registry (n = 150 534, nearly 100% of all births in the country during this time). We then divided the time period into pre-policy (January 1, 2017, to December 31, 2017) and post-policy (January 1, 2018, to December 31, 2019). An interrupted time series analysis was used to compare the cesarean section rates (both overall and stratified by parity), neonatal intensive care unit transfer rates, and perinatal mortality rates in the two time periods. Descriptive statistics were used to assess differences in maternal socio-demographic characteristics.ResultsThe mean cesarean section rate in Georgia decreased from 44.7% in the pre-policy period to 40.8% in the post-policy period, mainly among primiparous women. The largest decrease in cesarean section births was found among women <25 years of age and those with higher education. There were no significant differences in the neonatal intensive care unit transfer rate or the perinatal mortality rate between vaginal and cesarean section births in the post-policy period.ConclusionThe cesarean section rate in Georgia decreased during the 2-year post-policy period. The reduction mainly took place among primiparous women. The policy had no impact on the neonatal intensive care unit transfer rate or the perinatal mortality rate. The impact of the national cesarean section reduction policy on other outcomes is not known.

Effect Analysis of In-Hospital Transfer Care Based on STABLE Technology in Critically Ill Newborns.

Purpose Analysis of the effectiveness of in-hospital transfer care based on the STABLE (sugar and safe care, temperature, airway, blood pressure, lab work, emotional support) technique in critically ill neonates. Methods Retrospective analysis of the case data of 180 critically ill neonates transferred to the NICU (neonatal intensive care unit) via the delivery room (operating room) in our hospital from April 2020 to December 2021. Of which, 88 newborns from April 2020 to February 2021 were resuscitated by conventional resuscitation and then transferred to the NICU by the nurses in the delivery room (operating room) through the green channel, and they were recorded as the control group; and 92 newborns from March to December 2021 were transferred to the NICU by the NICU transfer nurses who arrived at the delivery room (operating room) earlier and used the in-hospital transfer care based on STABLE technology, and they were recorded as the intervention group. The indicators to be assessed were the execution pass rate in the simulated assessment of the transfer emergency procedure for both groups of transporters, execution times of the various subprocesses during the transfer procedure for both groups of transporters, accidents in transit, and blood glucose, blood pressure, body temperature, respiration, blood gas indicators, and family satisfaction of children in both groups after transfer. Results The total execution pass rate for transporters was higher in the intervention group than in the control group (P < 0.05). The execution times of the various subprocesses during the transfer procedure of transporters were shorter in the intervention group than in the control group (P < 0.05). The incidence of accidents in transit was lower in the intervention group than in the control group (P < 0.05). After transfer, the blood glucose, blood pressure, body temperature, respiratory, and blood gas indicators of the children in the intervention group were all more stable than those in the control group (P < 0.05). The satisfaction of the families of the children in the intervention group was higher than that of the control group (P < 0.05). Conclusion The implementation of transfer care based on STABLE technology for newborns in urgent need of in-hospital transfer can effectively improve the comprehensive quality and emergency response ability of transfer nurses and shorten the in-hospital transfer time, and the incidence of adverse reactions during the transfer of children is less, the vital signs are stable, and the satisfaction of family members is high, which is of promotion value.

Clinical analysis of 2860 cases of diabetes in pregnancy: a single-center retrospective study

BackgroundTo investigate the epidemiological, clinical characteristics and outcomes of diabetes in pregnancy (DIP).MethodsThis single-center, retrospective study included 16,974 pregnant women hospitalized during 2018–2019. Among them, 2860 DIP patients were grouped according to diabetes type, glycemic status, and insulin use. Multivariate logistic regression analysis was conducted.ResultsThe incidence of DIP [17.10%; pregestational diabetes mellitus (PGDM), 2.00% (type I, 0.08%; type 2, 1.92%); gestational diabetes mellitus (GDM), 14.85% (GDM A1, 13.58%; GDM A2, 1.27%)] increased annually. Premature birth, congenital anomalies, large for gestational age (LGA), neonatal asphyxia, neonatal intensive care unit transfer, hypertension, and puerperal infection were more common in DIP than in healthy pregnancies. The most common comorbidities/complications were hypertension, thyroid dysfunction, cervical incompetence, intrahepatic cholestasis, premature membrane rupture, oligo/polyhydramnios, and fetal distress. GDM incidence at ages ≥35 and ≥ 45 years was 1.91 and 3.26 times that at age < 35 years, respectively. If only women with high-risk factors were screened, 34.8% GDM cases would be missed. The proportion of insulin use was 14.06% (PGDM, 55%; GDM, 8.53%). Mean gestational age at peak insulin dose in DIP was 32.87 ± 5.46 weeks. Peak insulin doses in PGDM and GDM were 3.67 and 2 times the initial doses, respectively. The risks of LGA, premature birth, cesarean section, and neonatal hypoglycemia in PGDM were 1.845, 1.533, 1.797, and 1.368 times of those in GDM, respectively. The risks of premature birth and neonatal hypoglycemia in women with poor glycemic control were 1.504 and 1.558 times of those in women with good control, respectively.ConclusionsThe incidence of adverse outcomes in DIP is high.

Adverse Perinatal and Early Life Outcomes following 15q11.2 CNV Diagnosis.

The copy number variation (CNV) of 15q11.2, an emerging and common condition observed during prenatal counseling, is encompassed by four highly conserved and non-imprinted genes—TUBGCP5, CYFIP1, NIPA1, and NIPA2—which are reportedly related to developmental delays or general behavioral problems. We retrospectively analyzed 1337 samples from genetic amniocentesis for fetal CNV using microarray-based comparative genomic hybridization analysis between January 2014 and December 2019. 15q11.2 CNV showed a prevalence of 1.5% (21/1337). Separately, 0.7% was noted for 15q11.2 BP1–BP2 microdeletion and 0.8% for 15q11.2 microduplication. Compared to the normal array group, the 15q11.2 BP1–BP2 microdeletion group had more cases of neonatal intensive care unit transfer, an Apgar score of <7 at 1 min, and neonatal death. Additionally, the group was symptomatic with developmental delays and had more infantile deaths related to congenital heart disease (CHD). Our study makes a novel contribution to the literature by exploring the differences in the adverse perinatal outcomes and early life conditions between the 15q11.2 CNV and normal array groups. Parent-origin gender-based differences may help in the prognosis of the fetal phenotype; development levels should be followed up in the long term and echocardiography should be offered prenatally and postnatally for the prevention of a delayed diagnosis of CHD.

Parental Perspectives on the Postpartum Bonding Experience after Neonatal Intensive Care Unit Transfer to a Referral Hospital.

The aim of this study is to describe the postpartum bonding experience of parents whose newborns were transferred to a referral hospital while their mothers remained at the delivery hospital. A total of 18 semi-structured interviews conducted with mothers within 2 weeks of birth were completed. Thematic analysis was performed. In total, 72% of mothers were unable to hold their newborns, and mothers spent a median of 15 minutes with their newborn prior to transfer. Thematic analysis revealed five themes: three barriers to bonding (medical, hospital, and family barriers) and two themes of interventions that helped promote bonding (parent and hospital-initiated interventions). Using technology such as bedside cameras, recording of heart beats, and video chatting on rounds were extremely popular. Parents identified multiple barriers to maternal-infant bonding and suggested several parent-focused and hospital-focused interventions to enhance bonding. Strategies that address barriers should be used to help parents promote bonding during separation from their newborns. · Transfer to referral neonatal intensive care units interrupts bonding.. · Interviews reveal multiple barriers to bonding.. · Interventions can be parent or hospital initiated.. · Technology is playing a growing role..

Glucose Gel in Infants at Risk for Transitional Neonatal Hypoglycemia.

To evaluate whether glucose gel as a supplement to feedings in infants admitted to the newborn nursery at risk for neonatal hypoglycemia (NH) reduces the frequency of transfer to a higher level of care for intravenous dextrose treatment. We revised our newborn nursery protocol for management of infants at risk for NH to include use of 40% glucose gel (200 mg/kg). Study population included late preterm, small and large for gestational age infants, and infants of diabetic mothers. We compared outcomes before (4/1/14-3/31/15: Year 1) and after (4/1/15-3/31/16: Year 2) initiation of the revised protocol. Our prospective primary outcome was transfer to the neonatal intensive care unit (NICU) for treatment with a continuous infusion of dextrose. NICU transfer for management of NH fell from 8.1% in Year 1 (34 of 421 at-risk infants screened) to 3.7% in Year 2 (14 of 383 at-risk infants screened). Rate of exclusive breastfeeding increased from 6% in Year 1 to 19% in Year 2. Hospital charges for the study population decreased from 801,276 USD to 387,688 USD in Year 1 and Year 2, respectively. Our study supports the adjunctive use of glucose gel to reduce NICU admissions and total hospitalization expense.

Is trial of labor harmful in breech delivery? A cohort comparison for breech and vertex presentations

IntroductionPlanned vaginal delivery in breech presentation is accompanied by an excess neonatal risk that has, however, rarely been compared to that of delivery in vertex presentation. Because of the severity of complications that can occur in long-term follow-up, the risk of asphyxia is of particular concern. Material and methodsTo assess immediate neonatal status after a planned vaginal delivery of fetuses in breech compared with vertex presentation, we planned a retrospective hospital cohort study of singleton term deliveries from 2000 to 2011. The indicators used to assess neonatal status were: 5-min Apgar score<7, acidosis, both moderate (pH<7.15) and severe (pH<7.0), asphyxia (pH<7.0 and base deficit≥12.0mmol/L), transfer to the neonatal intensive care unit (NICU), and in-hospital neonatal death. ResultsCompared with 43,595 trials of vaginal delivery in vertex presentation at term during the 12-year study period (93.8% of all vertex presentations), the 665 breech deliveries for which planned vaginal delivery was planned (43.2% of all breech presentations) had a quadrupled risk of severe acidosis (ORa 4.3 [2.2–7.5]), but no increase in the risk of asphyxia (ORa 0.7 [0.1–3.0]), NICU transfer (ORa 0.8 [0.4–1.3]) or in-hospital death (ORa 1.3 [0.1–6.0]). Moreover, compared with the 876 planned cesareans, the risk of severe acidosis in the 665 trials of vaginal delivery in breech presentation was four times higher (OR 4.3 [2.3–4.7]), but we observed no increase in neither asphyxia nor other risks studied. ConclusionIn our hospital, planned vaginal delivery is safe for breech presentations because it is associated with an increase of severe acidosis but not asphyxia.

Primary Cesarean Delivery Prevention

INTRODUCTION: Reducing the cesarean delivery rate is a national priority. Obstetrician–gynecologists working in collaboration with certified nurse-midwives demonstrate that a Collaborative Model of Care has the potential to yield the very best obstetric outcomes. This model is based on 1) screening criteria; 2) antepartum guidelines; 3) communication patterns of consultation, collaboration, and referral; 4) evidence-based intrapartum guidelines; 5) innovative labor management strategies; 6) removal of time limits for labor progress; and 7) availability of operative vaginal and breech delivery. METHODS: This is an observational report and data analysis of the first 1,000 deliveries managed by certified nurse-midwives in consultation with obstetrician–gynecologists in a Collaborative Model of Care in an academic medical center from 2010 to 2013. RESULTS: Outcome data from this innovative Collaborative Model of Care show a cesarean delivery rate of 3.6% and a primary cesarean delivery rate of 2.6%. If antepartum transfers at term are included in the analysis, the cesarean delivery rate is 5.6%. The model yields an 88% normal vaginal delivery rate and a 12% epidural rate. The vaginal birth after cesarean delivery success rate is 93%. Vaginal breech birthrate is 75%. The neonatal intensive care unit transfer rate is 5%. CONCLUSIONS: A Collaborative Model of Care between obstetrician–gynecologists and certified nurse-midwives in a university-based setting has the potential to significantly reduce the cesarean delivery rate. Duplication of this model in diverse patient populations will significantly reduce the national cesarean delivery rates, increase rates of normal vaginal delivery, and yield optimal outcomes for our nations' mothers and neonates.

Pregnancy outcomes according to increasing maternal age

ObjectivesTo investigate the risks of increasing maternal age on the perinatal and obstetric outcomes. Materials and MethodsInformation about 29,760 singleton pregnancies delivered between 2005 and 2008 was extracted from our database. Patients were categorized into four groups according to age: 20–29 years, 30–34 years, 35–39 years, and ≥40 years. Multivariable logistic regression analysis was used to evaluate the adjusted odd ratios (AORs) of adverse pregnancy outcomes according to maternal age after adjusting for parity, body mass index, medical history and use of in vitro fertilization. ResultsThe majority of adverse perinatal outcomes were associated with a maternal age ≥35 years as follows: low birth weight (AOR 1.2 and 1.6 for women aged 35–39 years and ≥40 years, respectively); Apgar score < 7 at 1 minute (AOR: 1.7 and 1.8); and chromosomal anomaly (AOR: 2.7 and 12.3). However, women aged ≥30 years also had greater risks for adverse maternal outcomes such as: gestational diabetes (AOR: 2.0, 3.6 and 5.1 for women aged 30–34 years, 35–39 years and ≥40 years, respectively); placenta previa (AOR: 1.6, 2.1 and 3.6); and cesarean delivery (AOR: 1.5, 2.3, and 4.1), as well as adverse fetal outcomes such as: preterm delivery (AOR: 1.2, 1.4 and 1.8) and neonatal intensive care unit transfer (AOR: 1.1, 1.2, and 1.6). ConclusionIncreasing maternal age is an independent and substantial risk factor for adverse perinatal and obstetric outcomes. These adverse outcomes become more common as increasing maternal age without a clear cutoff age.

Neonatal Outcomes of Twin Pregnancy According to the Planned Mode of Delivery

To assess neonatal morbidity in twin pregnancy according to the planned mode of delivery. A retrospective cohort study of 758 consecutive sets of twins born after 35 weeks of gestation with a cephalic-presenting first twin was undertaken in a level III maternity unit in which active management of the second twin delivery is performed routinely. The primary outcome was a composite measure of neonatal mortality and morbidity, including pH less than 7.0, 5-minute Apgar score less than 4, neonatal intensive care unit transfer more than 4 days, pneumothorax, and fracture. Control for potential confounders was performed by excluding from the analysis women who experienced pregnancy complications and by using logistic regression models. Vaginal or cesarean delivery was planned for 657 (86.7%) and 101 (13.3%) women, respectively. Among planned vaginal deliveries, 515 (78.4%) patients delivered both twins vaginally, 139 (21.1%) had a cesarean delivery during labor, and 3 (0.5%) had cesarean delivery for the second twin. After vaginal birth of the first twin, the mean intertwin delivery interval was 4.9+/-3.2 minutes. When patients who experienced pregnancy complications were excluded (n=202), the neonatal composite morbidity for the second twin did not differ between planned cesarean and planned vaginal delivery (5.0% compared with 4.7%, adjusted odds ratio 1.5, 95% confidence interval 0.3-7.4, P=.63). Neonatal composite morbidity of first twins did not differ between groups. For twin gestations with a cephalic-presenting first twin, planned vaginal delivery after 35 weeks of gestation in selected women remains a safe option in centers used to active management of the second twin delivery.

Young Moms’ Clinic: A Multidisciplinary Approach to Pregnancy Education in Teens and in Young Single Women

Study ObjectiveTo study outcome of pregnant adolescents and single young women who attended and those who chose not to attend a nonurban, developmentally appropriate, pilot antenatal clinic called the “Young Moms’ Clinic.” To study “perceived” outcome among the Young Moms’ Clinic participants. MethodsA multidisciplinary clinic was established to provide education about pregnancy, childbirth, infant care, contraception, and healthy lifestyles to young mothers with similar backgrounds. Over a 2-year period, all adolescents and single young mothers aged 13–23 years were invited to attend the Young Moms’ Clinic after the first trimester. The Clinic group consisted of the first 101 young women who were invited and chose to attend. The nonclinic group consisted of the first 95 young wonlen who were invited but declined to attend. Both groups had the same obstetric care givers, had a similar number of prenatal visits (median number, 12), and delivered in the same hospital. Univariate and multivariate analyses were performed to determine whether participation in the clinic was an independent factor in outcome. ResultsMaternal weight gain and infant birth weight were significantly higher in the Clinic group. Pregnancy complications (preterm labor, intrauterine growth retardation, anemia) were significantly higher in the nonclinic group. Participants in the nonclinic group were almost three times as likely to have cesarean section delivery as those in the Clinic group. Neonatal intensive care unit transfer occurred only in infants of the control group. ConclusionsParticipation of pregnant adolescent and young adult women from a nonurban community in a developmentally targeted pilot, prenatal program resulted in fewer pregnancy complications and improved outcome in comparison with those who chose not to participate in the program. The results may be subject to bias because of self-selection among partIcIpants.