Death In NICU Research Articles

Validity of Clinical Risk Index for Babies (CRIB) Score in Predicting the Neonatal Mortality

Objective: To determine the validity of Clinical Risk Index for Babies (CRIB) score in predicting the neonatal mortality in very preterm neonates. Methodology: The 145 patients enrolled in this study were registered from NICU of Children Hosp, Lahore, they were preterm neonates with gestational age of ≤ 32 weeks. We determined six parameters of CRIB score; gestational age, birth weight, any congenital malformation, minimum and maximum FiO2 requirementduring 1st 12 hours of life and maximum base excess during 1st 12 hours of life. All parameters were recorded and assigned an individual score base upon CRIB scoring chart. Total CRIB score was determined by adding individual score of each parameter. We reviewed thebabiesdaily in NICU till discharge or death. Results: Out of 145 patients, 52.4%(n=76)male and female were 47.59%(n=69). Congenital malformations were present in 6.21% (n=9), mortality in 36.55%(n=53). Mean gestational age was 29.90±1.70weeks, mean birth weight1147.52±190.21grams, mean maximum base excess during first 12h of life-8.04±3.92mmol/L, mean minimum appropriate FiO2 in first 12h34.38±13.02 %, mean maximum appropriate FiO2 in first 12h69.17±21.11 % and mean CRIB Score was 4.63±3.67. AUR curve was 0.816 and std. error was recorded as =0.039;p=0.000. Conclusion: Mortality in very preterm neonates can be accurately predicted by using CRIB score. Keywords: Very Preterm Babies, Neonatal Mortality, CRIB Score, Validity

Incidence, risk factors, and feto-maternal outcomes of inappropriate birth weight for gestational age among singleton live births in Qatar: A population-based study.

Abnormal fetal growth can be associated with factors during pregnancy and at postpartum. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes associated with small-for-gestational age (SGA) and large-for-gestational age (LGA) infants. We performed a population-based retrospective study on 14,641 singleton live births registered in the PEARL-Peristat Study between April 2017 and March 2018 in Qatar. We estimated the incidence and examined the risk factors and outcomes using univariate and multivariate analysis. SGA and LGA incidence rates were 6.0% and 15.6%, respectively. In-hospital mortality among SGA and LGA infants was 2.5% and 0.3%, respectively, while for NICU admission or death in labor room and operation theatre was 28.9% and 14.9% respectively. Preterm babies were more likely to be born SGA (aRR, 2.31; 95% CI, 1.45-3.57) but male infants (aRR, 0.57; 95% CI, 0.4-0.81), those born to parous (aRR 0.66; 95% CI, 0.45-0.93), or overweight (aRR, 0.64; 95% CI, 0.42-0.97) mothers were less likely to be born SGA. On the other hand, males (aRR, 1.82; 95% CI, 1.49-2.19), infants born to parous mothers (aRR 2.16; 95% CI, 1.63-2.82), or to mothers with gestational diabetes mellitus (aRR 1.36; 95% CI, 1.11-1.66), or pre-gestational diabetes mellitus (aRR 2.58; 95% CI, 1.8-3.47) were significantly more likely to be LGA. SGA infants were at high risk of in-hospital mortality (aRR, 226.56; 95% CI, 3.47-318.22), neonatal intensive care unit admission or death in labor room or operation theatre (aRR, 2.14 (1.36-3.22). Monitoring should be coordinated to alleviate the risks of inappropriate fetal growth and the associated adverse consequences.

732 Neonatal morbidity risk of small for gestational age births by race/ethnicity using popular growth curves

To compare ability of popular growth curves and ethnicity-specific growth curves to predict neonatal morbidity and mortality. Retrospective population-based cohort study of all US live births, stillbirths, and neonatal deaths using birth and death certificate records, 2012-2016. Birth outcomes were compared between 4 strata of race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (Hisp), and non-Hispanic Asian (NHA). The primary outcome was neonatal morbidity among SGA births defined by the Alexander, Hadlock, and NICHD race/ethnicity-specific growth curves. Composite neonatal morbidity was defined as neonatal use of antibiotics or surfactant, seizures, assisted ventilation, admission to NICU, stillbirth, or neonatal death. Severe neonatal morbidity was defined as seizures, assisted ventilation, stillbirth, or neonatal death. There were 17,750,507 live births, stillbirths, and neonatal deaths delivered between 35-40 weeks of gestation in the US, 2012-2016. Of those, 12.1% were categorized as SGA on either the Alexander, Hadlock, or the NICHD growth curve. The Alexander growth curve had a stronger association with neonatal morbidity for NHW SGA births (adjRR 1.99, CI 1.98-2.00) but the ethnicity-specific NICHD curves had stronger associations in NHB (adjRR 1.93, CI 1.91-1.95), Hisp (aRR 2.20, CI 2.18-2.22), and non-Hisp Asian births (adjRR 2.05, CI 2.01-2.09). However, all growth curves had overall poor predictive ability for neonatal morbidity, with AUCs ranging from 0.5867 to 0.6172. The predictive ability of all growth curves for diagnosis of SGA infants and associated morbidity is low, as not all diagnoses of SGA are pathologic. The Alexander and Hadlock growth curves were generated from a predominantly NHW population and may not appropriately determine SGA for other major ethnicities in the US. Using ethnicity specific curves may minimize over-diagnosis of SGA, although this practice change may not prove to be clinically significant. Updating growth curves may improve overall diagnostic capabilities.

Comparison of Respiratory Outcome between Sustained Lung Inflation and Intermittent Positive Ventilation in Preterm Infants Requiring Resuscitation at Birth

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for intubation and subsequent respiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess the efficacy of initial sustained lung inflation compared to standard intermittent positive pressure ventilation (IPPV) in preterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that was conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September 2019. The study included 115 preterm infants between 26 - 32 weeks of gestation who needed resuscitation at delivery room. The infants were randomly allocated into 2 groups; SLI group: included the preterm infants who received the SLI at initial inflation pressure of 25 cm H2O for 15 seconds using the Neopuff/T piece. IPPV group: preterm infants who received standard resuscitation; IPPV using the self-inflating bag. The heart rate (HR), oxygen saturation (SpO2), oxygen requirement, and intubation rate as well as need of surfactant in the delivery room were assessed. All cases were evaluated after admission to the NICU for the need of mechanical ventilation in the first 72 hours of life, death in delivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post menstrual age (PMA). Results: The percentage of preterm infants who needed resuscitation was 25.5% from the total deliveries during the study period. 56.5% of them received SLI and 43.4% received conventional IPPV. There were no significant differences between the studied groups regarding gestational age, birth weight. Apgar score, heart rate, oxygen saturation was not significantly increased in the SLI group at fifth minutes of age. The percentage of infants who needed further resuscitation was 20% in SLI group and 12% in the IPPV group. There were no significant differences in need for surfactant, CPAP or ventilator among the studied groups. There were no significant differences in relation to complications as BPD, air leak or retinopathy and death between the two groups. Conclusion: This study showed that there was no advantage from use of SLI in delivery room using T-piece upon the conventional IPPV using self-inflating bag.

A STUDY OF MATERNAL AND FETAL OUTCOME IN ANTEPARTUM HEMORRHAGE

Background: Antepartum hemorrhage has always been one of the most feared complications in obstetrics. The present study was conducted to assess maternal and fetal outcome in patients with antepartum hemorrhage. Materials & Methods: The present study was conducted on 94 cases of antepartum hemorrhage. In all cases, maternal and fetal outcome was recorded. Results: Common type of APH was abruptio placentae seen in 52, placenta Praevia in 30 and undetermined in 12 patients. Out of 52 cases of abruptio placentae, 20 were live birth, 15 were still birth, 12 were IUD and 5 were NICU death. IIN PP, 11 were live birth, 10 were still birth, 6 were IUD and 3 were NICU death. In undetermined, 5 were live birth, 3 were still birth, 2 were IUD and 2 were NICU death. Common cause of deaths in AP was sepsis in 14 and respiratory distress syndrome in 10. 32 in AP and 20 in PP had baby birth weight

Estimation of Level of Serum Lactate Dehydrogenase in Pre-eclampsia Patients and its Association with Maternal and Fetal Outcome

Introduction: Pre-eclampsia is a pregnancy-specific syndrome recognised as a leading cause of maternal and perinatal mortality. Etiopathogenesis of preeclampsia is defective placentation and endothelial dysfunction leading to oxidative stress and cellular lysis. Lactate Dehydrogenase (LDH) is an intracellular enzyme of glycolysis. Hypoxia and cellular lysis results in elevated levels of LDH. Early detection and management are important in prevention of Preeclampsia complications and deaths. Hence, the present study was conducted to estimate levels of Sr. LDH in Pre-eclampsia patients to find its association with maternal and fetal outcome was undertaken. Materials and Methods: Present prospective study was conducted in Department of Obstetrics and Gynaecology from August 2016 to December 2018 consisting of 84 cases of preeclampsia of ≥28 weeks gestation divided in 2 groups; Mild and Severe Preeclampsia. Sr. LDH was estimated in all study participants and its association with parameters of maternal and fetal outcome was observed. Results: In the present study, 46 patients had Mild Preeclampsia. and 38 had Severe Preeclampsia. Most cases of Mild preeclampsia. i.e., 78.3% had LDH <600 IU/L whereas 71.1% of Severe Preeclampsia. had LDH >600 IU/L. Complications like eclampsia in 66.7%, HELLP in 33.3%, Abruptio placenta in 55.6%, ARF and DIC in 33.3% cases were noted more in patients with LDH >800 IU/L. Fetal still birth in 55.6%, Lower APGAR score and more NICU admission and Early neonatal death was present in babies of preeclampsia mother with LDH >800 IU/L. There was found statistically significant association (p<0.001) of raised Sr. LDH levels with poor maternal and fetal outcome in preeclampsia patients. Conclusion: Elevated levels of Sr. LDH during hypoxia, indicate the cellular damage and dysfunction occurring in preeclampsia. Detection of patients with increased levels of LDH is of crucial importance to detect and promptly manage the complicated cases and decrease the morbidity and mortality in mother and fetus.

Assessment of Some Factors related to Admission of the Neonates to Neonatal Intensive Care Unit and their outcome at Al-Kut Hospital In Wassit Governorate.

Objective: In order to assess the some factors related with the admission of the neonates to neonatal intensive care unit, moreover to find out the relationship between these factors and outcome of the neonates. Methodology: A retrospective review of record / cross sectional study was conducted in Al-Kut hospital at Wassit governorate among a sample of women under 34 years of age during the period from 1st of January 2015 to end of February 2015. Data collection was done by using a hospital records that includes all the information. Results: The results showed that the mean(±SD) values of age for Neonates was (26.12 ±0 .093weeks), and the mean(±SD) values of weight for Neonates was (2.9809± 0.03616 kg). The majority of neonates admission to the NICU because of respiratory distress syndrome, they have accounted more than half . Correlation analysis of results, showed that there was significantly positive correlation between birth type and other risk factors for the neonates. Also, it was observed from the results that there was significantly positive correlation between birth type with causes of admission and causes of death in NICU. Recommendations: One of the main recommendations of the study are improvement the health and nutrition of mothers and provision of reproductive health services especially obstetric care and postpartum care at the right time for both mothers and newborns. In addition to enhancing the links between the different levels of care in health facilities.

The Relationship between Amniotic Fluid Index (AFI) & Single Largest Vertical Pocket and Perinatal Outcome in Late Severe Preeclampsia

Backgound: the amniotic fluid is a clear fluid that surrounds the fetus, and produced in part by the amniotic cells, maternal blood during the first trimester of pregnancy and fetal urine and lung fluid during the second trimester of pregnancy. It serves as a cushion to the fetus allowing musculoskeletal development and protecting it from trauma. It also maintains temperature and has a minimal nutritive function. Evaluation of AFV through ultrasound measurement is an essential part in tests of fetal well-being (BPP), by measuring the AFI or the MVP. Objective: the aim of this study was to evaluate both AFI and single deepest pocket in patients with late severe preeclampsia, and to correlate both markers with different parameters of fetal outcome. Patients and Methods: the study was a prospective controlled study involving 100 women with severe preeclampsia >34w managed at Al Hussein University Hospital and Al Arish General Hospital with the following inclusion criteria, pregnant patients, age 18- 40 years old, with variable parity and a singleton living fetus >34 weeks gestation, and with severe preeclampsia. Results: the neonatal outcomes regarding meconium is more with AFI group than MVP group while the neonatal outcome regarding NICU, RDS & Neonatal death in both groups were similar with no evidence of a statistical difference between both techniques. Conclusion: we concluded that AFI had more significant statistical relationship with perinatal outcome, hence AFI appeared to be a better predictor of perinatal outcome in preeclamptics in late severe preeclampsia.

497: Angiogenic factors vs. standard evaluation in the prediction of adverse outcome among pregnancies with suspected fetal growth restriction

Prediction of adverse neonatal outcome in growth restricted fetuses (FGR) is challenging. Currently, standard evaluation includes Doppler surveillance and repeated clinical assessments. While this management protocol identifies most anticipated complications, some cases are missed and the health-care provider’s ability to predict adverse outcome may be improved. We studied the added value of angiogenic factors in management of FGR cases for the prediction of adverse perinatal outcomes. This prospective cohort study included hospitalized women with singleton pregnancies diagnosed with FGR between 24 and 35+6 weeks’ gestation (n=58). At hospitalization blood was drawn from women for sFlt-1 and PlGF measurements. Hence, three attending maternal-fetal medicine (MFM) assessed the risk of these pregnancies to develop adverse neonatal outcome (blinded), after examining the available maternal and pregnancy data upon admission. Data presented included: Doppler surveillance, clinical data and obstetrical history. The specialists predicted the risk (1-5 scale) for adverse neonatal outcome defined as: prolong NICU hospitalization, IVH, ARDS, NEC, convulsions and death. A given score of above 2 (scale of 1-5) was considered a high predicted risk for developing a complication. A score of over 14.5 multiple of the expected median (MoM) in the sFlt-1/ PlGF ratio was defined as a high predicted risk for complication. To describe performance, receiver-operating characteristic (ROC) curves were constructed for biochemical markers and clinical prediction. Disagreement between specialists was defined as a difference of 2 points or more in a given score. Of the 58 FGR cases included, 30 were complicated by adverse neonatal outcome (52%). The predictive values of the clinical assessments and of the bio-marker ratios are presented in the Table. Areas under the curve (AUCs)are presented in the Figure. Disagreement between specialists was identified in 19 cases - 32%. In 18 (95%) of these cases the marker predicted outcome accurately. Maternal serum sFlt-1/PlGF ratio can substantially improve clinical prediction of adverse neonatal outcome in FGR management. Furthermore, these biochemical tools appear to have a unique role in cases of disagreement between MFM specialists managing these cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

MR. SOPA-DRILLS TO IMPROVE MASK VENTILATION IN THE DELIVERY ROOM

BACKGROUND: Effective positive pressure ventilation (PPV) via facemask is dependent on adequate mask ventilation technique. Mask leak and airway obstruction can affect effective PPV. The Neonatal Resuscitation Program (NRP) emphasizes that during PPV corrective steps “MR. SOPA” should be performed to ensure effective mask PPV. However, skills taught during a NRP-course generally decline shortly afterwards and often do not result in proficiency during mask PPV. OBJECTIVES: We hypothesized that daily simulation drills to teach the MR. SOPA corrective steps will improve mask ventilation performance in preterm infants <33 weeks requiring PPV at birth. DESIGN/METHODS: After a 4-month observation period (baseline), we randomly assigned 58 healthcare members from the local neonatal resuscitation team to either daily MR. SOPA drills or self-directed revision of the 2015 NRP algorithm over a period of 3 months (intervention phase). This was followed by a 4-month post-observation phase (post-training phase). During baseline and post-training phase resuscitations of infants <33weeks gestation were recorded using our unique recording system (incl. respiratory function monitoring and video recordings). Mask ventilation performance and use of MR. SOPA were compared between pre and post intervention phase. RESULTS: Overall, there was a significant increase in efficiently and correctly applying MR. SOPA corrective steps during PPV in the MR. SOPA drill group. There was no difference in the rate of delivery room intubation post intervention. There was no difference on days of respiratory support following admission to NICU or neonatal death at discharge. CONCLUSION: Healthcare provider receiving daily MR. SOPA drills had improved mask ventilation technique and performance compared to self-directed NRP learning.

Risk factors and newborn outcomes associated with maternal deaths in the UK from 2009 to 2013: a national case-control study.

ObjectivesTo identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK.DesignUnmatched case–control analysis.SettingAll hospitals caring for pregnant women in the UK.PopulationComprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life‐threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS).MethodsMultivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.OutcomesOdds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk.ResultsSeven factors, of 13 examined, were independently associated with increased odds of maternal death: pre‐existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29–11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14–11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33–2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61–111.94), substance misuse (aOR 12.21; 95% CI 2.33–63.98), unemployment (aOR 1.81; 95% CI 1.08–3.04) and maternal age (aOR 1.06; 95% CI 1.04–1.09). There was a four‐fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died.ConclusionThis study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio‐economic inequalities in maternal death in the UK.Tweetable abstractMedical comorbidities and socio‐economic inequalities are important risk factors for maternal death in the UK.

Perinatal Outcome in 1515 Cases of Prolonged Second Stage of Labour in Nulliparous Women.

To examine perinatal outcomes among nulliparous women with a second stage of labour lasting more than three hours. We conducted a retrospective review of all nulliparous women over a 14-year period who had a term, live, singleton, cephalic fetus ≥ 2500 g and who had a second stage of labour lasting at least three hours. Outcome measures included five-minute Apgar score < 7, cord arterial pH < 7.10, admission to the NICU, neonatal seizures, and neonatal death. Rates of serious long-term neurologic morbidity were also analyzed. Outcomes were compared with those of a similar cohort of women who delivered after less than three hours in the second stage. During the study period, 1515 women met the inclusion criteria. The majority of women (67%) delivered vaginally, after up to 10 hours in the second stage of labour. The overall rate of Caesarean section was low (15.7%). The rate of permanent neurologic impairment was 2.6 per 1000 deliveries. Among nulliparous women, 84% were spared a possibly difficult Caesarean section in the second stage of labour or a potentially difficult operative vaginal delivery by allowing a longer second stage. However, surviving neonates had a higher risk of permanent neurologic handicap. Our study indicates that the optimal management of the second stage of labour remains controversial.

Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial.

Hypothermia at 33.5°C for 72 hours for neonatal hypoxic ischemic encephalopathy reduces death or disability to 44% to 55%; longer cooling and deeper cooling are neuroprotective in animal models. To determine if longer duration cooling (120 hours), deeper cooling (32.0°C), or both are superior to cooling at 33.5°C for 72 hours in neonates who are full-term with moderate or severe hypoxic ischemic encephalopathy. A randomized, 2 × 2 factorial design clinical trial performed in 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network between October 2010 and November 2013. Neonates were assigned to 4 hypothermia groups; 33.5°C for 72 hours, 32.0°C for 72 hours, 33.5°C for 120 hours, and 32.0°C for 120 hours. The primary outcome of death or disability at 18 to 22 months is ongoing. The independent data and safety monitoring committee paused the trial to evaluate safety (cardiac arrhythmia, persistent acidosis, major vessel thrombosis and bleeding, and death in the neonatal intensive care unit [NICU]) after the first 50 neonates were enrolled, then after every subsequent 25 neonates. The trial was closed for emerging safety profile and futility analysis after the eighth review with 364 neonates enrolled (of 726 planned). This report focuses on safety and NICU deaths by marginal comparisons of 72 hours' vs 120 hours' duration and 33.5°C depth vs 32.0°C depth (predefined secondary outcomes). The NICU death rates were 7 of 95 neonates (7%) for the 33.5°C for 72 hours group, 13 of 90 neonates (14%) for the 32.0°C for 72 hours group, 15 of 96 neonates (16%) for the 33.5°C for 120 hours group, and 14 of 83 neonates (17%) for the 32.0°C for 120 hours group. The adjusted risk ratio (RR) for NICU deaths for the 120 hours group vs 72 hours group was 1.37 (95% CI, 0.92-2.04) and for the 32.0°C group vs 33.5°C group was 1.24 (95% CI, 0.69-2.25). Safety outcomes were similar between the 120 hours group vs 72 hours group and the 32.0°C group vs 33.5°C group, except major bleeding occurred among 1% in the 120 hours group vs 3% in the 72 hours group (RR, 0.25 [95% CI, 0.07-0.91]). Futility analysis determined that the probability of detecting a statistically significant benefit for longer cooling, deeper cooling, or both for NICU death was less than 2%. Among neonates who were full-term with moderate or severe hypoxic ischemic encephalopathy, longer cooling, deeper cooling, or both compared with hypothermia at 33.5°C for 72 hours did not reduce NICU death. These results have implications for patient care and design of future trials. clinicaltrials.gov Identifier: NCT01192776.

The educational needs of neonatal nurses regarding neonatal palliative care

Studies have shown that education can improve the knowledge, attitudes, and beliefs of neonatal nurses regarding neonatal palliative care. However, no study has investigated the need for neonatal nurse education in neonatal palliative care in Taiwan. The purpose of this study was to explore neonatal nurses' experiences in caring for dying neonates and their educational backgrounds regarding palliative care, as well as to assess their educational needs. A cross-sectional survey was used for this research. A research structural questionnaire was used to investigate the research goals. One hundred fifteen nurses participated in this survey. Few participants indicated having received neonatal palliative care education (13%), but most responded that palliative care is necessary in neonatal nursing education (97.4%). Participants also responded that they were often or always exposed to death in NICU (62.6%), but few reported providing pain management to dying neonates (8.7%) and few had experience providing symptomatic care for dying neonates (19.1%). Fifty percent ranked "pain control" as the area in which they most required training. Another high-ranked need was in discussing with parents and families the outcomes of CPR and their neonate's progress. Research indicates that the education currently provided to neonatal nurses does not meet their distinctive needs. Neonatal nurses in Taiwan expressed an urgent desire for training in pain control and communication. Research suggests that the most important topics to trainees are pain management and end-of-life communication. Additionally, non-pharmacological pain control interventions are valuable and should be included in an educational program.

828: Perinatal outcomes associated with obstructive sleep apnea in pregnancy: a prospective study

sleep apnea in pregnancy: a prospective study Judette Louis, Susan Redline, Dennis Auckley, Anna Shepherd, Patricia Mencin, Brian Mercer MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, MetroHealth Medical CenterCase Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. All studies were manually scored by a central masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. An apnea hypopnea index (AHI) 5 was considered to be diagnostic of OSA, [Mild (AHI: 5-15), Moderate (AHI: 15-30) and Severe (AHI: 30]. Perinatal outcomes were compared between women with and without OSA (p5 days, and readmission. Evaluated neonatal outcomes were: NICU admission, RDS, transient tachypnea (TTN), sepsis, and death. RESULTS: Among 170 evaluated obese women, the prevalence of OSA was 12.4% (12 mild, 7 moderate, 2 severe). Women with OSA had a mean AHI of 20 / 6 events per hour of sleep and spent 6.5 / 2.5% of the night with an SpO2 90%. Compared with controls, the OSA group had higher BMIs (49 / 11 vs. 39 / 6 k/m2, p 0.001) but similar rates of chronic hypertension (58 vs. 33%, p 0.07) and pregestational diabetes (15 vs. 20%, p 0.76). Severe maternal complications included: Maternal death (N 1, amniotic fluid embolus, control group) and cardiac arrest (N 1, intraoperative at cesarean delivery, OSA group). One previable birth and 2 stillbirths occurred in the control group. Among livebirths, OSA was associated with more frequent PET, NICU admission and TTN. (Table). After controlling for BMI, OSA was not associated with PET [OR .4(.11-1.4, p 0.15). After controlling for diabetes, gestational age and cesarean, neonates of women with OSA were more likely to have TTN (OR 4.7 (1.1-19.1, p 0.02) CONCLUSION: Untreated OSA among obese women in pregnancy is associated with more frequent neonatal respiratory complications 829 Nocturnal hypoxemia and neonatal body composition Judette Louis, Dennis Auckley, Susan Redline, Anna Shepherd, Patricia Mencin, Brian Mercer, Patrick Catalano MetroHealth Medical Center-Case Western Reserve University, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, MetroHealth Medical Center-Case Western Reserve University, Division of Pulmonary, Critical Care and Sleep Medicine, Cleveland, OH, Harvard Medical School, Division of Sleep Medicine, Department of Internal Medicine, Boston, MA, MetroHealth Medical Center-Case Western Reserve University, Obstetrics G Carlsbad, CA) that recorded nasal pressure, oxygen saturation, snoring, and head movements. Sleep studies were manually scored by an independent masked Sleep Reading Center using American Academy of Sleep Medicine diagnostic criteria. Any SpO2 90% was considered an episode of hypoxemia. Maternal and neonatal body composition was measured by air displacement plethysmography (BodPod, PeaPod). Neonatal morphometry was evaluated using a standardized protocol within 72 hours of birth. The primary outcome was neonatal lean body composition (%lean body mass, NLBM %). This analysis was restricted to neonates delivered 37 weeks. RESULTS: The cohort included 78 maternal/neonatal pairs. On average women were screened for OSA at mean [S.D.] gestational age of 22 [5] weeks, were age 27 [6] years, BMI 40.1 [8] kg/m2, % body fat (MBF %) 44 [6] %. And delivered at 38.6[1.3] weeks. Chronic hypertension (33%), pregestational (18%) and gestational diabetes (14%) were common. Eleven percent of these mothers had OSA who spent 2.5[1.1] % of the total sleep time with hypoxemia, and had a mean lowest SpO2 of 85 [5] %. Mean birth weight for the cohort was 3284 [507] gm, and NLBM% 86 [4] %. NLBM% was associated with maternal BMI (r 0.23, p 0.04), but not MBF% ( .15, p 0.06), degree of nocturnal hypoxemia (r .07, p 0.58) or lowest SpO2 (r .266, p 0.1). Neonates of OSA mothers were similar to neonates of non-OSA mothers regarding ponderal index (2.8 vs. 2.9, p 0.45) and NLBM% (85.1 vs. 87.7%, p 0.05). CONCLUSION: In obese pregnant women, using standardized methodology and criteria, neither prospectively diagnosed maternal OSA nor nocturnal hypoxia were associated with increased neonatal adiposity

Long-Term Forecasting of Death in the Neonatal ICU using Heart Rate Characteristics Monitoring and Clinical Data

Background: Early and on-going prediction of in-NICU mortality can aid clinicians and parents who are caring for high-risk preterm infants.We developed heart rate characteristics (HRC) monitoring based on findings of reduced variability and transient decelerations prior to signs of sepsis. The HRC index, or HeRO score, is the fold-increase in risk of sepsis in the next 24 hours. Rising HeRO scores prompt clinicians to evaluate infants not otherwise suspected of illness. In the HeRO trial, we randomized 3000 VLBW infants in 9 US NICUs either to display of HeRO scores or to conventional monitoring. Those whose HeRO score results were displayed had statistically significant mortality reduction in excess of 20%.Aims: In this work, our aim was to test the hypothesis that average HeRO scores and knowledge of sepsis and ventilation can accurately predict NICU mortality from early in the stay.Methods: We modeled 152 deaths in 1489 VLBW infants who received only conventional monitoring in the HeRO trial using multivariable logistic regression.Results: In order of significance, the average HeRO score, presence of ventilator, birth weight, Apgar score at 5 (but not 1) minutes, and sepsis within the past 10 days predicted mortality (p< 0.005 for each). The model had good discrimination, with ROC area near 0.85 starting at 3 hours of monitoring.Conclusions: Heart rate characteristics monitoring and clinical data about ventilation and sepsis predict NICU death beginning at 3 hours. These findings may add to the mortality benefit of HeRO monitoring.

Analysis of neonatal death in NICU during the latest 5 years

Objective To analyze the cause and change of neonatal death during the latest 5 years,to discuss the ways to decrease the mortality.Methods A retrospective analysis of 69 cases in NICU were performed from Jan 2004 to Dec 2008.Results(1)The sex ratio of male to female was 1.7:1.The preterm infants accounted for 34.8%,preterm infants with gestational ages of less than 32 weeks accounted for 70.8% of the total premature deaths.(2)59.4% of the deaths in newborn infants occurred in the first 7days of life.69.6% occurred within 3 days after admission.(3)The three leading causes of premature infant death were RDS,sepsis and scleredema neonatorum,accounted for 75% of premature death.The three leading canses of full term death were sepsis,neonate severe asphyxia and pneumonia,accounted for 71.1% of all full term death.(4)The newborn who died of RDS were gradually decreasing.Those who died of sepsis and severe asphyxia weren't changing.Condusion Heath care during the perinatal period should be strengthened to decrease the premature birth and asphyxia.The neonatal new resuscitation technique should be widely adovocated and neonatal sepsis should be treated positively. Key words: Infant; newborn; Neonate; premature; Death

El intervalo intergenésico: un factor de riesgo para complicaciones obstétricas y neonatales

Objective To determine the impact of the interval between pregnancies on maternal-foetal morbidity. Materiads Method A cohort study carried out from 1st May until 31st December 2002 in the Gynaecology and Obstetric Department of the Metropolitan Hospital Complex (Social Security) in Panama. We included patients with previous pregnancies, and who were admitted with spontaneous abortion, and patients of any gestational age who were admitted because of pregnancy termination. We excluded primigravidas, patients with a disease existing before pregnancy, and those with incomplete records. We correlated obstetric pathologies, neonatal outcome, and the interval between pregnancies. Statistical analysis was made with EPI-INFO 2002, Chi-square. The odds ratio (OR) had a confidence interval (CI) of 95% and p < 0.05. Results A total of 1044 patients were analysed, the average age was 29.7 ± 5.14 years and 8.1% were multiparous patients. The average interval between pregnancies was 45 ± 31.7 months. The obstetrical and neonatal pathologies associated with the interval between pregnancies were pre-eclampsia, gestational diabetes, placental abruption, stillbirth, foetal distress, premature delivery, placenta previa, admission to NICU, apgar score and perinatal death. We found that the period between 25 and 48 months had a protective factor against the development of obstetric and neonatal complications. A period ≤ 24 months is a risk factor for the development of premature delivery, OR 13 (95% CI, 9-18), a higher number of admissions to NICU, OR 5.7 (95% CI, 3-9), and perinatal death OR 3.2 (95% CI, 1.3-8). An interval between pregnancies o ≥ 49 months is a risk factor for the development of pre-eclampsia OR 29 (95% CI, 19-45), placental abruption OR 3.6 (95% CI, 1.2-11) and caesarean section OR 10.1 (95% CI, 6-17). Conclusions An interval between pregnancies ≤ 24 months and = 49 months are associated with an increase in obstetric and neonatal complications, thus the period between 25 and 48 months is optimal to prevent maternal-foetal complications.

Willingness or unwillingness to perform cesarean section for impending preterm delivery at 24 weeks gestation: A cost effectiveness analysis

Willingness or unwillingness to perform cesarean section for impending preterm delivery at 24 weeks gestation: A cost effectiveness analysis