Occurrence Of Neonatal Death Research Articles

Unplanned cesarean sections in advanced maternal age: Apredictive model.

As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40-44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72-0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section.

Perception of pregnant women towards midwives: attitude and practice during child delivery in health institutions in Ogbomoso, South-West, Nigeria


 Background: This study aims to ascertain pregnant women’s perceptions of the attitudes and practice of midwives during labour in a mission teaching hospital and a state hospital in Ogbomoso, Southwest Nigeria, and to determine whether or not a relationship exists between patients’perceptions of midwives practice during delivery and the occurrence of neonatal deaths.
 Methods: The survey was conducted by administering the questionnaire adapted from Caring Behaviour Inventory (CBI) to a random sample of five hundred and seventy nine respondent mothers who gave birth in either a Mission teaching hospital or a state hospital in Ogbomoso, Southwest Nigeria. This standardised questionnaire collects demographic data and patient perceptions of nursing attitudes and practice, ranking patients’ responses to a series of statements about the midwives on a four point Likert scale. Data was analysed using Pearson product moment correlation analyses and multiple regression analyses.
 Results: Our study revealed that there was a positive response on the attitude and practise of midwives during delivery by the respondents. Secondly, there was a positive impression on the influence of the attitude and practice of midwives during delivery by the respondents.
 Conclusions: There was no evidence of a relationship between patients’ perceptions of midwives practice during delivery and the occurrence of neonatal deaths.

1115 A comparison of maternal and neonatal outcomes in acute and chronic hepatitis B

We sought to estimate differences in maternal and neonatal outcomes between acute hepatitis B (HBV) infections and chronic HBV infections in pregnancy. We conducted a retrospective cohort study of patients with singleton, non-anomalous births in California from 2007 to 2011. We included only those with gestational ages between 27 and 42 weeks. We evaluated maternal outcomes using occurrence of gestational hypertension, gestational diabetes, preterm delivery, mild to severe preeclampsia, eclampsia, severe maternal morbidity, rupture of membranes before thirty-seven weeks gestation and induction of labor. We evaluated neonatal outcomes using neonatal death (within six weeks of birth), infant death (within one year of birth), NICU admissions over twenty-four hours, birth injuries and hypoxic ischemia encephalopathy. Analysis was performed with chi-square tests using a significance cutoff of 0.05 and logistic multivariate regressions controlling for ethnicity, age, parity, basal metabolic index, smoking status, insurance type and education level. In a California cohort of 2,805 pregnant individuals with confirmed HBV infections, 1370 (49%) had acute infections and 1435 (51%) had chronic infections. Gestational diabetes (aOR 1.40, 95% CI 1.09-1.79) , pre-eclampsia (aOR 1.81, 95% CI 1.11-2.93) and premature rupture of membranes (aOR 1.95, 95% CI 1.39-2.74) were statistically significantly different for women with chronic infections (Table 1). No statistically significant differences were observed between the two groups (Table 2). The occurrence of neonatal death, infant death and hypoxic ischemia encephalopathy in both groups was insignificant. In this analysis, chronic HBV infected persons had significantly different maternal outcomes compared to those with acute infections in pregnancy however, infants born to women with acute and chronic hepatitis B infections showed no difference in neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Fatores associados à mortalidade neonatal em recém-nascidos de baixo peso ao nascer

Objetivo: Analisar os fatores associados à mortalidade neonatal de recém-nascidos com baixo peso ao nascer. Métodos: Estudo do tipo coorte retrospectiva, com recém-nascidos de baixo peso que foram a óbito nos primeiros 27 dias de vida, no período de 2011 a 2014. Coletou-se dados no Sistema de Informação sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. O Linkage determinístico unificou os dados dos dois sistemas. Para a análise no efeito de covariáveis sobre a força da mortalidade neonatal em recém-nascidos de baixo peso aplicou-se a regressão simples. E, posteriormente a regressão logística. As variáveis testadas nos modelos de regressão foram selecionadas quando apresentaram a significância estatística para os valores de p ≤ 0,05, bem como a presença de variáveis de ajuste. Resultados: Mostraram-se como fatores associados à mortalidade neonatal: parto vaginal; realização de 1 a 6 consultas de pré-natal; peso ao nascer entre 500 a 999 gramas; Apgar menor que sete e a presença de anomalia congênita. Conclusão: A ocorrência de óbito neonatal de recém-nascidos com baixo peso se relaciona à qualidade da assistência durante a gestação, ao parto e ao recém-nascido.

Inquérito soro-epidemiológico sobre neosporose bovina no norte do estado de Mato Grosso, Brasil

This work involved the study of anti-Neospora caninum antibodies by indirect immunofluorescence assay in serum samples of 205 cows (Bos taurus indicus) Nellore, pure origin, aged over 24 months, reared on farms in the municipalities of Sinop, Itaúba, Colíder, Carlinda and Guarantã do Norte, Mato Grosso state, Brazil. An epidemiological evaluation through an interview with employees responsible for taking care of the animals during the period of 2010-2012. The studied area revealed epidemiological conditions favorable for the occurrence of bovine neosporosis, with 37.56% seropositive animals for anti-N. caninum. Sinop (70%) and Carlinda (50%) showed a frequency of seropositive animals was statistically equal to that observed (26.67%) in other studies for other cities in Brazil. By confronting the serological status of the animals with variables of questionnaire, there was association (p < 0.01) between seropositivity of cows and the natural sources of drinking water, the incidence of abortion and repeating estrus. However, there was no statistical association between seropositive cows and the occurrence of neonatal deaths (p = 0.075), stillbirths (p = 0.02), presence of domestic dogs (p = 0.9) and the habit of giving raw offal to dogs (p = 0.93). Besides the occurrence of N. caninum, it was evidenced misinformation about bovine neosporosis and its control among interviewed people. This first study shows the need for further research on the epidemiology of bovine neosporosis in northern Mato Grosso state.

Urine S100 BB and A1B dimers are valuable predictors of adverse outcome in full-term asphyxiated infants

To investigate whether S100A1B and BB dimers are predictors of early perinatal death in newborns with perinatal asphyxia (PA). The study compared 38 full-term newborns with PA [neonatal death n = 11; hypoxic ischaemic encephalopathy (HIE): n = 27] with a control group of 38 healthy infants. Clinical and laboratory parameters were recorded at eight time points and urine collected for S100B assessment. Multivariate analysis was performed in order to analyse the influence of various clinical parameters on the occurrence of neonatal death. A1B and BB in PA nonsurvivor infants were significantly higher (p < 0.001) than in controls at all monitoring time points. BB at first void (cut-off>42 ng/L) was the best predictor of early neonatal death (p < 0.05) of all the clinical and laboratory parameters studied. These results suggest that S100s are valuable predictors of adverse outcome in PA infants. It is also suggested that these biomarkers be used in daily clinical practice, due to their low cost and stress, reproducibility and the possibility of longitudinal monitoring.

Diagnostic Accuracy of S100B Urinary Testing at Birth in Full-Term Asphyxiated Newborns to Predict Neonatal Death

BackgroundNeonatal death in full-term infants who suffer from perinatal asphyxia (PA) is a major subject of investigation, since few tools exist to predict patients at risk of ominous outcome. We studied the possibility that urine S100B measurement may identify which PA-affected infants are at risk of early postnatal death.Methodology/Principal FindingsIn a cross-sectional study between January 1, 2001 and December 1, 2006 we measured S100B protein in urine collected from term infants (n = 132), 60 of whom suffered PA. According to their outcome at 7 days, infants with PA were subsequently classified either as asphyxiated infants complicated by hypoxic ischemic encephalopathy with no ominous outcome (HIE Group; n = 48), or as newborns who died within the first post-natal week (Ominous Outcome Group; n = 12). Routine laboratory variables, cerebral ultrasound, neurological patterns and urine concentrations of S100B protein were determined at first urination and after 24, 48 and 96 hours. The severity of illness in the first 24 hours after birth was measured using the Score for Neonatal Acute Physiology-Perinatal Extension (SNAP-PE). Urine S100B levels were higher from the first urination in the ominous outcome group than in healthy or HIE Groups (p<0.001 for all), and progressively increased. Multiple logistic regression analysis showed a significant correlation between S100B concentrations and the occurrence of neonatal death. At a cut-off >1.0 µg/L S100B had a sensitivity/specificity of 100% for predicting neonatal death.Conclusions/SignificanceIncreased S100B protein urine levels in term newborns suffering PA seem to suggest a higher risk of neonatal death for these infants.

S100B Protein in Urine of Preterm Newborns with Ominous Outcome

Prematurity is an important cause of perinatal death, and no reliable biochemical/biophysical markers exist to identify newborns with an increased mortality risk. We aimed to use S100B concentrations in urine as an early indicator of risk of neonatal death. We did a cross-sectional study using urine obtained from 165 preterm newborns, of whom 11 suffered neonatal death within the first week, 121 displayed no overt neurologic syndrome, and 33 suffered neonatal hypoxia and intraventricular hemorrhage (IVH) but not ominous outcome. Urine S100B concentrations were determined at four time-points and corrected for gestational age by conversion to multiples of median (MoM) of healthy controls of the same gestational age. Ultrasound imaging was assessed within the first 72 h from birth. In infants that died within the first week, S100B levels in urine were already higher than controls at first urination and increased progressively between the 24 and 96-h time-points. Multiple logistic regression analysis showed a significant correlation between urine S100B protein concentrations and the occurrence of neonatal death. An S100B concentration cut-off of 12.93 MoM at first urination had a sensitivity of 100% and a specificity of 97.8% for predicting an ominous outcome. The positive predictive value was 78.6%, the negative predictive value was 100%. Measurement of urine S100B protein levels in preterm newborns could be useful to identify newborns at higher risk of neonatal death.

92 Increased S100B Urinary Measurements at Birth May Predict Neonatal Death in Preterm Newborns

Background: To date no effective biochemical/biophysical tools exist to predict, among preterm infants, the cases at higher risk for perinatal death. The present study is aimed at investigating whether the measurement of S100B protein in urine may represent a useful tool to early identify patients at risk of postnatal death. Methods: A retrospective case-control study was performed to measure S100B protein in urine fluid of preterm infants (n= 165) admitted to three tertiary NICUs (from January 1, 1999 to May 31, 2003), of whom a subgroup (n= 11) suffered spontaneous early neonatal death within the first week of age. Routine laboratory variables, neurological patterns and urine concentrations of S100B protein were determined at four time-points (at first urination, and after 24, 48, 96 hour). Ultrasound imaging were assessed within the first 72 hours from birth. Results: S100B levels, in infants who died within the first week of age, were already higher at first urination and progressively increased from 24 to 96 hour time-points than controls (p< 0.001, for all). Multiple logistic regression analysis showed a significant correlation between S100B protein urine concentrations and the occurrence of neonatal death. An S100B concentration cut-off of 12.7 MoM at first urination had a sensitivity of 100 percent and a specificity of 98.3 percent for predicting an abnormal neonatal follow-up. The positive predictive value was of 78.57%, the negative predictive value was of 100%. Conclusion: Measurement of S100B protein urine levels in newborns, could be aid to identify newborns at higher risk for developing neonatal death.

Cardiotocografia Anteparto e Prognóstico Perinatal em Gestações Complicadas pelo Diabete: Influência do Controle Metabólico Materno

Objetivo: relacionar a qualidade do controle metabólico com os resultados da cardiotocografia (CTG) anteparto e avaliar sua capacidade preditiva no prognóstico perinatal de gestações associadas ao diabete. Pacientes e Métodos: estudo retrospectivo de 125 gestantes, portadoras de diabete gestacional ou clínico, no qual se relacionou a última CTG anteparto (intervalo máximo de 48 horas) à qualidade do controle metabólico materno e aos resultados perinatais. A qualidade do controle metabólico foi definida pela média glicêmica do dia do exame (MGd) e da gestação (MG) e pelo comportamento da requisição de insulina (R/insulina). Para os resultados perinatais foram analisados os índices de Apgar de 1º e 5º minuto, a classificação peso/idade gestacional, o tempo de internação, a necessidade de cuidados de UTI e a ocorrência de óbito neonatal (ONN) precoce. A capacidade diagnóstica da CTG anteparto foi avaliada pelos índices de sensibilidade, especificidade e valor preditivo positivo e negativo. Resultados: a MGd adequada (<120 mg/dL) associou-se a 2,9% dos resultados de CTG anteparto alterados e a inadequada ( > ou = 120 mg/dL), a 26,1% (p<0,005). A MG mantida inadequada se relacionou a 13,7% de CTG anteparto alterada e a adequada, a apenas 2,7% (p<0,005). O comportamento da requisição de insulina não interferiu nos resultados da CTG anteparto. Os índices de Apgar de 1º e 5º minuto, a necessidade de cuidados de UTI e a ocorrência de ONN precoce não dependeram do último traçado da CTG anteparto. O exame diferenciou o tempo de internação dos recém-nascidos: quando normal, 46,4% tiveram alta hospitalar até o 3º dia de vida e, quando alterado, 62,5% deles ficaram internados por mais de sete dias. Conclusões: os resultados alterados da última CTG anteparto relacionaram-se com níveis inadequados de MG, diária e da gestação, e não dependeram da R/insulina. O resultado normal da CTG anteparto foi adequado para garantir a saúde neonatal. Ao contrário, os resultados alterados indicaram risco de complicações nos filhos de mães diabéticas.

A matched case-control study of factors associated with retention of fetal membranes in dairy ewes in Southern Greece

We defined retention of fetal membranes (RFM) in dairy ewes as failure to expel the placenta within 6 h after lambing the last lamb and designed a matched case-control study to identify factors that affect the risk of retention. For each ewe with RFM, the next ewe in the flock that lambed and expelled the placenta in <6 h after lambing the last lamb was selected as control. Data analyzed included 92 pairs of ewes from 25 flocks comprising a total of 7275 ewes (median flocksize 270 ewes). Factors investigated for associations with RFM were induction of lambing, obstetrical assistance because of dystocia, parity, the number of liveborn lambs, the occurrence of stillbirth(s), the mean weight of the litter on the third day post-lambing and the occurrence of neonatal death in the litter. Conditional logistic regression indicated (1) that the risk of RFM increased linearly with increasing number of liveborn lambs and (2) that the risk of retention was 4-fold higher in ewes that received assistance at lambing than those that lambed normally.