Terms Of Neonatal Outcomes Research Articles

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years. This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minute Apgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire. Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1(st) and 5(th) min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus). With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.

Preventive induction of labor for non-urgent indications at term and maternal and neonatal outcomes.

BackgroundInduction of labor (IOL) is a common practice in many parts of the world. However, the benefits and risks of preventive IOL for the mother and baby have yet to be critically assessed. This study is to investigate the effects of preventive IOL for non-urgent indications at term on maternal and neonatal outcomes.MethodsIn this study, we applied a propensity score model to mimic a randomized clinical trial. Maternal and neonatal outcomes were compared between women with preventive IOL at 37–39 weeks of gestation and women with ongoing pregnancy (expectant management). The subjects were from the Consortium on Safe Labor, a study of over 200,000 births from 19 hospitals across the US from 2002 to 2008.ResultsBoth nulliparous and multiparous women induced preventively for non-urgent indications at 37–38 weeks’ gestation had lower rates of cesarean delivery compared to those delivered at later gestational weeks. However, preventive IOL was associated with increased risks of adverse neonatal outcomes (adjusted odds ratio [aOR] = 1.68, 95 % confidence interval [CI], 0.97–2.92 for nulliparas; aOR = 2.22, 1.32–3.74 for multiparas) and admission to NICU (aOR = 1.48, 0.99–2.20 for nulliparas; aOR = 2.08, 1.47–2.96 for multiparas) at 37 weeks’ gestation. A longer maternal hospital stay was found among all women with preventive IOL.ConclusionsPreventive IOL for non-urgent indications may be associated with a decreased risk of cesarean delivery at early term but increased risks of adverse neonatal outcomes at 37 weeks. It also results in a longer hospital stay than expectant management.

Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates.

To determine whether an isolated single umbilical artery (iSUA) is an independent risk factor for perinatal mortality in term neonates with normal estimated fetal weight (EFW) prior to delivery. A population-based study was conducted, including all deliveries occurring between 1993 and 2013, in a tertiary medical center. Pregnancies with and without iSUA were compared. Multiple gestations, chromosomal, and structural abnormalities were excluded from the cohort. Only pregnancies delivered at term with normal EFW evaluated prior to delivery were included. Stratified analysis was performed using multiple logistic regression models to evaluate the risk of adverse outcomes and perinatal mortality for iSUA fetuses. During the study period, 233,123 deliveries occurred at "Soroka" University Medical Center, out of which 786 (0.3%) were diagnosed with iSUA. Different pregnancy complications were more common with iSUA fetuses including: placental abruption (OR=3.4), true knot of cord (OR=3.5) and cord prolapse (OR=2.8). Induction of labor and cesarean delivery were also more common in these pregnancies (OR=1.5 and OR=1.9, respectively). iSUA neonates had lower Apgar scores at 1 and 5min (OR=1.8, OR=1.9, respectively) compared to the control group and perinatal mortality rates were higher both antenatally (IUFD, OR=8.1) and postnatally (PPD, OR=6.1). iSUA appears to be an independent predictor of adverse perinatal outcomes in term neonates.

Effect of maternal antenatal influenza vaccination on adverse neonatal outcomes in terms of premature birth, small-for-gestational age and low birth weight: A comparative study

Background: Maternal influenza infection can impose significant health risks to pregnant women and their neonates. Objective: The objective of this study was to assess the effect of maternal antenatal influenza vaccination on adverse neonatal outcomes in terms of premature birth, small-for-gestational age (SGA), and low birth weight (LBW). Material and Methods: The present cross-sectional retrospective study included women who gave birth to their live third trimester neonates at a secondary care hospital in Saudi Arabia after exposure to the 2013/2014 influenza season in any entire trimester of their pregnancy. Neonatal outcomes of women who received inactivated influenza vaccine in their first, second, or early third trimester have been compared to the neonates of women who did not receive the vaccine throughout pregnancy. Data were collected by chart review. Results: In the present study, 1237 women were included, of these 347 (28.05%) received the trivalent inactivated influenza vaccine during pregnancy. Neonates born to vaccinated mothers were, on average, 97 g heavier (3279.7934 ± 337.6 compared with 3182.5107 ± 424.06, P = 0.001). Adverse neonatal outcomes were significantly lower in the vaccinated group; premature (9.1% compared with 17.6%, P = 0.001), SGA (8% compared with 14%, P = 0.003), and LBW (6.3% compared with 10.4%, P = 0.022). There was no significant increase in birth defects (2.2% compared to 2.6%, P = 0.711). Logistic regression analysis revealed that, compared to the neonates of mothers who received the vaccine, neonates of unvaccinated mothers are at almost two-fold increased risk of being premature (OR = 1.957; 95% CI, 1.310–2.923; P = 0.001), 40% risk for SGA (OR = 1.409; 95% CI, 0.872–2.275; P = 0.161), and 30% risk for LBW (OR = 1.306; 95% CI, 0.773–2.206; P = 0.319). Conclusion: Maternal antenatal influenza vaccination is associated with reduced adverse neonatal outcomes in terms of premature birth, SGA, and LBW. Moreover, it is associated with having heavier babies, and not associated with increased birth defects.

Recovery of aEEG Patterns at 24 Hours of Hypothermia Predicts Good Neurodevelopmental Outcome

Background: The clinical use of amplitude integrated electroencephalogram (aEEG) in the neonatal intensive care unit has largely increased. This method has been reported to have a very good predictive value for neurodevelopmental outcome in term neonates after perinatal asphyxia. Aim: The aim of this study was to assess the recovery of aEEG patterns during hypothermic treatment in full term asphyxiated neonates. Our working hypothesis is that children with aEEG recovery within 24 h of therapeutic hypothermia will have a normal development outcome (i.e., no or mild neurological impairment). Study design: We performed an observational prospective study on a group of asphyxiated patients admitted to our Neonatal Intensive Care Unit from April 2009 to April 2012. Results: 24 patients with moderate to severe perinatal asphyxia had an aEEG recorded for at least 72 h during hypotermia (at the beginning of the registration 13 patients presented moderate aEEG abnormalities and 11 severe aEEG abnormalities). Respectively 11 neonates with moderate aEEG abnormalities and 1 neonate with severe abnormalities normalized the aEEG pattern during the treatment. At the follow up 3 patients died during neonatal age, 5 babies developed cerebral palsy, 4 babies developed dyskinetic cerebral palsy and 12 babies did not develop any disability (babies with good outcome were those with normal aEEG pattern at 24 h). Conclusion: Recovery to a normal aEEG background pattern within the first 24 h of hypothermia after perinatal asphyxia predicts a normal outcome. Abnormal aEEG pattern persisting after 24 h correlates with poor outcome (death or cerebral palsy).

Relationship between immediate postpartum umbilical cord blood pH and fetal distress

Background: Umbilical cord pH is best indicator of fetal hypoxemia. Objectives: To establish relation between cord blood pH and fetal distress, diagnose true fetal distress retrospectively, reduce caesarean section rates. Methods: Prospective study of 30 term women reporting to labour room of department of Obstetrics Gynecology of a rural tertiary care centre of Central India with complaints of labour pains and during labour who developed fetal distress was conducted between April - May 2015. Immediately after delivery, umbilical cord arterial blood sample was collected. Maternal demographic profile, neonatal outcomes in terms of APGAR score, cord pH, immediate ventilation, NICU admissions were recorded. The correlation between non-reassuring fetal hearts, meconium stained liquor and neonatal outcome was analyzed using SPSS version 20. Results: Of 30 cases, 2 (6.67%) women had fetal bradycardia, 13 (43.34%) abnormal non-stress test, 5 (16.67%) meconium stained liquor and 10 (33.34%) fetal bradycardia/tachycardia with meconium stained liquor. Of all delivered babies, 10 (33.34%) had acidosis, with one having severe hypoxemia and acidosis (pH 6.85). Of these, 7 (70%) required NICU admission, one intubated for severe birth asphyxia. Rest 23 (76.67%) were born healthy, cared by mother. Of 13 women having abnormal NST, 10 (76.92%) underwent emergency cesarean section, 3 (23.07%) delivered vaginally. Of these, only 3 (23.07%) babies had acidosis and required NICU admission. All mothers were discharged with their babies healthy. Conclusions: Neither Non-reassuring fetal heart rate, nor thin meconium stained liquor correlate with adverse neonatal outcome. Furthermore NST resulted in unnecessary increased cesarean sections.

Analysis of late preterm births: Are there any differences among etiologic subgroups in terms of neonatal outcomes?

Analysis of late preterm births: Are there any differences among etiologic subgroups in terms of neonatal outcomes?

Factors affecting the outcome in multiple gestations

Introduction: Twin births are the commonest form of multiple births. Twins have attracted considerable attention and excited curiosity from early times as a biological variety in the study of the human species. Twin pregnancy is considered as high risk pregnancy. There is poor neonatal outcome in terms of mortality and morbidity. Materials and methods: A retrospective study was conducted from Jan 2015 to Jan 2014 Mac Gann Government General Hospital. During this period there were 2643 deliveries occurred out of which 48 twins and 8 were triplets. Results: In the present study, Incidence of twin pregnancy is 18/1000 live birth. Monozygotic twinning rate is 4.2/1000 live births, while dizygotic twinning rate is 14.2/1000 live births. Perinatal mortality in twins is 177/1000 births as compared to 74.3/1000 births in singleton pregnancy i.e., 2.38 times that of singleton pregnancy. In twin pregnancy Perinatal mortality rate in 1st twin is 62.5/1000 live births while in second twin it is 114.5/1000 births. Frequency of IUGR in twin pregnancy is 85.4%. Risk of preterm labour in twin pregnancy is 64.5%. IUGR babies are more in monochorionic than in dichorionic placenta. Conclusion: Perinatal mortality in twin is higher than in of singleton pregnancy. Risk of single fetal loss (antepartum deaths) in twin pregnancy is higher than risk of both fetal losses. Perinatal mortality rate in 2st twin is double compared to first twin. Perinatal mortality increases as the gestational age decreases. Frequency of IUGR in twin pregnancy is very high and more in monochorionic than in dichorionic placenta.

683: Impact of intrapartum fetal surveillance training on adverse term neonatal outcomes

683: Impact of intrapartum fetal surveillance training on adverse term neonatal outcomes

Undiagnosed Breech In Banbury: A Study of Undiagnosed Breech at a District Hospital Maternity in Banbury, Oxford Radcliffe Hospitals NHS Foundation Trust, Oxfordshire, United Kingdom

Aims and Objectives: The aim of this study was to evaluate the prevalence and management of undiagnosed breech, relating our figures with the national statistics, comparing our management with “standard” and to see if there could be any benefit from introducing additional intervention(s) to enhance breech detection. The author was also interested in finding out if there could have been any associated co-morbidity which could have contributed to failure to diagnose breech and whether relevant co-morbidities were born in mind or noted during clinical assessment of these women. Methods: This is essentially a retrospective study of deliveries at the Horton Hospital Maternity Unit for a 12 month period, covering the period of October 2003 to September 2004. Delivery summaries of all deliveries were systematically studied twice for consistency. Case notes of breech deliveries were also reviewed twice. Cases of undiagnosed breech deliveries were clearly identified and studied in greater detail. Results/Conclusion: Cases of diagnosed breech were 64, which was 83.1% of the total breech births and 4.12% of the total annual birth. Cases of undiagnosed breech were 13, which was 16.88% of total annual breech deliveries and 0.84% of total annual birth. Interestingly, majority of the diagnoses of undiagnosed breech were made during first stage of labour and most of the women had spent hours with staff and each had 2 or more clinical examinations before discovery was made. There was no diagnosis of undiagnosed breech in women with body mass index (BMI) of 40 kg/m 2 or higher. As shown in Table 3, contrary to author’s expectation, most cases were diagnosed in women with normal BMI (61.54%). Co-morbidities like uterine anomaly, polyhydramnios, large fibroids and pelvic mass were not apparent from the study. Most cases (61.54%) of undiagnosed breech were made in primigravidas and most cases of undiagnosed breech (61.54%) were delivered by emergency caesarean section. There was no significant impact on maternal morbidity and short term neonatal outcomes. The author’s view is that this study could rekindle the argument that trends of misdiagnoses should ideally prompt reviews rather that few spikes in misdiagnoses, in some aspects of obstetric care. However, one cannot deny the knowledge and reassurance from such reviews prompted by few spikes in misdiagnoses.

Proton magnetic resonance spectroscopy and outcome in term neonates with chorioamnionitis.

Objective:Evaluate brain metabolites, which reflect neuroinflammation, and relate to neurodevelopmental outcomes in healthy term neonates exposed to chorioamnionitis.Study Design:Thirty-one healthy term neonates with documented fetal inflammatory response after maternal chorioamnionitis underwent magnetic resonance spectroscopy (MRS), with voxels placed in basal ganglia (BG) and frontal white matter. Bayley III examinations were performed at 12 months of age.Result:Infants with below average outcomes did not show the same increase in NAA/Cho ratios postnatally as the group with normal outcomes. Decreased NAA/Cho and increased Lac/Cr in BG correlated with lower motor and cognitive composite scores, respectively, controlling for postnatal age. In males, increased lactate/NAA in BG were associated with lower motor scores. Funisitis severity was associated with decreased NAA/Cho and increased mI/NAA in males.Conclusion:In healthy term newborns with chorioamnionitis, MRS ratios shortly after birth may provide evidence of occult neuroinflammation, which may be associated with worse performance on 1-year neurodevelopmental tests.

Intraventricular Hemorrhage in Term Neonates: Sources, Severity and Outcome.

Intraventricular hemorrhage (IVH) occurs in preterm infants; however, the occurrence of this event is less frequent in term neonates. The present study evaluated clinical characteristics, pathophysiological features, and early outcome of term neonates with IVH in a referral neonatal center in Iran. This study was performed on 30 full-term neonates admitted to the Neonatal Intensive Care Unit (NICU) of Ali-Asghar Hospital, Tehran, Iran between March 2005 and April 2011. IVH was diagnosed using cranial ultrasonography, or brain magnetic resonance imaging (MRI). The mean age at onset of symptoms was 3.9 days. Seizure was the commonest clinical symptoms followed by poor feeding and fever. The sources of bleeding in the brain were choroid plexus (60%), germinal matrix (20%) and parenchyma (6.7%). Severity of bleeding included 33.3% grade I, 30.0% grade II, 36.7% grade III to IV. Fifteen (50%) cases had coagulopathy. Twenty-five (83.3%) cases were discharged with a good condition, three (10%) cases were referred to surgical ward and two cases (6.7%) died in NICU. The main source of IVH in term neonates is choroid plexus; the most common clinical symptoms include seizure and poor feeding, and one-third of IVH events are graded as III to IV. Most affected neonates are discharged from NICU without CNS complication, about 10% need to refer to surgical interventions, and death was occurred in a few of neonates.

Behavioural and neurodevelopmental outcome of 2-year-old children after preterm premature rupture of membranes: follow-up of a randomised clinical trial comparing induction of labour and expectant management

ObjectiveWe recently reported that induction of labour does not improve short term neonatal outcome in women with late preterm premature rupture of membranes (PPROM) as compared to expectant management (PPROMEXIL trial). In this study the neurodevelopmental and behavioural outcome of the children from this trial at 2 years of age was studied. Study designWe studied outcome of offspring of women randomised in the PPROMEXIL study. These women had >24h of ruptured membranes and were between 34 and 37 weeks of pregnancy when they were randomised to induction of labour (IoL) or expectant management (EM). Two years after delivery, the parents received the ages and stages questionnaire (ASQ), the child behaviour checklist (CBCL) and a general questionnaire. ResultsFollow-up data were obtained from 234 children (121 after IoL, 113 after EM, response rate 59% (44% of the original 532 randomised women)). In the IoL group 16 children (14%) had an abnormal score in ≥1 domains of the ASQ, versus 27 (26%) in the EM group (difference in percentage −11.4 (95% CI −21.9 to −0.98; p=0.033)). For the CBCL, an abnormal score was found in 13% (n=15) in the IoL group and in 15% (n=16) in the EM group (difference in percentage −2.13 (95% CI −11.2 to 6.94; p=0.645)). ConclusionAlthough a policy of induction of labour in women with late PPROM does not improve short term neonatal outcome, it might be associated with a decrease in neurodevelopmental difficulties at the age of two years as compared to expectant management. Expectant management did not lead to a difference in behavioural problems.

To do or not to do emergency cervical cerclage (a rescue stitch) at 24-28 weeks gestation in addition to progesterone for patients coming early in labor? A prospective randomized trial for efficacy and safety.

To measure the outcome of emergency cervical cerclage (ECC) combined with progesterone vs. progesterone alone in pregnancy prolongation for preterm labor at 24-28 weeks. One hundred patients in early labor were allocated randomly into two equal groups. Group A were treated by ECC and progesterone, and group B were on the same progesterone dose only treatment. No significant differences were observed in both groups as regard demographic data, fetal gestational age or cervical state on admission. However, a significant pregnancy prolongation was observed in group A (28.44 ± 12.73 days vs. 9.96 ± 3.27 in group B, p < 0.001) with subsequent increase in fetal gestational age (32.04 ± 3.2 vs. 27.86 ± 3.213, p < 0.001), heavier weight, higher Apgar score at 1 and 5 min, and lower rate of cesarean delivery (1033.1 ± 170.83 vs. 715.1 ± 138.73, p < 0.001) (2.68 ± 1.132 vs. 2.14 ± 0.93, p < 0.001), (5.48 ± 2.6 vs. 2.38 ± 1.59, p = 0.01) and (16 vs. 62 %, p = 0.01), respectively. Also neonatal outcomes in terms of early neonatal deaths were lower in this group (18 vs. 46 %, p = 0.049). ECC is effective in pregnancy prolongation when judiciously used in combination with progesterone compared to progesterone alone.

EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review

ObjectivesHypoxic ischaemic encephalopathy is a significant cause of mortality and morbidity in the term infant. Electroencephalography (EEG) is a useful tool in the assessment of newborns with HIE. This systematic review of published literature identifies those background features of EEG in term neonates with HIE that best predict neurodevelopmental outcome. MethodsA literature search was conducted using the PubMed, EMBASE and CINAHL databases from January 1960 to April 2014. Studies included in the review described recorded EEG background features, neurodevelopmental outcomes at a minimum age of 12months and were published in English. Pooled sensitivities and specificities of EEG background features were calculated and meta-analyses were performed for each background feature. ResultsOf the 860 articles generated by the initial search strategy, 52 studies were identified as potentially relevant. Twenty-one studies were excluded as they did not distinguish between different abnormal background features, leaving 31 studies from which data were extracted for the meta-analysis. The most promising neonatal EEG features are: burst suppression (sensitivity 0.87 [95% CI (0.78–0.92)]; specificity 0.82 [95% CI (0.72–0.88)]), low voltage (sensitivity 0.92 [95% CI (0.72–0.97)]; specificity 0.99 [95% CI (0.88–1.0)]), and flat trace (sensitivity 0.78 [95% CI (0.58–0.91)]; specificity 0.99 [95% CI (0.88–1.0)]). ConclusionBurst suppression, low voltage and flat trace in the EEG of term neonates with HIE most accurately predict long term neurodevelopmental outcome. SignificanceThis structured review and meta-analysis provides quality evidence of the background EEG features that best predict neurodevelopmental outcome.

Therapeutic hypothermia modifies perinatal asphyxia-induced changes of the corpus callosum and outcome in neonates.

What Is Known about this Subject?Diffusion-weighted MRI has demonstrated changes in the corpus callosum of term neonates with perinatal asphyxia. The severity of cerebral changes demonstrated using diffusion-weighted MRI is difficult to assess without measuring values of the Apparent Diffusion Coefficient (ADC).What Is New?ADC values of the anterior part of the corpus callosum are slightly higher than of the posterior part in full term infants with perinatal asphyxia. Low ADC values of the corpus callosum were associated with an adverse outcome in infants with perinatal asphyxia. In infants treated with hypothermia lower ADC values than with normothermia were associated with a poor outcome, supporting neuroprotective effects of hypothermiaBackgroundUsing MRI, changes can be detected in the corpus callosum (CC) following perinatal asphyxia which are associated with later neurodevelopmental outcome.AimTo study the association between the apparent diffusion coefficient of water (ADC) in the CC on MRI in neonates with perinatal asphyxia and neurodevelopmental outcome at 18 months of age.Subjects, MethodsOf 121 infants 32 (26%) died and 13 (11%) survived with an adverse neurological outcome. Sixty-five (54%) received therapeutic hypothermia. MRI was performed within 7 days after birth using a 1.5 T or 3.0 T system, and ADC values were measured in the anterior and posterior CC. The association between ADC and composite outcome (death or abnormal neurodevelopment) was analyzed for both normothermia and hypothermia cases using receiver operating characteristics.ResultsADC values of the posterior CC were lower than of the anterior part (mean difference 0.050 x 10-3 mm2/s, p<0.001). Field strength did not affect ADC values. ADC values of the posterior part of the CC were significantly lower in infants with basal ganglia/thalamus or near total brain injury (p<0.001). Lower ADC values were associated with an adverse outcome, but cut-off levels were lower after hypothermia (1.024 x 10-3 mm2/s vs 0.969 x 10-3 mm2/s)ConclusionLow ADC values of the posterior part of the corpus callosum are associated with an adverse outcome in term or near term neonates with perinatal asphyxia. Therapeutic hypothermia slightly modifies this association, showing that lower values were needed for an adverse outcome.

Evaluating Pre-Incision Versus Post Umbilical Cord Clamping Antibiotic Prophylaxis in the Prevention of Post Caesarean Section Infections in a Nigerian Specialist Teaching Hospital.

: Introduction : Caesarean delivery is the single most important factor associated with post partum infection and carries a 5-20 fold increased risk of infection compared to vaginal delivery. With the increase in Caesarean delivery rates worldwide, post-Caesarean delivery infections are likely to become a significant health and economic burden. Pre-incision antibiotic prophylaxis prevents maternal infectious morbidity without prejudice to neonatal infectious morbidity. This Study compared pre-incision versus post-umbilical cord clamping antibiotic prophylaxis in the prevention of post caesarean section infection. Methods : This is an interventional, single blinded, two-armed, randomized, single centre study using amoxicillin/ clavulanic acid plus metronidazole. One hundred and fifty patients that met the inclusion criteria were randomised into pre-incision and post umbilical clamp arm with seventy five patients in each study arm. Patients were followed up for six weeks postpartum. Results : The overall post-operative fever rate was 10.7% with 4.00% in pre-incision and 6.67% in post umbilical clamp group (fisher’s exact test of 0.428 and cumulative incidence relative risk of 0.533 (95%CL: 0.194-1.64). Two percent and 4.67% of studied population developed endometritis in pre-incision and post umbilical groups respectively (fisher’s exact test of 0.327 and cumulative incidence relative risk of 0.44(95%CL: 0.101-1.625). Superficial wound infection occurred in 2.00% of the studied population in pre-incision group and 3.33% in post umbilical group. The overall wound infection prevalence rate was therefore 5.33% (fisher’s exact test of 0.719 and cumulative incidence relative risk of 0.66 (95%CL: 0.395-7.446). Staphylococcus aureus was the commonest isolate. No significant difference between the study groups in this study in terms of neonatal outcome. Conclusion/Recommendation : Antimicrobial agent for surgical prophylaxis could prevent surgical site infection and related morbidity, reduce the duration of hospital stay and therefore cost of health care. Post caesarean section infectious surveillance should be encouraged in all delivery units.

Can a single lactate value predict adverse outcome in critically ill newborn?

The aim of this study was to investigate the role of the lactic acidosis, as an early predictor of significant consequences and/or a fatal outcome in term neonates after a perinatal asphyxia. Severe perinatal asphyxia can generate multiple organ dysfunction and neonatal mortality. In routine clinical practice, after an admission to the Intensive Care Unit, lactate concentration was determined in capillary blood samples during the first one to six hours after birth in 55 term newborns with the post-asphyxial hypoxic-ischemic encephalopathy. The control group consisted of 36 healthy term neonates randomly selected in the maternity ward at the Gynecology and Obstetrics Clinic. Significantly higher concentrations of lactate (p 8.7 mmol/L with 80 % sensitivity and 82% specificity indicated the development of the hypoxic-ischemic encephalopathy stage II/III, while the lactate level>9.95 mmol/L was a predictor of death, with 75% sensitivity and 74.4% specificity. Determination of lactate concentrations in serum of term newborns associated with risk factors for the perinatal asphyxia is a useful tool in diagnosing metabolic disorders and ischemic damage, particularly severe clinical forms (Tab. 2, Fig. 3, Ref. 34).

Risk factors for late-onset hyponatremia and its influence on neonatal outcomes in preterm infants.

Late-onset hyponatremia (LOH), hyponatremia occurring after two weeks of age with the achievement of full feeding, is the result of a negative sodium balance caused by inadequate salt intake or excessive salt loss due to immature renal or intestinal function in preterm infants. The aims of our study were to identify the risk factors for LOH and its influence on neonatal outcomes. This was a retrospective cohort analysis of 161 preterm infants born before 34 weeks of gestation between June 2009 and December 2010 at Seoul National University Hospital. LOH was defined as a sodium level ≤ 132 mEq/L or 133-135 mEq/L with oral sodium supplementation. LOH occurred in 49 (30.4%) of the studied infants. A lower gestational age, a shorter duration of parenteral nutrition, the presence of respiratory distress syndrome, the use of furosemide, and feeding with breast milk were significant risk factors for LOH. In terms of neonatal outcomes, the infants with LOH had longer hospital stays and higher risks of bronchopulmonary dysplasia and retinopathy of prematurity requiring surgery. LOH lasting at least 7 days significantly increased moderate to severe bronchopulmonary dysplasia, periventricular leukomalacia, and extra-uterine growth retardation. LOH is commonly observed in preterm infants; it may be a risk factor for bronchopulmonary dysplasia and retinopathy of prematurity or a marker of illness severity.

Prognostic Markers of Neonatal Outcomes in Full Term Neonates Suffering from Perinatal Asphyxia

Abstract Objective The aim of this study were, using only the score clinic of Sarnat and Sarnat, the blood markers of asphyxia that are routinely used in all hospitals of our country (Brazil) and the ultrasonography imaging method performed with 24 and 72 hours and 28 days of life, verify if these are sufficient to detect the neurological evolution of the patient. Methods The study was conducted with a prospective cohort of term newborns that suffering perinatal asphyxia by Buonocore criteria (2002). These criteria identify the level of the pH in cord blood that was collected of all newborns and also the blood markers: glutamic oxaloacetic transaminase, glutamic pyruvate transaminase, lactate dehydrogenase and creatine kinase (CKMB).These testes were collected at birth, with 24, 48 and 72 hours of life. The score clinical of Sarnat and Sarnat was performed with 24 hours, 48 hours and 72 hours of life and the ultrasound skull with 24, 48, 72 hours of life and in the end of neonatal period with 28 days of life. The period of study was one year. Results In the study´s period 2989 babies were born. The Buonocore criteria were found in 28 newborn showing a frequency of 1% of perinatal asphyxia. The marker of asphyxia were between the normal value of reference and only de iso-enzyme CKMB was a good marker, com value more than 5,10 ng/mL. The brain ultrasonography was altered with 72 hours of life, but one newborn presented alterations only with 28 days of life. The clinical examination using the clinical score of Sarnat and Sarnat demonstrated that 21,42% presented hypoxic-ischemic encephalopathy. In the ROC curve we observed sensitivity of 85,7%, specificity of 85,7% and accuracy of 85,7% correlated the value of CKMB and the brain ultrasonography of 72 hours of life. Conclusions Perinatal asphyxia may be diagnosed in any hospital if the neonatologist or the neurologist apply the easy score clinical of Sarnat and Sarnat, the iso-enzime CKMB and the serial ultrasonography. In this study the worse alteration was with 72 hours of life, however we must be careful because in one neonate the alteration was present only with 28 days of life.