Terms Of Neonatal Outcomes Research Articles

Predictive value of electroencephalography for developmental outcome at 6 month of age in full term neonates with seizures

Background: Electroencephalography (EEG) is an important tool to evaluate infant with symptoms refer to central nervous system. The objective of the work was to study the predictive value of EEG for developmental outcome in full term neonates with seizures at 6 month of age.Methods: This was prospective observational study at tertiary care centre, Gandhi Medical College, Bhopal. The participants were full term hospitalized neonates with documented seizures. Newborns admitted for complaints other than seizure, hypoxic-ischemic encephalopathy (HIE) stage I, preterm and neonates born to mother on anti-epileptic therapy were excluded from the study.Results: Out of total 54 registered neonates 7 expired and 5 lost to follow up. In remaining 42 cases, 18 (42.9%) had generalized discharge, 8 (19%) had focal and 3 (7.1%) had multifocal discharge while 22 (52.3%) had normal EEG patterns. HIE being the most common cause and subtle seizure being the most common type of seizures. On follow up at 6 month, all neonates with normal EEG pattern (n=22) had normal developmental outcome. Out of 20 neonates with abnormal EEG discharges, 13(65%) had developmental delay while 7 (35%) had normal development for age.Conclusions: EEG could be a simple and cost effective prognostic tool where neonates presenting with seizure. Newborn with abnormal discharge should be closely monitored on DDST for early identification and early intervention.

Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants.

Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P < 0.001) and hypothermic (P < 0.001) than those who only needed positive pressure ventilation (PPV). On logistic regression, DR-CPR resulted in greater early mortality of less than 7 days (OR, 5.64; 95% CI 3.25-9.77) increased intraventricular hemorrhage ≥ grade 3 (OR, 2.71; 95% CI 1.57-4.68), periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI.

Combined spinal–epidural analgesia in labour: its effects on delivery outcome

Background and objectivesCombined spinal–epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. MethodsOne hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. ResultsThe mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups. ConclusionThere were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Effect of various techniques of Anesthesia in elective Caesarian section on short term Neonatal outcome

Introduction: The basic aim of obstetric anesthesia is to provide adequate maternal pain relief with no deleterious effect on mother and newborn. This study aimed to assess the effect of spinal anesthesia, epidural anesthesia and general anesthesia using thiopentone sodium as induction agent on neonates delivered after elective caesarian section. Materials and methods: This is a prospective descriptive study at a tertiary care teaching hospital from June 2013 to May 2014. 60 cases of elective caesarian section admitted in Department of Obstetrics and Gynecology were studied. Patients were randomly divided into 3 groups each of 20 cases. Group 1 received spinal anesthesia, group 2 epidural anesthesia and group 3 general anesthesia. Neonatal outcome was assessed in relation to anesthetic techniques used. Results: The mean Apgar score at 1 min was lower in GA group (7 +/- 1.025) than in spinal anesthesia group (8.1+/- 0.78) and epidural anesthesia group (8.35 +/- 0.745). Total 3/60 (5%) neonates required resuscitation at birth all of which were in GA group. Induction delivery interval of 20 min was associated with need for resuscitation at birth. Moderate depression of neonates (1 min Apgar score of 4-6) was observed in 2/20 (10%) neonates in group 3. Conclusion: Neonates born by elective LSCS under GA have lower 1 min Apgar scores. Induction delivery interval of 20 min is associated with need for resuscitation at birth in neonates in GA group. These effects can be minimized by maintaining the ID interval between 5 – 15 minutes.

Short-term neonatal outcome in singleton, late preterm deliveries: a three-year experience at a single Lebanese center.

There has been a decrease in the mean gestational age at delivery worldwide mostly due to an increase in deliveries occurring at late preterm period (LPP) with a concomitant rise in the rate of morbidities among newborns delivered at this period. To report the frequency of common short-term neonatal morbidities in infants born at LPP (between 34(0/7) and 36(6/7) weeks' gestation) and to compare these frequencies with those of full-term infants born at our institution. A descriptive cohort study (2008-2010) at Makassed General Hospital. All deliveries occurring at LPP constituted the study group (n = 361), while births at or beyond 37 weeks' gestation were considered as controls (n = 2814). The average rate of deliveries in LPP was 11.4% for the entire study period. The rate of Neonatal Intensive Care Unit admissions, respiratory morbidities, sepsis, jaundice, hypothermia, hypoglycemia and overall neonatal morbidity were all significantly higher in LPP infants when compared to those at term (p-value < 0.013). In our cohort of Lebanese newborns delivered at LPP, significantly higher morbidities were encountered when compared to full-term newborns. Every possible effort should be exerted to avoid elective deliveries during LPP in order to curb the incidence of neonatal morbidities.

PC.72 Neonatal Outcomes Following Rotational Instrumental Delivery

IntroductionRotational instrumental delivery has previously been associated with adverse neonatal outcomes. Since a 1979 study demonstrated 3.49% neonatal mortality associated with Kielland’s forceps there has been a gradual decline in...

PFM.38 Clinical Outcomes from a Specialist Preterm Labour Clinic: A 5 Year Overview

BackgroundSpecialist Preterm Labour (PTL) clinics are a relatively novel innovation and allow translation of current research into clinical practise in an effort to reduce and prevent spontaneous preterm birth (sPTB)...

Placental and neonatal outcome in maternal malaria.

Primary: To determine the incidence of congenital malaria in a cohort of pregnant women in a hyper-endemic area of central India. Secondary: (1) To find out the placental weight and placental malaria positivity, and to assess fetal and neonatal outcome in terms of survival, mean hemoglobin and mean birth weight. Prospective observational study. Maternity and neonatal ward of a tertiary level hospital attached to a medical college located in Rewa, Madhya Pradesh, India. Near term and term pregnant women admitted in the maternity ward with a singleton pregnancy, whose neonates were available for examination till at least 6 hours after birth. Thick and thin blood smear were examined for malarial parasites from mothers prior to delivery. Based on the results of peripheral smear they were divided into 'exposed group' (peripheral smear positive for malaria parasite) and unexposed group' (smear negative for malaria parasite). These groups were then followed prospectively till delivery and subsequently till the mother and the neonates were discharged from the hospital. Primary: Presence of asexual parasite in neonate. Secondary: Placental weight, presence of asexual malarial parasite in placenta, still births, early neonatal deaths, mean birth weight and mean hemoglobin. Seventy-two (35.5%) of 203 blood smears of near term and term pregnant women were found positive for malaria parasite (60 P. vivax and 12 P. falciparum); rest 131 comprised the unexposed group. Six (2.95%) neonates had parasitemia (4 P. vivax and 2 P. falciparum). Of the 203 smears made from placental blood, 24 (11.8%) were positive for malaria parasite. The mean (SD) birth weight [2300 (472) g vs 2430 (322) g; P=0.98], proportion of preterm babies (6.9% vs 8.4%, P=0.71), incidence of still birth (4.2% vs 3.0%, P=1.0) and early neonatal death (2.8% vs 3.0%, P=1.0) were not significantly different between the exposed and unexposed group. The incidence of congenital malaria is low despite high maternal smear positivity for malaria.

G321 Lactate Clearance and Neurological Outcome in Neonates cooled for Hypoxic Ischaemic Encephalopathy

AimsTo investigate the correlation between the clearance of blood lactate level over the first 96 h of life and neurological outcome in neonates undergoing whole body cooling for hypoxic ischaemic...

Nifedipine versus atosiban in the treatment of threatened preterm labour (Assessment of Perinatal Outcome after Specific Tocolysis in Early Labour: APOSTEL III-Trial)

BackgroundPreterm birth is the most common cause of neonatal morbidity and mortality. Postponing delivery for 48 hours with tocolytics to allow for maternal steroid administration and antenatal transportation to a centre with neonatal intensive care unit facilities is the standard treatment for women with threatening preterm delivery in most centres. However, there is controversy as to which tocolytic agent is the drug of first choice. Previous trials have focused on tocolytic efficacy and side effects, and are probably underpowered to detect clinically meaningfull differences in neonatal outcome. Thus, the current evidence is inconclusive to support a balanced recommendation for clinical practice. This multicenter randomised clinical trial aims to compare nifedipine and atosiban in terms of neonatal outcome, duration of pregnancy and maternal side effects.Methods/DesignThe Apostel III trial is a nationwide multicenter randomised controlled study. Women with threatened preterm labour (gestational age 25 – 34 weeks) defined as at least 3 contractions per 30 minutes, and 1) a cervical length of ≤ 10 mm or 2) a cervical length of 11-30 mm and a positive Fibronectin test or 3) ruptured membranes will be randomly allocated to treatment with nifedipine or atosiban. Primary outcome is a composite measure of severe neonatal morbidity and mortality. Secondary outcomes will be time to delivery, gestational age at delivery, days on ventilation support, neonatal intensive care (NICU) admittance, length admission in neonatal intensive care, total days in hospital until 3 months corrected age, convulsions, apnoea, asphyxia, proven meningitis, pneumothorax, maternal side effects and costs. Furthermore, an economic evaluation of the treatment will be performed. Analysis will be by intention to treat principle. The power calculation is based on an expected 10% difference in the prevalence of adverse neonatal outcome. This implies that 500 women have to be randomised (two sided test, β 0.2 at alpha 0.05).DiscussionThis trial will provide evidence on the optimal drug of choice in acute tocolysis in threatening preterm labour.Trial registrationClinical trial registration: NTR2947, date of registration: June 20th 2011.

Mode of Delivery at Term and Adverse Neonatal Outcomes

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A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly.Aim: The aim of this study is to compare the duration and quality of analgesia, maternal and neonatal outcomes after CSE labor analgesia with intrathecal dexmedetomidine and intrathecal fentanyl followed by epidural bupivacaine.Settings and Design: A randomized observational study with 112 parturients in a tertiary care hospital.Materials and Methods: 112 parturients were randomly divided to two groups. Group D (n = 58) received dexmedetomidine 10 μg and group F (n = 54) received fentanyl 20 μg intrathecally for labor analgesia. The time of onset, time to maximum analgesia, duration and quality of analgesia were noted. Maternal parameters of heart rate, noninvasive blood pressure, motor block and side-effects of pruritus, nausea and vomiting were recorded. Neonatal outcome in terms of mode of delivery, neonatal APGAR score, time to first cry, need for resuscitation, umbilical cord blood pH, initiation of breast feeding, Neurologic and Adaptive Capacity Score at 24 h and exclusivity of breast feeding at 6 weeks were recorded.Results: Duration of analgesia was 160.54 ± 52.4 min with dexmedetomidine and 124.1 ± 46.93 min with fentanyl (P < 0.001). Visual analog score (VAS) recorded at maximal analgesia was significantly lesser in the fentanyl group compared to dexmedetomidine group, denoting a significantly deeper level of analgesia with fentanyl. However, all the mothers in the dexmedetomidine group achieved a VAS <3 and were satisfied with the quality of analgesia. About 74% patients in the fentanyl group experienced pruritus after intrathecal injection whereas none of the mothers in dexmedetomidine group experienced pruritus (P < 0.001). There were no significant differences in neonatal outcome between the two groups.Conclusion: 10 μg dexmedetomidine intrathecally provides a longer duration of analgesia with lesser incidence of pruritus compared to 20 μg fentanyl intrathecally for CSE labor analgesia with comparable neonatal side-effects.

Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy.

Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.

Extracorporeal Cardiopulmonary Resuscitation Outcomes in Term and Premature Neonates*

Extracorporeal cardiopulmonary resuscitation appears to improve survival in patients with acute refractory cardiopulmonary failure. This analysis was performed to determine survival outcomes and predictors of in-hospital mortality for term and preterm neonates who received extracorporeal cardiopulmonary resuscitation. Retrospective review of data from the Extracorporeal Life Support Organization international registry. Pediatric and neonatal ICUs. Infants less than or equal to 30 days. Extracorporeal cardiopulmonary resuscitation. Demographic, clinical, and survival data from patients who received extracorporeal cardiopulmonary resuscitation between 1998 and 2010 were analyzed to determine factors that affect in-hospital mortality. Overall survival to hospital discharge for the 641 neonates who received extracorporeal cardiopulmonary resuscitation was 39%. In univariate analysis, gestational age correlated inversely with stroke (odds ratio, 0.84 [95% CI, 0.75-0.95]; p = 0.006) and death (odds ratio, 0.87 [95% CI, 0.78-0.96]; p = 0.005) as did corrected gestational age (odds ratio, 0.89 [95% CI, 0.81-0.97]; p = 0.006) and birth weight (odds ratio, 0.53 [95% CI, 0.38-0.74]; p < 0.001). Dysrhythmia as the primary diagnosis had significantly lower odds of death than single-ventricle cardiac disease (odds ratio, 0.24 [95% CI, 0.06-0.95]; p = 0.04). Higher pre-extracorporeal cardiopulmonary resuscitation oxygenation decreased the odds of death (odds ratio, 0.996 [95% CI, 0.994-0.999]; p = 0.01), whereas complications occurring on extracorporeal life support increased the odds of death. In the multivariate analysis, lower birth weight and pre-extracorporeal cardiopulmonary resuscitation oxygenation, as well as complications including CNS hemorrhage, pulmonary hemorrhage, acidosis, renal replacement therapy, and mechanical complications, increased the odds of death. Overall survival for neonates receiving extracorporeal cardiopulmonary resuscitation is similar to older pediatric patients but decreases with lower gestational age and weight. Despite this, many low-birth weight neonates survive to hospital discharge.

The Relationship Between Umbilical Cord Arterial pH and Serious Adverse Neonatal Outcome

Please cite this paper as: Yeh P, Emary K, Impey L. The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51 519 consecutive validated samples. BJOG 2012;119:824–831. Objective To examine the relationship between umbilical cord pH at term and serious neonatal outcomes. Design Observational cohort study. Settings Deliveries within the Oxford Radcliffe Hospital NHS Trust between 1991 and 2009. Population In all, 51 519 singleton, term, nonanomalous live neonates with validated umbilical cord arterial pH values. Methods Absolute risks, relative risks with 95% confidence intervals, and numbers needed to harm were calculated for different levels of arterial pH across the entire range. Main outcome measures Neonatal encephalopathy with seizures and/or death, encephalopathy within 24 hours of birth, 5-minute Apgar scores and neonatal unit admission. Results The median arterial pH was 7.22, interquartile range 7.17–7.27. The absolute risk of an adverse neurological outcome was significantly increased below 7.10 (0.36%) and was lowest between 7.26 and 7.30 (0.16%). Even below 7.00, the risk was only 2.95%. However, more than 75% of neonates with neurological outcomes examined, including seizures within 24 hours of birth, had a pH above 7.10. A small increase in risk was evident at higher pH levels. Conclusion The threshold pH for adverse neurological outcomes is 7.10 and the ‘ideal’ cord pH is 7.26–7.30. Above 7.00, however, neonatal acidaemia is weakly associated with adverse outcomes. Most neonates with neurological morbidity have normal cord pH values. Other variables must influence adverse outcomes and account for more of these than acidaemia. A better understanding of these is required before intrapartum fetal monitoring can improve.

Haemorrhagic stroke in term and late preterm neonates

ObjectiveFew data regarding causes and outcomes of haemorrhagic stroke (HS) in term neonates are available. We characterised risk factors, mechanism and short-term outcomes in term and late preterm neonates with...

Timing of planned repeat cesarean delivery after two or more previous cesarean sections – Risk for unplanned cesarean delivery and pregnancy outcome

Objective: To assess the effect of the scheduled gestational age for a repeat planned cesarean section (CS) on the risk for adverse pregnancy outcome in women with two or more previous CS.Methods: A retrospective cohort study of all women after ≥2 previous CS who were scheduled for a repeat planned CS. Women were divided into two groups at which the planned CS was scheduled: 38-week group or 39-week group.Results: Overall, 377 were enrolled, 264 (70.0%) and 113 (30.0%) in the 38-week and the 39-week groups, respectively. The rate of an unplanned CS was significantly higher in the 39-week versus the 38-week group (23.0% versus 13.3%, p = 0.02). A repeat planned CS scheduled to week 39 was associated with an increased risk of maternal adverse outcome (31.9% versus 21.6%, p = 0.03). There was no significant difference in the rate of adverse neonatal outcome between the two groups (20.8% versus 23.0%, p = 0.5). The lowest rate of any adverse outcome (maternal and/or neonatal) was observed when CS was scheduled to 38 + 1 weeks of gestation.Conclusions: In women after two cesarean sections, scheduling a planned CS at around 39 weeks compared with at around 38 weeks is associated with an increased risk for maternal adverse outcome with no apparent advantage in terms of neonatal outcome.

Mode of Delivery at Term and Adverse Neonatal Outcomes

ABSTRACTDebate still rages on the high rate of cesarean deliveries (CDs). Operative vaginal delivery usually results in a healthy neonate, but concerns are voiced about the iatrogenic perinatal morbidity, and thus many clinicians avoid this delivery option. This cohort study was undertaken to determ

PL.22 Lactate Clearance and Outcome in Neonates Cooled For Hypoxic Ischaemic Encephalopathy

AimsTo investigate the clearance of blood lactate level in neonates undergoing whole body cooling for hypoxic ischaemic encephalopathy (HIE) related to their outcome. MethodsRetrospective case note review of infants receiving...

PL.76 Failure to Identify the New Onset of Intrapartum Risk Factors in Low Risk Pregnancies: A Missed Opportunity for Better Neonatal Outcome

ObjectiveEvaluate the risk factors and immediate outcome of term neonates born with Apgar Score (AS) of <7 at 5 minutes.MethodsRetrospective review of maternity database to identify 187 live born neonates...