Outcome Of Such Infants Research Articles

Usporedba neonatalnog ishoda u majki s gestacijskim dijabetesom tijekom dva razdoblja

Gestational diabetes is one of the most common metabolic complications during pregnancy. Pregnant diabetic mothers, if not well regulated, are more often subject to a number of acute conditions and complications during pregnancy and childbirth. Hypoglycemia, hypocalcemia, hypertrophy, lower Apgar is often seen in children. This is a case control study. We compared mothers with GD and their infants to mothers without GD and their children both in 2015 and 2018 in order to determine whether there are any differences among them, and to compare the perinatal outcome of their infants. Examinees have been born in 2015 and 2018 (262) at KBC Osijek. The control group (262) was first neonates born after the examinees in 2015 and 2018. The results are shown in tables, with absolute and relative frequencies, and the significance of differences in the chi-square test with confidence interval at 95 %. Statistical significance will be accepted at p <0.05 level. Different acute conditions and other chronic illnesses are more common in mothers with GD. They have more complications during labor. Their infants are more often diagnosed with hypertrophy, hypoglycemia, and hypocalcemia. They also require more oxygen tratment, longer hospitalization and birth by C-section. In 2018, the number of hypoglycemic and hypocalcemic infants was twice lower, and children have been hospitalized much shorter. Better care for mothers during pregnancy and their glycemic control lead to significantly less complications in their infants and better perinatal outcome of such infants.

Antenatal Corticosteroids at the Limits of Fetal Viability

Faced with threatened extreme preterm delivery, clinicians and parents must decide whether to intervene, given poor outcomes of such infants. Data are

Morbidities of preterm VLBW neonates and the bacteriological profile of sepsis cases

Background: Preterm very low birth weight babies are at increased risk of perinatal, neonatal and postnatal mortality and morbidity, mainly due to infections and complications of prematurity. Mortality of VLBW neonates is 30 times more than that of normal weight. Outcomes of such infants have been reported extensively from developed countries, but less is known from developing countries like Bangladesh though prematurity is very common.Objective: To determine the morbidities associated with preterm VLBW neonates with particular emphasis on sepsis. Methods: A prospective cohort study was done in Special Care Baby Unit of a tertiary care teaching hospital from July 2009 to December 2009. Preterm VLBW neonates admitted within 7 days of age comprised the cohort for the study. Detailed physical findings and information on pregnancy, delivery and immediate postnatal period were recorded on enrolment. Sepsis workup was done whenever sepsis was suspected clinically. Daily follow-up was given till discharge/death and relevant clinical findings recorded. Data were analyzed using SPSS 12. Results: A total of 738 neonates were admitted during study period, 92 were preterm VLBW and enrolled in the cohort. Fifty-two (56.5%) of the enrolled cases were male and 40 (43.5%) female, male female ratio of 1.3:1. Mean gestational age was 30.8±2.4 weeks and mean birth weight 1,320±133 grams. Eight cases (8.7%) had features of septicaemia on admission and 49 (53.2%) neonates subsequently developed nosocomial infections. Other morbidities were jaundice (34.8%), RDS (8.7%), NEC (4.3%), TTN (3.3%), IVH (2.2%) and PDA (1.1%). Blood culture was positive in 29.8% among 57 suspected sepsis cases; Acinetobacter (41.2%) was the most common organism, followed by Klebsiella pneumoniae (23.5%), Escherichia coli (23.5%) and Pseudomonas sp. (11.8%). Sixty (62.5%) preterm VLBW neonates were improved and discharged, 3 (3.3%) cases were discharged on risk bond and 29 (31.5%) died.Conclusions: Preterm VLBW neonates are at increased risk of morbidity and mortality. Septicemia is the most common and devastating morbidity, most infections are hospital acquired. Therefore strict protocol for asepsis in neonatal units must be adhered to when handling these high risk infants. Key words: Preterm; very low birth weight; septicaemia; morbidity; mortalityDOI: http://dx.doi.org/10.3329/pulse.v4i1.6955Pulse Vol.4 January 2010 p.5-9

Impact of Land-Based Neonatal Transport on Outcomes in Transient Tachypnea of the Newborn

We sought to determine the effect of neonatal transport on the incidence of adverse events of transient tachypnea of the newborn (TTN) in term neonates. A retrospective study was performed of neonates who had TTN and were admitted to Neonatal Intensive Care Unit (NICU) of Sami Ulus Maternity, Children's Education and Research Hospital by land-based transport. Data from 208 newborns with TTN were evaluated, and clinical and laboratory findings were compared between patients who were transported from within the city (group 1) or from outside of the city (group 2). In the present study, long-distance land-based neonatal transport increased the adverse effects of TTN in newborns. Arterial blood gas parameters of the neonates in both groups before transport were similar, and these parameters and Downes' scores were comparable in both groups, implying that patients from outside the city had greater respiratory insufficiency than those from inside the city at admission to NICU. Respiratory support in the NICU and pulmonary air leak syndrome ratios were found to be significantly higher in the group from outside the city. Long-distance land-based transport in neonates with TTN increases the severity of illness. Furthermore, adverse events and the outcome of such infants depend on the effectiveness of the neonatal transport system.

The negative impact of Alagille syndrome on survival of infants with pulmonary atresia

Alagille syndrome (AGS) is a complex disorder with multisystemic involvement, including the liver, heart, kidneys, cerebral vasculature, skeleton, eyes, and face.' A structural heart defect is one of the diagnostic criteria for AGS. These vary in severity, with peripheral pulmonary arterial stenosis being a common problem. Pulmonary atresia (PA) is a rare presentation in AGS, but we were impressed by the poor outcome of such infants following review of our institutional experience over the last 20 years. The information has particular relevance in this era where prenatal diagnosis of both AGS and PA can be made.

Growth and developmental outcomes of three high‐risk infant rhesus macaques (Macaca mulatta)

Infants classified as "high risk" are born with a greater chance of developing medical complications at birth, and may have cognitive and other developmental complications later in life. Very few reports exist regarding the survival and outcome of such infants in primate colonies. Here we present early growth and developmental data on three high-risk infant rhesus macaques (one female and two males) that were born either with intrauterine growth restriction (IUGR; born below the 1st birth weight percentile for gestational age) or extremely prematurely (at gestational days 128 and 140; mean full-term gestation=164 days). We compared the outcome of these infants with that of healthy controls born at term and found no gross developmental delays in these infants with respect to growth, neonatal reflex and motor skill development, early cognitive development, or social behavior. Neurological and cognitive assessments were compared in terms of both postnatal and gestational age. The survival of these infants was dependent on a 24-hr staffed nursery and a fluid protocol that catered to each high-risk infant's individual needs. When such measures are implemented, infants such as these have a good chance of survival and can serve as excellent models for high-risk human babies and their subsequent development.

Follow-up of children who received complex invasive therapies early in life

The present article reviews existing literature and outcome assessment processes used in programs that provide various complex paediatric therapies. The published literature is summarized, and enrolment and assessment details used in the Complex Paediatric Therapies Registry in the province of Alberta are discussed. Several studies have reported the outcomes of infants and children who received various complex invasive therapies. Four hundred eighty-three infants and children who received specific complex therapies in Alberta and survived to discharge were enrolled in neonatal follow-up programs in their home provinces. Compliance rates are 96% or higher at baseline, 18 months and four years of age. In general, cerebral palsy, blindness and deafness are very rare, but developmental delay and borderline cognitive function are more frequent. Analysis of the predictors of the adverse outcomes of such infants has permitted optimal parent counselling and initiation of efforts to improve outcomes.

Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease.

Before the 1960s newborn infants with severe lung disease, usually due to respiratory distress syndrome (RDS), had a very high mortality rate. Standard treatment consisted of supportive measures including supplemental oxygen and correction of metabolic acidosis. Mechanical ventilation (MV) was introduced in the 1960s to correct hypoxaemia and respiratory acidosis in infants who were likely to die. MV is now standard treatment for infants with severe RDS but the degree to which this made a contribution to the outcome of such infants compared with standard neonatal care, is uncertain. To evaluate the effects of the use of MV compared with no MV on mortality and morbidity in newborn infants with severe respiratory failure due to pulmonary disease. Searches were last updated in March 2002 on the Cochrane Controlled Trials Register (Cochrane Library Issue 1, 2002), MEDLINE from 1966 and EMBASE from 1980. In order to detect trials that may not have been published in full, searches carried out of the Oxford Database of Perinatal Trials and for abstracts published by the Society for Pediatric Research (1967 to 2001) and the European Society for Pediatric Research 1970 to 1977. Experts were consulted with emphasis on those who were in active neonatal practice in the 1960s and 1970s when the majority of these trials were likely to have been done. Randomised or quasi-randomised controlled trials in newborn infants with respiratory failure due to pulmonary disease evaluating the use of MV versus standard neonatal care without MV. The standard methods of the Cochrane Collaboration and its Neonatal Review Group were used. Two authors independently assessed eligibility, methodological quality of each trial and extracted the data. Additional information was obtained from all trial authors on methodology or data. The data were analysed using relative risk and risk difference and their 95% confidence intervals. A fixed effect model was used for meta-analyses. The five trials reported on a total of 359 infants with RDS. In one study there is a higher neonatal mortality in the mechanical ventilation group [7/10 vs 1/10; RR 7.00 (1.04, 46.95)]. Overall any reported mortality is less frequent in the mechanical ventilation group with the upper 95% confidence limit on 1.00 [summary RR 0.86 (0.74, 1.00), RD -0.10 (-0.20, -0.01), NNT 10 (5, 100)]. In infants with a birth weight of 1 - 2 kg, no significant difference in mortality is found [summary RR for two trials 0.86 (0.70, 1.07)]. In infants with a birth weight of more than 2 kg, one study reports a significant reduction in mortality in the MV group compared with control [RR 0.67 (0.51, 0.86)]; overall for this birth weight group there is a significant reduction in mortality with MV in the two trials [summary RR 0.67 (0.52, 0.87), RD -0.27 (-0.45, -0.10), NNT 4 (2, 10)]. Any IVH at autopsy is not significantly different between the groups in any study or overall in four studies reporting on 202 infants who had an autopsy. Pneumothorax was reported in two studies of 275 infants and there is a non-significant trend towards an increase in the mechanical ventilation group [summary RR 2.75 (0.72, 10.45)]. When MV was introduced in the 1960s to treat infants with severe respiratory failure due to pulmonary disease, trials showed an overall reduction in mortality which was most marked in infants born with a birthweight of more than 2 kg. This review does not provide information to evaluate the relative benefits or harms of MV in the setting of modern perinatal care. In settings without modern neonatal care, the introduction of MV should ideally be evaluated in randomised controlled trials for its relative benefits, harms and costs.

Outcome of infants with bronchopulmonary dysplasia who receive extracorporeal membrane oxygenation therapy

Background/Purpose: Extracorporeal membrane oxygenation (ECMO) is an accepted therapy for acute respiratory failure but more recently has been used in infants with bronchopulmonary dysplasia (BPD) and superimposed acute pulmonary insults. The purpose of this study was to review the outcomes of such infants. Methods: Charts of infants at The Children's Hospital of Philadelphia (CHOP) who had a diagnosis of BPD before ECMO were reviewed. In addition, to obtain survival data in a larger population, the Extracorporeal Life Support Organization (ELSO) Registry was searched for infants with BPD before ECMO. Results: Of 204 patients who received noncardiac ECMO at CHOP, 9 had BPD before ECMO. Of 7 survivors, 4 were still ventilator dependent at 9 to 39 months of corrected age. Developmentally, 4 had significant global delays, whereas 3 had significant language and motor delays with average to mildly delayed cognitive abilities. The ELSO Registry search showed 76 patients with BPD before ECMO, with a 78% survival. Conclusions: The survival rate of infants with BPD who receive ECMO is comparable to, or better than, the survival rates in most other ECMO populations. However, there appears to be a high risk of severe pulmonary and neurodevelopmental sequelae. J Pediatr Surg 36:1479-1484. Copyright © 2001 by W.B. Saunders Company.

Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Network experience.

The limited literature available to date suggests that the use of delivery room cardiopulmonary resuscitation (DR-CPR) is associated with very poor outcomes, especially for extremely low birth weight infants. We reviewed the cumulative experience of the Vermont Oxford Network to determine the actual utilization of DR-CPR and the neonatal outcomes of such infants. A retrospective review of information available in the Vermont Oxford Network Database for the years 1994 to 1996. The data set was collected from 196 neonatal units who participate in the Network (data for infants 401 to 500 g were from 1996 only). Infants were eligible for study if they received DR-CPR defined as the administration of chest compressions and/or epinephrine in the delivery room as noted on the Vermont Oxford Network Database record. Information regarding survival was available for 27 707 newborns with birth weights from 501 to 1500 g, and 497 infants with birth weights from 401 to 500 g. There were 24 001 (86.6%) survivors. Overall DR-CPR was given to 9.3% of infants from 401 to 500 g and 6% of infants from 501 to 1500 g, 82.1% receiving chest compressions, and 66.7% receiving epinephrine. Survival of infants receiving DR-CPR was 23. 9% for infants of 401 to 500 g, and 63.3% for infants of 501 to 1500 g, compared with 16.7% and 87.9% for infants in these weight groups not receiving DR-CPR. Survival was greater for infants of 501 g or greater without DR-CPR compared with those who received this intervention within each 250-g birth weight subgroup. For infants of <1000 g, survival was 53.8% with DR-CPR compared with 74.9% without. Head ultrasounds were available for 95.5% of all surviving infants and 96.7% of infants who received DR-CPR. Overall, any grade of intraventricular hemorrhage (IVH) occurred more frequently in infants who received DR-CPR (38%) than in those who did not (21%). Grade 3 or 4 (severe) IVH was seen in 15.3% of infants who received DR-CPR compared with 4.9% of the infants who did not. Overall, survival without severe IVH occurred in 52.2% of DR-CPR infants compared with 81.3% of infants who did not require this intervention. The majority of very low birth weight and extremely low birth weight infants who receive DR-CPR survive, and at least half of such infants who survive do not have evidence of severe IVH. Further follow-up studies are required to determine the long-term neurodevelopmental outcome of such infants. The current study does not support the previously noted poor outcome in extremely low birth weight infants who receive DR-CPR.

Prognosis for Development in the Newborn Requiring Neurosurgical Intervention

The long-term prognosis of the newborn infant destined for neurosurgery may depend in large part on preexisting neurologic disturbances. The ability to delineate preoperatively the likely long-term neurologic outcome of such infants facilitates the formulation of optimal interventions and the prediction of likely benefit of a specific intervention and addresses parental concerns for the likely outcome with and without neurosurgical intervention. This article describes two fundamental approaches, using clinical observations or laboratory investigations for delineating such a prognosis. Clinically important factors include the underlying cause, the extent of associated parenchymal injury, and the nature of comorbid factors, particularly those of cerebrovascular and dysgenetic origin. Other important prognostic factors include the age at presentation, the rate of progression, and timing of intervention. The use and limitations of current structural brain imaging, electrophysiologic and perfusion studies, and newer neurodiagnostic techniques are discussed.

The relationship between psychosocial factors and developmental outcome for very low and extremely low birthweight infants: a review.

Over the last quarter century, the improved survival rate of very low birthweight infants has sharpened questions about their residual disabilities. Longitudinal studies have devoted attention to the cognitive and neurodevelopmental outcome of these infants, but much less is known about their long-term social and emotional development. Psychiatrists consulting to neonatal intensive care units and assessing these infants in their families, will be assisted by a better understanding of the developmental and psychological outcomes of such infants. This paper reviews the state of knowledge in both of these areas. It argues the paramount importance of psychosocial factors to the infants' developmental outcome, and the importance of longitudinal research in further clarifying the predictive value of these factors. In a subsequent paper, we consider the efficacy of interventions with this group.

Benefits of early maternal participation in care of low birth weight infants leading to early discharge.

The morbidity and mortality of low birth weight infants in Andhra Pradesh India is examined. After discharge from Special Care Nurseries these infants survival depends largely upon the mothers ability to feed and care for them. This ability is impaired when the infants hospital stay is prolonged for the purposes of gaining weight and is undermined by frequent bouts of infection overcrowding understaffing a disturbed mother-child relationship and the subsequent failure of breastfeeding. Mothers are encouraged to participate in the care and feeding of the infants as soon as possible. Once breastfeeding has been successfully established infants are discharged irrespective of body weight. Out patient follow up is conducted to insure that infants are able to maintain normal temperature and are not subject to infection. This study is an analysis of the progress and outcome of such infants discharged over the period of 1 year 1976. The mean weight on discharge was 1580 gm with a range of 1100 to 1800 gm. Results revealed that 82% came for follow up out of which 53% were doing well and gaining weight rapidly while 38% fared moderately. Only 9% did poorly requiring readmission with a 5% mortality rate. The significant factor determining a favorable outcome was the ability of the mother to breastfeed her infant. (authors modified)

Salmonella bacteremia in the first year of life

THE INCIDENCE of nontyphoidal Salmonella infection is greater in the first year of life than at any other time? Infected infants demonstrate a highly variable clinical picture, ranging from asymptomatic stool carriage'-' to severe bloody diarrhea, bacteremia, and metastatic infection. 3 Previous studies ~-7 have shown a low (4 to 13%) incidence of bacteremia in nonepidemic infections in patients less than one year of age, although nursery outbreaks have been associated with a higher incidence of bacteremia. 8. ~ The predisposing factors, clinical correlates, and consequences of Salmonella bacteremia in children under one year of age have not been adequately identified. Accordingly, we analyzed the course and outcome of such infants with Salmonella infection seen in a recent three year period at this hospital.