Neonatal Parameters Research Articles

Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns.

The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.

Risks of urgent cesarean delivery preceding the planned schedule: A retrospective cohort study.

The aim of the study was to ascertain risk factors and outcomes of elective cesarean deliveries performed urgently prior to their scheduled date. Women carrying a viable singleton fetus who were scheduled for elective cesarean delivery at a tertiary medical center between 2012-2020 were identified by retrospective database. Differences in maternal and neonatal parameters between those who ultimately required urgent cesarean delivery and those who underwent the procedure as scheduled were analyzed. Of 4403 women who met the inclusion criteria, 559 underwent urgent cesarean delivery before the scheduled date. On multivariate analysis, factors significantly associated with a risk of transformation to an urgent cesarean delivery were chronic hypertension (aOR 1.92, 95% CI 1.30-2.83 P = 0.001), antenatal corticosteroids administration (aOR 3.26, 95% CI 2.38-4.47, P <0.001), and contraindication for vaginal delivery as the reason for elective cesarean delivery (aOR 1.67, 95% CI 1.32-2.12, P <0.001). Neonates born via urgent cesareans had an increased risk of 1-minute Apgar <7 (6% vs. 1.7%, P <0.001), intensive care unit admission (6.6% vs. 2.5%, P <0.001); their mothers were at risk of postpartum hemorrhage (5.9% vs. 3%, P = 0.001). The present study sheds light on the risk factors and maternal and fetal morbidities associated with elective cesarean deliveries that become urgent before the originally scheduled date. Physicians should take this information into account when planning an optimal date for elective cesarean delivery.

Physical activity and sedentary time across pregnancy and associations with neonatal weight, adiposity and cord blood parameters: a secondary analysis of the DALI study.

Obesity during pregnancy is associated with neonatal adiposity, which is a risk factor for childhood obesity. Maternal physical activity (PA) and sedentary behaviours during pregnancy might modify this risk. We therefore studied associations between maternal PA and sedentary time (ST) during pregnancy and neonatal anthropometry and cord blood parameters and investigated whether associations differed by offspring sex. Participants of the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) study with a BMI ≥ 29 kg/m2 were analysed as a cohort. Maternal moderate-to-vigorous PA (MVPA) and ST were measured repeatedly with accelerometers across pregnancy. Associations between mean levels and changes in MVPA and ST and birthweight, neonatal adiposity (fat mass (FM)%) and cord blood parameters, including C-peptide, leptin and lipids, were analysed in 213 mother-child pairs with Bayesian multilevel models. Interactions with offspring sex were considered. Almost all women decreased MVPA levels and increased ST throughout gestation. Both higher maternal mean MVPA and increasing MVPA were associated with lower offspring FM% in males (-0.520%; 95% CI: -1.011%, -0.031% and -4.649%; -7.876%, -1.432% respectively). In female offspring, mean ST was associated with lower cord blood C-peptide (-0.145 µg/l; -0.279 µg/l, -0.005 µg/l). No associations were found with birthweight or other cord blood parameters. Maternal MVPA is associated with neonatal fat mass, but not birthweight, in male offspring. Our findings underline the importance of physical activity throughout pregnancy.

Effect of nalbuphine plus ropivacaine on vaginal labor in epidural analgesia

BackgroundVarious approaches using epidural analgesia have been employed for relieving labor pain and promoting spontaneous delivery. We aimed to evaluate the effect of nalbuphine and ropivacaine versus fentanyl and ropivacaine on the duration of delivery in parturients.MethodsClinical data of 160 full-term primiparous women who received either nalbuphine or fentanyl in combination with ropivacaine infusion for epidural labor analgesia in our hospital from December 2020 to May 2022 were retrospectively analyzed. The participants were divided into two groups based on anesthesia methods: nalbuphine group (NR group, n = 78) received 0.2 mg/mL nalbuphine combined with 0.1% ropivacaine hydrochloride for patient-controlled epidural analgesia (PCEA) and fentanyl group (FR group, n = 82) received 2 ug/mL fentanyl citrate and 0.1% ropivacaine hydrochloride for PCEA. Both groups received an epidural blockade for labor analgesia at lumbar 2–3 interspace. The duration of the first, second, and third stages of labor, the onset of analgesia, and time before delivery (T0), 15 min of analgesia (T1), 30 min of analgesia (T2), full opening of the uterine opening (T3),exerts force during childbirth(T4), heart rate (HR), blood pressure (BP), blood saturation (SpO2), visual analogue pain scale (VAS) score, Ramsay sedation score, and modified Bromage score, and 5 min were recorded at 2 h postpartum (T5). The neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, maternal nausea, vomiting, and itchy skin were recorded.ResultsCompared with the FR group, the first stage of labor duration (p < 0.05) and total duration of labor (p < 0.05) were shortened and the onset of analgesia (p < 0.05) was increased in the NR group. NR group had lower incidence of urinary retention than FR group (p < 0.05). The maternal and neonatal investigational parameters and scores had no significant difference between the two groups.ConclusionsNalbuphine combined with ropivacaine in epidural block labor has a faster onset of analgesia and has a lower incidence of urinary retention than fentanyl combined with ropivacaine, and nalbuphine shortens the duration of the first and total stages of labor. Both nalbuphine and fentanyl can reduce pain during labor, have little effect on maternal hemodynamics, and have no significant effect on neonatal Apgar or NBNA scores.

The impact of early versus delayed cord clamping on hematological and cardiovascular changes in preterm newborns between 24 and 34weeks' gestation: a randomized clinical trial.

This study aimed to investigate hematological and cardiac changes after early (ECC) versus delayed cord clamping (DCC) in preterm infants at 24-34weeks of gestation. Ninety-sixhealthy pregnant women were assigned randomly to the ECC (< 10s postpartum, n = 49) or DCC (45-60s postpartum, n = 47). Primary endpoint was evaluation of neonatal hemoglobin, hematocrit and bilirrubin levels within the first 7days after birth. A postpartum blood test was performed in the mother and a neonatal echocardiography in the first week of life. We found differences in hematological parameters during the first week of life. On admission, the DCC group had higher hemoglobin levels than the ECC group (18.7 ± 3.0 vs. 16.8 ± 2.4, p < 0.0014) and higher hematocrit values (53.9 ± 8.0 vs. 48.8 ± 6.4, p < 0.0011). Around day 7 of life, hemoglobin levels were also higher in the DCC group compared with the ECC group (16.4 ± 3.8 vs 13.9 ± 2.5, p < 0.005), as was the hematocrit (49.3 ± 12.7 vs 41.2 ± 8.4, p < 0.0087). The need of transfusion was lower in the DCC compared to the ECC (8.5% vs 24.5%; OR: 0.29, 95% CI: 0.09-0.97, p < 0.036). The need for phototherapy was also higher in the DCC (80.9% vs 63.3%; OR: 0.23, 95% CI: 0.06-0.84, p < 0.026). No differences in cardiac parameters or maternal blood tests. DCC improved neonatal hematological parameters. No changes in cardiac function were found and maternal blood loss did not increase to require transfusion.

Prospective Evaluation of the Correlation of Lung Ultrasonography Score and Blood Gas Parameters in Neonates With Respiratory Distress.

Introduction Lung ultrasonography (LUS) has become frequently used in neonatal intensive care units (NICU) because it is diagnostic, useful, harmless, radiation-free, and practical for bedside use due to its portability. Objective This study aimed to evaluate the association between lung ultrasound (LUS) scores and diagnoses of neonates hospitalized for respiratory distress and determine the value of the combined use of laboratory and imaging methods in patient evaluation by looking at the correlation between blood gas parameters and LUS score. Materials and methods Between March and July 2022, a total of 55 patients who were born term or premature and admitted due to respiratory distress in the NICU of Malatya Training and Research Hospital were included in the study. In this observational, prospective study, demographic information such as birth weights, gestational weeks, mode of delivery, Apgar scores, blood gas sample results, LUS results and scores, ventilation types, and discharge time were recorded during hospitalization in our unit. According to the newborns' clinical, laboratory, and radiologic evaluations, the diagnoses of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), or congenital pneumonia were made, and the relationship between the diagnoses and LUS scores was evaluated. The pH value and PCO2 value in the venous blood gas obtained on the day of LUS were recorded. Correlation analysis was performed between the LUS score and pH value, LUS score and PCO2 value. Results Twenty-seven newborns were diagnosed with TTN, 18 with RDS, and 10 with congenital pneumonia. There was a statistical difference between LUS scores and diagnoses (p<0.001). According to Spearman correlation analysis, a significant negative moderate correlation was found between LUS scores and venous blood gas pH value (p<0.001, r:-0.49). There was also a significant positive low, moderate correlation with venous blood gas PCO2 value (p<0.001, r:0.36). Conclusion This study demonstrates that LUS scoring has a role in determining the severity of disease and making diagnoses in patients hospitalized for respiratory distress. When LUS is widely used, it will be informative about the severity and prognosis of the disease, together with laboratory evaluation.

Neonatal Outcome of Pregnancies with Oligohydramnios and Polyhydramnios

Objective: To asses’ factors associated with neonatal outcome of pregnancies with oligohydramnios and polyhydramnios.&#x0D; Study Design: Comparative Cross-sectional Study.&#x0D; Place and Duration of Study: Department of Pediatrics and Gynecology, Fauji Foundation Hospital, Lahore Pakistan, from Oct 2020 to Sep 2021&#x0D; Methodology: A prospective comparative study was conducted on the babies born to mothers diagnosed witholigohydramnios and polyhydramnios during the course of pregnancy. Neonates were evaluated by neonatologist within first 24 hours of birth. The cases were admitted and well babies were handed over to parents. The neonatal outcome parameters were observed in all these babies for first two weeks of life. Those who lost follow up they were excluded from study. Age of mother, gestational age of baby, maternal hypertension and maternal diabetes were associated with presence of complications among these babies.&#x0D; Results: Two thousand One hundred and Twenty-nine deliveries took place in given duration. About 322 had either polyhydramnios or oligohydramnios. About 150 cases could be followed completely. Fifty-five (36.7%) showed presence of one or more complications, of which 29(41.4%) cases had oligohydramnios and 26(32.5%) had polyhydramnios. Maternal age and presence of maternal diabetes and maternal hypertension had statistically significant association with complications in neonates (p-value &lt;0.005).&#x0D; Conclusion: Complications rate was high among neonates born to mothers with oligohydramnios or polyhydramnios. Advanced maternal age, presence of diabetes mellitus and hypertension were factors association with presence of complications in neonates included in our study.

Correlations of Placental Histopathology, Neonatal Outcome, and Cardiotocogram Baseline Variability and Acceleration Patterns in the Growth Restricted Preterm Population.

To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.

Cut umbilical cord milking (C-UCM) as a mode of placental transfusion in non-vigorous preterm neonates: a randomized controlled trial.

Routine practice of delayed cord clamping (DCC) is the standard of care in vigorous neonates. However there is no consensus on the recommended approach to placental transfusion in non-vigorous neonates. In this trial, we tried to examine the effect of cut umbilical cord milking (C-UCM) as compared to early cord clamping (ECC) on hematological and clinical hemodynamic parameters in non-vigorous preterm neonates of 30-35weeks gestation. The primary outcome assessed was venous hematocrit (Hct) at 48 (± 4) hours of postnatal age. The important secondary outcomes assessed were serum ferritin at 6weeks of age, mean blood pressure in the initial transitional phase along with important neonatal morbidities and potential complications. In this single centre randomized controlled trial, 134 non vigorous neonates of 30-35weeks gestation were allocated in a 1:1 ratio to either C-UCM (n = 67) or ECC (n = 67). For statistical analysis, unpaired Student t and Chi square or Fisher's exact test were used. The mean Hct at 48h was higher in the C-UCM group as compared to the control group, 50.24(4.200) vs 46.16(2.957), p < .0001. Also significantly higher was the mean Hct at 12h, 6weeks and mean serum ferritin at 6weeks of age in the milked group (p < .0001). Mean blood pressure at 1h and 6h was also significantly higher in the milked arm. Need for transfusion and inotropes was less in the milked group but not statistically significant. No significant difference in potential complications was observed between the groups. Conclusion: C-UCM stabilizes initial blood pressure and results in higher hematocrit and improved iron stores. It can be an alternative to DCC in non-vigorous preterm neonates of 30-35weeks' gestation. Further large multicentric studies are needed to fully establish its efficacy and safety. Trial registration: CTRI/2021/12/038606; registration date December 14, 2021. What is Known: • DCC is the routinely recommended method of placental transfusion for vigorous neonates but no consensus exist for neonates requiring resuscitation at birth. • C-UCM is easier to perform in non-vigorous neonates but there is paucity of studies in the preterm population. What is New: • C-UCM is effective as well as safe in non-vigorous preterm neonates of 30-35weeks gestational age. • C-UCM holds promise as an alternative to DCC, especially in resource limited settings and in situations where the later is not feasible.

Correlation between hyperbilirubinemia risk and immune cell mitochondria parameters in neonates with jaundice.

To explore the correlation between mitochondria parameters of immune cells and hyperbilirubinemia risk in hospitalized neonates with jaundice. This retrospective study included jaundiced neonates born between September 2020 and March 2022 at Shaoxing Keqiao Women & Children's Hospital. The neonates were divided into low, intermediate-low, intermediate-high, and high-risk groups according to the hyperbilirubinemia risk. The purpose parameters including percentage, absolute count, mitochondrial mass (MM), and single-cell MM (SCMM) of peripheral blood T lymphocytes detected by flow cytometry were collected. Finally, 162 neonates with jaundice (47, 41, 39, and 35 with low, intermediate-low, intermediate-high, and high-risk) were included. CD3+ SCMM was significantly higher in the high-risk group compared with the low and intermediate-low-risk groups (both P < 0.0083), CD4+ SCMM was significantly higher in the high-risk group compared with the three other groups (all P < 0.0083), and CD8+ SCMM was significantly higher in the intermediate-low and high-risk groups compared with the low-risk group (both P < 0.0083). CD3+ (r = 0.34, P < 0.001) and CD4+ (r = 0.20, P = 0.010) SCMM positively correlated with bilirubin levels. The mitochondrial SCMM parameters differed significantly among jaundiced neonates with different hyperbilirubinemia risks. CD3+ and CD4+ T cell SCMM values were positively correlated with the serum bilirubin levels, and might correlated with hyperbilirubinemia risk.

Transplacental Transfer of SARS-CoV-2 Receptor-Binding Domain IgG Antibodies from Mothers to Neonates in a Cohort of Pakistani Unvaccinated Mothers.

The presence of COVID-19 antibodies in the maternal circulation is assumed to be protective for newborns against SARS-CoV-2 infection. We investigated whether maternal COVID-19 antibodies crossed the transplacental barrier and whether there was any difference in the hematological parameters of neonates born to mothers who recovered from COVID-19 during pregnancy. The cross-sectional study was conducted at the Saidu Group of Teaching Hospitals, located in Swat, Khyber Pakhtunkhwa. After obtaining written informed consent, 115 healthy, unvaccinated mother-neonate dyads were included. A clinical history of COVID-19-like illness, laboratory-confirmed diagnosis, and contact history were obtained. Serum samples from mothers and neonates were tested for SARS-CoV-2 anti-receptor-binding domain (anti-RBD) IgG antibodies. Hematological parameters were assessed with complete blood counts (CBC) and peripheral blood smear examinations. The study population consisted of 115 mothers, with a mean age of 29.44 ± 5.75 years, and most women (68/115 (59.1%)) were between 26 and 35 years of age. Of these mothers, 88/115 (76.5 percent) tested positive for SARS-CoV-2 anti-RBD IgG antibodies, as did 83/115 (72.2 percent) neonatal cord blood samples. The mean levels of SARS-CoV-2 IgG antibodies in maternal and neonatal blood were 19.86 ± 13.82 (IU/mL) and 16.16 ± 12.90 (IU/mL), respectively, indicating that maternal antibodies efficiently crossed the transplacental barrier with an antibody transfer ratio of 0.83. The study found no significant difference in complete blood count (CBC) parameters between seropositive and seronegative mothers, nor between neonates born to seropositive and seronegative mothers.

Comparison of Apgar score and neonatal parameters between ET and ICSI foals

ICSI (Intracytoplasmic Sperm Injection) in the mare has been growing considerably in Brazil. This technique allows foals to be produced from mares with fertility problems, optimizes the use of rare or high-cost semen and embryos can be cryopreserved and achieve good pregnancy rates after transfer. An increasing number of ICSI foals are born each year and it is common to be asked by clients and veterinarians if these neonates have differences or altered behavior after birth compared to conventional embryo transfer (ET) foals. Therefore, the present study evaluated Apgar score and neonatal parameters in ICSI foals compared with conventional ET foals. A total of 25 Quarter Horse foals were evaluated, 11 born after conventional ET and 14 after ICSI. All parturitions were monitored and foals were evaluated. Heart and respiratory rates, muscle tone, and nasal stimulus were observed for the Apgar assessment (Knottenbelt.et.al. Equine Neonatol Med Surg 2004; 69-71) at 1 hour of life. Post-partum parameters evaluated were time to show a sucklingreflex, sit in sternal recumbency, stand and nurse. Regarding the Apgar score, there was no statistical difference (p = 0.8) comparing ET (7.64) and ICSI (7.57) foals. There was no statistical difference between groups (ET vs ICSI) for time to sit in sternal recumbency (8 vs 15.1 min, p = 0.1), show a suckling reflex (36.43 vs 34.25 min, p=0.9), stand (35.5 vs 39.92, p = 0.3) or nurse (108.88 vs 93.5 min, p = 0.4). The only detected difference was the time taken to start meconium elimination, ET foals showed an average of 122.75 compared to 61.75 min for the ICSI foals (p=0.02) but this difference has no biological significance, as values are within physiological parameters. Based on these results, foals produced by ICSI have the same neonatal parameters as conventional ET foals. Thus the same timeframes can be used to evaluate ET and ICSI neonates during the postpartum period. Acknowledgements: Fapesp 2020/10260-3 and RH Ranch (Campos dos Goytacazes – Brazil).

Impact on postoperative, neonatal and 2-year neurodevelopmental outcomes of UA-AREDF during and after fetal spina bifida repair.

Absent or reversed end-diastolic flow (AREDF) in the umbilical artery (UA) on Doppler is a known phenomenon during fetal interventions, such as fetal open spina bifida (OSB) repair. We aimed to evaluate the clinical importance of these Doppler findings by investigating the impact of UA-AREDF on postoperative, neonatal and 2-year neurodevelopmental outcomes. This was a prospective study of pregnancies undergoing fetal OSB repair at the Zurich Center for Fetal Diagnosis and Therapy between 2010 and 2019. The group with UA-AREDF during or immediately after the intervention was compared to the group with normal UA Doppler. Primary endpoint was the FIGO scores of cardiotocography (CTG) 1, 2 and 6 h postoperatively and on day 1 after surgery. Secondary endpoints were the neonatal parameters and 2-year neurodevelopmental outcome assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Data of 130 patients were analyzed. None of the fetuses had UA-AREDF before OSB repair. Normal UA Doppler was observed in 107 (82%) patients and UA-AREDF was observed in 23 (18%) during or immediately after OSB surgery. UA-AREDF was more often observed after version of the fetus (P = 0.045). Seventeen (13%) cases had absent end-diastolic flow (UA-AEDF) and six (5%) cases had reversed end-diastolic flow (UA-REDF). UA-AREDF disappeared in all 23 cases within the first day after OSB surgery. One-third of all CTGs were restricted in oscillation after surgery, but no significant difference in CTG 1, 2 and 6 h postoperatively or on the first postoperative day was found between the UA-AREDF and normal-Doppler groups (P > 0.05). Gestational age at delivery, UA pH, 5-min Apgar score and birth weight were comparable between the two groups, and there was no difference in the 2-year neurodevelopmental outcome (P > 0.05). The neonatal and 2-year neurodevelopmental outcomes also did not differ significantly between the UA-REDF and UA-AEDF groups. Postoperative CTG abnormalities occur and recover at a similar rate in fetuses with transitory UA-AREDF and those with normal Doppler during fetal OSB repair. UA-AREDF during fetal OSB repair did not negatively influence postnatal or 2-year neurodevelopmental outcomes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Determination of sex from occipitofrontal circumference, birth weight and placenta weight of neonates in selected private hospitals in Ilorin metropolis in Nigeria

The aim of the study is to determine the sex of neonates from the occipitofrontal circumference, weight of neonate, and weight of placenta in selected private hospitals in the Ilorin metropolis. The sample study comprised 244 subjects (122 males and 122 females) having no birth deformities. The occipitofrontal circumference was taken using an infant head circumference tape. The weight of birth and the weight of the placenta was measured using an analogue baby weighing scale. Pearson’s Chisquare and Chi-square Automatic Interaction Detector (CHAID) decision tree analysis were used to analyze the data. 𝑃 &lt; 0.05 was considered significant. The result showed that birth weight, placental weight and occipitofrontal circumference did not determine the sex of neonates. There were no significant relationships between each of the neonatal parameters and the sex of neonates. An increase in the birth weight led a significant increase in the placental weight. Also, the placental weight was significantly different in terms of the mode of delivery; it being higher in neonates born via C/S.

Optimizing the timing of antenatal corticosteroid administration prior to anticipated preterm birth: A retrospective cohort study.

To examine suboptimal antenatal corticosteroid (ACS) administration based on indications and maternal-obstetrical factors. Women who prematurely delivered (24 + 0 to 36 + 6 gestational weeks) a viable neonate following ACS treatment between 2012 and 2019 were identified by a retrospective database review. The cohort was divided into patients in whom ACS administration was optimally timed (≥24 h to ≤7 days) or suboptimally timed (>7 days). The groups were compared for ACS indications and maternal, obstetrical, and neonatal parameters. The cohort included 399 women. ACS timing was optimal in 233 patients (58%) and was associated with nulliparity (109 [46.8%] vs. 54 [32.5%], P = 0.004) and preterm premature rupture of membranes (89 [38.2%] vs. 45 [27.1%], P = 0.021). Suboptimal timing was associated with chronic hypertension (22 [9.4%] vs. 36 [21.7%], P < 0.001) and asymptomatic cervical shortening (23 [9.9%] vs. 26 [15.7%], P = 0.020). Optimal ACS timing was associated with higher neonatal intensive care unit admission (135 [58%] vs. 71 [42.8%], P = 0.003). On multivariate analysis, the adjusted odds ratio (aOR) of neonatal intensive care unit admission was 0.69 (95% confidence interval [CI], 0.58-0.83, P < 0.001) and 0.99 (95% CI, 0.99-1, P = 0.003) when adjusted for gestational age and birth weight, respectively. When adjusting for maternal age, the aOR for suboptimal ACS administraion due to chronic hypertension was 2.65 (95% CI, 1.49-4.72; P < 0.001). Optimal timing of ACS varies based on different maternal characteristics and clinical indications. In the presence of certain parameters physicians tend to administer ACS suboptimally, diminishing its beneficial effect.

An Evaluation into Procalcitonin Levels in Full-Term Neonates Managed for Suspected Early Onset Sepsis due to Probable Maternal Intrapartum Sepsis

Purpose To investigate procalcitonin (PCT) levels in full-term neonates managed for suspected early onset sepsis (EOS) due to probable maternal intrapartum sepsis. Methods Prospective longitudinal observational study at University Hospitals of Bristol NHS Foundation trust. Included were a total of 117 neonates managed for suspected EOS from June to October 2020. In addition to routine full-blood-counts and c-reactive protein (CRP) tests, serum PCT levels were also measured as part of the septic screen and follow-up blood tests. Placentas were sent for histopathology analysis. Neonatal parameters were used to categorize cases into: “high-suspicion bacterial sepsis (BS),” “equivocal BS” and “low-suspicion BS.” Statistical test Kruskal-Wallis compared categories with biomarker values and placental histopathology scores. Results A higher percentage of PCT levels showed elevation in comparison to CRP levels in the initial testing (55.3% versus 5.9%) and follow-up testing (98.9% versus 35%). There was a significant difference between the “low-suspicion BS” and “high-suspicion BS” categories for both the initial and follow-up PCT results. 71.2% of placentas showed varying degrees of chorioamnionitis. Conclusion This study provides evidence to the physiological rise in PCT during the first few days of life. The significant difference in PCT levels according to clinical severity shows that PCT could be utilized in calculating odds for EOS, but as a standalone test will have limited use.

Haematological Parameters in Preterm Neonates Admitted in Neonatal Intensive Care Unit in a Tertiary Care Hospital

Though reference haematological parameters are defined for neonates, ranges vary in preterm. Few data are available regarding the premature population during the first month of life. Objective: To observe the variation in haematological parameters concerning different gestational ages, birth weights and gender among preterm neonates admitted to NICU with common illnesses like respiratory distress (RDS), neonatal hyperbilirubinemia (NNH) and sepsis in a tertiary care hospital. A total of ninety preterm neonates admitted to the neonatal intensive care unit (NICU) were analyzed over two years. Complete blood counts were obtained, grouped and analyzed according to the underlying diagnosis of sepsis, NNH and RDS. Clinical data were also extracted. The data were analyzed using SPSS software version 25. Mean, Chi-square test and ANOVA tests were used for data analysis. P value &lt;0.05 was considered significant. Result: Variation was seen concerning gestational age and birth weight. Eosinophils were significantly decreased in LBW, while a decrease in neutrophils and an increase in lymphocyte count were seen in EPT. Haemoglobin and RBC indices also showed significant variation according to birth weight. Conclusions research complete blood counts of preterm depend on the degree of prematurity, birth weight, and other clinical findings.

Predicting a clinically narrow pelvis using neural network data analysis

Aim: to improve the efficiency of predicting a clinically narrow pelvis (СNP) using neural network data analysis and to evaluate its prognostic characteristics.Materials and Мethods. The study was designed as a retrospective non-randomized clinical trial. An analysis of 184 born neonates was carried out: group 1 included 135 female patients whose delivery occurred through the natural birth canal, group 2 – 49 patients whose delivery was complicated by СNP development and ended up with emergency caesarean section. Examination of patients was carried out on the eve of childbirth (1–2 days) and included anamnesis, general and special obstetric examination, including pelvimetry, a clinical assessment of cephalopelvic disproportion was carried out during childbirth. The condition of newborns was assessed using the Apgar scale, height and body weight were measured. Neural network analysis was performed using the built-in Neural Networks module of SPSS Statistics Version 25.0 (IBM, USA).Results. Despite hypothetically important role of anatomically narrowed pelvis in development of cephalopelvic disproportion, no significant inter-group differences were found. Significant parameters (abdominal circumference, uterine fundus height and woman’s weight, fetal head circumference, as well as data on the presence or absence of oligohydramnios and fetal macrosomia) were determined, which were included in the test database to create the basis for training the multilayer perceptron. Out of 135 patients of group 1, the prognosis was negative in 131 (97.0 %), positive in 4 (3.0 %); out of 49 patients in group 2, negative in 0 (0.0 %), positive in 49 (100.0 %). The forecast accuracy of the developed model was 98 % (sensitivity – 100 %, specificity –97 %). The information content of neural network data analysis in СNP predicting is presented in ROC analysis: area under the curve (AUC) = 0.99 (95 % confidence interval = 0.97–1.00). Neonatal anthropometric parameters were significantly higher in group 2 vs. group 1, and the Apgar score at 1 minute was correspondingly lower.Conclusion. The use of neural network analysis of clinical data obtained on the eve of childbirth allows to predict СNP development at sufficient degree of accuracy (98.0 %), which, in the future, after being introduced into clinical practice, will optimize a choice of delivery method in patients at risk (anatomically narrow pelvis, large fetus), reduce emergency caesarean sections and improve birth outcomes.

Maternal and infant cannabis testing and associated birth outcomes.

The objective of the study was to determine any identifiable clinical utility of the practice of universal maternal and infant tetrahydrocannabinol (THC) testing at the time of birth. This was cross-sectional, retrospective cohort study comparing the following birth outcomes in relation to maternal and infant tetrahydrocannabinol (THC): APGAR scores, cord gases, NICU admission and need for immediate resuscitation. All births at the University of Maryland Medical Center between January 1, 2018 and December 31, 2020 were reviewed. Those that had either maternal or infant test results missing were excluded. Statistical analysis was performed using STATA v27. Birth outcomes were adjusted for gestational age at delivery and tobacco use. Infant resuscitation was considered the need for any respiratory support. A total of 4260 maternal/infant pairs were included. Of these, 314 (7.4%) birthing parents and 161 (3.8%) of infants tested positive for THC. Of the birth parents who tested positive for THC, 51.3% of their infants also tested positive for THC. Maternal/infant pairs that both tested positive for THC had the lowest need for immediate resuscitation and Neonatal Intensive Care Unit admission. Cord gases and APGAR scores were similar between the groups. Birth parents who tested positive for THC delivered infants at an earlier gestational age (37w6d v 38w5d, p = 0.001) and lower mean birth weight (2690gm v 3061gm, p = 0.001) than those who tested negative even after adjusting for confounders. When limited to only term births and broken down by weeks completed gestation, the mean birth weights were lower for every week in those who tested positive for THC versus those who tested negative. Our study shows that maternal and neonatal testing for THC at the time of birth is not predictive of important neonatal outcome parameters. Therefore, even though it is likely that there are some effects of in utero THC exposure on the neonate, we did not find any clinical benefits that would justify routine maternal and/or infant testing for THC at the time of birth.

Growth Parameters and Follow up of Low-Birth-Weight Healthy Newborn Discharged from Post Natal Ward of Dr. BRAMH Raipur till 4 Month of Age

Introduction: LBW is known to be associated with subsequent health issues such as poor anthropometric growth in childhood. Late catch-up growth of preterm infants throughout childhood linked to an adverse health outcome. The aim of this study is to study the growth parameters of healthy low birth weight neonates discharged from post-natal ward. Material and methods: This was a hospital based prospective cross-sectional study conducted in year of 2022 in the department of pediatrics at Pt JNMCH, Raipur. Vitally stable LBW neonates were recruited in the study. The sample size calculated was 140. At the time of birth anthropometric measurement i.e. head circumference, length, weight was taken. Follow up was done again at 1.5 month, 2.5 month and 3.5 month. Informed consent was taken form care takers prior to inclusion in the study. Results: In present study 140 newborns were followed up for their growth. The mean difference between birth weight at birth and at 1.5 months was 1.150 kg (p&lt;0.01), at 1.5 months and weight at 2.5 months was 1.129 kg (p&lt;0.01) and at 2.5 months and weight at 3.5 months was 1.436 kg (p&lt;0.01). Type of feed wise mean weight gain at 1.5 months was highest on those on formula feed, mother milk and those on mixed feed. Male had higher mean weight gain than female. Conclusion: The present study concluded that postnatal lactation counseling leads to higher weight gain in infants as compared to those on formula feed.