Perinatal Asphyxia Research Articles

Effectiveness of simulation-based interprofessional education on teamwork and communication skills in neonatal resuscitation

BackgroundThe role of effective interprofessional teamwork is especially vital in the Neonatal Intensive Care Unit (NICU) where infants facing emergency situations are admitted. Proper neonatal resuscitation, facilitated by comprehensive resuscitation training, can significantly decrease the mortality rates associated with neonatal asphyxia and respiratory failure. This study aimed to develop a simulation-based interprofessional education (IPE) programme for medical staff working in a nursery and NICU and to assess its effectiveness on teamwork, communication skills, clinical performance, clinical judgement, interprofessional attitudes, and education satisfaction.MethodsThrough a demand survey, neonatal resuscitation was selected as the theme, and an IPE team comprised of one doctor and two nurses was formed. The education programme consisted of three sessions lasting a total of 140 min: two simulation exercises and one theoretical education session. Data were collected from 18 nurses working in the nursery and NICU and 9 doctors working in the paediatrics department.ResultsA comparison of the metrics before and after applying simulation-based IPE programmes revealed teamwork (Z=-2.67, p = .008), communication skills (Z=-2.68, p = .007), clinical performance (Z=-2.52, p = .012), clinical judgement (Z=-4.52, p < .001), and interprofessional attitude (Z=-3.64, p < .001) to have significantly improved. Education satisfaction scores were 4.73 points on average out of a maximum of 5. The simulation-based IPE programme was effective in improving the teamwork, communication, and clinical performance of resuscitation teams, individual clinical judgement, and interprofessional attitude.ConclusionsSimulation-based IPE is effective for enhancing teamwork, team communication, clinical judgement skills, and clinical performance in neonatal resuscitation. This programme has the potential to contribute to the improvement of patient safety and the quality of neonatal care. Additional studies are needed to longitudinally examine the effects of the programme on patient safety and quality of neonatal care.

Factors affecting postnatal weight gain of very low birth weight babies during NICU stay in a tertiary care centre in Southern India: an observational study

Background: The survival of very low birth weight babies has significantly improved in recent years. Postnatal growth has an impact on neurodevelopment and hence identifying the risk factors that curb growth is crucial. Methods: We did a retrospective cohort study over 3 months in our NICU studying 40 very low birth weight babies. Our objective was to observe the time taken to regain birth weight and study the risk factors affecting postnatal weight gain. Results: Among the 40 babies studied, 22 babies had significant delay in regaining birth weight. Risk factors such as birth weight, birth asphyxia, parenteral nutrition, respiratory distress syndrome, surfactant requirement, patent ductus arteriosus, necrotizing enterocolitis, sepsis, hyperbilirubinemia, anemia had statistically significant association with delay in regaining birth weight. Conclusions: Many studies have established a linear correlation between postnatal growth velocity and neurodevelopmental outcome. Ascertaining and managing the factors affecting weight gain in very low birth weight babies is essential and challenging part and anticipating the risk factors in advance helps us to achieve desirable weight gain in these babies.

Feasibility Analysis of ECG-Based pH Estimation for Asphyxia Detection in Neonates.

Birth asphyxia is a potential cause of death that is also associated with acute and chronic morbidities. The traditional and immediate approach for monitoring birth asphyxia (i.e., arterial blood gas analysis) is highly invasive and intermittent. Additionally, alternative noninvasive approaches such as pulse oximeters can be problematic, due to the possibility of false and erroneous measurements. Therefore, further research is needed to explore alternative noninvasive and accurate monitoring methods for asphyxiated neonates. This study aims to investigate the prominent ECG features based on pH estimation that could potentially be used to explore the noninvasive, accurate, and continuous monitoring of asphyxiated neonates. The dataset used contained 274 segments of ECG and pH values recorded simultaneously. After preprocessing the data, principal component analysis and the Pan-Tompkins algorithm were used for each segment to determine the most significant ECG cycle and to compute the ECG features. Descriptive statistics were performed to describe the main properties of the processed dataset. A Kruskal-Wallis nonparametric test was then used to analyze differences between the asphyxiated and non-asphyxiated groups. Finally, a Dunn-Šidák post hoc test was used for individual comparison among the mean ranks of all groups. The findings of this study showed that ECG features (T/QRS, T Amplitude, Tslope, Tslope/T, Tslope/|T|, HR, QT, and QTc) based on pH estimation differed significantly (p < 0.05) in asphyxiated neonates. All these key ECG features were also found to be significantly different between the two groups.

'We did everything by phone': a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal.

International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers' perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal. This is an explorative qualitative study that used focus group discussions (n = 2) and individual interviews (n = 4) with mothers of term-born infants surviving birth asphyxia or neonatal seizures. Parents used the NeuroMotion™ smartphone app to film their children at home and the videos were analysed using Precthl's General Movements Assessment. Sekhon et al.'s framework on the acceptability of health care interventions guided the design of the group discussions and interviews, and the deductive qualitative content analysis. Mothers were interested in engaging with the programme and expressed hope it would benefit their children. Most felt using the app was intuitive. They were, however, unclear about the way the analysis was performed. Support from the research team was often needed to overcome an initial lack of self-confidence in using the technology, and to reduce anxiety related to the follow-up. The intervention was overall perceived as recommendable but should be supplemented by a face-to-face consultation. Smartphone aided remote screening of cerebral palsy is acceptable in a lower middle-income population but requires additional technical support.

Volumetric apparent diffusion coefficient histogram analysis in term neonatal asphyxia treated with hypothermia.

Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). Brain MRI studies of 83 term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) fourth and sixth days were retrospectively re-evaluated by 2 radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major, and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (P = .02 and P = .03, respectively) and ADCmin (P = .03 and P = .04, respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (P = .04) and normal development (P = .04) via cytotoxic oedema of the thalamus, corpus striatum, and diffuse cerebral cortical. The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimated similarly with volumetric ADC-HA and the conventional assessment of the ADC map. This study compares early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We could not find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA.

Expiratory braking defines the breathing patterns of asphyxiated neonates during therapeutic hypothermia.

Although neonatal breathing patterns vary after perinatal asphyxia, whether they change during therapeutic hypothermia (TH) remains unclear. We characterized breathing patterns in infants during TH for hypoxic-ischemic encephalopathy (HIE) and normothermia after rewarming. In seventeen spontaneously breathing infants receiving TH for HIE and in three who did not receive TH, we analyzed respiratory flow and esophageal pressure tracings for respiratory timing variables, pulmonary mechanics and respiratory effort. Breaths were classified as braked (inspiratory:expiratory ratio ≥1.5) and unbraked (<1.5). According to the expiratory flow shape braked breaths were chategorized into early peak expiratory flow, late peak expiratory flow, slow flow, and post-inspiratory hold flow (PiHF). The most braked breaths had lower rates, larger tidal volume but lower minute ventilation, inspiratory airway resistance and respiratory effort, except for the PiHF, which had higher resistance and respiratory effort. The braked pattern predominated during TH, but not during normothermia or in the uncooled infants. We speculate that during TH for HIE low respiratory rates favor neonatal braked breathing to preserve lung volume. Given the generally low respiratory effort, it seems reasonable to leave spontaneous breathing unassisted. However, if the PiHF pattern predominates, ventilatory support may be required.

Enteral feeding in neonates ≥34 weeks of gestation with moderate to severe birth asphyxia: A retrospective observational study.

There are no standard guidelines regarding time for initiation of feeds in moderate to severely asphyxiated neonates and data regarding the same in neonates are scanty. Case sheets of all neonates born ≥34 weeks of gestation who satisfied the definition were analysed. The early feeding group was defined as those in whomh feeds were started <24 h and the late feeding group as those started ≥24 h of life. The primary outcome of the study was time to achieve full enteral feeds. A total of 184 neonates were enrolled. Mean time to reach full enteral feeding was 53.7 ± 24.8 h in the early feeding group as compared to 95.0 ± 81.1 h in late enteral feeding group, with a mean difference of 41.3 (25.7-56.8) h. The incidence of adverse secondary outcomes was higher in the late feeding group.

Initial Steps in Resuscitation of Suspected Birth Asphyxia in the Context of Nursing and Midwifery: A Quantitative Study in Upper East Region of Ghana

Background: A newborn’s inability to initiate and maintain breathing immediately after birth is referred to as birth asphyxia. In developed countries, the incidence of Birth Asphyxia is 2 per 1000 births, but in developing countries, the rate can be up to 10 times higher than that figure. Globally, 130 million babies are born each year, with Birth Asphyxia accounting for 20.9 percent of all neonatal deaths occurring within the first four weeks of life during this period. Approximately 10% of these babies require some form of assistance to breathe when they are born. Nurses and midwives must have a high level of expertise in the management of birth asphyxia in order to avoid further complications. Methods: A quantitative descriptive, cross-sectional study design was used to assess the management of Birth Asphyxia among Nurses and Midwives at the maternity department of War Memorial Hospital. Convenient sampling technique was used to select study subjects and the sample size was determined using sample size determination table. Results: Of the total 80, 79 (98.8%) of the respondents had knowledge on the standard guidelines and protocols for the management of Birth Asphyxia. Nurses and midwives who were trained, thus 60 out of the total 80 respondents (75%), were more likely to have knowledge of Birth Asphyxia management as compared to those who didn’t get training. The study revealed that 98.8% of nurses and midwives had knowledge of birth asphyxia management. Conclusions: More than half of these health professionals had training on the management of Birth Asphyxia. Frequent trainings were recommended to improve knowledge of nurses and midwives on Birth Asphyxia management.

Factors Influencing Success Rate of Referral for Asphyxiated Newborns Before and After Helping Babies Breathe (HBB) Training

Introduction: Referral for asphyxia newborns is the process of transferring newborns with difficult breathing conditions from one health facility to another. Emergency management of asphyxia newborns must be handled properly; one of the examples is taught in a Helping Babies Breath (HBB) training. Other factors that influence the determinants of referral are positive-pressure ventilation action, the state of hypothermia, and the duration of referral. Methods: The research design used in this study was cross-sectional. The samples were collected by purposive sampling from January 2019 to December 2020 from the medical records of Puskesmas Kabupaten Grobogan. Results: There was no significant association between the success rate of referral for asphyxia newborns and the Helping Babies Breathe (HBB) training (p=0.213). Before the HBB was implemented, there was no significant association between the incident and positive-pressure ventilation action (p = 0.092). Still, there was a significant association between the incidence of hypothermia (p=&lt;0.001) and referral duration (p=0.011). After the HBB was implemented, there was no significant association between the incident with positive-pressure ventilation action (p=0.758) and the duration of the referral (p=0.2). Still, there was a significant association with the incidence of hypothermia (p=0.002). Conclusion: There is a significant association between the success rate of referral of asphyxia newborns and hypothermia before and after the HBB Program was implemented and the duration of referrals before the HBB Program was implemented.

A prospective study on the causes of hyperbilirubinemia and its clinical markers in term and near-term newborns admitted to a tertiary care hospital in Patna, India

This study aimed to investigate the root causes, prognostic factors, and therapeutic strategies for neonatal hyperbilirubinemia among term and near-term infants admitted to the Neonatal Intensive Care Unit (NICU) at IGIMS, Patna. Furthermore, the research aimed to analyze the clinical progression of these infants throughout their NICU stay.Conducted within the NICU at IGIMS, Patna, Bihar, this study encompassed term and late preterm infants admitted with serum bilirubin levels exceeding 12 mg/dl. The primary focus was on identifying risk factors, etiological factors, and the clinical profile of these infants during their NICU tenure.The study examined birth weight distribution and concurrent medical conditions. Parameters included the initiation of phototherapy based on bilirubin levels and treatment methodologies. Out of the 210 infants studied, 27.14% and 47.62% weighed between 2001 and 2500 grams. The most prevalent causes were physiological (129 cases), fetal prematurity (30 cases), birth asphyxia (7 cases), and prolonged labor (18 cases). Idiopathic causes were observed in 28 instances, ABO incompatibility in 7 cases, and Rh incompatibility in 7 cases. G6PD deficiency was identified once. At the commencement of phototherapy, 19.52% had bilirubin levels between 12 and 15 mg/dl, 58.57% between 15.1 and 18 mg/dl, 11.91% above 20 mg/dl, and 10% between 18.1 and 20 mg/dl.Physiological causes emerged as the most frequent contributors to neonatal hyperbilirubinemia, followed by septicemia and idiopathic factors. Infrequent causes included blood group incompatibility. Phototherapy was established as a cost-effective and efficient method for reducing bilirubin levels in neonatal jaundice. Exchange transfusion proved to be a safe therapeutic measure in cases of severe hyperbilirubinemia. Blood group incompatibility was the main determinant requiring exchange transfusion.

Quantitative EEG features during the first day correlate to clinical outcome in perinatal asphyxia.

To assess whether computational electroencephalogram (EEG) measures during the first day of life correlate to clinical outcomes in infants with perinatal asphyxia with or without hypoxic-ischemic encephalopathy (HIE). We analyzed four-channel EEG monitoring data from 91 newborn infants after perinatal asphyxia. Altogether 42 automatically computed amplitude- and synchrony-related EEG features were extracted as 2-hourly average at very early (6 h) and early (24 h) postnatal age; they were correlated to the severity of HIE in all infants, and to four clinical outcomes available in a subcohort of 40 newborns: time to full oral feeding (nasogastric tube NGT), neonatal brain MRI, Hammersmith Infant Neurological Examination (HINE) at three months, and Griffiths Scales at two years. At 6 h, altogether 14 (33%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.61, p < 0.05), and one feature correlated to NGT ([r]= 0.50). At 24 h, altogether 13 (31%) EEG features correlated significantly to the HIE grade ([r]= 0.39-0.56), six features correlated to NGT ([r]= 0.36-0.49) and HINE ([r]= 0.39-0.61), while no features correlated to MRI or Griffiths Scales. Our results show that the automatically computed measures of early cortical activity may provide outcome biomarkers for clinical and research purposes. The early EEG background and its recovery after perinatal asphyxia reflect initial severity of encephalopathy and its clinical recovery, respectively. Computational EEG features from the early hours of life show robust correlations to HIE grades and to early clinical outcomes. Computational EEG features may have potential to be used as cortical activity biomarkers in early hours after perinatal asphyxia.

M-CHAT-R: UTILIZING FOR SCREENING AUTISM SPECTRUM DISORDER

Background: Autism Spectrum Disorder (ASD) is a multifaceted condition marked by challenges in communication and social interactions, behavioral restrictions, and repetitive actions. Identifying children who may be at risk of ASD early on is crucial for prompt consultation, monitoring, and intervention. Objectives: Determine the rate of Autism Spectrum Disorder in children between the ages of 18 and 36 months by utilizing the M-CHAT-R scale at the clinic of Can Tho Children's Hospital. And identify the associated risk factors for that rate of Autism Spectrum Disorder. Materials and methods: A descriptive cross-sectional study conducted on 608 children aged 18-36 months who were examined at the clinic of Can Tho Children's Hospital. Results: The majority of children in the study, comprising 88.3%, fell within the age range of 24-36 months, with proportions of boys and girls at 57.6% and 42.4%, respectively. Among the children, 94.7% (576/608 children) were classified as low risk, while medium risk and high risk accounted for 4.28% (26/608 children) and 1.02% (6/608 children), respectively. Questions with notably high positive rates among at-risk children were item 2 (38.9%), item 5 (15.2%), item 12 (16.2%), item 11 (4.8%). Conversely, the least common symptom was indicated in question 9, where children showed a preference for moving activities, accounting for only 2.7%. Associations were observed between the risk of Autism Spectrum Disorder and factors such as gender (p=0.04), father’age (p=0.024), alcohol consumption (p=0.047), birth asphyxia (p=0.036), seizures due to high fever/unknown cause (p=0.035). Conclusion: In the study, the rate of positive M-CHAT-R was 5.3% (32 out of 608 children), predominantly observed in the low-risk group, accounting for 94.7%. The majority of positive cases fell within the 24-36 month age group, comprising 26 out of the 32 children. The risk of Autism Spectrum Disorder showed correlations with gender, father’s age older or equal to 35 years old, alcohol consumption, birth asphyxia and seizures triggered by high fever or unknown causes. However, there was no observed relationship between the risk of Autism Spectrum Disorder and age group factors.

Ultrasound Diagnosis and Near-Infrared Spectroscopy in the Study of Encephalopathy in Neonates Born under Asphyxia: Narrative Review.

Brain injury resulting from adverse events during pregnancy and delivery is the leading cause of neonatal morbidity and disability. Surviving neonates often suffer long-term motor, sensory, and cognitive impairments. Birth asphyxia is among the most common causes of neonatal encephalopathy. The integration of ultrasound, including Doppler ultrasound, and near-infrared spectroscopy (NIRS) offers a promising approach to understanding the pathology and diagnosis of encephalopathy in this special patient population. Ultrasound diagnosis can be very helpful for the assessment of structural abnormalities associated with neonatal encephalopathy such as alterations in brain structures (intraventricular hemorrhage, infarcts, hydrocephalus, white matter injury) and evaluation of morphologic changes. Doppler sonography is the most valuable method as it provides information about blood flow patterns and outcome prediction. NIRS provides valuable insight into the functional aspects of brain activity by measuring tissue oxygenation and blood flow. The combination of ultrasonography and NIRS may produce complementary information on structural and functional aspects of the brain. This review summarizes the current state of research, discusses advantages and limitations, and explores future directions to improve applicability and efficacy.

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p&lt;0.0001). Sepsis is more prevalent in out born unit (p&lt;0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p&lt;0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

Neonatal Scurvy- A Rare Case Report

Scurvy, a disease of vitamin C deficiency, is now considered as a rare disease in paediatric population. The human body is dependent on the external supply of vitamin C. The newborn infant receives this from breast milk. Therefore, infantile scurvy is generally observed only in infants over the age of three months. The occurrence of scurvy before that age is extremely rare. We described a case of neonatal scurvy in a 28 days old boy who was on parenteral nutrition for initial 10 days of age due to neonatal sepsis with perinatal asphyxia. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 92-94

Enhancing Fetal Electrocardiogram Signal Extraction Accuracy through a CycleGAN Utilizing Combined CNN-BiLSTM Architecture.

The fetal electrocardiogram (FECG) records changes in the graph of fetal cardiac action potential during conduction, reflecting the developmental status of the fetus in utero and its physiological cardiac activity. Morphological alterations in the FECG can indicate intrauterine hypoxia, fetal distress, and neonatal asphyxia early on, enhancing maternal and fetal safety through prompt clinical intervention, thereby reducing neonatal morbidity and mortality. To reconstruct FECG signals with clear morphological information, this paper proposes a novel deep learning model, CBLS-CycleGAN. The model's generator combines spatial features extracted by the CNN with temporal features extracted by the BiLSTM network, thus ensuring that the reconstructed signals possess combined features with spatial and temporal dependencies. The model's discriminator utilizes PatchGAN, employing small segments of the signal as discriminative inputs to concentrate the training process on capturing signal details. Evaluating the model using two real FECG signal databases, namely "Abdominal and Direct Fetal ECG Database" and "Fetal Electrocardiograms, Direct and Abdominal with Reference Heartbeat Annotations", resulted in a mean MSE and MAE of 0.019 and 0.006, respectively. It detects the FQRS compound wave with a sensitivity, positive predictive value, and F1 of 99.51%, 99.57%, and 99.54%, respectively. This paper's model effectively preserves the morphological information of FECG signals, capturing not only the FQRS compound wave but also the fetal P-wave, T-wave, P-R interval, and ST segment information, providing clinicians with crucial diagnostic insights and a scientific foundation for developing rational treatment protocols.

Clinicopathological profile and management challenges of congenital encephaloceles in a tertiary hospital in southwest Nigeria.

A congenital encephalocele is the herniation of intracranial contents through skull defects of various sizes. Depending on the site, content, and size, it is associated with significant morbidity and mortality in children. There is a paucity of recent and comprehensive local clinical data regarding this anomaly. Understanding the peculiarities, clinical-pathologic profiles, and management challenges will help prevent and effectively manage congenital encephalocele to improve outcomes. This was a retrospective study of all cases of congenital encephalocele managed between July 2000 and December 2023 at a tertiary hospital in the southwest region of Nigeria. Relevant demographic, clinicopathological, and management data were retrieved and analysed. There were 31 females and 11 males. Their ages ranged from 3hours to 24years. Sixteen (35.3%) were delivered in a non-health facility. Birth asphyxia was reported in 5 babies. Few mothers (4.8%) used preconception folic acid. Anaemia (n = 5) and sepsis (n = 4) were the common preoperative morbidities. All patients had definitive surgery, with 18 operated on within the first month of life. Cerebrospinal fluid (CSF) leak was the most common postoperative complication and was significantly observed in the sincipital group (p = 0.018). Thirty-one patients (73.8%) presented for follow-up after surgery, and the mean follow-up duration was 26.6weeks. Mortality was recorded in a patient (2.4%) due to Klebsiella meningitis. Congenital encephaloceles are relatively common in our setting. Therefore, there is a need to address the associated poor maternal and neonatal health conditions. Early surgery can be performed with a favourable outcome.

Does the use of antenatal corticosteroids reduce respiratory morbidity in babies born in late preterm period?

BackgroundThe aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.MethodsTwo hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.ResultsThe primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.ConclusionsAdministration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.Trial registrationPACTR (www.pactr.org) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.

Determinants of birth asphyxia among new born babies in Bekoji public hospital, Arsi zone, Oromia regional state, Ethiopia, 2023

Background: Birth asphyxia stands out as a significant factor contributing to morbidity and mortality among newborns. However, the determinants of birth asphyxia have not been thoroughly investigated within the local context, particularly in this specific area. Hence, this study aims to identify these determinants to tackle the issue effectively. Objectives: The goal of this study is to pinpoint the determinants of birth asphyxia at Bekoji Public Hospital in Bekoji Town, Arsi Zone, Oromia Region, Southeast Ethiopia, in 2023. Methods: A case-control study was conducted between June 1, 2023, and August 30, 2023. A total of 198 newborns (75 cases and 123 controls) at Bekoji Public Hospital were selected using a systematic random sampling technique. Data collection involved a checklist for record review and an interviewer-administered questionnaire. The data were entered into Epi Data version 7.1 and analyzed using SPSS version 25. Variables with a P-value &lt; 0.25 were subjected to multivariable regression analysis. The Odds Ratio estimated with a 95% Confidence Interval was utilized to indicate the strength of association, with a significance level set at P &lt; 0.05. Results: 196 mothers of newborns (73 cases and 123 controls) were interviewed, resulting in a response rate of 98.9%. Factors such as prolonged duration of labor (AOR=2.54; [95% CI: 1.78, 6.39]), delivery by Caesarean section (AOR=0.64; [95% CI: 0.004, 1.114]), presence of stained amniotic fluid (AOR=0.473; [95% CI: 0.180, 1.242]), and non-cephalic fetal presentation (AOR=2.12; [95% CI: 1.019, 3.80]) were identified as predictors of birth asphyxia. Additionally, being male (AOR=1.885; [95% CI: 0.899, 3.950]) was also found to be a predictive factor for birth asphyxia. Conclusion and recommendations: Duration of labor, fetal presentation, type of amniotic fluid, mode of delivery, and the gender of newborns emerged as significantly associated factors with birth asphyxia. As a result, interventions targeting these factors, particularly focusing on duration of labor and fetal presentation, should be rigorously implemented.

Exome sequencing reveals genetic heterogeneity and clinically actionable findings in children with cerebral palsy.

Cerebral palsy (CP) is the most common motor disability in children. To ascertain the role of major genetic variants in the etiology of CP, we conducted exome sequencing on a large-scale cohort with clinical manifestations of CP. The study cohort comprised 505 girls and 1,073 boys. Utilizing the current gold standard in genetic diagnostics, 387 of these 1,578 children (24.5%) received genetic diagnoses. We identified 412 pathogenic and likely pathogenic (P/LP) variants across 219 genes associated with neurodevelopmental disorders, and 59 P/LP copy number variants. The genetic diagnostic rate of children with CP labeled at birth with perinatal asphyxia was higher than the rate in children without asphyxia (P = 0.0033). Also, 33 children with CP manifestations (8.5%, 33 of 387) had findings that were clinically actionable. These results highlight the need for early genetic testing in children with CP, especially those with risk factors like perinatal asphyxia, to enable evidence-based medical decision-making.