Prediction Of Neonatal Outcome Research Articles

Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy cause significant neonatal complications. Disease severity is often used to predict neonatal outcomes, however gestational age (GA) at delivery may be a better predictor. We aimed to assess whether disease severity or GA was more predictive of adverse neonatal outcomes. We included 165 participants with confirmed HELLP syndrome or severe preeclampsia (sPE). Two predictive models were constructed to assess the ability of disease severity compared to GA to predict a composite adverse neonatal outcome. The composite outcome included low birth weight, SGA, IUGR, Apgar score, and neonatal death. Using severity as a predictor of binary neonatal outcome had an AUC of 0.73 (0.65-0.81), with a sensitivity (SE) of 70.3% and a specificity (SP) of 64.4%. For GA, we observed an AUC of 0.82 (0.75-0.89), with a SE of 75.7% and a SP of 76.7%. For the composite neonatal outcome, GA was a better predictor than ACOG diagnosis (severity). This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.

Prognostic value of serum high-mobility group box 1 in neonates with neonatal encephalopathy.

This study aimed to investigate the diagnostic potential of serum high-mobility group box 1 (HMGB1) in neonatal encephalopathy (NE). A retrospective study was conducted, analyzing 216 neonates diagnosed with NE. The neonates were divided into two groups based on their outcomes at 28 days. Serum HMGB1 levels were compared between the two groups. ROC analysis was used to determine the predictive value of HMGB1. At 28 days, 174 infants had a good prognosis, while 42 had a poor prognosis. Infants with a poor prognosis had higher serum HMGB1 concentrations within 24 h of birth. Multifactorial analysis revealed that extremely preterm birth, extremely low birth weight, an Apgar score of 0-3 at 5 min, premature rupture of membranes by the mother, moderate to severe NE, and serum HMGB1 > 6.14 ng/mL are independent risk factors for poor prognosis. HMGB1 has predictive value for short-term prognosis with an area under the curve of 0.79. Elevated HMGB1 levels in the acute phase of NE are associated with poor short-term neonatal outcomes. The decrease in HMGB1 concentrations over time correlates with a good prognosis; whereas an increase suggests a poor prognosis. Early measurement of serum HMGB1 could aid in the prognostic assessment of neonates with NE. Although serum HMGB1 has emerged as a potential predictor of neonatal outcomes in neonatal encephalopathy, the relationship of HMGB1 levels to neonatal encephalopathy severity remains unclear. The current results demonstrate that infants with a poor prognosis had higher serum HMGB1 concentrations within 24 h of birth. Importantly, elevated serum HMGB1 levels in the acute phase of neonatal encephalopathy are associated with poor short-term neonatal outcomes. Our findings reveal the clinical values of HMGB1 in the prediction of neonatal outcomes in NE patients.

Clinical characteristics and predictors of neonatal outcomes in chorioamnionitis at term gestation: A cohort study.

To investigate the association between clinical and laboratory characteristics of chorioamnionitis in deliveries at term gestation with adverse neonatal outcomes. Retrospective cohort study. The study is based on data from the Swedish Pregnancy Register, enriched with clinical data extracted from medical charts. A cohort of 500 term singleton deliveries in Stockholm County with registered diagnosis of chorioamnionitis (based on the assessment of the responsible obstetrician) in the Swedish Pregnancy Register between 2014 and 2020. Logistic regression was used to estimate odds ratios (ORs) as a measurement of the association between clinical and laboratory characteristics and neonatal complications. Neonatal infection and asphyxia-related complications. The prevalence of neonatal infection and asphyxia-related complications was 10% and 22%, respectively. First leukocyte count in the second tertile (OR2.14, 95%CI 1.02-4.49), maximum C-reactive protein (CRP) level in the third tertile (OR4.01, 95%Cl 1.66-9.68) and positive cervical culture (OR2.22, 95%Cl 1.10-4.48) were associated with an increased risk of neonatal infection. Maximum level of CRP in the third tertile (OR1.93, 95%Cl 1.09-3.41) and fetal tachycardia (OR1.63, 95%Cl 1.01-2.65) were associated with an increased risk of asphyxia-related complications. Elevated inflammatory laboratory markers were associated with both neonatal infection and asphyxia-related complications, and fetal tachycardia was associated with asphyxia-related complications. Based on these findings, the incorporation of maternal CRP in the management of chorioamnionitis should be considered, and a continuous communication between obstetric and neonatal care extending past the delivery time point endorsed.

Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction

Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I-Neonates with morbidity/mortality (NMM); II-Neonates without morbidity with acidosis/asphyxia (NAA); III-Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‱ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery.

Data-driven longitudinal characterization of neonatal health and morbidity.

Although prematurity is the single largest cause of death in children under 5 years of age, the current definition of prematurity, based on gestational age, lacks the precision needed for guiding care decisions. Here, we propose a longitudinal risk assessment for adverse neonatal outcomes in newborns based on a deep learning model that uses electronic health records (EHRs) to predict a wide range of outcomes over a period starting shortly before conception and ending months after birth. By linking the EHRs of the Lucile Packard Children's Hospital and the Stanford Healthcare Adult Hospital, we developed a cohort of 22,104 mother-newborn dyads delivered between 2014 and 2018. Maternal and newborn EHRs were extracted and used to train a multi-input multitask deep learning model, featuring a long short-term memory neural network, to predict 24 different neonatal outcomes. An additional cohort of 10,250 mother-newborn dyads delivered at the same Stanford Hospitals from 2019 to September 2020 was used to validate the model. Areas under the receiver operating characteristic curve at delivery exceeded 0.9 for 10 of the 24 neonatal outcomes considered and were between 0.8 and 0.9 for 7 additional outcomes. Moreover, comprehensive association analysis identified multiple known associations between various maternal and neonatal features and specific neonatal outcomes. This study used linked EHRs from more than 30,000 mother-newborn dyads and would serve as a resource for the investigation and prediction of neonatal outcomes. An interactive website is available for independent investigators to leverage this unique dataset: https://maternal-child-health-associations.shinyapps.io/shiny_app/.

The Reproducibility of 3D power Doppler in Intrauterine Growth Restriction

Objective: it is to examine the reproducibility of 3D power Doppler in the management of intrauterine growth restriction compared with the conventional 2d Doppler. Patients and Methods: This study was performed between Jan 2021 and Feb 2022 and included 100 pregnant women recruited from outpatient clinic at Elgalaa Teaching Hospital, 3D power Doppler US was done for assessment of IUGR and compare the findings with 2D Doppler. Results: it is found that 3D Power Doppler parameters were significant in prediction of poor neonatal outcome regarding development of respiratory complications, neurological complications and IUFD as complications to IUGR comparing to 2D colour Doppler parameters which were non-significant in these cases. Our results also showed that the only parameter of 2D Colour Doppler that showed significance and positive correlation to birth weight among these cases was Middle Cerebral Artery Pulpability Index. Conclusion: 2D Doppler flow-velocity waveforms are of limited value in the prediction of poor neonatal outcome in IUGR except for MCAPI. 3D power Doppler was superior in the diagnosis and prediction of neonatal outcome.

W227 The role of plasma N-terminal pro-B type natriuretic peptide level in the diagnosis of pregnancy complications and prediction of neonatal outcomes

W227 The role of plasma N-terminal pro-B type natriuretic peptide level in the diagnosis of pregnancy complications and prediction of neonatal outcomes

Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study.

Birth asphyxia is a common cause of perinatal morbidity, mortality. To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.

The relevance of Short-Term Variation (STV) value measured within 1 hour before delivery in predicting adverse neonatal outcome.

Computer CTG analysis (cCTG) included short-term variation (STV) is one of the methods of monitoring fetal condition during delivery. The aim of our study was to define appropriability of STV measured within 1 hour before delivery in prediction of neonatal outcomes. The retrospective study included 1014 pregnant women, who gave birth in the Department of Obstetrics and Perinatology. Participants were divided into two groups: group 1 - term pregnancies (37-41 weeks) and group 2 - preterm pregnancies (lower than 37 weeks). In each of them, two subgroups have been separated: control (STV ≥ 3 ms) and study group (STV < 3 ms). In both groups 1 and 2, there were no statistically significant differences related to Apgar scores in 1st, 3rd and 5th minute between group with STV < 3 ms and group with STV > 3 ms Moreover, for 37-41 weeks the sensitivity, specificity, positive predictive value and negative predictive value were: 22.7%, 83.9%, 3.3% and 97.8% and for lower than 37: 45.7%, 65.4%, 47.1%, 64.2% in 1st minute after delivery. In group 1 the area under curve (AUC) measurements were 0.45 (95% CI: 0.32-0.58) for 1st minute and 0.55 (95% CI: 0.35-0.74) for 5th minute and in group 2: 0.58 (95% CI: 0.45-0.71) for 1st minute and 0.57 (95% CI: 0.42-0.72) for 5th minute. High specificity and negative predictive value of STV indicates a good Apgar score of newborns in term pregnancies. Analysis of STV in preterm pregnancy is not clear. Fetal well-being in preterm pregnancy should include STV and other non-invasive and invasive tools.

The Doppler velocimetry of ductus venosus in fetuses with cardiac defects during pregnancy

Background Fetal medicine researches were directed to replace the invasive screening tests done at the first and early second trimesters such as cardiovascular status and amniocentesis to discover fetal anomalies, especially cardiac malformations with noninvasive ultrasonic markers such as ductus venosus Doppler. It is associated with cardiac defects. It is the main concern of fetal medicine researches nowadays to improve neonatal outcome. It leads to abnormal heart rhythm or abnormal heart muscle, in which the heart fails to contract normally. Aims We aim to study ductus venosus Doppler and pulsatility index (PI) of veins in fetuses with cardiac malformations to improve fetal and neonatal outcome. Patients and methods This study includes 50 pregnant females attending Tanta University Hospital. This study was carried on during the period from May 2019 to July 2020. Some cases were excluded: who had twin pregnancy. Results There is a correlation between abnormal PI and occurrence of congenital heart disease, especially the major types. As regards A wave, we found that it is present in 17 (34%) of 50 cases and 11 of them had normal PI. It is absent in 33 (66%) of cases. This study concluded that in chromosomally normal fetuses, assessment of ductus venosus could improve the predictive capacity for major cardiac defect. Conclusions DV Doppler is a very important scan in pregnancy. PI is very important as first-trimester sonographic marker for fetal congenital heart diseases and in prediction of neonatal outcome.

Thyroid Function of Pregnant Women and Perinatal Outcomes in North Macedonia.

Thyroid diseases are the second most common endocrine disorders in the reproductive period of women. They can be associated with intrauterine growth restriction (IUGR), preterm delivery, low Apgar score, low birthweight (LBW) or fetal death. The aim of the present study is to explore thyroid dysfunction and its relationship with some poor perinatal outcomes (Apgar Score, low birthweight, and preterm delivery). Dried blood spot samples from 358 healthy pregnant women were analyzed for thyroid stimulating hormone (TSH), total thyroxine (TT4), and thyroglobulin (Tg). Neonatal data were collected upon delivery. Four groups were formed based on thyroid function tests (TFTs). Of the 358 tested women, 218 (60.72%) were euthyroid. Isolated hypothyroxinemia was present in 132 women (36.76%), subclinical hyperthyroidism in 7 women (1.94%), and overt hypothyroidism in 1 (0.28%). The perinatal outcomes IUGR (p = 0.028) and Apgar score 1 minute (p = 0.015) were significantly different between thyroid function test [TFT]-distinct groups. In the multiple regression analysis, TT4 showed a statistically significant inverse predictive impact on LBW (p < 0.0001), but a positive impact of Tg on LBW (p = 0.0351). Thyroid hormones alone do not have a direct impact on neonatal outcomes, but the percentage of their participation in the total process cannot be neglected. Based on the regression analysis, we can conclude that TT4 and Tg can be used as predictors of neonatal outcome, expressed through birthweight and Apgar score. The present study aims to contribute to determine whether a test for thyroid status should become routine screening during pregnancy.

P-071. Application of fullpiers as predictor of neonatal outcomes in pre-eclampsia

P-071. Application of fullpiers as predictor of neonatal outcomes in pre-eclampsia

Validation of the Vasoactive-Ventilation-Renal Score for Neonatal Heart Surgery.

Objectives: We aimed to validate the vasoactive-ventilation-renal (VVR) score and to compare it with other indices as a predictor of outcome in neonates recovering from surgery for critical congenital heart disease. We also sought to determine the optimal time at which the VVR score should be measured.Methods: We retrospectively reviewed neonates recovering from cardiac surgery between July 2017 and June 2020. The VVR score was calculated at admission, 24, 48, and 72 hours postoperatively. Max values, defined as the highest of the four scores, were also recorded. The main end result of interest was a composite outcome which included prolonged intensive care unit stay and mortality. Receiver operating characteristic curves were generated, and areas under the curve with 95% confidence intervals were calculated for all time points. Multivariable logistic regression modeling was also performed.Results: We reviewed 73 neonates and 21 of them showed composite outcomes. The area under the curve value for VVR score as a predictor of composite outcome was greatest at postoperative 72-hour max (AUC= 0.967; 95% confidence interval, (0.927-1). On multivariable regression analysis, the VVR max 72 hours remained a strong independent predictor of prolonged ICU stay and mortality (odds ratio, 1.452; 95% confidence interval, 1.036-2.035).Conclusions: We validated the utility of the VVR score in neonatal cardiac surgery for critical congenital heart disease. The VVR follow-up in postoperative 72 hours is superior to other indices and especially the maximum VVR value is a potentially powerful clinical tool to predict ICU stay and mortality.

Correlation between Doppler Indices as A Predictor of Neonatal Outcome in Normal and Preeclamptic Pregnant Women in The Third Trimester

Background: Doppler flow velocimetry of the umbilical artery and cerebral circulation is a non-invasive modality used for assessment of fetal wellbeing. Doppler studies are more specific and are potentially useful tool in prediction of adverse perinatal outcome in high risk patients. Aim of the current study was to evaluate the efficacy of middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), uterine artery pulsatility index (UAT-PI), and a cerebroplacental ratio (CPR) Doppler indices in assessment of fetal wellbeing. For documentation of the neonatal outcome in preeclamptic women with abnormalities of Doppler indices. Objectives: Assessment of fetal wellbeing and prediction of neonatal outcome in normal pregnant women and woman with preeclampsia by using Doppler indices. Patients and Methods: the study isacase control study included 94 pregnant women (47 normal pregnancy and 47 preeclamptic patients) admitted in Obstetrics and Gynecology Department of Menoufia University during the period from August 2018 to November 2019. All included women underwent Doppler study and were followed up till delivery. Results: Doppler velocimetry studies of both placental and fetal circulation can provide important information as regard fetal wellbeing so can be used to improve fetal outcome. Conclusions: It was observed that all three parameters UAT-PI, MCA-PI and UA-PI when taken into consideration together are good parameters in predictions of perinatal outcome.

Cerebro-placental ratio as a predictor of neonatal outcome in hypertensive disorders of pregnancy

Cerebro-placental ratio as a predictor of neonatal outcome in hypertensive disorders of pregnancy

Association between maternal cervicovaginal swab positivity for Ureaplasma spp. or other microorganisms and neonatal respiratory outcome and mortality

We investigated the association between maternal cervicovaginal cultures, its antibiotic treatment, and neonatal outcome. This retrospective cohort study enrolled 480 neonates born prior to 32 weeks' gestation. They were divided into groups according to maternal cervicovaginal culture results. Multivariate logistic regression analysis was used to predict neonatal outcome based on maternal culture results, adjusted for perinatal risk factors and neonatal morbidities. Maternal cervicovaginal Ureaplasma colonization was independently associated with bronchopulmonary dysplasia at 36 weeks (BPD) (OR 8.34; 95% CI 1.21-57.45). In neonates with and without maternal cervicovaginal Ureaplasma colonization BPD occurred in 12.3% and 3.8%, respectively. Maternal colonization with other microorganisms was associated with a higher neonatal mortality (p = 0.002), lower gestational age (p = 0.026), and birth weight (p = 0.036). This study underscores the role of the maternal cervicovaginal microbiome as a predictor of neonatal outcome. Cervicovaginal Ureaplasma colonization seems not to be an innocent bystander in the multifactorial etiology of BPD.

Role of umbilical cord arterial pH and lactate in newborn assessment of term antenatal women with hypertensive disorders of pregnancy

ProblemTo know role of cord arterial blood pH and lactate dehydrogenase levels in neonatal outcome assessment. MethodsPresent observational study was conducted in Obstetrics and Gynecology department of a rural tertiary center of Northern India over 6 months (July–January 2019) on 155 term (≥37-≤42 weeks) antenatal women with hypertensive disorders of pregnancy fulfilling inclusion criteria. Immediately after delivery, arterial blood sample was drawn from doubly clamped 10–12 cm long umbilical cord in pre-heparinized insulin syringe, which was sent for pH estimation and 0.5 ml in lithium heparin tube for lactate dehydrogenase levels. One- and 5-min neonatal Apgar score was noted by pediatrician. Cord blood pH and lactate levels were then compared with overall neonatal outcome. Statistical analysis was done using SPSS-22 version. ResultsMean values of umbilical cord arterial pH and LDH was 7.2 ± 0.1 and 449.5 ± 562.9 U/L respectively. Significantly low mean cord blood pH (7.03 ± 0.12) and high LDH levels (939.74 ± 781.75 U/L) were observed in neonates of eclamptic mothers (p = 0.00). Mode of delivery had significant effects on cord blood parameters with significantly low pH and elevated LDH levels seen in neonates delivered by emergency LSCS for fetal distress (p < 0.05). Cord blood LDH levels were more significantly associated with NICU admission, neonatal morbidity and mortality. Cord blood LDH was a better predictor of neonatal outcome with 100% sensitivity and 79.73% specificity. ConclusionCord arterial blood lactate dehydrogenase levels were better predictor of overall neonatal outcome.

Correlation between Cerebroplacental ratio and umbilical artery Doppler with pregnancy outcome in postdates

Background: Postdate pregnancy is a real problem in modern obstetrics. Its incidence has been reported to be between 4-14% with an average of 10.5%. Postdate pregnancy is associated with increased risk of perinatal morbidity and mortality. Assessment of fetal wellbeing is a corner stone in the management of prolonged pregnancy.Aim: To assess the usefulness of cerebroplacental ratio (CPR) compared with umbilical artery Doppler alone in prediction of the intrapartum fetal hypoxia and the adverse perinatal outcome in uncomplicated pregnancies (low risk pregnancy) beyond 40 weeks. Patients and Methods: This study was carried out on 60 pregnant women with uncomplicated postdate pregnancies beyond 40 weeks gestation attending the antenatal clinics of Al-Zahraa University Hospital for antepartum assessment of CPR. Results:CPR had a high predictive value in postdate pregnancy with sensitivity, specificity, PPV and NPV (85.7%, 73.9%, 50%, and 94.4%), respectively, in comparison to other parameters, with cut off value (0.94).Conclusion:CPR had the highest sensitivity and NPV in prediction of neonatal outcome. Cerebroplacental ratio less than 0.94 were the best predictor of adverse perinatal outcome and neonatal ICU admission.

Third-trimester Cerebroplacental Ratio as a Predictor of Neonatal Outcome in a Low-risk Pregnancy

Third-trimester Cerebroplacental Ratio as a Predictor of Neonatal Outcome in a Low-risk Pregnancy

Newborn gender as a predictor of neonatal outcome in mixed gender twins born with very low birth weight

BackgroundMost studies have revealed that the incidence of morbidity and mortality of preterm male infants is greater than that of preterm female infants. Recently, conflicting outcomes have been reported regarding mixed-gender twins. The aim of this study was to estimate the association between gender and outcome in newborn twins of different gender.MethodsWe conducted a retrospective review of mixed-gender twins weighing < 1500 g that were born at Shamir Medical Center (Assaf Harofeh) between the years 1995 and 2016 (158 newborns). The incidence of morbidity and mortality until discharge from the hospital were evaluated while looking at gender differences.ResultsNo significant differences were found in neonatal mortality or morbidity between females and males from different-gender twins. Even after considering confounding variables (gestational age, birth weight & birth order) in linear and logistic regression models, no significant differences were found between the genders.ConclusionsOur study suggests that there are no significant differences in neonatal mortality or morbidity among different-gender twins. Our results support the need for further studies.