Prolonged Rupture Research Articles

A clinical, radiological and etiological study of neonatal pneumonia

Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children’s Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children’s Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.

Incidence of neonatal sepsis in relation to prolonged rupture of membranes (PROM)>18 hours and associated risk factors for early onset neonatal sepsis (EONS)

Introduction: PROM is significant not only in perinatal morbidity and mortality, but also in the long-term neonatal complications and sequelae in survived neonates. The evaluation of neonatal sepsis is important so as to institute treatment as quickly as possible. Hence the present study is undertaken to determine the incidence of early onset neonatal sepsis in relation to PROM of more than 18 hours. Method: The present prospective study was conducted from December 2013 to November 2014 in GSL medical college and hospital, Rajahmundry. All the neonates born to mothers with history of prolonged rupture of membranes >18hrs during study period was formed sample size for present study. Institutional Ethical Clearance was obtained prior begin of the study. A detailed history was taken including age, parity, Obstetric history of the mother with emphasis on exact time of rupture of membranes, duration history and antibiotics before labour were evaluated. Result: The incidence of EONS in present study was found to be 14.5%. In present study the incidence of sepsis is higher in low birth weight neonates (66%) compared to normal birth weight babies (34%) and higher rate of incidence in preterm neonates (61.5%) than in term neonates (38.5%). Further, Staphylococcus aureus was the commonest isolate (45.45%) followed by CONS (27.27%). Conclusion: In conclusion, evaluation of neonatal sepsis is very important so as to institute treatment as quickly as possible.

Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress

Humidified high-flow nasal cannula (HHFNC) has gained popularity because it is easier to use, more comfortable for babies, and advantageous for mother-infant bonding. HHFNC is not inferior to other non-invasive ventilators for preventing adverse outcomes, but more studies are needed to ensure the safe use of HHFNC as an initial respiratory support for newborns. The aim of this study was to investigate risk factors for treatment failure of HHFNC as an initial respiratory support in newborns with respiratory distress after birth. We included 97 newborns who required non-invasive respiratory support within 24h after birth. The success group included 68 infants who were successfully managed only on HHFNC, and 29 infants were the failure group who required other respiratory support because of respiratory acidosis, hypoxia, or apnea. Compared with the success group, the failure group had lower GA, a higher rate of antenatal steroid use, prolonged rupture of membrane, lower pH, higher pCO2 on blood-gas analysis after HHFNC application and higher incidence of respiratory distress syndrome of newborn (RDS). After adjusting for GA, higher FiO2 settings during acidosis, hypercarbia after the application of HHFNC shown on blood-gas analysis and the presence of RDS remained significant. The rate of treatment failure was 16.2% for ≥36 weeks, 19.3% for ≥34 weeks, and 22.1% for ≥33 weeks. Treatment failure of HHFNC should be considered a risk for newborns of less than 34 weeks and infants with respiratory distress from RDS. Higher FiO2 settings during HHFNC, and acidosis and hypercarbia after the application of HHFNC shown on blood-gas analysis may help identify high-risk newborns for other non-invasive ventilators or intubation.

Predictors of Early Onset Neonatal Sepsis among Neonates in Dodoma, Tanzania: A Case Control Study.

To assess the predictors of early onset neonatal sepsis (EONS) among neonates in Dodoma Tanzania. A hospital-based case-control study of randomly selected 105 cases and 217 controls in three hospitals in Dodoma region. Cases were neonates diagnosed with neonatal sepsis. Controls were matched to the cases by mother's age and parity at a ratio of 1 case to 2 controls. A semi-structured questionnaire was used to collect data on the potential mother, neonate and interventional predictors of EONS. Both descriptive and inferential statistical analysis were employed to test for independent association. Most (92.5%) of neonates were born at term (≥37 weeks) and 84% had normal birth weight of ≥3 kg. After adjusting for confounders, the maternal factors which showed significant association with EONS were maternal history of chorioamnionitis [adjusted odds ratios (AOR) = 1.910, p = 0.042, 95% confidence interval (CI): 1.0223.56], HIV status (AOR = 2.909, p = 0.012, 95% CI: 1.020-8.296), prolonged rupture of membrane (AOR = 2.857, p = 0.014, 95% CI: 1.233-6.619) and multiple digital vaginal examinations during labor (AOR = 5.178, p = 0.026, 95% CI: 1.220-21.986). The neonatal history of perinatal asphyxia was observed to have a significant association with EONS (AOR = 6.781, p = 0.006, 95% CI: 1.725-26.652). Both maternal and neonatal predictors had significant contribution to EONS. Results shed light on critical factors for consideration to prevent this disease and poor outcomes.

Neonatal Outcomes and Maternal Characteristics in Monochorionic Diamniotic Twin Pregnancies: Uncomplicated versus Twin-to-Twin Transfusion Syndrome Survivors after Fetoscopic Laser Surgery

Preterm birth remains a major complication of fetal laser surgery (FLS) due to twin-to-twin transfusion syndrome (TTTS). Objectives: We tested the hypothesis that neonatal outcomes in fetuses born at >24 weeks are worse in TTTS survivors compared to uncomplicated monochorionic diamniotic (MCDA) twins. Methods: 196 patients with TTTS treated with laser therapy and 91 uncomplicated MCDA gestations were compared. Neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Risk factors assessed were TTTS, maternal age, maternal body mass index, race, premature prolonged rupture of membranes, stage of TTTS, parity, and gestational age (GA) at delivery. Results: GA at delivery was lower in the TTTS group (31.0 ± 4.6 vs. 33.5 ± 2.4 weeks, p < 0.001). RDS and TTN occurred at higher rates in the TTTS than in the uncomplicated MCDA group. After multivariate logistic regression, the only factor significantly associated with the composite adverse outcome was GA at delivery (OR 0.61; 95% CI: 0.58–0.7). Conclusion: TTTS twins treated with FLS are deliver 2.5 weeks earlier than uncomplicated MCDA twins. Respiratory complications were significantly higher in TTTS twins and were mainly the consequence of the early GA at delivery.

Does an elevated midline head position prevent periventricular-intraventricular haemorrhage in extremely low birth weight neonates?

Kochan M, Leonardi B, Firestine A, McPadden J, Cobb D, Shah TA, et al. Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. J Perinatol 2019, 39(1): 54-62. Germinal matrix-intraventricular haemorrhage (IVH) of the premature infant is the most common form of neonatal intracranial haemorrhage. A portion of infants with IVH suffer a related parenchymal injury called periventricular haemorrhagic infarction. Fluctuations in cerebral blood flow and increases in cerebral venous pressure have been implicated in the pathogenesis of these injuries 1. Head position can affect cerebral haemodynamics and has been evaluated for preventing IVH 2. A recent systematic review evaluated trials involving head positioning strategies to prevent IVH, reviewed two trials (n = 110), and found insufficient evidence to determine the effectiveness of a particular strategy 3. Both trials reviewed and examined the effect of head rotation. No trials were identified which investigated head elevation 3, 4. The current study aims to close this knowledge gap. This single-centre, prospective, randomized trial compared the use of an elevated midline head position to a flat head position for the prevention of intracranial haemorrhage in neonates <1000 g at birth. Baseline characteristics differed among the groups with more pre-eclampsia in the treatment group and more prolonged rupture in the control group. There was no difference in the primary outcome. However, there was improved survival and decreased grade IV (but not grade III) IVH in the treatment group. There was a trend towards escalating respiratory support in the treatment group. Of interest, none of the infants with grade IV IVH developed cystic PVL. A strength of the study included the early enrolment by four hours of life. Although enrolment at birth (with prenatal consent) would be preferred, this may be impractical as flat positioning may be required during initial stabilization procedures. There is a risk for bias with this study as it is unclear if allocation was concealed. Although the interpreting radiologists were blinded, blinding of all caretakers is not possible when evaluating this intervention. It is unclear if the effect of the intervention was due to the absence of periodic turning or the elevation, as infants in the two groups were treated differently in both regards. In fact, the control group may have been affected by compromised venous return due to turning the head only rather than head and body. A weakness of the study is the lack of long-term developmental follow-up. As demonstrated in the largest trial of prophylactic indomethacin, a decrease in severe IVH does not always produce an improvement in long-term developmental outcome 5. Another weakness is the lack of magnetic resonance imaging (MRI) to assess for periventricular leukomalacia (PVL). Mean blood pressures were slightly higher in the elevated group, but cerebral perfusion may have been affected by the elevation placing the infants at risk for PVL. These results suggest that an elevated head position may be beneficial over flat supine head positioning with periodic turning for improving survival and decreasing grade IV IVH. Further, the results suggest that the control and intervention conditions are both safe with no harm shown in either group. With the differences in baseline characteristics, lack of allocation concealment, lack of MRI to assess for PVL, and most importantly, lack of developmental follow-up, it is not possible to strongly suggest a practice change from the results of this trial. However, these results should inform the design of a large, multicentre trial of this simple intervention. https://ebneo.org/2019/06/head-position-intraventricular-hemorrhage/ None. None.

Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion Summary, Number 782.

Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1- 2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal-rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including Table 1, Box 2, and Figures 1-3, updates and replaces the obstetric components of the CDC 2010 guidelines, "Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010."

Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 782.

Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1-2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal-rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including , , and , updates and replaces the obstetric components of the CDC 2010 guidelines, "Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010."

Intrapartum PCR-assay for detection of Group B Streptococci (GBS).

ObjectiveWe have recently introduced intrapartum PCR-testing for group B streptococcus (GBS) in women in labor with prolonged rupture of membranes or preterm delivery to offer intrapartum antibiotic prophylaxis only for GBS positive women.The goal of the present study is to report our experience and results from the first half year of GBS testing.Study designThis is a retrospective study. Rectovaginal swabs from 321 women presenting in the labor ward with pre-labor rupture of membranes for >14 h/rupture of membranes during delivery for >14 h, or labor between gestational weeks 35 0/7 and 36 6/7 from February 7, 2017 to August 6, 2017, were tested.We performed a molecular GBS test (Xpert GBS®, Cepheid Ltd., Sunnyvale, USA).Data from patient files including mode of delivery, use of antibiotics, infection of mother and child are presented in more detail.Data on the PCR results from the first year of testing were also collected.ResultsIn the first half-year of testing a positive GBS test result was found in 58 (18.1%) and a negative test result in 263 women (81.9%). No invalid test result was achieved.The indication for performing PCR testing was PROM > 14 h or rupture of membranes during labor for >14 h in 266 women (82.9%) and labor in gestational weeks 35 0/7–36 6/7 in 44 women (13.7%). In the remaining 11 women, the PCR test was performed for other reasons.Of the 321 women tested 126 (39%) received antibiotics during labor.Ten women (3.4%) were treated after delivery on suspicion of infection. 25 newborns (7.8%) were treated with antibiotics. In 11 cases, the treatment was stopped after 2–4 days as there were no signs of infection.ConclusionsThe introduction of the intrapartum GBS test in selected groups of women who gave birth in our department has been well accepted by the women, the midwifes and doctors. The result of the test is available within two hours, and as we only offer intrapartum antibiotic prophylaxis to GBS-positive women, we have reduced the use of antibiotics to approximately 40% in the groups tested, without an increase of infection in mother or child.

The influence of time of birth and seasonal variations on weight loss in breastfeeding neonates.

Breastfeeding (BF) neonates generally lose weight after birth. Neonatal factors like gestational age, birth weight and mode of delivery can affect the neonatal weight loss after birth. Similarly, maternal age, parity and illness may contribute to newborn weight loss. However, influence of the time of birth and season on changes in weight is not well elucidated. The aim of this study is to determine the effect of birth time and the seasonal variations on weight loss in BF newborns. In this retrospective study of a prospectively maintained database of two sets of groups, from January 2013 to October 2016, were evaluated- Birth time group and Seasonal group; Birth time of the groups was: night time 7pm to 7am and day time 7am to 7pm; and the seasonal variations groups studies were summer, fall, winter and spring. Weight loss of >5%, 7%, and 10% at <24 hours (h), 48 h and 72 h of birth, respectively, were considered as a significant weight loss. Preterm, exclusively formula fed and neonates admitted to NICU were excluded. A total of 2044 newborns were analyzed. In the birth time group, babies born during the night time had significantly lost >5% of birth weight at <24 h (p < 0.01) and >7% birth weight at <48 h of life (p < 0.02). Weight loss >10% at <72 h was similar in both birth time cohorts. C-section, prolonged rupture of membrane, and maternal pre-delivery hospital stay for >12 h were significant contributing factors. Whereas, seasonal variations were not associated with weight loss in neonates. BF babies born at night time lose significantly more weight during the first two days of life and seasonal association was not found to affect weight loss in the neonates.

Latency period and early initiation of breastfeeding in term premature rupture of membrane in Southern Ethiopia, 2017

BackgroundWorld Health Organization recommended timely initiation of breastfeeding within the first hour of delivery. Less than half of newborn babies (43%) receive the benefits of immediate breastfeeding in the world. In East Africa and Ethiopia, the prevalence of early initiation of breastfeeding was 61.82 and 73%, respectively. But, the prevalence of early initiation of breastfeeding was not assessed in relation to the duration of term premature rupture of the membrane in Ethiopia. Therefore, the aim of this study was to assess the effect of the latency period of term premature rupture of the membrane on early initiation of breastfeeding in Southern Ethiopia, 2017.MethodsThe study was conducted in Southern Ethiopia public hospitals by using facility based prospective follow up study from 20th February to 20th August 2017. Then, based on the duration of latency period of term premature rupture of the membrane, 98 and 294 mothers with prolonged and short latency period were followed until the initiation of breastfeeding respectively. Logistic regression analysis was performed to see the association between predictor and outcome variables. Adjusted odds ratio, with 95% CI, was calculated for each independent variable to check the adjusted association between independent variables and dependent variable. The statistical significance was set at P < =0.05.ResultsFrom a total of 91 mothers with prolonged latency period of premature rupture of membrane, 66.0% of them initiated breastfeeding after 1 h of birth. One the other hand, from 289 women with short latency period, 65.7% of them initiated breastfeeding within 1 h of delivery. The odds of initiation of breastfeeding within 1 h of delivery was higher in mothers with a short latency period of term premature rupture of membrane as compared to a prolonged latency period (AOR = 4.169: 95% CI; [1.933, 8.991]). Other variables such as educational status, wealth index, and place of residence were also independent predictors of initiation of breastfeeding.ConclusionThis study pointed out that women with short latency period of premature rupture of the membrane were more likely to initiate breastfeeding within an hour of delivery than women with prolonged latency period. Therefore, this finding suggested that women with prolonged premature rupture of membrane need special attention to increase early initiation breastfeeding.

État des lieux des pratiques de déclenchement en France

ObjectiveTo describe induction of labor practices in France and to identify factors associated with the use of different methods. MethodsThe data came from the French prospective population-based cohort MEDIP (MEthodes de Déclenchement et Issues Périnatales), including consecutively during one month in 2015 all women with induction of labor and a live fetus in 7 perinatal networks. The characteristics of women, maternity units, gestational age, Bishop's score, decision mode, indication and methods of labor induction were described. Factors associated with the use of different methods were sought in univariate analyzes. ResultsThe rate of induction of labor during the study was 21% and 3042 women were included (95.9% participation rate). The two main indications were prolonged pregnancy (28.7%) and premature rupture of the membranes (25.4%). More than one-third of women received intravenous oxytocin in first method, 57.3% prostaglandins, 4.5% balloon catheter and 1.4% another method. Among the prostaglandins, the vaginal device of dinoprostone was the most used (71.6%) then the gel (20.7%) and the vaginal misoprostol (6.7%). Women with a balloon were more often of higher body mass index and multiparous with scarred uterus. The balloon and misoprostol were mainly used in university public hospitals. ConclusionsThe evolution of induction of labor methods, due to new data from the literature and the development of new drugs or devices, invites to regularly repeat population-based studies on induction of labor.

Microbiological Pattern of Surgical Site Infection Following Caesarean Section at the University of Calabar Teaching Hospital.

BACKGROUND:Surgical site infection (SSI) is among the most common problems of patients who undergo a caesarean section, despite improved infection control practices. It contributes to increased morbidity and negative impact on the mental, social and economic aspect of patients’ life.AIM:To determine the incidence, risk factors and the bacteriological aetiology for SSI following caesarean section and their antimicrobial susceptibility patterns at UCTH.METHODS:This was a prospective study of 600 patients who had a caesarean section over 6 months. Wound swab was collected from the patients who developed clinical evidence of SSI during this study period were recorded. Microbiology culture and antibiotic sensitivity were conducted for both aerobic and anaerobic organisms. The data obtained were analysed using the SPSS version 22 statistical program.RESULTS:Out of the 600 participants who had a caesarean section, 51 patients had SSI, giving an incidence of 8.5%. The common isolates were S. aureus (37.3%), Klebsiella pneumonia (27.1%) and E. coli (22.0%). Independent risk factors significantly associated with post caesarean section wound infection in the logistic regression model were emergency caesarean section, prolonged rupture of membrane rupture greater than 24 hours, prolonged labour, intra-operative blood loss greater than one litre, duration of surgery greater than one hour and post-operative PCV less than 30%. Most isolates were highly resistant to cephalosporins, gentamycin and amoxicillin; moderately resistant to fluoroquinolones and highly sensitive to amikacin and imipenem.CONCLUSION:The post-caesarean wound infection rate in our centre of 8.5% was high. Imipenem and amikacin antibiotics were very sensitive for SSIs and can be used as evidenced-based sensitive antibiotics to be commenced initially when wound infection is identified in our wards while awaiting the result of wound swab microscopy, culture and sensitivity to reduce the complications of post-caesarean wound infection in our centre.

Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes &lt; 34 Weeks Gestation

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Materials and methods:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; This retrospective study included 65 patients who were born to mothers with Prolonged PPROM &amp;lt;34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P &amp;lt; 0.05). &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Prolonged PPROM before the 34&lt;sup&gt;th&lt;/sup&gt; gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.&lt;/em&gt;&lt;/p&gt;

English

In the face of recent improvements in neonatal care, the influences of neonatal sepsis remain a public health problem in developing countries. Thus, identifying the determinants of neonatal sepsis is an indispensable matter of enhancing neonatal care. Therefore, this study intends to identify the determinants of neonatal sepsis among neonates admitted to the Neonatal Intensive Care Unit at Jinka General Hospital in Southern Ethiopia. An institution-based case-control study was conducted from September to October 2017. A total of 335 neonates who were admitted at Jinka General Hospital were incorporated. Cases (n=112) were neonates who were with sepsis and their mother. Controls (n=223) were neonates who were not with neonatal sepsis and their mother. Study participants were selected using the simple random sampling technique. Bi-variable and multivariable logistic regression analyses were performed to identify determinants of neonatal sepsis. A total of 335 (112 cases and 223 controls) medical charts of neonates with their index mother was reviewed. History of urinary tract infection during the index pregnancy [AOR= 4.47, 95% CI (2.06, 9.71)], prolonged rupture of membrane [AOR= 2.2, 95% CI (1.24, 3.92)], birth weight of neonate less than 2.5kg [AOR= 1.68, 95% CI (1.25, 3.75)] and birth asphyxia [AOR= 2.34, 95% CI (1.14, 4.81)] were identified as determinants of neonatal sepsis. This study concludes that history of urinary tract infection, prolonged rupture of membrane, birth weight of neonate and birth asphyxia were the independent determinants of neonatal sepsis. Therefore, preventive efforts of neonatal sepsis should focus on high-risk neonates such as neonate born from mothers who have of urinary tract infection and prolonged rupture of membranes, a neonate with low birth weight and neonate who developed neonatal asphyxia by careful monitoring and follow-up as well as by prudently treating the victims. Key words: Neonatal sepsis, determinants of neonatal sepsis, neonatal intensive care unit.

Intrapartum antibiotics for prolonged rupture of membranes at term to prevent Group B Streptococcal sepsis

The timely administration of intrapartum antibiotic prophylaxis (IAP) to eligible pregnant mothers reduces the risk of early onset Group B Streptococcus (GBS) neonatal sepsis. The incidence of neonatal GBS sepsis is increasing, in spite of national guidelines for its prevention. This retrospective cohort study was undertaken to assess the incidence of culture-proven GBS sepsis before and after a change of practice on intrapartum management of GBS sepsis in babies born at Sunderland Royal Hospital between January 1 2008 and December 31 2017. The data regarding the risk factors, the intrapartum antibiotic prophylaxis and the outcomes of the babies were collected. Twenty-nine cases were identified and presented in two epochs—before and after changing guidelines for intrapartum management. There was a statistically significant reduction in early onset sepsis rates and no difference in late-onset sepsis rates. The prolonged rupture of membranes is a significant risk factor at any gestation. Impact statement What is already known on this subject? Appropriate intrapartum administration of antibiotics in mothers reduces 80% of early-onset GBS infections. In the United Kingdom, IAP is given based on risk factors, which fail to accurately identify and treat the woman who harbours GBS in the birth canal in labour and the incidence of GBS neonatal sepsis is increasing. The national guideline on the prevention of GBS sepsis is not consistent and is open to interpretation. What do the results of this study add? This study highlights prolonged rupture of membranes as a significant risk factor at any gestation and there were missed opportunities to prevent GBS sepsis in term babies with the prolonged rupture of membranes. This study also highlights that it is possible to reduce the neonatal GBS sepsis burden by adhering to guidelines and administering timely intrapartum antibiotics. What are the implications of these findings for clinical practice and/or further research? The timely administration of IAP to all eligible women is possible if the national guidelines are consistent and interpreted correctly. Our national guideline on the prolonged rupture of membranes at term is not clear and is interpreted differently. If IAP is provided in all those with risk factors irrespective of gestation, this would involve additional costs to the NHS; but in the long term, it will benefit as it reduces morbidity.

Prolonged premature rupture of membranes in nullipara and the risk of spontaneous premature birth in the subsequent pregnancy

Prolonged premature rupture of membranes in nullipara and the risk of spontaneous premature birth in the subsequent pregnancy

Perinatal outcome of prolonged preterm premature rupture of membranes near the limit of fetal viability

Purpose of investigation: The purpose of the present study is to evaluate the perinatal outcome of expectant management for prolonged preterm premature rupture of membranes (PPROM) near the limit of fetal viability. Materials and Methods: Pregnant women who delivered babies between January 2000 and March 2015 and had a history of PPROM at 22-23 weeks of gestation with a latency of one week or longer were included in the PPROM cohort. The control cohort included women who delivered babies within 24 hours after PPROM during the same period. Perinatal outcomes were compared between the two cohorts. Results: No differences were observed between the two cohorts in terms of survival to discharge from the NICU (p = 0.43) and respiratory complication at one year of corrected AGE (p = 1.00). Conclusions: Prolonged PPROM did not affect the rate of survival discharge from NICU and respiratory complication at one year of corrected age.

Perinatal Outcomes Following Prolonged Preterm Premature Rupture of Membranes before Limit of Viability - A Single Center Experience

Objective: To investigate maternal and neonatal outcomes following prolonged preterm premature rupture of membrane (PPROM) before limit of viability in a single center. Methods: Thirty-two women with PPROM before 25 weeks'' gestation without overt intrauterine infection were administered expectant management. We investigated maternal and neonatal outcomes of pregnancies following PPROM occurring before 25 weeks’ gestation and with latent period (from membrane rupture to delivery) of 7 days or more. Results: Median gestational age at membrane rupture was 22.1 weeks. Median latent period was 32 days. Median gestational age at delivery was 26.6 weeks. The incidence of clinical pulmonary hypoplasia and early onset sepsis was 43.5% (10/23) and 21.7% (5/23), respectively. The overall mortality in neonatal intensive care unit (NICU) was 43.5% (10/23). Latent period was negatively correlated with gestational age at membrane rupture (r=-0.501, P=0.015), but not associated with maternal complications. As the length of latent period increased, overall mortality in NICU decreased (relative risk=0.898, P=0.011). Conclusion: The expectant management in women with PPROM before 25 weeks'' gestation did not induce maternal complications and might help to improve the neonatal outcomes rather than the immediate delivery.

Retrospective Evaluation of Perinatal and Early Neonatal Outcomes in Infants of Migrant Mothers: A Case-Controlled Study.

Objective:To investigate the incidence of perinatal features and neonatal morbidities in migrant mothers in comparison with native Turkish mothers.Method:A retrospective analysis was conducted using the medical records of 89 infants born to Syrian immigrants and 89 infants born to native Turkish mothers who were consecutively admitted to the neonatal intensive care unit of our hospital between 2015 and 2019. Statistical analyses were used to compare demographic data and perinatal and neonatal outcomes between the two groups.Results:Compared to Turkish mothers, Syrian mothers were significantly younger and adolescent pregnancy rate was significantly higher (p<0.01). The rates of multiple pregnancy, consanguineous marriage, and prolonged premature membrane rupture were also significantly higher in Syrian mothers (p<0.05). The incidence rates of congenital anomalies, respiratory distress syndrome, transient tachypnea of newborn pneumonia/bronchiolitis, sepsis, jaundice, and feeding problems were the same for infants born to Syrian and Turkish mothers (p>0.05). In addition, the two groups did not differ with respect to gestational week at birth, birth weight, sex, types of delivery, Apgar score, duration of hospital stay, and incidence of infant mortality (p>0.05).Conclusion:The immigrant status negatively affects perinatal and neonatal outcomes. However, the incidence rates of infant mortality and neonatal morbidity did not differ between infants born to Syrian and those born to Turkish mothers. This may be due to the recent improvements in the of overall health status of migrant women or of those migrants living in Turkey being able to have access to increased prenatal and postnatal period policies of mother-child health services which have been successfully implemented.