Proportion Of Preterm Infants Research Articles

Clinical characteristics of postoperative necrotizing enterocolitis in patients with congenital jejunoileal atresia and its risk factors

ObjectiveTo review postoperative necrotizing enterocolitis (NEC) in patients with jejunoileal atresia (JIA) and to explore the potential risk factors related to the concurrence of NEC.MethodsPatients diagnosed with JIA who received...

Neonatal Respiratory Support Utilization in Low- and Middle-Income Countries: A Registry-Based Observational Study

Background: Newborns with hypoxemia often require life-saving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low- and middle-income countries, more term newborns received respiratory support than preterm newborns. Methods: This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women’s and Children’s Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 g and born from January 1, 2015, to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation. Test for trends over time were conducted using robust Poisson regression. Results: 177,728 (86.3%) infants included in this study were term, and 28,249 (13.7%) were preterm. A larger number of term infants (n = 5,108) received respiratory support compared to preterm infants (n = 3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p < 0.001). The rate of provision of respiratory support varied between sites. Conclusions: Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.

Prevalence of anaemia and associated factors among preterm infants at six weeks chronological age at Muhimbili National Hospital, Dar es Salaam, Tanzania: a cross-sectional study.

preterm infants are vulnerable to several medical complications including anaemia, a significant public health problem with consequences on neurodevelopment. This study looked at the magnitude of anaemia and its associated factors among preterm infants at 6 weeks chronological age in a paediatric clinic of Muhimbili National Hospital (MNH). this was a hospital based cross-sectional study conducted among preterm infants at 6 weeks chronological age attending follow-up clinic at MNH from October 2019 to March 2020. Parental interviews, medical records reviews and haemoglobin assessment was done during the clinic visits. Logistic regression was used to determine the association between studied factors and anaemia. the proportion of preterm infants with anaemia at 6 weeks chronological age was 38.4% (142/370) with 74% of these infants having moderate anaemia. Morphological types of anaemia were normocytic (56.3%) and microcytic anaemia (4.9%). Two-thirds of preterm infants (62%) were on haematinics supplementation. Moderate preterm born at gestation age 32 to <34 weeks (OR=2.21, 95% CI 1.15-4.25, p=0.017), two or less phlebotomies (OR=2.3; 95% CI 1.23-4.30; P=0.010) and more than two phlebotomies (OR=7.2, 95% CI 3.62-14.16, p≤0.001) were significantly associated with anaemia. the proportion of preterm infants with anaemia at 6 weeks chronological age is high despite two-thirds being on haematinics supplementation. Moderate preterm and multiple phlebotomies significantly contributed to the occurrence of anaemia. Screening preterm infants for anaemia, appropriate management, and close follow-up are recommended to reduce its burden.

Gestational age: comparing estimation methods and live births' profile.

To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) - physical examination and ultrasound, between 2012-2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.

Growth Pattern of Preterm Newborns under 34 Weeks of Gestation in a Tertiary Care Hospital, Tamil Nadu, India: A Retrospective Study

Introduction: The proportion of preterm babies is increasing now a days and these babies are more prone to short and long term disabilities. Hence, growth monitoring is essential, to identify the premature infants, who are at increased risk of growth lag and poor neurodevelopmental outcomes. Aim: To assess the growth pattern of infants, who are born ≤34 weeks of gestational age using the intergrowth-21st growth charts. Materials and Methods: This retrospective study was conducted in the Department of Neonatology at Chengalpattu Medical College and Hospital, a Tertiary Care Center Chengalpattu, Tamil Nadu, India. The duration of the study was one year, from January 2020 to December 2020. A total of 118 neonates born at ≤34 weeks gestational age, who were admitted in the hospital and stayed for 14 days and more were included in the study. The data was collected from discharge sheets and an electronic database. Intergrowth-21st growth charts are used to assess growth. Weight, duration of hospital stay and Extrauterine Growth Restriction (EUGR) were assessed for all the newborns. At discharge, the EUGR status of the babies was determined using a weight ≤-1.28 Standard Deviation (SD) criterion. Continuous variables were presented as means with SD. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.0. Results: The mean maternal and gestational age of the study participants was 24.9±4.14 years and 31.6 ±1.42 weeks and birth weight of babies were 1608.06 gm (±275), respectively. The proportions of Appropriate for gestational age (AGA) and Small For Gestational Age (SGA) were 95 (80.5%) and 18 (15.2%), respectively. The mean time to reach full feeds was 10.4 days (±2.7days), and the duration of stay in the hospital was 24.8 days (±9.6 days). The mean discharge weight and gestational age of babies were 1732 gm (±226 gm) and 35.4 weeks (±1.47 weeks), respectively. The common complications observed, were those requiring antibiotics (73.7%), respiratory support (61.01%), and Respiratory Distress Syndrome (RDS) (22.8%). Conclusion: Preterm newborns are more vulnerable to EUGR. The EUGR proportion in present study was 72.8%. The issues that raise the risk of EUGR, during the hospital stay must be adequately addressed in order to ensure that, preterm neonates develops normally.

The Disease Spectrum and Influencing Factors of NICU in Xiangxi, Underdeveloped Area of China: A 9-Year Retrospective Study.

ObjectiveInvestigation of the basic conditions and disease spectrum in neonatal intensive care unit (NICU) from 2012 to 2020, in the underdeveloped area of Xiangxi, China.MethodsAll newborns (N = 16,094) admitted to the NICU of a hospital in the Xiangxi area from 2012 to 2020 were selected for the retrospective study.ResultsThe average male/female ratio was 1.43:1, with 9,482 males and 6,612 females admitted to the NICU. The sample comprised 41.02% premature infants, and 56.52% had been delivered via cesarean delivery (CD). The most prevalent diseases diagnosed in the NICU were jaundice (22.01%), respiratory (18.45%) and neurological diseases (17.54%). Over the 9-year study window, the prevalence of jaundice and cardiovascular diseases increased, while respiratory and neurological diseases became less frequent. The prevalence of the remaining diseases remained unchanged. Prevalence of neonatal diseases is influenced by gender, patient sources, delivery methods, gestational age and birth weight (P < 0.05). The prevalence of neonatal diseases was significantly higher in males, infants born via CD, and in infants of lower gestational age and birth weight.ConclusionThe study contributes in-depth information about infant characteristics in an NICU in an undeveloped region of China. In the past 9 years, the average proportion of premature infants in the NICU decreased to 37.38% in 2020, but this figure remains higher than the Chinese national average of 26.2%. Similarly, the CD rate is higher than the Chinese average. The spectrum of neonatal diseases in the NICU in Xiangxi area is drawn, included jaundice, respiratory and neurological diseases, primarily. Through statistical analysis, it is found that the types and prevalence of neonatal diseases are closely related to different gender, gestational age, patient sources, delivery methods, and birth weight (P < 0.05). Newborns of specific gestational age, birth weight and delivery method should be considered “at-risk” and targeted in the formulation of preventive measures. There is a great need to improve the diagnosis and treatment of neonatal diseases—and perinatal health care in general—to ensure improved outcomes for newborns admitted to NICUs in underdeveloped regions.

Nursing of prematurely born children: indicators of the effectiveness

The study and monitoring of international indicators of the health status of premature infants is the current vector of scientific research in neonatology.Objective. To assess the effectiveness of the nursing technologies of premature babies in the Republic of Belarus based on the analysis of long-term indicators of morbidity, mortality and survival of the infants with extremely low body weight.Material and methods. Statistical reports data were used for a retrospective analysis of epidemiological indicators for the period of 2002–2018.Results. The proportion of premature infants in the Republic of Belarus was stabilized at 4,2–4,5% increase in the absolute numbers, including those born weighing less than 1500 g. The ratio of the absolute number of alive and stillborn infants with extremely low body weight is many times higher than the initial values (p&lt;0,05). The survival rate of infants with a body weight of 500–999g up to 1 year increased 2 times to the maximum level in 2018 (81,5%). There was an increase in the overall incidence of premature children in 2002–2010 (p&lt;0,05) and a decrease by 2016 (p=0,001), including those born with a body weight of 500–999 g. Respiratory distress syndrome, intrauterine hypoxia and asphyxia during childbirth, an increase in the frequency of infections specific to the perinatal period (p &lt;0,05) were registered more often. Among the children born with a body weight of 500–999 g, the incidence of congenital pneumonia for the period 2002–2009 increased to a maximum level of 263,4 ‰ (p &lt;0,05) with a twofold decrease by 2018. The republican mortality rate of premature babies was stabilized at the level of 0,95 ‰ in the last 9 years, while the indicator was decreased 5 times among children weighing 500–999 g.Conclusion. The assessment of the long-term dynamics of the main indicators of the health status of premature infants in the Republic of Belarus testified to the effectiveness of a complex of organizational and medical measures for their nursing.

Impact of COVID-19 lockdown measures on institutional delivery, neonatal admissions and prematurity: a reflection from Lagos, Nigeria

We assessed the effect of COVID-19 lockdown on deliveries and neonatal admissions according to gestation in Lagos, Nigeria. During lockdown (April–June 2020), there was a marked fall of about 50%...

Association of Routine Infant Vaccinations With Antibody Levels Among Preterm Infants

The standard schedule of national immunization programs for infants may not be sufficient to protect extremely and very preterm infants. To evaluate the immunogenicity of routine vaccinations administered to preterm infants. A multicenter, prospective, observational cohort study of preterm infants stratified according to gestational age recruited from 8 hospitals across the Netherlands between October 2015 and October 2017, with follow-up until 12 months of age (October 2018). In total, 296 premature infants were enrolled and compared with a control group of 66 healthy term infants from a 2011 study, immunized according to the same schedule with the same vaccines. Three primary doses of the diphtheria-tetanus toxoids-acellular pertussis-inactivated poliomyelitis-Haemophilus influenza type b-hepatitis B combination vaccine were given at 2, 3, and 4 months after birth followed by a booster at 11 months and a 10-valent pneumococcal conjugate vaccine at 2, 4, and 11 months after birth. Primary end points were (1) proportion of preterm infants who achieved IgG antibody against vaccine antigens at concentrations above the internationally defined threshold for protection after the primary series and booster dose and (2) serum IgG geometric mean concentrations after the primary series and booster vaccination. Proportions and geometric mean concentrations were compared in preterm infants and the control group of term infants. Of 296 preterm infants (56.1% male; mean gestational age, 30 weeks), complete samples before vaccination, 1 month after the primary series, and 1 month after the booster were obtained from 220 preterm infants (74.3%). After the primary series, the proportion of preterm infants across all gestational age groups who achieved protective IgG antibody levels against pertussis toxin, diphtheria, tetanus and 6 of 10 pneumococcal serotypes varied between 83.0% and 100%, Haemophilus influenzae type b between 34.7% and 46.2% (40.6% among all preterm infants overall), and pneumococcal serotypes 4, 6B, 18C, and 23F between 45.8% and 75.1%. After the booster dose, protective antibody levels were achieved in more than 95% of all preterm groups, except for Haemophilus influenzae type b (88.1%). In general, geometric mean concentrations of all vaccine-induced antibodies were significantly lower in all preterm infants vs term infants, except for pertussis toxin and pneumococcal serotypes 4 and 19F after the primary series and booster vaccination. Among preterm infants, administration of routine vaccinations during the first year of life was associated with protective antibody levels against most antigens in the majority of infants after the primary series and booster, except for Haemophilus influenzae type b. However, antibody concentrations were generally lower among preterm infants compared with historical controls.

EARLY USE OF CONTINUOUS POSITIVE AIR WAY PRESSURE FOR PREVENTION AND TREATMENT OF RESPIRATORY DISTRESS SYNDROME IN PRETERM INFANTS

Respiratory support is the mainstay intervention for support of postnatal respiratory adaptation and treatment of preterm infants. There is no doubt today about the clinical benefits of early use of non-invasive respiratory support over traditional tracheal intubation and mechanical ventilation in the context of reducing the risk of death, lung injury, and long-term chronic morbidity. In particular, continuous positive airway pressure (CPAP) is the most commonly used method of initial non-invasive respiratory support (NRS) for spontaneously breathing preterm newborns. This method of NRS is preferred in practice because of its easy use, accessibility and effectiveness. Application of CPAP increases functional residual lung capacity and tidal volume, which is important for the prevention and treatment of respiratory distress- syndrome. However, significant proportion of preterm infants managed on CPAP require transfer to mechanical ventilation as NRS becomes ineffective ultimately. The requirement for tracheal intubationand initiation of mechanical ventilation increases the risk of complications and adverse outcomes in such infants. In particular, CPAP failure is associated with higher rate of intraventricular hemorrhages, bronchopulmonary dysplasia, and increases the risk of death. Therefore, the priority is to maximize effectiveness of CPAP application. This can be achieved by identifying a risk group, namely the infants, who have a high probability of this respiratory support type failure, and by timely adding supplementary measures that can increase the effectiveness of CPAP. This review substantiates the expediency of early CPAP use for treatment of preterm newborns, describes the risk factors of CPAP failure and ways to improve the effectiveness of this method of NRS.

Role of Fibronectin-1 polymorphism genes with the pathogenesis of intraventricular hemorrhage in preterm infants

Background/introductionIntraventricular hemorrhage (IVH) is a dangerous complication facing a significant proportion of preterm infants. It is multifactorial in nature, and an observed fibronectin deficiency in the germinal matrix basal lamina is among the most prominent factors that influence such rupture. Better understanding of the FN1 gene polymorphisms and their role in IVH may further clarify the presence of a genetic susceptibility of certain babies to this complication. The aim of this study was to assess if 5 single nucleotide polymorphisms of the fibronectin gene may be linked to an increased incidence of IVH.Material and methodsThe study included 108 infants born between 24 and 32 weeks of gestation. IVH was diagnosed using cranial ultrasound performed on the 1st,3rd, and 7th day after birth and classified according to Papile et al. IVH classification. The 5 FN1 gene polymorphisms assessed in the study were the following: rs3796123; rs1968510; rs10202709; rs6725958; and rs35343655.ResultsIVH developed in 51 (47.2%) out of the 108 preterm infants. This includes, 18 (35.3%) with stage I IVH, 19 (37.3%) with stage II, 11 (21.6%) with stage III, and 3 (5.9%) with stage IV IVH. Incidence of IVH was higher in infants with lower APGAR scores, low gestational age, and low birthweight. Analysis showed that IVH stage II to IV was approximately seven times more likely to occur in infants with the genotype TT FN1 rs10202709 (OR 7237 (1046–79.59; p = 0,044)). No other significant association was found with the rest of the polymorphisms.ConclusionThe results of our study indicate a sevenfold increased genetic susceptibility to IVH in preterm infants with the TT FN1 rs10202709 gene polymorphism. The fibronectin gene polymorphism may therefore be of crucial importance as a genetic risk factor for IVH in preterm infants. Further studies are warranted.

Management of abdominal distension in the preterm infant with noninvasive ventilation: Comparison of cenit versus 2x1 technique for the utilization of feeding tube.

Preterm infants are fed by orogastric / nasogastric tube until they reach maturation and coordination of sucking, swallowing and respiration at approximately 32-34 weeks of corrected age. While being on non-invasive ventilation (NIV), they frequently present abdominal distension. Currently at our institution two techniques are used for the management of abdominal distension in preterm infants fed by bolus via orogastric tube: cenit and 2 x 1.The aim of this study was to compare the proportion of preterm infants presenting NIV-associated abdominal distension with each of these techniques. We conducted a randomized clinical trial including infants of < 36.6 weeks of gestation and < 1500 g of birth weight who were admitted to our NICU during the period of April 1, 2016 to April 1, 2018 and received NIV. The presence of abdominal distension > 2 cm was the primary outcome. Secondary outcomes were presence of reflux, regurgitation, oxygen saturation during feeding and days to reach full feedings. Feeding tube drainage, stool characteristics and the use of prokinetics were confounding variables. A total of 97 patients were included. Forty-six in the cenit group and 51 in the 2 x 1 group. There was no difference in the proportion of infants with abdominal distension > 2 cm between groups. Oxygen saturation during feeding at volume of 150 ml/kg/day was higher in the cenit group with statistical significance. The use of cenit or 2 x 1 technique in preterm infants with NIV did not improve abdominal distension or other indicators of feeding tolerance.

Analysis of the effect of pregnancy complicated with acute pancreatitis on maternal and infant outcomes

Objective To explore the effect of pregnancy with acute pancreatitis on maternal and infant outcomes, thus to provide reference for the development of clinical intervention programs. Methods From January 2012 to January 2018, 62 pregnant patients with acute pancreatitis in the Maternal and Child Health Hospital of Jiaxing were selected as study objects.All of them were singletons.The patients were grouped according to the cause of acute pancreatitis and the severity of the disease.The pregnancy outcomes and neonatal conditions were analyzed. Results Of 62 patients with acute pancreatitis, 40 cases (64.52%) had full-term delivery, 20 cases (32.26%) had premature delivery, and 2 cases(3.22%) had intrauterine fetal death.The newborns included in the study were 60 cases.There were no statistically significant differences in the proportion of premature infants between different morbidity factors, neonatal birth weight and neonatal disease composition (the premature infants: F=0.691, P=0.352; birth weight: F=1.042, P=0.382; biliary erythremia: F=1.382, P=0.521; respiratory distress syndrome: F=0.496, P=0.584; hypoglycemia: F=3.102, P=0.165; infectious disease: F=0.895, P=0.124; intracranial hemorrhage: F=0.004, P=0.932). The difference of termination pregnancy rate was statistically significant (biliary 57.69%, hyperlipidemia 82.14%, other 25.00%) (F=12.541, P=0.000), and the rate of the lipemia group was the highest (82.14%). The proportion of premature infants with moderate pregnancy and acute pancreatitis was the highest (75.0%), and the birth weight was the lowest (F=8.142, 4.581, P=0.000, 0.001). The proportion of termination of pregnancy among different degrees of disease had no statistically significant difference (mild 12.19%, moderate 75.0%, and severe 69.23%) (F=1.251, P=0.4125). The intracranial hemorrhage (0.00%), neonatal respiratory distress syndrome (2.44%) and infectious disease rate (4.88%) were the lowest in mild pregnancy with acute pancreatitis (F=8.641, 7.362, 6.982, P=0.000, 0.000, 0.000). Conclusion Pregnancy with acute pancreatitis can cause adverse pregnancy outcomes and affect the health of newborns.As the patients' condition worsens, the adverse outcome will be more serious. Key words: Pregnancy outcome; Pancreatitis; Infant, premature; Pregnancy complications; Respiratory distress syndrome, newborn

Neonatal and neurodevelopmental outcomes in preterm infants according to maternal body mass index: A prospective cohort study.

ObjectiveMaternal obesity is associated with an increase in maternal, foetal and neonatal morbidity and mortality. The aim of our study was to evaluate the relationships between maternal pre-pregnancy body mass index and (1) neonatal outcome in preterm infants, and (2) neurodevelopmental outcome at 2 years of corrected age.MethodWe conducted a single-centre cohort study. Infants born between 24+0 and 33+6 weeks of gestation between January 2009 and December 2013, hospitalised in the neonatal intensive care unit of Angers University Hospital, and with available data regarding maternal pre-pregnancy body mass index were eligible. Three groups were defined according to maternal body mass index: normal (n = 418), overweight (n = 136) and obese (n = 89). The primary outcome was neurodevelopment at 2 years of corrected age. Children with a non-optimal neuromotor and/or psychomotor assessment and/or a sensory disability were regarded as having a “non-optimal neurodevelopmental outcome”. Neuromotor function was regarded as non-optimal when cerebral palsy was present or when the clinical examination revealed neurological signs of abnormal muscular tone. Psychomotor assessment was regarded as non-optimal if the revised Brunet-Lézine test was < 85 or when the overall score in the parental Ages and Stages Questionnaire (ASQ) was < 185. Finally, sensory disabilities such as blindness and children who required a hearing aid were taken into account. The secondary outcome was the composite criteria of neonatal complications. Multivariable analysis included the following variables: mother’s age, gestational age, smoking during pregnancy, magnesium sulphate and steroid treatment during pregnancy, twin status, gender, socioeconomic status and social security benefits for those with low incomes.ResultsThe study population was composed of 643 preterm infants. Among them, 520 were assessed at 2 years. There was no difference in the proportion of infants with non-optimal neurodevelopmental outcomes between the three groups (16.6% for obese, 13.5% for overweight, 16.9% for normal body mass index mothers; p = 0.73). According to multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neuro-development at 2 years (adjusted OR = 0.84 [0.40–1.76] for obese, adjusted OR = 0.83 [0.43–1.59] for overweight mothers). There was no difference in the proportion of preterm infants with a non-optimal composite criterion of neonatal complications between the three groups. In the multivariable analysis, being born from an overweight or obese mother was not associated with an increased risk of non-optimal neonatal outcomes (adjusted OR = 0.95 [0.49–1.83] for obese, adjusted OR = 1.18 [0.69–2.01] for overweight mothers).ConclusionIn this large prospective cohort of preterm infants born before 34 weeks of gestation, we found no relationship between maternal body mass index and neurodevelopmental outcomes at 2 years of corrected age and no relationship between maternal body mass index and neonatal outcomes. Other prematurity-related factors may be more relevant for neurodevelopmental outcome than the mother’s pre-pregnancy BMI.

Differential diagnosis and treatment of intestinal perforation caused by neonatal necrotizing enterocolitis and Hirschsprung′s disease

Objective To retrospectively analyze the differential diagnosis and treatment strategy of neonatal intestinal perforation caused by neonatal necrotizing enterocolitis (NEC) and Hirschsprung′s disease (HD). Methods The clinical data of 42 cases with NEC and 22 cases with HD combined with intestinal perforation from Ja-nuary 2012 to January 2017 admitted at Fujian Provincial Maternity and Children′s Hospital were collected, the proportion of premature infants, and the proportion of low birth weight infants, age of onset, preoperative clinical symptoms and surgical treatment was compared between the two groups. Results The proportion of premature infants[95.23%(40/42 cases) vs.27.27%(6/22 cases)], the proportion of low birth weight infant[90.48%(38/42 cases) vs.45.45%(10/22 cases)]and the age of onset [(14.48± 10.51) d vs.(3.18±3.43) d]were statistically different between the NEC group and the HD group, and the differences were statistically significant(all P<0.05). There were significant differences in the presence of normal defecation before the operation[71.4% (30/42 cases)vs.27.3%(6/22 cases)], and in the the defecation characteristics at the onset[95.2% (40/42 cases)vs.9.1%(2/22 cases)]between the NEC group and HD group(all P<0.05). Among 42 cases of NEC patients, 8 cases underwent intestinal anastomosis, and 34 cases underwent enterostomy because of the high risk of anastomosis.All of 22 patients with HD underwent double-lumen enterostomy. Conclusions The general conditions, preoperative manifestations and intraoperative fin-dings of the children should be comprehensively analyzed for identification.Enterostomy is recommended for NEC intestinal perforation, but if the risk of anastomosis is high, then fistula should be performed.Double-lumen fistula should be recommended for HD intestinal perforation, and enterostomy should be recommended if the two cannot be clearly distinguished. Key words: Infant, newborn; Intestinal perforation; Necrotizing enterocolitis; Hirschsprung′s disease

Changing patterns of early childhood blinding conditions presenting to a tertiary eye center: The epidemic of retinopathy of prematurity in India

Purpose:Retinopathy of prematurity (ROP) is now emerging as one of the major causes of preventable childhood blindness. The proportion of preterm babies has increased dramatically over the past decade. Our study aims to emphasize the need for ROP screening and management services in these preterm infants.Methods:ICD-coded medical records of children less than 10 years of age presenting to a subspecialty eye hospital from 2000 to 2017 were reviewed. ROP, congenital cataract, congenital glaucoma, and vitamin A deficiency were the most common diagnoses. We evaluated the trend of these diseases from 2000 to 2017.Results:Our data suggested a 20-fold increase in the attendance of children with a diagnosis of ROP who now make over 2% of outpatient children. Vitamin A deficiency has declined over time whereas cataract and glaucoma have remained stable.Conclusion:Our data indicate a need to scale up ROP screening integrated with neonatal care, as well as to build capacity for the treatment of acute and late-stage ROP in India.

Перинатальні висліди багатоплідної вагітності після запліднення in vitro та при спонтанних вагітностях

Objective - to evaluate perinatal outcomes in multiple gestations after in vitro fertilization compared with spontaneous pregnancies. Material and methods. A retrospective analysis of 375 labour and delivery medical records that were provided in the Medical centre Isida — IVF LLC (Kyiv, 2010-2017), and resulted in 279 twin deliveries after in vitro fertilization and 96 twin deliveries after spontaneous pregnancy (the group of comparison). Results. The risk of miscarriage during pregnancies induced by assisted reproductive technologies is significantly high. The proportion of premature infants (<37 weeks) in the in vitro fertilization group was 227 (41.1%), in the group of spontaneous twins - 63 (32.8%). Analysing the anthropometric indicators of newborns of the in vitro fertilization group, it was found that they were lower than in children of the comparison group. The perinatal pathology incidence in infants from mothers after in vitro fertilization procedure was 1.8 times higher than in the comparison group. The mothers who underwent in vitro fertilization procedure had 1.2 times more often lactation disorders. Early neonatal mortality in twins did not depend on the fertilization type and made up 4.0% for the in vitro fertilization group and 3.1% for the comparison group. Conclusions. The perinatal pathology incidence in multiple gestations associated with in vitro fertilization increases, which can be illustrative of usefullness of further development of reproductive technologies that allow implantation of one embryo.

Trend and causes of neonatal mortality in a level III children's hospital in Shanghai: a 15-year retrospective study.

To determine the trend and causes of neonatal mortality in a large level III neonatal intensive care unit in Shanghai during a 15-year period. This is a retrospective, single-centered study. All neonates who died during the period from January 1, 1999 to December 31, 2013 at Children's Hospital of Fudan University were included. We extracted relevant clinical information from their medical records, analyzed neonatal mortality rate and the characteristics of these patients, and compared neonatal deaths between different periods and populations. Among a total of 50,957 admissions during the study period, there were 929 neonatal deaths. The neonatal mortality rate was 1.82%. Trends in neonatal mortality rate showed an increase in the period from 1.0% in 2003 to 2.2% in 2013. The main causes of neonatal mortality were complications of preterm birth (33.6%), congenital anomalies (21.3%), infections (12.6%), and birth asphyxia (9.1%). The proportions of complications of preterm birth (P<0.001) and congenital anomalies (P=0.018) increased yearly, while the proportions of birth asphyxia (P<0.001) and infections (P<0.001) decreased. Proportions of deaths caused by birth asphyxia (P=0.005) and infections (P<0.001) were both higher in the migrating population than in the permanent residents. Neonatal mortality rate increased from 2003 to 2013 in our study. The proportion of preterm infants in neonatal deaths also increased within the same period. Complications of preterm birth were the main cause of neonatal mortality and the percentage increased year by year. Neonates in the migrating population appeared to be at a higher risk of death during the neonatal period compared to those in the permanent residents, and efforts should be made towards improving perinatal care to prevent infections and birth asphyxia in this vulnerable population.

Neonatal Cholestasis: A Pandora's Box.

Neonatal cholestasis (NC) is a diagnostic dilemma frequently countered in a neonatal care unit. Early diagnosis is vital for achieving an optimal patient outcome as many causes of cholestasis such as biliary atresia are time-sensitive and amenable to treatment if analyzed and treated early. Nonetheless, it is not generally simple to analyze these cases right on time as some of them are regularly missed due to the presence of pigmented stools, lack of newborn metabolic screening, and named as instances of prolonged jaundice. In this manner, we prescribe to explore all reasons for prolonged jaundice stretching out past 14 days in neonates. Besides, we suggest that stool card ought to be a piece of release rundown for all newborn children being released from the nursery. This is of most extreme significance in the nation like India where guaranteeing customary follow-up is as yet a tough assignment. These stool cards will help in the early determination of patients with NC particularly biliary atresia and guarantee their auspicious cure. Another reason which needs exceptional say is parenteral nutrition–associated liver illness, as the proportion of preterm babies is getting greater and greater with better neonatal care. These extreme preterm infants are in the requirement for prolonged (>14 days) total parenteral nourishment because of which they are at high hazard for NC contrasted with their more developed peers. In this survey, we will give an understanding of clinical approach, differential diagnosis, and clinical review of NC.

Efficacy of Indomethacin in Pharmacological Closure of PDA in Preterm Neonates: A Prospective Study from Tertiary Care Centre in Rural India

Background: Patent ductusarteriosus (PDA) is a fetal shunt necessary for intrauterine survival of the baby, however its closure at birth occurs as pulmonary vascular resistance drops and lungs get expanded for participating in ventilation. However, PDA remains patent in a large proportion of preterm babies and by day -7, 87% of babies <24 wk gestation have a PDA which hinders in ventilation and causes ductal steal to vital organs. Hence, we aimed to study pharmacological closure of ductus in preterm babies. Aims and Objectives: 1) To study the efficacy of COX inhibitor, Indomethacin in ductal closure in preterm babies <34 wk gestation. 2) To compare the symptomatology of PDA in different groups of preterm babies <34 wk GA. Methods: A Hospital-based prospective study was conducted in tertiary care NICU.A total of 104 consecutive, eligible preterm babies <34 wk with echocardiographically documented PDA. Indomethacin (COX inhibitor) was administered orally in a dose of 0.2 mg/kg 12 h for 3 doses and the babies underwent Echo study in first 48 h, after2 days, 7days, and weekly thereafter till PDA closure. A second cycle of indomethacin was repeated if PDA did not respond to the initial treatment. Results: 75/104 (72%) PDAs closed with indomethacin while 13(12.5%) did not respond, and 16(15.38%) showed a reduction in the calibre of PDA. 26–30 wk group showed a brisk response to ductal closure with indomethacin within 108.1±12.44 h, and a mean no. of cycles of indomethacin of 0.98±5.75. Conclusion: With indomethacin we achieved 72% (75/104) closure rates. The best response to indomethacin was noted in 30–32 wk GA group, while maximum nonresponders were in 32–34 wk; suggesting as gestation increases, response to PG inhibitors decreases. KEYWORDS: Patent ductusarteriosus, Cyclo-oxygenase, Indomethacin, Preterm Neonates, PG inhibitors, Ductus arteriosus, Ductal flow.