Neonatal Intensive Care Unit Admission Rate Research Articles

Cost-Effectiveness of Transdermal Nitroglycerin Use for Preterm Labor

Objective The objective of this study was to determine the cost-effectiveness of using transdermal nitroglycerin (GTN) for cases of preterm labor. Methods The study included 153 women with clinical preterm labor, who were randomly allocated to either a GTN or placebo arm. All randomized cases were included in the final economic analysis. Differences between the two arms in gestational age at delivery, neonatal intensive care unit (NICU) admission, length of NICU stay, and NICU cost were assessed. Costs for non-NICU cases were calculated using Ottawa Hospital data through the Ontario Case Costing Initiative (OCCI). Cost-effectiveness and sensitivity analyses using a hospital perspective were both conducted. Results In the 153 randomized cases, 55 babies were admitted to NICU (GTN = 24; placebo = 31). We found no significant differences between the two arms in gestational age at delivery, NICU admission rate (32.4% vs. 39.2%), NICU length of stay (42.7 days vs. 52.8 days), or NICU cost (CAN $34,306 vs. CAN $44,326). Overall, (based on all randomized cases) the cost-effectiveness analyses showed that the GTN arm was the dominant strategy, with both lower cost (CAN $13,397 vs. CAN $18,427) and higher NICU admission avoided rate (67.6% vs. 60.8%) compared to the placebo arm. This dominance persisted in all sensitivity analyses. Conclusion The use of GTN patch for preterm labor could reduce NICU costs, while improving important neonatal outcomes.

Apgar scores in assessing morbidity of the second neonate of cephalic/non-cephalic twins in different delivery modes

Our study was undertaken to determine whether caesarean section for the second of cephalic/non-cephalic presenting twins may prevent or diminish neonatal morbidity. For this study, 482 cephalic/non-cephalic presenting twins admitted to our hospital were retrospectively evaluated. They were separated into two groups according to their delivery mode: vaginal or caesarean delivery. Records of Apgar score (<7) at 5 min, seizure occurrence, neonatal intensive care unit (NICU) admission and duration, need for mechanical ventilation and perinatal mortality of second twins were compared. Second fetuses' mortality rates of the two groups were similar. NICU admission rate and duration, seizure and mechanical ventilation necessity rates of second fetuses were similar for both groups. Only 5 min Apgar score rates of the vaginal group were lower than the caesarean group. Caesarean section for cephalic/non-cephalic presenting twins does not decrease morbidity scores but provides effective improvement on morbidity of second fetus, according to Apgar scores.

Analysis of High-Risk Infant Births and Their Mortality: Ten Years' Data from Chonnam National University Hospital

Prematurity and low birth weight are major factors associated with neonatal morbidity and mortality, and their incidence is not decreasing despite an annual decrease in the total number of live births in Korea. The objective of this study was to establish a strategy to reduce neonatal mortality by analyzing the clinical characteristics of high-risk infant births along with their mortality and causes of death. We retrospectively surveyed the medical records of infants born at Chonnam National University Hospital and of patients admitted to the neonatal intensive care unit (NICU) for 10 years from October 1999 to December 2008. Premature and low birth weight infants were almost half of the live births, and their NICU admission rate increased with increases in the numbers of outborns and multiples. Also, their mortality decreased dramatically over the past 10 years. About 60% of deaths occurred within 1 week of life, and the causes of death were mostly related to prematurity. Perinatal asphyxia was the major cause of death in infants less than 1 week old, whereas sepsis was the major cause after 4 weeks of age. The major cause of death was sepsis in premature or low birth weight infants and perinatal asphyxia in term or normal weight infants. The major cause of death was sepsis in inborns and perinatal asphyxia in outborns. Our results suggest that medical personnel training for immediate postnatal care including neonatal resuscitation, infection control, and a systematic team approach to regionalization are all needed to reduce the mortality rate.

Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study

Objective To compare incidences of perinatal mortality and severe perinatal morbidity between low risk term pregnancies supervised in primary care by a midwife and high risk pregnancies supervised in secondary...

Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Aim This observational study aims to describe: (1) the use of positive pressure ventilation (PPV) for resuscitation in the delivery room among newly born near-term infants; (2) the methods used for PPV resuscitation [e.g., bag–facial mask (BFM), laryngeal mask airway (LMA), endotracheal tube (ETT)]; and (3) the association of each device with short-term neonatal outcomes. Methods We identified near-term (34 0/7–36 6/7 weeks) infants delivered at the Padua University Hospital (Padua, Italy) during the years 2002–2006. The mode of delivery, gestational age, birth weight, Apgar scores, methods of resuscitation and respiratory outcome after NICU admission were analysed. Results During the 5-year study period, 921 (4.9%) near-term infants were identified from a total of 18,641 live births. PPV was provided in the delivery room to 86 (9.3%) of these infants. Among them, 36 (41.8%) were managed by LMA, 34 (39.5%) by BFM and 16 (18.6%) by ETT. Thirty-four (39.5%) resuscitated near-term infants were admitted to the Neonatal Intensive Care Unit (NICU): 15 (44.1%) after BFM, 12 (75%) after ETT and seven (19.4%) after LMA. Resuscitation with an ETT was associated with an increased rate of respiratory distress syndrome when compared with either BFM or LMA. Resuscitation with an LMA was associated with a lower rate of NICU admission and shorter length of stay when compared with either BFM or ETT. Conclusion The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation.

680: Vacuum use during term cesarean delivery and rate of NICU admission

Vacuum-assisted cesarean delivery (VACD) may permit a smaller uterine incision to reduce the risk of lacerating the uterine vessels. We sought to determine whether VACD increased the rate of neonatal intensive care unit (NICU) admission.

Efficacy of insulin lispro in pregnancies complicated with pregestational diabetes mellitus

AbstractInsulin is the mainstay in the management of pregnancies complicated by pregestational diabetes. Insulin analogues are useful in the non‐pregnant state, leading to better glycaemic control. Our study tested the hypothesis that using insulin lispro in such pregnancies would lead to better feto‐maternal outcome when compared to human insulin.The study was conducted as a retrospective case‐control study, and was undertaken in the antenatal clinic of Lancashire Teaching Hospitals NHS Trust between 1997 and 2001. The study involved 153 consecutive women with pregestational diabetes, 83 of whom were treated with insulin lispro and the rest with human insulin. Details of their management and outcome were derived from their medical, obstetric and paediatric notes. The main outcome measures were: maternal glycaemic control at term, conclusion of pregnancy, Caesarean section rate, birth weight, neonatal intensive care unit (NICU) admission, neonatal jaundice, congenital anomalies and neonatal hypoglycaemia.There was a significant improvement in HbA1c at term in the group treated with insulin lispro (‐0.75%, [‐1.04 to ‐0.46]) when compared with the human insulin group (‐0.18%, [‐0.47 to 0.11]); p=0.005. This was not associated with a significant difference in feto‐maternal outcome, apart from a higher NICU admission rate in the insulin lispro group. This adverse effect disappeared after adjusting for other co‐variates.Hence, when compared to human insulin, insulin lispro provides better glycaemic control, without adversely affecting feto‐maternal outcomes in pregnancy complicated with pregestational diabetes, which may be reflected in a better developmental outcome in the children. Copyright © 2009 John Wiley &amp; Sons.

Fetal Exposure to Oral Pathogens and Subsequent Risk for Neonatal Intensive Care Admission

Maternal periodontal infection has been associated with adverse maternal and neonatal outcomes. In utero fetal exposure to oral pathogens was also recognized as deleterious to the fetus. The objective of this study was to determine the relationship between fetal exposure to oral pathogens and neonatal intensive care unit (NICU) admission. This was a secondary analysis of a prospective cohort study of maternal oral health and pregnancy outcome. Fetal immunoglobulin M against oral pathogens was detected in umbilical cord serum by immunoblot. The presence of at least one oral pathogen-specific antibody was considered seropositivity. The cord level of C-reactive protein was determined by enzyme-linked immunosorbent assay and categorized as detectable versus undetectable. Chi-square and logistic regression analyses were used to determine the association between cord serum seropositivity or detectable C-reactive protein and NICU admission and length of stay. Of 650 infants, 45 (6.9%) were admitted to the NICU. The admission rate was higher among seropositive infants compared to seronegative infants (11% versus 5%; P = 0.0019). Seropositive infants were also more likely than seronegative infants to stay >3 or >7 days (8% versus 3% and 6% versus 2%; P = 0.004 and 0.003, respectively). Adjusting for gestational age, the odds ratio (95% confidence interval) for NICU admission was 2.14 (1.01 to 4.54); for a length of stay >3 or >7 days, it was 2.38 (1.01 to 5.60) and 3.29 (1.13 to 9.58), respectively. The NICU admission rate was not significantly higher for those with detectable versus undetectable umbilical cord serum C-reactive protein (8% versus 6%; P = 0.3). In utero fetal exposure to oral pathogens increases the risk for NICU admission and the length of stay. Interventions that interrupt fetal exposure to oral pathogens may reduce these risks.

Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth.

Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency or timing of use or the route of administration. To assess the effects of different corticosteroid regimens for women at risk of preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008). Randomised and quasi-randomised controlled trials of antenatal corticosteroid regimens in women at risk of preterm birth. Two authors assessed trial quality and extracted the data independently. Ten trials (1089 women and 1161 infants) were included. Dexamethasone decreased the incidence of intraventricular haemorrhage compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes including respiratory distress syndrome, bronchopulmonary dysplasia, severe intraventricular haemorrhage, periventricular leukomalacia, perinatal death, or mean birthweight. Results for biophysical parameters were inconsistent, but mostly no important differences were seen for these, or any other secondary outcome except for neonatal intensive care unit (NICU) admission. In one trial of 105 infants, significantly more infants in the dexamethasone group were admitted to NICU compared with the betamethasone group (RR 3.83, 95% CI 1.24 to 11.87).Oral dexamethasone compared with intramuscular dexamethasone increased the incidence of neonatal sepsis (RR 8.48, 95% CI 1.11 to 64.93) in one trial of 183 infants. No statistically significant differences were seen for other outcomes reported.In one small trial of 69 infants comparing betamethasone acetate and phosphate with betamethasone phosphate no differences were seen for any of the outcomes reported. Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. Trials of commonly used corticosteroids are most urgently needed, followed by trials of dosages and other variations in regimens.

The Coexistence of Gestational Hypertension and Diabetes: Influence on Pregnancy Outcome

Gestational hypertension (GHTN) and gestational diabetes mellitus (GDM) are both insulin resistance states. Perinatal outcome of GHTN or GDM alone are well established, but their combined effect on pregnancy outcome is underinvestigated. Our objective was to determine if pregnancies complicated by GHTN/GDM have higher rates of morbidity. We identified nulliparous women with singleton pregnancies delivering at 37 to 40 weeks of gestation from 1995 to 2004 from a database. Outcomes of pregnancies complicated by GHTN only, GDM only, or combined GHTN/GDM were compared with controls. Data analysis included the Mann-Whitney U test, the Kruskal-Wallis H test, and analysis of variance. Multivariate analysis was used to adjust for confounders. Of 14,880 patients, there were 11,349 controls, 2604 GHTN, 728 GDM, and 199 GHTN/GDM. After controlling for covariates, GHTN significantly increased cesarean section (C/S) rate (odd ratio [OR], 1.62; confidence interval [CI], 1.47 to 1.78), rates of admittance to the neonatal intensive care unit (NICU), and birth of large for gestational age (LGA) infants. GDM significantly increased C/S (OR, 1.42; CI 1.21 to 1.66), rates of NICU admission (OR, 1.32; CI, 1 to 1.75), birth of LGA (OR, 1.51; CI 1.14 to 1.98), and macrosomic infants (OR, 1.53; CI, 1.12 to 2.08). Rates of LGA infants (OR, 1.85; CI, 1.19 to 2.86) and C/S (OR, 2.03; CI, 1.52 to 2.71) were significantly increased with GHTN/GDM. We concluded that GHTN or GDM is associated with increased rates of adverse outcomes. Their coexistence further increases adverse perinatal outcomes.

Primary Cesarean Delivery among Uncomplicated Term Nulliparous Parturients: The Influence of Group Practice Within a Community Hospital

In a community hospital, the rate of cesarean delivery varied significantly for uncomplicated nulliparous patients managed by four practice groups, although the rate of shoulder dystocia did not. Among four practice groups in a single center, our objective was to discern the rate of cesarean delivery (CD) among uncomplicated, term nulliparous parturients, and the likelihood of shoulder dystocia and admission to the neonatal intensive care unit (NICU). The inclusion criteria for this retrospective study were uncomplicated nullipara > or = 37 weeks. Multivariable models were used for analysis. Over 2 years, 1217 women met the inclusion criteria. The overall rate of primary CD was 21%, with rates of 15%, 24%, 17%, and 32% for the four groups. After controlling for confounding variables, the rate of primary CD was significantly higher for group 2 (odd ratio [OR] 1.68; 95% confidence interval [CI] 1.17, 2.42) and 4 (OR 1.83; 95% CI, 1.25, 2.68) versus groups 1 and 3 combined. Shoulder dystocia and admission to NICU did not vary between groups. Among uncomplicated term nulliparous patients, the rate of primary CD varied significantly by practice groups, without an effect on rate of shoulder dystocia or NICU admission.

Perinatal outcome of pregnancies with intrauterine passage of meconium at 37-39 compared with 40-42 weeks' gestation

MECONIUM AT 37-39 COMPARED WITH 40-42 WEEKS’ GESTATION SHARON MASLOVITZ, ISHAI LEVIN, BENNY ALMOG, KUPFERMINC MICHAEL, DAVID PAUZNER, ARIEL MANY, Tel-Aviv Sorasky medical center., 0bstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: Meconium staining of amniotic fluid is considered by some as a marker of fetal maturity but others relate to it as fetal gastro-intestinal (GI) tract response to hypoxia. We sought to assess whether detection of antenatal meconium during earlier gestation (37-39w) is associated with adverse perinatal outcome compared with later appearance of intrauterine meconium (4042w). STUDY DESIGN: All patients delivering at Lis maternity hospital between June 2000 and June 2004 were reviewed for the presence of meconium and divided into two groups by gestational age at delivery (group I: 37-39 weeks, group II: 40-42 weeks). Maternal demographics and birth outcomes including mode of delivery, Apgar scores, NICU (neonatal intensive care unit) admission rate and neonatal complications and mortality were collected. Exclusion criteria included multiple gestations, breech presentations and fetal anomalies. RESULTS: 32428 women delivered at our hospital during the study period and 4798 of them were complicated by antenatal meconium (14.8%). After excluding multiple pregnancies, elective cesareans, induced deliveries and malformed fetuses we reviewed the computerized medical files of 2991 women, 1281 of them delivered spontaneously at 37-39 weeks’ (group I) gestation and 1710 at 40-42 weeks(group II). Cesarean rate was 22.2% and 16.8% (for group I and II respectively, P!0.05), while overall non-elective cesarean rate was 12.6% during that period (p!0.05). Neonates of group I were at higher risk for 5’ Apgar score!7 compared with neonates from group II (4.7% vs 2.8%, respectively, p!0.05) and at higher risk for NICU admission as well (9% VS 6.3%, respectively, p!0.05). No differences were detected with regards to meconium aspiration syndrome, respiratory distress syndrome, intraventricular hemorrhage and neonatal mortality. CONCLUSION: antenatal passage of meconium is associated with less favorable perinatal outcome when detected at 37-39 weeks’ gestation as compared with 40-42 weeks’ gestation in terms of non-elective cesarean rate, low 5’ Apgar scores and NICU admission rate.

Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis.

To compare routine labor induction with expectant management for patients who reach or exceed 41 weeks' gestation. Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating induction and expectant management of labor for postterm pregnancies. We identified RCTs that compared induction and expectant management for uncomplicated, singleton, live pregnancies of at least 41 weeks' gestation and evaluated at least one of the following: perinatal mortality, mode of delivery, meconium-stained fluid, meconium aspiration syndrome, meconium below the cords, fetal heart rate (FHR) abnormalities during labor, cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and neonatal intensive care unit (NICU) admissions. The primary outcomes assessed were cesarean delivery rate and perinatal mortality. Sixteen studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Estimates of ORs for dichotomous outcomes were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Compared with women allocated to expectant management, those who underwent labor induction had lower cesarean delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99). Although subjects whose labor was induced experienced a lower perinatal mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, meconium below the cords, or abnormal Apgar scores. A policy of labor induction at 41 weeks' gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes.

Review of 49 neonates with acquired fungal sepsis: further characterization.

Neonatal acquired fungal sepsis (AFS) is a risky condition that warrants every effort for early diagnosis and management. We retrospectively reviewed the medical charts of all 4445 neonatal intensive care unit (NICU) admissions in the past 10 years and detected 49 neonates with AFS. We then compared their data with those of 49 matched control neonates who did not have AFS. The following details were collected: gestational, perinatal and neonatal courses; bacterial sepsis; antibacterial therapy; laboratory and imaging investigations; and antifungal therapy and its complications. The incidence of AFS was.4 to 2 cases per 1000 live-births and 3.8% to 12.9% of very low birth weight (VLBW) infants. Compared with 1989 through 1992, between 1993 and 1995 the rate of AFS in VLBW neonates significantly increased (3. 8%-5.6% --> 9.6%-12.9%), along with a significant increase of NICU admission rate (369-410 --> 496-510 admissions/year). Compared with controls, AFS neonates had significantly longer hospitalizations, higher rates of mechanical ventilation, umbilical vein catheterization, and previous treatment with broad-spectrum antibacterial agents (amikacin, vancomycin, ceftazidime, or imipenem). At the onset of AFS, 42.8% of patients had hyperthermia and 40.9% had normal white blood cell count. Causative fungi were as follows: Candida albicans-42.8% of cases, Candida parapsilosis-26.5%, and Candida tropicalis-20.4%. Fungal dissemination was rare, complications of antifungal therapy were infrequent, and no deaths occurred. First, non-albicans Candida have become more frequent in neonatal AFS. Second, mechanical ventilation and antibacterial agents are significant risk factors for AFS. Third, hyperthermia is a frequent presenting sign of AFS. Fourth, a normal white blood cell count does not rule out AFS. Fifth, meningeal involvement in neonatal AFS should be ruled out before initiation of antifungal therapy. Sixth, the policy of empiric antifungal therapy for AFS should be considered on an individual NICU basis.newborn infant, fungal sepsis, clinical signs, risk factors.

Elective Induction Versus Spontaneous Labor: A Case-Control Analysis of Safety and Efficacy

Objective: To investigate the incidence, efficacy, and safety of elective induction in a community teaching hospital over 1 year. Methods: This is a retrospective case-control study of rate, safety, and efficacy of all term inductions with vertex presentations judged to be elective by chart analysis. Cases were matched one for one for age, parity, and pay status with controls in spontaneous labor. The elective induction women were compared with those in spontaneous labor using χ 2 Student t test, and Fisher exact test. Potential risk factors for cesarean delivery and neonatal intensive care unit (NICU) admission were then selected and subjected to bivariate analysis. Stepwise logistic regression was applied to control for confounding and to select which risk factors were important for those end points. Results: There were 461 case-control pairs. The elective induction rate was 12.3%. Cesarean delivery was increased by elective induction in bivariate analysis (odds ratio [OR] = 1.81, confidence interval [CI] = 1.07, 3.08; power = .60). The cesarean delivery rate was 8.7% (control 5.0%). In a multiple regression model of potential risk factors for cesarean delivery, nulliparity (OR = 6.14, CI = 2.90, 13.04), cervical priming (OR = 3.06, CI = 1.46, 6.40), oxytocin usage (OR = 2.82, CI = 1.03, 7.75), gestational age at least 287 days (OR = 2.51, CI = 1.38, 4.58), and birth weight at least 3800 g (OR = 2.29, CI = 1.27, 4.13) were significant, but elective induction and epidural anesthesia were not. Elective induction did not significantly increase the rate of NICU admission (4.6% versus control 3.9%). In a multiple regression model of potential factors predicting NICU admission, only a 5-minute Apgar score of at most 8 was significant (OR = 12.34, CI = 6.01, 25.3). Conclusion: Elective induction is commonly practiced, safe, and efficacious. Cesarean delivery is increased significantly by nulliparity and/or an unfavorable cervix, among other factors, but not by elective induction itself.

Religious Affiliation and Obstetric Outcome

The purpose of this study was to explore the relationship between religious affiliation and obstetric outcome. We reviewed 1,919 records of patients whose infants were born at a university medical center. Data obtained from maternal and newborn records included demographic information, prenatal history, labor and delivery records, and religious affiliation. Maternal complications and neonatal intensive care unit (NICU) admissions were lowest for mainline Christians (11%, 11%), intermediate for evangelical Christians (17%, 12%), and highest for patients with no religious preferences (21%, 18%). After controlling for possible confounders, the association of religious affiliation and lower NICU admission rates remained. Mainline Christians had a lower frequency of maternal complications. Patients with a religious affiliation had better obstetric outcome than those without. Most of the association seems to be due to a lower risk social profile, but a small positive influence of religion persisted.