Requiring Neonatal Intensive Care Unit Admission Research Articles

The Association between the Social Vulnerability Index and Adverse Neonatal Outcomes.

Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. · Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..

Improving Amniotic Fluid Index with L-Arginine Supplementation

Background: Oligohydramnios, characterized by a low Amniotic Fluid Index (AFI), is associated with adverse pregnancy outcomes, including fetal growth restriction, preterm labor, and low birth weight. Effective interventions for improving AFI are critical, particularly in resource-limited settings. L-Arginine, a nitric oxide precursor, has shown promise in enhancing uteroplacental circulation and increasing AFI. This study aimed to evaluate the efficacy of L-Arginine supplementation in improving AFI and associated maternal and neonatal outcomes in pregnant women with oligohydramnios in Bangladesh. Methods: This study was conducted at Islami Bank Hospital over one year (July 2023 to June 2024), involving 90 pregnant women diagnosed with oligohydramnios. Participants received daily L-Arginine supplementation, and AFI was measured before and after the intervention. Maternal and neonatal outcomes, including gestational age at delivery, birth weight, and neonatal intensive care unit (NICU) admissions, were recorded. Statistical analysis was performed using paired t-tests, with p &lt; 0.05 considered statistically significant. Results: The mean AFI increased significantly from 5.4 cm (SD ±1.7) before the intervention to 8.6 cm (SD ±2.1) after supplementation, with a mean difference of 3.2 cm (p &lt; 0.001). Low birth weight was observed in 20% of the neonates, while 17.78% required NICU admission. There was a notable improvement in neonatal outcomes with L-Arginine supplementation. Conclusion: L-Arginine supplementation significantly improved AFI and neonatal outcomes, making it a viable intervention for managing oligohydramnios in pregnant women. Further research is recommended to confirm these findings in larger populations.

Clinical Profile of Neonates Getting Readmitted to Neonatal Intensive Care Unit (NICU) after Discharge from Hospital.

To estimate the proportion of neonates getting readmitted to neonatal intensive care unit (NICU), after discharge from the hospital. Secondary objectives were to describe the clinical characteristics, reason for readmission and outcome of neonates getting readmitted. A retrospective descriptive study was conducted to identify neonates getting readmitted to NICU within 28 d of birth and/or before 40 wk post-menstrual age (PMA). Details of neonates who were readmitted to NICU were identified and data extracted in predesigned proforma from digitalized case records (July 2021-June 2023), and outcomes were analyzed. Out of 26,403 live-births, 5175 neonates required NICU admission (19.6%). Readmissions accounted for 5.9% (95%CI: 5.3-6.6%) of NICU admissions (305/5175) and 1.2% (95%CI: 1.0-1.3%) of live-births. Mean gestational age and birthweight were 36.8 (2.9) wk (range 25-41) and 2584 (713) g (range = 650-4900). Ninety-six (31.5%) were preterm. One hundred and three (33.8%) were high risk neonates. Median age at readmission was 17 d (range: 3-150). Infections (n = 109, 35.7%), infection-related complications (n = 18, 5.9%), feeding problems (n = 63, 20.6%), and jaundice (n = 42, 13.7%) were commonest reasons for readmission. Median duration of hospital stay was 5 d (range: 1-120). Two hundred and ninety four (96.4%) were discharged, and 10 (3.2%) neonates expired. Readmissions accounted for 5.9% of total NICU admissions. Infections, jaundice and feeding related issues accounted for 76% of all the readmissions.

Association Between Intrapartum Nitrous Oxide for Labor Analgesia and Short-Term Neonatal Outcomes.

To evaluate the association between intrapartum nitrous oxide use and adverse short-term neonatal outcomes. This was a retrospective cohort study of individuals with singleton gestations at 35 or more weeks who attempted labor and delivered at an academic hospital between June 1, 2015, and February 28, 2020. Data were extracted from the electronic medical record using billing and diagnostic codes. Patients were classified based on whether they received no intrapartum analgesia or received nitrous oxide only. Those who received other analgesia types were excluded. The primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included Apgar score less than 7 at 1 minute and 5 minutes, respiratory composite outcome (including meconium aspiration syndrome, neonatal bronchopulmonary disorders, neonatal transient tachypnea, and other neonatal respiratory distress that required NICU admission), hypoglycemia, and hyperbilirubinemia. Univariable and multivariable analyses were used to estimate the association between nitrous oxide exposure intrapartum and the selected outcomes. Of 6,047 included, 4,153 (68.7%) received no analgesia, and 1,894 (31.3%) received nitrous oxide only. In comparison with individuals who received no analgesia, those who received nitrous oxide were more likely to be nulliparous, be of Black racial identity, have noncommercial insurance, and be less likely to deliver by intrapartum cesarean. The reception of nitrous oxide, compared with the reception of no analgesia, was associated with a lower likelihood of NICU admission (6.4% vs 8.1%; adjusted odds ratio [aOR] 0.77, 95% CI, 0.62-0.96) and an increased likelihood of neonatal hyperbilirubinemia (aOR 1.23, 95% CI, 1.08-1.41). Inhaled nitrous oxide exposure, in comparison with the reception of no analgesia, was not associated with the other secondary outcomes, including Apgar score less than 7 at 1 minute (odds ratio [OR] 0.74, 95% CI, 0.50-1.10) or 5 minutes (OR 0.91, 95% CI, 0.32-2.60), respiratory composite outcome (OR 0.91, 95% CI, 0.70-1.17), and hypoglycemia (OR 0.82, 95% CI, 0.64-1.05). In this single-center retrospective cohort of low-risk patients, intrapartum inhaled nitrous oxide, compared with the reception of no analgesia, was associated with a decreased risk for NICU admission but with an increased risk for hyperbilirubinemia; other outcomes did not differ. These findings may be used to counsel patients when considering nitrous oxide for labor analgesia.

Rate of clinically significant red blood cell antibody seroconversion in pregnancy

Objective To determine the rate of clinically significant red blood cell (RBC) antibody seroconversion in pregnancy and associated risk factors and neonatal outcomes. Methods This is a retrospective cohort study of all deliveries within a large multi-hospital system from July 2016 to March 2023. Deliveries with a missing RBC antibody screen on admission for delivery were excluded, as were deliveries with a positive antibody screen on admission for delivery without a record of antecedent type and screen (T&S) in that pregnancy. Deliveries were categorized as 1) not possessing clinically significant antibodies (which includes those with a negative antibody screen, evidence of passive immunity solely due to Rh(D) immune globulin (RhIG), or possessing only non-clinically significant RBC antibodies); 2) previously alloimmunized (i.e. pregnancies that demonstrated clinically significant antibodies on the first T&S, regardless if they accrued additional antibodies throughout the pregnancy); or 3) seroconverted (i.e. no clinically significant antibodies on the first T&S with subsequent development of alloimmunization with clinically significant antibodies). For neonates born to seroconverted patients with clinically significant antibodies, neonatal outcomes such as initial hemoglobin, need for transfusion, and neonatal intensive care unit (NICU) admission were ascertained via chart abstraction. All records were linked with an existing validated database, inclusive of maternal characteristics and pregnancy outcomes, and comparisons were made between three categories based on antibody status with a sub-analysis of two categories. Bivariate analysis was performed with Chi-square for categorical and Wilcoxon rank-sum or Kruskal–Wallis test for continuous variables. Results There were 58,912 pregnant individuals with 71,384 eligible deliveries during the study period, with 67,570 deliveries remaining after data linkage. Of these, 67,209 (99.5%) deliveries had a negative or non-clinically significant antibody screen at delivery. Of the remaining 361 (0.53%) deliveries, 185 (0.27%) were previously alloimmunized and 176 (0.26%) seroconverted in pregnancy. Among pregnancies demonstrating seroconversion, the most common newly acquired antibodies were anti-E, anti-c, anti-JkA, anti-C, anti-D, anti-M, anti-K, and anti-S. Among the 176 pregnancies complicated by seroconversion, there were four unexplained fetal losses, none of which were attributable to HDFN. Among the 178 liveborn neonates born to the 176 pregnancies demonstrating seroconversion, three (1.7%) infants had initial hemoglobin <13.5 mg/dL, four (2.2%) required postnatal transfusion but all were unrelated to HDFN, and 34 (19.1%) required NICU admission. When comparing deliveries demonstrating seroconversion with those with a negative antibody screen at delivery, advanced maternal age and increasing gravidity and parity were most strongly associated with seroconversion. Conclusion Development of new clinically significant RBC antibodies in pregnancy occurred at a rate of 0.26% in this large cohort study with no cases of stillbirth or neonatal demise attributable to RBC alloimmunization among pregnancies demonstrating seroconversion. Advanced maternal age and increasing gravidity and parity were most strongly associated with seroconversion in pregnancy. Routine third trimester prenatal assessment of maternal antibody status may not be indicated due to low likelihood for clinically significant seroconversion.

Assessment of Skin Maturity by LED Light at Birth and Its Association With Lung Maturity: Clinical Trial Secondary Outcomes

Background Clinicians face barriers when assessing lung maturity at birth due to global inequalities. Still, strategies for testing based solely on gestational age to predict the likelihood of respiratory distress syndrome (RDS) do not offer a comprehensive approach to addressing the challenge of uncertain outcomes. We hypothesize that a noninvasive assessment of skin maturity may indicate lung maturity. Objective This study aimed to assess the association between a newborn’s skin maturity and RDS occurrence. Methods We conducted a case-control nested in a prospective cohort study, a secondary endpoint of a multicenter clinical trial. The study was carried out in 5 Brazilian urban reference centers for highly complex perinatal care. Of 781 newborns from the cohort study, 640 were selected for the case-control analysis. Newborns with RDS formed the case group and newborns without RDS were the controls. All newborns with other diseases exhibiting respiratory manifestations were excluded. Skin maturity was assessed from the newborn's skin over the sole by an optical device that acquired a reflection signal through an LED sensor. The device, previously validated, measured and recorded skin reflectance. Clinical data related to respiratory outcomes were gathered from medical records during the 72-hour follow-up of the newborn, or until discharge or death, whichever occurred first. The main outcome measure was the association between skin reflectance and RDS using univariate and multivariate binary logistic regression. Additionally, we assessed the connection between skin reflectance and factors such as neonatal intensive care unit (NICU) admission and the need for ventilatory support. Results Out of 604 newborns, 470 (73.4%) were from the RDS group and 170 (26.6%) were from the control group. According to comparisons between the groups, newborns with RDS had a younger gestational age (31.6 vs 39.1 weeks, P&lt;.001) and birth weight (1491 vs 3121 grams, P&lt;.001) than controls. Skin reflectance was associated with RDS (odds ratio [OR] 0.982, 95% CI 0.979-0.985, R2=0.632, P&lt;.001). This relationship remained significant when adjusted by the cofactors antenatal corticosteroid and birth weight (OR 0.994, 95% CI 0.990-0.998, R2=0.843, P&lt;.001). Secondary outcomes also showed differences in skin reflectance. The mean difference was 0.219 (95% CI 0.200-0.238) between newborns that required ventilatory support versus those that did not and 0.223 (95% CI 0.205-0.241) between newborns that required NICU admission versus those that did not. Skin reflectance was associated with ventilatory support (OR 0.996, 95% CI 0.992-0.999, R2=0.814, P=.01) and with NICU admission (OR 0.994, 95% CI 0.990-0.998, R2=0.867, P=.004). Conclusions Our findings present a potential marker of lung immaturity at birth using the indirect method of skin assessment. Using the RDS clinical condition and a medical device, this study demonstrated the synchrony between lung and skin maturity. Trial Registration Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-3f5bm5; https://tinyurl.com/9fb7zrdb International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-027442

Optimally Controlled Diabetes and Its Influence on Neonatal Outcomes at a Level II Center: A Study on Infants Born to Diabetic Mothers.

Background and Objectives: We investigated the effect of optimal maternal glycemic control on neonatal outcomes among infants born to mothers with diabetes. Materials and Methods: In this prospective study, we assessed 88 eligible mothers admitted to the obstetrics department for pregnancy evaluation. Our analysis included 46 infants born to diabetic mothers (IDMs) and 138 infants born to unaffected mothers, all admitted to the Level II Neonatal Intensive Care Unit (NICU). Results: Mothers affected by diabetes were generally older and exhibited a higher body mass index (BMI) and a greater number of gestations, although parity did not differ significantly. Cesarean section emerged as the most frequently chosen mode of delivery. A significantly higher proportion of infants in the affected group presented with respiratory disease (3% vs. 19.5%), which required NICU admission (4.3% vs. 23.9%), phototherapy (18.1% vs. 43.5%), and had congenital heart defects or myocardial hypertrophy (15.2% and 26% vs. 3% and 4.3%) compared to matched controls (p < 0.05). Conclusions: This study underscores the persistence of adverse neonatal outcomes in IDMs, even when maternal glycemic control is optimized. It calls for further investigation into potential interventions and strategies aimed at enhancing neonatal outcomes in this population.

Maternal Colonization Versus Nosocomial Transmission as the Source of Drug-Resistant Bloodstream Infection in an Indian Neonatal Intensive Care Unit: A Prospective Cohort Study.

Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. We conducted a prospective cohort study, 12 October 2018 to 31 October 2019 to describe the association of maternal and environmental GN colonization with bloodstream infection (BSI) among neonates admitted to a neonatal intensive care unit (NICU) in Western India. We assessed rectal and vaginal colonization in pregnant women presenting for delivery and colonization in neonates and the environment using culture-based methods. We also collected data on BSI for all NICU patients, including neonates born to unenrolled mothers. Organism identification, antibiotic susceptibility testing, and next-generation sequencing (NGS) were performed to compare BSI and related colonization isolates. Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 24 (9.3%) developed BSI. Among mothers of neonates with GN BSI (n = 21), 10 (47.7%) had rectal, 5 (23.8%) had vaginal, and 10 (47.7%) had no colonization with resistant GN organisms. No maternal isolates matched the species and resistance pattern of associated neonatal BSI isolates. Thirty GN BSI were observed among neonates born to unenrolled mothers. Among 37 of 51 BSI with available NGS data, 21 (57%) showed a single nucleotide polymorphism distance of ≤5 to another BSI isolate. Prospective assessment of maternal GN colonization did not demonstrate linkage to neonatal BSI. Organism-relatedness among neonates with BSI suggests nosocomial spread, highlighting the importance of NICU infection prevention and control practices to reduce GN BSI.

Fetal Diaphragmatic Excursion Is Decreased in Hospitalized Pregnant Women Infected with COVID-19 during the Second and Third Trimesters.

In the present study, we aimed to evaluate coronavirus disease 2019 (COVID-19) infection effects on fetal diaphragm thickness and diaphragmatic excursion, which together show the quality of diaphragmatic contractions. One hundred and ninety-two pregnant women were included in this prospective case-control study. Patients were divided into four groups according to their COVID-19 infection history in their second or third trimester: hospitalized COVID-19-infected pregnant women group (n = 48), outpatient COVID-19-infected pregnant women group (n = 48), common cold (COVID-19 polymerase chain reaction negative) pregnant women group (n = 48), and noninfected healthy controls (n = 48). The number of patients was determined by power analysis following the pilot study. All participants underwent an ultrasound examination to determine fetal diaphragm parameters at 32 to 37 weeks of gestation. Demographic characteristics were similar among the four groups. The gestational age at ultrasound examination and gestational age at delivery were similar among the groups. Neonatal intensive care unit (NICU) admission rate was significantly higher in the hospitalized COVID-19-infected pregnant women group than the other groups. The fetal diaphragm thickness during inspiration and expiration, and fetal costophrenic angles at inspiration and expiration were similar among the groups. Fetal diaphragmatic excursion was significantly decreased in the hospitalized COVID-19-infected pregnant women group compared with the other groups. Our results indicated that moderate maternal COVID-19 infection decreased fetal diaphragmatic excursion, and ultrasonographic evaluation of fetal diaphragmatic excursion before delivery can provide critical information to predict whether infants will require NICU admission. · Diaphragm ultrasound as a new technique for characterizing the diaphragm's structure and function.. · Fetal diaphragmatic excursion is decreased in the presence of moderate COVID-19 infection.. · Ultrasonographic evaluation of fetal diaphragmatic excursion provides critical information to predict NICU admission..

The association between social vulnerability index and neonatal intensive care unit admission

The social vulnerability index (SVI) measures a community’s vulnerability to external stressors on health and is composed of four themes. Higher community-level SVI has been associated with adverse maternal outcomes. We evaluated the association between SVI and neonatal intensive care unit (NICU) admission. Retrospective cohort study of all patients delivering >22 weeks gestational age at our institution (2014-2018). Patients with only a PO box address, multiple gestations, or known fetal anomalies were excluded. Patient addresses were used to assign each individual a community-level composite SVI score and a score for each theme. The primary outcome was NICU admission. We compared mean composite SVI scores (95% CIs) and for each theme; individual components of each theme were also compared between those with and without NICU admissions. From 2014-2018, 13,757 patients were included for analysis. Overall, 2837 (21%) had a neonate with a NICU admission. Patients with the highest SVI scores were more likely to be obese, not non-Hispanic white, and use tobacco (p< 0.001) compared to those with lower SVI scores. Patients whose neonates had NICU admissions had higher overall and individual theme mean SVI scores, with the exception of Theme 3: minority status/language (Table). Those requiring NICU admission had lower per capita income, were less likely to have a high school diploma, more likely to live with people who are disabled or ≥ 65 years of age, or live in mobile homes or households with more people and were less likely to have minority/non-English speakers in the home compared to those without NICU admission (Table, p< 0.001). Patients who deliver a neonate requiring NICU admission have higher mean SVI scores both overall and from a variety of social themes including household composition, housing type, and SES. Targeted prenatal care strategies in these patients and increasing social support may improve perinatal outcomes.

Preterm Labour Management with Glyceryl Trinitrate Patch and Isoxsuprine: A Longitudinal Study

Introduction: Nitric oxide donors in the form of nitroglycerine and β-mimetic drugs (Isoxsuprine hydrochloride) are commonly used in managing preterm labour. It is one of the most challenging obstetric complications encountered by obstetricians, as well as preterm neonates for paediatricians. Preterm labour refers to the onset of uterine contractions of sufficient strength and frequency to effect progressive dilatation and effacement of the cervix between 20 and 37 weeks of gestation. Aim: To compare the effects of transdermal Glyceryl Trinitrate (GTN) with Isoxsuprine in terms of maternal complications, perinatal outcomes, and their tocolytic effectiveness. Materials and Methods: A hospital-based longitudinal study was conducted in the Department of Obstetrics and Gynaecology at JNU Medical College and Research Centre, Jaipur, Rajasthan, India. The study duration of the study was one year, from March 2022 to February 2023. A total number of 100 cases of preterm labour were enrolled and equally divided into two groups: Groups A (GTN patch) and group B (Isoxsuprine) with a defined dosing schedule. Singleton pregnancies with intact membranes and gestational age of 26-36 weeks were included in the study, metting the diagnostic criteria for preterm labour. Both the groups received pharmacological intervention, and outcome measures such as success rate of treatment (i.e., prolongation of labour),. maternal side effects, and foetal outcomes {Neonatal Intensive Care Unit (NICU) admission and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score) were measured and evaluated. Predefined parameters and other data were tabulated in Microsoft Excel and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0. The Chi-square test was applied to identify significant differences. Results: The incidence of preterm labour was highest in the age group of 21-30 years (76% in Group A and 70% in Group B) among patients treated with nitroglycerine and isoxsuprine, respectively. The mean prolongation of pregnancy in the nitroglycerine group was 21.42 days, and in the isoxsuprine group, it was 16.22 days (p=0.042). The most common side effect in the nitroglycerine group was headache (60%), while in the isoxsuprine group, it was maternal hypotension (24%). The mean APGAR score in Group A and Group B was 8.18 and 8.06, respectively. It was observed that 24% of newborns in the nitroglycerine group and 36% in the isoxsuprine group required NICU admission. The success rate was 90% in the nitroglycerine group and 80% in the isoxsuprine group. Conclusion: Both drugs were effective in prolonging pregnancy for the first 48 hours, but nitroglycerine was found to be slightly better in terms of success rate. Nitroglycerin was more acceptable to patients with preterm labour, as it did not have to be administered through painful injections.

The outcome of newborn babies born to COVID-19 positive mothers - An observational study from Eastern India

Background: The study was done on outcome of the newborns born to COVID-19 positive mothers in a tertiary care hospital. Method: For this retrospective observational study, the COVID-positive mothers who delivered between August 1, 2020 to July 31, 2021 were identified. The mothers belonged to middle socioeconomic group, had regular antenatal care and had access to good nutrition and healthcare. The data of their babies was collected. All the babies had a Reverse-Transcriptase Polymerase Chain Reaction (RTPCR) test for diagnosis of COVID-19 infection. The babies who were well, were roomed in with their mothers and exclusively breastfed. Sick babies were admitted to the Neonatal Intensive Care Unit (NICU). They were managed according to standard guidelines. No COVID-specific treatment was given to any of them. Their course in the hospital was recorded and the data analysed. Results: Among 52 babies, only 18.4% were positive on RTPCR testing. 32.7% were preterm. 23 (44.2%) babies required NICU admission while the rest were roomed in with the mother. Out of the 23 NICU admissions, 14 (26.9%) of them had sepsis, 6 (11.5%) had RDS, 6 (11.5%) had pneumonia, 14 (26.9%) had hyperbilirubinaemia while 2 (3.8%) had meningitis. None of the babies fulfilled the criteria for neonatal multisystem inflammatory syndrome. The babies who were positive on RTPCR testing were found to have some complications, of which sepsis and hyprerbilirubinaemia were the most frequent. Most of the babies required only appropriate supportive care with intravenous (IV) fluids, antibiotics and phototherapy. Continuous positive airway pressure (CPAP) was administered to 3 (3.8%) babies for RDS and 2 of them needed mechanical ventilation. All the babies were discharged in a stable condition. Conclusion: The rate of perinatal acquisition is low. The babies of COVID positive mothers respond well to treatment, and more than half are asymptomatic. They are not at increased risk of mortality though there are complications needing treatment. Keywords: SARS-COV2; pregnancy; preterm; perinatal; neonatal; COVID-19, RTPCR; sepsis; hyperbilirubinaemia

Increased Rates of Obstetric Complications Prior to Systemic Sclerosis Diagnosis.

To investigate whether obstetric complications prior to systemic sclerosis (SSc) diagnosis are more common in SSc patients compared to the general obstetric population. A case-control study was performed at Kaiser Permanente Northern California to compare prior obstetric complications in adult women who later developed SSc (cases) with women from the general obstetric population who did not develop SSc (controls; matched 10:1 by age and year of delivery) from 2007 to 2016. Exposures included past hypertensive disorders of pregnancy (preeclampsia, eclampsia, gestational hypertension), premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), maternal infections, neonatal intensive care unit (NICU) admission, and preterm birth. Fischer's exact tests were used to compare categorical variables. Conditional logistic regression models estimated the odds ratio (OR), and corresponding 95% confidence intervals (95% CIs) for the outcome SSc. Seventeen SSc cases and 170 non-SSc controls were identified, with median maternal age at delivery 34 years (range 23-46 years) and median time from delivery to SSc diagnosis 2 years (range 0.2-7.3 years). Women with SSc were more likely to be Hispanic and Black. Prior obstetric complications appeared higher in women with an eventual SSc diagnosis compared to controls (70.6% versus 50%), including hypertensive disorders (17.7% versus 9.4%), PROM (11.8% versus 4.1%), IUGR (5.9% versus 1.8%), maternal infection (29.4% versus 14.1%), NICU admissions (23.5% versus 7.7%), and preterm delivery (29.4% versus 21.8%). Women with SSc had a higher odds of delivering infants requiring NICU admission (OR 4.7 [95% CI 1.2-18.8]). Women who eventually develop SSc had trends toward more complicated pregnancy histories before overt diagnosis.

Maternal and Perinatal Outcomes of Hospitalized COVID-19 Positive Pregnant Women

IntroductionThe consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) /Coronavirus disease 2019 (COVID-19) on mothers and neonates are uncertain due to the lack of robust evidence from various available studies. Furthermore, conflicting data exist regarding the vertical transmission of coronavirus. Therefore, a hospital-based study was conducted to evaluate the effect of COVID-19 on maternal and perinatal outcomes of COVID-19 infected pregnant women.MethodologyA hospital-based retrospective observational study was conducted between July-December 2020 in Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, a designated level-2 COVID-19 Hospital. A total of 37 confirmed COVID-19 positive pregnant women (mean age 27.5 ± 05 years) of more than 28 weeks of gestation were included in this study to evaluate the effect of COVID-19 on maternal and perinatal outcomes. Maternal symptoms related to COVID-19, comorbidities, intensive care unit (ICU) admissions, intrauterine growth retardation (IUGR), leaking per vagina, mode of delivery, preterm deliveries, and maternal deaths were recorded. Birth weight of newborns, neonatal intensive care unit (NICU) admissions, neonatal illness, neonatal deaths, and COVID-19 testing reports were recorded. ResultOut of 37 COVID-19 positive pregnant women, 27 (72.9%) women were asymptomatic, nine (24.4%) women were having mild disease, and one (2.7%) developed severe disease requiring ICU admission. No maternal deaths were observed. Twenty-six (70.3%) women were delivered by caesarean section, 11 (29.7%) women by normal vaginal delivery, four (10.8%) were of leaking per vagina. Among newborns, five (13.5%) were preterm, one (2.7%) newborn require NICU admission, two (5.4%) were tested COVID-19 positive on the 5th day of life but were asymptomatic, and four (10.8%) newborns developed a fever but were COVID-19 negative. One case (2.7%) was of stillbirth. No neonatal deaths were observed.ConclusionThe present study did not reveal any direct evidence for vertical transmission of SARS-CoV-2 virus through the placenta and during vaginal delivery, but the possibility of mother-to-child infection cannot be completely ignored. SARS-CoV-2 infection during late pregnancy may have a maternal and neonatal impact. COVID-19 infections in late pregnancy might lead to an increased incidence of caesarean deliveries as observed in the present study. This study reveals that most of the COVID-19 positive pregnant women remained asymptomatic or had mild infections. Hence, efforts to limit exposure to COVID-19 of pregnant women should be strengthened for saving mother and child.

Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents.

Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.

#36: A Review of Maternal and Neonatal Characteristics and Outcomes in Pregnant Women with Serious Infectious Complications from Injection Drug Use

Abstract Background Pregnant people who inject drugs (PWID) and their infants are unique populations that have emerged from the opioid epidemic. Numerous studies have evaluated vertical transmission of HIV, HCV, sequelae of neonatal abstinence syndrome, and maternal and fetal mortality in these mother-infant dyads; however there still remains a large knowledge gap regarding how serious infections in pregnant PWID affect more proximal outcomes such as fetal and maternal distress leading to preterm delivery, risk of neonatal sepsis, need for invasive diagnostic procedures to rule-out neonatal sepsis such as lumbar puncture, neonatal intensive care unit (NICU) admission, and potential consequences of prolonged intrauterine antibiotic exposure. Methods We identified pregnant PWID ≥18 years old with serious infectious complications (defined as (sepsis, endocarditis, osteomyelitis, epidural abscesses, septic arthritis/bursitis, thrombophlebitis, and skin and soft tissue infections requiring IV antibiotics) admitted between 2017–2018 to the University of Kentucky Medical Center and their neonates treated at Kentucky Children’s Hospital. Patients were identified using positive urine or serum pregnancy test results, IVDU-associated ICD9/10 codes, infectious disease, neonatology, and obstetrics notes. Results 261 women with infectious complications from IVDU were identified, 25 were pregnant and 16 dyads were able to be matched with identification of 14 viable neonates born at the University of Kentucky. Mean maternal age was 31 years and median 30 years. Mean gestational age (GA) at time of admission was 25 weeks with median 29 weeks. Sepsis was the most common complication reported 18 (72%) followed by endocarditis 11 (44%). Staphylococcus aureus was the most isolated organism (16) 64% with 12 (48%) of isolates identified as MRSA and MSSA comprising 4 (16%). 96% were screened for HCV, with 72% HCV antibody positive and 32% with detectable viral load. There was 1 reported maternal death, 1 spontaneous abortion and 2 intrauterine fetal demises (IUFD) in the 3rd trimester and no neonatal deaths. Average GA at time of delivery was 33 weeks with median 36 weeks. 6 (42%) were routine deliveries with 3 (22%) deliveries for emergent maternal indications and 5 emergent deliveries for fetal indications (36%). 12 neonates (86%) required NICU admission with average length of stay 17 days and median 10 days. 10 (71%) underwent limited sepsis screen with 9 (64%) receiving at least 48 hours of antibiotics and 3 (22%) receiving an extended course. However none of the blood cultures yielded any organisms. All passed their hearing screening and had no evidence of renal dysfunction or cytopenias. Conclusions Pregnant PWID dyads may be at increased risk for morbidity and mortality secondary to infectious complications of IVDU. The majority of neonates were delivered early for either fetal distress or maternal distress. 2 mothers suffered IUFD in the 3rd trimester and the majority of the neonates required NICU admission (86%) due to prematurity-related factors, concern for neonatal abstinence syndrome or concern for infectious complications. Over half received 48+ hours of antibiotics in the NICU however none of the neonatal blood cultures yielded an organism. Larger cohort studies are needed to better ascertain risk in these expanding populations.

A quality improvement initiative to reduce hypothermia in a Baby-Friendly nursery - our story of algorithms, K-cards, and Key cards.

Baby-Friendly hospitals encourage rooming-in newborns with mothers. In our institution, we noticed increased incidence of hypothermia following Baby-Friendly designation. We aimed to reduce the incidence of hypothermia in the mother-baby-unit to <15% and to decrease the rate of isolated hypothermia admissions to the neonatal intensive care unit (NICU) by 20% over two years. After a retrospective review of newborns ≥35 weeks gestation in the mother-baby-unit with hypothermia, we implemented multiple interventions such as nursing education, hypothermia algorithm, Kamishibai cards, and Key cards. Hypothermia incidence in the mother-baby-unit decreased from 20.9 to 14.5% (p < 0.001) and infants requiring NICU admission decreased by 71% (p < 0.001) following all interventions. Apart from nursing education, all interventions led to significant reductions in both outcomes from baseline. Instituting a hypothermia algorithm and utilizing K-cards and Key cards reduces the incidence of hypothermia in the mother-baby-unit and NICU admissions for isolated hypothermia.

Cord-Blood High-Sensitivity Troponin-I Reference Interval and Association with Early Neonatal Outcomes.

This study was aimed to establish a reference interval for high-sensitivity cardiac troponin I (hs-cTnI) in umbilical cord blood of infants and to assess its association with the risk of predetermined early neonatal outcomes in a high-acuity tertiary care hospital. Umbilical cord-blood samples were collected and hs-cTnI was measured in all infants born between August 2015 and September 2015 at McMaster Children's Hospital (n = 256). Gestational age, birth weight, Apgar's scores, age in days at which feeding was established, neonatal intensive care unit (NICU) admission, and discharge in days after birth were recorded. The 90th, 95th, and 99th percentiles for the term infant subcohort were 19.75, 41.45, and 166.30 ng/L, respectively. We observed decreased mean gestational ages and birth weights in both the 90th (37.7 weeks; 2,961.4 g) and 95th percentiles (37.1 weeks; 2,709.9 g) when compared with the remaining infants. Moreover, levels of hs-cTnI were significantly higher in infants with respiratory distress requiring intervention (p < 0.05), low birth weight infants (p < 0.01), preterm infants (p < 0.001), and those requiring NICU admission (p < 0.01). Multiple linear regression of the recorded demographic factors revealed prematurity (gestational age <35 weeks: coefficient 0.346 ± 0.160, p < 0.05; gestational age <37 weeks: coefficient 0.253 ± 0.105, p < 0.05) and male sex (coefficient 0.138 ± 0.047; p < 0.01) to be most predictive of log-hs-cTnI levels. This study establishes the reference values for cord-blood hs-cTnI in infants at a tertiary care center. Premature and sick infants requiring NICU admission had significantly higher levels of hs-cTnI. · Established the 90th, 95th, and 99th percentiles of neonatal cord-blood hs-cTnI in term infants as 19.75, 41.45, and 166.30 ng/L, respectively.. · Infants with hs-cTnI levels exceeding the 90th percentile had lower gestational ages and birth weights with higher rates of NICU admissions.. · Infants with respiratory distress or requiring NICU admission were found to have higher levels of hs-cTnI..

854 Maternal smoking status during pregnancy and the effect on adverse maternal and neonatal outcomes

We sought to evaluate the association between maternal smoking status during pregnancy and adverse maternal and neonatal outcomes. We conducted a retrospective cohort study of singleton, non-anomalous gestations in the United States in 2015. We assessed the association of adverse outcomes with smoking status by women who never smoked, women who quit smoking during the first or second trimesters of pregnancy, and women who continued smoking throughout the pregnancy. Outcomes examined included preterm delivery, neonatal intensive care unit (NICU) admissions, neonates requiring assisted ventilation, small-for-gestational-age infants, infant death, and hypertensive disorders of pregnancy. Chi-squared tests were employed for statistical comparisons and multivariable logistic regression analyses for confounding. Maternal smoking status during pregnancy was associated with significant differences in all maternal and neonatal outcomes (Table 1). Women who continued to smoke during pregnancy or quit smoking during pregnancy were more likely to have a preterm delivery (aOR 1.32, 95% CI 1.30-1.35 and aOR 1.02, 95% CI 1.01-1.05), small-for-gestational-age infants (aOR 2.46, 95% CI 2.43-2.49 and aOR 1.12, 95% CI 1.01-1.14), neonates requiring NICU admission (aOR 1.34, 95% 1.32-1.36 and aOR 1.07, 95% CI 1.05-1.10), infant death (aOR 1.61, 95% CI 1.51-1.71 and aOR 1.15, 95% CI 1.05-1.26), and a neonate requiring assisted ventilation (aOR 1.29, 95% CI 1.26-1.32 and aOR 1.24, 95% CI 1.20-1.27), respectively (Table 2). We found that smoking at any time during pregnancy is associated with adverse maternal and neonatal outcomes. Those who smoked only during the first or second trimester had increased adverse outcomes as compared to women who never smoked, emphasizing the need to focus cessation efforts prior to pregnancy. However, there was an even larger difference between those who smoked throughout pregnancy and those who were able to quit during pregnancy, underscoring the importance of cessation counseling during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1144 Influence of maternal insurance status on maternal and neonatal outcomes in term pregnancy

The goal of this study was to assess the adverse maternal and neonatal outcomes associated with maternal insurance status in term pregnancies. We conducted a retrospective cohort study of 1,985,087 singleton, non-anomalous, non-cesarean term gestations in California between 2007-2011 using birth registry and ICD-9 data. Maternal insurance status was classified as either public or private insurance. Maternal outcomes included preeclampsia, eclampsia, gestational diabetes mellitus (GDM), induction of labor (IOL), and severe maternal morbidity (SMM). Neonatal outcomes included infant death, neonatal intensive care unit (NICU) admission >24 hours, newborn hypoglycemia, respiratory distress syndrome (RDS), and newborn septicemia. Multivariate regression analyses and chi-squared tests were employed for statistical comparisons, controlling for maternal age, body mass index, ethnicity, education, insurance status, smoking status, and parity. A p-value of less than 0.05 was used to indicate statistical significance. We found a significant association between maternal insurance status and maternal and neonatal outcomes (Table 1). When compared to women with private insurance, women with public insurance were more likely to have SMM (aOR 1.18, 95% CI 1.14-1.23), preeclampsia (aOR 1.03, 95% CI 1.01-1.05), eclampsia (aOR 1.36, 95% CI 1.22-1.53), infant death (1.54, 95% CI 1.38-1.72), neonates requiring NICU admission (aOR 1.25, 95% CI 1.23-1.27), neonates with RDS (aOR 1.09, 95% CI 1.07-1.11), and newborn septicemia (aOR 1.49, 95% CI 1.44-1.54) (Table 2). Women with public insurance were less likely to have an induction of labor (aOR 0.96, 95% CI 0.95-0.97) and GDM (aOR 0.91, 95% CI 0.90-0.92). We found that maternal public insurance status was associated with an increased risk of certain adverse maternal and neonatal outcomes. Further exploration about whether these differences could be reduced with greater access or quality of care is needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)