Score For Neonatal Acute Physiology Research Articles

Multiple organ dysfunction syndrome prediction in newborn children

There are several directions for predicting multiple organ dysfunction syndrome (MODS), but almost all of them are poorly tested in neonatology. This review is presented to indicate the problem of the condition severity objectification of newborns and the possibility of predicting the development of MODS. Scales for assessing the severity of MODS in critically ill children have been developed and used since the end of the last century, but their validation in the newborns faces certain difficulties. Prognostic nosospecific scales: NICHD (National Institute of Child Health and Human Development) calculator, CRIB II (Clinical Risk Index for Babies), SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension II) are used in neonatology, however their comparison in this category of patients has not been carried out.Theoretical and practical issues of the short-term and long-term prediction of the MODS onset and its outcomes in newborns is a promising area of neonatology, since it allows a doctor to be warned about an impending catastrophe and opens a “window of opportunity” for timely correction of treatment tactics and complications prevention. Obtaining different phenotypes of critical illness and predicting their outcomes in children may have good predictive potential, but such studies have not been conducted in newborns. A promising direction in predicting MODS is the identification of biomarkers of inflammation, among which endocan, cluster of differentiation 64, cluster of differentiation molecules 11b, “pancreatic stone protein” (PSP), soluble intercellular adhesionmolecule-1 (sICAM-1), progranulin, neopterin, resistin (FIZZ3, presepsin (PSP)) carry a good potential, but their effectiveness in neonatology is still to be investigated.Thus, the prediction of MODS in children and newborns remains an unresolved problem. At the same time, several promising scientific directions are actively being developed today, which may lead to a significant breakthrough in predicting MODS in neonatology.

Assessment of the diagnostic ability of RIFLE classification and neutrophil gelatinase-associated lipocalin biomarker in detecting acute kidney injury in newborns at the intensive care unit

Introduction/Objective. This study was designed to demonstrate the association of the RIFLE classification and neutrophil gelatinase-associated lipocalin (NGAL) in predicting of newborns with acute kidney injury (AKI). Methods. This was a prospective study. We included 100 newborns suspected of having a kidney injury. These newborns were admitted to the intensive care unit (ICU) at the University Clinic of Pediatrics from the period of two years. The severity of the disease was determined by RIFLE classification. The biochemical marker NGAL was included in this study because it is an early biomarker of AKI in newborns. The statistical processing of the material was by methods of descriptive statistics. Results. The prevalence rate of AKI was 6.25%, but according to the RIFLE classification the prevalence was 8.7%. According to RIFLE classification, we reported ?risk? in 36%, ?injury? in 50% and ?failure? in 14% of newborns with AKI. In newborns with perinatal asphyxia, kidney injury was seen in 34% and 30%, making perinatal asphyxia the most common predisposing factor. The difference in average value of the score for neonatal acute physiology with perinatal extension in newborns with AKI and the control group without AKI was confirmed significant (p < 0.001). Also, there was a significant difference (p < 0.001) between serum creatinine and urinary NGAL values, on the day they were admitted to the ICU. Conclusion. In newborns hospitalized in the ICU, AKI is a serious condition. We could identify kidney injury and follow up the progression of the disease by using RIFLE classification. The need for early diagnosis of kidney injury, in a period when the disease is not clinically manifest, in the first hours of its occurrence, is provided by NGAL.

Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry.

Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. Results: The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. Conclusion: Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality.

Predicting Outcome in Persistent Pulmonary Hypertension of the Newborn with Score for Neonatal Acute Physiology- Version II (SNAP-II)

Persistent pulmonary hypertension of the Newborn is a serious disease related to the adaptation of fetal circulation after birth. This study aims to determine the ability of Score for Neonatal Acute Physiology- version II (SNAP-II) for predicting outcome in neonates with persistent pulmonary hypertension of the newborn (PPHN). This prospective cohort study of 52 neonates with PPHN was carried out in the Neonatal Center and Surgical Intensive Care Unit, Vietnam National Children’s Hospital over a period of 7 months (10/2020 to 4/2021). SNAP-II score was evaluated within the first 12 hours of admission. Outcome of treatment was recorded at the 28th day of treatment. The study results show that the mortality rate was 25.0%; 11.5% of the patients had to use ventilators; 28.8% of the patients used NO inhalers and 9;6% of the patients required ECMO. SNAP-II score has the power of predicting mortality in PPHN with the area under the ROC curve of 0.76 (95% CI: 0.61- 092, p &lt; 0.05). SNAP-II score ≥ 27 was calculated as cutoff for predicting mortality with the sensitivity of 92;3% and specificity of 53.8%. Each point increase in SNAP-II score increased the odd of mortality by 1.10 (95% CI: 1.03- 1.18, p&lt; 0.05). SNAP-II score also has the ability of predicting secondary outcome of PPHN: using ECMO (AUC 0.81). Notably, this study finds that the SNAP-II scoring system is a useful and reliable tool to predict mortality of neonates with PPHN and to assess the need of ECMO therapy.&#x0D; Keywords: Persistent pulmonary hypertension of the newborn, Score for Neonatal Acute Physiology- version II, neonatal mortality.&#x0D; References&#x0D; [1] J. Nair, S. Lakshminrusimha, Update on PPHN: Mechanisms and Treatment, Seminars in Perinatology, Vol. 38, No. 2, 2014, pp. 78-91, https://doi.org/10.1053/j.semperi.2013.11.004.[2] M. A. Steurer, R. J. Baer, S. Oltman, K. K. Ryckman, S. K. Feuer, E. Rogers, R. L. Keller, L. Jelliffe- Pawlowski, Morbidity of Persistent Pulmonary Hypertension of the Newborn in The First Year of Life, Journal of Pediatric, Vol. 213, 2019, pp. 58-65, https://doi.org/10.1016/j.jpeds.2019.06.053.[3] N. Nakwan, N. Nakwan, J. Wannaro, Predicting Mortality in Infants with Persistent Pulmonary Hypertension of the Newborn with The Score for Neonatal Acute Physiology-Version II (SNAP-II) in Thai Neonates, Journal of Perinatal Medicine, Vol. 39, No. 3, 2011, pp. 311-315, https://doi.org/10.1515/jpm.2011.011.[4] D. K. Richardson, J. D. Corcoran, G. J. Escobar, G. J. Escobar, S. K. Lee, SNAP-II and SNAPPE-II: Simplified Newborn Illness Severity and Mortality Risk Scores, The Journal of pediatrics, Vol. 138, No. 1, 2001, pp. 92-100, https://doi.org/10.1067/mpd.2001.109608.[5] S. Sardar, S. Pal, R. Mishra, A Retrospective Study on The Profile of Persistent Pulmonary Hypertension of Newborn in A Tertiary Care Unit of Eastern India, Journal of Clinical Neonatology, Vol. 9, No. 1, 2020, pp. 18-26, https://doi.org/10.4103/jcn.JCN_68_19.[6] M. Sauthier, L. Rose, P. Jouvet, Pediatric Prolonged Mechanical Ventilation: Considerations for Definitional Criteria, Respiratory care, Vol. 62, No. 1 2017, pp. 49-53, https://doi.org/10.4187/respcare.04881.[7] M. N. M. Bah, R. Y. H. Tan, H. Razak, M. H. Sapian, N. Abdullah, E. Y. Alias, Survival and Associated Risk Factors for Mortality among Infants with Persistent Pulmonary Hypertension of The Newborn in Malaysia, Journal of Perinatology, Vol. 41, 2021, pp. 786-793, https://doi.org/10.1038/s41372-021-00962-6.[8] E. D. Skarsgard, Y.C. MacNab, Z. Qiu, R. Little, S. K. Lee, SNAP-II Predicts Mortality among Infants with Congenital Diaphragmatic Hernia. Journal of Perinatology, Vol. 25, No. 5, 2005, pp. 315-319, https://doi.org/10.1038/sj.jp.7211257.[9] L. Y. Chien, R. Whyte, P. Thiessen, R. Walker, D. Brabyn, S. K. Lee, SNAP-II Predicts Severe Intraventricular Hemorrhage and Chronic Lung Disease in The Neonatal Intensive Care Unit, Journal of Perinatology, Vol. 22, No. 1, 2002, pp. 26-30, https://doi.org/10.1038/sj.jp.7210585.[10] S. Jaroensri, W. Kamolvisit, N. Nakwan, Risk Factor Analysis of Pneumothorax Associated with Persistent Pulmonary Hypertension of The Newborn in Thai Neonates, The Journal of Maternal-Fetal &amp; Neonatal Medicine, Vol. 33, No. 24, 2020, pp. 4090-4095, https://doi.org/10.1080/14767058.2019.1596403.[11] F. Kipfmueller, L. Schroeder, T. Melaku, A. Geipel, C. Berg, U. Gembruch, A. Heydweiller, C. Bendixen, H. Reutter, Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using The SNAP-II Score, Klinische Pädiatrie, Vol. 231, No. 6, 2019, pp. 297-303, https://doi.org/10.1055/a-1009-6671.

Neonatal outcome in neonatal intensive care unit Sanglah Hospital: Assessed by SNAPPE- II score

Neonatal mortality is topic of concern for many medical faculties. Recently Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) is used to predict the mortality and morbidity of neonates in neonatal intensive care unit (NICU). This study aimed to find the association of mortality and morbidity among neonates using SNAPPE-II score in NICU of Sanglah Hospital with cross-sectional design. All newborns admitted in NICU within 48 hours of birth since January - December 2020 were recruited as sample and assessed by using SNAPPE-II. Statistical analysis was performed by using Chi-square test and Mann–Whitney U test. Eighty-three newborns fulfilled inclusion criteria. In the mortality group, 75.6% had SNAPPE score ≥ 37 and 24% had SNAPPE score &lt;37. SNAPPE-II score ≥ 37 showed an association with mortality group in NICU (p-value 0.000). Moreover, subgroup analyst of neonatal outcome in survived group related to SNAPPE-II score showed significant different in length of stay (P=0.033), ventilator usage (P=0.017) and duration of antibiotic usage (P=0.049). The Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE-II) is a useful tool to assess severity of illness and mortality. SNAPPE-II score &gt; 37 is associated with neonatal mortality. The high SNAPPE-II score in the survived group also affects length of stay in NICU, ventilator and antibiotic usage. These findings imply that SNAPPE-II can be applied routinely in NICU to know the most critical newborn for prioritizing the management of care and for counselling the parents.

Severity Index of Neonatal Septicemia in Neonatal Intensive Care units Using Score for Neonatal Acute Physiology-II

Background This study aimed to evaluate the competence of the score for neonatal acute physiology (SNAP-II) as a tool to anticipate morbidity and mortality of neonates with early or late sepsis in neonatal intensive care units (NICUs).Methods This prospective cohort study was conducted on all neonates of > 32 weeks with sepsis in tertiary NICUs at Cairo University Children Hospital and El Galaa Hospital For Armed Forces Officers Families, Cairo, Egypt, within May-October 2019. The eligible samples consisted of 100 neonates with septicemia who met inclusion and exclusion criteria and were enrolled. the score for neonatal acute physiology-II was calculated within 24 h of sepsis onset and followed up for 2 weeks for mortality and organ dysfunction (OD). The collected data were analyzed in SPSS software (version 25).Results It was revealed thatSNAP-II was significantly higher in neonates who passed away, compared to the survived neonates (46±17 vs. 12±10, respectively; P<0.001). Moreover, SNAP-II was significantly higher in neonates who developed OD within 14 days of sepsis onset, compared to those without OD (37±17 vs. 9±7, respectively; P<0.001). The score for neonatal acute physiology-II at 14.5 was considered the best cut-off point in predicting OD with a sensitivity of 100%, positive predictive value of 70.4%, specificity of 81.2%, and negative predictive value of 100%. In addition, SNAP-II at 23.5 was considered the best cut-off point in predicting overall mortality with 100% sensitivity, 58.6% PPV, 85.5% specificity, and 100% NPV.Conclusion Higher SNAP-II within 24 h of the early- or late-onset neonatal sepsis was a reliable predictor of OD and death.

Rotational Thromboelastometry in Neonates Admitted to a Neonatal Intensive Care Unit: A Large Cross-sectional Study.

The aim of the present study was to assess the coagulation profile in neonatal critical illness using rotational thromboelastometry (ROTEM), and to investigate its association with disease severity and its potential prognostic role in this clinical setting. Over a period of 67 months (July 2014-February 2020) 423 critically ill neonates with confirmed or suspected sepsis, perinatal hypoxia, or respiratory distress syndrome, hospitalized in our neonatal intensive care unit were included in the study. Demographic, clinical, and laboratory data were recorded on admission day and arterial blood was analyzed on ROTEM analyzer using the standard extrinsically activated rotational thromboelastometry assay (EXTEM). Neonatal illness severity scores (Modified NEOMOD [Neonatal Multiple Organ Dysfunction] and SNAPPE [Score for Neonatal Acute Physiology with Perinatal Extension]) were calculated at the same time as ROTEM analysis. Mortality during in-hospital stay was the main outcome measure. Multivariable analyses showed that a 10 mm decrease in EXTEM clot amplitude recorded at 10 minutes (A10) is significantly associated with a higher mortality (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.33-2.08). Higher modified NEOMOD (OR = 1.36, 95% CI: 1.26-1.47) and higher SNAPPE scores (OR = 1.06, 95% CI: 1.04-1.08) were also associated with increased mortality. The CT and A10 variables demonstrated the best prognostic performance among the EXTEM parameters for mortality (area under the curve [AUC] = 0.78; 95% CI: 0.69-0.86 and AUC = 0.76; 95% CI: 0.66-0.85, respectively), showing an optimal cut-off CT ≥63 seconds and A10 ≤37 mm. Using optimal cut-off values of the EXTEM parameters for prediction of mortality, neonates with CT ≥63 seconds were 7.4 times more likely to die (OR = 7.40, 95% CI: 3.50-15.65), while neonates with A10 ≤37 mm were 5.8 times more likely to die (OR = 5.88, 95% CI: 2.94-12.50). An EXTEM hypocoagulable profile on disease onset was shown to be an independent risk factor for in-hospital mortality in neonatal critical illness.

Association of inotrope use with neurodevelopmental outcomes in infants

Objective The primary objective was to compare neurodevelopmental (ND) outcomes at 18–24 months in preterm infants <29 weeks gestational age (GA) who received versus those who did not receive inotropes in the first week of life. The secondary objective was to assess ND outcomes according to the duration of inotropic support in the first week of life (≤3 or >3 days). Study design Retrospective population-based cohort study of preterm infants <29 weeks GA admitted to participating neonatal intensive care units (NICUs) of the Canadian Neonatal Network (CNN) from January 2010 to September 2011 with follow-up data available at 18–24 months. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Long-term outcomes were categorized as neurodevelopmental impairment (NDI) and significant neurodevelopmental impairment (sNDI), and effect modification due to other neonatal morbidities including receipt of antenatal steroids, GA, small for gestational age (SGA) status, sex, score for neonatal acute physiology (SNAP-II) >20, postnatal steroids, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) grade ≥3/periventricular leukomalacia (PVL), early- and late-onset sepsis, retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC) was assessed. Maternal and infant demographic characteristics and short- and long-term outcomes were compared using Pearson’s Chi-square test for categorical variables and Student’s t-test or the Wilcoxon rank test for continuous variables. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using multivariable regression analysis. Results Of the 491 (18.7%) eligible preterm infants who received inotropes during the first week of life, 314 (64%) survived to NICU discharge and 245 (78%) had ND outcome data available. A total of 1775 eligible preterm infants did not receive inotropes in the first week of life; 1647 (92.7%) survived to NICU discharge and 1149 (70%) had ND outcome data. Maternal and infant characteristics associated with infants receiving inotropes included: younger maternal age, clinical chorioamnionitis, no antenatal steroids, outborn, lower GA, BW and Apgar scores at both one and five minutes; and higher SNAP-II scores (p < .05). Infants who received inotropes in the first week of life were more likely to be require postnatal steroids, had higher rates of BPD, IVH grade ≥3/PVL, early- and late-onset sepsis, ROP, NEC and mortality (p < .05). Infants who received inotropes in the first week of life also had higher rates of sensorineural or mixed hearing loss with an AOR (95% CI) of 1.99 (1.13, 3.49). After adjusting for confounding variables, there was no difference in the risk of NDI or sNDI between infants who did and did not receive inotropes in the first week of life. Of the infants with neurodevelopmental outcome data available, 186 received inotropes for ≤3 days and 59 for >3 days. After adjusting for confounding variables there was no difference in the risk of NDI or sNDI. Infants who received inotropes for >3 days were more likely to have lower BSID-III cognitive [AOR 2.43 95% CI (1.03, 5.76)] and motor scores <85 [AOR 2.38 95% CI (1.07, 5.30)] respectively. Conclusions In this large, population-based cohort, infants who received inotropes in the first week of life were at increased risk for sensorineural or mixed hearing loss. There was no difference in NDI or sNDI after adjusting for confounding variables. A longer duration of inotrope use in the first week of life was associated with lower BSID-III cognitive and motor scores, but no difference in overall NDI or sNDI.

Safety, speed, and effectiveness of air transportation for neonates.

In Japan, 44.3% of neonates are delivered in private clinics without an attending pediatrician. Obstetricians in the clinics must resuscitate asphyxiated neonates in unstable condition, such as respiratory failure, and they are frequently transferred to tertiary perinatal medical centers. There has been no study comparing the physiological status and prognosis of neonates transported by ambulance with those transported by helicopter. Medical and transport records were used to compare the physiological status of neonates transported to Kagoshima City Hospital by land and those transported by air between January 1, 2013, and December 31, 2017. Data from 425 neonates transferred by land and 143 by air were analyzed. There were no significant differences between the two groups in mean gestational age, mean birthweight, fetal blood pH, Apgar score, or the Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) on arrival to the tertiary center (16.3±15.4 [95% confidence interval (CI): 13.2-17.7] vs 16.4±15.4 [95% CI: 13.9-19.0], respectively; P=0.999); both groups had SNAPPE-II score 10-19, indicating no difference in mortality risk. The times to starting first aid and to admission to the intensive care unit were significantly reduced in neonates transported by air than by land. In subgroup analysis of patients of a gestational age ≤28weeks, all cases of severe intraventricular hemorrhage (IVH) were observed in the land transportation group. Neonatal transportation by air is as safe as land transportation, and time to first aid and intensive care are significantly reduced by transportation by air than by land. Air transport could also contribute to the prevention of IVH in neonatal transportation.

Comparison of Hematocrit Change in Preterm Neonates with Birth Weight Based Versus Formula Based Packed Red Blood Cell Transfusion: A Randomized Control Trial.

Conventionally the packed red blood cell (PRBC) transfusion volume given to neonates is 10 ml/kg to 20 ml/kg. The weight-based formulae underestimate the volume of PRBC required to achieve a target hematocrit (Hct) in preterm neonates. The study was done to compare the rise in Hct after transfusing PRBC volume calculated either based on body weight or using formula considering Hct of blood bag and Hct of preterm neonates. This prospective study included a total of 68 preterm neonates requiring transfusion for the first time having ≤ 34 weeks of gestational age. Neonates were randomized using block randomization, to receive 15 ml/kg of PRBC transfusion (group A) or transfusion based on the formula (group B). The primary outcome of interest was post-transfusion rise in hematocrit. The secondary outcome was the effect of transfusion on neonatal morbidities in terms of retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and death. Baseline variables (birth weight, gestation age, APGAR score and score of neonatal acute physiology) pre-transfusion hemodynamics and hematocrit of the bag were comparable in both groups. The mean volume of PRBC in group A was 18.8 ± 4.9 ml, whereas in group B it was 29.6 ± 7.3 ml, p = 0.0001. Group B transfusions had a statistically significant change in 24 h post-transfusion hematocrit. Secondary outcomes were comparable in two groups. Post transfusion rise in Hct of the patient in group B was significant as compared to group A. The study needed huge sample size to establish a difference in the number of re-transfusions required across two groups. The trial was registered under the clinical trial registry of India (CTRI/2018/01/011,063).Supplementary InformationThe online version contains supplementary material available at 10.1007/s12288-021-01420-1.

Gestational Age-Dependent Variations in Effects of Prophylactic Indomethacin on Brain Injury and Intestinal Injury

To evaluate the impact of prophylactic indomethacin on early death (<10days after birth) or severe neurologic injury and on early death or spontaneous intestinal perforation by completed weeks of gestational age in neonates born <29weeks of gestation. This was a multicenter, retrospective cohort study of neonates (n=12 515) born at 236/7 weeks of gestational age, admitted to neonatal intensive care units participating in the Canadian Neonatal Network who received prophylactic indomethacin started within the first 12hours after birth. Univariate and multivariate analysis compared the composite outcomes of early death or severe neurologic injury and early death or spontaneous intestinal perforation. Of 12 515 eligible neonates, 1435 (11.5%) were exposed to prophylactic indomethacin; recipients were of lower gestational age and birth weight and had greater severity of illness (Score of Neonatal Acute Physiology with Perinatal Extension) on admission compared with nonrecipients. After we adjusted for confounders, prophylactic indomethacin was associated with reduced odds of early death or severe neurologic injury and early death or spontaneous intestinal perforation in neonates born at 23-24weeks of gestational age. However, prophylactic indomethacin was associated with increased odds of early mortality or spontaneous intestinal perforation for neonates born at 26-28weeks of gestational age. Prophylactic indomethacin use was associated with benefit in neonates born at 23-24weeks of gestational age, but with harm at 26-28weeks of gestational age. Given the observation of significantly improved survival, a randomized controlled trial is needed to investigate the effect of prophylactic indomethacin in babies born at 23-25weeks of gestational age.

Absence of relationship between serum cortisol and critical illness in premature infants

BackgroundInadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship...

Impact of Neonatal Counselling on Parental Stress in a Neonatal Intensive Care Unit: A Quasi-experimental Study

Introduction: There are various reasons for stress in the parents of infants admitted in Neonatal Intensive Care Unit (NICU) e.g., sickness, environment and communication with healthcare staff. An effective communication and structured counselling may help in alleviating the parental stress. Aim: To determine the impact of counselling in alleviating parental stress of the sick babies admitted in the NICU. Materials and Methods: This quasi-experimental study was conducted in NICU of a tertiary care hospital during April- September 2020. The babies with a Score for Neonatal Acute physiology with Perinatal Extension II (SNAPE II) score ≥7 at the time of admission were included. Either parent was counselled daily by physician in charge of the unit for at least one counselling session and more so depending on the clinical condition of the baby. The parental stress was evaluated on Parental Stressor Scale: NICU (PSS: NICU) scale at two time points: 24 hours after admission and subsequently after three to five days of counselling. This scale uses the stressor points in four domains (Physical environment, Infant behaviour and appearance, Parental role alteration and Parental relationships with the staff of the unit). Each item was rated on a 5-point Likert scale; 0 being least stress and 5 being maximum stress. The overall pre and post counselling scores were compared using t-test. Results: There were total 61 study subjects. The mean±SD gestational age and birth weight was 343/7±41/7 weeks and 2225±598 grams respectively for the neonates. The mean SNAPE II score was 27.7±18.76. There was significant reduction in cumulative score on PSS: NICU scale after counselling (7.41 to 3.55, p&lt;0.001). The results were also significant for individual domains. Conclusion: The structured daily counselling helps in ameliorating the parentral stress of sick babies admitted in NICU.

Prevalence and Outcomes of Congenital Heart Disease in Very Low Birth Weight Preterm Infants: An Observational Study From the Brazilian Neonatal Network Database.

To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants. Post hoc analysis of data from the Brazilian Neonatal Network database, complemented by retrospective data from medical charts and a cross-sectional survey. Twenty public tertiary-care university hospitals. A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017. None. The prevalence of congenital heart disease was 2.45% (95% CI, 2.20-2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11-2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73-2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43-0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21-0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55-0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22-2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03-2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13-2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41-4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used. The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.

The Value of Using an Acuity Score for Neonatal Nursing Research.

The Score for Neonatal Acute Physiology (SNAP) is a physiological-based illness severity tool developed in 1993, and since that time, it has been revised to include SNAP-II Perinatal Extension (SNAPPE-II) for mortality risk assessment and SNAP-II to assess severity of illness. The purpose of this methodologically based article is to provide an overview of SNAP methodology and then to critically evaluate the feasibility and utility of SNAP-II in neonatal nursing research. The SNAP-II scoring measure is parsimonious and has been utilized in a variety of retrospective and prospective medical research with good results; yet, it is not often employed in nursing studies. For research purposes, the required data are readily obtainable from medical records, calculations can be performed via computer to reduce errors, and the resultant score is parsimonious and reproducible. SNAP-II has some limitations, however, and additional research is needed to further refine the scoring system. This methodological article outlines the strengths and limitations of SNAP-II and recommends the use of a severity score to better describe research samples for clinical benchmarking and comparative research. There is extensive interest in validating acuity scores for appropriate patient assignments. Rather than having established ratios, often established by law, nurses are interested in measuring patient acuity and appropriately assigning ratios based on patient needs.

Perinatal factors associated with amplitude‐integrated electroencephalography abnormalities in preterm infants on the first day of life

ObjectiveEvaluate the association between perinatal factors and amplitude‐integrated electroencephalogram abnormalities in preterm infants on the first day of life. MethodsThis was a cross‐sectional study of 60 infants with gestational age between 23 and 32 weeks, without malformations. Infants were continuously monitored by amplitude‐integrated electroencephalogram on the first day of life, for at least 3h. The tracings were recorded and analyzed in each column for the following: burst‐suppression pattern, sleep‐wake cycle, and amplitude of the lower margin (<3μV or <5μV). The association of maternal complications, mode of delivery, birth weight, gestational age, neonatal sex, resuscitation procedures, hypothermia on admission, and the Score for Neonatal Acute Physiology, Perinatal Extension, Version II [SNAPPE‐II]) with amplitude‐integrated electroencephalogram alterations was assessed by multiple logistic regression. ResultsA discontinuous pattern occurred in 65% of infants, and a continuous pattern occurred in 23%. The burst‐suppression pattern was associated with vaginal delivery (OR: 7.6; 95% CI: 1.1–53.1) and SNAPPE‐II≥40 (OR: 13.1; 95% CI: 1.8–95.1). A lower margin of the amplitude‐integrated electroencephalogram of <3μV was also associated with SNAPPE‐II≥40 (OR: 10.6, 95% CI: 2.3–49.2), while a value <5μV was associated with lower GA (OR: 0.51, 95% CI: 0.34–0.76). There were no associations between the perinatal variables and the absence of a sleep‐wake cycle in amplitude‐integrated electroencephalogram recordings on the first day of life. ConclusionBiological variables and clinical severity are associated with electroencephalographic characteristics of preterm infants on the first day of life and should be considered in clinical practice when amplitude‐integrated electroencephalogram is performed.

Can Phase Angle in Newborns at Neonatal Intensive Care Units Be an Indicator of Mortality and Prognosis?

The bioelectrical impedance (BI) phase angle (PA), analyzed directly through BI analysis (BIA), is determined by tissue cellularity, representing a direct measure of cellular stability and, for this reason, has been studied and considered as an indicator of prognosis and nutrition status in adults and children. We aimed to determine if PA can be an indicator of mortality and prognosis in newborns admitted to the neonatal intensive care unit (NICU). Transversal study conducted at a public NICU in Curitiba, Paraná, Brazil. All newborns, preterm and term, were considered eligible for the study if admission to the NICU occurred by the first hour of life. The Score for Neonatal Acute Physiology II, as well as the Perinatal Extension version, were developed to assess the risk of mortality for all newborns, measured within 12hours of admission. BIA measurements were conducted using the tetrapolar BioScan Maltron 916, with single-frequency (50 kHz) tetrapolar BI. PA was calculated as the arc tangent: (Xc/R) x 180°/π. BIA was measured during the first 24hours of admission for all newborns (n = 93), repeated between 24 and 48hours (n = 79) and again after 7 days (n = 55), always when possible. PA measurements decreased in the first 48hours in premature newborns, particularly among those who died. The premature newborns also showed a significant decrease from the first to the last PA measurement (P = .001). In addition, whereas full-term newborns showed an increase of PA at 1week of life, preterm infants continued to have a decrease in values. For preterm newborns, PA measurements decreased and more sharply so for those who died. This result should be viewed with caution given the small number of deaths, but it should be investigated to understand the role of PA in the prognosis of NICU newborns. The absolute value of PA during the first 24hours of life was not a good marker for severity or mortality. However, the decrease of PA between different moments of evaluation was a good marker of severity. The decrease of PA in the first 48hours in premature newborns, and that when the decrease is more pronounced, may be indicative of mortality. The difference in PA values between these newborns is probably a significant variable for mortality and prognosis and not a cutoff value.

Evaluation of the clinical value of circulating miR-101, miR-187 and miR-21 in neonatal sepsis diagnosis and prognosis

BackgroundNeonatal sepsis is considered as a complicated syndrome, which requires urgent intervention to avoid the unfavorable outcome. Thus, biomarkers that can either distinguish sepsis early or predict sepsis outcome are of critical need. Therefore, the aim of the current study was to investigate the clinical value of miR-187, miR-101, and miR-21 on neonatal sepsis diagnosis and prediction of prognosis. Fifty neonates with sepsis, 30 neonates with SIRS, and 20 healthy neonates were selected. Relative expression levels of the selected miRNAs were quantified by qRT-PCR. Serum CRP and PCT were analyzed.ResultsmiR-101 and miR-187 expression levels were elevated in septic neonates compared with SIRS neonates and normal controls. The AUC of miR-101, miR-187, and PCT to predict sepsis diagnosis were 0.908, 789, and 0.856, respectively. miR-21 expression levels in non-survivors were significantly higher than in survivors. The AUC of miR-21, a score of neonatal acute physiology (SNAP-II), and PCT to detect the predictive mortality value were 0.793, 0.781, and 0.635, respectively. Survival analysis revealed that high miR-21 expression levels were related to low survival rates. miR-21 and SNAP II were independent risk factors for sepsis mortality, and the AUC of the two combined variables’ predictive probabilities was 0.926 and yielded a specificity of 91.2% and a sensitivity of 81.3%, which was higher than that of either miR-21 or SNAP II.ConclusionmiR-101 might function as a hopeful diagnostic biomarker for neonatal sepsis. Additionally, miR-21 gained attention to be a valuable predictor for sepsis prognosis especially if combined with SNAP II.

Predictive ability of neonatal illness severity scores for early death in extremely premature infants

Background The predictive ability of neonatal illness severity scores for mortality or morbidity in extremely premature infants has not been extensively studied. We aimed to evaluate the ability of neonatal illness severity scores [Clinical Risk Index for Babies II (CRIB II), Score for Neonatal Acute Physiology II (SNAP-II), and SNAP-Perinatal Extension II (SNAPPE-II)] in predicting mortality and short-term morbidity of extremely premature infants. Methods This retrospective study involved 171 infants with gestational age (GA) between 22 and 27 weeks who were admitted to the NICU during 2010–2017. Predictive ability of neonatal illness severity scores for mortality and short-term morbidity (bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, and gastrointestinal perforation) was assessed by comparing their area under the receiver operating characteristic curve. Results The overall mortality rate was 11.1%. Mortality at 23 weeks’ gestation was higher than that at 24–27 weeks’ gestation (p < .01, adjusted residual 4.5). Neonatal illness severity scores were significantly higher in infants who died than in those who survived (p < .01). CRIB II (AUC 0.93, 95% CI 0.85–1.00), SNAP-II (AUC 0.90, 95% CI 0.76–1.00), and SNAPPE-II (AUC 0.95, 95% CI 0.91–0.99) appeared to be excellent predictors and were superior to birth weight (AUC 0.88, 95% CI 0.80–0.95) or GA (AUC 0.84, 95% CI 0.72–0.96) alone in predicting early death (died on <28th postnatal day). CRIB II, SNAP-II, and SNAPPE-II were better predictors of early death than mortality in extremely premature infants. Neonatal illness severity score and short-term morbidity were not strongly associated. Conclusions The neonatal illness severity scores were excellent predictors of early death in extremely premature infants and might be useful for selecting extremely preterm infants who need intervention.

The effects of latency period in PPROM cases managed expectantly

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 240/7–346/7 weeks of gestation.Material and method: The study group consisted of 206 patients at 240/7–346/7 weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 240/7−286/7, 290/7−316/7, and 320/7−346/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3–7 days, 8–13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO2/FiO2 ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3–7-day latency period group. Total complications were significantly lower in the 290/7–316/7 week PPROM group in which the latency period was ≥14 days, compared to those in 3–7 days and 8–13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3–7 days and 8–13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 240/7–286/7, and 11.0 days between weeks 290/7–316/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.