Severe Asphyxia Research Articles

Analysis of the effect of intensive therapy of premature infants on the development of neonatal retinopathy

Retinopathy of prematurity is one of the most severe diseases that lead to permanent blindness from early childhood. The frequency of retinopathy of prematurity in neonatology closely correlates with the degree of maturity of the child’s body.Goal. To conduct a analysis of the correlation of the degree of oxygenation, the number of blood transfusions with the severity of progressive retinopathy in newborns. The study included 40 premature infants diagnosed with retinopathy of newborns who were being treated in the neonatal intensive care unit. Conducted: clinical and diagnostic examination of patients; analysis of the dependence of the degree of oxygenation, the number of blood transfusions, gestational age, inotropic support and the severity of retinopathy.Materials and methods. Out of 40 patients diagnosed with neonatal retinopathy, 6 children were operated on.Results and discussion. The study showed that all the operated children were born at a gestation period of less than 29 weeks, were treated with antibacterial and inotropic drugs. There was no direct relationship between the number of blood transfusions and the risk of developing a severe form of the disease with further surgical treatment. In 40% of cases, children who developed retinopathy of stages 1 and 2 did not receive transfusion of erythrocyte suspension at all. At the treatment stage, all operated patients received a gas-air mixture with an oxygen content above 45%, as well as inotropic and vasopressor support with epinephrine and norepinephrine. Statistical analysis has shown that the number of blood transfusions is not the leading factor in the decision to refer a child for surgery. Among children with a gestation period of less than 29 weeks, retinopathy of varying severity was found in all infants; in the group of children aged 30–35 weeks, the disease developed only in 45% of patients.Conclusion. The conducted studies have shown that the parameter number of hours spent using IVL (the parameter artificial lung ventilation) is informative, and parameters such as weight and gestational age are significant.It is necessary to note the importance of additional parameters. Among the operated children, the condition of severe asphyxia was suffered by 45.5% of children in group A, in Weight groups severe asphyxia was in 28% of cases. Statistical analysis showed that children who required surgical treatment received catecholamine therapy at the initial stages. The most unfavorable percentage of oxygen supplied with the air mixture starts from 40–45%. The children who required surgical treatment received catecholamine therapy at the initial stages.

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

Neurodevelopmental outcome of babies with moderate to severe birth asphyxia with hypoxic ischemic encephalopathy treated with and without therapeutic hypothermia followed up till 6-24 month of age at tertiary care hospital of Southern Rajasthan

hypoxic ischemic encephalopathy. There are very few studies comparing the neurodevelopmental outcomes in neonates with moderate to severe HIE who received and not received TH. Objective was assessment of neurodevelopmental outcome between TH and non-TH group till last follow-up. Methods: Hospital Based Prospective study. All term neonates with Moderate to severe birth asphyxia with HIE who received TH and not received TH, admitted in NICU of BalChikitsalay, RNTMC, Udaipur, consenting for the study were followed up at age 3-6 month, 6-12 month, 12-18 month and 18-24 month from September 2018 to February 2021 and neurodevelopment outcome was assessed. Results: 70 neonates with birth asphyxia HIE II / III were included in the study, 35 in TH group and 35 in non-TH group. Out of 70 babies enrolled 46 (65.7%) were having normal development and 24 (34.3%) were having development delay. Out of 46 who were having development delay 6 (17.4%) were of TH group and 18 (51.4%) were of non-TH group. Most of the babies of TH group i.e., 30 (85.7%) were neurodevelopmentally normal and 5 (14.3%) were having some neurodevelopmental abnormality. In non-TH group 15 (42.8%) were normal and 20 (57.2%) were having some neurodevelopmental abnormality. Conclusions: Results of the study showed significantly better outcome in infant who received therapeutic hypothermia than those who did not.

Effect of Intravenous Magnesium Sulphate on in-Hospital Mortality in Neonates with Perinatal Asphyxia: A Prospective Cohort Study

Background: Early neonatal deaths in Pakistan account for 7% of global neonatal mortality rate, with perinatal asphyxia being responsible for 23% of these cases. Controversy exists in the literature regarding role of magnesium sulphate administration on reducing in-hospital mortality in newborns with perinatal asphyxia.
 Objectives: To determine the effect of intravenous magnesium sulphate on in-hospital mortality in neonates with perinatal asphyxia.
 Methods: This prospective cohort study was conducted at the Department of Pediatric Medicine, Nishtar Hospital Multan over a period of six months from January 2022 to June 2022. A total of 183 consecutive full-term neonates, weighing ≥ 2500 grams, with Apgar score < 7 at 5-minutes after birth, presenting within 48-hours of life were included in the study. Neonates presenting within 6-hours after birth received intravenous magnesium sulphate (MgSO4) – exposed group and neonates presenting after 6-hours did not get MgSO4 – unexposed group. Baseline characteristics and survival outcome was recorded. Binary logistic regression analysis was run and Kaplan-Meier survival curve is constructed for the assessment of mortality.
 Results: There were 90 neonates in exposed group and 93 in unexposed group. Males constituted 53% of the study population. Overall mortality rate was 15.8% (n=29). Severe asphyxia (RR 8.5, 95% CI 4.0 – 18.0; p < 0.001) and spontaneous vaginal delivery (RR 1.8, 95% CI 1.1 – 2.9; p = 0.02) were the independent predictors of mortality. Mortality (7.8% vs. 23.6%, p-value 0.003) was significantly higher in unexposed group compared to exposed group. In exposed group the median survival time was 16 days (95% CI- 8.7 – 23.3) compared to 11 days (95% CI 9.9 – 12.0) in unexposed group (Log-rank test: χ2 = 6.03, df -1, p = 0.01). 
 Conclusion: Magnesium sulphate was effective in lowering neonatal mortality due to moderate-severe perinatal asphyxia. In order to further validate its impact on mortality, multi-center studies are suggested.

Сепсис-асоційоване ураження нервової системи в передчасно народжених дітей із дуже малою масою тіла

The immaturity of the organs and systems of preterm born children significantly complicates the differentiation between physiological and pathological changes in the brain. The etiology of brain damage in premature babies is complex and multifactorial, and even with the most favorable course of the neonatal period, they require additional respiratory support, a large number of invasive medical interventions and have a high risk of infectious complications. Sepsis-associated encephalopathy (SAE) is defined as diffuse or multifocal cerebral damage that is caused by a systemic response to infection even without clinical or laboratory evidence of direct brain infection. Purpose - to determine the clinical features of sepsis-associated brain damage in prematurely born children <32 weeks gestation with a birth weight <1500 g. Materials and methods. 38 prematurely born children, who were divided into two groups, were examined. The Group I (n=14) included children who were diagnosed with sepsis in the early neonatal period. The Group II (n=24) included prematurely born, in which no septic lesions were observed. Results. Children of both groups were born in a state of severe and moderate asphyxia. Analysis of associations between maternal, obstetric, and antenatal factors showed a significant prevalence of such factors as prelabor rupture of membranes, сervical weakness, rupture of the fetal bladder, and placement of an obstetric pessary in children with sepsis. All children with sepsis had pneumonia, acute kidney injury, and brain injury in the neonatal period. In the neurological status of children with very low birth weight who underwent SAE, the seizure syndrome, 3-4 grade intraventricular hemorrhages, periventricular leukomalacia, complications in the form of post-hemorrhagic ventriculomegaly were significantly more common. Conclusions. In children with very low birth weight who underwent SAE, convulsive syndrome, 3-4 grade intraventricular hemorrhages, and periventricular leukomalacia were significantly more common. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Newborn asphyxia: features of the course of pregnancy and delivery and the structure of the placenta

BACKGROUND: The main cause of early neonatal death is neonatal asphyxia. Asphyxia transferred during childbirth can lead to damage of the brain, respiratory disorders, hemodynamic disorders, and impaired renal function.
 AIM: The aim of the study is to determine the factors predisposing to the birth of a child in a state of asphyxia.
 MATERIALS AND METHODS: A retrospective study was conducted, which included the analysis of medical records of 11,662 women who gave birth at the Perinatal Center of the Saint Petersburg State Pediatric Medical University (level IIIB obstetric institution), whose pregnancy ended in urgent delivery. The main group included patients who gave birth to full-term babies in a state of moderate and severe asphyxia (n = 70), the control group included patients who gave birth to children without asphyxia (n = 11,592).
 RESULTS: Factors predisposing to the birth of a full-term baby in a state of moderate and severe asphyxia were identified, which can be used to develop a system for predicting the birth of a child in a state of asphyxia and a set of preventive measures.
 CONCLUSIONS: More frequent ascending infection of stage II and III makes it necessary to timely identify and treat a bacterial infection in all full-term pregnant women. A prognostic model for the birth of a full-term baby in a state of asphyxia has been constructed. Women at risk should undergo an additional examination at 37 weeks of pregnancy: sowing from the cervical canal for flora and sensitivity to antibacterial drugs to identify pathogenic and opportunistic microflora, childbirth should be carried out under mandatory constant monitoring control.

Myocardial dysfunction in newborns with severe birth asphyxia

Background: Severe birth asphyxia is one of the leading causes of mortality and morbidity in developing countries like India. Severe birth asphyxia can result in transient myocardial ischemia, myocardial dysfunction, and cardiac failure. Aims and Objectives: The current study was undertaken for a better understanding of myocardial dysfunction with the help of serum levels of CPKMB and their correlation with mortality. Materials and Methods: It was a prospective observational study. We studied 150 newborns with severe birth asphyxia admitted to be SNCU of Maharaja Yashwantrao Hospital Indore from August 2021 to July 2022 after clearance from the Institutional Ethics Committee and informed parental consent. Results: A total of 150 newborns with severe birth asphyxia were enrolled. Nearly 75% were males, and 25% were females. Most of the mothers (80%) were multigravidas. Antenatal complications were present in 85.33% of cases. Amniotic fluid was meconium stained in 73.33%, and fetal distress was present in 72.70%. CPKMB was deranged in 93%, and the ejection fraction was reduced in 53%. Out of the total 150 cases, 72 died, with levels of CPKMB elevated in 70 cases and ejection fraction reduced in 62 cases. Conclusion: We conclude that serum CPKMB levels rise early before ejection fraction is reduced and can help us identify myocardial dysfunction early. There is a statistically significant association between CPKMB, ejection fraction, and mortality in babies with severe birth asphyxia. Cardiac-specific enzyme CPKMB helps in the early recognition of myocardial dysfunction, and there is significant correlation with neonatal mortality.

Ischemia-Modified Albumin and Antioxidant Protection in Newborns with Asphyxia of Varying Severity.

The content of ischemia-modified albumin (IMA), serum albumin, and antioxidant capacity of blood serum was studied in healthy newborns and in newborns with moderate and severe asphyxia on days 1-2 and 3-4 of the postnatal period. Changes in these indicators were found in both groups of newborns with birth asphyxia in comparison with the group of healthy newborns and were more pronounced in children with severe asphyxia. An increase in the IMA level (by 1.6 times; p<0.001) and antioxidant capacity of blood serum (by 2.4 times; p<0.001) and a decrease in serum albumin content (by 1.5 times; p<0.001) were found in severe asphyxia on days 1-2. Analysis of changes in these indicators by days 3-4 allows to talk about a decrease in the intensity of free-radical reactions in newborns with birth asphyxia during complex therapy.

Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death A Randomized Clinical Trial

ABSTRACT Sepsis is a leading cause of neonatal mortality, and rates have not decreased in recent years despite medical advances. Azithromycin has been shown in previous research to be effective in reducing infection and sepsis; in particular, a recent study showed that administration of the drug during labor reduced gram-positive bacteria over the next 4 weeks, along with reduced disease in mothers and newborns. This study was designed to assess the effectiveness of azithromycin administered during labor in reducing instances of neonatal sepsis and mortality. The primary outcome for this study was neonatal sepsis or death within the first 28 days of life. Deaths that were identifiably due to severe birth asphyxia, low birth weight, and severe congenital malformations were excluded. Secondary outcomes included neonatal sepsis, neonatal mortality, culture-confirmed sepsis, fever, skin infections, bacterially confirmed skin infections, conjunctivitis, umbilical infection/omphalitis, malaria, prescribed antibiotics, and hospitalization. Secondary outcomes for parents included postpartum sepsis, bacterially confirmed postpartum sepsis, mastitis, malaria, puerperal fever, prescribed antibiotics, hospitalization, and mortality. The final analysis included 11,625 parents and 11,783 neonates; baseline characteristics between the azithromycin and placebo groups were not significantly different. Of the total sample, 225 instances of neonatal sepsis or death occurred. The incidence of either mortality or sepsis was similar between groups (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.80–1.38; P = 0.70), as well as the individual outcomes of mortality (OR, 1.05; 95% CI, 0.70–1.60; P = 0.80) and sepsis (OR, 1.02; 95% CI, 0.74–1.40; P = 0.92). Incidence of neonatal skin infections (P &lt; 0.001), bacterially confirmed skin infections (P = 0.003), and need for antibiotics (P &lt; 0.001) were all significantly reduced in the azithromycin group. Azithromycin reduced instances of both mastitis (P = 0.04) and puerperal fever (P = 0.04), but there were no other significant differences between groups. These results indicate no effect of azithromycin on neonatal sepsis or mortality. There were reductions in some instances of infection in both parents and newborns, specifically newborn skin infections, but there was no effect on the primary outcome. These results are in contrast to the previous proof-of-concept trial that showed azithromycin to reduce the amount of gram-positive bacteria carried by mothers and infants. Recent studies from different countries have found some conflicting results in longer-term outcomes, but the differing time periods limit comparison of results. This study was limited by underestimation of incidence of infections due to follow-up design, as well as slight differences between the 2 countries involved in the study. Overall, the results of this analysis do not support a change in clinical practice to introduce azithromycin to prevent neonatal sepsis and mortality.

The left ventricle in well newborns versus those with perinatal asphyxia, haemodynamically significant ductus arteriosus or fetal growth restriction.

Hemodynamic changes accompanying the initial breaths at the time of birth are especially important for a smooth transition of fetal to neonatal circulation. Understanding the normal transitional physiology and the clinical impact of adverse adaptation is important for delineating pathology so as to guide physiologically relevant therapies. Disorders such as severe perinatal asphyxia, hemodynamically significant patent ductus arteriosus (and its surgical ligation) and utero-placental insufficiency underlying fetal growth restriction, can adversely affect left ventricular (LV) function. The left ventricle is the predominant chamber involved in systemic perfusion during postnatal life. Cardiac output is closely linked to afterload; the latter is determined by arterial properties such as stiffness and compliance. This article outlines normal transition in term and preterm infants. It also highlights the adverse impact of three not uncommon neonatal disorders on LV function. Perinatal asphyxia leads to a reduced LV output, superior vena cava and coronary artery blood flow and an increase in the troponin level. Multiple haemodynamic changes are observed in the premature infant with a large patent ductus arteriosus. They need careful analysis to determine when ligation should proceed. Ligation itself generally results in a dramatic increase in afterload which may lead to a reduction in LV contractility and the need for ionotropic support. Fetal growth restricted infants have a higher systolic pressure, a somewhat hypertrophied heart arising from an increased arterial wall thickness/stiffness and systemic peripheral resistance. Point of care ultrasound (POCUS) helps differentiate normal transition and that resulting from neonatal disorders. It may be increasingly utilized in guiding management.

Treatments and outcomes of neonatal disseminated intravascular coagulation with and without neonatal asphyxia: A retrospective study using nationwide data in Japan

Although neonatal disseminated intravascular coagulation (DIC) is associated with high mortality and severe complications, few studies have reported its clinical course. We aimed to describe the characteristics, treatments, and outcomes of neonatal DIC by using a national inpatient database. Using the Japanese Diagnosis Procedure Combination database, we identified 5533 patients with neonatal DIC who were admitted to neonatal intensive care units between July 2010 and March 2020. We categorized the patients into those with asphyxia (n=2911) and those without asphyxia (n=2622). We investigated the patient characteristics, treatments, and outcomes. We further categorized neonates with asphyxia according to its severity. The gestational age of neonates with asphyxia was significantly lower than that of neonates without asphyxia (P<0.001). Antithrombin was most commonly used for DIC (40%). Neonates with asphyxia were more likely to receive antithrombin (43% vs. 38%; P<0.001), recombinant human soluble thrombomodulin (28% vs. 20%; P<0.001), and fresh frozen plasma transfusion (68% vs. 51%; P<0.001) than those without asphyxia. Neonates with asphyxia had higher in-hospital mortality (17% vs. 10%; P<0.001), severe bleeding (11% vs. 6.8%; P<0.001), and hospitalization costs than those without asphyxia. Additionally, neonates with severe asphyxia were more likely to receive several DIC therapies (such as recombinant human soluble thrombomodulin [30% vs. 24%]) and had higher in-hospital mortality (19% vs. 11%) and hospitalization costs than those with mild asphyxia. In this large retrospective study of neonatal DIC, patients with asphyxia received several treatments and demonstrated unfavorable outcomes when compared to those without asphyxia.

Causes of Neonatal Morbidity and Mortality in Bingham University Teaching Hospital, Jos, Plateau State, Nigeria

Introduction: Neonatal morbidity and mortality continue to be serious public health issues in developing countries, where it also has a considerable impact on the under-five mortality rate.&#x0D; Aims: To determine the causes of morbidity and mortality in neonates admitted to the inborn Special Care Baby Unit (SCBU) at Bingham University Teaching Hospital (BHUTH), Jos.&#x0D; Study Design: Cross Sectional Descriptive study.&#x0D; Place and Duration of Study: Inborn Neonatology Unit of the Department of Paediatrics, Bingham University teaching Hospital, Jos, Plateau State, Nigeria.&#x0D; Methodology: A retrospective analysis of the records of all the babies admitted into the inborn SCBU of BHUTH over an 18-month period of January 2021 to June 2022 was done. We included 195 babies (99 males, 96 females)&#x0D; Results: A total of 196 patients were admitted into the inborn SCBU of BHUTH during the period reviewed and 195 (99.5%) had complete records. There were 99 (50.8%) males and 96 (49.2%) females with M: F of 1.03:1. The leading causes of admission were prematurity (51.3%), asphyxia (21.5%) and neonatal jaundice (10.8%). Nine (4.6%) infants had severe birth asphyxia, while 33 (16.9%) had moderate birth asphyxia. Twenty-eight deaths were recorded over the 18-month period giving a mortality rate of 14.4%. Prematurity (71.4%) and severe birth asphyxia (17.9%) were the leading causes of death. Of all the deaths that occurred, 9 (32.1%) occurred within the first 24 hours of hospitalization, while 3 (10.7%) of them died after 7 days of admission.&#x0D; Conclusion: In our community, the neonatal mortality rate is still very high. This death rate can be decreased with the support of concerted efforts to guarantee appropriate antenatal care, close monitoring of labour, and enhanced neonatal unit facilities for newborn care.

Clinical Factors Predicting Disseminated Intravascular Coagulation (DIC) in Women With Placental Abruption and a Live Fetus.

We examined predicting factors other than blood test results for disseminated intravascular coagulation (DIC) in patients with placental abruption and a live fetus who were transported by ambulance to our institute. We reviewed the obstetric records of 60 singleton deliveries between January 2006 and December 2018. In this study, we excluded four cases with fetal demise at the time of transportation. In the other 56 cases, therefore, emergency cesarean section was performed at the time of diagnosis of placental abruption. Of the 56 cases, 12 cases were complicated by DIC (21.4%). Therefore, clinical risk factors leading to DIC other than intrauterine fetal demise (IUFD) were retrospectively examined with the remaining 44 cases set as control (78.6%). In evaluation with multivariate analysis, severe neonatal asphyxia (neonatal Apgar score <4 at 1 minute: adjusted odds ratio 2.89, p <0.01 and umbilical artery pH <7: adjusted odds ratio 4.01, p <0.01) was an independent risk factorfor DIC, while short time interval from the onset to delivery (<1 hour; adjusted odds ratio 0.195, p = 0.04) was an independent negative risk factor for DIC. Severe neonatal asphyxia was a risk factorfor DIC in cases of placental abruption in those transported by ambulance with surviving singleton fetuses, while a short time interval from the onset to delivery was a negative risk factor for DIC.

Clinical analysis of 31 cases of fetal umbilical artery thrombosis

Objective: To analyze the ultrasonic manifestations, clinical features, high risk factors and key points of pregnancy management in prenatal diagnosis of umbilical artery thrombosis (UAT). Methods: The data of 31 pregnant women of UAT diagnosed by prenatal ultrasonography and confirmed after birth from July 2017 to July 2022 at the Women's Hospital, Zhejiang University School of Medicine were retrospectively analyzed, including the maternal characteristics, pregnancy outcomes and fetal complications. In addition, the baseline data and pregnancy outcomes were compared in 21 patients who continued pregnancy after diagnosis of UAT. Of the 21 UAT cases that continued pregnancy, 10 cases were treated with low molecular weight heparin (LMWH; LMWH treatment group), while the other 11 patients had expectant treatment(expectant treatment group). Results: The age of the 31 pregnant women was (30.2±4.7) years, of which 5 cases (16%,5/31) were advanced age pregnant women. The gestational age at diagnosis was (32.9±4.0) weeks, and the gestational age at termination of pregnancy was (35.6±2.9) weeks. In 31 fetuses with UAT, 15 cases (48%) had fetal distress, 11 cases (35%) had fetal growth restriction, and 3 cases (10%) had intrauterine stillbirth. There were 28 cases of live births, including 26 cases by cesarean section and 2 cases by vaginal delivery. There were also 3 stillbirths, all delivered vaginally. Four neonates had mild asphyxia and two newborns had severe asphyxia. Among the 31 cases, 10 cases were terminated immediately after diagnosis, the gestational age at diagnosis was (35.9±2.9) weeks. Another 21 pregnancies continued, and their gestational age at diagnosis was (31.4±3.7) weeks. The median prolonged gestational age in LMWH treatment group was 7.9 weeks (4.6-9.4 weeks), and all were live births. The median prolonged gestational age in the expectant treatment group was 0.6 weeks (0.0-1.0 weeks), and 2 cases were stillbirths. There was a statistically significant difference in prolonged gestational age (P=0.002). Conclusions: Ultrasound is the preferred method for prenatal detection of UAT. Clinicians need to be vigilant for UAT when a newly identified single umbilical artery is detected by ultrasound in the second or third trimesters. The decision to continue or terminate the pregnancy depends on the gestational age and the condition of fetus. Attention should be paid to fetal movements as the pregnancy continues. The treatment of LMWH as soon as possible after diagnosis of UAT may improve the pregnancy outcome.

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study.

Induction of labour has remained one of the most valuable interventions in obstetric practice. Over the years, the proportion of women undergoing induction of labour (IOL) has been on a steady increase. The significance to obstetrics practice as well as its maternal and perinatal outcomes are sacrosanct, hence the need for its periodic review. To determine the obstetric outcomes of induction of labour. A five-year retrospective study of all cases of induction of labour at the maternity unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between January 1st 2017 and 31st December 2021. The labour ward's records were assessed to determine the total number of women who had induction of labour during the study period. Women whose case files could be not retrieved were excluded. The folder numbers of the patients were extracted and their case files retrieved from the medical records department of the hospital. The primary outcomes measures were the indications and the methods of induction of labour, while the secondary outcome measures were the mode of delivery, cause of failed induction, and the perinatal outcome. Data were obtained using proformas and analysed using statistical packages for social sciences (SPSS) version 26.0 IBM corporation. A total of 3,638 deliveries were taken during the period under review and 168 patients had induction of labour giving an overall prevalence of 4.6% (46/1000 deliveries). Induction of labour was successful in 71.2% of cases. Misoprostol was used in 90.4% of cases as an induction agent. The commonest indication for induction of labour was postdate pregnancy (53.8%). Failed induction was due to fetal distress, poor progress of labour from cephalopelvic disproportion/malposition and failed cervical ripening. In about 72% of deliveries, there was good perinatal outcome, 10.3% of babies had moderate to severe asphyxia while 1.3% had neonatal death. Induction of labour is a safe and beneficial procedure in obstetrics. However, it can be associated with adverse obstetric outcomes.

Comparative study of neonatal brain injury fetuses using machine learning methods for perinatal data

ObjectiveCTG is used to record the fetus's fetal heart rate and uterine contraction signal during pregnancy. The prenatal fetal intrauterine monitoring level can be used to evaluate the fetal intrauterine safety status and reduce the morbidity and mortality of the perinatal fetus. Perinatal asphyxia is the leading cause of neonatal hypoxic-ischemic encephalopathy and one of the leading causes of neonatal death and disability. Severe asphyxia can cause brain and permanent nervous system damage and leave different degrees of nervous system sequelae. MethodsThis paper evaluates the classification performance of several machine learning methods on CTG and provides the auxiliary ability of clinical judgment of doctors. This paper uses the data set on the public database UCI, with 2126 samples. ResultsThe accuracy of each model exceeds 80%, of which XGBoost has the highest accuracy of 91%. Other models are Random tree (90%), light (90%), Decision tree (83%), and KNN (81%). The performance of the model in other indicators is XGBoost (precision: 90%, recall: 93%, F1 score: 90%), Random tree (precision: 88%, recall: 91%, F1 score: 89%), lightGBM (precision: 87%, recall: 93%, F1 score: 90%), Decision tree (precision: 83%, recall: 86%, F1 score: 84%), KNN (precision: 77%, recall: 85%, F1 score: 81%). ConclusionThe performance of XGBoost is the best of all models. This result also shows that using the machine learning method to evaluate the fetus's health status in CTG data is feasible. This will also provide and assist doctors with an objective assessment to assist in clinical diagnosis.

The Main Casual Factors Associated with The Incidence of Asphyxia Neonatorum

Background: Asphyxia is the second most common cause of neonatal death after babies with low birth weight (LBW). The factors that can cause asphyxia include preeclampsia, premature birth, prenatal anemia, antepartum bleeding and premature rupture of membranes. Purpose: This study aimed to determine the main causative factors associated with the incidence of asphyxia neonatorum at RSUP Dr. M. Djamil Padang in 2021. Methods: This research was a quantitative research with an analytic approach with a cross sectional design, was conducted in the Medical Record Sub-Division of RSUP Dr. M. Djamil Padang in December 2022. The sample in this study were babies who were diagnosed with asphyxia totaling 132 people obtained by total sampling technique. Collection data were taken from patient medical records and analyzed univariately, bivariately (test chi square), and multivariate (logistic regression analysis) with 95% CI. Results: The result showed that 77.3% of patients had moderate asphyxia. The result of this study showed that majority of patients with severe asphyxia with preeclampsia mothers 60.0% (p=0.001), premature birth 76,7% (p=0.044), anemia mothers 53,3% (p=0.035), did not experience antepartum hemorrhage 83,3% (p=0.390), and premature rupture of membranes 73,3% (p=0.000). The most dominant factor was premature rupture of membranes with OR=34.988). Conclusion: It was concluded that there was a relationship between preeclampsia, premature birth, prenatal anemia, premature rupture of membranes, and there was no relationship between antepartum bleeding and neonatal asphyxia. The factor that has the most dominant influence on the incidence of neonatal asphyxia is premature rupture of membranes. Suggestions for health workers to maintain and improve services to patients, especially asphyxia neonatorum.

Перинатальні наслідки інноваційної тактики лікування звичного невиношування вагітності при істміко-цервікальній недостатності

Purpose - to improve the effectiveness of the treatment of miscarriage due to isthmic-cervical insufficiency (ICI) by using improved management tactics for women at high risk of ICI. Materials and methods. A two-stage innovating tactic for the treatment of miscarriage caused by ICI was proposed, including the prediction of the ineffectiveness of vaginal cerclage and the implementation of transabdominal cerclage in certain groups of patients. Starting from the pregravid stage, 30 women at risk of ICI were examined, which were conducted according to the developed scheme. 2 patients with a history of failed vaginal cerclage had abdominal cerclage prior to pregnancy and had not yet become pregnant at the time of writing. In 28 remaining women, the course and results of pregnancy were monitored. 3 patients after trachelectomy for cervical cancer were given abdominal cerclage in early pregnancy. 23 pregnant women were subjected to vaginal cerclage prophylactically or for sonographic or physical indications, these women constituted the main group for evaluating the effectiveness of the proposed treatment regimen for miscarriage in ICI. The comparison group consisted of 80 women with intravaginal cerclage, who were managed according to the protocols of the Ministry of Health of Ukraine. Results. The effectiveness of the proposed tactics for the treatment of miscarriage caused by ICI reflects the frequency of miscarriage and its structure. No cases of late miscarriages were observed. The rate of preterm birth significantly decreased from 37.5% to 21.7% (p&lt;0.05), while no cases of early preterm birth (before 28 weeks) were observed. In the structure of miscarriage, 80.0% is the proportion of preterm births at 34-36 weeks of gestation (against 35.5%; p&lt;0.05). The frequency of premature rupture of membranes decreased by 4 times (8.7% vs. 36.3%; p&lt;0.05). The frequency of birth of children in a state of asphyxia decreased by more than 2 times (17.4% vs. 43.4%; p&lt;0.05), and there was not a single case of birth in a state of severe asphyxia. The incidence of complications in the early neonatal period decreased by 20% (43.5% vs. 63.2%; p&lt;0.05), mainly due to a decrease in the frequency of such dangerous complications as respiratory distress syndrome (13.0% vs. 31.6%; p&lt;0.05) and disorders of central nervous system (17.4% vs. 44.7%; p&lt;0.05). Conclusions. The use of the proposed tactics for the treatment of miscarriage caused by CI made it possible to significantly reduce the frequency of miscarriage and improve its structure, avoid cases of spontaneous miscarriages and neonatal deaths, improve the condition of newborns, which makes it possible to recommend the introduction of this tactic in the practical work of obstetric and gynecological institutions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Adverse Effects of Topiramate in Neonate with Moderate to Severe Perinatal Asphyxia: A Randomized Controlled Trial

Introduction: A harmful pregnancy condition that harms both the mother and the fetus is perinatal asphyxia. It frequently happens as a result of challenges during labour, including protracted or challenging delivery, concerns with the umbilical cord, placental abnormalities, or maternal health conditions. Topiramate, an anticonvulsant, works through a variety of different methods. Topiramate looks to be effective as a neuroprotective agent as well as an anti-seizure medication in animal models of newborn brain injury. Angiogenesis, neurogenesis, and neuronal anti-apoptotic pathways are all stimulated and regulated by topiramate. In light of this, this observational study was conducted to ascertain Topiramate's negative consequences in kids with mild to moderate neonatal hypoxia. Methods: This observational case-control study was carried out in the Neonatal ward and ICU of Dhaka Shishu Hospital from April 2015 to March 2016. A total of 64 neonates were enrolled in this study and were assigned Group A -the interventional group (n=32) received topiramate and standard treatment protocol, and Group B or the control group (n=32) received only standard treatment protocol. The data were analyzed according to standard procedure. Results: Among the study neonates, based on sex in case and control groups, respectively, seventeen (17,53%) and twenty-one (21,66%) neonates were male, and fifteen (15,47%) and eleven (11,44%) neonates were female. Statistically, the sex distribution between groups was not significant (p=0.44). USG finding of the neonates after treatment was normal in 12 (48%) and 13(41%), and abnormal in 20(32%) and 19 (59%) neonates in the control and case groups, respectively. Out of 27 neonates in the control group, 11 (41%) were neurologically normal, and 16 (59%) had abnormal neurological findings. Out of 29 neonates in the case group, 24 (73%) were neurologically normal, and 5(17%) showed abnormal neurological findings. Statistically, significant variation ..

Improved neonatal outcomes by multidisciplinary simulation-a contemporary practice in the demonstration area of China.

Simulation-based training improves neonatal resuscitation and decreases perinatal mortality in low- and middle-income countries. Interdisciplinary in-situ simulation may promote quality care in neonatal resuscitation. However, there is limited information regarding the effect of multidisciplinary in-situ simulation training (MIST) on neonatal outcomes. We aimed to investigate the impact of MIST on neonatal resuscitation in reducing the incidence of neonatal asphyxia and related morbidities. Weekly MIST on neonatal resuscitation has been conducted through neonatal and obstetrical collaboration at the University of Hong Kong-Shenzhen Hospital, China, since 2019. Each simulation was facilitated by two instructors and performed by three health care providers from obstetric and neonatal intensive care units, followed by a debriefing of the participants and several designated observers. The incidence of neonatal asphyxia, severe asphyxia, hypoxic-ischemic encephalopathy (HIE), and meconium aspiration syndrome (MAS) before (2017-2018) and after (2019-2020) the commencement of weekly MIST were analyzed. There were 81 simulation cases including the resuscitation of preterm neonates of different gestational ages, perinatal distress, meconium-stained amniotic fluid, and congenital heart disease with 1,503 participant counts (225 active participants). The respective incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS decreased significantly after MIST (0.64%, 0.06%, 0.01%, and 0.09% vs. 0.84%, 0.14%, 0.10%, and 0.19%, respectively, all P < 0.05). Weekly MIST on neonatal resuscitation decreased the incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS. Implementation of regular resuscitation simulation training is feasible and may improve the quality of neonatal resuscitation with better neonatal outcomes in low- and middle-income countries.