Significant Differences In Neonatal Morbidity Research Articles

Effect of Oropharyngeal Administration of Colostrum in Premature Newborns ≤32 Weeks of Gestation on the Immune Response and Neonatal Morbidity: A Double-Blind Randomized Clinical Trial

IntroductionThe mother's colostrum carries immunological components, such as cytokines and immunoglobulins (Igs), derived from the maternal circulation with bacteriostatic properties.ObjectiveThe objective of this study was to evaluate the effect of oropharyngeal administration of colostrum (OPAC) vs. placebo in the first 4 days of life in premature newborns ≤32 weeks of gestation on serum Ig concentration, neonatal morbidity, and total days of hospitalization.HypothesisThe OPAC increases serum Igs and decreases morbidity and total days of hospitalization.Materials and MethodsA double-blind randomized controlled trial was carried out. Participants were randomly assigned to one of the two groups, namely, group 1: placebo (P) (n = 50) and group 2: colostrum (C) (n = 46). A blood sample was obtained at baseline and 7 and 28 days of life to quantify immunoglobulin G (IgG), immunoglobulin A (IgA), and IgM. Results: The C group showed an increase in serum IgA on day 28 expressed as median and [interquartile range]; C: 25 [12–35] vs. P: 11 [8–18], p < 0.001. There were no significant differences in neonatal morbidity. Newborns in the colostrum group showed the completed enteral feeding earlier (days), C: 13.9 ± 7 vs. P: 17.4 ± 8.4, p < 0.04; they reached the birth weight earlier, C: 10.9 ± 2.8 vs. P: 12.9 ± 4, p < 0.01, and had less days of hospitalization, C: 60.2 ± 33.8 vs. P: 77.2 ± 47.3, p < 0.04. Neonatal mortality was lower in the colostrum group than the placebo group 0% vs. 12%, respectively, without a statistical difference (p = 0.06).ConclusionIn premature newborns ≤32 weeks of gestation, the OPAC within 4 days after birth increases serum IgA concentration at day 28 compared to placebo. Similarly, OPAC decreased the days to complete enteral feeding and reach the birth weight and total days of hospitalization.Clinical Trial Registration[https://clinicaltrials.gov/ct2/show/NCT03578341], identifier: [NCT03578341].

Neonatal morbidity among African refugee women in Israel: a case–control study

ObjectivesReports on neonatal morbidity (NM) among refugees in developed countries remain inconsistent. We aimed to compare NM among infants of African refugees in Israel to the native population based on...

Impact of free newborn care service package on out of pocket expenditure\u2010evidence from a multicentric study in Nepal

BackgroundSustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal.MethodsMinistry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period.ResultsA total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented.ConclusionsWe found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal.Trial registrationISRCTN- 30829654, Registered on May 02, 2017.

Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

A previously created and validated calculator provides an individualized cesarean delivery risk score for women undergoing labor induction. A higher predicted risk of cesarean delivery on the calculator has been associated with increased maternal and neonatal morbidity regardless of ultimate delivery mode. The effect of this calculator when implemented in clinical care has yet to be evaluated. To determine whether implementation of a validated calculator that predicts the likelihood of cesarean delivery at the time of labor induction is associated with maternal morbidity and birth satisfaction. This prospective cohort study used medical record review to compare the 1 year before calculator implementation (July 1, 2017, to June 30, 2018) with the 1 year after implementation (July 1, 2018, to June 30, 2019) at a US urban, university labor unit. Women admitted for labor induction with singleton gestation in cephalic presentation, intact membranes, and an unfavorable cervix were included. Data were analyzed from August 1, 2019, to September 13, 2020. Patient and clinician knowledge of the calculated cesarean delivery risk score based on the validated calculator. The primary outcomes were (1) composite maternal morbidity defined by at least 1 of the following within 30 days of delivery: endometritis, postpartum hemorrhage (estimated or quantitative blood loss >1000 mL), blood transfusion, wound infection, venous thromboembolism, hysterectomy, intensive care unit admission, and readmission and (2) patient satisfaction assessed via Birth Satisfaction Scale-Revised (BSS-R) scores. Secondary outcomes included rate of cesarean delivery and neonatal morbidity. A total of 1610 women were included in the analysis (788 in the preimplementation and 822 in the postimplementation periods) with a median age of 29 (interquartile range [IQR], 24-34) years. There were no significant baseline differences between groups except fewer inductions at a gestational age of 40 weeks or later in the postimplementation period (256 [31.1%] vs 298 [37.8%]). Calculator implementation was associated with decreased maternal morbidity overall, even when adjusting for confounders (141 [17.9%] vs 95 [11.6%]; adjusted absolute risk difference [aARD], -6.3%; 95% CI, -9.7% to -2.8%). Although there was no difference in birth satisfaction overall, calculator implementation was associated with improvements on items pertaining to quality of care provision (median BSS-R score, 19 [IQR, 16-20] vs 19 [IQR, 17-20]; P = .006). Calculator implementation was also associated with a decrease in cesarean delivery rate (228 [28.9%] vs 167 [20.3%]; aARD, -8.5% [95% CI, -12.6% to -4.5%]). There were no significant differences in neonatal morbidity. These findings suggest that implementation of a validated calculator to predict risk of cesarean delivery in clinical care is associated with reduced maternal morbidity. Implementation should occur broadly to determine whether calculator use improves national maternal outcomes.

Preterm prelabor rupture of membranes: evaluating latency and neonatal morbidity for pregnancies with expectant management ≥34 weeks

Objective To evaluate the association between latency and neonatal morbidity for pregnancies with expectant management of PPROM ≥34 w. Materials and Methods A retrospective cohort of singletons with PPROM from 2011 to 2016. Exposure was defined as latency (period from diagnosis of PPROM to delivery) and was analyzed as a count variable (i.e. number of days) and binary variable (≥7 days and <7 days; ≥21 days and <21 days). Primary outcome was composite neonatal morbidity defined as need for respiratory support, culture positive neonatal sepsis, and/or neonatal antibiotics >72 h. Fisher’s exact test, chi-square test, Mann–Whitney U and binary logistic regression tests were performed with p<.05 considered significant. Results Of 813 pregnancies, 104 met inclusion criteria: 73 (70.2%) pregnancies with PPROM diagnosed at <34 weeks and 31 (29.8%) pregnancies with PPROM diagnosed ≥34 weeks. A total of 58 (55.8%) pregnancies had a latency of ≥7 days and 46 (44.2%) had a latency <7 days. There was no difference in composite neonatal morbidity for latency ≥7 d versus <7 d (aOR 0.92; 95% CI 0.30–2.82) or latency as a count variable (aOR 0.70; 95% CI 0.23–2.13). However, a latency ≥21 d was associated with increased composite neonatal morbidity (aOR 10.24, 95% CI 1.42–73.99). Conclusion In pregnancies with PPROM expectantly managed ≥34 w, a latency of ≥7 d is not associated with significant differences in neonatal morbidity. However, different latency thresholds may be more clinically relevant for late preterm pregnancies. The increase in composite neonatal morbidity associated with a latency >21 days should be an area of future investigation and may suggest there is a population of pregnancies with PPROM which may not benefit from expectant management past 34 weeks.

Survival and neonatal outcome after fetoscopic guided laser occlusion (FLOC) of twin-to-twin transfusion syndrome (TTTS) in Sweden

To determine infant survival and neonatal outcome after fetoscopic laser treatment of twin-to-twin transfusion syndrome (TTTS). In 53/71(75%) laser-treated TTTS cases, at least one twin was liveborn and in 42/71(59%) cases at least one twin survived infancy. Fetal survival did not differ between donors [41/71(58%)] and recipients [46/71(65%), P=0.36]. Among liveborns, infant survival was 29/41(71%) in donors and 36/46(78%) in recipients (P=0.12). Infant survival did not correlate to maternal characteristics (age, BMI, smoking or parity), gestational age at treatment or severity of TTTS (Quintero stage). No TTTS infant born before 25 weeks of gestation survived the first week. Among the 87 infant survivors, 26 (30%) had an Apgar score <7 at 5 min, 47 (54%) developed respiratory distress syndrome, 10 (11%) showed signs of severe brain damage, nine (10%) renal failure, eight (9%) bronchopulmonary dysplasia, and five (6%) infants developed retinopathy of prematurity ≥stage 3. There was no significant difference in neonatal morbidity between recipients and donors. Fetal survival after laser treatment was comparable to that reported by other international centers. There was no significant difference in survival or neonatal morbidity between donors and recipients. Major neonatal morbidity was common, and combined with extremely preterm delivery the prognosis of TTTS is poor.

Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome

To compare maternal and perinatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzyme levels, and low platelets) syndrome. Maternal and neonatal charts of 1,222 consecutive pregnancies complicated by severe preeclampsia, eclampsia, or HELLP syndrome at our maternal-perinatal unit were reviewed. Patients were divided into three groups: 903 (73.9%) with severe preeclampsia, 123 (10.1%) with eclampsia, and 196 (16.0%) with HELLP syndrome. The overall incidence of adverse maternal outcome was 5.9%. The rates of adverse maternal outcomes for women with HELLP syndrome and eclampsia were higher than for severe preeclampsia (13.8% vs. 11.4% vs. 3.4%, respectively) (p=0.000). Birth weight was lower in patients with HELLP syndrome than in patients with eclampsia and severe preeclampsia (p=0.005). No significant difference in neonatal morbidity was found among the three groups. Perinatal mortality tended to be higher in the severe preeclampsia group than in the HELLP syndrome and eclampsia groups (p=0.231). Pregnancies complicated by HELLP syndrome had significantly higher maternal morbidity than those with severe preeclampsia and eclampsia. Perinatal and neonatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP syndrome were dependent on gestational age rather than being disease dependent.

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Time of delivery and neonatal morbidity and mortality

The objective of the study was to examine the association between time of delivery and neonatal outcomes in term deliveries. We conducted a retrospective cohort study of all term pregnancies delivered at an academic institution with 24-hour in-house obstetric and anesthesia coverage. Time of delivery was categorized as day (7 am to 6 pm), evening (6 pm to 12 midnight), and late night (12 midnight to 7 am). Outcomes included 5-minute Apgar less than 7, umbilical artery pH less than 7.0, base excess less than -12, admission to the neonatal intensive care unit (NICU), and neonatal death. We excluded patients delivered via cesarean delivery not in labor. We had greater than 80% power to detect a 25% difference in Apgar score, base excess, and admission to the NICU and 80% power to detect a 50% difference in umbilical artery pH less than 7.0. Among the 34,424 deliveries meeting inclusion criteria, 15,664 were during the day, 8495 were during the evening, and 10,265 were during the night. In univariate comparisons, there were no statistically significant differences in neonatal outcomes. For example, the rate of pH less than 7.0 was 0.7% during the day, 1.0% in the evening, and 0.6% at night (P = .12). Admissions to the NICU were 3.6% during the day, 3.7% in the evening, and 3.5% at night (P = .81). When we controlled for obstetric history, demographic factors, and labor characteristics, there were still no differences in rates of either neonatal morbidity or mortality by time of delivery. At our institution, we could not demonstrate any significant differences in neonatal morbidity or mortality by time of day among neonates delivered at term. These data can be used to counsel patients and families concerned about differences in time of delivery and potential impact on their infant's health. Future research should include time of delivery in relation to maternal and neonatal outcomes in various types of inpatient settings.

Use of insulin glargine during pregnancy: a case–control pilot study

To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. A matched case-control study. Women's Centre, John Radcliffe Hospital, Oxford, UK. Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.

The effect of prenatal consultation with a neonatologist on human milk feeding in preterm infants.

To study the effect of prenatal consultation (PC) with a neonatologist on the incidence and duration of human milk feeding (HMF) in preterm infants. A retrospective matched case-control study was preformed at a perinatal centre. Study infants were preterm infants (23-35 wk) whose mothers had received PC emphasizing the importance of HMF. Control infants were matched by birthweight, gestational age and multiplicity. Each group included 29 mothers and 46 preterm infants. Mean gestational age was 30.1 +/- 3 wk in both groups. Mean birthweight was 1329 +/- 489 (PC) and 1334 +/- 441 g (control). PC infants received HMF for significantly longer, both in the hospital and after discharge (hospital: PC 37 +/- 34 d vs control 15 +/- 19 d, p = 0.001; discharge PC 60 +/- 57 d vs control 21 +/- 32 d; p = 0.0001). No significant difference in neonatal morbidity was detected between the groups. PC is associated with significantly longer HMF in preterm infants, both in hospital and after discharge.

Preterm premature rupture of membranes is not an independent risk factor for neonatal morbidity

To evaluate the risk factors for development of neonatal morbidity in cases of preterm premature rupture of membranes (PPROM). The study population consisted of 2326 singleton preterm births occurring between 1994 and 1997 at Soroka University Medical Center. The neonatal morbidity included respiratory distress syndrome, intraventricular hemorrhage (grade III-IV), necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia, neonatal pneumonia and sepsis. A cross-sectional study was designed to compare neonatal morbidity between two groups: the study group consisted of patients with PPROM (n = 376) and the comparison group of patients without PPROM (n = 1950). The prevalence of the neonatal morbidity associated with PPROM was 13.0% (49/376). There was no statistically significant difference in neonatal morbidity rates between the PPROM group and the group with intact membranes in any of the birth-weight groups (Mantel-Haenszel weighted odds ratio 1.20; 95% CI 0.80-1.20), or gestational-age groups (Mantel-Haenszel weighted odds ratio 1.03; 95% CI 0.79-1.55). There was no statistically significant difference in neonatal morbidity between patients with PPROM and those with intact membranes according to clinical chorioamnionitis. Congenital anomalies did not influence the neonatal morbidity when comparing patients with and without PPROM (44.4% vs. 32.8%, respectively; p = 0.23). PPROM was not an independent risk factor for neonatal morbidity in preterm births. Neonatal morbidity was affected mainly by prematurity itself, rather than by the occurrence of PPROM.

The Effect of Maternal Magnesium Sulfate Treatment on Neonatal Morbidity in ≤1000-Gram Infants

Data from retrospective observational studies suggest that fetal exposure to magnesium sulfate may correlate with a lower risk of both intraventricular hemorrhage and cerebral palsy in live-born infants. The present study, also retrospective, was done to learn whether extremely low birth weight (1000 gm or less) infants who live at least 2 days after being born to a woman given magnesium for uterine tocolysis had neonatal outcomes differing from those of unexposed infants. Only potentially viable singleton infants with a gestational age of at least 20 weeks were included. None had major congenital anomalies. The final study group of 308 infants, seen in a 12-month period, included 124 exposed in utero to magnesium sulfate and 184 who were not so exposed. Mortality from day 3 to 4 months of life was similar in the two groups. Women given magnesium sulfate for tocolysis were less often black, were more often in active labor at the time of delivery, and received more steroids, but in other respects, the groups were comparable. The infants were similar in birth weight and gestational age at delivery, and there were no significant differences in neonatal morbidity. Multivariate analysis affirmed the lack of any significant association between neonatal disorders and exposure to magnesium sulfate. This included measures of neurological morbidity such as seizure activity and intraventricular bleeding. A prospective randomized trial is needed before concluding that intrapartum magnesium sulfate does not improve the neurological outcome in very premature infants.

Perinatal and neonatal outcomes in multiple gestations: Assisted reproduction versus spontaneous conception

Objective: Our purpose was to test the hypothesis that multiple pregnancies resulting from assisted reproductive therapy have a better outcome than those resulting from spontaneous conception. Study Design: This was a retrospective cohort study. Cases came from pregnancies from assisted reproductive techniques. Controls were identified from spontaneous multiple pregnancies delivered in the same time period. Matching was done for maternal age, parity, fetal number, and presence of maternal medical problems. A total of 72 cases (56 twins and 16 triplets) and 124 controls (108 twins and 16 triplets) were studied. The primary outcome was perinatal mortality. Secondary outcomes were preterm delivery, birth weight, maternal complications, neonatal morbidity, and length of hospitalization. Results: Perinatal mortality is significantly increased in spontaneous twin gestations compared with twins resulting from assisted reproductive techniques (24 vs 2, P = .003). No difference is seen in the perinatal mortality in triplets. Mean gestational age at diagnosis was lower for twins and triplets resulting from assisted reproductive techniques (9.4 vs 13.3; P < .001 and 8.8 vs 15.8; P < .001, respectively). Rate of cerclage and number of prenatal visits was higher for triplets in the assisted reproductive techniques group ( P = .05 and .02, respectively). Mean gestational age at delivery, birth weight, rate of preterm labor, preterm premature rupture of membranes, pregnancy-induced hypertension, and incidence of gestational diabetes were not significantly different between the groups. No significant differences in neonatal morbidity were detected. Conclusions: Assisted reproductive techniques–associated twins have lower perinatal mortality than spontaneously conceived twins. Perinatal and neonatal morbidity, gestational age at delivery, and birth weight are not affected by assisted reproductive techniques, even with closer surveillance and earlier gestational age at diagnosis in this group. Differences may be due to a higher frequency of monochorionic placentation in the spontaneously conceived group. (Am J Obstet Gynecol 1998;179:1162-7.)

Expectant management of placenta previa: Cost-benefit analysis of outpatient treatment

OBJECTIVE: In this study outpatient and inpatient expectant management for complete placenta previa were compared in terms of maternal and neonatal outcome and overall cost. STUDY DESIGN: We reviewed the outcomes and hospital costs of 72 mother-infant pairs where the pregnancy was complicated by second- or third-trimester placenta previa and was managed expectantly either with hospitalization or outpatient bed rest. The data were analyzed with the two-sided unpaired t test, χ2, and simple correlation analysis. RESULTS: There were no differences in maternal morbidity as measured by estimated total blood loss, number of blood transfusions, nadir hematocrit, or need for emergency delivery. Fetal mortality was comparable in both groups, and there were no significant differences in neonatal morbidity as measured by gestational age, birth weight, 5-minute Apgar score, or occurrence of fetal distress. Among outpatients the number of maternal hospital days was reduced by 50% (p < 0.01). Outpatient management achieved a hospital cost reduction of 48.5% for mothers (p < 0.001) and 39.4% for mother-infant pairs (p < 0.05). CONCLUSION: In selected patients outpatient management of complete placenta previa can be cost-effective and safe. OBJECTIVE: In this study outpatient and inpatient expectant management for complete placenta previa were compared in terms of maternal and neonatal outcome and overall cost. STUDY DESIGN: We reviewed the outcomes and hospital costs of 72 mother-infant pairs where the pregnancy was complicated by second- or third-trimester placenta previa and was managed expectantly either with hospitalization or outpatient bed rest. The data were analyzed with the two-sided unpaired t test, χ2, and simple correlation analysis. RESULTS: There were no differences in maternal morbidity as measured by estimated total blood loss, number of blood transfusions, nadir hematocrit, or need for emergency delivery. Fetal mortality was comparable in both groups, and there were no significant differences in neonatal morbidity as measured by gestational age, birth weight, 5-minute Apgar score, or occurrence of fetal distress. Among outpatients the number of maternal hospital days was reduced by 50% (p < 0.01). Outpatient management achieved a hospital cost reduction of 48.5% for mothers (p < 0.001) and 39.4% for mother-infant pairs (p < 0.05). CONCLUSION: In selected patients outpatient management of complete placenta previa can be cost-effective and safe.

Expectant management of placenta previa: Cost-benefit analysis of outpatient treatment

OBJECTIVE: In this study outpatient and inpatient expectant management for complete placenta previa were compared in terms of maternal and neonatal outcome and overall cost. STUDY DESIGN: We reviewed the outcomes and hospital costs of 72 mother-infant pairs where the pregnancy was complicated by second- or third-trimester placenta previa and was managed expectantly either with hospitalization or outpatient bed rest. The data were analyzed with the two-sided unpaired t test, χ2, and simple correlation analysis. RESULTS: There were no differences in maternal morbidity as measured by estimated total blood loss, number of blood transfusions, nadir hematocrit, or need for emergency delivery. Fetal mortality was comparable in both groups, and there were no significant differences in neonatal morbidity as measured by gestational age, birth weight, 5-minute Apgar score, or occurrence of fetal distress. Among outpatients the number of maternal hospital days was reduced by 50% (p < 0.01). Outpatient management achieved a hospital cost reduction of 48.5% for mothers (p < 0.001) and 39.4% for mother-infant pairs (p < 0.05). CONCLUSION: In selected patients outpatient management of complete placenta previa can be cost-effective and safe. (AM J OBSTET GYNECOL 1994;170:1254-7.)