Newborn Status Research Articles

Assessment of nutritional status in preterm newborns admitted to a tertiary neonatal intensive care unit

Introduction: The increase in survival rates of preterm newborns, especially newborns of very low birth weight and extreme low birth weight, has brought challenges to clinical practice: promoting adequate nutritional support to this population, to favor future neuropsychomotor growth and development, since the interaction between nutrition, growth, metabolic and genetic phenomena are determinant in subsequent health and quality of life. Objectives: Evaluate the incidence of extrauterine growth restriction (EUGR) in preterm newborns and describe the evolution of anthropometric parameters during hospitalization in the neonatal unit. Methods: Prospective cohort study included patients with birth weight ≤1500g and/or gestational age ≤32 weeks. Data collection of anthropometric parameters at birth and at hospital discharge, as well as data regarding clinical evolution and nutritional support. Descriptive statistics were used; comparisons of non-parametric data were used by the Mann-Whitney test and comparison of data matched by the Wilcoxon test, with a significance level of 5%. Results: The incidence of EUGR was 60.5%. There was a decrease in the Z score of weight (p<0.0001), length (p<0.0001) and head circumference (p<0.0001), comparing birth and hospital discharge. The evolution of weight was similar to that described in the literature and nutritional management showed late onset of parenteral and enteral nutrition. Patients with complications related to prematurity had a greater difference in Z-score of weight between birth and discharge. Conclusion: EUGR has a high incidence in preterm newborns, as a consequence of the impact of preterm birth, complications related to prematurity and nutritional practices implemented.

Impact of medication correction of labor weakness on obstetrical complications and newborn status

Objectives: To analyze the impact of medical correction of labor weakness with oxytocin on obstetric and newborn complications.Materials and methods. 100 cases of childbirth with weakness of labor activity and medical correction with oxytocin (main group) and 50 cases of childbirth without weakness of labor activity (control group) were analyzed. The analysis included pregnancy and childbirth histories of mothers aged 20–32 years with a gestation period of 37– 41 weeks with uncomplicated pregnancies, without significant somatic and obstetric-gynecological pathology, who gave birth in the Perinatal Center of Kyiv during the last 3 years.Depending on the method of delivery, the women of the main group were divided into 3 subgroups: Iа – natural vaginal, spontaneous delivery (n = 60), Ib – operative vaginal delivery using a vacuum extractor (n = 22), Іc – delivery by cesarean section (n = 18).The following factors were studied in each group: assessment of newborns status according to the Apgar scale at the 1st and 5th minutes, pH level of the umbilical cord blood, frequency of fetal distress based on cardiotocography (Fischer score < 6 points), duration of labor induction, color of the amniotic fluid.Results. The average duration of labor was the largest in the subgroup of spontaneous vaginal deliveries, the smallest in the subgroup of cesarean section. In subgroup Ib in 14 (63.6%) cases indications for the vacuum extractor were signs of fetal distress and only in 8 (36.4%) cases – weakness of labor activity.In subgroup Ia compared to subgroup Ic, there was a longer average duration of labor and higher percentage of deliveries with meconium-stained waters (28.3%), higher frequency of neonatal acidemia (16.7%) and the birth of children with an Apgar score at the 5th minute ≤ 6 points (8.4%). In subgroup Ic compared to subgroup Ia, there was a higher value of cases of Fischer score < 6 points (50%), the duration of labor reinforcement for more than 4 hours (44.5%), more cases of asphyxia (44.5%), and the birth of children with an Apgar score at the 1st minute ≤ 6 points (38.9%). Indications for caesarean section in subgroup Ic in 50% of cases were signs of fetal distress, in 38.9% – weakness of labor activity which was not associated with medication, in 11.1% – a clinically narrow pelvis.In all groups there was a relationship between the duration of labor induction and the condition of the newborn (the frequency of asphyxia of newborns was higher when the infusion of oxytocin lasted more than 4 hours).In subgroup Ib fetal distress was the indication for urgent delivery in 63.6% of cases, and in subgroup Iс it was 50%. This indicates signs of a mediated negative effect of exogenous oxytocin on the fetus during childbirth. The newborns condition, according to the studied criteria, was worse in the groups with labor reinforcement compared to the control group, regardless of the method of delivery.Conclusions. The use of oxytocin during childbirth can have a negative effect on the fetus, which increases the frequency of operative vaginal deliveries and cesarean sections and, as a result, is a risk factor for complications in the postpartum period. There is a correlation between duration of oxytocin injection and condition of the newborn.

Association between thiol-disulfide hemostasis and transient tachypnea of the newborn in late-preterm and term infants

BackgroundTransient tachypnea of the newborn (TTN), which is the most common respiratory disease in the neonatal period, increases respiratory workload in newborns. We purposed to evaluate the oxidative stress (OS) status and thiol disulfide hemostasis in late preterm and term newborns with TTN in this study.MethodsThe study was carried out in a single-centre neonatal intensive care unit to investigate the effect of continuous airway positive pressure (CPAP) on the oxidative system in newborns with TTN. Thiol (native and total) and disulfide levels, total antioxidant and oxidant status (TAS/TOS) and Oxidative stress index (OSI) levels were measured.ResultsTotal thiol levels measured before treatment was 429.5 (369.5–487) µmol/L in the late preterm group and 425 (370–475) µmol/L in the term group (p = 0.741). We found significant changes in TOS, OSI and TAS levels after CPAP treatment in the late preterm group (p < 0.001, p < 0.001, p = 0.012 respectively). It was also found that the disulfide level, which was 26.2 (19.2–31.7) before the treatment, decreased to 19.5 (15.5–28.75) after the treatment (p = 0.001) in late preterms.ConclusionCPAP treatment reduced the OS status burden associated with TTN in neonates. The late preterm newborns with TTN are more affected by OS and increased OS levels decrease with CPAP treatment.

Стан здоров’я новонароджених від матерів із HCV-інфекцією

Purpose - to study the health status of newborns from mothers with viral hepatitis С (HCV infection). Materials and methods. A prospective clinical and statistical analysis of the health status of 40 newborns born to mothers with HCV infection (the main group - MG) and 50 newborns born to healthy women (the control group - CG) was performed. The statistical processing of the study results was carried out using standard software Microsoft Excel 5.0 and Statistica 8.0. Results. In children of MG compared to children of CG had a lower Apgar score at birth (p&lt;0.001). An Apgar score ˂7 points in 15.0% (6/40) of newborns of MG (F=4.61; p=0.032) was diagnosed, which was significantly higher than in newborns of CG - 4.0% (2/50), (р&lt;0.001). The frequency of conjugated jaundice in newborns of CG was 4.0% (2/50), while in children of MG it was 17.5% (7/40) (χ2=7.97; p=0.005). Correlation analysis revealed that the Apgar score has medium strength positive correlations with body length (τ=0.266; p&lt;0.001), and the development of conjugated jaundice in newborns has medium negative correlations with these physical parameters at birth as body weight (τ=-0.302; p&lt;0.001) and body length (τ=-0.306; p&lt;0.001), as well as with Apgar score (τ=-0.302; p&lt;0.001) and gestational age at birth (τ=-0.249; p&lt;0.001). Conclusions. The condition of newborns from women with HCV infection is characterized by lower parameters of physical development and a decrease in Apgar score, increased frequency of development of conjugation jaundice. Physical and clinical parameters of newborns from mothers with HCV infection were related to pathological conditions during pregnancy and delivery. 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 author.

The relationship between hematological indices as indicators of inflammation and 25-hydroxyvitamin D3 status in newborns

BackgroundThere is still much unknown about the relationship between hematological parameters and vitamin D status in newborns. The aim of the study is to evaluate the relationship between 25(OH)D3 (vitamin D) status and new defined systemic inflammatory markers neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) in newborns.MethodsOne hundred newborns were enrolled in the study. Serum vitamin D status, below < 12 ng/mL (< 30 nmol/L) as deficient, 12–20 ng/mL (30–50 nmol/L) as insufficient, and > 20 ng/mL (> 50 nmol/L) was considered as sufficient.ResultsParallel to maternal and newborn vitamin D status were also statistically different between the groups (p < 0.05). Moreover, there was a statistically significant difference was found between the deficient, sufficient and insufficient groups in terms of newborn hemoglobin, neutrophil, monocytes, NLR, PLT, PLR and neutrophil to monocyte ratio (NMR) (p < 0.05, in all). There was also a positive correlation between maternal and newborn vitamin D status (r = 0.975, p = 0.000). The newborn NLR were negative correlated with newborn vitamin D status (r = -0.616, p = 0.000).ConclusionsThe results of this study suggest that there may be potential new biomarkers to predict inflammation associated with the inflammatory state that may arise due to changes in NLR, LMR, and PLR in vitamin D deficiency in newborns. NLR and other hematologic indices may be non-invasive, simple, easily measurable, cost-effective markers of inflammation in newborns.

Associations between per and polyfluoroalkyl ether sulfonic acids and vitamin D biomarker levels in Chinese newborns

Skeleton develops extremely fast during fetal and neonatal stages; thus, fetuses and newborns exhibit unique vulnerabilities to vitamin D metabolism dysregulation, giving vitamin D's principal role in calcium homeostasis. Previous studies linked legacy per and polyfluoroalkyl ether sulfonic acids (PFAS) with vitamin D biomarker status in adults and children; however, how PFAS, especially emerging CI-PFESAs, influence vitamin D among newborns is unknown. This study focused on the epidemiological linkages between PFAS and vitamin D biomarkers. Eleven PFAS, including legacy PFAS and emerging CI-PFESAs, as well as two vitamin D metabolites [25-hydroxyvitamin D2 (25(OH)D2) and 25-hydroxyvitamin D3 (25(OH)D3)], were determined in cord sera of 992 newborns from a birth cohort in Wuhan, China. The cord serum levels of 25(OH)D2 and 25(OH)D3 were summed as total 25(OH)D, which is a reliable biomarker of vitamin D status. The associations of separated PFAS with vitamin D biomarker levels were analyzed via multiple linear models, whereas the mixture effect was estimated by utilizing the weighted quantile sum (WQS) regression. We observed that per doubling changes in perfluorotridecanoate (PFTrDA), perfluorohexane sulfonate (PFHxS), and perfluorooctane sulfonate (PFOS) were associated with a 6.04 to 9.05 % change in total 25(OH)D levels. PFHxS contributed over half of the PFAS mixture effect on total 25(OH)D. Stratified analysis indicated that the associations of certain PFAS with vitamin D biomarkers were more pronounced among boys. The emerging CI-PFESAs were not robustly related to vitamin D biomarker levels. The results suggested that exposure to legacy PFAS might disturb vitamin D status in newborns. Future epidemiological studies are required to confirm the association and to determine healthy implications at a later age.

Состояние здоровья новорожденных у матерей с манифестацией SARS-CoV-2 инфекции в разные сроки беременности

Aim: to study the health status of newborns in mothers who have undergone a new coronavirus infection (NCI, COVID-19) at different gestation period. Design: a prospective cohort uncontrolled study. Materials and methods. 162 newborns were examined, born to women who had had NCI during pregnancy and had no clinical manifestations of the disease at the time of delivery. Group 1 included 38 children whose mothers had NCI in the 1st trimester of pregnancy; group 2 — 74 children with the manifestation of infection in mothers in the 2nd trimester; group 3 — 50 children whose mothers had NCI in the 3rd trimester. Results. In children of groups 1 and 3, clinical and laboratory manifestations of intrauterine infection were detected in 42.1% and 32% of cases, perinatal lesions of the central nervous system (CNS) 15.8% and 36%, respectively, respiratory disorders — 10.4% and 20%, intrauterine development delay (IVD) in 10.4% and 12% of cases. The most frequent pathological condition of group 2 newborns was transient disorders of carbohydrate metabolism — 32.4%. Congenital malformations were more common in children of group 1, 15.8%. Discussion. The analysis of the literature data and the results of our study dictates the need for further study of the mechanisms of influence of the SARS-CoV-2 virus on the course of pregnancy and the health of newborns. Conclusion. In the absence of statistically significant differences in the frequency of pathological conditions in newborns of the selected groups, their severity was higher in children whose mothers underwent NCI in the 1st or 3rd trimesters of pregnancy, which is confirmed by the nature of the pathology, the need for transfer to specialized neonatal units. Keywords: new coronavirus infection, COVID-19, pregnancy, newborns.

АКУШЕРСКАЯ ТАКТИКА ПРИ НЕДОНОШЕННОЙ БЕРЕМЕННОСТИ, ОСЛОЖНЕННОЙ ПРЕЖДЕВРЕМЕННЫМ РАЗРЫВОМ ПЛОДНЫХ ОБОЛОЧЕК, СОСТОЯНИЕ ПЛОДА И НОВОРОЖДЕННОГО

The present study is due to the high urgency of the problem of managing preterm labor initiated by premature rupture of the membranes. The purpose of this study was to analyze obstetric and neonatal outcomes during the prolongation of preterm pregnancy complicated by premature rupture of the membranes, and to assess the health status of newborns. Clinical observations were carried out on the basis of the State Health Institution "Clinical Perinatal Center of the Saratov Region".In 148 patients with a singleton pregnancy (the main observation group) at a period of 28-34 weeks, prenatal rupture of water occurred, while the pregnancy was prolonged to achieve greater morphological and functional maturity of the fetus. In 181 patients with a singleton pregnancy at the same gestational age, preterm labor occurred within the next 6-12 hours after prenatal rupture of water; these patients were included in the comparison group. Pregnancy in patients of the main group was prolonged by an average of 12.2±1.9 days (from 2 to 29 days). The paper presents the structure of indications for terminating the prolongation of preterm pregnancy with prenatal rupture of water, an analysis of the characteristics of the course of the birth act and the structure of indications for delivery by caesarean section in patients with premature pregnancy after a period of prolongation of gestation. A comparative analysis of the condition of 148 children born to patients of the main group and 181 newborns born to women of the comparison group showed the advantages of expectant management of patients with premature rupture of the membranes during preterm gestation. A decrease in the frequency of development and severity of respiratory disorders, the frequency of occurrence and degree of intraventricular hemorrhages in premature babies with the prolongation of a premature pregnancy complicated by prenatal rupture of water has been proven.

Iron supplementation in pregnant Danish women revisited: Effects on prepartum and postpartum iron deficiency, anemia, serum erythropoietin; including iron status, erythropoietin and anthropometrics in newborns. A randomized, placebo-controlled study.

To assess effects of iron supplementation, 66 mg elemental iron daily as ferrous fumarate, on iron status markers during normal pregnancies. Randomized, double-blind, placebo-controlled study of 119 women (62 iron-, 57 placebo -treated) and their newborns. Hemoglobin (Hb), serum (S)-ferritin, S-transferrin saturation percentage (TSAT) and S-erythropoietin (S-EPO) were measured at 14-18, 24-27 weeks of gestation, prepartum, 1 and 8 weeks postpartum. From 24-27 weeks gestation to 8 weeks postpartum, the iron group had higher Hb, S-ferritin and TSAT than the placebo group; prepartum, 11% had iron deficiency (ID) and 0% iron deficiency anemia (IDA) in the iron group, vs 60% and 18% in the placebo group; 8 weeks postpartum 1.6% in the iron group had ID and 1.6% IDA vs 14% and 7% in the placebo group. S-EPO levels in the iron group were lower than in the placebo group (p < 0.001). Mothers prepartum S-EPO values were correlated to newborns cord S-EPO values (p < 0.001). Newborns to iron treated mothers had higher cord S-ferritin levels than those to placebo treated mothers (p = 0.02). Newborn girls had higher cord S-ferritin levels than boys (p < 0.01). There was no impact of iron supplementation on the length of gestation, placental weight, or newborns birth weight. Birth weight was correlated only with mothers' body weight, length of gestation and placental weight. Iron supplementation had a "positive" impact on iron status and Hb both during pregnancy and postpartum, with a low frequency of ID/IDA and also a "positive" influence on newborns iron status.

A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms.

Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

Maternal Diet Quality and the Health Status of Newborns.

The maternal diet during pregnancy affects neonatal health status. The objective of this study was to assess the nutritional quality of the maternal diet, and its contamination by persistent organic pollutants (POPs), in pregnant women living in two areas of the Czech Republic with different levels of air pollution, and subsequently to assess the relationship of these two factors with birth weight and neonatal oxidative stress. To determine the level of oxidative stress, 8-isoprostane concentrations in umbilical cord plasma were measured. The overall nutritional quality of the maternal diet was not optimal. Of the nutritional factors, protein intake proved to be the most significant showing a positive relationship with birth weight, and a negative relationship with the oxidative stress of newborns. Dietary contamination by persistent organic pollutants was low and showed no statistically significant relationship with birth weight. Only one of the 67 analyzed POPs, namely the insecticide dichlorodiphenyltrichloroethane (DDT), showed a statistically significant positive relationship with the level of neonatal oxidative stress.

The Apgar score in clinical research: for what, how and by whom it is used.

To review how the Apgar score is used in published clinical research as well as who uses it, and how this may have changed between 1989-90 and 2018-19. Pubmed search for English publications using MeSH Terms "apgar score" OR "apgar" AND "score" AND "humans" for epochs 1989-90 & 2018-19. The location and specialty of first author, primary purpose and how the Apgar score was used was recorded. There was a 61% increase in number of publications in 2018-19 compared to 1989-90, from all regions except North America. The most common purpose for using the Apgar was to assess newborn status after pregnancy/delivery interventions. There were 50 different definitions of a significant score. Definition of significance was influenced by specialty in 2018-19 and by study purpose in both epochs. Most studies using the Apgar score are focused on the mother. There is no consistent definition of a significant score. Development of any future newborn assessment tools should account for the multiple purposes for which the Apgar score is used.

Red blood cell parameters in early childhood: a prospective cohort study.

Red blood cell parameters are frequently used biomarkers when assessing clinical status in newborns and in early childhood. Cell counts, amounts, and concentrations of these parameters change through gestation and after birth. Robust age-specific reference intervals are needed to optimize clinical decision making. The Copenhagen Baby Heart Study (CBHS) and the COMPARE study are prospective cohort studies including red blood cell parameters from 7,938 umbilical cord blood samples and 295 parallel venous blood samples from newborns with follow-up at two and at 14-16months after birth. For venous blood at birth, reference intervals for hemoglobin, erythrocytes, and hematocrit were 145-224g/L, 4.1-6.4×1012/L, and 0.44-0.64, respectively. Hemoglobin, erythrocytes, and hematocrit were lower at birth in children delivered by prelabor cesarean section compared to vaginal delivery. Conversion algorithms based on term newborns were: venous hemoglobin=(umbilical cord hemoglobin-86.4)/0.39; venous erythrocytes=(umbilical cord erythrocytes-2.20)/0.44; and venous hematocrit=(umbilical cord hematocrit-0.24)/0.45. This study presents new reference intervals for red blood cell parameters in early childhood, describes the impact of delivery mode, and provide exact functions for converting umbilical cord to venous blood measurements for term newborns. These findings may improve clinical decision making within neonatology and infancy and enhance our clinical understanding of red blood cell parameters for health and diseases in early life.

Macronutrients Management for Growth in Neonates with Congenital Gastrointestinal Malformation.

BACKGROUND Congenital gastrointestinal (GI) malformations are developmental disorders that can result in secondary intestinal failure. Nutrient intakes must be adapted according to the newborn's nutritional requirements based on frequent anthropometric and biochemical assessments. Deficiencies or excess of a macronutrient can hinder the growth of the newborn. MATERIAL AND METHODS To assess the clinical condition of newborns with GI malformations, together with the postoperative nutritional status of newborns who underwent surgery due to congenital GI malformations, we performed a case-control study. The study group comprised newborns with digestive malformations (n=51) and the control group consisted of newborns without digestive pathologies (n=102), matched by sex, gestational age, and weight at admission. RESULTS Bivariate comparisons and multiple logistic regression analyses were performed. A P value <0.05 was considered to be statistically significant; these were observed in abdominal distension, gastric residue, and vomiting. The duration of hospitalization was shorter in the case group, as on average, they were transferred to the Pediatric Surgery Department on the 6th day, where they further remained admitted to treat the underlying cause. Differences between groups in administration of breast milk versus formula were not statistically significant. CONCLUSIONS We concluded that the clinical examination had a major role in early detection of digestive malformations and in the effective management of specific necessary nutrition. Proper evaluation of when to start enteral feeding can help post-surgical cases to recover faster, minimizing complications. Further studies are required to assess how financial factors affect implementation of the standardized guidelines of nutrition in children and to find possible solutions to financial constraints.

Application of Donabedian quality-of-care framework to assess quality of neonatal resuscitation, its outcome, and associated factors among resuscitated newborns at public hospitals of East Wollega zone, Oromia, Western Ethiopia, 2021

BackgroundGlobally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they received at birth. However, the quality of care newborns received at birth may be below the WHO resuscitation standard. The reason for the poor quality of care is unclear. The Donabedian model, according to the World Health Organization (WHO), is an appropriate framework for health care assessment that focuses on improving the quality of care. So this study aims to assess the quality of neonatal resuscitation, outcome, and its associated factors among newborns with birth asphyxia at public hospitals in the East Wollega zone, 2021.MethodsAn institution-based cross-sectional study was conducted to observe 410 asphyxiated newborns using consecutive sampling methods. Data was gathered using a pretested structured questionnaire and checklist. Epi-data version 3.1 was used to enter data, which was subsequently exported to Statistical Package for Social Sciences version 25 for analysis. A logistic regression model was employed to determine the variables associated with the outcome variable. The adjusted odds ratio with a 95% confidence interval was calculated, and all variables associated with the outcome variable with a p-value less than 0.05 in multivariable analysis were determined to be significant factors for the outcome of resuscitated newborns.ResultA total of 410 asphyxiated newborns were included in this study with a response rate of 97%. From this 87.6% of resuscitated newborns survived. Keeping baby warm [AOR = 6.9; CI (3.1, 15.6)] is associated significantly with increased chances of survival while meconium presence in the airway [AOR = 0.26; CI (0.1, 0.6)], prematurity [AOR = 0.24; CI (0.12, 0.48)], and presence of cord prolapse [AOR = 0.08; CI (0.03, 0.19)] were factors significantly associated with decreased survival of resuscitated newborns at 1 h of life.ConclusionNewborns who were kept warm were more likely to survive compared to their counterparts. While the presence of meconium in the airway, preterm, and cord prolapse was associated with the decreased survival status of newborns. Facilitating referral linkage in the event of cord prolapse, counseling on early antenatal care initiation to decrease adverse outcomes (prematurity), and neonatal resuscitation refresher training is strongly recommended.

Assessment of Health Status of Newborns Discharged From Sick Newborn Care Units of the Five Cyclone Fani Affected Districts of Odisha, India.

This study was undertaken to assess the health status of newborns discharged from Sick Newborn Care Units (SNCU) of the Cyclone Fani affected districts of Odisha, which is amongst the highest neonatal mortality rate states in the country. Cyclone Fani hit the coast of Odisha on May 3, 2019. This cross-sectional study was conducted in 5 districts and targeted the babies discharged from SNCU's from January to May 2019. A telephonic interview of the caregivers was conducted to assess the health status of the newborns. Data was collected in a web-based portal and analyzed by statistical package for social sciences SPSS (IBM Corp., Armonk, New York, USA). We inquired about 1840 babies during the study period but only 875 babies could be followed up, with the highest proportion of the babies from the most affected district. Out of 875 babies, 111 (12.7%) had 1 or more illnesses during follow up. Distance from the health facility and time constraints were the major reasons for not seeking health care. Of the babies, 35.7% were reported as being underweight. Poor breastfeeding (14.1%) and kangaroo mother care (31.7%) practices were reported. Only 32% of the babies were completely immunized. The health status of the babies discharged from the SNCUs was found to be poor. Newborn care can be strengthened by improving home-based and facility-based newborn care.

Goal-directed fluid therapy and combined spinal-epidural anesthesia in management of pregnant woman with severe aortic stenosis

Introduction: In parturients with heart disease, appropriate anesthetic, cardiac, and obstetric collaboration is necessary, especially in those with aortic stenosis (AS). Physiological changes during pregnancy can worsen AS symptoms, causing challenges in obstetric anesthetic management. Patient concerns and diagnosis: A 33-year-old woman with severe AS and progressive orthopnea, 33 weeks pregnant, required a cesarean section due to heart failure. Interventions: We used invasive goal-directed fluid therapy (GDFT) with real-time information on hemodynamic status and a more sophisticated approach to maintain intravascular volume balance. Combined spinal-epidural anesthesia was used under GDFT guidance. Outcomes: The patient underwent cesarean section under combined spinal-epidural with no complications, with a stable newborn status, and was discharged on postoperative day 4. Vasopressors or inotropes were not used during the operation. Conclusion: For cesarean section in severe AS, low-dose sequential spinal anesthesia and slowly titrated epidural anesthesia under GDFT guidance could be a safe way to manage challenging conditions.

Association of maternity formula supplementation during pregnancy with small for gestational age birth in Chinese newborns

ObjectivesThis study aimed to explore the association between maternity formula supplementation and small for gestational age (SGA) status in Chinese newborns. MethodsData were from a population-based cross-sectional survey conducted in Shaanxi, Northwest China between August and December 2013. A total of 27 780 women pregnant with singletons and 356 with twins were included in this survey. Information on use of maternity formulas fortified with vitamins, folic acid, pantothenic acid, calcium, iron, zinc, and docosahexaenoic acid (DHA) was collected. SGA was defined as birthweight <10th percentile of fetal growth. Generalized linear models and estimating equation models were used to estimate crude odds ratios (ORs) or adjusted ORs with 95% confidence intervals (CIs) for SGA. ResultsThe rate of maternity formula supplementation during the entire pregnancy was 13.0% in the overall population. There was no significant association between maternal formula supplementation during pregnancy and the risk of total SGA birth (OR: 1.00; 95% CI, 0.90–1.11; P = 0.950). However, maternity formula supplementation during pregnancy was related to a lower risk of SGA for twins (OR: 0.49; 95% CI, 0.31–0.80; P = 0.004), twin A (OR: 0.50; 95% CI, 0.25–0.98; P = 0.045), and twin B (OR: 0.48; 95% CI, 0.25–0.95; P = 0.034). Furthermore, maternity formula supplementation during the first trimester was inversely associated with the risk of SGA birth of twins (OR: 0.32; 95% CI, 0.15–0.65; P = 0.002). ConclusionsNo significant association was observed between maternity formula supplementation and total SGA birth. However, women supplemented with maternal formula during pregnancy, especially during the first trimester, may have a reduced risk of SGA birth of twins.

Перинатальні наслідки при передчасному розриві плодових оболонок до 36 тижнів вагітності

The purpose - to evaluate the clinical status of newborns in women with pregnancy complicated by preterm premature rupture of membranes (pPROM) and its relationship with the course of pregnancy and childbirth, the duration of the latency period between pPROM and delivery (LP), as well as with the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the mother’s blood. Materials and methods. The condition and morbidity of newborns with preterm birth due to pPROM have been carefully studied. The levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in the blood serum of 109 women with singleton pregnancy complicated by pPROM at 23-36 weeks of gestation and 20 pregnant women of the control group with intact membranes, who subsequently gave birth to full-term babies, were studied by enzyme-linked immunosorbent assay. Results. No significant relationship between the condition of newborns and the duration of LP was found. Medical tactics of pregnancy management with pPROM led to the presence of a direct relationship between the prolongation of LP and the prevention of respiratory distress syndrome with dexamethasone/betamethasone (r=+0.36; p&lt;0.001), tocolytic therapy with nifedipine (r=+0.30; p&lt;0.01) against the background of antibacterial therapy. Groups of pregnant women with different duration of LP were statistically comparable in terms of gestation at the time of delivery. The average content of vitamin 25(OH)D in the blood of pregnant women with pPROM was reduced by half (26.3±0.9 pg/ml vs. 52.9±2.4 pg/ml), and the expression level of β-defensins 2 - by 1.4 times compared to the control group (78.4±1.8 pg/ml vs. 107.4±2.6 pg/ml). It has been confirmed that the level of vitamin 25(OH)D in the blood of women with pregnancy complicated by pPROM is directly associated with the gestational age of the newborn (r=+0.22; p&lt;0.05) and the corresponding assessments of its condition. Reliable associations of the expression level of β-defensins 2 in the mother's blood with the indicators of the course of pregnancy and perinatal period, as well as with certain characteristics of the condition of newborns were found. Conclusions. No reliable association between the condition of newborns and the LP was found, which can be explained by the adequate tactics of managing pregnant women with pPROM. A significant decrease in the levels of vitamin 25(OH)D and the expression of antimicrobial peptides (β-defensins 2) in blood serum of the examined pregnant women with pPROM compared to the control group was determined. 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 patients was obtained for conducting the studies. No conflict of interests was declared by the authors.

Newborns in the early neonatal period in a group of mothers at high obstetric and perinatal risk

AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA). MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women. RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p 0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p 0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p 0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p 0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p 0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p 0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p 0.05). CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.