Predischarge non-invasive risk assessment for prediction of significant hyperbilirubinemia in term and late preterm neonates

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

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Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-322152 ◽

2021 ◽

pp. fetalneonatal-2021-322152

Author(s):

Amir Aviram ◽

Kellie Murphy ◽

Sarah McDonald ◽

Elizabeth Asztalos ◽

Arthur Zaltz ◽

...

Keyword(s):

Birth Weight ◽

Neonatal Resuscitation ◽

Late Preterm ◽

Preterm Neonates ◽

Neurocognitive Disorder ◽

Antenatal Corticosteroids ◽

Neurodevelopmental Outcomes ◽

Increased Risk ◽

Visual Testing

ObjectivesAntenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 340/7–366/7 weeks of gestation), when the benefits of ACS are subtle.DesignPopulation-based, retrospective cohort.SettingOntario, Canada, between 2006 and 2011.PatientsAll live singleton infants born during the LPT period with a minimum 5-year follow-up.InterventionsExposure to ACS prior to 340/7 weeks of gestation.Main outcome measuresSuspected neurocognitive disorder, audiometry testing or visual testing.ResultsOverall, 25 668 infants were eligible for analysis, of whom 2689 (10.5%) received ACS. Infants in the ACS group had lower mean birth weight and higher rates of birth weight <10th percentile, neonatal resuscitation and neonatal intensive care unit admission. At 5 years of age, ACS exposure was associated with an increased risk of suspected neurocognitive disorder (adjusted HR (aHR) 1.12, 95% CI 1.05 to 1.20), audiometry testing (aHR 1.20, 95% CI 1.10 to 1.31) and visual testing (aHR 1.06, 95% CI 1.01 to 1.11).ConclusionIn children born during the LPT period, exposure to ACS prior to 340/7 weeks of gestation is associated with an increased utilisation of the healthcare system related to audiometry and visual testing and suspected neurocognitive disorders by 5 years of age.

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A RETROSPECTIVE ANALYSIS OF MATERNALAND FETAL OUTCOMES OF PRETERM DELIVERIES IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA.

10.36106/ijsr/0701516 ◽

2021 ◽

pp. 42-44

Author(s):

Varsha Konyala ◽

Poornima M ◽

Suma K.B

Keyword(s):

Preterm Delivery ◽

South India ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Preterm Births ◽

Late Preterm ◽

Preterm Neonates ◽

Care Hospital ◽

Maternal Complications ◽

Record Keeping

Aim:To study preterm delivery outcomes in a tertiary care hospital in South India. Methods: The study was conducted for a 7 month period from July 1, 2020 to January 31, 2021at JSS Hospital, Mysuru. Relevant details of every pregnant woman who underwent a preterm delivery and the subsequent neonate born were collected and followed till discharge. Results: The prevalence rate of preterm births was 11.81%. There were 44 early preterm deliveries and 88 late preterm deliveries. The most common maternal complications that lead to preterm births PPROM and preeclampsia.36 early preterm and 29 late preterm neonates required an NICU admission. This included 7 pairs of twins in the early preterm and 1 pair of twins in the late preterm. In the NICU, the most common complications noted were RDS, and sepsis.4 neonates remained by mother's side soon after delivery in the early preterm subset, whereas 54 of late preterm neonates were kept by the mother's side soon after delivery. 31 of 40 early preterm, 86 of the 88 of late preterm neonates were healthy and t for discharge. Conclusion:The prevalence of preterm birth rate in our study stands comparable to the reported global average. Preterm births have a multifactorial etiology. Timely referral to higher centers, experienced obstetricians, and a good NICU facility proved helpful to both the mother and neonate. Thorough record keeping also allows a true picture of preterm prevalence on the basis of which, policies and decisions can be made to further improve preterm care.

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Pulmonary air leak syndrome in term and late preterm neonates

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180411081m ◽

2019 ◽

Vol 147 (9-10) ◽

pp. 578-582

Author(s):

Gordana Markovic-Sovtic ◽

Tatjana Nikolic ◽

Aleksandar Sovtic ◽

Jelena Martic ◽

Zorica Rakonjac

Keyword(s):

Mechanical Ventilation ◽

Medical Center ◽

Perinatal Asphyxia ◽

Late Preterm ◽

Respiratory Support ◽

Medical Emergency ◽

Preterm Neonates ◽

Air Leak ◽

Average Birth Weight ◽

Air Leak Syndrome

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ? 1.9 g.w. were included in the study. The average birth weight was 3182.5 ? 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

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Cranial ultrasound in detection of neurological lesions in preterm neonates in a tertiary center in North Kerala, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171524 ◽

2017 ◽

Vol 4 (3) ◽

pp. 804 ◽

Cited By ~ 1

Author(s):

Kavya M. K. ◽

Radhamani K. V. ◽

Mahesh P.

Keyword(s):

Gestational Age ◽

Brain Injuries ◽

Radiology Department ◽

Preterm Neonates ◽

Cranial Ultrasound ◽

Medical College ◽

Non Invasive ◽

Tertiary Center ◽

The Central Nervous System ◽

Neurodevelopmental Abnormalities

Background: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these. Hence the present study was undertaken to assess the prevalence of neurosonological abnormality in preterm infants. The aims of the study were to identify and enumerate the neurosonographic features, to assess the severity of brain injuries by grading the neurosonographic findings and to correlate the clinical presentations with the neurosonographic findings.Methods: The present study was conducted in Department of Radiodiagnosis, Pariyaram Medical College. It consisted of all preterm neonates (less than 37 weeks of gestational age) referred to the Radiology department. The initial scan will be done as soon as possible (within 2 weeks of birth) followed by a repeat scan of the same infants at 36 weeks of corrected age, and at 8weeks post-partum.Results: A total of 100 neonates with gestational age varying from 29 to 37 weeks were studied, with the birth weight varying from 1.5 to 1.9 kg. The most common abnormality found on neurosonogram was germinal-matrix haemorrhage, followed by periventricular leukomalacia.Conclusions: Real time sonography is a sensitive non-invasive initial investigation for the detection of various brain lesions in the preterm neonates.

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Association of Antenatal Terbutaline and Respiratory Support Requirements in Preterm Neonates

American Journal of Perinatology ◽

10.1055/a-1695-8220 ◽

2021 ◽

Author(s):

Buranee Yangthara ◽

Visanu Kittiarpornpon ◽

Pitiporn Siripattanapipong ◽

Walaiporn Bowornkitiwong ◽

Ratchada Kitsommart ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Lung Compliance ◽

Respiratory Support ◽

Preterm Neonates ◽

Non Invasive ◽

Antenatal Steroids ◽

Respiratory Outcomes ◽

Record Review ◽

Retrospective Medical Record Review

Background: Before the advent of antenatal steroids, early non-invasive respiratory support (NIV) and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives: To study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with gestational age (GA) of < 32 weeks. And to study the association between antenatal terbutaline, and ET or NIV within the first 24 hours of life, and RDS in infants with GA of 32 to 36 weeks. Method: A retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result: 1,794 infants were included, 234 (13.0%) had GA < 32 weeks and 1,560 (86.9%) had GA 32 to 36 weeks. Antenatal terbutaline, corticosteroid, or both agents were administered in 561 (31.3%), 1,461 (81.4%), and 555 (30.9%), respectively. Antenatal terbutaline was significantly associated with a reduction in ET (adjusted odds ratio (aOR) = 0.40, 95% confident interval (CI) 0.19 to 0.82, p = 0.012) in infants of GA < 32 weeks, but not in infants with GA 32 to 36 weeks. Antenatal terbutaline was not associated with RDS or BPD, but was significantly associated with a reduction in grade III-IV IVH (aOR 0.11, CI 0.01 to 0.98; p = 0.048), in infants of GA < 32 weeks. Conclusion: In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants of GA < 32 weeks. The use of antenatal terbutaline to improve acute neonatal respiratory outcomes merits reconsideration.

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"COMPARATIVE STUDY OF EARLY NEONATAL MORBIDITIES OF LATE PRETERM AND TERM NEONATES"

10.36106/8532772 ◽

2021 ◽

pp. 23-25

Author(s):

Jatin Manocha ◽

Kusum Mahajan ◽

Anuj Kumar

Keyword(s):

Preterm Infants ◽

Prospective Observational Study ◽

Neonatal Period ◽

Newborn Infants ◽

Late Preterm ◽

Preterm Neonates ◽

Feeding Problems ◽

Term Neonates ◽

Late Preterm Infants ◽

Study Results

Background- Newborn infants are unique in their physiology and the health problems that they experience. Neonatal period is dened from birth to under four weeks of age. Late preterm infants may physiologically and physically appear like infants born at term, but most late preterm infants may undergo complications like respiratory distress, apnea, hypothermia, feeding problems, hypoglycemia, hyperbilirubinemia, sepsis, and mortality. AIM-To compare the clinical prole of late preterm neonates with term neonates. MATERIALAND METHODS: This prospective observational study was carried out in neonatal division of department of pediatrics MMIMSR, Mullana. Eligible neonates delivered at MMIMSR, Mullana born from 34 weeks up to 42 weeks gestation were included. All infants enrolled in the study was followed daily till rst 7 days of life for any morbidity by clinical evaluation and review of hospital records.104 preterms included in the study and 226 term neonates were included in the study. Results- Preterms born via LSCS and NVD were(58%vs.42%).Morbidities in late preterms were Hypoglycemia (21.2% vs. 9.3%), Hypothermia (15.4%vs5.7%), hypocalcaemia (38.4% vs. 5.3%), neonatal hyperbilirubinemia(67.3% vs. 30.5%), feeding difculties(44.2% vs. 14.6%), sepsis(40.4% vs. 19.5%), respiratory support(53% vs. 47%)

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