Antibiotic Timing in Previable Prelabor Rupture of Membranes Less Than 24 Weeks of Gestation

2020 ◽  
Author(s):  
Rubymel J. Knupp ◽  
Sarah Pederson ◽  
Christina Blanchard ◽  
Jeff Szychowski ◽  
Deepa Etikala ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Neonatal Outcomes ◽  
Maternal Outcomes ◽  
Antibiotic Administration ◽  
Neonatal Birth Weight ◽  
Significant Difference ◽  
Adverse Neonatal Outcomes

Objective This study aimed to compare neonatal and maternal outcomes between immediate and delayed prophylactic antibiotic administration after previable prelabor premature rupture of membranes (PROM) less than 24 weeks of gestation. Study Design Retrospective cohort study of singleton pregnancies with PROM between 160/7 and 236/7 weeks of gestational age conducted at a single tertiary care referral center between June 2011 and December 2015. Patients with multiple gestations, fetal anomalies, those who elected augmentation, or with a contradiction to expectant management, such as suspected intra-amniotic infection or stillbirth, were excluded from the study. We compared pregnancy characteristics, maternal complications, and neonatal outcomes between women who received a course of antibiotics within 24 hours of PROM and women who received antibiotics after 24 hours of PROM. The primary outcome was neonatal survival to hospital discharge. Secondary outcomes included gestational age at delivery, time from PROM to delivery, neonatal birth weight, days in the neonatal intensive care unit (NICU), composite adverse neonatal outcomes, and maternal morbidity. Results Ninety-four women met inclusion criteria, 57 (61%) received antibiotics within 24 hours of PROM and 37 (39%) received antibiotics 24 hours after PROM. Baseline maternal characteristics were similar in both groups. The mean gestational age at PROM was similar between groups at 20.8 ± 2.3 weeks in the immediate antibiotics group and 20.6 ± 2.1 weeks in the delayed antibiotics group (p = 0.48). Compared with delayed antibiotic administration, immediate antibiotic administration was not associated with a significant difference in latency time from PROM to delivery, rate of stillbirth, days in an ICU, or adverse neonatal outcomes. Maternal outcomes also did not differ significantly between groups. Neonatal birth weight was lower in the immediate antibiotics group (p = 0.012). Conclusion Our data suggest that there is no maternal or neonatal benefit to immediate administration of latency antibiotics compared with delayed administration. Key Points

scholarly journals Birth-weight centiles and the risk of serious adverse neonatal outcomes at term

2018 ◽  
Vol 46 (9) ◽  
pp. 1048-1056 ◽  
Author(s):  
Joanna Yu ◽  
Christopher Flatley ◽  
Ristan M. Greer ◽  
Sailesh Kumar
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Predicted Probability ◽  
Exposure Variable ◽  
Adverse Neonatal Outcomes ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

Abstract Background: Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences. Aim: To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies. Materials and methods: This was a retrospective cohort study of singleton term births at the Mater Mother’s Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤−12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile. Results: Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06–4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30–1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60–7.75). Conclusions: Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.

ASSESSMENT OF NEONATAL OUTCOME IN BOOKED AND UNBOOKED PREGNANCY CASES IN A TERTIARY CARE CENTRE

2021 ◽  
pp. 63-65
Author(s):  
Pranoy Dey ◽  
L. Lotha ◽  
Sawant Kumar Sahu ◽  
Rajlakshmi Borgohain
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
Gestational Age ◽  
Neonatal Outcome ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Neonatal Deaths ◽  
And Child Health

Majority of neonatal deaths occurs in low and middle income countries indicating poor quality of health services provided by the government of the respective countries.In a developing country like India , a high morbidity and mortality serves as an sensitive indicator reecting the poor maternal and child health care services of the country.Most of the neonatal deaths can be attributed to avoidable factors which can be minimized by the effective utilization of antenatal services , early detection of high risk pregnancy and timely referral of these cases.The current study was conducted to determine the neonatal outcomes in booked and unbooked pregnancy cases in the tertiary care centre ,Assam Medical College and Hospital, Dibrugarh. METHODS: Close ended structured questionnaires were used to collect information from the parents (150 booked and 150 unbooked).Neonatal outcomes were categorised under groups of term and preterm ,live birth and stillbirts, birthweight, Gestational age, iugr, large for gestational age APGAR score ,NICU admissions and clinical course during hospital stay,course during rst 28 days of life along with complications,if any are all taken into consideration. RESULTS: During the study period 28.67% had low birth weight in booked cases and 41.33% had low birth weight in unbooked cases.The incidence of stillbirth and early neonatal deaths were 2%,4% respectively in booked cases and 4.67% , 6% respectively in unbooked cases.Higher incidence of MSL,prematurity ,birth asphyxia ,respiratory problems ,birth injuries,congenital malformations,infections and hyperbilirubinemia were seen in unbooked cases. CONCLUSIONS: The inference derived from the study ,showed that availability of antenatal care is directly proportional to the neonatal outcome .Thus unavailbility or lack of proper medical attention during the pregnancy results in unfavourable neonatal outcomes which can be prevented by increasing the range of availability , utilization and effectiveness of maternal and child health services alongwith ensuring booking of all the pregnancy cases in our country.

Does Fetal Gender Really Affects Neonatal Birth Weight and Gestational Age at Birth? A Prospective Cohort Study

2019 ◽  
Vol 9 (4) ◽  
pp. 203-210
Author(s):  
Naina Kumar ◽  
Ashu Yadav
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Apgar Scores ◽  
Fetal Gender ◽  
Neonatal Birth Weight ◽  
Tertiary Center ◽  
Significant Difference ◽  
Gestational Age At Birth ◽  
The Impact ◽  
Age At Birth

OBJECTIVEThe objective of this study was to understand the impact of fetal gender on neonatal birth weight for the gestational age at the time of birth. Only neonates with a gestational age of 28 weeks or more than 28 weeks were included in the study.METHODSThis prospective study was conducted within the Obstetrics and Gynecology Department of a rural tertiary center in Northern India. The study was conducted after ethical clearance and informed consent from participants who fulfilled the inclusion criteria. Data collection included neonatal gender, birth weight, Apgar scores, and gestational age. Neonates were delivered vaginally or by cesarean section at 28 or more weeks of gestation. Statistical analysis was done using version SPSS-22 software.RESULTSOf 2,997 live fetuses, 1,574 (52.5%) were male, 1,421 (47.4%) were female, and 2 (0.07%) had ambiguous genitalia. Mean ± standard deviation (SD) for male neonate's birth weight was 2.79 ± 0.503 kg (95% confidence interval [CI]: 2.76–2.81), for females 2.67 ± 0.485 kg (95% CI: 2.64–2.69) respectively (p = .000). Males had lower Apgar scores at 1 and 5 minutes of age compared to females (7.06 ± 0.859, 8.83 ± 0.838 vs. 7.12 ± 0.645, 8.88 ± 0.612). There were no significant difference between fetal gender and gestational age at birth (18% females were preterm vs. 15.4% males, 81.8% females were term vs. 84.2% males, 0.1% females post-term vs. 0.4% males; p = .079).CONCLUSIONFetal gender was related to birth weight. Male neonates had a higher birth weight, but lower Apgar scores than female neonates. Fetal gender was not correlated with gestational age at the time of birth.

scholarly journals Association of Calcium Supplementation During Pregnancy with the Birth Weight of Single-Born Neonates in Rural Northwest China

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1106-1106
Author(s):  
Gao Xiangyu ◽  
Mi Baibing ◽  
Dang Shaonong ◽  
Yan Hong
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Regression Models ◽  
Calcium Supplementation ◽  
Northwest China ◽  
Incidence Rates ◽  
Shaanxi Province ◽  
Significant Difference ◽  
Birth Weight Percentile ◽  
Weight Percentile

Abstract Objectives To investigate the association of calcium supplementation during the pregnancy with the birth weight of single-born neonates. Methods The survey employed a multistage, stratified and random sampling to investigate 15–49 aged pregnant women in 2010 to 2013 in Shaanxi province. A self - designed questionnaire was utilized. Birth weight between the 10(th) and 90(th) percentile was classified as appropriate for gestational age(AGA) infants. Chi-square test and logistic regression models were conducted to evaluate the association of calcium supplementation with single-born neonatal birth weight. Results A total of 28,490 women was enrolled in this study, 17 349 (60.9%) of participants had calcium supplementation during pregnancy. The incidence rates of small and large gestational age infants were 13.5% and 8.3%, respectively. The study conducted that calcium supplementation had a statistically significant difference in SGA (birth weight percentile &lt;10) (P &lt; 0.01). After adjusting the regression models by confounding factors, we found that calcium supplementation was still protective towards SGA birth, the difference was statistically significant (OR = 0.89, 95% CI: 0.82–0.96, P &lt; 0.05), but there was no significant difference in the birth to LGA (birth weight percentile &lt;10). Conclusions Calcium supplementation during pregnancy reduced the risk of SGA, but was not associated with the birth of LGA. Funding Sources

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

Neonatal outcomes in case of euglycemic control in gestational diabetes using insulin versus metformin. Randomized controlled trial

2021 ◽  
Vol 04 (01) ◽  
pp. 01-08
Author(s):  
Ahmed Mansour
Keyword(s):  
Randomized Controlled Trial ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Controlled Trial ◽  
Insulin Injection ◽  
Neonatal Outcomes ◽  
Insulin Group ◽  
Randomized Controlled ◽  
Metformin Group ◽  
Significant Difference

Background: Gestational diabetes mellitus (GDM) is a major global public health issue, with prevalence increasing in recent years due to the epidemic of obesity and type 2 diabetes. Aim of the Work: to compare different neonatal outcomes according to the different treatment modalities used in the management of GDM. Our hypothesis was that Metformin is as effective and safe as insulin in patients with gestational diabetes. Patients and Methods: The current non inferiority-Randomized controlled trial was conducted at Ain Shams Maternity hospital between June 2020 to February 2021. The study included 140 outpatient cases or admitted patients for antenatal care: Group A: women were given Metformin (Total 70) and Group B: Women were given insulin. (Total 70). Results: there was no significant difference between Metformin and Insulin groups regarding age, enrollment BMI, parity and family history of DM. There was no significant difference between Metformin and Insulin groups regarding gestational age at enrollment and delivery as well as pregnancy duration after intervention. BMI at delivery, BMI increase as well as BMI increase rate were significantly lower in Metformin group. There were no significant differences between Metformin and Insulin groups regarding fasting, two-hour postprandial and HbA1c blood glucose at enrollment and throughout treatment as well as their reduction after intervention. Maternal complications as hypoglycemia, hyperglycemia and preeclampsia were non-significantly less frequent among Metformin group than among Insulin group. Compliance to treatment was significantly more frequent among Metformin group than among Insulin group. Cesarean delivery was non­significantly less frequent among Metformin group than among Insulin group. There was no significant difference between Metformin and Insulin regarding birth weight APGAR-1, but APGAR-5 was significantly higher in Metformin group. Neonatal complications as IUFD, IUGR, macrosomia, congenital anomalies, neonatal hypoglycemia, respiratory distress and NICU admission were non-significantly less frequent among Metformin group. Conclusions: From the results of current study we can conclude that: Oral metformin was effective as insulin injection in control and management of GDM. BMI was controlled with oral metformin better than insulin injection. Maternal and neonatal complications specially birth weight were the same with both types of treatment. Women had better compliance to metformin treatment. Type of delivery wasn’t affected by type of treatment.

scholarly journals MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e27
Author(s):  
Sarah McKnight ◽  
Bishal Gautam ◽  
Michael Miller ◽  
Bryan S Richardson ◽  
Orlando da Silva
Keyword(s):  
Caesarean Section ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

Procalcitonin levels in sepsis and its association with clinical outcome in southern India

2017 ◽  
Vol 47 (4) ◽  
pp. 331-336
Author(s):  
Alex Rebello ◽  
Molly Mary Thabah ◽  
Tarun Kumar Dutta ◽  
Zachariah Bobby ◽  
BN Harish ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Antibiotic Administration ◽  
Mean Values ◽  
Good Marker ◽  
Significant Difference ◽  
Medical Intensive Care ◽  
Medical Wards

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.

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