scholarly journals 541A Nationwide Evaluation of International Standards and Commonly-used Growth Charts for Predicting Adverse Perinatal Outcomes

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Stephanie Choi ◽  
Adrienne Gordon ◽  
Lisa Hilder ◽  
Amanda Henry ◽  
Jon A. Hyett ◽  
...  

Abstract Background Abnormal fetal growth is a risk factor for perinatal mortality and morbidity. There is considerable debate about the choice and performance of growth charts to classify newborns as small or large for gestational age (SGA and LGA) as a proxy for the at-risk infants. Several international charts have been proposed to be adopted worldwide. We aim to evaluate the performance of commonly-used growth charts (including international INTERGROWTH-21st-standards) for predicting adverse outcomes among SGA and LGA babies. Methods A population cohort of 2.4 million singleton births (24+0–40+6 weeks) delivered in Australia, 2004–2013. Performance was evaluated by prevalence, relative risk and diagnostic accuracy for adverse outcome based on AUC. Results There was wide variation in SGA and LGA classification across charts. For example, compared to other charts, the INTERGROWTH-21st-standards classified half of the number of term-SGA babies (prevalence: 3-4% vs. 7-10%) (<10th-centile) and double the number of LGA babies (prevalence: 24-25% vs. 8-18%) (>90th-centile), resulting in a smaller cohort of term-SGA at higher-risk of adverse outcome, and a larger LGA cohort with lower-risk of adverse outcome. All charts performed poorly for detecting adverse outcomes (AUC range for a composite outcome: 0.49-0.68) and across birthweight centiles. Conclusions Significant differences in the classification of newborns and the chart performance raises concerns about whether the INTERGROWTH-21st-standards are applicable to a multi-ethnic population such as Australia. Key messages Significant differences in the classification of newborns and the relatively poor predictive ability of growth charts means that over reliance on infant size alone may misclassify, and thus miss at-risk infants.

2021 ◽  
pp. 1-9
Author(s):  
Nieves L. González González ◽  
Enrique González Dávila ◽  
Agustina González Martín ◽  
Erika Padrón ◽  
José Ángel García Hernández

<b><i>Objective:</i></b> The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC<sub>(18.5–25)</sub>) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. <b><i>Material and Methods:</i></b> Data from 20,331 infants were used to construct CC and from 11,604 for CC<sub>(18.5–25)</sub>, after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. <b><i>Results:</i></b> The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in LGA<sub>only by CC</sub>. In SGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub>, neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGA<sub>only by CC</sub>. Adverse outcomes rate was higher in LGA<sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in LGA<sub>only by CC</sub> (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA <sub>only by CC</sub><sub><sub>(18.5−25)</sub></sub> than in SGA<sub>only by CC</sub> (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). <b><i>Conclusion:</i></b> The use of CC<sub>(18.5–25)</sub> allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.


2018 ◽  
Vol 51 (4) ◽  
pp. 1702037 ◽  
Author(s):  
Kristian Hellenkamp ◽  
Piotr Pruszczyk ◽  
David Jiménez ◽  
Anna Wyzgał ◽  
Deisy Barrios ◽  
...  

To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a post hoc analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5–3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7–2.5) died due to PE. Patients with copeptin ≥24 pmol·L−1 had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6–15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3–25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1–9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5–15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6–27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2–43.6, p<0.001; highest risk group versus all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6–22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4–16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.


2020 ◽  
Vol 04 (2) ◽  
pp. 26-38
Author(s):  
Azhar Abdul-Hameed ◽  
Israa Abid Al-Karim ◽  
Raad Hameed

Studies of Doppler flow velocimetry have been proceeding as a principle mechanism for identification the compromised small fetus from a small fetus that is improbable to suffer from dangerous perinatal complications. The aim of this study is the Prediction of Perinatal Outcome in Fetuses Suspected to Have Intrauterine Growth Restriction: Doppler US Study of Fetal Cerebral, and Umbilical Arteries. This is a longitudinal prospective study done at department of Obstetrics and Gynecology in Salah Al-Deen General Hospital in Tikrit city between February-July 2020. The study included a convenient sample 100 pregnant women in 3rd trimester suspected of IUGR (n=100). Studies of various fetal vessels were performed using color Doppler ultrasound curvilinear probe with a high pass filter. The following vessels were studied with the mother in a recumbent position during fetal inactivity and apnea. 1st Umbilical Artery (UA), 2nd Middle Cerebral Artery (MCA). Fetal outcome was studied under major and minor adverse outcomes. The current study found that the umbilical artery systolic/diastolic ratio was concordant with major and minor adverse outcome among 55 cases regarding of abnormal finding, and among 25 case regarding negative findings. The umbilical artery RI was concordant with major and/or minor adverse outcome among 34 cases regarding of abnormal finding, and among 28 case regarding negative findings. The umbilical artery PI was concordant with major and/or minor adverse outcome among 52 cases regarding of abnormal finding, and among 29 case regarding negative findings. Serial Doppler examinations of fetal (S/D ratio, UA RI, & UA PI), and (MCA PI, & MCA/UA PI) provide better information than does a single measurement.


2018 ◽  
Vol 219 (2) ◽  
pp. 195.e1-195.e14 ◽  
Author(s):  
Nansi S. Boghossian ◽  
Marco Geraci ◽  
Erika M. Edwards ◽  
Jeffrey D. Horbar

2018 ◽  
Vol 36 (08) ◽  
pp. 818-827 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Suneet P. Chauhan ◽  
Tyisha Barrett ◽  
Van Thi Thanh Truong ◽  
Claudia Pedroza ◽  
...  

Objective To assess the ability of customized and population growth nomograms in identifying newborns with composite neonatal morbidity (CNM). Study Design This study included women who participated in the 10 Maternal-Fetal Medicine Units (MFMU) trials and delivered a nonanomalous singleton with a known gestational age (GA) of 24 weeks or more and documented birthweight. Population nomograms were based on Alexander's nomogram, whereas customized nomograms used publicly available softwares. Random-effect logistic regression was used to estimate the adjusted odds ratio (aOR). Positive and negative likelihood ratios (LRs) were calculated to assess nomogram performance. Results Of 92,225 women, 85% met the inclusion criteria. Using the population nomogram, 12% were small for gestational age (SGA) and 10% were large for gestational age (LGA), and using customized nomograms, 15% were SGA and 16% LGA. SGA newborns had a higher likelihood of CNM (aOR: 2.62; 95% confidence interval [CI]: 2.48–2.76) for population nomograms and 3.22 (95% CI: 3.07–3.39) for customized nomograms. LGA newborns had a similar CNM with population nomogram but significantly higher with customized nomogram (aOR: 1.42; 95% CI: 1.34–1.50). For the adverse outcomes among SGA and LGA, the positive LRs for the two nomograms were similar with overlapping 95% CI. Conclusion Though both SGA and LGA are associated with adverse perinatal outcomes, the detection using both nomograms was similar.


2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Natasha Pritchard ◽  
Susan Walker ◽  
Stephen Tong ◽  
Anthea Lindquist

Abstract Background Sex impacts birthweight, with male babies heavier on average. However, growth charts in pregnancy are often sex-neutral. Small babies (&lt;10th centile) are at risk of adverse outcomes. We aimed to identify the impact of using sex-specific charts during pregnancy, and if this detected more babies at risk of stillbirth. Methods Retrospective cohort study including all infants born in Victoria from 2005-2015 (n = 529,261). We applied the same growth centiles, either adjusted or not adjusted for fetal sex. We compared overall &lt;10th centile populations, populations of males considered small by sex-specific charts only, and populations of females considered small by sex-neutral charts only. Stillbirth risk was our primary outcome. Results Of those &lt;10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of &lt; 10th centile females were reclassified as &gt; 10th centile using sex-specific charts. These females were not at increased risk of stillbirth or adverse outcomes compared with a healthy weight infant, but were at greater risk of being delivered by obstetricians on suspicion of growth restriction. A further 25.0% of male infants were reclassified as &lt; 10th centile by sex-specific charts. These male newborns, compared to a healthy weight baby, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and other adverse outcomes. Conclusions Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as &lt; 10th centile, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Key messages Male babies are heavier than female babies. Thus, ultrasound charts growth charts should be sex-specific.


Author(s):  
Sunitha .T ◽  
Shyamala .J ◽  
Annie Jesus Suganthi Rani.A

Data mining suggest an innovative way of prognostication stereotype of Patients health risks. Large amount of Electronic Health Records (EHRs) collected over the years have provided a rich base for risk analysis and prediction. An EHR contains digitally stored healthcare information about an individual, such as observations, laboratory tests, diagnostic reports, medications, procedures, patient identifying information and allergies. A special type of EHR is the Health Examination Records (HER) from annual general health check-ups. Identifying participants at risk based on their current and past HERs is important for early warning and preventive intervention. By “risk”, we mean unwanted outcomes such as mortality and morbidity. This approach is limited due to the classification problem and consequently it is not informative about the specific disease area in which a personal is at risk. Limited amount of data extracted from the health record is not feasible for providing the accurate risk prediction. The main motive of this project is for risk prediction to classify progressively developing situation with the majority of the data unlabeled.


2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1084-1088
Author(s):  
Deepanshu Chawla ◽  
Pankaj Wagh ◽  
Saood Ali ◽  
Ulhas Jadhav ◽  
Babaji Ghewade

Covid19 or SARS COV 2 is the most dreaded pandemic of the century, causing widespread mortality and morbidity. On the other hand, tuberculosis is an age-old disease killing billions around the globe every year. Both the diseases have caused a significant loss of human lives along with socio-economic constraints. While SARS Cov 2 is a very new disease, tuberculosis is known to humanity for thousands of years. Tuberculosis is an airborne infection while Covid spreads via droplet spread and through fomite as well. Tuberculosis and complications related to it may lead to increased mortality due to poor lung compliance. Moreover, Tuberculosis control programmed may get affected due to the ongoing pandemic. To decrease the adverse outcome of Covid19 on Tb strict measures like proper social distancing, hand hygiene, compliance to Anti Tubercular drugs, domiciliary Tb care and strengthening immune system may prove important. Measures like the use of masks, proper cough hygiene and repeated washing of hands may play a role in decreasing the spread of tuberculosis as well and might also play a role in the elimination of tuberculosis. The article also highlights the measures taken in a rural hospital in central India for the management of COVID 19 and Tuberculosis and the possible difficulties faced in the management of tuberculosis during the Covid pandemic.


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