scholarly journals OUTCOME OF PRETERM INFANTS AFTER DELIVERY ROOM CARDIOPULMONARY RESUSCITATION. A RETROSPECTIVE OBSERVATIONAL STUDY

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e19-e19
Author(s):  
Bishal Gautam ◽  
Sarah McKnight ◽  
Michael Miller ◽  
Bryan Richardson ◽  
Abrar Ahmed ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Chest Compression ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Bivariate Analysis ◽  
Care Hospital ◽  
Mortality And Morbidity

Abstract BACKGROUND Chest compression in the delivery room (CPR-DR) during neonatal resuscitation is considered as an extreme measure. When respiratory support alone is unable to establish circulatory transition, chest compression with or without epinephrine is necessary. The results of earlier studies have shown varied results in mortality and morbidity of preterm infants who received CPR-DR. OBJECTIVES To examine the relationship between need of CPR-DR in infants born between 23 and 32 weeks gestation and neonatal mortality and morbidity. DESIGN/METHODS This was a population-based cohort study of 23 0/7 to 32 6/7 weeks gestational age infants born at a Canadian tertiary care hospital between January 1, 2007 and December 31, 2016. Data were retrieved from the Neonatal-Perinatal database. Neonatal mortality and morbidities were examined between infants who did and did not need CPR-DR. RESULTS Of 1443 newborns meeting study criteria, 55 (3.8%) received CPR-DR. On bivariate analysis, outcome of infants requiring CPR-DR was associated with higher mortality (40% vs. 5.8%, p <0.001), intraventricular hemorrhage grade 3 or 4 (21.8% vs. 6.1%, p <0.001), patent ductus arteriosus (54.5% vs. 27.7%, p<0.001), bronchopulmonary dysplasia (35.4% vs. 19.6%, p=0.007), need of mechanical ventilation (90.9% vs. 61.1%, p<0.001) and sepsis (23.6% vs. 13.5%, p=0.034). However, in a multivariable logistic regression analysis controlling for predictor variables, CPR-DR was only associated with increased neonatal mortality (aOR=4.41 p<0.001, 95%CI [2.18, 8.92]). CONCLUSION While CPR-DR is associated with a high mortality rate in infants less than 32 weeks gestation, associated morbidities are largely predicted by other risk factors.

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.

scholarly journals Burden of congenital heart diseases in a tertiary cardiac care institute of high altitude area

2019 ◽  
Vol 7 (5) ◽  
pp. 1441
Author(s):  
Zubair Mushtaq Tramboo ◽  
Aamir Rashid Patigaroo ◽  
Nazir Ahmad
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Indian Subcontinent ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Developed Countries ◽  
Care Hospital ◽  
Mortality And Morbidity

Background: Congenital heart disease is one of the major causes of mortality and morbidity in the paediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors.  The objective of the study was to find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (Jammu and Kashmir).Methods: All children admitted at territary care hospital with age 0-15 years were screened for congenital heart disease. The study was conducted for period of one year to ascertain the prevalence and spectrum of CHDs.Results: A total of 232 patients out of 23000, were found having CHDs measuring a prevalence of 10.5/1000. About 170 (73%) were the acyanotics, and 62 (27%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 54 (23%), followed by patent ductus arteriosus in 50 (22%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 15 (6.4%) patients.Conclusions: Authors observed high prevalence of CHD in our population. The pattern and spectrum of CHD were comparable to national and international data.

scholarly journals Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman

2021 ◽  
Author(s):  
Hilal KT Al Mandhari ◽  
Buthina Al Riyami ◽  
Ashfaq Khan ◽  
Mika Nonoyama ◽  
Syed GA Rizvi
Keyword(s):  
Risk Factors ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Binary Logistic Regression ◽  
Extubation Failure ◽  
Binary Logistic Regression Analysis ◽  
Care Hospital ◽  
Airway Extubation

Objectives: To determine extubation failure (EF) rate among intubated preterm infants (<37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF. Methods: Charts of all intubated preterm infants (<37 weeks GA) from January 2013 to December 2017 were retrospectively reviewed. EF was defined as reintubation within 7 days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups, and binary logistic regression analysis. Results: A total of 190 preterm infants were intubated during the study period, with 140 eligible for analysis. N=106 were successfully extubated; 34 (24.3%) failed extubation. GA <28 weeks (p=0.029), lower 1-minute APGAR score (p=0.023) and patent ductus arteriosus diagnosis (PDA) (p=0.018) were significantly associated with EF. After the multivariate analysis, only GA <28 weeks predicted EF with adjusted odds ratio (95% confidence interval) of 2.62 (1.17 – 6.15). Conclusions: EF rate in preterm infants admitted at our NICU in Oman, was within international rates. GA <28 weeks was the only predictor of extubation failure identified. Neonatal practitioners need to seriously consider extreme prematurity in extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants. Keywords: Premature Infants; Neonate; Airway Extubation; Extubation Failure, Risk Factors.

scholarly journals Predictors of mortality in neonatal septicemia in a tertiary care centre

2020 ◽  
Vol 7 (10) ◽  
pp. 2037
Author(s):  
Dhara Gosai ◽  
Bela H. Shah ◽  
Jyothi S.
Keyword(s):  
Neonatal Mortality ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Coagulase Negative Staphylococci ◽  
Neonatal Septicemia ◽  
Mortality And Morbidity ◽  
Laboratory Parameters ◽  
Predictors Of Mortality

Background: Neonatal septicemia continues to be a major cause of mortality and morbidity in new-borns all over the world. Aim and objectives of the study were determining the risk factors for mortality in neonatal septicemia.Methods: A retrospective observational study of the demographics, clinical features and laboratory parameters of 100 neonates admitted in NICU of a tertiary care hospital from September 2019 to March 2020.Results: 67% of neonates delivered outside centre and 33% of neonates delivered at centre were found to have sepsis exclusively based on culture positivity. A significant association was found between very low birth rate (VLBW) (p value<0.001), prematurity (p value<0.01) and high neonatal mortality. Among the different clinical presentations of neonatal sepsis, lethargy (p value<0.02), apnea (p value<0.01) and hypothermia (p value<0.02) were found to be frequently associated with neonatal mortality. Further, C-reactive protein (CRP) positivity (p value<0.003), hyperglycaemia (p value<0.0009) and thrombocytopenia (p value<0.0009) were also associated with high neonatal mortality. Gram positive bacteria were frequently isolated from blood cultures of deceased neonates, Coagulase negative staphylococci (CoNS) (36.1%), being the commonest bacteria followed by B. subtilis (11.1%), Klebsiella spp. (11.1%) and Acinetobacter spp. (8.3%).Conclusion: Demographic factors like VLBW, prematurity, outborn deliveries, clinical and laboratory parameters like lethargy, apnea, hypothermia, thrombocytopenia and hyperglycemia are strong predictors of mortality in neonatal.

scholarly journals Clinico-bacteriological profile of neonatal sepsis in rural tertiary care hospital

2017 ◽  
Vol 4 (4) ◽  
pp. 1259
Author(s):  
K. Venkataramana Reddy ◽  
K. Sailaja ◽  
A. Ashok ◽  
K. Poojitha
Keyword(s):  
Developing Countries ◽  
Neonatal Mortality ◽  
Neonatal Sepsis ◽  
Opportunistic Infections ◽  
Tertiary Care ◽  
Developed Countries ◽  
Care Hospital ◽  
Group B Streptococci ◽  
Mortality And Morbidity ◽  
Group B

Background: Neonatal sepsis one of the most common cause for neonatal mortality and morbidity in developing countries. Group B Streptococci being the most common organism in developed countries, whereas CONS and Gram negative bacteria frequently encountered organisms in developing countries. It is advisable to have an individualised institutional protocol based on their own culture reports to reduce the antibiotic resistance.Methods:A prospective observational study was conducted from September 2016- February 2017, at the Department of Paediatrics, S.V.S. Medical College and Hospital, Mahabubnagar, Telangana, India. The study included 65 neonates admitted in our NICU. A questionnaire was filled by mothers after taking consent. Data was Collected data was analysed.Results: In present study, we found that CONS were the most commonly isolated organisms followed by Klebsiella.Conclusions:Neonatal sepsis creates a significant burden due to its impact on neonatal mortality and long-term morbidity. Following proper hand washing techniques with minimal handling in intensive care units will reduce neonatal sepsis from opportunistic infections. 

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Marlies Bruckner ◽  
Gianluca Lista ◽  
Ola D. Saugstad ◽  
Georg M. Schmölzer
Keyword(s):  
Preterm Infants ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Delivery Room ◽  
Temperature Management ◽  
Term Infants ◽  
Term Newborn ◽  
Resuscitation Guidelines ◽  
Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

scholarly journals Epidemiology and outcome of sepsis in a tertiary-care hospital in a developing country

2005 ◽  
Vol 134 (2) ◽  
pp. 315-322 ◽  
Author(s):  
M. D. TANRIOVER ◽  
G. S. GUVEN ◽  
D. SEN ◽  
S. UNAL ◽  
O. UZUN
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Approach ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Mortality And Morbidity ◽  
Underlying Diseases ◽  
Major Pathogens ◽  
Very High

Sepsis continues to have a substantial mortality and morbidity despite advances in the diagnosis and management of this condition. We retrospectively analysed hospital charts of patients diagnosed to have sepsis between January 2002 and June 2003. Demographic characteristics of patients, microbiological findings and predictors of survival were evaluated. Sixty-nine sepsis episodes that occurred in 63 patients were analysed. The most common underlying diseases were hypertension, malignancies and diabetes mellitus. Renal insufficiency, respiratory distress and disseminated intravascular coagulation developed in 52·2, 30·4 and 30·4% of the episodes respectively; 47·7% of the blood cultures yielded an organism. Gram-negative bacteria were the predominant microorganisms (65·9%). Fifty-five patients (87·3%) died. Mechanical ventilation and underlying renal disease were significant determinants of mortality. In conclusion, Gram-negative bacteria remain the major pathogens in sepsis. The mortality remains very high, and a change in the clinical approach to the septic patient should be employed to improve the outcome.

Opinions of paediatricians who teach neonatal resuscitation about resuscitation practices on extremely preterm infants in the delivery room

2016 ◽  
Vol 42 (11) ◽  
pp. 725-728 ◽  
Author(s):  
Cristiane Ribeiro Ambrosio ◽  
Adriana Sanudo ◽  
Alma M Martinez ◽  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals IV Paracetamol for closure of patent ductus arteriosus in preterm neonates admitted to a tertiary care centre

2018 ◽  
Vol 5 (2) ◽  
pp. 294 ◽  
Author(s):  
Sunil B. ◽  
Shruthi Patel ◽  
Girish N.
Keyword(s):  
Side Effects ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Treatment Options ◽  
Tertiary Care ◽  
Current Treatment ◽  
Preterm Neonates ◽  
Tertiary Care Centre ◽  
Vascular Connection ◽  
Intravenous Paracetamol

Background: Ductus arteriosus is a vascular connection between the pulmonary artery and descending aorta. The incidence is inversely related to birth weight and gestational age (GA). In preterm infants it varies between 40% and 60% on the third day of life. At present, the choice of treatment of clinically significant PDA is with either ibuprofen or indomethacin, but they carry many contraindications and potential side effects. Hence it is important to consider that paracetamol may be used as an alternative to other non steroidal anti-inflammatory drugs and is effective in ductal closure with minimal side effects.Methods:Thirty six preterm infants with hemodynamically significant PDA(hs-PDA) were treated with intravenous paracetamol and subsequent closure was evaluated clinically and by follow-up 2D-Echo.Results: PDA closure following intravenous paracetamol was evident in 27 babies (75%). There were no significant side effects noted with paracetamol therapy.Conclusions: This study shows that paracetamol could offer favourable safety profile in comparison to current treatment options. Therefore, paracetamol may be accepted as a first-line drug treatment for PDA in preterm infants. 

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