Early identification of preterm neonates at birth with a Tablet App for the Simplified Gestational Age Score (T-SGAS) when ultrasound gestational age dating is unavailable: A validation study

In methadone-exposed preterm neonates, early identification of those at risk of severe neonatal abstinence syndrome (NAS) and use of a methadone dosing regimen that can provide effective and safe drug exposure are two important aspects of optimal care. To this end, we reviewed 17 methadone dosing recommendations in the international guidelines and literature and explored their variability in key dosing strategies. We selected three of the reviewed dosing regimens for their pharmacokinetics (PK) characteristics and their exposure–response relationship in three gestational age groups of preterm neonates (28, 32 and 36 gestational age weeks) at risk for development of severe NAS (defined as an umbilical cord methadone concentration of ≤60 ng/mL, following fetal exposure). We applied early (12 h after birth) vs. typical (36 h after birth) initiation of treatment. We observed that use of universally recommended dosing regimens in preterm neonates can result in under- or over-exposure. Use of a PK-guided dosing regimen resulted in effective target exposures within 24 h after birth with early initiation of treatment (12 h after birth). Future prospective studies should explore the incorporation of umbilical cord methadone concentrations for early identification of preterm neonates at risk of developing severe NAS and investigate the use of a PK-guided methadone dosing regimen, so that treatment failure, prolonged length of stay and opioid over-exposure can be avoided.

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Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study (Preprint)

10.2196/preprints.11913 ◽

2018 ◽

Author(s):

Archana B Patel ◽

Kunal Kurhe ◽

Amber Prakash ◽

Savita Bhargav ◽

Suchita Parepalli ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Validation Study ◽

Scoring System ◽

Age Dating ◽

Resource Limited Settings ◽

Resource Limited ◽

Care Facilities

BACKGROUND Although rates of preterm birth continue to increase globally, identification of preterm from low birth weight infants remains a challenge. The burden of low birth weight vs preterm is greatest in resource-limited settings, where gestational age (GA) prior to delivery is frequently not known because ultrasound in early pregnancy is not available and estimates of the date of the mother’s last menstrual period (LMP) may not be reliable. An alternative option is to assess GA at birth to optimize referral and care of preterm newborns. We previously developed and pilot-tested a system to measure the simplified gestational age score (SGAS) based on 4 easily observable neonatal characteristics. OBJECTIVE The objective of this study is to adapt the scoring system as a tablet app (potentially scalable approach) to assess feasibility of use and to validate whether the scoring system accurately predicts prematurity by itself, over and above birth weight in a large sample of newborns. METHODS The study is based in Nagpur, India, at the Research Unit of the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. The Android tablet app for the SGAS (T-SGAS) displays de-identified photographs of skin, breasts, and genitalia across a range of GAs and line drawings of infant posture. Each item is associated with a score. The user is trained to choose the photograph or line drawing that most closely matches the newborn being evaluated, and the app determines the neonate’s GA category (preterm or term) from the cumulative score. The validation study will be conducted in 3 second level care facilities (most deliveries in India occur in hospitals, and women known to be at risk of preterm birth are referred to second level care facilities). Within 24 hours of delivery, women and their babies who are stable will be enrolled in the study. Two auxiliary nurse midwives (ANMs) blinded to prior GA assessments will use the T-SGAS to estimate the GA status of the newborn. An independent data collector will abstract the GA from the ultrasound recorded in the hospital chart and record the date of the mother’s LMP. Eligibility for analysis is determined by the ultrasound and LMP data being collected within 1 week of each other to have a rigorous assessment of true GA. RESULTS Publication of the results of the study is anticipated in 2019. CONCLUSIONS Until GA dating by ultrasound is universally available and easy to use in resource-limited settings, and where there are restrictions on ultrasound use due to their use for sex determination and abortion of female fetuses, this study will determine whether the T-SGAS app can accurately assess GA in risk categories at birth. CLINICALTRIAL ClinicalTrials.gov NCT02408783; https://clinicaltrials.gov/ct2/show/NCT02408783 (Archived by Webcite at http://www.webcitation.org/75S2kmr3T) INTERNATIONAL REGISTERED REPORT DERR1-10.2196/11913

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Gestational age dating using newborn metabolic screening: A validation study in Busia, Uganda

Journal of Global Health ◽

10.7189/jogh.11.04012 ◽

2021 ◽

Vol 11 ◽

Author(s):

Scott P Oltman ◽

Elizabeth A Jasper ◽

Richard Kajubi ◽

Teddy Ochieng ◽

Abel Kakuru ◽

...

Keyword(s):

Gestational Age ◽

Validation Study ◽

Age Dating ◽

Metabolic Screening

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Acute kidney injury in preterm neonates with ≤30 weeks of gestational age and its risk factors

Minerva Pediatrica ◽

10.23736/s0026-4946.18.04964-2 ◽

2019 ◽

Vol 71 (5) ◽

Author(s):

Rita Ladeiras ◽

Filipa Flor-De-Lima ◽

Henrique Soares ◽

Bárbara Oliveira ◽

Hercília Guimarães

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Gestational Age ◽

Kidney Injury ◽

Preterm Neonates

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Intestinal Permeability in Preterm Neonates is not Related to Gestational Age or Birth Weight. 75

Pediatric Research ◽

10.1203/00006450-199609000-00098 ◽

1996 ◽

Vol 40 (3) ◽

pp. 527-527

Author(s):

Ruurd M van Elburg ◽

Femke M van Overbeek ◽

Carin M Bunkers ◽

Willem PF Fetter ◽

Sidarto Bambang Oetomo ◽

...

Keyword(s):

Birth Weight ◽

Intestinal Permeability ◽

Gestational Age ◽

Preterm Neonates

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Comparison of Prophylaxis and Rescue Treatment With Curosurf in Neonates Less than 30 Weeks' Gestation: A Randomized Trial

PEDIATRICS ◽

10.1542/peds.92.6.768 ◽

1993 ◽

Vol 92 (6) ◽

pp. 768-774 ◽

Cited By ~ 1

Author(s):

Johannes Egberts ◽

J. Peter de Winter ◽

Gunnar Sedin ◽

Martin J.K. de Kleine ◽

Ulf Broberger ◽

...

Keyword(s):

Mechanical Ventilation ◽

Gestational Age ◽

Periventricular Leukomalacia ◽

Ductus Arteriosus ◽

Expectant Management ◽

Supplemental Oxygen ◽

Preterm Neonates ◽

Transcutaneous Oxygen ◽

Prophylaxis Group ◽

Rescue Treatment

Objective. The aim of this randomized clinical trial was to evaluate the immediate effects of prophylactic administration of Curosurf and to compare outcomes after prophylactic or expectant management. Study design. Porcine surfactant (Curosurf, 200 mg/kg body weight) was administered intratracheally within 10 minutes of birth to preterm neonates with a gestational age of 26 to 29 weeks (n = 75); rescue-eligible neonates (n = 72) were initially subjected to a sham maneuver. The primary end points of the trial, evaluated at the age of 6 hours, were to obtain (1) a 40% decrease in the ratio between transcutaneous oxygen tension (tcPo2) (kPa) and fraction of inspired oxygen (Fio2), and (2) a 50% decrease in the incidence of radiologically verified respiratory distress syndrome (RDS). After 6 to 24 hours, a similar dose of surfactant was given to the neonates of both the prophylaxis and the rescue-eligible group, if they needed mechanical ventilation with an Fio2 ≥ 0.6. Results. At 6 hours the prophylaxis group had, in comparison with the rescue-eligible group, significantly higher tcPo2/Fio2 ratios (mean ± SD: 39.7 ± 15.3 vs 28.1 ± 18.1; P < .001) and less severe RDS by radiological scoring (χ2 = 14.9; P = .005). Severe RDS was present in 19% of the prophylactically treated neonates versus 32% in the rescue-eligible group (P < .05). The prophylaxis group needed shorter periods of Fio2 > 0.40 than the rescueeligible neonates (P < .01), and eight neonates of the prophylaxis group (11%) versus 23 of the rescue-eligible group (32%) qualified for rescue treatment with surfactant in the interval 6 to 24 hours (P < .01). There were no differences in the incidence or severity of pneumothorax, pulmonary interstitial emphysema, cerebral hemorrhage, periventricular leukomalacia, patent ductus arteriosus, in the duration of mechanical ventilation or time in supplemental oxygen, or in mortality. Conclusions. Subgroup analysis revealed (1) that administration of corticosteroids reduced the risk of developing neonatal RDS as effectively as did surfactant prophylaxis at birth, and (2) that prophylaxis was effective especially in neonates with gestational age <28 weeks or birth weight <1000 g, in male neonates, and in neonates who had received no antenatal treatment with corticosteriods. Our data indicate that prophylactic treatment with surfactant should be considered in high-risk neonates fulfilling these latter criteria.

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Oral acetaminophen administration for patent ductus arteriosus (PDA) closure in preterm neonates

Medical Journal of Tabriz University of Medical Sciences ◽

10.34172/mj.2021.051 ◽

2021 ◽

Vol 43 (3) ◽

pp. 254-259

Author(s):

Mahmood Samadi ◽

Zahra Nabaee ◽

Manizheh Mostafagharebaghi ◽

Majid Mahalei ◽

Elham Sheykhsaran ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Gestational Age ◽

Statistical Significance ◽

Ductus Arteriosus ◽

Preterm Neonates ◽

Term Infants ◽

Treatment Data ◽

Kolmogorov Smirnov ◽

Study Population ◽

Patent Ductus

Background: Patent Ductus Arteriosus (PDA) is considered one of the most prevalent types of congenital heart disease. The closure of the ductus arteriosus physiologically occurs at the first 48-72 hours after the birth in healthy term infants. Different causes can result in the pathological opening of ductus arteriosus. This study aims to investigate the effect of oral acetaminophen on the closure of PDA in preterm neonates. Methods: The present study is a trial without control. Forty-five preterm neonates with a gestational age of <32 weeks were studied. Acetaminophen was orally administered with a dose of 10mg/kg every 6 hours for three days. Closure of ductus arteriosus was considered as the success of treatment. Data were analyzed using SPSS 15. Data were reported as )frequency-percent) and mean ± SD. To evaluate the normal distribution of data, we used a Kolmogorov-Smirnov test. Statistical significance was defined as P<0.05. Results: The study population consisted of 20 male and 25 female infants with the mean gestational age of 28.95 ± 1.66 weeks. Cesarean-born infants and vaginal-born infants consisted 17.8% and 82.2% of the study population, respectively. The proportion of PDA closure after administration of oralacetaminophen was 82.3%. Conclusion: The current study indicates that oral acetaminophen is highly effective in closing PDA. Considering its trivial side effects, it has the potency to be a convenient option for treating this condition.

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Preterm Pulmonary Hemorrhage Is Associated with Multiple Births but Not with Intracytoplasmic Sperm Injection: A Cohort Study on Medical Records

American Journal of Perinatology ◽

10.1055/s-0038-1641589 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1087-1092

Author(s):

Stefanie Stierling ◽

Ralf-Dieter Hilgers ◽

Sonja Trepels-Kottek ◽

Konrad Heimann ◽

Thorsten Orlikowsky ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Gestational Age ◽

Intracytoplasmic Sperm Injection ◽

Medical Records ◽

Ductus Arteriosus ◽

Pulmonary Hemorrhage ◽

Multiple Births ◽

Preterm Neonates ◽

Increased Risk

Objective Pulmonary hemorrhage (PH) is a severe complication in preterm neonates. This study aims to identify risk factors and comorbidities of PH. Study Design A single-center cohort study on medical records including all preterm neonates of <30 weeks' gestational age was conducted in the neonatal intensive care unit of Universitätsklinikum Aachen, Germany. The occurrence of PH served as a primary end point. Gestational age, birthweight, sex, multiple births, intracytoplasmic sperm injection (ICSI), intubation, surfactant, antenatal steroids, intraventricular hemorrhage (IVH), amniotic infection syndrome, and persistent ductus arteriosus were studied as risk factors. Results In this study, 344 preterm neonates were included, of whom 36 suffered from PH (10.5%). The mean time of the first occurrence was the third day of life (standard deviation [SD]: 1.2). On average, the patients suffered from 1.5 incidents (SD: 0.8) of PH, of whom 50% were severe. Preterm neonates born as multiples (95% confidence interval [CI]: 3.1, 26.9) and those who suffered from IVH (95% CI: 2.7, 18.9) had a significantly increased risk of PH. ICSI was not an independent risk factor. Conclusion PH is significantly associated with IVH and multiple births but not with ICSI. The identification of patients at risk allows to apply prophylactic strategies of ventilation and pharmacological treatment.

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