Evaluation of Perinatal Outcome Using Individualized Growth Assessment: Comparison With Conventional Methods

Objective. To evaluate individualized growth assessment using the Rossavik growth model for detection of growth-retarded neonates with poor perinatal outcomes. Methods. Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 154 singleton neonates. Individual fetal growth curve standards for head and abdominal circumference and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index and the Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes (mechanical delivery, low Apgar score, abnormal fetal heart rate [FHR] patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications), using NGAS, were compared with those by the traditional birth weight-for-gestational age method and the ponderal index, respectively. Results. Of the 154 fetuses studied, 120 had normal growth outcomes at birth; 18 showed evidence of intrauterine growth retardation; and 16 had macrosomia, based on NGAS. According to birth weight-for-gestational age classification, 32 fetuses were small for gestational age; 118 were appropriate for gestational age; and only 4 were large for gestational age. According to the ponderal index, 55 fetuses had growth retardation, 99 showed appropriate growth and there was no macrosomia. There was a significant increase in mechanical deliveries in cases of growth-retarded neonates, determined using the NGAS classification, when compared with events related to normally grown or macrosomic neonates. However, there were no significant differences in mechanical deliveries among the groups by birth weight classification or ponderal index. Both birth weight classification and NGAS classification showed a significant increase in the low Apgar score, abnormal FHR patterns, and neonatal acidosis in infants classified as growth retarded when compared with appropriately grown or macrosomic infants. However, there were no significant differences in the low Apgar score, abnormal FHR patterns, and neonatal acidosis between growth-retarded and appropriately grown infants when they had been so classified by ponderal index. Three growth category classification methods failed to reveal significant differences in meconium staining of amniotic fluid, neonatal intensive care unit admission, and maternal complications among the groups. Conclusion. We do cast doubt on the usefulness of the ponderal index for detection of growth-retarded neonates with poor perinatal outcomes, and individualized growth assessment seems to perform at least as well as the traditional birth weight-for-gestational age method.

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Estimating outcomes in newborn infants using fuzzy logic

Revista Paulista de Pediatria ◽

10.1590/0103-058220143228413 ◽

2014 ◽

Vol 32 (2) ◽

pp. 164-170 ◽

Cited By ~ 2

Author(s):

Luciano Eustáquio Chaves ◽

Luiz Fernando C. Nascimento

Keyword(s):

Fuzzy Logic ◽

Intensive Care ◽

Birth Weight ◽

Gestational Age ◽

Apgar Score ◽

Neonatal Intensive Care ◽

Newborn Infants ◽

Membership Functions ◽

Risk Of Death ◽

Minute Apgar Score

OBJECTIVE: To build a linguistic model using the properties of fuzzy logic to estimate the risk of death of neonates admitted to a Neonatal Intensive Care Unit.METHODS: Computational model using fuzzy logic. The input variables of the model were birth weight, gestational age, 5th-minute Apgar score and inspired fraction of oxygen in newborn infants admitted to a Neonatal Intensive Care Unit of Taubaté, Southeast Brazil. The output variable was the risk of death, estimated as a percentage. Three membership functions related to birth weight, gestational age and 5th-minute Apgar score were built, as well as two functions related to the inspired fraction of oxygen; the risk presented five membership functions. The model was developed using the Mandani inference by means of Matlab(r) software. The model values were compared with those provided by experts and their performance was estimated by ROC curve.RESULTS: 100 newborns were included, and eight of them died. The model estimated an average possibility of death of 49.7±29.3%, and the possibility of hospital discharge was 24±17.5%. These values are different when compared by Student's t-test (p<0.001). The correlation test revealed r=0.80 and the performance of the model was 81.9%.CONCLUSIONS: This predictive, non-invasive and low cost model showed a good accuracy and can be applied in neonatal care, given the easiness of its use.

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Can 5-minute Apgar score be considered as an additional independent risk factor for screening of retinopathy of prematurity?

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.004 ◽

2020 ◽

Vol 8 (1) ◽

pp. 4-4

Author(s):

Amir Eftekhari Milani ◽

Mohamad Reza Niyousha ◽

Ali Kiavar ◽

Hanieh Sakha ◽

Ali Mahdavi Fard ◽

...

Keyword(s):

Risk Factor ◽

Birth Weight ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Apgar Score ◽

Neonatal Intensive Care ◽

Independent Risk Factor ◽

P Value ◽

Cross Sectional ◽

Minute Apgar Score

Introduction: Because of increasing the population of premature infants due to improving neonatal care we try to find other independent criteria in addition to birth weight and gestational age to reduce the number of infants who need a retinopathy of prematurity (ROP) screening examination. Methods: This is a retrospective cross-sectional study, included 150 preterm infants with gestational age of ≤ 32 weeks or birth weight ≤ 1500 g or receives oxygen therapy for more than 2 days, who were examined from the fourth week of life for ROP in Tabriz Al-Zahra hospital’s neonatal intensive care unit (NICU), from March 2017 to January 2018. All infants with other risk factors such as multi gestational pregnancy, blood transfusion or exchange, phototherapy, underlying disease, cerebral hemorrhage, chronic lung disease and sepsis were excluded from the study. Infants divided to two group ROP (n=47) and non-ROP (n=133) and their 5-minute Apgar score was Apgar score was compared as an independent risk factor. Exploratory data analysis was performed using descriptive measures with independent samples t tests. Kolmogorov-Smirnov tests were used to test the normality of data distribution. Results: The mean 5-minute Apgar scores were statistically lower in ROP group (5.4±2.3) than non-ROP group 6.2±2.1 (P value=0.041). Conclusion: Apgar score was statistically significant, but in light of the very close results obtained, it seems prudent to consider an independent risk factor.

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Umbilical cord coiling index as a marker of perinatal outcome

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.068 ◽

2021 ◽

Vol 8 (3) ◽

pp. 323-327

Author(s):

Pragati Jain ◽

Monika Aggarwal ◽

Meenu V Ahuja ◽

Surbhi Gupta

Keyword(s):

Umbilical Cord ◽

Apgar Score ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Well Being ◽

Ponderal Index ◽

Amniotic Fluid Index ◽

Meconium Staining ◽

Nicu Admission ◽

In Pregnancy

The umbilical cord is very important for the well-being and survival of the fetus, however this is susceptible to compressions, kinking, traction and torsion which may influence the perinatal outcome and an abnormal umbilical coiling index has been related to adverse fetal and pregnancy outcomes. To determine the umbilical cord coiling index (UCI) and compare its association with perinatal outcome in normal and complicated pregnancies.It was a prospective observational study done on 200 patients at term (after 37 weeks) pregnancy, delivered either vaginally or by cesarean section. The umbilical cord coiling index was calculated. The mean coiling index of our study was 0.256+0.07 per cm. The outcomes measured were maternal age, parity, body mass index, hypertension in pregnancy, diabetes in pregnancy, amniotic fluid index, meconium staining of liquor, neonatal birth weight, Apgar score at birth, ponderal index, NICU admission. The coils were then divided into three categories on the basis of UCI and their association with the maternal and fetal outcomes were analyzed. Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers exact test and the t test where applicable. Hypocoiled cords (UCI <10th centile) were associated with pregnancy induced hypertension (PIH), diabetes mellitus, meconium staining of liquor, low Apgar score, growth restricted fetus and NICU admission. Hypercoiled cords were associated with liquor abnormalities and low ponderal index. Abnormal umbilical cord coiling index was associated with adverse perinatal outcomes.

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Cranial ultrasonography and doppler in neonates: an observational study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181542 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1058

Author(s):

Santosh Kumar Karamasi ◽

Nivedita Patil

Keyword(s):

Birth Weight ◽

Observational Study ◽

Gestational Age ◽

Apgar Score ◽

Neonatal Intensive Care ◽

Transcranial Doppler Sonography ◽

Resistive Index ◽

Cranial Ultrasound ◽

Intracranial Lesions ◽

Doppler Evaluation

Background: The CUS and transcranial doppler sonography is an emerging technique used in neonatal intensive care unit. It is noninvasive, ionizing, portable, safe and inexpensive for serial and long-term studies. Objectives of this study were to study intracranial abnormalities in neonates using ultra sonography on 3rd and 7th day of life and to study ACA blood flow velocity and RI (Resistive index) in neonates on 3rd and 7th day of life.Methods: It was a prospective observational study conducted on 229 neonates at NICU, Department of Pediatrics, Dr. D. Y. Patil Hospital and Research Institute, Kolhapur. During August 2015 to August 2017. After obtaining Informed consent from the parents/guardian details were recorded in a pre-designed pretested, structured proforma. Detailed clinical examination and Cranial ultrasound and doppler evaluation was performed on 3rd and on 7th post-natal day.Results: In the present study, out of 229 study participants, 65.5% were preterm, 34.5% were term. 67.2% had abnormal CUS findings. The PVHE, ICH, PVL, cyst and edema were common cranial abnormalities. These were statistically significant on 3rd day with gestational age, birth weight, low APGAR Score. Out of 229 neonates 58.9% had low, 35.3% normal and 5.8% had high RI index. Statistically significant association was found between gestational age, birth weight and APGAR score. Doppler analysis done on 3rd and 7th day showed rise in systolic and diastolic velocities regardless of the gestational age.Conclusions: Study concludes that CUS and Doppler is an ideal tool to detect various intracranial lesions efficiently in non-invasive manner.

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Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03467-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Na Zeng ◽

Erica Erwin ◽

Wendy Wen ◽

Daniel J. Corsi ◽

Shi Wu Wen ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Preterm Birth ◽

Cesarean Section ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Population Based ◽

Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

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Evaluation of Morbidities and Complications of Neonatal İntensive Care Unit Patients with Respiratory Disorders at Different Gestational Ages

American Journal of Perinatology ◽

10.1055/s-0041-1722942 ◽

2021 ◽

Author(s):

Erbu Yarci ◽

Fuat E. Canpolat

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Respiratory Diseases ◽

Respiratory Disorders ◽

Live Births

Objective Respiratory distress presented within the first few days of life is life-threatening and common problem in the neonatal period. The aim of this study is to estimate (1) the incidence of respiratory diseases in newborns and related mortality; (2) the relationship between acute neonatal respiratory disorders rates and gestational age, birth weight, and gender; and (3) the incidence of complications associated with respiratory disturbances. Study Design Only inborn patients with gestational age between 230/7 and 416/7 weeks having respiratory distress were included in the study. The data were collected from the medical records and gestational age was based on the menstrual dating. Results There were 8,474 live births between January 1, 2013 and June 30, 2013 in our hospital. A total of 1,367 newborns were hospitalized and oxygen therapy was applied in 903 of them because of respiratory distress. An acute respiratory disorder was found to be in 10.6% (903/8,474) among all live births. Mortality was 0.76% (66/8,474). The incidence of respiratory distress syndrome was 2.8% (n = 242). The occurrence of transient tachypnea of newborn was 3.1% (n = 270). Meconium aspiration syndrome, pneumonia, congenital diaphragmatic hernia, and pulmonary maladaptation and primary persistent pulmonary hypertension rates were 0.1, 0.7, 2.2, and 0%, respectively. Overall, 553 (61%) of the 903 newborns having respiratory diseases had complications. The occurrence of necrotizing enterocolitis, patent ductus arteriosus, bronchopulmonary dysplasia, intraventricular hemorrhage and air leak was 6.8, 19.8, 4.7, 24.9, and 5%, respectively. Conclusion This study offers an epidemiological perspective for respiratory disorders from a single-center level-III neonatal intensive care unit. Although number of births, premature newborns, extremely low birth weight/very low birth weight infants, and complicated pregnancies increase in years, decreasing rates of mortality and complications are very promising. As perinatal and neonatal cares are getting better in every day, we think that more promising results can be achieved over the coming years. Key Points

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Perinatal Outcome of the Second Twin

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v10i1.13206 ◽

2015 ◽

Vol 10 (1) ◽

pp. 89-93

Author(s):

R Joshi ◽

G Baral

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Neonatal Intensive Care Unit ◽

Apgar Score ◽

Perinatal Outcome ◽

Neonatal Intensive Care ◽

Mode Of Delivery ◽

Admission Rate ◽

Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins.

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Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Journal of Clinical Medicine ◽

10.3390/jcm10040643 ◽

2021 ◽

Vol 10 (4) ◽

pp. 643

Author(s):

Veronica Giorgione ◽

Corey Briffa ◽

Carolina Di Fabrizio ◽

Rohan Bhate ◽

Asma Khalil

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Chi Square ◽

Increased Risk ◽

Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Maternal Thinness and Obesity and Customized Fetal Weight Charts

Fetal Diagnosis and Therapy ◽

10.1159/000515251 ◽

2021 ◽

pp. 1-9

Author(s):

Nieves L. González González ◽

Enrique González Dávila ◽

Agustina González Martín ◽

Erika Padrón ◽

José Ángel García Hernández

Keyword(s):

At Risk ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Analysis Of Covariance ◽

Large For Gestational Age ◽

Perinatal Morbidity ◽

Accurate Identification ◽

Cephalopelvic Disproportion

Objective: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5–25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. Material and Methods: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5–25), 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. Results: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5−25) than in LGAonly by CC. In SGAonly by CC(18.5−25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5−25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA only by CC(18.5−25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). Conclusion: The use of CC(18.5–25) 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.

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