scholarly journals A defined grey zone with in fetal growth curves for predicting adverse neonatal morbidity in fetuses being small for their gestational age at term in uncomplicated pregnancies

2019 ◽  
Author(s):  
Mefkure Eraslan Sahin ◽  
Ilknur Col Madendag ◽  
Erdem Sahin ◽  
Yusuf Madendag ◽  
Fatma Ozdemir ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Gestational Age ◽  
Apgar Score ◽  
Neonatal Sepsis ◽  
Neonatal Death ◽  
Neonatal Morbidity ◽  
Grey Zone ◽  
Increased Risk ◽  
Significant Difference

Abstract Background: “Small for gestational age” (SGA) is a term used to define an important risk factor for both neonatal morbidity and mortality. Our hypothesis suggests that adverse neonatal morbidity (ANM) in fetuses can occur when the birth weight is closer to 10th percentile. For example, although a fetus with a birth weight within the 11th or 12th percentile is appropriate for gestational age (AGA), it is difficult to clearly distinguish these fetuses from SGA fetuses for ANM; therefore we suggest defining a transition zone, or “grey zone”, for ANM. The aim of the present study was to examine ANM frequency in fetuses using this newly defined grey-zone percentile. Methods: This retrospective analysis comprised 7,817 pregnant women with uncomplicated pregnancies and single deliveries between 37 0/7 and 41 6/7 gestational weeks. The babies were divided into groups according to birth weight percentiles as follows: (1) SGA, (2) 10–20 percentile, and 21–90 percentile. The primary outcome was ANM, defined as any of the following: Apgar score <4 at 5 min; respiratory distress; mechanical ventilation; intraventricular hemorrhage, grade III or IV; necrotizing enterocolitis, stage 2 or 3; neonatal sepsis, stillbirth or neonatal death. Results: Demographic and obstetric characteristics of the mothers were similar among the groups. ANM rates were 10.7% in the SGA group, 6.8% in the 10–20 percentile group, and 2.1% in the 21–90 percentile group, a significant difference. ANM was 5-fold higher in the SGA group and 3.2-fold higher in the 10–20 percentile group than in the 21–90 percentile group. Delivery induction or augmentation, cesarean delivery for non-reassuring fetal heart rate or fetal distress, apgar score <4 at 5 min, mechanical ventilation, neonatal sepsis, stillbirth, or neonatal death significantly increased in the 10–20 percentile group compared with those in the 21–90 percentile group. Conclusion: In uncomplicated pregnancies, ANM for SGA fetuses born at term are significantly worse than that for AGA fetuses. Fetuses with a birth weight within the 10–20 percentile (grey zone) had a significant increased risk of ANM than those within the 21–90 percentile.

Neonatal Outcomes at Extreme Prematurity by Gestational Age Versus Birth Weight in a Contemporary Cohort

2021 ◽  
Author(s):  
Elizabeth B. Ausbeck ◽  
Phillip Hunter Allman ◽  
Jeff M. Szychowski ◽  
Akila Subramaniam ◽  
Anup Katheria
Keyword(s):  
Birth Weight ◽  
Umbilical Cord ◽  
Gestational Age ◽  
Predictive Value ◽  
Neonatal Death ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Mortality And Morbidity ◽  
Severe Morbidity ◽  
Multicenter Randomized Controlled Trial

Objective The aim of the study is to describe the rates of neonatal death and severe neonatal morbidity in a contemporary cohort, as well as to evaluate the predictive value of birth gestational age (GA) and birth weight, independently and combined, for neonatal mortality and morbidity in the same contemporary cohort. Study Design We performed a secondary analysis of an international, multicenter randomized controlled trial of delayed umbilical cord clamping versus umbilical cord milking in preterm infants born at 23 0/7 to 31 6/7 weeks of gestation. The current analysis was restricted to infants delivered <28 weeks. The primary outcomes of this analysis were neonatal death and a composite of severe neonatal morbidity. Incidence of outcomes was compared by weeks of GA, with planned subanalysis comparing small for gestational age (SGA) versus non-SGA neonates. Multivariable logistic regression was then used to model these outcomes based on birth GA, birth weight, or a combination of both as primary independent predictors to determine which had superior ability to predict outcomes. Results Of 474 neonates in the original trial, 180 (38%) were included in this analysis. Overall, death occurred in 27 (15%) and severe morbidity in 139 (77%) neonates. Rates of mortality and morbidity declined with increasing GA (mortality 54% at 23 vs. 9% at 27 weeks). SGA infants (n = 25) had significantly higher mortality compared with non-SGA infants across all GAs (p < 0.01). There was no difference in the predictive value for neonatal death or severe morbidity between the three prediction options (GA, birth weight, or GA and birth weight). Conclusion Death and severe neonatal morbidity declined with advancing GA, with higher rates of death in SGA infants. Birth GA and birth weight were both good predictors of outcomes; however, combining the two was not more predictive, even in SGA infants. Key Points

scholarly journals Effects of Hypertensive Disorders of Pregnancy On The Mortality and Complications in Very Low Birth Weight Neonates

2021 ◽  
Author(s):  
Baoquan Zhang ◽  
Xiujuan Chen ◽  
Changyi Yang ◽  
Huiying Shi ◽  
Wenlong Xiu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Apgar Score ◽  
Very Low Birth Weight ◽  
Fetal Distress ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Abstract Purpose This study was designed to investigate the effects of hypertensive disorders of pregnancy (HDP) on the mortality and complications in very low birth weight neonates. Methods Premature infants at a gestational age of < 37 weeks with a birth weight of < 1,500g were included in this retrospective analysis. Gestational age-matched pregnant women with normal blood pressure giving birth to a very low birth weight neonate served as normal control. HDP neonates were divided into three subgroups based on the disease severity, including gestational hypertension, pre-eclampsia and eclampsia. Then we compared the incidence of complications among three subgroups. We also analyzed the relationship between the subgroups and the neonatal prognosis. Results The incidence of fetal distress, small for gestational age (SGA), mechanical ventilation, neonatal respiratory distress syndrome (RDS), neonatal necrotizing enterocolitis (NEC, ≥ 2 stage), and mortality in HDP group were significantly higher than those of the control. The 1 min Apgar score in HDP group was significantly lower than that of the normal control (P < 0.05). There were significant differences in fetal distress, 1 min Apgar score, mechanical ventilation, RDS and NEC (≥ 2 stage) among HDP, pre-eclampsia and eclampsia subgroups (P < 0.05). Multivariate regression analysis indicated that pre-eclampsia was an independent risk factor for SGA (OR = 4.123, 95%CI: 2.783–6.109) and NEC (OR = 2.493, 95%CI: 1.161–5.351). Eclampsia was a risk factor for SGA (OR = 3.804, 95%CI: 1.239–11.681) and NEC (OR = 7.264, 95%CI: 1.771–29.797). Conclusions HDP may affect the prognosis of very low birth weight neonates. Pre-eclampsia and eclampsia were risk factors for SGA and NEC.

scholarly journals Cerebroplacental Ratio on Doppler as a Predictor of Fetuses at Risk of Perinatal Complications

2021 ◽  
pp. 120-131
Author(s):  
Salwa Abdelmaged Elraey ◽  
Mohammed Mohsen Elnamoury ◽  
Ahmed Mohammed Othman ◽  
Ahmed Mahmoud Awara
Keyword(s):  
At Risk ◽  
Neonatal Sepsis ◽  
Neonatal Death ◽  
Perinatal Complications ◽  
Ratio Measurement ◽  
Neonatal Complication ◽  
Cerebroplacental Ratio ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean

Background: Doppler velocimetry is the best method of surveillance for fetal hypoxemia during pregnancy. Cerebroplacental ratio (CPR), has been suggested as a useful clinical simplification. It is believed that the CPR better predicts adverse perinatal outcomes than its individual components and better than conventional anthropometric models. Therefore, the aim of this study is to evaluate the significance of the cerebroplacental 10th centile threshold measured weekly from 36 weeks of gestation till delivery as a screening test for prediction of need for Cesarean section for intrapartum fetal compromise and the adverse neonatal outcome in women with normally grown fetuses and uncomplicated pregnancy. Methods: This study was carried out on 40 pregnant women uncomplicated, singleton pregnancy with appropriately grown fetuses on clinical assessment. The last Doppler indices including cerebroplacental ratio measurement obtained before labor was reported. CPR values below 1.1 were reported as abnormal. Various studies have variably defined the threshold of abnormal CPR ratio as <1.08. Results: There was significant decrease in the Mean of CPR among patients who had anemia compared to those without anemia. In addition, there was no significant association seen between low CPR and having previous history of abortion or IUGR as well as being a smoker. There was no significant difference between cases who had normal and abnormal CPR regarding gestational age at delivery. There was no difference between cases who had normal and abnormal cerebroplacental ratio regarding mode of delivery. there was significant decrease in the prevalence of low birth weight among group who had CPR≥1.08. CPR <1.08 was significantly associated with neonatal complication like NICU admission, and neonatal death. There was no statistically significant relationship between cerebroplacental ratio and neonatal complication like IUFD, and neonatal sepsis. There was no statistically significant association between the mean cerebroplacental ratio and IUFD. There was statistically significant association between the mean cerebroplacental ratio and NICU. There was no statistically significant association between the mean cerebroplacental ratio and neonatal sepsis. The mean cerebroplacental ratio of 0.93± 0.22 has a significant association with neonatal death. Conclusion: A low cerebroplacental ratio reflects redistribution of the cardiac output to the cerebral circulation and has been shown to improve accuracy in predicting adverse outcome compared with Middle cerebral artery (MCA) or Umbilical artery (UA) Doppler alone. Therefore, integrating CPR in clinical management may help to better identify fetuses at risk for adverse perinatal events, since abnormal CPR has been associated with an increased risk of perinatal complications.

scholarly journals Perinatal Outcomes of Babies Born with Fresh or Frozen-Thawed Testicular Sperm in Patients with Azoospermia

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mehmet AK ◽  
Nur Dokuzeylul Gungor
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Gestational Age ◽  
Neonatal Death ◽  
Perinatal Outcomes ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Testicular Sperm ◽  
Significant Difference ◽  
Gestational Age At Delivery

Aim: To compare the perinatal outcomes of pregnancies obtained with fresh or frozen-thawed sperm in patients who underwent surgical sperm extraction for the diagnosis of azoospermia. Materials and Methods: In this retrospective study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved fresh or frozen-thawed sperm. Participants were divided into two equal groups as follows. Group 1 (n = 100) consisted of patients who underwent ICSI and subsequent embryo transfer using fresh testicular sperm and Group 2 (n = 100) consisted of patients who underwent ICSI by using frozen-thawed testicular sperm. Perinatal outcome was compared according to the use of fresh or frozen-thawed sperm. Primary outcome measures included clinical pregancy, miscarriage, live birth, congenital abnormality, birthweight, gestational age at delivery, stillbirth and neonatal death. Results: Live birth and clinical pregnancy rates were found to be significantly higher in patients who underwent ICSI/ET with frozen-thawed testicular sperm compared to fresh sperm group. The miscarriage rates were significantly lower in the frozen-thawed sperm group compared to the fresh testicular sperm group. Clinical pregnancy was detected in 18 cases, while no pregnancy was detected in 82 cases undergoing ICSI with fresh sperm. In the group where ICSI/ET was applied with frozen sperm, clinical pregnancy was detected in 51 cases, whereas pregnancy was not detected in 49 cases. In the frozen sperm group, in addition to C/S and multiple pregnancy rates, the number of babies with a birth weight below 2500 g was significantly higher than in the fresh sperm group. There was no significant difference between the groups in terms of minor and major congenital anomalies, birth weight, gestational age at delivery, stillbirth and neonatal death. Conclusion: Using fresh or frozen testicular sperm does not have a significant effect on perintal outcome in patients with azoospermia.

scholarly journals Study of renal profile in septicemic neonates

2018 ◽  
Vol 5 (2) ◽  
pp. 448
Author(s):  
Sharwari J. Bhutada ◽  
Chandrakant M. Bokade
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Age Of Onset ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
P Value ◽  
Etiological Agents

Background: Neonatal sepsis can cause multiorgan involvement causing neonatal morbidity and mortality. The kidneys are an important organ affected in septicemic newborns. In this study we evaluated the renal functions and its association with various risk factors along with outcome in septicemic neonates.Methods: This study was a prospective observational study conducted in a tertiary care teaching hospital. The sample size was 276 cases of septicemic new-borns and study duration was 2 years. The profile of acute renal failure (ARF) and various risk factors were studied in a sample of 276 septicemic neonates. Detailed clinical examination and investigations were done to confirm the diagnosis of neonatal sepsis and the occurrence of ARF was studied among these septicemic newborns. Risk factors like birth weight, gestational age, shock, etiological agents, DIC were studied for the occurrence of ARF and mortality in ARF patients among septicemic neonates.Results: 30.07% of septicemic neonates developed ARF. DIC (p value=0.014), shock (p value=<0.0001), gestational age (p value=0.005), birth weight (p value=0.003), were found to be analytically significant for the occurrence of ARF. Birth weight (p value=0.006), age of onset of sepsis (p value=0.019), shock (p value =<0.0001), oliguria (p value =<0.0001), and DIC (p value=0.015) were significant predictors of mortality in ARF among septicemic neonates.Conclusions: Awareness and early identification of various risk factors and ARF in septicemic neonates can prevent morbidity and mortality among neonates. 

scholarly journals Neonatal Outcome of Antenatal Mothers with Pregnancy Induced Hypertension in Antenatal Ward of Kathmandu Medical College and Teaching Hospital

2018 ◽  
Vol 2 (3) ◽  
pp. 255-259
Author(s):  
Santoshi Shrestha Pradhan ◽  
Sabitra Paudel ◽  
Puspa Parajuli ◽  
Bina Rana Khagi
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Apgar Score ◽  
Neonatal Death ◽  
Neonatal Outcome ◽  
Pregnancy Induced Hypertension ◽  
Perinatal Morbidity ◽  
Medical College ◽  
Induced Hypertension ◽  
Perinatal Management

Introduction: Hypertensive disorders seem to complicated in approximately 5-15% of pregnancies. Pregnancy induced hypertension (PIH) increases the risk of maternal and perinatal morbidity and mortality.Objective: To assess the neonatal outcome and to identify the association between the demographic variables and outcome of Pregnancy Induced Hypertension in antenatal ward of Kathmandu Medical College and Teaching Hospital.Methodology: Prospective study design was conducted for the study in Obstetrics ward of Kathmandu Medical College Teaching Hospital. The population was the 100 antenatal mothers with pregnancy induced hypertension admitted in antenatal ward and purposive convenient sampling technique was used to collect the data. The structured questionnaire was designed and the data was collected through interview technique from 1st February 2014 to 10 March 2016. The collected data was analyzed using SPSS programme.Results: Regarding neonatal outcome the findings of the study showed that most of the babies 83% had normal weight. The most of the babies 82% had adequate for gestational age. Regarding Apgar score half of the babies 50% scored mild asphyxia at the first minute whereas most of the babies 93% scored no asphyxia at five minutes after delivery. Regarding perinatal outcome 13% babies were delivered premature, 7% had birth asphyxia, 5% were born with low birth weight and stillbirth whereas only 1% had early neonatal death. The present study revealed that there was significant association between gestational age of delivery and Apgar score at 5 minutes and there was significant association between age and perinatal management outcome, gestational age of delivery and perinatal morbidity management, grading of proteinuria and perinatal morbidity management, grading of oedema and perinatal management outcome regarding neonatal outcome of pregnancy induced hypertension.Conclusion: Pregnancy induced hypertension during pregnancy were associated with a higher risk of adverse neonatal outcomes. Women with pregnancy induced hypertension during pregnancy had a higher risk of emergency caesarean section, pre-term birth, neonatal death, low birth weight children and neonates with low Apgar score. Maternal and fetal morbidity and mortality can be reduced by early recognition and institutional management.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 255-259

scholarly journals 444: Severity of small For gestational age birth weight at term: increased risk for neonatal morbidity

2016 ◽  
Vol 214 (1) ◽  
pp. S244-S245
Author(s):  
Molly J. Stout ◽  
Methodius G. Tuuli ◽  
Roxane M. Rampersad ◽  
Jeffrey M. Dicke ◽  
George A. Macones ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Neonatal Morbidity ◽  
Increased Risk

scholarly journals Growth and Neurodevelopmental Outcome in Preterm LBW Infants with Sepsis in India: A Prospective Cohort

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sunil J. Pawar ◽  
Tejopratap Oleti ◽  
Siluvery Bharathi ◽  
Shyamsunder Tipparaju ◽  
Ershad Mustafa
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Prospective Cohort ◽  
Neurodevelopmental Outcome ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Poor Growth ◽  
Increased Risk ◽  
Significant Difference

Objective. Neonatal sepsis is associated with abnormal neurodevelopmental outcomes but not with poor growth at 9 to 15 months of corrected age in LBW infants. Design, Setting, and Participants. This is a prospective cohort study involving 128 eligible preterm low-birth-weight (LBW) infants admitted during the period of 2013-2014 to the Durgabai Deshmukh Hospital and Research Center. All patients were followed up in the outpatient Department of Pediatrics. They were divided into the sepsis and nonsepsis group. Results. A total of 94 infants were evaluated (40 in sepsis and 54 in nonsepsis group). At the age of 9–15 months, low-birth-weight infants with neonatal sepsis had an increased risk of neurodevelopmental disorders (67.5 versus 20.3%; RR: 3.31 (1.87–5.85)). There is no statistically significant difference in the growth outcomes. Conclusion. Neonatal infections are associated with the abnormal neurodevelopmental outcomes in LBW infants but there was no significant difference at growth outcome at 9 to 15 months of corrected age between both groups.

scholarly journals Effects of maternal anaemia on neonatal outcome – a study done in the specialized urban hospital set up in Bangladesh

1970 ◽  
Vol 10 (3) ◽  
pp. 177-180
Author(s):  
B Mahamuda ◽  
S Tanira ◽  
W Feroza ◽  
HA Perven ◽  
A Shamim
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Apgar Score ◽  
Neonatal Outcome ◽  
Maternal Anaemia ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Context: Anaemia is a common pregnancy related disorder in Bangladesh that causes various maternal and fetal problems. A prospective study was designed to see the associated maternal factors and fetal outcome in different categories of anaemia and to compare with that of normal pregnancy. Methods: The study was carried out on 60 Bangladeshi women within 35-40 weeks of gestation. Among them, 20 with normal uncomplicated pregnancies were considered as control group or group A, another 27 having pregnancies with mild anaemia were considered as group B, and 13 having pregnancies with moderate anaemia were considered as group C. Severe anaemic mothers were considered as group D, but not found during the period of collection of data for this study. The mothers were selected as who were suffering from antenatal anaemia i.e. having heamoglobin level <10 gm/dl (mild, if <10 gm/dl; moderate, if <8 gm/dl; and severe, if <6 gm/dl) and control i.e. having heamoglobin level ≥10 gm/dl. The foetal outcome was observed and recorded after delivery. Results: The mean age of the mother was 23.65±3.83 years, 27.26±4.93 years and 25.85±4.62 years and the mean number of gravidity was 1.65±0.67, 2.15±0.72 and 2.69±1.03 in group A, group B and group C respectively. The difference was statistically highly significant in between A and C (p<0.001) and also significant in between A & B and B & C (p<0.05). The mean gestational age of the mother was 38.65±0.88 weeks, 37.37±1.01 weeks and 37.15±1.28 weeks in group A, group B and group C respectively and the difference was statistically significant between A & B and A & C (p<0.001). The mean birth weight of the neonate was 3.09±0.30 Kg., 2.99±0.16 Kg. and 2.95±0.21 Kg., while the mean APGAR score of the neonate at first minute of birth was 8.90±1.07, 8.11±0.89 and 7.69±0.48 in group A, group B and group C respectively. No significant difference was found in birth weight of the newborn babies in between the groups of the mothers. However, the difference was found significant in between A & B (p<0.01) and A & C (p<0.001), in case of APGAR score. Key words: Maternal anaemia, gestational age, neonatal outcome, birth weight, APGAR score. DOI: http://dx.doi.org/10.3329/bjms.v10i3.8361 BJMS 2011; 10(3): 177-180

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

Sign in / Sign up

Export Citation Format

Share Document