Risk factors and outcome of neonatal jaundice in a tertiary hospital

Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, the characteristics and outcomes related to neonatal jaundice in Bangladesh has not been studied so far. This study addressed the outcomes, characteristics and risks of the jaundiced newborn admitted into hospital. The babies who had significant jaundice and required phototherapy and /or exchange transfusion were investigated. A detailed history of delivery with gestational age was noted and clinical examination of the admitted newborn was done. Birth weight was recorded. The investigations included complete blood count, ABO and Rh compatibility, serum bilirubin, glucose 6 phosphate dehydrogenase (G6PD), thyroid stimulating hormone (TSH) and ultrasonography (USG) of brain. The newborns were closely monitored for the prognosis. The requirement of individualized phototherapy and exchange transfusion were also noted. Finally, the outcomes were recorded. Overall, 60 (m v. f = 58.3 v. 41.7%) newborns were found who developed significant jaundice and were investigated. Of them, 35% had gestational age less than 32wks and only 32% had equal to or greater than 35wks. Regarding delivery, 83.3 % had the history of caesarean section. ABO- and Rh– incompatibilities were found in 13.3% and 3.3%, respectively. Septicemia was diagnosed among 26.7% though blood culture yielded growth only in 20%. Compared with the higher gestational age-group (? 35 wks) the lower group (<32 wks) showed significantly higher rate of septicemia (12.5 v. 68.8%, p<0.005). G6PD deficiency was found in only one (1.7%) case. Birth asphyxia was found as a concomitant factor in three patients. Exchange transfusion was done only in 2 (3.3%) babies. Among them one was preterm IDM with septicemia and other had G6PD deficiency. None of these babies developed kernicterus. Five (8.3%) babies died, all of them had septicemia and one baby also had intraventricular hemorrhage (IVH) with PDA. The study revealed that a substantial number of neonatal jaundice had the history of lower gestational age in Bangladeshi newborns; and the lower gestational age is significantly associated with septicemia and possibly with hyperbilirubinemia. More study is needed to establish the study findings. DOI: 10.3329/imcj.v4i2.6500Ibrahim Med. Coll. J. 2010; 4(2): 70-73

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From Prejudice to Evidence: The Case of Rhizoma Coptidis in Singapore

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/871720 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Chin Ee Ho ◽

You Li Goh ◽

Chang Zhang

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

G6pd Deficiency ◽

Neonatal Jaundice ◽

Therapeutic Effects ◽

Evidence Based ◽

Rhizoma Coptidis ◽

History Of ◽

Hepatoprotective Effects ◽

Glucose 6 Phosphate Dehydrogenase

Rhizoma Coptidis (RC), commonly known ashuanglian, is a herb frequently used in Traditional Chinese Medicine (TCM) prescriptions. Known to have “clearing damp-heat, quenching fire and counteracting poison” properties, it was widely used in the Chinese community in Singapore. Berberine, an alkaloid isolated from RC, is known to have a wide array of therapeutic effects including antimicrobial, antineoplastic, and hepatoprotective effects. In 1978, RC was implicated in causing neonatal jaundice (NNJ) and kernicterus in neonates suffering from glucose-6-phosphate dehydrogenase (G6PD) deficiency, leading to the banning of RC and berberine in Singapore. More than three decades later, accumulating evidence-based studies pointing to the safety of RC for general public and better understanding of G6PD deficiency, the Health Sciences Authority (HSA) in Singapore reviewed and lifted the prohibition on RC and berberine, turning a brand new chapter in the history of TCM in Singapore. This paper aims to review the safety of RC and berberine, using the prohibition of use and subsequent lifting of ban on RC and berberine in Singapore as an illustration to highlight the importance of evidence-based studies in Traditional Chinese Medicine (TCM).

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Cardiometabolic and mental health in women with early gestational diabetes mellitus: A prospective cohort study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab791 ◽

2021 ◽

Author(s):

Dan Yedu Quansah ◽

Justine Gross ◽

Leah Gilbert ◽

Amelie Pauchet ◽

Antje Horsch ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Weight Gain ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Gestational Age ◽

Prospective Cohort ◽

Gestational Weight ◽

Pregnancy And Postpartum ◽

History Of

Abstract Context Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes. Objective We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM. Methods This prospective cohort included 1185 women with cGDM and 76 women with eGDM. eGDM had GDM-risk factors (BMI >30kg/m 2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age and diagnosed using ADA prediabetes criteria. Women underwent lifestyle adaptations. Obstetric, neonatal, mental, cardiometabolic outcomes were assessed during pregnancy and postpartum. Results eGDM had lower gestational weight gain than cGDM (10.7±6.2 vs 12.6±6.4, p=0.03), but needed more medical treatment (66% vs 42%, p<0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%, p=0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (p≤0.001). In eGDM, the postpartum prevalence of metabolic syndrome (MetS) was 1.8-times, prediabetes was 3.1-times and diabetes was 7.4-times higher than cGDM (MetS-waist circumference-based: 62% vs 34%/MetS-BMI-based: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all p<0.001). These differences remained unchanged after adjusting for GDM-risk factors. Conclusion Compared to cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM-risk factors and gestational weight gain. This hints to a pre-existing risk-profile in eGDM.

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Factors Influencing Maternal Mortality from Severe Preeclampsia and Eclampsia

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v36i2.293 ◽

2016 ◽

Author(s):

Denny Khusen

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Maternal Mortality ◽

Maternal Death ◽

Gestational Age ◽

Post Partum ◽

Severe Preeclampsia ◽

Maternal Complications ◽

History Of ◽

Post Partum Bleeding

Objective: To analyze risk factor, both clinical and laboratory findings, associated with maternal mortality from severe preeclampsia and eclampsia in Atma Jaya Hospital. Methods: This was a retrospective case control study. All medical records of maternal death associated with severe preeclampsia and eclampsia between 1st January 2009 and 31st December 2011 were obtained and then information about risk factors were collected and tabulated. Risk factor analyzed were maternal age, gestational age, parity, coexisting medical illness (hypertension), antenatal examination status, maternal complications, systolic and diastolic blood pressure at admission, and admission laboratory data. Results: There were 19 maternal deaths associated with severe preeclampsia and eclampsia during period of study (Consisted of 6 cases of eclampsia and 13 cases of severe preeclampsia). Maternal mortality rate for severe preeclampsia and eclampsia were 16.7% and 33.3% respectively. Multivariate analysis identified the following risk factors associated with maternal death: gestation age <32 week, history of hypertension, thrombocyte count < 100.0000/Î¼l, post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. Conclusion: In this study, we found that gestational age, history of hypertension, and platelet count are the cause of maternal mortality. Maternal complications associated with maternal mortality are post partum bleeding, acute pulmonary edema, HELLP syndrome, and sepsis. [Indones J Obstet Gynecol 2012; 36-2: 90-4] Keywords: eclampsia, maternal mortality, preeclampsia

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Study of perinatal factors in children with developmental delay

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20164602 ◽

2016 ◽

Vol 4 (1) ◽

pp. 182 ◽

Cited By ~ 1

Author(s):

Goli Sri Charan ◽

Jayant Vagha

Keyword(s):

Birth Weight ◽

Developmental Delay ◽

Gestational Age ◽

Birth Asphyxia ◽

Global Developmental Delay ◽

Developmental Quotient ◽

Birth History ◽

History Of ◽

Observational Descriptive Study ◽

Birth Body Weight

Background: Birth history gives important information in children with developmental delay. Developmental challenge in children is an emerging problem across the globe, which is largely associated with improved neonatal survival. The present study highlights the importance of birth history in children with developmental delay in our hospital. The objective of this study was to study the perinatal events in children with developmental delay.Methods: Observational descriptive study was conducted on children between 6 months to 5 years who were admitted in Pediatric wards with suspected history of developmental delay. DDST II scale was performed on these children and children who failed on Denver II scale were recruited into the study. Birth history was noted in detail, if available, documentation of birth events was asked for and noted. Developmental history with developmental quotient (DQ), were noted in detail.Results: 135 children had developmental delay, 113 (83.70%) were born by vaginal delivery and 22 (16.30%) were born by caesarian section, 46 (34.18%) had no cry at birth and remaining 89 (65.92%) had normal cry at birth. 104 (77.04%) were born by term gestation and 31 (22.96%) were born preterm. Birth weight was normal in 78 (57.7%) children, LBW was seen 47 (34.81%) and 5 children each with VLBW and ELBW and 35 (25.93%) were IUGR. On comparing the children born gestational age and birth body weight with all four domains, there was no significant difference.Conclusions: Global developmental delay was more common in children born at preterm, low birth weight, IUGR and children who had birth asphyxia. Birth weight and gestational age did not significantly affect any particular domain of development.

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Risk Factors for Silent Cerebral Infarcts in a Pediatric Sickle Cell Anemia (SCA) Cohort

Blood ◽

10.1182/blood.v112.11.2487.2487 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2487-2487 ◽

Cited By ~ 1

Author(s):

Francoise Bernaudin ◽

Suzanne Verlhac ◽

Annie Kamdem ◽

Cécile Arnaud ◽

Lena Coïc ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

G6pd Deficiency ◽

Significant Risk ◽

Significant Risk Factor ◽

History Of ◽

Independent Risk Factors

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (< 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p<0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p<0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p<0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.

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Prevalence and Risk Factors of Monoclonal Proteinemia in Thai Population.

Blood ◽

10.1182/blood.v114.22.1416.1416 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1416-1416

Author(s):

Phandee Watanaboonyongcharoen ◽

Thanyaphong Na Nakorn ◽

Ponlapat Rojnuckarin ◽

Panisinee Lawasut ◽

Tanin Intragumtornchai

Keyword(s):

Risk Factors ◽

Complete Blood Count ◽

Conflicts Of Interest ◽

Demographic Data ◽

Significant Risk ◽

Chemical Exposure ◽

Blood Chemistry ◽

Serum Samples ◽

Thai Population ◽

History Of

Abstract Abstract 1416 Poster Board I-439 Background: Monoclonal gammopathy of undetermined significance (MGUS) is associated with progression to multiple myeloma and related hematologic malignancies at the rate of 1% per year in western population. Reliable information on prevalence, risk factors and natural history of MGUS in general population are necessary for designing an early detection strategy for myeloma in Thailand. Patients and methods: The study was performed in subjects, 50 years of age or older, in Bangkok, one nearby province and 2 remote provinces of Thailand. The demographic data and suspected risk factor history were collected by questionnaires. Complete blood count as well as blood chemistry were done to exclude underlying hematologic and/or systemic conditions. Serum monoclonal proteins were detected using high-resolution gel electrophoresis. Results: Serum samples were obtained from 3,261 participants. There were 1,105 males (33.9%) and 2,156 females (66.1%). The median age was 57. Abnormal protein electrophoresis findings were detected in 76 samples (prevalence 2.3%, 95% confidence interval [CI] 1.8% - 2.8%) showing small M-spikes at gamma-globulin region in 50 (1.5%) or at beta-globulin region in 25 (0.8%) or hypogammaglobulinemia in 1 case (0.03%). The prevalence of MGUS in subjects less than 60, 60-69 and 70 yrs or more was 2.0% (41/1975), 2.6% (22/851) and 3.0% (13/435), respectively. Using multivariate analysis, presence of MGUS was strongly associated with history of drug abuse (odd ratio 4.63, 95%CI 1.14-22.08) and current residences outside Bangkok (odd ratio 2.30, 95%CI 1.18-4.79). Radiation and chemical exposure, hair and nail-coloring products and pesticides were not statistically significant risk factors in our population. Conclusions: The overall prevalence of MGUS in Thai population was 2.3%, lower than those of western countries but comparable to what reported from Japan and Taiwan. Disclosures: No relevant conflicts of interest to declare.

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Relationship between perinatal period problems and developmental delay in children aged 4-24 months

Acta Facultatis Medicae Naissensis ◽

10.5937/afmnai2004337k ◽

2020 ◽

Vol 37 (4) ◽

pp. 337-348

Author(s):

Masoumeh Kaviani ◽

Zhaleh Ranjbaran ◽

Roksana Janghorban

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Developmental Delay ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Neonatal Jaundice ◽

Fetal Distress ◽

Perinatal Period ◽

Medical Problems ◽

History Of

Normal development is one of the reliable criteria for the assessment of children's health status. Perinatal events affect the future development of children. Nevertheless, there are different views on the impact of events in the perinatal period on child development. The aim of this study was to determine the relationship between perinatal period and developmental delay in 4-24-month-old children. Three hundred and thirty children aged 4-24 months who were referred to Imam Reza Clinical Development Center and Shiraz Health Centers were enrolled. Information about perinatal events was collected by a researcher-made questionnaire containing demographic and reproductive information related to pregnancy, delivery and neonatal period. The developmental status of children was evaluated by age and stage questionnaire. Data were analyzed using Chi-square, Mann-Whitney and logistic regression by SPSS version 14. Sex (P = 0.025), maternal medical problems (P = 0.011), fetal distress (P = 0.022), history of hospitalization in the neonatal intensive care unit (P < 0.001), severe neonatal jaundice (P = 0.005) and small for gestational age (P= 0.012) after controlling the confounding of other factors had a significant effect on developmental delay. The results of this study showed that being male, having maternal medical problems, fetal distress, the history of hospitalization in the neonatal intensive care unit, severe neonatal jaundice and small for gestational age can predict developmental delay. Special attention to screening of children who are at risk of developmental delay due to perinatal conditions can be effective in early diagnosis of developmental delay.

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Study of risk factors among stroke patients in a tertiary hospital of Northern India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20171039 ◽

2017 ◽

Vol 4 (2) ◽

pp. 446

Author(s):

Amit Kumar ◽

Onkar Nath Rai

Keyword(s):

Risk Factors ◽

Tertiary Hospital ◽

Stroke Incidence ◽

Medical College ◽

Northern India ◽

Different Types ◽

History Of ◽

Chest X Ray ◽

Associated Risk Factors

Background: Stroke is one of the leading causes of death and disability worldwide. The aim of the study was to find out the incidence of different types of strokes and the associated risk factors and to establish the role of different investigations in patients of stroke.Methods: The study dealt with 100 patients of stroke who were admitted to B. R. D. Medical College, Gorakhpur, India. Each patient was analyzed in detail about clinical presentation and the investigations were aimed to establish the pathologic type of stroke and estimation of risk factors.Results: Stroke incidence was more in males (Male: Female= 1.43:1). Maximum incidence of stroke was in 6th decade (32%) followed by 7th decade (30%). Among modifiable risk factors, history of hypertension was the commonest (51%) followed by smoking (36% patients) exclusively, found in males. Hemiparesis was the most common presentation (95%) followed by altered sensorium (55%). Chest X-ray was abnormal in 16% patients, abnormal ECG was found in 27% patients and abnormal lipid values were found in 54 patients.Conclusions: Apart from control of hypertension and diabetes, abnormal lipid profile remains an important modifiable risk factor for stroke.

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Prevalence of hyperemesis gravidarum and associated risk factors among pregnant women in a tertiary health facility in Northeast, Nigeria

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203827 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3557

Author(s):

Muhammad B. Aminu ◽

Mohammed Alkali ◽

Bala M. Audu ◽

Toyin Abdulrazak ◽

Dauda Bathna

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Hyperemesis Gravidarum ◽

Past History ◽

Tertiary Hospital ◽

Grand Multiparity ◽

History Of ◽

Associated Risk Factors ◽

Age Range ◽

Northeast Nigeria

Background: One of the commonest symptoms observed in pregnant women before the 20th week of gestation is nausea and vomiting, an exaggeration of these symptoms hyperemesis gravidarum (HEG) could result in maternal and fetal catastrophes and even death. The objective of this study was to determine the prevalence and associated risk factors for hyperemesis gravidarum among pregnant women at booking.Methods: A prospective institutional based study design was done among 452 pregnant women seen at booking in a tertiary hospital in Northeast Nigeria from the 1st February 2019 to 30th June 2019. Data was summarized using descriptive statistics. OR was used to measure significant risk.Results: The observed prevalence of hyperemesis gravidarum among pregnant women in the study is 44.9%. The Majority (81.4%) of these women were between the age range of 21 and 35 years. Mean age of 27 years. Multiparity (33.4%), previous (44.9%) and family history of HEG (31.6%) were identified as important risk factors for developing HEG. Grand multiparity (11.5%) and gestational age less than 13 weeks (6.64%) were however less likely observed to be risks for HEG.Conclusions: HEG is a common problem in pregnancy with almost half of the number of pregnant women at booking affected. Multiparity and past history of HEG are pointers to developing the condition and it should be looked out for among at risk group of pregnant women, so that early intervention can be instituted to avoid any possible adverse outcome.

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High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

PLoS ONE ◽

10.1371/journal.pone.0258127 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258127

Author(s):

Laurence Thielemans ◽

Pimnara Peerawaranun ◽

Mavuto Mukaka ◽

Moo Kho Paw ◽

Jacher Wiladphaingern ◽

...

Keyword(s):

Risk Factors ◽

Gestational Age ◽

G6pd Deficiency ◽

Mixed Model ◽

Total Serum ◽

Cox Proportional Hazard ◽

Resource Limited ◽

Genetic Impact ◽

Karen Refugees

Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks’ gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35–37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35–37 weeks with risk factors.

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