Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction

AIM: This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA). METHODS: The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital “Koço Gliozheni” in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated. RESULTS: Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups. CONCLUSION: Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.

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Neonatal Outcomes of Late-Preterm Birth Associated or Not with Intrauterine Growth Restriction

Obstetrics and Gynecology International ◽

10.1155/2010/231842 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 19

Author(s):

Cristiane Ortigosa Rocha ◽

Roberto Eduardo Bittar ◽

Marcelo Zugaib

Keyword(s):

Neonatal Intensive Care ◽

Pulmonary Hemorrhage ◽

Neonatal Morbidity ◽

Late Preterm ◽

Morbidity And Mortality ◽

Control Group ◽

Exact Test ◽

Intrauterine Growth ◽

Appropriate For Gestational Age ◽

Singleton Pregnancies

Objective. To compare neonatal morbidity and mortality between late-preterm intrauterine growth-restricted (IUGR) and appropriate-for-gestational-age (AGA) infants of the comparable gestational ages (GAs).Methods. We retrospectively analyzed neonatal morbidity and mortality of 50 singleton pregnancies involving fetuses with IUGR delivered between 34 and 36 6/7 weeks of GA due to maternal and/or fetal indication. The control group consisted of 36 singleton pregnancies with spontaneous preterm delivery at the same GA, in which the infant was AGA. Categorical data were compared between IUGR and AGA pregnancies by analysis and Fisher's exact test. Ordinal measures were compared using the Kruskal-Wallis test.Results. The length of stay of newborns in the nursery, as well as the need for and duration of hospitalization in the neonatal intensive care unit, was longer in the group with IUGR. Transient tachypnea of the newborn or apnea rates did not differ significantly between the IUGR and AGA groups. IUGR infants were found to be at a higher risk of intraventricular hemorrhage. No respiratory distress syndrome, pulmonary hemorrhage or bronchopulmonary dysplasia was observed in either group. The frequency of sepsis, thrombocytopenia and hyperbilirubinemia was similar in the two groups. Hypoglycemia was more frequent in the IUGR group. No neonatal death was observed.Conclusion. Our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications when compared to late-preterm AGA infants.

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Influence of a Breastfeeding Coaching Program on the Breastfeeding Rates and Neonatal Morbidity in Late Preterm Infants

Child Health Nursing Research ◽

10.4094/chnr.2020.26.3.376 ◽

2020 ◽

Vol 26 (3) ◽

pp. 376-384

Author(s):

Gun Ja Jang

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Neonatal Morbidity ◽

Late Preterm ◽

University Hospital ◽

Control Group ◽

Late Preterm Infants ◽

Breastfeeding Rate ◽

Breastfeeding Rates ◽

Experimental Group

Purpose: This study aimed to determine the influence of a breastfeeding coaching program (BCP) for mothers of late preterm infants (LPIs) on the breastfeeding rate and neonatal morbidity within 1 month after discharge.Methods: This was a non-randomized quasi-experimental study with a time series design. The participants were 40 LPIs and their mothers who were hospitalized in a neonatal intensive care unit at a university hospital. Nineteen LPIs were assigned to the control group, and 21 to the experimental group. The mothers of the LPIs in the experimental group received the BCP once on the discharge day and then once a week for 1 month. Neonatal morbidity was defined as an outpatient department or emergency room visit due to an LPI's health problem.Results: The breastfeeding rate in the experimental group was significantly higher than in the control group at the fourth week after discharge (x2=7.17, p=.028). Five and two LPIs in the control group and the experimental group, respectively, visited a hospital due to neonatal jaundice. Neonatal morbidity was not significantly different between the two groups (x2=1.95, p=.164).Conclusion: The BCP was useful for improving the breastfeeding rates of LPIs and may have potential to reduce neonatal morbidity.

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Increasing adherence to plotting e-partograph: a quality improvement project in a rural maternity hospital in India

BMJ Open Quality ◽

10.1136/bmjoq-2021-001404 ◽

2021 ◽

Vol 10 (Suppl 1) ◽

pp. e001404

Author(s):

Shuchi Jain ◽

Pramod Kumar ◽

Manish Jain ◽

Megha Bathla ◽

Shiv Joshi ◽

...

Keyword(s):

Quality Improvement ◽

Control Charts ◽

Neonatal Intensive Care ◽

Data Entry ◽

Birth Asphyxia ◽

Maternity Hospital ◽

Improvement Project ◽

Mortality And Morbidity ◽

Prolonged Labour ◽

Labour Room

Abnormal prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. E-partograph is a modern tool for real-time computerised recording of labour data which improves maternal and neonatal outcome. The aim was to improve the rates of e-partograph plotting in all eligible women in the labour room from existing 30% to achieve 90% in 6 months through a quality improvement (QI) process.A team of nurses, obstetricians, postgraduates and a data entry operator did a root cause analysis to identify the possible reasons for the drop in e-partograph plotting to 30%. The team used process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address the issues identified.The interventions included training labour room staff, identification of eligible women and providing an additional computer and internet facility for plotting and assigning responsibility of plotting e-partographs. We implemented these interventions in five PDSA cycles and observed outcomes by using control charts. A set of process, output and outcome indicators were used to track if the changes made were leading to improvement.The rate of e-partograph plotting increased from 30% to 93% over the study period of 6 months from August 2018 to January 2019. The result has been sustained since the last PDSA cycle. The maternal outcome included a decrease in obstructed and prolonged labour with its associated complications from 6.2% to 2.4%. The neonatal outcomes included a decrease in admissions in the neonatal intensive care unit for birth asphyxia from 8% to 3.4%. It can thus be concluded that a QI approach can help in improving adherence to e-partography plotting resulting in improved maternal health services in a rural maternity hospital in India.

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Maternal Smoking, Intrauterine Growth Restriction, and Placental Apoptosis

Pediatric and Developmental Pathology ◽

10.1007/s10024-004-0105-1 ◽

2004 ◽

Vol 7 (5) ◽

pp. 433-442 ◽

Cited By ~ 27

Author(s):

Christina Vogt Isaksen ◽

Rigmor Austgulen ◽

Lisa Chedwick ◽

Pål Romundstad ◽

Lars Vatten ◽

...

Keyword(s):

Gestational Age ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Tunel Method ◽

Cytokeratin 18 ◽

University Of Pittsburgh ◽

Intrauterine Growth ◽

Appropriate For Gestational Age ◽

The Difference ◽

Syncytiotrophoblast Layer

Pregnant women who smoke are at greater risk of delivering a growth-restricted infant than nonsmoking mothers. We wanted to see if apoptosis could be involved in the mechanisms behind smoke-induced growth restriction, and our aim was to compare apoptosis in the placenta of smoking mothers giving birth to growth-restricted infants and nonsmoking mothers with infants of appropriate weight. The project was conducted at the Magee—Womens Hospital and Magee—Womens Research Institute, University of Pittsburgh, PA. Histological sections from 20 placentas were selected from smoking mothers who had given birth to small-for-gestational-age infants (birth weight ≤ 2 SD). The controls were gestational-age matched nonsmoking mothers with infants having appropriate-for-gestational-age weight. The TUNEL method was used to demonstrate DNA fragmentation in nuclei, and a monoclonal antibody M30, specific for a neo-epitope on cytokeratin 18, was used to identify apoptotic epithelial cells. The positive nuclei (TUNEL) and positive cells (M30-positive cytoplasm) were counted blindly both in villous tissue and in decidual/basal plate tissue. M30-positive cells in villous tissues were significantly increased in placentas from smoking mothers compared to nonsmoking mothers. When evaluated by the TUNEL method, the difference between the two groups of women was not significant. Our study shows that apoptosis was increased in the placentas of smoking mothers with growth-restricted infants. The difference between the two groups was mainly in the syncytiotrophoblast layer and in connection with perivillous fibrin deposition. Cigarette smoke with reduction in blood flow has previously been shown to increase apoptosis, and it is possible that this could be one of the mechanisms playing a role in the growth restriction.

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Severe Birth Asphyxia without Sequelae: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.4572 ◽

2019 ◽

Vol 57 (218) ◽

Author(s):

Sujata Dahal ◽

Roshan Lama ◽

Nita Lohala ◽

Prashant Simkhada ◽

Meena Thapa ◽

...

Keyword(s):

Heart Rate ◽

Neonatal Intensive Care ◽

Life Support ◽

Perinatal Asphyxia ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Advanced Life Support ◽

Neonatal Morbidity ◽

Neurodevelopmental Delay ◽

History Of

Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. It mainly causes neurodevelopmental delay leading to hypoxic-ischemic encephalopathy. We present here the case of a preterm male baby of 1670 grams born at 31+3 weeks of gestation delivered by 25-year-old primi mother through vaginal delivery with history of umbilical cord prolapse. At birth, the baby had no heart rate and cyanosed following which he was resuscitated according to the Neonatal Advanced Life Support 2015 guidelines protocol. After 5 minutes of neonatal resuscitation, the baby’s heart rate reappeared, but was only upto 20 beats/min and resuscitation thus continued. But heart rate did not improve despite of using all form of resuscitation procedure including intubation and drugs. After 2 hours, baby cried spontaneously and later baby was managed in Neonatal Intensive Care Unit according to the neonatal unit protocol of the hospital.

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Specialties of course of early and late preeclampsia in women in Vinnitsya region

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(2)-10 ◽

2021 ◽

Vol 25 (2) ◽

pp. 247-251

Author(s):

A. O. Piskun

Keyword(s):

Perinatal Death ◽

Statistical Processing ◽

Blood Stream ◽

Maternity Hospital ◽

Control Group ◽

Intrauterine Growth ◽

Pregnancy Toxemia ◽

Gynecological Diseases ◽

Excessive Body Weight ◽

Personalized System

Annotation. Preeclampsia is one of the leading causes of maternal and perinatal death, and it complicates from 5 to 8% of all pregnancies. The aim of the research was to show the differences in anamnesis, diagnostics and prognosis, in groups of pregnant with hypertensive disorders. Retrospective investigation included 138 delivery histories and perinatal record cards from Vinnitsya Municipal Clinical Maternity hospital №1, in a period from 2016 till 2018. Women were divided into two investigated groups: I – 36 women with early preeclampsia, and II group – 52 women with late preeclampsia, and a control group of 50 women. The structure of somatic and gynecological diseases of pregnant women was studied, the severity of preeclampsia and the condition of the newborn were assessed according to the Apgar scale. Statistical processing of the obtained results was performed by odds ratio, its standard error and 95% confidence interval were calculated according to D. G. Altman (1991). It is established that in women with obesity or excessive body weight (every second women in groups), and those who had cardiovascular disorders (twice more often with late preeclampsia) developed preeclampsia more often, comparing to control group. All cases of antenatal and early neonatal death of newborn were registered in a group with early preeclampsia, which points out on heavier flow of the disease and different pathogenesis. Cases of early pregnancy toxemia and edema of pregnant occurred twice more often, in group with early preeclampsia, and ran more heavy (up to the development of ascites), comparing to the second group. Debut of symptoms was earlier, that requires earlier prophylaxis (since week 12). Fetal intrauterine growth retardation, reversible and high resistant blood stream during ultrasound were marked only in group with EP. In future, this research together with pathohistological investigation of placentas and immunohistochemical research of those tissues, can underlie predictive and preventive personalized system for early and late preeclampsia.

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Electrolyte abnormalities in asphyxiated newborns

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181537 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1036

Author(s):

Satheesh Kumar D. ◽

Thenmozhi M. ◽

Kumar .

Keyword(s):

Serum Sodium ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Postnatal Period ◽

P Value ◽

Sodium Potassium ◽

Neonatal Deaths ◽

Electrolyte Abnormalities

Background: Perinatal asphyxia is the most common cause of neonatal morbidity and mortality in worldwide. It accounts for 23% of all neonatal deaths. Electrolyte abnormalities are more common in the immediate post asphyxiated period and influence neonatal the outcome effectively. Aim of this study was to measure the serum sodium, potassium and calcium levels in immediate postnatal period of asphyxiated newborns and assess the correlation with different degree of birth asphyxia.Methods: The serum sodium, potassium and calcium levels were measured in asphyxiated newborns in the early post-natal period. Both intramural and extramural newborns were included irrespective of their mode of delivery but according to the Apgar score. The measured electrolyte values were compared with the different severity of asphyxia. Results: Out of 100 newborns 53 had hyponatremia, 10 had hyperkalemia and 3 had hypocalcemia. The serum sodium and potassium levels showed significant P value (<0.00) with the different degree of both asphyxia but calcium levels were not significant (p valve = 0.06). There was a negative linear correlation with sodium and calcium levels and positive correlation with the serum potassium levels.Conclusions: Hyponatremia was significant in all stages of birth asphyxia, hyperkalemia was significant with increased severity of birth asphyxia and hypocalcemia was only weakly significant even in severe birth asphyxia.

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Neonatal Outcome and Its Correlation with Hemoglobin A1c in Gestational Diabetes Mellitus

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1498 ◽

2017 ◽

Vol 9 (3) ◽

pp. 216-220

Author(s):

Savita Somalwar ◽

Preksha Jain ◽

Pritesh Jain

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Neonatal Intensive Care ◽

Hemoglobin A1c ◽

Neonatal Outcome ◽

Statistical Tests ◽

Neonatal Morbidity ◽

P Value ◽

Neonatal Deaths

ABSTRACT Aim To determine neonatal outcome in women with gestational diabetes mellitus (GDM) diagnosed using Diabetes in Pregnancy Study Group of India (DIPSI) recommended method. Materials and methods Out of 487 antenatal women, 52 were diagnosed with GDM using DIPSI test. All women were followed up until delivery and evaluated for neonatal outcome and managed accordingly. The appropriate statistical tests for various variables were applied by using Epi Info 7 software and evaluated at the level below than 5%. Results Apgar score of <6 at 5 minutes was found in 10 (20%) neonates of GDM mothers as compared with 18 (4.1%) in non-GDM group (p-value of 0.00001). Respiratory distress was present in 19 (38%) neonates in GDM group, while it was 48 (11.1%) in non-GDM group (p-value of 0.00002). Association of GDM and hyperbilirubinemia was nonsignificant in 2 (4%) neonates among GDM group, while it was 6 (1.4%) in non-GDM group. Hypoglycemia was 5 (10%) in GDM group, while 3 (0.7%) in non-GDM group (p-value of <0.0003). A total of 3 (6%) among GDM group had hypocalcemia, while 3 (0.7%) had hypocalcemia in non-GDM group (p-value of 0.02). The neonatal intensive care unit admissions were 29 (58%) in GDM group, while it was 96 (22.1%) neonates belonging to non-GDM group (p-value of 0.00001). No neonatal deaths were reported in GDM group, while there were 2 (0.5%) in non-GDM group. Anomalies were found in 6 (11.5%) in GDM group as compared with 5 (1.1%) in non-GDM (p-value of 0.00001). About 44.2% women with GDM had hemoglobin (Hb)A1c levels between 6 and 6.9%. Among GDM women, 4 (7.7%) had pregnancy losses as compared with 7 (1.6%) in non-GDM group. Conclusion The GDM is associated with significant fetal and neonatal morbidity; hence, preconceptional counseling, early diagnosis, and proper treatment are recommended. Clinical significance Preconceptional correction of HbA1c is also recommended based on risk of anomalies in fetus of GDM mother. How to cite this article Jain P, Somalwar S, Jain P. Neonatal Outcome and Its Correlation with Hemoglobin A1c in Gestational Diabetes Mellitus. J South Asian Feder Obst Gynae 2017;9(3):216-220.

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Fetal malposition and malpresentation: Mode of delivery and perinatal outcomes at Maternity Teaching Hospital in Erbil city

Zanco Journal of Medical Sciences ◽

10.15218/zjms.2020.044 ◽

2020 ◽

Vol 24 (3) ◽

pp. 367-375

Author(s):

Shahen Kak Hussein ◽

Shahla Alalaf

Keyword(s):

Cesarean Section ◽

Teaching Hospital ◽

Neonatal Intensive Care ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Cross Sectional Study ◽

Cross Sectional ◽

Neonatal Deaths

Background and objective: Delivering a malpositioned and malpresenting fetus remains uncertainty, despite advances in obstetric practice. This study aimed to determine the mode of delivery and neonatal outcome in cases of fetal malposition and malpresentation. Methods: A cross-sectional study of women delivering malpositioned and malpresenting fetuses was conducted at Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from the 1st of June, to the 30th of November, 2018. Three hundred women and their newborns were followed for seven days of life. Results: The total rate of malposition and malpresentation was 4.8%. Most women (87.3%) delivered by cesarean section, 25% of the neonates were admitted to the neonatal intensive care unit, where 69.3% of these infants stayed for seven days. There were three early neonatal deaths (1.0%), all of them were in occipito-posterior, or occipito-transverse position and were delivered abdominally. Among occipito-posterior and occipito-transverse deliveries, 2.2% ended with the death of the fetus (P = 0.360). An Apgar score of 7 was recorded after 5 minutes for 97.7% of the infants. Around 11% of the women had postpartum hemorrhage. Conclusion: Fetal malpresentation and malposition are not uncommon during labor, and most cases are delivered by cesarean section. Neonatal morbidity and mortality are dependent on the type of presentation and the mode of delivery. Keywords: Malposition; Malpresentation; Perinatal outcome; Breech presentation.

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A prospective observational study of morbidity and mortality profile of neonates admitted in neonatal intensive care unit of secondary care centre in central Maharashtra, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182536 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1403

Author(s):

Hemant Adikane ◽

Kishor Surwase ◽

Vishal Pawar ◽

Kalidas Chaudhari

Keyword(s):

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Observational Study ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Admission Rate ◽

Study Data ◽

Neonatal Deaths ◽

Low Birth Weight Babies

Background: Globally, 2.6 (2.5-2.8) million newborns died in 2016-i.e. nearly 7,000 every day. Neonatal deaths accounted for 46 % of all under-five deaths, increasing from 41 % in 2000. Five countries accounted for half of all newborn deaths including India. NFHS 4 data suggests that neonatal mortality rate (NMR) declined to 30 deaths per 1,000 live births.Methods: Present observational study was conducted at district hospital, Parbhani. Study period was Jan 2017 to Dec 2017. All the admitted babies to NICU were included into study. Data was collected by interview method using a predesigned, semi-structured questionnaire. Various morbidities and reasons for mortality were included.Results: There were total 2471 admission during year of 2017. There was slightly higher admission rate for Males 1432 (57.95%) than females 1039 (42.05%). Pre-term admissions were 501 (20.28%). Majority of admissions were due to low birth weight 1170 (47.35%).Conclusions: In the year of 2017, total 2472 NICU admissions took place. Out of these, 126 (5.09%) died. Respiratory distress syndrome, low birth weight, birth asphyxia were accounting for mortalities. The neonatal jaundice, preterm and low birth weight babies had significantly high mortality even with standard intensive care.

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