Neural Function Recovery and Safety of Mild Hypothermia Therapy Combined with Monosialotetrahexosylganglioside on Neonatal Asphyxia Complicated by Hypoxic Ischemic Encephalopathy

Objective. To explore the effect and safety of mild hypothermia therapy combined with monosialotetrahexosylganglioside (GM1) on neural function recovery of neonatal asphyxia complicated by hypoxic ischemic encephalopathy (HIE). Methods. The clinical data of 90 neonates with HIE were retrospectively analyzed. According to the treatment methods, the neonates were divided into a routine group, a mild hypothermia group, and a combination group, with 30 cases in each group. The differences in neural function recovery, biochemical indexes, clinical signs recovery, efficacy, and complications were observed in the three groups after treatment. Results. After treatment, the score of neonatal behavioral neurological assessment (NBNA) and level of superoxide dismutase (SOD) in the combination group were higher than those of the other two groups ( P < 0.05 ). The levels of neuron-specific enolase (NSE), S-100β protein, and plasma neuropeptide Y (NPY) in the combination group were lower than those in the other two groups, and the recovery time of consciousness, muscle tension, and reflex was shorter ( P < 0.05 ). The combination group showed higher total effective rate and lower incidence of complications as compared with the other two groups ( P < 0.05 ). Conclusion. Mild hypothermia therapy combined with GM1 for the treatment of neonatal asphyxia complicated by HIE can promote the recovery of neural function and reduce the incidence of complications in neonates.

Analysis of Pregnancy Characteristics and Perinatal Outcome of Mediastinal Uterus in China

Background: To analyze the complications and outcome of mediastinal uterine pregnancy, and put forward targeted prevention and treatment measures. Methods: A total of 248 pregnant women with mediastinal uterus treated were enrolled from Jan 2015 to Dec 2018 in the Maternal and Child Health Hospital of Hubei Province, China. The data, including complications of pregnancy, gestational weeks, mode of delivery, postpartum hemorrhage, placental condition and perinatal prognosis, were collected and analyzed. Results: There were 12 cases with abnormal fetal position in the previous cesarean section. The total number of cases with abnormal fetal position was 99(49.75%). For women with abnormal fetal position during mediastinal uterine pregnancy, there was a significant increase in the incidence of placental abruption (P<0.05). The average gestational age at termination of pregnancy was 37+5weeks. There were 55 cases (22.18%) of premature and 49 cases (19.75%) of premature rupture of membranes, including 29 cases of abnormal fetal position and premature rupture of membranes, mediastinal uterus preterm birth, premature rupture of membranes (P<0.05). There were 13 cases (5.24%) of postpartum hemorrhage, natural birth without neonatal asphyxia, five cases (2.02%) of neonatal asphyxia, preterm birth, and 51 cases (20.56%) of placental adhesion. Of these, 37 cases were cesarean, 13 were spontaneous production, and 71 were fetal umbilical cord winding. Conclusion: The pregnancy induced spontaneous abortion, premature delivery, premature rupture of membranes and abnormal fetal position in mediastinal uterus are significantly higher than normal pregnancy. The complications during delivery are significantly higher than in normal pregnant women.

Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica

Background Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. Methods A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011–2013) and at second-phase follow-up (2017–2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. Results Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3–4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4–12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). Conclusion SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

Analisis Korelasi Pre Eklampsia Dalam Kehamilan Dengan Kejadian Asfiksia Neonatorum

Asphyxia neonatorum is the failure of the newborn to breathe spontaneously and regularly, causing further disturbances. The onset of asphyxia in infants with pre-eclamptic mothers is due to high blood pressure causing reduced blood delivery to the placenta, this will reduce the supply of oxygen and food for the baby. As a result, the baby's development is slow, and intrauterine hypoxia occurs. The purpose of this study was to determine the correlation between pre-eclampsia in pregnancy and the incidence of asphyxia neonatorum in the NICU Room of the Mataram City Hospital, NTB in 2020. The research method used in this study was analytical correlational with a case control design with a retrospective time approach. The population is the data of all women giving birth in the NICU Room of Mataram City Hospital in 2020 as many as 1,098 people. The sampling technique used was systematic random sampling so that the number of samples obtained was 124 samples. The tools used are medical records. The statistical analysis used was the chi square test. The results showed that of the 124 samples studied, the neonatal asphyxia infants in mothers with pre-eclampsia were 39 (62.9%) compared to 23 (37.1%) non-preeclamptic mothers, the results of the probability value (p value) = 0.000 <α 0.05, by itself Ho is rejected, which means that there is a relationship between pre-eclampsia and newborn asphyxia at the Mataram City Hospital. So it can be concluded that, mothers who experience preeclampsia tend to have neonatal asphyxia. It is recommended that health workers at the Mataram City Hospital to further improve the quality of health services to the community, especially mothers giving birth, to keep their health checked at the health service place so that the risk of pre-eclampsia can be prevented.

Ichthyosis Prematurity Syndrome: A Rare Form but Easily Recognizable Ichthyosis

Ichthyosis prematurity syndrome is a rare autosomal recessive genodermatosis that is associated with mutations in the <i>SLC27A4</i> gene. Its onset occurs in early childhood and presents with the clinical triad of premature birth, thick caseous desquamating epidermis, and neonatal asphyxia. Here, we describe a prematurely born baby patient (33 weeks of gestation) with a homozygous variant at the initiation codon site (<i>c</i>.<i>1</i> A&#x3e; <i>G</i>, <i>p</i>.<i>Met1Val</i>) in the <i>SLC27A4</i> gene to raise awareness of this rare syndrome despite its distinctive features as we believe it is still underdiagnosed.

The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon

Background Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon’s maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. Methods This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. Results Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. Conclusion The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

P–397 Threatened Miscarriage and increase in Perinatal Morbidity

Study question Are women presenting with bleeding in the first trimester of pregnancy at a higher risk for perinatal complications later in pregnancy? Summary answer Women presenting with bleeding in the first trimester of pregnancy are more likely to experience perinatal and neonatal morbidity in pregnancy. What is known already Observational studies and a previously reported systematic review showed that women who experienced threatened miscarriage are more likely to have still birth, intra uterine growth restriction (IUGR), low birth weight, pre-eclampsia, placental abruption, placenta previa, preterm labour, preterm prelabour rupture of membrane, neonatal asphyxia and congenital anomalies in pregnancy. However, the evidence has been inconclusive and currently the women who experience threatened miscarriage receive low risk care. Study design, size, duration This was a prospective cohort study conducted on 298 women with threatened miscarriage (Cohort A) and 107 asymptomatic women (Cohort B). The women were recruited over a period of 18 months and were followed up for 9 months until delivery. Participants/materials, setting, methods Cohort A were women who presented with bleeding in the early pregnancy assessment unit and had a confirmed heartbeat on ultrasound scan between 6 weeks and 11 + 6 weeks of pregnancy and cohort B were women who were asymptomatic and booked with the community midwives as low risk. Both groups of women were followed up prospectively until delivery and data were collected on any perinatal outcomes and complications for both mother and the neonate. Main results and the role of chance The analysis showed that women who had bleeding in early pregnancy were more likely to have preterm delivery (RR 95% CI; 2.98 (1.07 – 8.27)); IUGR (unable to calculate the RR, as none of the women who continued their pregnancies beyond 24 weeks of gestation, developed IUGR in the asymptomatic control cohort. Nonetheless, IUGR occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)); LBW (RR 95% CI; 6.14 (1.49 – 25.19), neonatal asphyxia (unable to calculate the RR, as none of the babies who were born to women in the asymptomatic control cohort develop neonatal asphyxia. Nonetheless, neonatal asphyxia occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)). Preterm prelabour rupture of membrane was not significant with a P-value of 0.07. Limitations, reasons for caution The major limitation of this study was lower sample size and hence due to the rarity of many of the perinatal and neonatal outcomes, we were unable to calculate the relative risk. Wider implications of the findings: Current study agrees with the existing literature and reaffirms the association of perinatal and neonatal morbidities with threatened miscarriage and this group of women need to be managed as high-risk group antenatally. Trial registration number Not applicable

Metformin Combined LMWH Intervention in 25 Pregnant Women with History of Hyperlipidemia Pancreatitis in Pregnancy

Objective: To explore the early preventive treatment of hypertriglyceridemia-induced acute pancreatitis (HTGP) in pregnancy. Methods: A retrospective cohort analysis was performed to examine the drug intervention on recurrent HTGP and related pregnancy outcomes among women who had HTGP in their past pregnancy and developed hyperlipidemia during the second pregnancy. Participants were identified through inpatient case records under a single physician at the clinic and divided into two groups. The intervention group was given metformin lipid-lowering combined with low-molecular-weight heparin to prevent thrombosis when hypertriglyceridemia was developed during the pregnancy. In contrast, the non-intervention group includes those who did not receive active drug treatment until they developed recurrent HTGP. Metabolic markers were also examined by comparing them with their respective past pregnancies. Results: All participants experienced elevated triglycerides during their two consecutive pregnancies. No pregnant women developed HTGP in the intervention group (n=12), while 10 of 13 (76.9%) women developed HTGP in the non-intervention group. Thus, the outcome seemed to be markedly different. In the intervention group, 11 women were gestated to term, and one was premature; one of 12 (8.3%) births was neonatal asphyxia; there was no low-weight birth, and the prognosis of mother and baby was favorable. Of 10 women who developed recurrent HTGP in the non-intervention group, four suffered from fetal loss, four had premature, and two had full-term delivery; among the three pregnant women without HTGP, one had a premature and two had full-term births; five of thirteen (38.5%) births were neonatal asphyxia. Conclusion: Pregnant women with HTGP history, if not treated, are likely to develop the condition recurrently during pregnancy, but timely intervention on hypertriglyceridemia with lipid-lowering and thrombosis-preventing seemed complete to reduce the recurrent HTGP and improve the pregnancy outcomes.