Neonatal Problems and Infancy Growth of Term SGA Infants: Does “SGA” Definition Need to Be Re-evaluated?

Introduction: The exact definition of small-for-gestational-age (SGA) infant is still controversial among clinicians. In this study, we aimed to understand which definition is better in terms of establishing both early postnatal problems and growth. In this way, we compared early neonatal problems and infancy growth of term infants with birth weight (BW) < -2 SDS and with BW between 10th percentile (−1.28 SDS) and −2 SDS.Methods: A single center retrospective cohort study was conducted. Preterm infants, multiple gestations and newborns with any congenital anomalies were excluded from the study. Study group was defined as Group 1 (n = 37), infants BW < −2.00 SDS; Group 2 (n = 129), between −1.28 and −2.00 SDS; and Group 3 (n = 137), randomly selected newborns with optimal-for-gestational-age (BW between −0.67 and +0.67 SDS) as a control group.Results: The incidence of severe hypoglycemia was highest in Group 1 (%10.8) and Group 2 and 3 had similar rates of severe hypoglycemia (0.8 and 0.7%, respectively). The incidence of polycythemia was 5.4% in Group 1 and was significantly higher than Group 3 (0.0%) while it was 2.3% in Group 2. Short stature (length < −2 SDS) ratio at the age of 1 and 2 years were similar in each group. Overweight/obesity ratio at the age of 1 were 9.5, 20.8 and 16.7% in each group, respectively (p = 0.509).Conclusion: This study was planned as a pilot study to determine potential differences in the problems of hypoglycemia, polycythemia, and growth according to the differences in definition. Short term disturbances such as hypoglycemia and polycythemia are found to be higher in infants with a BW SDS below −2. From this point of view, of course, it will not be possible to change the routine applications immediately, however this study will be an initiative for discussions by making long-term studies.

Pediatric Pulmonary Radiology

Chapter 11 examines radiologic images for common and uncommon pediatric pulmonary disorders. These include neonatal problems such as meconium aspiration, transient tachypnea of the newborn, respiratory distress syndrome, pulmonary interstitial emphysema, bronchopulmonary dysplasia, persistent pulmonary hypertension, neonatal pneumonia, and congenital diaphragmatic hernia. The chapter goes on to look at congenital lung anomalies such as congenital lobar overinflation, bronchopulmonary sequestration, and congenital pulmonary airway malformation. The lung tumor pleuropulmonary blastoma is described. Infections reviewed include pneumonia and viral bronchiolitis, and genetic disorders examined include acute chest syndrome, cystic fibrosis, and primary ciliary dyskinesia. The chapter covers the clinical features and anatomy associated with these disorders as well as their diagnosis based on the radiologic imaging.

Neonatal Presentations to the Children's Emergency Department

Background Paediatric attendances to Emergency Departments (EDs) in the UK are increasing, particularly for younger children. Neonates present a challenge due to their non-specific presentations. Community services are under increasing pressure and parents may preferentially bring their children to the ED, even for non-urgent problems. Neonatal attendances have not been extensively studied, but previous reviews have shown many are well, often not requiring specific medical intervention. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a tertiary Children's ED (CED). Methods Retrospective observational review of medical records identified via the ED Electronic database of neonatal attendances (<28 days) to Bristol Royal Hospital for Children (BRHC) over 12 months (01/01/2016-31/12/2016). Further information was obtained from investigation results, discharge summaries and historical admissions data. Results Neonatal attendances increased from 655 to 1205 from 2008-2016. The most common presenting complaints were breathing difficulty (18.1%), vomiting (8.3%) and poor feeding (8.2%). The most common diagnoses were "no significant medical problem" (41.9%), bronchiolitis (10.5%) and suspected sepsis (10.0%). Just over 1/3 were admitted (23% inpatient, 12% Short Stay Unit). Median length of stay for inpatients was 2 days. Half of neonatal attendances to the ED had no investigations performed and most (77.7%) needed advice or observation only. Conclusion Many neonates presenting to the CED were well and discharged with observation only. This suggests not only that there is potential for improved community management but that increased support for community colleagues and new parents is needed. There are also implications for reviewing training in emergency medicine, especially the ability to assess "well" infants and to manage common neonatal problems. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families

PREDICTION OF FETAL BIRTH WEIGHT BY JOHNSON'S FORMULA & ULTRASONOGRAPHY COMPARED WITH ACTUAL BIRTH WEIGHT

INTRODUCTION Birth weight is the greatest single factor which determines the survival of the fetus and future health of neonate. It is an important factor for prediction of neonatal problems. Accurate estimation of fetal weight is of paramount importance in the management of labor and delivery. Fetal weight is also important in assessing whether the fetus is small for gestational age or large for gestational age in order to have a good obstetrical decision making and also to avoid the intra partum distress, birth trauma and thereby to reduce the neonatal morbidity and mortality1.

Parents’ perceptions of core outcomes in neonatal research in two Nigerian neonatal units

BackgroundThere is a scarcity of information regarding the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes by different stakeholder groups would inform the development of a core outcome set (COS) for use in neonatal research.ObjectiveTo determine the perceptions and opinions of parents of newborn babies regarding what outcomes were most important to them in order to contribute towards development of a COS for neonatal research in sub-Saharan Africa.MethodsSemistructured interviews were undertaken with parents, mostly mothers, of babies admitted to one neonatal unit in North central and one in Southwest Nigeria. Participants were purposively sampled to include parents of babies with common neonatal problems such as prematurity.ResultsWe conducted 31 interviews. The most frequently raised outcomes were breast feeding, good health outcomes for their baby, education, growth and financial cost. Parents placed more emphasis on quality of life and functional status than health complications.ConclusionsThe opinions of parents need to be considered in developing a COS for neonatal research in low-resource settings. Further research should assess the opinions of families in other low-resource settings and also engage a broader range of stakeholders.

Risk Factors of Early Breastfeeding Jaundice: How Can Gynecologists and Nurses be Effective in Reducing It?

Background: Neonatal jaundice is one of the most common neonatal problems. About 60% of term and 80% of preterm neonates have jaundice. Objectives: Due to the high prevalence of early neonatal jaundice, which can lead to mothers’ concerns and even hospitalization of neonates, we decided to study the frequency and risk factors of breast feeding jaundice to determine the role of gynecologists and nurses in the development of this type of jaundice. Methods: This study was a cross-sectional descriptive study. The sampling method was by convenience. Study populations included one hundred terms, exclusively breastfed neonates aged equal or less than seven days with jaundice who were admitted in Golestan and Khanevadeh hospitals Tehran, Iran from July 2019 to January 2020. Results: The percentage of causes of jaundice in the study population was 65% non-breastfeeding jaundice (29 male, 36 female), including 36% blood group incompatibility, 19% Rh incompatibility and 10% G6PD deficiency. The amount of breast feeding jaundice was 35% (18 male, 17 female). The most significant factors in breastfeeding jaundice were: use of water or sugar water, depressed nipple, mother’s unwillingness to breastfeed; inappropriate breastfeeding technique, and birth weight < 2500 g. Conclusions: The high prevalence of breastfeeding jaundice indicates that policies of breastfeeding education need to be revised. Breastfeeding education before delivery, attention of gynecologists to breast problems of mothers during pregnancy, professional coordination of nurses and physicians for effective breastfeeding training, and early mothers’ revisit after the initial discharge of neonates can reduce the frequency of breastfeeding jaundice and readmission of neonates.

Oxford Textbook of Obstetrics and Gynaecology

The Oxford Textbook of Obstetrics and Gynaecology is an up-to-date, objective, and readable text that covers the full speciality of obstetrics and gynaecology. This comprehensive and rigorously referenced textbook will be a vital resource in print and online for all practising clinicians. Larger sections on the basics in obstetrics and gynaecology, fetomaternal medicine, management of labour, gynaecological problems, and gynaecological oncology are complemented by specialist sections on areas such as neonatal care and neonatal problems, reproductive medicine, and urogynaecology and pelvic floor disorders, to name a few. The evidence-based presentation of current diagnostic and therapeutic methods is complemented in the text by numerous treatment algorithms, giving the reader the knowledge and tools needed for effective clinical practice.

Neonatal care and neonatal problems

The birth of a healthy baby is a cardinal pregnancy outcome, and one that is best brought about by midwifery, obstetric, and neonatal teams working in partnership with the expectant mother. The last decades have seen considerable improvement in the management of high-risk pregnancies and this has resulted in better condition of the infant at birth, thus optimizing chances for intact survival. Very often, decisions that need to be made are not black and white, such as the timing of preterm delivery when the health of the mother must be weighed against the risks for the infant. This chapter aims to provide an overview for obstetricians of the basic principles of newborn management, and wider aspects such as the organization of services, evaluating practice, and reducing uncertainties, that are also integral to high-quality care.

Disturbances in the Acute Cardiorespiratory Adaptation of Full-Term Neonates

Summary We studied the incidence and causes of transition disturbances in the first 30 minutes of life in full-term newborns. This one-year study was retrospective and included 1147 full- term live-born neonates without life-threatening congenital anomalies and surgical complications. They were divided into four groups: 0 (with normal transition), 1 (resuscitated without endotracheal intubation), and 2 (intubated); A (without underlying maternal, obstetric or fetal/neonatal problem, with adequate for GA eight and from single birth) and B (with one or more of following: underlying maternal, obstetric or fetal/neonatal problem, SGA or LGA, from multiple pregnancies). Of the newborns, 9.1% of required resuscitation and 1.6% - extensive resuscitation with intubation. The groups significantly differed in the incidence of underlying maternal, obstetric, or fetal/neonatal problems. Resuscitated babies were born via Caesarean section (CS), in abnormal presentation (PaN) and by vacuum extraction or forceps (V/F) predominantly. The highest incidence of the small for gestational age (GA) babies – SGA, was detected in Group 2. Twins and large for GA (LGA) had prevalence in Group 1. Resuscitation was necessary for 18.1% of CS-delivered babies. V/F and PaN lead to the highest need for intubation. According to our data, every 10th of the full-term neonates required assistance in the fetal-to-neonatal transition. The causes could be diseases of the mother or fetus/newborn, multiple births, SGA, or LGA. A compromised medical decision about the time and way of delivery may result in iatrogenic transition disturbances.