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Cureus Aug 2022Introduction Neonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean...
Introduction Neonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes. Methods A prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma. Results Our sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries. Conclusion Based on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.
PubMed: 36059308
DOI: 10.7759/cureus.27607 -
Journal of Clinical Sleep Medicine :... May 2022We aimed to examine (1) sleep quality trends of pregnant smokers and (2) their associations with health outcomes. (Clinical Trial)
Clinical Trial
STUDY OBJECTIVES
We aimed to examine (1) sleep quality trends of pregnant smokers and (2) their associations with health outcomes.
METHODS
A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (nonrandomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at preintervention, postintervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until preintervention, until postintervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain and smoking cessation. Infant outcomes included birth weight, gestational age, and Apgar score.
RESULTS
There was a significant increase ( = .046) in Pittsburgh Sleep Quality Index score from postintervention (mean, 5.5 [standard deviation (SD), 2.6]) to end of pregnancy (6.6 [SD, 2.8]). Mean gestational weight gain was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs 36.1 kg [SD, 22.8]; = .008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute Apgar score (8.1 [SD, 1.3] vs 9.0 [SD, 0.0]; = .021) than newborns with good maternal sleep quality. Preintervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (< 7 hours/night) vs sufficient sleep duration (47.4% vs 92.3%, = .011).
CONCLUSIONS
Sleep quality worsened toward the end of pregnancy among smokers. Poor sleep might negatively influence gestational weight gain and Apgar score. Insufficient preintervention sleep might negatively influence smoking cessation.
CITATION
Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. . 2022;18(5):1343-1353.
Topics: Birth Weight; Body Mass Index; Female; Gestational Age; Gestational Weight Gain; Humans; Infant, Newborn; Pregnancy; Sleep Quality; Smokers
PubMed: 34978278
DOI: 10.5664/jcsm.9868 -
Cureus Aug 2023Around the world, very few babies require a more intensive resuscitative effort for stabilization. The optimal timing of an intact umbilical cord to help with... (Review)
Review
Around the world, very few babies require a more intensive resuscitative effort for stabilization. The optimal timing of an intact umbilical cord to help with resuscitation is controversial. Our objective in the review is to compare the outcomes of neonatal resuscitation with and without an intact umbilical cord. A search of six electronic database libraries was explored for data released between 2014 and 2023. A manual search of secondary references in relevant studies was also performed. Studies focused only on randomized controlled trials comparing the outcomes of neonatal resuscitation with and without an intact umbilical cord at any gestational age. Two reviewers retrieved data for relevant outcomes and independently evaluated trial quality and eligibility. Mortality rate and APGAR (appearance, pulse, grimace, activity, and respiration) scores were noted as common in the two studies. Four randomized control trials were assessed for the impact of delayed cord clamping on neonates. One study focused on neurodevelopmental outcomes and noted significant improvement. Other studies noted delayed clamping as beneficial for improving oxygen saturation, APGAR score, and mortality rate. The meta-analysis included three controlled trials with a total of 528 babies and tested the effects of clamping the umbilical cord either late (n = 264) or early (n = 264). The heterogeneity of mortality and APGAR score at 5 minutes were not significant, which may be because only two studies of each case were available to compare. We concluded that very few studies are available to identify a significant impact of delayed cord clamping in neonates. However, delayed clamping for up to 5 minutes is noted as beneficial to the newborn.
PubMed: 37791162
DOI: 10.7759/cureus.44449 -
BMC Pregnancy and Childbirth Mar 2020The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum... (Observational Study)
Observational Study
BACKGROUND
The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management.
METHODS
We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age ≥ 35 weeks, birthweight ≥1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH ≤7.0 or Base Excess (BE) ≤ - 12 mMol/L in Umbical Artery (UA) or within 1 h, 10 min Apgar < 5, or need for resuscitation > 10 min. FHR monitoring was classified in three categories according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancies were divided into four classes: 1) low risk; 2) antepartum risk; 3) intrapartum risk; 4) and both ante and intrapartum risk. In the first six hours of life asphyxiated neonates were evaluated using the Thomson score (TS): if TS ≥ 5 neonates were transferred to Hub for further assessment; if TS ≥ 7 hypothermia was indicated.
RESULTS
Perinatal asphyxia occurred in 21.5‰ cases (321/14,896) and HIE in 1.1‰ (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45-0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes. Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR.
CONCLUSIONS
We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.
Topics: Apgar Score; Asphyxia Neonatorum; Female; Heart Rate, Fetal; Humans; Hypoxia-Ischemia, Brain; Incidence; Infant; Infant, Newborn; Italy; Male; Pregnancy; Probability; Prospective Studies; Risk Factors
PubMed: 32228514
DOI: 10.1186/s12884-020-02876-1 -
Children (Basel, Switzerland) Apr 2022To investigate the survival rate of hydrops fetalis after fetal interventions and neonatal intensive care.
OBJECTIVES
To investigate the survival rate of hydrops fetalis after fetal interventions and neonatal intensive care.
METHODS
We reviewed the medical records of patients diagnosed with hydrops fetalis from January 2009 to December 2019 at Changhua Christian Children's Hospital. All cases had abnormal fluid accumulation in at least two body compartments during pre- and postnatal examination. The primary outcome measure was the mortality rate. We also collected information regarding disease etiology, duration of hospital stay, Apgar score, gestational age at birth, initial hydrops fetalis diagnosis, fetal intervention, first albumin and pH levels, and maternal history.
RESULTS
Of the 42 cases enrolled, 30 survived and 12 died; the mortality rate was 28.6%. Furthermore, 22 cases received fetal intervention, while 20 cases did not; there was no significant difference in their survival rates (75% and 68%, respectively). Survival rate was associated with gestational age at birth, initial diagnosis time, birthweight, Apgar score, initial albumin and pH levels, and gestational hypertension. Only one case was immune-mediated. Among the nonimmune-mediated cases, the three most common etiologies were lymphatic dysplasia (12/42), idiopathic disorders (10/42), and cardiovascular disorders (5/42).
CONCLUSIONS
Overall, hydrops fetalis was diagnosed early, and fetal intervention was performed in a timely manner. Preterm births were more frequent, and birthweight was lower in the cases that underwent fetal intervention than in those that did not, but there was no significant between-group difference in mortality. The initial diagnosis time, gestational age at birth, birthweight, Apgar score, and first albumin and pH levels were independently associated with mortality.
PubMed: 35455574
DOI: 10.3390/children9040530 -
BMC Pregnancy and Childbirth Jan 2021To examine the association between the Apgar score and neonatal mortality over gestational age in China and to explore whether this association changed when Apgar scores... (Observational Study)
Observational Study
BACKGROUND
To examine the association between the Apgar score and neonatal mortality over gestational age in China and to explore whether this association changed when Apgar scores were combined at 1 and 5 min.
METHODS
Data for all singleton live births collected from 438 hospitals between 2012 and 2016 were used in this study. Poisson regression with a robust variance estimator adjusted for a complete set of confounders was used to describe the strength of the association between the Apgar score and neonatal mortality.
RESULTS
The relative risks of neonatal death-associated intermediate Apgar score at 5 min peaked at 39-40 weeks of gestation and subsequently decreased if the gestational age increased to 42 weeks or above, in contrast to the low Apgar score. Among both preterm and term new-borns with Apgar scores at 5 min, new-borns that were not small for gestational age had a lower mortality rate than those that were small for gestational age. The association between Apgar score and the neonatal mortality was even stronger when scores at 1 and 5 min were combined.
CONCLUSIONS
Apgar score is not only meaningful for preterm new-borns but also useful for term new-borns, especially term new-borns that are not small for gestational age. Once the baby's Apgar score worsens, timely intervention is needed. There is still a gap between China and high-income countries in terms of sustained treatment of new-borns with low Apgar scores.
Topics: Adult; Apgar Score; China; Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Population Surveillance; Pregnancy; Pregnancy Outcome
PubMed: 33430809
DOI: 10.1186/s12884-020-03533-3 -
BMC Pediatrics Sep 2022The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal...
BACKGROUND
The 5-minute APGAR score is clinically used as a screening tool to assess how the newborn has reacted to previous care, remaining relevant for predicting neonatal survival. This study aimed to analyze the determinants of the 5th minute APGAR score, and the factors associated with the death and survival of newborns with low APGAR scores hospitalized in the neonatal intensive care unit (NICU) at a referral public hospital in North Brazil.
METHODS
This was a hospital-based retrospective case-control study with 277 medical records. Newborns who presented with a 1-minute APGAR score < 7 followed by a 5-minute APGAR score < 7 were considered cases, while a score ≥ 7 was categorized as controls. Univariate and multivariable logistic regression analyses were used to establish the determinant factors of the low APGAR score and death outcome in this group. Survival curves were obtained using the Kaplan-Meier estimator, and then univariate and multivariate Cox regression was performed.
RESULTS
After adjusted analysis, the factor associated with low APGAR scores was vaginal delivery (OR = 3.25, 95%CI = 1.60-6.62, p = 0.001). Birth injury (OR = 0.39, 95%CI = 0.19-0.83, p = 0.014) was associated with upper APGAR scores. No significant independent associations were observed between the variables analyzed and death in the low APGAR score group. The Kaplan-Meier curve showed that individuals who presented Cesarean delivery had a shorter survival time in the ICU.
CONCLUSION
In this setting, a 5-minute Apgar score < 7 was associated with the occurrence of vaginal delivery and birth injury with a 5-minute Apgar score ≥ 7. Survival in ICU was lower in newborns that were delivered via cesarean section.
Topics: Apgar Score; Birth Injuries; Case-Control Studies; Cesarean Section; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care, Neonatal; Pregnancy; Retrospective Studies
PubMed: 36151512
DOI: 10.1186/s12887-022-03592-9 -
Global Pediatric Health 2021Perinatal asphyxia (PA) is a major cause of morbidity and mortality in which dramatic transient impairment in liver functions occurs in some patients. We aimed to...
Perinatal asphyxia (PA) is a major cause of morbidity and mortality in which dramatic transient impairment in liver functions occurs in some patients. We aimed to evaluate the state of the liver in cases of Perinatal asphyxia and to assess the severity of hepatic impairment in relation to different grades of HIE. This case-control study was conducted on 100 full-term newborns with perinatal asphyxia (Group I) and 50 healthy neonates served as controls (Group II). All biochemical parameters of liver function were measured on the 1st, 3rd, and 10th day after birth. These parameters include serum alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein, serum albumin, serum bilirubin (total and direct), and international normalized ratio (INR), in both cases and controls. Among babies with PA, 25 (25%) had an Apgar score of 0 to 3 (severe PA), 43 (43%) had an Apgar score of 4 to 5 (moderate PA) and 32 (32%) had an Apgar score of 6 to 7 (mild PA) at 5 minutes of life. HIE was found in 39% among cases of PA and the remaining 61% were normal. Among babies with PA and HIE; 25.7% had stage I, 41% had stage II and 33.3% had stage III. Impaired liver function was reported in 48% of asphyxiated babies. On the first day of life, ALT, AST, ALP, LDH, PT, and INR were significantly higher in Group I compared to Group II. However, total protein and serum albumin were significantly lower in Group I compared to Group II. ALT and AST showed a positive correlation with the severity of HIE. On the third day of life, LDH rises as the stage of HIE progressed from stage 0 to stage 3. The difference in LDH among most stages of HIE was statistically significant. Liver enzymes can be used as an easy early diagnostic marker to differentiate between babies with asphyxia and those without asphyxia. Also, liver enzymes can be used for the detection of the severity of PA.
PubMed: 33614837
DOI: 10.1177/2333794X20987781 -
Frontiers in Medicine 2021The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts on healthcare systems worldwide, particularly regarding the care of pregnant women and their... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts on healthcare systems worldwide, particularly regarding the care of pregnant women and their neonates. The use of the Apgar score-a discrete numerical index used to evaluate neonatal condition immediately following delivery that has been used ubiquitously as a clinical indicator of neonatal condition and widely reported in the literature for decades-has continued during the pandemic. Although health systems adopted protocols that addressed pregnant women and their neonates during the pandemic, limited research has assessed the validity of Apgar scores for determining neonatal conditions in the context of COVID-19. Therefore, this scoping review was conducted on the first 2 years of the pandemic and included mothers with reverse transcription-polymerase chain reaction confirmed COVID-19 and their resulting positive or negative neonates. In total, 1,966 articles were assessed for eligibility, yielding 246 articles describing 663 neonates. Neonates who tested negative had median Apgar scores of 9 and 9 at 1 and 5 mins, respectively, while test-positive neonates had median Apgar scores of 8 and 9 at the same time points. The proportions of test-negative neonates with Apgar scores below 7 were 29 (4%) and 11 (2%) at 1 and 5 mins, which was not statistically significant ( = 0.327, χ = 0.961). These proportions were even lower for positive neonates: 22 (3%) and 11 (2%) at 1 and 5 mins, respectively, which was not statistically significant ( = 1, χ = 0). The low proportion of Apgar scores below 7 suggests that low Apgar scores are likely to be associated with severe maternal COVID-19 symptoms during delivery rather than neonatal COVID-19. Therefore, this study indicated that Apgar scores are poor indicators of neonatal COVID-19 status.
PubMed: 35087845
DOI: 10.3389/fmed.2021.782376 -
Prilozi (Makedonska Akademija Na... Sep 2020Neonatal hypoglycemia (HG) can cause neurologic damage, epilepsy, mental retardation, behavioral and personality disorders and death. The longest the HG lasts and the...
Neonatal hypoglycemia (HG) can cause neurologic damage, epilepsy, mental retardation, behavioral and personality disorders and death. The longest the HG lasts and the greatest the glucose nadir the consequences are more pronounced. Comorbidities are rather important in development of neurological damage. Hypoxemia and ischemia can cause permanent brain damage. Small for gestational age (SGA), large for gestational age (LGA), intrauterine growth restriction, gestational age bellow the 37th week, low Apgar score, sepsis, children whose mothers have toxemia, diabetes or chorioamnionitis are all newborns with increased HG risk. Comparing 34 patients with NH and 34 children without NH with similar GA, BW, BL, the Apgar score, we found statistically significant differences in motor and mental development using the Griffith scale. Children with neonatal HG fared significantly worse than those without neonatal HG. Therefore, CBG measurements and early recognition of neonatal HG is of significant importance in preventing motor and mental damage in children. A larger and well-balanced cohort of patients followed for a longer period is also necessary to clarify and discern in detail the importance of neonatal HG and other perinatal factors in neurodevelopmental damage.
Topics: Child; Female; Gestational Age; Humans; Hypoglycemia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Neurodevelopmental Disorders; Pregnancy; Risk Factors
PubMed: 33011693
DOI: 10.2478/prilozi-2020-0037