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Ultrasound in Obstetrics & Gynecology :... Feb 2020To perform a meta-analysis and meta-regression of randomized controlled trials (RCTs) to evaluate the impact of low-dose aspirin (LDA) on perinatal outcome, independent... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a meta-analysis and meta-regression of randomized controlled trials (RCTs) to evaluate the impact of low-dose aspirin (LDA) on perinatal outcome, independent of its effect on pre-eclampsia (PE), preterm birth and low birth weight.
METHODS
An electronic search of EMBASE, PubMed, CENTRAL, PROSPERO and Google Scholar databases was performed to identify RCTs assessing the impact of LDA in pregnancy, published in English prior to May 2019, which reported perinatal outcomes of interest (placental abruption, delivery mode, low 5-min Apgar score, neonatal acidosis, neonatal intensive care unit admission, periventricular hemorrhage and perinatal death). Risk ratios (RR) and 95% CI were calculated and pooled for analysis. Analysis was stratified according to gestational age at commencement of treatment (≤ 16 weeks vs > 16 weeks) and subgroup analysis was performed to assess the impact of aspirin dose (< 100 mg vs ≥ 100 mg). Meta-regression was used to assess the impact of LDA on perinatal outcome, independent of the reduction in PE, preterm birth and low birth weight.
RESULTS
Forty studies involving 34 807 participants were included. When LDA was commenced ≤ 16 weeks' gestation, it was associated with a significant reduction in the risk of perinatal death (RR, 0.47; 95% CI, 0.25-0.88; P = 0.02; number needed to treat, 92); however, this risk reduction was only seen when a daily dose of ≥ 100 mg was administered. If commenced > 16 weeks' gestation, LDA was associated with a significant reduction in 5-min Apgar score < 7 (RR, 0.75; 95% CI, 0.58-0.96; P = 0.02) and periventricular hemorrhage (RR, 0.68; 95% CI, 0.47-0.99; P = 0.04), but a trend towards an increase in the risk of placental abruption (RR, 1.20; 95% CI, 1.00-1.46; P = 0.06) was also noted. LDA was not associated with any significant increase in adverse events if commenced ≤ 16 weeks gestation. LDA had no effect on delivery mode, irrespective of the gestational age at which it was started. Meta-regression confirmed that the effect of LDA on perinatal death, when treatment was started ≤ 16 weeks' gestation, was independent of any reduction in the rate of PE and preterm birth.
CONCLUSION
LDA improves some important perinatal outcomes, without increasing adverse events such as placental abruption or periventricular hemorrhage, and its utility, if commenced prior to 16 weeks' gestation, may be considered in a wider context beyond the prevention of PE or fetal growth restriction. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Abruptio Placentae; Apgar Score; Aspirin; Delivery, Obstetric; Female; Fetal Growth Retardation; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Perinatal Death; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Care; Randomized Controlled Trials as Topic; Regression Analysis
PubMed: 31479546
DOI: 10.1002/uog.20859 -
Infection and Drug Resistance 2023To determine the clinical features, laboratory findings, antibiotic treatment, and outcomes of neonatal listeriosis in a specialized tertiary hospital in Wuhan, China.
PURPOSE
To determine the clinical features, laboratory findings, antibiotic treatment, and outcomes of neonatal listeriosis in a specialized tertiary hospital in Wuhan, China.
PATIENTS AND METHODS
We retrospectively analyzed the medical records of patients diagnosed with neonatal listeriosis at Maternal and Child Health Hospital of Hubei Province from January 2015 to December 2022. Listeriosis was indicated by positive culture for Listeria monocytogenes (LM).
RESULTS
A total of 11 cases were included in our study. The incidence rate of neonatal listeriosis was 2.06 per 100,000 live births. Seventy-three percent of the cases were born prematurely, caused early onset sepsis. Respiratory distress (100%) was the most common and earliest symptom, followed by fever (64%) and rashes (27%). The levels of C-reactive protein (CRP) and procalcitonin (PCT) were elevated in 100% of the cases. The median time-to-positivity (TTP) of the culture was 15 hours (range 9-28hours). Of the 11 neonates, 6 were cured, 2 showed improvement, and 3 died, with a mortality rate of 27%. There were statistically significant differences in Apgar score at 5 minutes (p=0.037) and CRP (p=0.025) between the survival group and fatality group. Ampicillin was sensitive to LM isolates and effective for therapy if initiated early.
CONCLUSION
Neonatal listeriosis is a rare but severe infection with a high mortality rate. Early identification and appropriate use of effective antibiotics are particularly critical for achieving positive outcomes. Apgar score and CRP are relevant indices for prognosis. Ampicillin is the first-line therapy and can be empirically administered to neonates suspected of having listeriosis.
PubMed: 37849792
DOI: 10.2147/IDR.S431402 -
Cureus Sep 2022Background Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with high rates of preeclampsia, stillbirth, and preterm birth. Adolescent...
Background Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with high rates of preeclampsia, stillbirth, and preterm birth. Adolescent pregnancy has also been associated with various adverse maternal and neonatal outcomes, including preeclampsia, stillbirth, preterm birth, congenital anomalies, and low birth weight. Therefore, this study aimed to determine whether COVID-19 infection associated with adolescent pregnancy represents an additional risk factor. Methods We performed a study that included 17 adolescent COVID-19- positive patients, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital, Bucharest, between 01.04.2020 and 15.04.2022, and a control group of 17 patients who were COVID-19-negative and delivered in the same period in the same unit. In the control group, additional risk factors that could affect neonatal outcomes were excluded. The COVID-19 infection was confirmed using a polymerase chain reaction (PCR) test. The analysis of neonatal outcomes included preterm birth, low birth weight, stillbirth, congenital anomalies, and Apgar score calculated at one minute. Results The data from this study showed that COVID-19 infection does not influence the newborn's weight or Apgar score in adolescent patients. Also, in our study, COVID-19 infection was not statistically significant according to preterm delivery in adolescents. Conclusion Adolescent pregnancy represents an important health problem associated with a high risk of maternal and neonatal complications. However, COVID-19 infection does not influence neonatal outcomes in this population.
PubMed: 36249615
DOI: 10.7759/cureus.29006 -
Journal of Feline Medicine and Surgery Jun 2022The aim of this study was to perform neonatal clinical assessments at birth to identify newborn kittens at risk according to type of delivery, thus allowing immediate...
OBJECTIVES
The aim of this study was to perform neonatal clinical assessments at birth to identify newborn kittens at risk according to type of delivery, thus allowing immediate intervention and increasing their chances of survival.
METHODS
This study compared Apgar scores, reflexes and clinical parameters (temperature, weight, blood glucose and peripheral oxygen saturation [SpO2]) between eutocic neonates and those delivered by emergency cesarean section. The animals were evaluated at birth and after 10 and 60 mins.
RESULTS
Thirty-two neonates were evaluated, with 19 animals in the eutocic group (EG) and 13 animals in the cesarean group (CG). When comparing groups, CG neonates had significantly lower Apgar scores ( <0.0001), lower SpO ( = 0.0535), higher blood glucose ( = 0.0009), reduced reflexes ( <0.0001) and lower respiratory rates ( <0.0001) at birth and after 10 and 60 mins than EG neonates. Apgar scores positively correlated with parameters such as heart rate, reflex score, SpO and weight. The mortality rate in evaluated newborns was 15.6% (5/32). The early mortality rate (0-2 days old) was 80% (4/5) and the late mortality rate (3-30 days old) was 20% (1/5).
CONCLUSIONS AND RELEVANCE
This study showed lower vitality in cats delivered by emergency cesarean section than in those delivered through eutocic birth. In general, neonates delivered by cesarean section have greater depression and low vitality at birth and may require advanced resuscitation procedures. The evaluations carried out in this study identified newborns with low vitality and those requiring advanced resuscitation, thus allowing immediate intervention. Apgar and reflex scores for feline neonates were suggested. Newborn-specific clinical assessment with these feline vitality scores allows the identification of at-risk neonates. Care immediately after birth increases the chance of survival among these patients.
Topics: Animals; Cats; Female; Pregnancy; Apgar Score; Blood Glucose; Cesarean Section; Oxygen Saturation; Reflex; Animals, Newborn
PubMed: 35352984
DOI: 10.1177/1098612X221081404 -
BMC Surgery Jul 2023The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy of the score and its correlation with the...
BACKGROUND
The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy of the score and its correlation with the complication severity has not been well established in many grounds of low resource settings.
OBJECTIVE
To determine the accuracy of Surgical Apgar Score in predicting the severity of post-operative complications among patients undergoing emergency laparotomy at Muhimbili National Hospital.
METHODS
A prospective cohort study was conducted for a period of 12 months; patients were followed for 30 days, the risk of complication was classified using the Surgical Apgar Score (SAS), severity of complication was estimated using the Clavien Dindo Classification (CDC) grading scheme and Comprehensive Complication Index (CCI). Spearman correlation and simple linear regression statistic models were applied to establish the relationship between Surgical Apgar Score (SAS) and Comprehensive Complication Index (CCI). The Accuracy of SAS was evaluated by determining its discriminatory capacity on Receiver Operating Characteristics (ROC) curve, data normality was tested by Shapiro-Wilk statistic 0.929 (p < 0.001).Analysis was done using International Business Machine Statistical Product and Service Solution (IBM SPSS) version 27.
RESULTS
Out of the 111 patients who underwent emergency laparotomy, 71 (64%) were Male and the median age (IQR) was 49 (36, 59).The mean SAS was 4.86 (± 1.29) and the median CCI (IQR) was 36.20 (26.2, 42.40). Patients in the high-risk SAS group (0-4) were more likely to experience severe and life-threatening complications, with a mean CCI of 53.3 (95% CI: 47.2-63.4), compared to the low-risk SAS group (7-10) with a mean CCI of 21.0 (95% CI: 5.3-36.2). A negative correlation was observed between SAS and CCI, with a Spearman r of -0.575 (p < 0.001) and a regression coefficient b of -11.5 (p < 0.001). The SAS demonstrated good accuracy in predicting post-operative complications, with an area under the curve of 0.712 (95% CI: 0.523-0.902, p < 0.001) on the ROC.
CONCLUSION
This study has demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital.
Topics: Humans; Male; Infant, Newborn; Female; Apgar Score; Laparotomy; Prospective Studies; Postoperative Complications; Risk Factors; Retrospective Studies
PubMed: 37415104
DOI: 10.1186/s12893-023-02088-2 -
The Journal of Maternal-fetal &... Dec 2023Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This... (Observational Study)
Observational Study
INTRODUCTION
Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia.
METHODS
This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases ( = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, = 92) and those with low lactate levels (below 2 mmol/L, = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, = 29, and high lactate group, = 45) were evaluated.
RESULTS
No difference was observed between the two groups in terms of demographic characteristics such as age ( = .1669), male gender ( = .906), mother's working situation ( = .948), mother's education level ( = .828), father's education level ( = .507), and family's total income ( = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, = .001), problem-solving (50 vs. 60, = .002), and personal social development (45 vs. 60, = .003). No difference was observed in terms of communication and gross motor total scores.
DISCUSSION
In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.
Topics: Child, Preschool; Female; Humans; Infant, Newborn; Male; Pregnancy; Apgar Score; Asphyxia; Asphyxia Neonatorum; Fetal Blood; Fetal Distress; Hypoxia; Lactic Acid
PubMed: 37989542
DOI: 10.1080/14767058.2023.2284115 -
BMC Psychiatry Mar 2020The present study examined the association between perinatal obstetric complications and executive dysfunction in early-onset schizophrenia (EOS), compared to healthy...
BACKGROUND
The present study examined the association between perinatal obstetric complications and executive dysfunction in early-onset schizophrenia (EOS), compared to healthy controls. Higher incidences of obstetric complications and more severe executive dysfunctions characterize EOS. Research shows extensive brain maturation in newborns, suggesting them to be particularly vulnerable for perinatal insults. Executive function is mainly mediated by the prefrontal cortex, an area that matures last during pregnancy. Thus, exposure to perinatal complications may influence executive dysfunction in EOS.
METHODS
The participants were 19 EOS patients and 54 healthy controls. Executive function was assessed with the D-KEFS Color Word Interference Test and the Wisconsin Card Sorting Test. Information on perinatal obstetric complications and Apgar 5-min scores were obtained from the Norwegian Medical Birth Registry. Associations between perinatal conditions and executive function were studied using stepwise regression analyses.
RESULTS
Perinatal complications, and especially shorter gestational lengths, were significantly associated with significant executive dysfunctions in EOS. Perinatal complications did not affect executive function among healthy controls. A significant relationship between lower Apgar 5-min scores and executive dysfunction was found among both EOS patients and healthy controls.
CONCLUSIONS
Exposure to perinatal complications, and particularly a shorter gestational length, was associated with increased executive dysfunction in EOS. Exposed healthy controls did not exhibit similar executive difficulties, suggesting that the EOS patients seemed especially vulnerable for executive deficits due to perinatal insults. The findings indicate that EOS youths learn more slowly and experience more difficulty with problem-solving, which carry important implications for clinical practice. Lower Apgar 5-min scores were associated with executive dysfunction in both groups. Low Apgar score at 5 min may therefore be an important early indicator of executive difficulties among adolescents, independent of diagnosis.
Topics: Adolescent; Age of Onset; Executive Function; Female; Humans; Infant, Newborn; Neuropsychological Tests; Norway; Pregnancy; Schizophrenia; Schizophrenic Psychology
PubMed: 32131788
DOI: 10.1186/s12888-020-02517-z -
Medicina (Kaunas, Lithuania) Jan 2023Background and Objectives: The present study assessed the fetal growth restriction and clinical parameters of both human immunodeficiency virus (HIV)-negative and...
Background and Objectives: The present study assessed the fetal growth restriction and clinical parameters of both human immunodeficiency virus (HIV)-negative and HIV-positive newborns from HIV-infected mothers in two HIV-acquired immunodeficiency syndrome regional centers (RCs) in Constanta and Craiova, Romania, in order to evaluate the adverse birth-related outcomes. Materials and Methods: These represent a retrospective study conducted between 2008 and 2019, in which 408 pregnant HIV-positive women, 244 from Constanta RC and 164 from Craiova RC, were eligible to participate in the study. Consecutive singleton pregnancies delivered beyond 24 weeks of pregnancy were included. Growth restriction in newborns was defined as the birth weight (BW) being less than the third percentile, or three out of the following: BW < 10th percentile; head circumference (HC) < 10th percentile; birth length (BL) < 10th percentile; prenatal diagnosis of fetal growth restriction; and maternal pregnancy information. Of the 244 newborns delivered in Constanta, RC, 17 were HIV-positive, while in Craiova, RC, of the 164 newborns, 9 were HIV-positive. All HIV-positive women were on combined antiretroviral therapy (cART) during pregnancy, similar to all HIV-positive newborns who received ARTs for the first six weeks. We search for the influence of anthropometrical parameters (i.e., HC, BL, and BW), as well as clinical parameters (i.e., newborn sex and Apgar score) for both HIV-negative and HIV-positive newborns, along with the survival rate of HIV-positive newborns. Results: There were no differences in the sex of the newborns within either group, with more than 50% being boys. Similarly, the Apgar score did not show any statistically significant values between the two groups (i.e., p = 0.544 for HIV-positive newborns vs. p = 0.108 for HIV-negative newborns). Interestingly, our results showed that in Craiova, RC, there was a chance of 2.16 to find an HIV-negative newborn with an HC < 10th percentile and a 2.54 chance to find an HIV-negative newborn with a BL < 10th percentile compared to Constanta, RC, without any significant differences. On the contrary, Constanta, RC, represented a higher risk of death (i.e., 3.049 times, p = 0.0470) for HIV-positive newborns compared to Craiova, RC. Conclusions: Our results support the idea that follow-up of fetal growth restriction should be part of postnatal care in this high-risk population to improve adverse birth-related outcomes.
Topics: Pregnancy; Male; Infant, Newborn; Humans; Female; Fetal Growth Retardation; Romania; Retrospective Studies; Birth Weight; HIV Infections
PubMed: 36676736
DOI: 10.3390/medicina59010111 -
Acta Obstetricia Et Gynecologica... Feb 2023Umbilical arterial pH of less than 7 is often used as the threshold below which the risks of neonatal death and adverse long-term neurological outcomes are considered to...
INTRODUCTION
Umbilical arterial pH of less than 7 is often used as the threshold below which the risks of neonatal death and adverse long-term neurological outcomes are considered to be higher. Yet within the group with pH <7, the risks have not been further stratified. Here, we aimed to investigate the predictors of adverse long-term outcomes of this group of infants.
MATERIAL AND METHODS
This was a retrospective study of 248 infants born after 34 weeks of gestation in a tertiary obstetric unit, between 2003 and 2017, with cord arterial pH <7 or base excess ≤-12 mmol/L at birth. The infants were categorized into two groups: (1) intact survivors, or (2) neonatal/infant deaths or cerebral palsy or developmental delay. The umbilical arterial pH and base excess levels, Apgar scores, mode of delivery, gestational age, small for gestational age, birth in the era before the implementation of neonatal hypothermic therapy, and the presence of a known sentinel event, were compared between the groups using univariate analysis followed by multivariate analysis.
RESULTS
Among the 248 infants, there were 222 intact survivors (89.5%) and 26 infants with poor outcomes (10.5%), including eight deaths (3.2%) and 18 (7.3%) with cerebral palsy and/or developmental delay. Univariate analysis showed that infants with adverse outcomes had significantly lower cord arterial pH (6.85 vs 6.95, with p < 0.001), lower cord arterial base excess (-19.95 vs -15.90 mmol/L, p < 0.001), a higher proportion of having AS at 5 min <7 (65.4% vs 13.1%, p < 0.001), and a higher proportion of having a sentinel event (34.6% vs 16.7%, p = 0.034). Multivariate analysis confirmed cord arterial pH of <6.9 and an Apgar score at 5 min <7 as independent prognostic factors (the adjusted odds ratios were 4.64 and 6.62, respectively). The risk of adverse outcome increased from 4.3% when the arterial pH was between 6.9 and <7, to 30% when the pH was <6.9.
CONCLUSIONS
Infants born with umbilical artery pH <7 still have a high chance of 89.5% to become intact survivors. A cord arterial pH of <6.9 and an Apgar score at 5 min <7 are independent prognostic factors for neonatal/infant death or adverse long-term neurological outcomes.
Topics: Infant, Newborn; Pregnancy; Female; Infant; Humans; Retrospective Studies; Hydrogen-Ion Concentration; Cerebral Palsy; Umbilical Cord; Infant, Newborn, Diseases; Umbilical Arteries; Apgar Score; Fetal Blood
PubMed: 36504253
DOI: 10.1111/aogs.14494 -
BMC Pregnancy and Childbirth May 2023Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their...
INTRODUCTION
Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations.
PURPOSE
To determine the association between inadequate PNC (< 10 visits) and poor infant outcomes neonatal intensive care unit (NICU) stay, low APGAR score, small for gestational age (SGA) and length of stay (LOS).
METHODS
The study used West Virginia (WV) Project WATCH population level data (May 2018-March 2022). Multiple logistic regressions and survival analysis were performed on infant outcomes; NICU stay, APGAR score, infant size, and infant length of stay (LOS) with PNC categories inadequate (< 10 PNC visits) vs adequate (10 or more) adjusting for covariates including maternal race, insurance status, parity, smoking status, substance use status, and diabetes status.
RESULTS
Of births to teenagers, 14% received inadequate PNC. Teens who received inadequate PNC had increased odds of infant admitted to NICU (aOR: 1.84, CI:(1.41, 2.42), p < 0.0001), low 5- minute APGAR score (aOR: 3.26, CI:(2.03,5.22), p < 0.0001), and increased LOS (Est. = -0.33, HR: 0.72, CI:(0.65,0.81), p < 0.0001).
CONCLUSIONS
Results demonstrated that infants of teenagers who received inadequate PNC are at increased risk of requiring a NICU stay, having a low APGAR score and requiring an increased LOS. PNC is particularly important for these groups as they are at increased risk of poor birth outcomes.
Topics: Adolescent; Female; Humans; Infant; Infant, Newborn; Pregnancy; Hospitalization; Length of Stay; Parity; Parturition; Prenatal Care; Pregnancy in Adolescence
PubMed: 37226124
DOI: 10.1186/s12884-023-05662-x