-
PloS One 2024Neonatal hypothermia, defined as an axillary temperature of <36.5C in a neonate, is common in neonatal intensive care units and is almost universal across all geographic...
A retrospective data analysis on prevalence and risk factors for hypothermia among sick neonates at presentation to the neonatal intensive care unit of the Tamale Teaching Hospital.
Neonatal hypothermia, defined as an axillary temperature of <36.5C in a neonate, is common in neonatal intensive care units and is almost universal across all geographic and climatic regions of the world. This is even though environmental temperature is a known risk factor for its occurrence. We conducted a retrospective study in the Neonatal Intensive Care Unit of the Tamale Teaching Hospital (TTH) to document the prevalence and risk factors associated with hypothermia at presentation to the hospital. The study spanned the period from January 2019 to December 2019 and involved all neonates with axillary temperature documented at the time of admission. The prevalence of neonatal hypothermia in this study was 54.76%. Hypothermia was most common in neonates diagnosed with meconium aspiration syndrome (87/105, 82.86%), prematurity and low birth weight (575/702, 81.91%), and birth asphyxia (347/445, 77.98%). Neonates who were delivered vaginally were less likely to develop hypothermia compared to those delivered via Cesarean section. Inborn neonates (delivered in TTH) were 3.2 times more likely to be hypothermic when compared to those who were delivered at home. Neonates with low birth weight and APGAR scores < 7 at 1 and 5 minutes were more likely to be hypothermic. The dry season was found to be protective against hypothermia when compared to the rainy season. The overall mortality rate was 13.68% and the mortality in the subgroup with hypothermia at presentation was 18.87%. Our study documented a high prevalence of hypothermia with higher rates in neonates requiring intervention at birth. It is therefore crucial for perinatal care providers to adhere to the warm chain precautions around the time of birth.
Topics: Humans; Infant, Newborn; Retrospective Studies; Intensive Care Units, Neonatal; Risk Factors; Hypothermia; Hospitals, Teaching; Female; Prevalence; Male; Infant, Low Birth Weight; Kenya; Asphyxia Neonatorum; Meconium Aspiration Syndrome
PubMed: 38753864
DOI: 10.1371/journal.pone.0303159 -
Acta Medica Portuguesa May 2024
Topics: Humans; Resuscitation; Infant, Newborn
PubMed: 38744233
DOI: 10.20344/amp.21415 -
Saudi Journal of Kidney Diseases and... Nov 2023Acute kidney injury (AKI) is common in premature newborns and is associated with high mortality. It is unclear which risk factors lead to AKI in these neonates. We aimed...
Acute kidney injury (AKI) is common in premature newborns and is associated with high mortality. It is unclear which risk factors lead to AKI in these neonates. We aimed to determine the incidence, risk factors, and outcomes of AKI in preterm neonates in the neonatal intensive care unit (NICU). They were screened and staged for AKI as per the amended neonatal criteria of Kidney Disease Improving Global Outcomes and followed up until discharge or death. Serum creatinine levels and urine output were measured. The incidence of AKI was 18.5% (37/200 neonates). The majority developed non-oliguric AKI. The risk factors significantly associated with AKI in neonates were the presence of sepsis, birth asphyxia, shock, respiratory distress syndrome, and hypothermia. The majority of neonates with AKI had a birthweight <1500 g and a gestational age of <32 weeks and had a higher risk of mortality, in contrast to than those without AKI. Mortality and NICU stay were significantly higher among those with Stage 3 AKI compared with Stage 2 and Stage 1 AKI. To prevent AKI and reduce the burden of high mortality in premature neonates, it is essential to prevent sepsis, birth asphyxia, and respiratory distress syndrome, as well as to detect shock and patent ductus arteriosus as early as possible. There is a need for good antenatal care to reduce the burden of prematurity.
Topics: Humans; Infant, Newborn; Acute Kidney Injury; Risk Factors; India; Incidence; Female; Male; Infant, Premature; Intensive Care Units, Neonatal; Gestational Age; Infant, Premature, Diseases; Birth Weight; Asphyxia Neonatorum
PubMed: 38725209
DOI: 10.4103/sjkdt.sjkdt_264_23 -
Journal of Medical Case Reports Apr 2024We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a...
BACKGROUND
We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. It has been reported that congenital uterine anomalies latently affect the fetal position. The clinical pitfalls in childbirth with uterine anomalies are discussed here on the basis of clinical evidence.
CASE PRESENTATION
At a perinatal medical center in Japan, a 29-year-old Japanese mother who had a history of bicornuate uterus, received tocolysis to prolong her pregnancy for 5 days during the late preterm period after preterm-premature rupture of the membrane. She gave birth to a 2304 g male neonate of the gestational age of 35 weeks and 5 days with severe asphyxia by means of crash cesarean section for fetal sustained bradycardia after sudden termination of tocolysis. We found the fetal position to reverse from cephalic to breech position during early labor. He ended up having severe cerebral palsy after brain cooling against hypoxic-ischemic encephalopathy for 3 days. The mechanism of inversion from cephalic to breech position without amnionic fluid remains unclear, although women with a known diagnosis of a uterine anomaly have higher risk of adverse outcomes such as malpresentation.
CONCLUSIONS
When considering the clinical course of this case on the basis of the medical reports, we suspected that uterine anomalies and changes in intrauterine pressure could cause fetal malpresentation and adverse neonatal outcomes.
Topics: Humans; Female; Pregnancy; Adult; Infant, Newborn; Male; Cesarean Section; Uterus; Tocolysis; Urogenital Abnormalities; Asphyxia Neonatorum; Labor Presentation; Asphyxia; Breech Presentation
PubMed: 38664817
DOI: 10.1186/s13256-024-04524-0 -
Journal of Mother and Child Feb 2024Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during... (Review)
Review
INTRODUCTION
Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during hypoxic-ischaemic encephalopathy (HIE). This study aimed to review published data on rScO2 monitoring during hypothermia treatment in neonates with perinatal asphyxia to predict short- and long-term neurological injury.
METHODS
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study identification was performed through a search between November and December 2021 in the electronic databases PubMed, Embase, Lilacs, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). The main outcome was short-term (Changes in brain magnetic resonating imaging) and long-term (In neurodevelopment) neurological injury. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) with CRD42023395438.
RESULTS
380 articles were collected from databases in the initial search. Finally, 15 articles were selected for extraction and analysis of the information. An increase in rScO2 measured by NIRS (Near-infrared spectroscopy) at different moments of treatment predicts neurological injury. However, there exists a wide variability in the methods and outcomes of the studies.
CONCLUSION
High rScO2 values were found to predict negative outcomes, with substantial discord among studies. NIRS is proposed as a real-time bedside tool for predicting brain injury in neonates with moderate to severe HIE.
Topics: Infant, Newborn; Humans; Hypoxia-Ischemia, Brain; Spectroscopy, Near-Infrared; Asphyxia; Brain; Hypothermia, Induced; Asphyxia Neonatorum
PubMed: 38639099
DOI: 10.34763/jmotherandchild.20242801.d-24-00010 -
Anales de Pediatria Apr 2024
Topics: Humans; Infant, Newborn; Asphyxia Neonatorum; Neuroprotection; Health Resources
PubMed: 38604933
DOI: 10.1016/j.anpede.2024.02.013 -
Italian Journal of Pediatrics Apr 2024Hypoxic-ischemic encephalopathy (HIE) appears in neurological conditions where some brain areas are likely to be injured, such as deep grey matter, basal ganglia area,...
BACKGROUND
Hypoxic-ischemic encephalopathy (HIE) appears in neurological conditions where some brain areas are likely to be injured, such as deep grey matter, basal ganglia area, and white matter subcortical periventricular áreas. Moreover, modeling these brain areas in a newborn is challenging due to significant variability in the intensities associated with HIE conditions. This paper aims to evaluate functional measurements and 3D machine learning models of a given HIE case by correlating the affected brain areas with the pathophysiology and clinical neurodevelopmental.
CASE PRESENTATION
A comprehensive analysis of a term infant with perinatal asphyxia using longitudinal 3D brain information from Machine Learning Models is presented. The clinical analysis revealed the perinatal asphyxia diagnosis with APGAR <5 at 5 and 10 minutes, umbilical arterial pH of 7.0 BE of -21.2 mmol / L), neonatal seizures, and invasive ventilation mechanics. Therapeutic interventions: physical, occupational, and language neurodevelopmental therapies. Epilepsy treatment: vagus nerve stimulation, levetiracetam, and phenobarbital. Furthermore, the 3D analysis showed how the volume decreases due to age, exhibiting an increasing asymmetry between hemispheres. The results of the basal ganglia area showed that thalamus asymmetry, caudate, and putamen increase over time while globus pallidus decreases.
CLINICAL OUTCOMES
spastic cerebral palsy, microcephaly, treatment-refractory epilepsy.
CONCLUSIONS
Slight changes in the basal ganglia and cerebellum require 3D volumetry for detection, as standard MRI examinations cannot fully reveal their complex shape variations. Quantifying these subtle neurodevelopmental changes helps in understanding their clinical implications. Besides, neurophysiological evaluations can boost neuroplasticity in children with neurological sequelae by stimulating new neuronal connections.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Child; Humans; Asphyxia; Brain; Hypoxia-Ischemia, Brain; Asphyxia Neonatorum; Seizures; Epilepsy
PubMed: 38594715
DOI: 10.1186/s13052-024-01633-w -
Clinical Neurophysiology : Official... Jun 2024To evaluate the utility of a fully automated deep learning -based quantitative measure of EEG background, Brain State of the Newborn (BSN), for early prediction of...
OBJECTIVE
To evaluate the utility of a fully automated deep learning -based quantitative measure of EEG background, Brain State of the Newborn (BSN), for early prediction of clinical outcome at four years of age.
METHODS
The EEG monitoring data from eighty consecutive newborns was analyzed using the automatically computed BSN trend. BSN levels during the first days of life (a of total 5427 hours) were compared to four clinical outcome categories: favorable, cerebral palsy (CP), CP with epilepsy, and death. The time dependent changes in BSN-based prediction for different outcomes were assessed by positive/negative predictive value (PPV/NPV) and by estimating the area under the receiver operating characteristic curve (AUC).
RESULTS
The BSN values were closely aligned with four visually determined EEG categories (p < 0·001), as well as with respect to clinical milestones of EEG recovery in perinatal Hypoxic Ischemic Encephalopathy (HIE; p < 0·003). Favorable outcome was related to a rapid recovery of the BSN trend, while worse outcomes related to a slow BSN recovery. Outcome predictions with BSN were accurate from 6 to 48 hours of age: For the favorable outcome, the AUC ranged from 95 to 99% (peak at 12 hours), and for the poor outcome the AUC ranged from 96 to 99% (peak at 12 hours). The optimal BSN levels for each PPV/NPV estimate changed substantially during the first 48 hours, ranging from 20 to 80.
CONCLUSIONS
We show that the BSN provides an automated, objective, and continuous measure of brain activity in newborns.
SIGNIFICANCE
The BSN trend discloses the dynamic nature that exists in both cerebral recovery and outcome prediction, supports individualized patient care, rapid stratification and early prognosis.
Topics: Humans; Infant, Newborn; Electroencephalography; Asphyxia Neonatorum; Male; Female; Brain; Hypoxia-Ischemia, Brain; Cerebral Palsy; Predictive Value of Tests; Child, Preschool; Deep Learning; Prognosis
PubMed: 38583406
DOI: 10.1016/j.clinph.2024.03.007 -
BMJ Paediatrics Open Apr 2024Birth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus,...
BACKGROUND
Birth asphyxia is still one of the primary causes of newborn mortality worldwide. Similarly, the risk of newborn asphyxia in Ethiopia remains unacceptably high. Thus, studies on the incidence and predictors of mortality among newborns admitted with birth asphyxia are crucial to addressing this problem. As a result, the purpose of this study was to assess the incidence and predictors of mortality among neonates admitted with birth asphyxia to the neonatal intensive care units (NICUs) of West Shewa Zone Public Hospitals in Central Ethiopia.
METHODS
An institution-based retrospective cohort study was conducted among 760 asphyxiated neonates admitted to the NICUs of West Shewa Zone Public Hospitals between 30 March 2021 and 30 April 2023. The data were collected using CSEntry and analysed bu using Stata V.17. Bivariate and multivariate Cox proportional hazard regression analyses were carried out, and significant predictors were found using a 95% CI and a p<0.05.
RESULTS
A total of 760 asphyxiated neonates were followed for a total of 6880 neonatal days. At the end of follow-up, 263 (34.6%) of the neonates died (95% CI 31.3% to 38.1%), which resulted in a mortality incidence of 10.6/100 person-days of observation. Chewing khat (adjusted HR, AHR 2.21; 95% CI 1.13 to 4.31), home delivery (AHR 1.45, 95% CI 1.1 to 1.9), lack of antenatal care follow-up (AHR 1.44, 95% CI 1.08 to 1.89), hypothermia (AHR 1.56, 95% CI 1.12 to 2.17), hypoglycaemia (AHR 2.23, 95% CI 1.91 to 2.25) and obstructed labour (AHR 1.4, 95% CI 1.02 to 1.91) were found to be the significant predictors of neonatal mortality among asphyxiated neonates at a p≤0.05.
CONCLUSION AND RECOMMENDATION
The magnitude of neonatal mortality among asphyxiated neonates in the study area was high. Therefore, in order to significantly reduce the risks of birth asphyxia and subsequent newborn death, all interested stakeholders should take these predictors into consideration.
Topics: Infant, Newborn; Humans; Female; Pregnancy; Retrospective Studies; Ethiopia; Intensive Care Units, Neonatal; Incidence; Asphyxia; Asphyxia Neonatorum; Hospitals, Public; Infant, Newborn, Diseases
PubMed: 38580447
DOI: 10.1136/bmjpo-2023-002403 -
BMC Pediatrics Apr 2024Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the...
Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia.
BACKGROUND
Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it's contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH).
METHODS
A hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05.
RESULTS
The magnitude of neonatal death was 14.2% (95% CI: 0.099-0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die.
CONCLUSION
The prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.
Topics: Infant; Infant, Newborn; Humans; Female; Pregnancy; Intensive Care Units, Neonatal; Retrospective Studies; Perinatal Death; Ethiopia; Cross-Sectional Studies; Asphyxia; Universities; Infant Mortality; Infant, Premature; Hospitals, University; Asphyxia Neonatorum; Infant, Newborn, Diseases; Sepsis
PubMed: 38570750
DOI: 10.1186/s12887-024-04689-z