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Thatrimontrichai A, Phatigomet M, Maneenil G, Dissaneevate S, Janjindamai W. Risk Factors for Mortality or Major Morbidities of Very Preterm Infants: A Study from Thailand. Am J Perinatol 2024; 41:1379-1387. [PMID: 36669757 DOI: 10.1055/a-2016-7568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Very preterm neonates have high rates of composite outcomes featuring mortality and major morbidities. If the modifiable risk factors could be identified, perhaps the rates could be decreased especially in resource-limited settings. STUDY DESIGN We performed a prospective study in a Thai neonatal intensive care unit to identify the risk factors of composite outcomes between 2014 and 2021. The inclusion criterion was neonates who were born in our hospital at a gestational age (GA) of less than 32 weeks. The exclusion criteria were neonates who died in the delivery room or had major congenital anomalies. The composite outcomes were analyzed by multivariable logistic regression with adjusted odds ratios (aORs) and a 95% confidence interval (CI). RESULTS Over the 8-year study period, 555 very preterm inborn neonates without major birth defects were delivered. The composite outcomes were 29.4% (163/555). The medians (interquartile ranges) of GA and birth weights of the neonates were 29 (27-31) weeks and 1,180 (860-1,475) grams, respectively. By multivariable analysis, GA (aOR: 0.65; 95% CI: 0.55-0.77), small for GA (aOR: 4.93; 95% CI: 1.79-13.58), multifetal gestation (aOR: 2.23; 95% CI: 1.12-4.46), intubation within 24 hours (aOR: 5.39; 95% CI: 1.35-21.64), and severe respiratory distress syndrome (aOR: 5.00; 95% CI: 1.05-23.89) were significantly associated with composite outcomes. CONCLUSION Very preterm infants who had a lower GA were small for GA, twins or more, respiratory failure on the first day of life, and severe respiratory distress syndrome were associated with mortality and/or major morbidities. KEY POINTS · In very preterm neonates, the composite outcomes and mortality rate were 29.4 and 12.3%.. · Composite outcomes were associated with lower GA, SGA, multifetal gestation, intubation, and severe RDS.. · Mortality was associated with lower GA or Apgar score at 5 minutes, SGA, and PPHN..
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MESH Headings
- Humans
- Thailand/epidemiology
- Infant, Newborn
- Prospective Studies
- Female
- Male
- Risk Factors
- Intensive Care Units, Neonatal/statistics & numerical data
- Gestational Age
- Logistic Models
- Infant, Extremely Premature
- Respiratory Distress Syndrome, Newborn/mortality
- Respiratory Distress Syndrome, Newborn/epidemiology
- Infant Mortality
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/epidemiology
- Multivariate Analysis
- Infant
- Odds Ratio
- Infant, Small for Gestational Age
- Birth Weight
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Affiliation(s)
- Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Manapat Phatigomet
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Gunlawadee Maneenil
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supaporn Dissaneevate
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Waricha Janjindamai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Li T, Zhang G, Li R, He S, Zhang F, Yan X, Yu Z, Xie Y. Survival and morbidity in very preterm infants in Shenzhen: a multi-center study. Front Pediatr 2024; 11:1298173. [PMID: 38464983 PMCID: PMC10920349 DOI: 10.3389/fped.2023.1298173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/05/2023] [Indexed: 03/12/2024] Open
Abstract
Objective To analyze survival and morbidity among very preterm infants (VPIs) in Shenzhen and explore factors associated with survival without major morbidity. Methods Between January 2022 and December 2022, 797 infants were admitted to 25 neonatal intensive care units in Shenzhen with gestational age (GA) < 32 weeks, excluded discharged against medical advice, insufficient information, and congenital malformation, 742 VPIs were included. Comparison of maternal and neonate characteristics, morbidities, survival, and survival without major morbidities between groups used Mann Whitney U test and X2 test, multivariate logistic regression was used to analyze of risk factors of survival without major morbidities. Results The median GA was 29.86 weeks (interquartile range [IQR], 28.0-31.04), and the median birth weight was 1,250 g (IQR, 900-1,500). Of the 797 VPIs, 721 (90.46%) survived, 53.52% (38 of 71) at 25 weeks' or less GA, 86.78% (105 of 121) at 26 to 27 weeks' GA, 91.34% (211 of 230) at 28 to 29 weeks' GA, 97.86% (367 of 375) at 30 to 31 weeks' GA. The incidences of the major morbidities were moderate-to-severe bronchopulmonary dysplasia,16.52% (113 of 671); severe intraventricular hemorrhage and/or periventricular leukomalacia, 2.49% (17 of 671); severe necrotizing enterocolitis, 2.63% (18 of 671); sepsis, 2.34% (16 of 671); and severe retinopathy of prematurity, 4.55% (27 of 593), 65.79% (450 of 671) survived without major morbidities. After adjustment for GA, birth weight, and 5-min Apgar score, antenatal steroid administration (OR = 2.397), antenatal magnesium sulfate administration (OR = 1.554) were the positivity factors to survival without major morbidity of VPIs, however, surfactant therapy (OR = 0.684,), and delivery room resuscitation (OR = 0.626) that were the negativity factors. Conclusions The present results indicate that survival and the incidence of survival without major morbidities increased with GA. Further, antenatal administration of steroids and magnesium sulfate, surfactant therapy, and delivery room resuscitation were pronounced determinants of survival without morbidities.
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Affiliation(s)
- Tingting Li
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, China
| | - Guofei Zhang
- Department of Neonatology, Qinghai Red Cross Hospital, Xining, China
| | - Rui Li
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, China
| | - Shengnan He
- Department of Neonatology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Fangshi Zhang
- Department of Neonatology, Shenzhen Yantian District People’s Hospital, Shenzhen, China
| | - Xudong Yan
- Department of Neonatology, Shenzhen People’s Hospital, Shenzhen, China
| | - Zhangbin Yu
- Department of Neonatology, Shenzhen People’s Hospital, Shenzhen, China
| | - Yingmei Xie
- Department of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Longgang Maternity and Child Institute of Shantou University Medical College, Shenzhen, China
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Mohamed Rasheed ZB, Hong J, Yaacob H, Omar SZ. Prevalence of Preterm Birth and Perinatal Outcomes in a Tertiary Hospital in Malaysia. Cureus 2024; 16:e55284. [PMID: 38562268 PMCID: PMC10982130 DOI: 10.7759/cureus.55284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Preterm birth (PTB) is defined as neonates that are born alive >22 weeks of gestation and <37 weeks of gestation. Because of the immaturity of different organ systems, 14.84 million newborns worldwide are born prematurely, which is the largest contributing factor to mortality and morbidity. Although studies have been conducted in this field, the magnitude of PTB is a major issue in most developing countries including Malaysia. Objective To assess the prevalence of PTB and the perinatal outcome among women delivered in a tertiary university hospital in Malaysia. Methods This was a cross-sectional study evaluating all singleton live births weighing>500g and delivered at >22+1 weeks of gestation between January 2015 and December 2019 in Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Data were collected from the hospital's recorded birth registry. The primary outcome was the PTB rate. Data were entered and analysed using Statistical Product and Service Solutions (SPSS) (version 28.0; IBM SPSS Statistics for Windows, Armonk, NY). Results A total of 26,022 singleton live births were reported for the period 2015-2019. PTB rates showed a sharp 6% decrease from 2015 to 2016, after which the trend was inconsistent until 2019. The risk of preterm babies being admitted to the neonatal intensive care unit (NICU) or the ward compared to the risk of neonatal mortality increases for babies of identified sex, delivered via caesarean, and with a birth weight between 2 and 3 kgs. Babies born at a gestational age between 22+1 and 33+6 have a higher risk of neonatal mortality compared to late preterm babies. Conclusions The PTB incidence trend was inconsistent from 2015 to 2019 in a tertiary university hospital in Malaysia, with a far higher prevalence compared to national data. The high NICU admission and mortality rates among preterm infants mean urgent strategies and policies are needed to improve perinatal outcomes.
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Affiliation(s)
- Zahirrah Begam Mohamed Rasheed
- Department of Craniofacial Diagnostics and Bioscience, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Jesrine Hong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Hannuun Yaacob
- Department of Decision Science, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur, MYS
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Helmy E, Lesimbang HB, Hossain Parash MT, Ruey S, Kamarudin NB, Siong OT, Sheng TJ, Ahmad KSB, Saman SNB, Bing Ling K. The Association Between Maternal Short Stature and Neonatal Intensive Care Unit Admission: A Longitudinal Study in Sabah. Cureus 2023; 15:e48924. [PMID: 38106728 PMCID: PMC10725517 DOI: 10.7759/cureus.48924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The rising number of newborns requiring neonatal intensive care unit (NICU) care poses immediate threats to their health and places emotional and financial burdens on families and healthcare systems. This study investigates the direct effect of maternal short stature on NICU admission in Sabah, Malaysia. METHODS A longitudinal study at Hospital Wanita Dan Kanak-Kanak Sabah (HWKKS) from 2018 to 2022 included 254 Malaysian women with singleton pregnancies and neonates born after the 37th week, excluding significant disorders, smoking/alcohol use, fetal death, and malformations. Birth weight, gestational age, and neonatal condition were recorded. The association between maternal height, low birth weight (LBW), and NICU admission was analyzed. RESULTS LBW prevalence was 15.35%, with an average participant height of 147.37 cm. Maternal stature was significantly associated with LBW, with the shortest quartile (Q1) having the highest risk. LBW was significantly associated with NICU admission, with LBW newborns at a sixfold higher risk. Maternal height was also significantly associated with NICU admission, with Q1 having the highest risk. The receiver operating characteristic (ROC) curve suggested combining Q1 and Q2 for the best prediction of NICU admission, indicating that shorter mothers face a higher risk of neonates requiring NICU care. CONCLUSION Maternal short stature could be a valuable predictor of LBW and NICU admission risk. It may be a screening tool to assess these risks in healthcare settings. However, further research is needed to explore this association's underlying mechanisms and potential interventions.
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Affiliation(s)
- Ehab Helmy
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, MYS
| | - Helen Benedict Lesimbang
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, MYS
| | - M Tanveer Hossain Parash
- Anatomy Unit, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, MYS
| | - Soon Ruey
- Department of Obstetrics and Gynaecology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
| | | | - Ong Teck Siong
- Department of Obstetrics and Gynaecology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
| | - Teoh Jie Sheng
- Department of Obstetrics and Gynaecology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
| | - Khairul Sabrin Bin Ahmad
- Department of Obstetrics and Gynaecology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
| | - Syaza Nadia Binti Saman
- Department of Obstetrics and Gynaecology, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
| | - Kueh Bing Ling
- Clinical Research Centre, Hospital Wanita Dan Kanak-Kanak Sabah, Kota Kinabalu, MYS
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Jo HS, Lim MN, Cho SI. Required biological time for lung maturation and duration of invasive ventilation: a Korean cohort study of very low birth weight infants. Front Pediatr 2023; 11:1184832. [PMID: 37416815 PMCID: PMC10320392 DOI: 10.3389/fped.2023.1184832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
Background We investigated the duration of invasive ventilation among very low birth weight (VLBW) infants to evaluate the current minimum time required for lung maturation to breathe without ventilator assistance after preterm birth. Methods A total of 14,658 VLBW infants born at ≤32+6 weeks between 2013 and 2020 were enrolled. Clinical data were collected from the Korean Neonatal Network, a national prospective cohort registry of VLBW infants from 70 neonatal intensive care units. Differences in the duration of invasive ventilation according to gestational age and birth weight were investigated. Recent trends and changes in assisted ventilation duration and associated perinatal factors between 2017-20 and 2013-16 were compared. Risk factors related to the duration of assisted ventilation were also identified. Results The overall duration of invasive ventilation was 16.3 days and the estimated minimum time required corresponded to 30+4 weeks of gestation. The median duration of invasive ventilation was 28.0, 13.0, 3.0, and 1.0 days at <26, 26-27, 28-29, and 30-32 weeks of gestation, respectively. In each gestational age group, the estimated minimum weaning points from the assisted ventilator were 29+5, 30+2, 30+2, and 31+5 weeks of gestation. The duration of non-invasive ventilation (17.9 vs. 22.5 days) and the incidence of bronchopulmonary dysplasia (28.1% vs. 31.9%) increased in 2017-20 (n = 7,221) than in 2013-16 (n = 7,437). In contrast, the duration of invasive ventilation and overall survival rate did not change during the periods 2017-20 and 2013-16. Surfactant treatment and air leaks were associated with increased duration of invasive ventilation (inverse hazard ratio 1.50, 95% CI, 1.04-2.15; inverse hazard ratio 1.62, 95% CI, 1.29-2.04). We expressed the incidence proportion of ventilator weaning according to the invasive ventilation duration using Kaplan-Meier survival curves. The slope of the curve slowly decreased as gestational age and birth weight were low and risk factors were present. Conclusions This population-based data on invasive ventilation duration among VLBW infants suggest the present limitation of postnatal lung maturation under specific perinatal conditions after preterm birth. Furthermore, this study provides detailed references for designing and/or assessing earlier ventilator weaning protocols and lung protection strategies by comparing populations or neonatal networks.
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Affiliation(s)
- Heui Seung Jo
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Myoung Nam Lim
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sung-Il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Kyokan M, Jirapaet V, Rosa-Mangeret F, Pisoni GB, Pfister RE. Clinical detection of 'cold stress' is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001606. [PMID: 36645785 PMCID: PMC9511651 DOI: 10.1136/bmjpo-2022-001606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings. METHODS A cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines. RESULTS 55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44-54/55) acknowledged the importance of the WHO's warm chain to keep a neonate warm. However, fewer participants (n=34-46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature's inaccuracy compared with core temperature. Opinions and preferences for rewarming methods differed among participants, and so did the availability of warming equipment at their institutions. CONCLUSION An inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines.
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Affiliation(s)
- Michiko Kyokan
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Veena Jirapaet
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Flavia Rosa-Mangeret
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Department of Neonatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
| | | | - Riccardo E Pfister
- Department of Neonatology, Geneva University Hospitals and Geneva University, Geneva, Switzerland
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