Can Obstetric Risk Factors Predict Fetal Acidaemia at Birth? A Retrospective Case-Control Study

Risk factors for neonatal hypoxic ischemic encephalopathy and therapeutic hypothermia: a matched case-control study

BACKGROUND

Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia.

METHODS

We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated.

RESULTS

Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia.

CONCLUSIONS

Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.

Newborns' clinical conditions are correlated with the neonatal assessment manual scorE (NAME)

OBJECTIVE

To investigate the relationship between the Neonatal Assessment Manual scorE (NAME) and newborns' clinical condition on a large number of infants. The NAME model was developed as an instrument to assess the infant's general conditions, especially in NICUs, by evaluating how the infant's body responds to an external stressor such as static touch. Previous studies, employing experienced assessors, showed good validity indices as well as high inter-rater reliability.

STUDY DESIGN

Newborns were recruited at the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan and their clinical conditions were collected through a standardized form-the complexity index. Two manual practitioners assessed all eligible newborns using the NAME scores. Data was analyzed using Kendall's τ correlation and odds ratio (OR) to assess the relationship between the NAME scores and the complexity index.

RESULTS

Two hundred two newborns (46% female; 34.1 w ± 4.3; birth weight of 2,093.4 gr ± 879.8) entered the study. The Kendall's correlation between the clinical conditions (complexity index) and the NAME score was -0.206 [95% CI: (-0.292, -0.116), p-value < 0.001], corresponding to an OR of 0.838 [95% CI: (0.757, 0.924), p-value < 0.001]. Further exploratory analyses showed significant correlation between gestational age, birth weight and NAME scores.

CONCLUSION

The present paper adds evidence to the NAME model validity by demonstrating its applicability in the clinical neonatological context.

The neonatal assessment manual score (NAME) for improving the clinical management of infants: a perspective validity study

BACKGROUND AND OBJECTIVES

The Neonatal Assessment Manual scorE (NAME) was developed to assist in the clinical management of infants in the neonatal ward by assessing their body's compliance and homogeneity. The present study begins its validation process.

METHODS

An expert panel of neonatal intensive care unit (NICU) professionals investigated the NAME face and content validity. Content validity was assessed through the content validity index (CVI). Construct validity was assessed using data collected from 50 newborns hospitalized in the NICU of "Vittore Buzzi" Children Hospital of Milan, Italy. Kendall's τ and ordinal logistic regressions were used to evaluate the correlation between the NAME scores and infants' gestational age, birth weight, post-menstrual age, weight at the time of assessment, and a complexity index related to organic complications.

RESULTS

The CVIs for compliance, homogeneity, and the whole scale were respectively 1, 0.9, and 0.95. Construct validity analysis showed significant positive correlations between the NAME and infants' weight and age, and a negative correlation between the NAME and the complexity index (τ = - 0.31 [95% IC: - 0.47, - 0.12], p = 0.016 and OR = 0.56 [95% IC: 0.32, 0.94], p = 0.034 for categorical NAME; τ = - 0.32 [95% IC: - 0.48, - 0.14], p = 0.005 for numerical NAME).

CONCLUSIONS

The NAME was well accepted by NICU professionals in this study and it demonstrates good construct validity in discriminating the infant's general condition. Future studies are needed to test the NAME reliability and predictive capacity.

[The Influence of Maternal Obesity on Selected Obstetric Parameters]

INTRODUCTION

In Austria, the percentage of obese people increased by 5.2% between 1999 and 2014; 14.8% of women between the age of 15 to 45 are overweight. An increased body mass index (BMI) of women increases the risk of pathologies and irregularities during pregnancy, childbirth and the puerperium. In this work, the influence of maternal obesity on selected obstetric parameters is analyzed.

METHODOLOGY

The data set includes all single births between 1.1.2008 and 31.12.2018 with a predictable BMI (n=640922) from the Austrian birth register. The maternal BMI was compared with the variables of age of the mother, parity, length of pregnancy, induction of labor, birth mode, child's APGAR value, child's umbilical cord pH value, and child's mortality and evaluated by means of a descriptive representation of the frequencies and bivariate analysis methods.

RESULTS

A BMI of women ≥30 resulted in an increased rate of premature births, childbirth, Caesarean sections, neonatal APGAR values < 8 and ≤ 4, lower umbilical cord pH values of < 7.2 and increased rates of child mortality. In contrast, vaginal operative birth termination is less common.

CONCLUSIONS

Obesity has a negative impact on various obstetric factors. Prevention should promote a healthy lifestyle before the onset of pregnancy.

Analysis of Factors Associated With Variability and Acidosis of the Umbilical Artery pH at Birth

Background: Perinatal asphyxia is a significant contributing factor for neonatal morbidity and mortality. The aim of this study was to investigate the clinical factors associated with umbilical artery pH variability and fetal acidosis at birth. Methods: This is a single center cross-sectional study in a public regional hospital in southeastern Spain from January to December 2019. The reference population was 1.655 newborns, final sample of 312 experimental units with validated values of umbilical cord blood pH. Results: Factors such as gestational age at term ( X ¯ at - term : 7.26 ± 0.08- X ¯ no -_at-term: 7.31 ± 0.05, p: 0.00), primiparity ( X ¯ primiparity : 7.24 ± 0.078- X ¯ multiparity : 7.27 ± 0.08, p: 0.01), induced labor ( X ¯ induced : 7.24 ± 0.07- X ¯ spontaneous : 7.26 ± 0.081, p: 0.02), vaginal delivery ( X ¯ vaginal :7.25 ± 0.08- X ¯ cesarean :7.27 ± 0.07, p: 0.01), and prolonged dilation duration ( X ¯ AboveAverage : 7.22 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00), expulsion duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.26 ± 0.08, p: 0.01), and total labor duration ( X ¯ AboveAverage : 7.23 ± 0.07- X ¯ BelowAverage : 7.27 ± 0.08, p: 0.00) are associated with a decrease in umbilical artery pH at birth. However, only three factors are associated with acidosis pH (<7.20) of the umbilical artery at birth: the induction of labor [OR: 1.74 (95% CI: 0.98-3.10); p: 0.04], vaginal delivery [OR: 2.09 (95% CI: 0.95-4.61); p: 0.04], and total duration of labor [OR: 2.06 (95% CI: 1.18-3.57); p: 0.01]. Conclusions: Although several factors may affect the variability of umbilical artery pH at birth by decreasing their mean values (gestational age, primiparity, induced labor, vaginal delivery and prolonged: dilation duration, expulsion duration and total labor duration), only induction of labor, vaginal delivery and total duration of labor are associated with an acidosis (<7.20) of same.