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Bacha LT, Hailu WB, Tesfaye Geta E. Clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College. SAGE Open Med 2022; 10:20503121221146068. [PMID: 36600978 PMCID: PMC9806403 DOI: 10.1177/20503121221146068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objective Aim of the study was to assess the clinical outcome and associated factors of respiratory distress syndrome among preterm neonates admitted to the neonatal intensive care unit of Adama Hospital and Medical College. Methods Hospital-based cross-sectional study was conducted using 242 randomly selected medical records of preterm neonates admitted to Adama comprehensive specialized hospital. Clinical outcome was categorized as poor if the neonate died or left against advice and good if discharged after improvement. Data were coded, entered into Epidata v.7.4.2 and exported to SPSS v.27 for analysis. After initial bi-variable logistic regression analysis, predictor variables with p-value of <0.2 were included in multivariable analysis. Significant association of factors with clinical outcome was claimed at p-value <0.05 and calculated 95% adjusted odds ratio. Results Majority of admissions were male (63.2%), mean birth weight of 1440.3 g (+321.2 SD) and sepsis (82%), hypothermia (73%), and apnea (21.5%) were leading comorbidities. One hundred fifty-two (62.8%) of preterm neonates had poor outcomes. Neonates born singleton were 47% less likely to develop poor clinical outcomes (adjusted odds ratio 0.53 (0.48-0.94). The odds of poor clinical outcomes were higher during the first 3 days of admission (adjusted odds ratio 3.83 (3.28-14.77). Extremely preterm neonates (adjusted odds ratio 4.16 (4.01-12.97), extremely low birth weight preterm neonates had higher odds of poor clinical outcome. Conclusion The study found higher poor clinical outcome among preterm neonates admitted with respiratory distress syndrome. Poor outcome was higher in lower gestational age, lower birth weight, twins and majority of it happened during 3 days of their life. Effective preventive care and initiation of low-cost, life-saving interventions including heated humidified high-flow nasal cannula and surfactant administration could significantly improve the clinical outcome of the neonates.
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Affiliation(s)
| | - Wase Benti Hailu
- Department of Public Health, Institute
of Health Sciences, Wollega University, Nekemte, Ethiopia,Wase Benti Hailu, Department of Public
Health, Wollega University, P.O. Box 395, East Wollega, Nekemte, Oromia 395,
Ethiopia.
| | - Edosa Tesfaye Geta
- Department of Public Health, Institute
of Health Sciences, Wollega University, Nekemte, Ethiopia
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Marwah M, Shokr H, Demitry A, Wang K, Ahmad S, Marwah S, Wandroo F. SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score. Infection 2022; 50:1121-1129. [PMID: 35247163 PMCID: PMC8897759 DOI: 10.1007/s15010-022-01773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
Background The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. Methods We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. Results Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =—0.162). Interpretation Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications.
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Affiliation(s)
- M Marwah
- Aston Medical School, Aston University, Gosta Green, Birmingham, B4 7ET, UK
| | - H Shokr
- Pharmacy Division, School of Health Sciences, University of Manchester, Oxford Street, Manchester, M13 9PL, UK
| | - A Demitry
- Department of Obstetrics, Sandwell and West, Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ, UK
| | - K Wang
- Aston Medical School, Aston University, Gosta Green, Birmingham, B4 7ET, UK
| | - S Ahmad
- Aston Medical School, Aston University, Gosta Green, Birmingham, B4 7ET, UK
| | - S Marwah
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ, UK
| | - F Wandroo
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, Hallam Street, West Bromwich, B71 4HJ, UK.
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Bovbjerg ML, Dissanayake MV, Cheyney M, Brown J, Snowden JM. Utility of the 5-Minute Apgar Score as a Research Endpoint. Am J Epidemiol 2019; 188:1695-1704. [PMID: 31145428 PMCID: PMC6736341 DOI: 10.1093/aje/kwz132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 01/01/2023] Open
Abstract
Although Apgar scores are commonly used as proxy outcomes, little evidence exists in support of the most common cutpoints (<7, <4). We used 2 data sets to explore this issue: one contained planned community births from across the United States (n = 52,877; 2012-2016), and the other contained hospital births from California (n = 428,877; 2010). We treated 5-minute Apgars as clinical "tests," compared against 18 known outcomes; we calculated sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve for each. We used 3 different criteria to determine optimal cutpoints. Results were very consistent across data sets, outcomes, and all subgroups: The cutpoint that maximizes the trade-off between sensitivity and specificity is universally <9. However, extremely low positive predictive values for all outcomes at <9 indicate more misclassification than is acceptable for research. The areas under the receiver operating characteristic curves (which treat Apgars as quasicontinuous) were generally indicative of adequate discrimination between infants destined to experience poor outcomes and those not; comparing median Apgars between groups might be an analytical alternative to dichotomizing. Nonetheless, because Apgar scores are not clearly on any causal pathway of interest, we discourage researchers from using them unless the motivation for doing so is clear.
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Affiliation(s)
- Marit L Bovbjerg
- Epidemiology Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Mekhala V Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Melissa Cheyney
- Anthropology Program, College of Liberal Arts, Oregon State University, Corvallis, Oregon
| | - Jennifer Brown
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Jonathan M Snowden
- School of Public Health, Oregon Health and Science University–Portland State University, Portland, Oregon
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Witcher TJ, Jurdi S, Kumar V, Gupta A, Moores RR, Khoury J, Rozycki HJ. Neonatal Resuscitation and Adaptation Score vs Apgar: newborn assessment and predictive ability. J Perinatol 2018; 38:1476-1482. [PMID: 30093618 DOI: 10.1038/s41372-018-0189-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the non-inferiority of an alternative to the Apgar score. STUDY DESIGN The Neonatal Resuscitation and Adaptation Score (NRAS) was recorded in parallel to the Apgar score by a resuscitation team at deliveries. Correlation between the systems was assessed, as well as the predictive ability of NRAS and Apgar scores for mortality or short-term morbidities. RESULTS A total of 340 infants were in the study group. The two scores correlated strongly (r = 0.87 and 0.83 at 1 and 5 min, respectively). Those needing ventilation at 48 h of life had a 5-min NRAS < 7 in 23/26 vs Apgar < 7 (23/36, p = 0.001). A low (0-3) 1-min NRAS score was more predictive of death, 53% vs 17%, p = 0.0065. CONCLUSIONS NRAS correlates with Apgar status assessment, and identifies newborns who die or may require further care better than the Apgar score.
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Affiliation(s)
- Teresa J Witcher
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Shadi Jurdi
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Vidhya Kumar
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Aditi Gupta
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Russell R Moores
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Joseph Khoury
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Henry J Rozycki
- Division of Neonatal Medicine, Children's Hospital of Richmond at VCU, Richmond, VA, USA.
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Svenvik M, Brudin L, Blomberg M. Preterm Birth: A Prominent Risk Factor for Low Apgar Scores. BIOMED RESEARCH INTERNATIONAL 2015; 2015:978079. [PMID: 26413554 PMCID: PMC4564604 DOI: 10.1155/2015/978079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine predictive risk factors for Apgar scores < 7 at 5 minutes at two hospitals providing tertiary care and secondary care, respectively. METHODS A retrospective registry cohort study of 21126 births (2006-2010) using data from digital medical records. Risk factors were analyzed by logistic regression analyses. RESULTS AS(5 min) < 7 was multivariately associated with the following: preterm birth; gestational week 32 + 0-36 + 6, OR = 3.9 (95% CI 2.9-5.3); week 28 + 0-31 + 6, OR = 8 (5-12); week < 28 + 0, OR = 15 (8-29); postterm birth, OR = 2.0 (1.7-2.3); multiple pregnancy, OR = 3.53 (1.79-6.96); previous cesarean section, OR = 3.67 (2.31-5.81); BMI 25-29, OR = 1.30 (1.09-1.55); BMI ≥ 30 OR = 1.70 (1.20-2.41); nonnormal CTG at admission, OR = 1.98 (1.48-2.66). ≥ 1-para was associated with a decreased risk for AS(5 min) < 7, OR = 0.34 (0.25-0.47). In the univariate logistic regression analysis AS(5 min) < 7 was associated with tertiary level care, OR = 1.48 (1.17-1.87); however, in the multivariate analysis there was no significant difference. CONCLUSION A number of partially preventable risk factors were identified, preterm birth being the most evident. Further, no significant difference between the two hospital levels regarding the risk for low Apgar scores was detected.
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Affiliation(s)
- Maria Svenvik
- Department of Obstetrics and Gynecology, Kalmar County Hospital, 391 85 Kalmar, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, 391 85 Kalmar, Sweden
- Department of Medicine and Health Sciences, Linköping University Hospital, 581 85 Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, 581 83 Linköping, Sweden
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Abstract
There is no controversy that women at risk of preterm delivery before 32 to 34 weeks' gestational age should be treated with antenatal steroids. Three recent meta-analyses by the Cochrane Collaboration on the benefits of antenatal steroids, the choice of steroid and dosing, and repeat doses of corticosteroids comprehensively summarize the available clinical information to about 2007. However, there are many unanswered questions about which steroid and dose to use and about their use in selected populations. This review focuses on those areas of uncertainty.
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Affiliation(s)
- Ronald Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center
| | - Alan H. Jobe
- Cincinnati Children’s Hospital Medical Center, Division of Pulmonary Biology, The University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, TEL: (513) 636-8563, FAX: (513) 636-8691
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Albertsson-Wikland K, Wennergren G, Wennergren M, Vilbergsson G, Rosberg S. Longitudinal follow-up of growth in children born small for gestational age. Acta Paediatr 1993; 82:438-43. [PMID: 8518519 DOI: 10.1111/j.1651-2227.1993.tb12718.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Postnatal growth was followed in a population-based group of 123 small-for-gestational-age (SGA, birth weight < -2 SD) children (66 boys and 57 girls) to four years of age in order to determine the incidence and time of catch-up growth. Gestational age was determined by ultrasound in gestational weeks 16-17 in all pregnancies, thus eliminating the problem of distinguishing between SGA and preterm infants. Infants with well-defined causes for slow growth rate, i.e. those infants with chromosomal disorders, severe malformations, intrauterine viral infections or cerebral palsy, were excluded. The boys showed an extremely fast weight catch-up, 85% of them reaching weights greater than -2 SD at the age of three months and remaining above this level to the end of the study period. Such a fast catch-up growth was observed in only two-thirds of the girls, but at four years of age 85% of the girls were also above -2 SD. Length catch-up was more gradual than weight catch-up. Of the boys, 54% had lengths below -2 SD at birth, 26% at 1 year of age, 22% at 2 years of age, 17% at 2.5 years of age and 11% (n = 8) at 4 years of age. Corresponding figures for girls were: 69% at birth, 28% at 1 year, 15% at 2 years, 12% at 2.5 years and 5% (n = 3) at 4 years. At 4 years of age, only six boys and three girls remained below -2 SD for both weight and height.(ABSTRACT TRUNCATED AT 250 WORDS)
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Aksit S, Yaprak I, Bakiler R, Caglayan S, Ergin S. Sigtuna score versus Apgar score: simple and practical evaluation of the newborn. Paediatr Perinat Epidemiol 1992; 6:29-34. [PMID: 1553315 DOI: 10.1111/j.1365-3016.1992.tb00740.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this prospective study, we investigated the relation between the Apgar and Sigtuna scores in 1605 newborns. In 169 of them, umbilical arterial blood specimens were analysed for blood gases. There were significant correlations between the Sigtuna and Apgar scores at 1, 5 and 10 minutes after birth (P less than 0.001). Umbilical arterial blood pH (pHua) values were shown to be correlated with both the Sigtuna and Apgar scores. The Sigtuna score was similar to the Apgar score in respect of sensitivity, specificity, positive predictive value and negative predictive value in relation to pH level. We conclude that because of the simplicity of the Sigtuna score, it may be used in place of the Apgar score to establish a rapid diagnosis of asphyxia.
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Affiliation(s)
- S Aksit
- SSK Tepecik Teaching Hospital, Yenisehir, Izmir, Turkey
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Abstract
It is well known that signs of respiratory distress or disease (RD), such as high breathing frequency, chest wall retractions, grunting, and cyanosis, are common in newborn infants. The signs may be very transient or develop into a potentially life-threatening condition. When they are first observed, they often have a very ambiguous prognostic significance.
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