Evaluation of the maternal and fetal risk factors associated with neonatal care unit hospitalization time

A case-based reasoning system for neonatal survival and LOS prediction in neonatal intensive care units: a development and validation study

Early prediction of neonates' survival and Length of Stay (LOS) in Neonatal Intensive Care Units (NICU) is effective in decision-making. We developed an intelligent system to predict neonatal survival and LOS using the "Case-Based Reasoning" (CBR) method. We developed a web-based CBR system based on K-Nearest Neighborhood (KNN) on 1682 neonates and 17 variables for mortality and 13 variables for LOS and evaluated the system with 336 retrospectively collected data. We implemented the system in a NICU to externally validate the system and evaluate the system prediction acceptability and usability. Our internal validation on the balanced case base showed high accuracy (97.02%), and F-score (0.984) for survival prediction. The root Mean Square Error (RMSE) for LOS was 4.78 days. External validation on the balanced case base indicated high accuracy (98.91%), and F-score (0.993) to predict survival. RMSE for LOS was 3.27 days. Usability evaluation showed that more than half of the issues identified were related to appearance and rated as a low priority to be fixed. Acceptability assessment showed a high acceptance and confidence in responses. The usability score (80.71) indicated high system usability for neonatologists. This system is available at http://neonatalcdss.ir/ . Positive results of our system in terms of performance, acceptability, and usability indicated this system can be used to improve neonatal care.

Risk factors for length of NICU stay of newborns: A systematic review

Background

The improvement in survival of preterm infants is accompanied by an increase in neonatal intensive care unit (NICU) admissions. Prolonged length of stay in the NICU (LOS-NICU) increases the incidence of neonatal complications and even mortality and places a significant economic burden on families and strain on healthcare systems. This review aims to identify risk factors influencing LOS-NICU of newborns and to provide a basis for interventions to shorten LOS-NICU and avoid prolonged LOS-NICU.

Methods

A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane library for studies that were published in English from January 1994 to October 2022. The PRISMA guidelines were followed in all phases of this systematic review. The Quality in Prognostic Studies (QUIPS) tool was used to assess methodological quality.

Results

Twenty-three studies were included, 5 of which were of high quality and 18 of moderate quality, with no low-quality literature. The studies reported 58 possible risk factors in six broad categories (inherent factors; antenatal treatment and maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; clinical scores and laboratory indicators; organizational factors).

Conclusions

We identified several of the most critical risk factors affecting LOS-NICU, including birth weight, gestational age, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. As only a few high-quality studies are available at present, well-designed and more extensive prospective studies investigating the risk factors affecting LOS-NICU are still needed in the future.

Cumulative prevalence of biological and social risk factors at birth in a city in São Paulo

OBJECTIVE

to identify the cumulative prevalence of biological and social risk factors at birth.

METHOD

a cross-sectional study, with retrospective data collection, carried out with live births in a medium-sized city, from January 2018 to July 2020. A database was used with information aimed at identifying social and biological risks after birth, assessed descriptively.

RESULTS

the sample consisted of 4,480 newborns, of which 78.9% were classified as at usual risk, and 21.1% as at risk. The cumulative prevalence showed that most newborns had more than one risk factor, with biological risks being the most prominent: need for admission to Intensive Care Unit, birth with less than 37 weeks of gestation and weight less than 2,500 g. Among the social risks, the following stand out: newborns who had a dead sibling aged less than 5 years old; head of family without income; mothers under 16 years old and who did not undergo prenatal care. The biological risk rate was 7.39 times higher than the social risk rate.

CONCLUSION

the cumulative prevalence of the risks found was significant, with a considerable part of the sample presenting some biological risk.

Improving the quality of neonatal data capture and clinical care at a tertiary-care hospital in Uganda through enhanced surveillance, training and mentorship

Introduction: Accurate documentation of neonatal morbidity and mortality is limited in many countries in sub-Saharan Africa. This project aimed to establish a surveillance system for neonatal conditions as an approach to improving the quality of neonatal care.Methods: A systematic data capture and surveillance system was established at Jinja Regional Referral Hospital, Uganda using a standardised neonatal medical record form which collected detailed individual patient level data. Additionally, training and mentorship were conducted and basic equipment was provided.Results: A total of 4178 neonates were hospitalised from July 2014 to December 2016. Median (IQR) age on admission was one day (1-3) and 48.0% (1851/3859) were male. Median (IQR) duration of hospitalisation was 17 days (IQR 10-40) and the longest duration of hospitalisation was 47 days (IQR 41-58). The majority were referrals from government health facilities (54.4%, 2012/3699), though 30.6% (1123/3669) presented as self-referrals. Septicaemia (44.9%, 1962/4371), prematurity (21.0%, 917/4371) and birth asphyxia (19.1%, 833/4371) were the most common diagnoses. The overall mortality was 13.8% (577/4178) and the commonest causes of death included septicaemia (26.9%, 155/577), prematurity (24.3%, 140/577), birth asphyxia (21.0%, 121/577), hypothermia (9.9%, 57/577) and respiratory distress (8.0%, 46/577). The majority of deaths (51.5%, 297/577) occurred within the first 24 h of hospitalisation although a significant proportion of deaths also occurred after 7 days of hospitalisation (24.1%, 139/577). A modest decrease in mortality and improvement in clinical outcome were observed.Conclusion: Improvement in neonatal data capture and quality of care was observed following establishment of an enhanced surveillance system, training and mentorship.Abbreviations: aOR: adjusted odds ratio; CHRP: Centre for Health research and Programmes; HC: health centre; HMIS: Health Management Information System; JRRH: Jinja Regional Referral Hospital; NMRF: neonatal medical record form; PMTCT: prevention of mother-to-child transmission of HIV; UPA: Uganda Paediatric Association.

Identification of risk factors in infants participating in a Follow-up program

ABSTRACT Purpose: to identify the main health risk factors of infants participating in a follow-up program. Methods: a longitudinal prospective study conducted with 540 high-risk infants observed in the follow-up clinic of the Hospital Materno Infantil in Goiânia in the State of Goiás, Brazil. All biological data of the infants from birth, prenatal, and postnatal periods were collected through assessment sessions with their mothers and medical chart reviews. Data were analyzed through binary logistic regression to identify the highest-risk variables for the infants’ health. Results: in a predictive analysis, the findings showed that neonatal risk was statistically associated with a lower Apgar score at the fifth minute of life, male infants, and longer hospital stay. Infants with increased neonatal risk were more likely to show alterations identified in cranial ultrasound examinations. Moreover, the longer hospital stay was related to mixed breastfeeding after discharge. Conclusion: the main risk factors for the health of high-risk infants in the follow-up program were: low Apgar score at the fifth minute; male sex; longer hospital stay; alterations detected in transfontanellar ultrasound; and mixed feeding after discharge.