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Bekele GG, Roga EY, Gonfa DN, Geda GM. Incidence and predictors of mortality among neonates admitted with birth asphyxia to neonatal intensive care unit of West Shewa Zone Public Hospitals, Central Ethiopia. BMJ Paediatr Open 2024; 8:e002403. [PMID: 38580447 PMCID: PMC11002380 DOI: 10.1136/bmjpo-2023-002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/20/2024] [Indexed: 04/07/2024] Open
Abstract
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.
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Taye K, Kebede Y, Tsegaw D, Ketema W. Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia. BMC Pediatr 2024; 24:237. [PMID: 38570750 PMCID: PMC10988874 DOI: 10.1186/s12887-024-04689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/02/2024] [Indexed: 04/05/2024] Open
Abstract
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.
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Affiliation(s)
- Kefyalew Taye
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- CEO at Makira Pediatrics and Child Health Specialty clinic, Hawassa, Sidama, Ethiopia
| | - Yenew Kebede
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tsegaw
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia
| | - Worku Ketema
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, School of Medicine, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia.
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Paudel PK, Bhandari P, Kc N, Devkota B. Morbidity and Mortality Profile of Neonates Admitted in Neonatal Intensive Care Unit. J Nepal Health Res Counc 2024; 21:373-379. [PMID: 38615206 DOI: 10.33314/jnhrc.v21i3.4168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The neonatal period faces the greatest risk of death as they are vulnerable to sepsis, birth asphyxia, hypoxic injuries etc. A substantial disparity exists in NMR between Nepal and other developed countries and among different provinces of Nepal as well. This study was conducted to describe the pattern of neonatal admission, and immediate hospital outcomes from NICU located in a remote part of Nepal. METHODS This prospective study was conducted in The Province Hospital, Karnali, Nepal over a period of six months (June 2021 to Dec 2021 AD). The variables used were neonatal age, sex, gestation, birth weight, maternal age, mode and place of delivery. Neonatal morbidities and final outcomes at discharge were recorded in a predesigned proforma. RESULTS A total of 396 neonates included, the majority were inborn 283(71%), male 241(61%), term 301(76%) and had normal birth weight 279 (70.4%). Neonatal sepsis 188(37.2%), prematurity 95(24%), and birth asphyxia 55(15.2%) were main indications for hospitalization. The majority 337(85%) improved after treatment, while 33(8.3%) died, 12 (3%) left against medical advice and 14(3.5%) cases were referred. Preterm neonates had thrice the risk of mortality than term neonates (OR =3.27). Low birth weight (< 2500 grams) had higher odds of poor outcomes (OR =3.5). Low maternal age (<20 years), prematurity, LBW, mechanical ventilation and inotrope use were predictors of poor outcomes. CONCLUSIONS Neonatal sepsis, prematurity and perinatal asphyxia were the most common causes of NICU admissions. Mechanical ventilation, inotropes use, extreme prematurity, low birth weight and younger age of the mother were predictors of poor outcome.
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Affiliation(s)
| | | | - Nawaraj Kc
- Department of Pediatrics, Province Hospital, Karnali
| | - Bibek Devkota
- Department of Anesthesia, Province Hospital, Karnali
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Vayssière C, Yli B, Ayres-de-Campos D, Ugwumadu A, Loussert L, Hellström-Westas L, Timonen S, Schwarz C, Nunes I, Roth GE. EUROPEAN ASSOCIATION OF PERINATAL MEDICINE (EAPM) Position statement: Use of appropriate terminology for situations related to inadequate fetal oxygenation in labor. Eur J Obstet Gynecol Reprod Biol 2024; 294:55-57. [PMID: 38218158 DOI: 10.1016/j.ejogrb.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
In high-resource countries, adverse perinatal outcomes are currently rare in term, non-malformed fetuses, undergoing labor, but they remain a leading cause of medico-legal dispute. Precise terminology is important to describe situations related to inadequate fetal oxygenation in labor, to ensure appropriate communication between healthcare professionals and adequate transmission of information to parents. This position statement provides consensus definitions from European perinatologists and midwives regarding the most appropriate terminology to describe situations related to inadequate fetal oxygenation in labor: suspected fetal hypoxia, severe newborn acidemia, newborn metabolic acidosis, and hypoxic-ischemic encephalopathy. It also identifies terms that are imprecise or nonspecific to this situation, and should therefore be avoided by healthcare professionals: fetal well-being, fetal stress, fetal distress, non-reassuring fetal state, and birth asphyxia.
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Affiliation(s)
- Christophe Vayssière
- Department of Obstetrics-Gynecology-Reproduction, Paule de Viguier Hospital, CHU Toulouse, University of Toulouse III, France
| | - Branka Yli
- Delivery Department, Oslo University Hospital, Oslo, Norway
| | | | | | - Lola Loussert
- Department of Obstetrics-Gynecology-Reproduction, Paule de Viguier Hospital, CHU Toulouse, University of Toulouse III, France
| | | | | | | | - Inês Nunes
- Department of Obstetrics and Gynecology, Centro Hospitalar Vila Nova de Gaia/Espinho, CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, University of Porto, Porto, Portugal
| | - Georges-Emmanuel Roth
- Department of Obstetrics and Gynecology, CHU Strasbourg, France, University of Strasbourg, France
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Löscher W. On hidden factors and design-associated errors that may lead to data misinterpretation: An example from preclinical research on the potential seasonality of neonatal seizures. Epilepsia 2024; 65:287-292. [PMID: 38037258 DOI: 10.1111/epi.17840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023]
Abstract
Unintentional misinterpretation of research in published biomedical reports that is not based on statistical flaws is often underrecognized, despite its possible impact on science, clinical practice, and public health. Important causes of such misinterpretation of scientific data, resulting in either false positive or false negative conclusions, include design-associated errors and hidden (or latent) variables that are not easily recognized during data analysis. Furthermore, cognitive biases, such as the inclination to seek patterns in data whether they exist or not, may lead to misinterpretation of data. Here, we give an example of these problems from hypothesis-driven research on the potential seasonality of neonatal seizures in a rat model of birth asphyxia. This commentary aims to raise awareness among the general scientific audience about the issues related to the presence of unintentional misinterpretation in published reports.
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Affiliation(s)
- Wolfgang Löscher
- Translational Neuropharmacology Lab, NIFE, Department of Experimental Otology of the ENT Clinics, Hannover Medical School, Hannover, Germany
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Hortigüela MM, Martínez-Biarge M, Conejo D, Vega-Del-Val C, Arnaez J. Motor, cognitive and behavioural outcomes after neonatal hypoxic-ischaemic encephalopathy. An Pediatr (Barc) 2024; 100:104-114. [PMID: 38331678 DOI: 10.1016/j.anpede.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION The current neurodevelopmental status of patients with neonatal hypoxic-ischaemic encephalopathy (HIE) in Spain is unknown. Recent European studies highlight a shift of severe pathology towards mild motor disorders and emotional problems. The aim of this study was to analyse neurodevelopmental outcomes in a cohort of neonates with HIE at age 3 years. PATIENTS AND METHOD Multicentre observational study of neonates born at 35 or more weeks of gestation with moderate to severe HIE in 2011-2013 in 12 hospitals in a large Spanish region (91 217 m2), with the recruitment extended through 2017 in the coordinating hospital. We analysed the findings of neonatal neuroimaging and neurodevelopmental test scores at 3 years (Bayley-III, Peabody Picture Vocabulary Test and Child Behavior Checklist). The sample included 79 controls with no history of perinatal asphyxia. RESULTS Sixty-three patients were recruited, of whom 5 (7.9%) were excluded due to other pathology and 14 (24%) died. Of the 44 survivors, 42 (95.5%) were evaluated. Of these 42, 10 (24%) had adverse outcomes (visual or hearing impairment, epilepsy, cerebral palsy or developmental delay). Other detected problems were minor neurological signs in 6 of the 42 (14%) and a higher incidence of emotional problems compared to controls: introversion (10.5% vs. 1.3%), anxiety (34.2% vs. 11.7%) and depression (28.9% vs. 7.8%) (P < .05). The severity of the lesions on neuroimaging was significantly higher in patients with motor impairment (P = .004) or who died or had an adverse outcome (P = .027). CONCLUSION In addition to classical sequelae, the followup of patients with neonatal HIE should include the diagnosis and treatment of minor motor disorders and social and emotional problems.
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Affiliation(s)
| | | | - David Conejo
- Servicio de Pediatría, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, Spain; Neurología Neonatal, Fundación NeNe, Madrid, Spain; SIBEN, Nueva Yersey, USA.
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Al-Abri K, Edge D, Armitage CJ. Prospective analysis of factors associated with perinatal depression. Midwifery 2024; 128:103871. [PMID: 37967499 DOI: 10.1016/j.midw.2023.103871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/13/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Perinatal depression is a significant public health problem that has adverse effects on both mothers and infants. Little research has been conducted on how depressive symptoms change throughout the perinatal period, especially in the Middle East. This study examines changes in depressive symptoms from pregnancy to the postnatal period, and what explains these changes. METHODS This prospective study recruited 306 Omani women in the third trimester of pregnancy and followed them up two to eight weeks after delivery. The Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥12, was used to assess depressive symptoms in both the antenatal and postnatal periods. Independent t-tests, one-way ANOVA, Tukey's honestly significant difference test and Chi-square tests were used to analyse the data. RESULTS The prevalence of depressive symptoms was 27.12 % (n = 83) during late pregnancy and 29.30 % (n = 81) during the postnatal period. Four groups of women were identified based on the EPDS scores: 1) antenatal depression group (8.82 %; n = 27); 2) ante- and postnatal depression group (14.38 %; n = 44); 3) postnatal depression group (12.09 %; n = 37); and 4) non-depression group (54.90 %; n = 168). Depressive symptoms were associated with low birth weight babies (d = 0.50), which confirms the negative effects of depression on perinatal health outcomes. When compared to the non-depression group, the three depressed groups had higher antenatal Perceived Stress Scale (PSS) scores (ds > 0.52), while the non-depression group had higher antenatal and postnatal Maternity Social Support Scale (MSSS) scores (ds > 0.63), and better relationships with the mother-in-law antenatally (d= 0.57). CONCLUSION The present study of this Middle Eastern cohort shows that there were distinct groups of women experiencing perinatal depressive symptoms, influenced by various psychosocial and obstetric factors, which were comparable to those identified in more regularly studied populations. However, this study also identified other novel factors, such as the quality of family relationships. There is a need for additional research into the factors associated with these groups in order to develop appropriate interventions.
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Affiliation(s)
- Khalood Al-Abri
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK; Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Oman.
| | - Dawn Edge
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK; Equality, Diversity & Inclusion Research Unit, Greater Manchester Mental Health NHS Trust, UK
| | - Christopher J Armitage
- Division of Psychology and Mental Health, University of Manchester, G35 Coupland 1 Building, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK
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Yilmaz A, Cebi MN, Yilmaz G, Karacaoglu G, Aydin SN, Perk Y, Vural M. Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn. J Matern Fetal Neonatal Med 2023; 36:2284115. [PMID: 37989542 DOI: 10.1080/14767058.2023.2284115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia. METHODS This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated. RESULTS No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother's working situation (p = .948), mother's education level (p = .828), father's education level (p = .507), and family's total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores. DISCUSSION In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.
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Affiliation(s)
- Aslan Yilmaz
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Memnune Nur Cebi
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gizem Yilmaz
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Gursel Karacaoglu
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Sümeyye Nur Aydin
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Yildiz Perk
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Mehmet Vural
- Department of Neonatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Fatih, Turkey
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Rajpoot A, Mishra A, Verma V, Raza IF. Modified universal new-born hearing screening: Practical approach for developing world (Georgean experience). Int J Pediatr Otorhinolaryngol 2023; 173:111717. [PMID: 37714022 DOI: 10.1016/j.ijporl.2023.111717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
AIM Analysis of newborn hearing screening (NBS) outcomes and proposing a modified strategy for better performance of NBS in developing world. DESIGN Descriptive (retrospective and prospective) study. METHODS A total of 8412 newborns/neonates were subjected to risk factor assessment followed by a set of subjective (behavioral audiometry: BoA) and objective (OAE: otoacoustic emissions, ABR: auditory brainstem-evoked responses) hearing-screening in different combinations. DPOAE (primary objective tool) was undertaken in 2565 cases. Predictive value of risk factors on deafness was statistically analysed along with affectivity of objective, subjective and questionnaire-based screening tools. RESULTS Amongst 8412 babies, 45.5% were 'at risk' (major 36.41%, minor 9.17%). The OAE was abnormal in 299 cases (11.6% of 2565 & 3.5% in 8412). The abnormal OAE rate in prospective cases was 3.5% while in retrospective cases that underwent initial screening with BoA was 41%. A significant correlation was seen with consanguinity, high blood pressure, NICU stay>5 days, low birth weight, neonatal jaundice, delayed birth cry, pre-mature status, birth asphyxia and maternal excessive vomiting, while regression models of OAE outcome (sensitivity 99%, accuracy 89%) revealed highest predictive value for the initial 3 factors. BoA-screening revealed a sensitivity of 72.6%, and negative predictive value of 42.4%. Also a perfect correlation was evident between OAE-ABR, OAE-BoA and ABR-BoA. CONCLUSION A subjective NBS screening through questionnaire-based-risk-assessment and modified-BoA followed by selective referral for objective assessment is more practical and focussed approach for poor resourced countries that is likely to screen a larger population.
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Affiliation(s)
- Arti Rajpoot
- Department of Otorhinolaryngology and Head and Neck Surgery, King George's Medical University, Lucknow, India
| | - Anupam Mishra
- Department of Otorhinolaryngology and Head and Neck Surgery, King George's Medical University, Lucknow, India.
| | - Veerendra Verma
- Department of Otorhinolaryngology and Head and Neck Surgery, King George's Medical University, Lucknow, India
| | - Iza Fatima Raza
- Department of Otorhinolaryngology and Head and Neck Surgery, King George's Medical University, Lucknow, India
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Vilkko R, Räisänen S, Gissler M, Stefanovic V, Kalliala I, Heinonen S. Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross-sectional register study of 601 247 hospital deliveries. BJOG 2023; 130:1328-1336. [PMID: 37078492 DOI: 10.1111/1471-0528.17502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To study the busy day effect on selected neonatal adverse outcomes in different sized delivery hospitals and in the entire nationwide obstetric ecosystem. DESIGN A cross-sectional register study. SETTING The lowest and highest 10% of the daily delivery volume distribution were defined as quiet and busy days, respectively. The days between (80%) were defined as optimal delivery volume days. The differences in the incidence of selected adverse neonatal outcome measures were analysed between busy versus optimal days and quiet versus optimal days at the hospital category and for the entire obstetric ecosystem level. POPULATION A total of 601 247 singleton hospital deliveries between 2006 and 2016, occurred in non-tertiary (C1-C4, stratified by size) and tertiary level (C5) delivery hospitals. METHODS Analyses were performed by the methods of the regression analyses with crude and adjusted odds ratios including 99% CI. MAIN OUTCOME MEASURES Birth asphyxia. RESULTS At the ecosystem level, adjusted odds ratio for birth asphyxia was 0.81 (99% CI 0.76-0.87) on busy versus optimal days. Breakdown to hospital categories show that adjusted odds ratios for asphyxia on busy versus optimal days in non-tertiary hospitals (C3, C4) were 0.25 (99% CI 0.16-0.41) and 0.17 (99% CI 0.13-0.22), respectively, and in tertiary hospitals was 1.20 (99% CI 1.10-1.32). CONCLUSIONS Busy day effect as a stress test caused no extra cases of neonatal adverse outcomes at the ecosystem level. However, in non-tertiary hospitals busy days were associated with a lower and in tertiary hospitals a higher incidence of neonatal adverse outcomes.
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Affiliation(s)
- Riitta Vilkko
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sari Räisänen
- School of Health, Tampere University of Applied Sciences, Tampere, Finland
| | - Mika Gissler
- Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Kalliala
- Department of Obstetrics and Gynaecology, University Hospital and University of Helsinki, Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, University Hospital and University of Helsinki, Helsinki, Finland
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The Lancet. Perinatal depression: a neglected aspect of maternal health. Lancet 2023; 402:667. [PMID: 37633661 DOI: 10.1016/s0140-6736(23)01786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
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Chalak LF, Kang S, Kota S, Liu H, Liu Y, Juul SE, Wu YW. Evaluation of neurovascular coupling during neuroprotective therapies: A single site HEAL ancillary study. Early Hum Dev 2023; 183:105815. [PMID: 37419079 PMCID: PMC10824020 DOI: 10.1016/j.earlhumdev.2023.105815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND There is a critical need for development of physiological biomarkers in infants with birth asphyxia to identify the physiologic response to therapies in real time. This is an ancillary single site study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (Wu et al., 2022 [1]) to measure neurovascular coupling (NVC) non-invasively during an ongoing blinded randomized trial. METHODS Neonates who randomized in the HEAL enrolled at a single-center Level III Neonatal Intensive Care Unit were recruited between 2017 and 2019. Neurodevelopmental impairment was blinded and defined as any of the following: cognitive score <90 on Bayley Scales of Infant Toddler Development, third edition (BSID-III), Gross Motor Function Classification Score (GMFCS) ≥1. RESULTS All twenty-seven neonates enrolled in HEAL were recruited and 3 died before complete recording. The rank-based analysis of covariance models demonstrated lack of difference in NVC between the two groups (Epo versus Placebo) that was consistent with the observed lack of effect on neurodevelopmental outcomes. CONCLUSION We demonstrate no difference in neurovascular coupling after Epo administration. These findings are consistent with overall negative trial results. Physiological biomarkers can help elucidate mechanisms of neuroprotective therapies in real time in future trials.
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Affiliation(s)
- Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
| | - Shu Kang
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States of America
| | - Srinivas Kota
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Hanli Liu
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States of America
| | - Yulun Liu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Sandra E Juul
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Yvonne W Wu
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America
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Anto EO, Boadu WIO, Ansah E, Tawiah A, Frimpong J, Tamakloe VCKT, Korsah EE, Acheampong E, Asamoah EA, Opoku S, Adua E, Afrifa-Yamoah E, Annani-Akollor ME, Anto AO, Obirikorang C. Prevalence of preeclampsia and algorithm of adverse foeto-maternal risk factors among pregnant women in the Central Region of Ghana: A multicentre prospective cross-sectional study. PLoS One 2023; 18:e0288079. [PMID: 37384786 PMCID: PMC10309986 DOI: 10.1371/journal.pone.0288079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Preeclampsia is a leading cause of foeto-maternal deaths especially in Sub-Saharan Africa. However, the prevalence and risk factors of preeclampsia are scarce in the Central region of Ghana with previous study assessing individual independent risk factors. This study determined the prevalence and algorithm of adverse foeto-maternal risk factors of preeclampsia. METHODS This multi-centre prospective cross-sectional study was conducted from October 2021 to October 2022 at the Mercy Women's Catholic Hospital and Fynba Health Centre in Central region, Ghana. A total of 1,259 pregnant women were randomly sampled and their sociodemographic, clinical history, obstetrics and labour outcomes were recorded. Logistic regression analysis using SPSS version 26 was performed to identify risk factors of preeclampsia. RESULTS Of the 1,259 pregnant women, 1174 were finally included in the study. The prevalence of preeclampsia was 8.8% (103/1174). Preeclampsia was common among 20-29 years age group, those who had completed basic education, had informal occupation, multigravida and multiparous. Being primigravida [aOR = 1.95, 95% CI (1.03-3.71), p = 0.042], having previous history of caesarean section [aOR = 4.48, 95% CI (2.89-6.93), p<0.001], foetal growth restriction [aOR = 3.42, 95% CI (1.72-6.77), p<0.001] and birth asphyxia [aOR = 27.14, 95% CI (1.80-409.83), p = 0.017] were the independent risk factors of preeclampsia. Pregnant women exhibiting a combination of primigravida, previous caesarean section and foetal growth restriction were the highest risk for preeclampsia [aOR = 39.42, 95% CI (8.88-175.07, p<0.001] compared to having either two or one of these factors. CONCLUSION Preeclampsia is increasing among pregnant women in the Central region of Ghana. Pregnant women being primigravida with foetal growth restriction and previous history of caesarean section are the highest risk population likely to develop preeclampsia with neonates more likely to suffer adverse birth outcome such as birth asphyxia. Targeted preventive measures of preeclampsia should be created for pregnant women co-existing with multiple risk factors.
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Affiliation(s)
- Enoch Odame Anto
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, Joondalup Drive, Perth, Australia
- Centre for Precision Health, ECU Strategic Research Centre, Edith Cowan University, Perth, Australia
| | - Wina Ivy Ofori Boadu
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ezekiel Ansah
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Tawiah
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joseph Frimpong
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Ekow Korsah
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Acheampong
- Centre for Precision Health, ECU Strategic Research Centre, Edith Cowan University, Perth, Australia
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Adua
- Rural Clinical School, Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Agartha Odame Anto
- Department of Obstetrics and Gynaecology, Ho Teaching Hospital, Ho, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Wuni FK, Kukeba MW, Zakariah Y, Nyaabila EA, Saanwie AS. Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana. Ghana Med J 2023; 57:128-133. [PMID: 38504758 PMCID: PMC10846648 DOI: 10.4314/gmj.v57i2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Objective This study examined factors identified during early neonatal death audits contributing to preventable newborn deaths at the Upper East Regional Hospital. Method Data for this study was collected retrospectively from perinatal death audit forms using three data collectors. Data collection lasted two weeks, from 18th June to 2nd July 2021. The data collectors submitted 113 filled hard copy data collection forms. This was then entered into a designed Excel sheet and exported to STATA software version 15.0 for analysis. The analysis was descriptive statistics with cross-tabulation. The results were presented in charts and tables focusing on percentages. Results Most of the 113 neonatal deaths were from birth asphyxia (63%). Forty-six (40.7%) of the deaths occurred within 24 hrs after birth. There were 38 factors reported 254 times in the audits as contributory to all the newborn deaths; 17 health personnel-related factors stated 141 (55.5%) times, four transportation and communication-related factors stated 43 (16.9%) times, seven health facility factors stated 31 (12.2%) times. Inappropriate care during transportation to the regional hospital was reported most - 21 times, followed by delay in referral - 18 times. Conclusion The study identified many factors, such as medical personnel-related factors, transportation and communication factors, family-related factors, and health facility administration factors, contributing to early neonatal deaths. Effective implementation of neonatal death audit-based recommendations arising from these contributory factors is critical to preventing avoidable newborn deaths. Funding This project was funded by Upper East Regional Hospital.
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Affiliation(s)
| | - Margaret W. Kukeba
- CK Tedam University for Technology and Applied Sciences, Navrongo, Upper East Region, Ghana
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15
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Hanaki M, Hitaka D, Miyazono Y, Takada H. Resuscitation of a full-term infant born with pulseless electrical activity. Pediatr Int 2023; 65:e15518. [PMID: 36847331 DOI: 10.1111/ped.15518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Mai Hanaki
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Daisuke Hitaka
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yayoi Miyazono
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Shi Z, Luo K, Deol S, Tan S. A systematic review of noninflammatory cerebrospinal fluid biomarkers for clinical outcome in neonates with perinatal hypoxic brain injury that could be biologically significant. J Neurosci Res 2022; 100:2154-2173. [PMID: 33543500 PMCID: PMC9249405 DOI: 10.1002/jnr.24801] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/07/2023]
Abstract
Neonatal encephalopathy (NE) that purportedly arises from hypoxia-ischemia is labeled hypoxic-ischemic encephalopathy (HIE). Perinatal asphyxia is a clinical syndrome involving acidosis, a low Apgar score and the need for resuscitation in the delivery room; asphyxia alerts one to the possibility of NE. In the present systematic review, we focused on the noninflammatory biomarkers in cerebrospinal fluid (CSF) that are involved in the development of possible brain injury in asphyxia or HIE. A literature search in PubMed and EMBASE for case-control studies was conducted and 17 studies were found suitable by a priori criteria. Statistical analysis used the Mantel-Haenszel model for dichotomous data. The pooled mean difference and 95% confidence intervals (CIs) were determined. We identified the best biomarkers, based on the estimation approach in evaluating the biological significance, out of hundreds in three categories: cell adhesion and proliferation, oxidants and antioxidants, and cell damage. The following subtotal-population comparisons were made: perinatal asphyxia versus no asphyxia, asphyxia with HIE versus asphyxia without HIE, asphyxia with HIE versus no asphyxia, and term versus preterm HIE newborn with asphyxia. Biological significance of the biomarkers was determined by using a modification of the estimation approach, by ranking the biomarkers according to the difference in the bounds of the CIs. The most promising CSF biomarkers for prognostication especially for the severest HIE include creatine kinase, xanthine oxidase, vascular endothelial growth factor, neuron-specific enolase, superoxide dismutase, and malondialdehyde. Future studies are recommended using such a combined test to prognosticate the most severely affected patients.
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Affiliation(s)
- Zhongjie Shi
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Kehuan Luo
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Saihaj Deol
- Department of Psychology, College of Liberal Arts & Sciences, Wayne State University, Detroit, MI, USA
| | - Sidhartha Tan
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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Zafer D, Adams T, Olson E, Stenman L, Taparli O, Eickhoff J, Cengiz P, Mezu-Ndubuisi OJ. Retinal vascular recovery revealed by retinal imaging following neonatal hypoxia ischemia in mice: Is there a role for tyrosine kinase receptor modulation? Brain Res 2022; 1796:148093. [PMID: 36116486 PMCID: PMC10013450 DOI: 10.1016/j.brainres.2022.148093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 09/06/2022] [Accepted: 09/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hypoxic ischemic encephalopathy (HIE) secondary to perinatal asphyxia leads to long-term visual disabilities. Dilated retinal exams in human newborns with HIE is an emerging diagnostic tool, but phenotypes of hypoxia ischemia (HI) related retinal vascular injury are unclear. 7,8-Dihydroxyflavone (7,8-DHF) is a TrkB agonist with protective effects on HI-related brain damage. We studied retinal vessels in a mouse model of neonatal HIE and the efficacy of 7,8-DHF in ameliorating HI-related retinal vascular injury. METHODS C57BL6/J mice at post-natal day (P) 9 received unilateral left carotid artery ligation followed by exposure to 10 % oxygen for 50 min. Phosphate buffered saline or 7,8-DHF (5 mg/kg) were administered daily for 7 days intraperitoneally. Control groups of naïve or carotid artery ligation only mice were studied. Fluorescein angiography was performed in acute (two weeks post-exposure) and chronic (four weeks post-exposure) time points. Retinal artery width, retinal vein width, and collateral vessel length were quantified. RESULTS Ligation of the common carotid artery alone caused retinal artery dilation in acute and chronic time points, but had no effect on retinal veins. At acute time point, HI caused increased retinal artery vasodilation, but was reversed by 7,8-DHF. HI caused short collateral vessel formation in ipsilateral eyes, rescued by 7,8-DHF treatment. CONCLUSION Retinal artery vasodilation and collateral vessel formation due to HI were rescued by 7,8-DHF treatment. Retinal and collateral vessel monitoring could be diagnostic biomarkers for HI severity. Studies to elucidate mechanisms of 7,8-DHF action on retinal vessels could aid development of therapies for neonatal HI.
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Affiliation(s)
- Dila Zafer
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA; Waisman Center, University of Wisconsin, Madison, WI, USA
| | - Thao Adams
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Ellie Olson
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Lauren Stenman
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.
| | - Onur Taparli
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA; Waisman Center, University of Wisconsin, Madison, WI, USA.
| | - Jens Eickhoff
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA.
| | - Pelin Cengiz
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA; Waisman Center, University of Wisconsin, Madison, WI, USA.
| | - Olachi J Mezu-Ndubuisi
- Department of Pediatrics, University of Rochester, Rochester, NY, USA; Department of Ophthalmology, University of Rochester, Rochester, NY, USA.
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Kebede DA, Tafere Y, Eshete T, Abebaw E, Adimasu M, Endalew B. The time to initiate trophic feeding and its predictors among preterm neonate admitted to neonatal intensive care unit, Multicenter study, Northwest Ethiopia. PLoS One 2022; 17:e0272571. [PMID: 35951594 PMCID: PMC9371352 DOI: 10.1371/journal.pone.0272571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. Delayed starting of trophic feeding had resulted in short and long-term physical and neurological sequels. The current study aimed to estimate the time to initiate trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive specialized hospitals. Methods An institutional-based prospective follow-up study was conducted among 210 neonates. The data were collected with interview and chart review, entered into Epi data 3.1 and exported to Stata 14.1 for analysis. Multivariable Cox regression models were fitted to identify predictors of time to initiate trophic feeding. Result A total of 210 neonates were followed for 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding. The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 2, 2.2) person-hours observations. The median survival time was 42 hours (95% CI: 36, 48). APGAR- score at first minute <7 (AHR: 0.6, 95% CI: 0.44, 0.82), gestational age of <34 weeks (AHR: 0.69, 95% CI: 0.5, 0.94), presence of respiratory distress syndrome (AHR: 0.5, 95% CI: 0.36, 0.68), presence of hemodynamic instability (AHR: 0.37, 95% CI: 0.24, 0.57), presence of perinatal asphyxia (AHR: 0.63, 95% CI: 0.44, 0.89), cesarean section delivery (AHR: 0.63, 95% CI: 0.44, 89) and being delivered within the study hospitals (AHR: 0.54, 95% CI: 0.39, 0.74) were found to be statistically significant predictors of time to initiate trophic feeding. Conclusion There was a significant delay to initiate trophic feeding in the studied hospitals. Gestational age of below 34 weeks, APGAR-score of less than seven, out-born delivery, cesarean delivery, presence of respiratory distress syndrome; perinatal asphyxia, and hemodynamic instability were predictors of delay in starting of trophic feeding. Standardized feeding guideline has to be implemented to overcome delays in enteral feeding initiation.
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Affiliation(s)
| | - Yilikal Tafere
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ermias Abebaw
- School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Mekonen Adimasu
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Kirabira VN, Nakaggwa F, Nazziwa R, Nalunga S, Nasiima R, Nyagabyaki C, Sebunya R, Latigi G, Pirio P, Ahmadzai M, Ojom L, Nabwami I, Burgoine K, Blencowe H. Impact of secondary and tertiary neonatal interventions on neonatal mortality in a low- resource limited setting hospital in Uganda: a retrospective study. BMJ Open 2022; 12:e055698. [PMID: 35953254 PMCID: PMC9379481 DOI: 10.1136/bmjopen-2021-055698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the impact of secondary and tertiary level neonatal interventions on neonatal mortality over a period of 11 years. DESIGN Interrupted time series analysis. SETTING Nsambya Hospital, Uganda. INTERVENTIONS Neonatal secondary interventions (phase I, 2007-2014) and tertiary level interventions (phase II, 2015-2020). PARTICIPANTS Neonates. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: neonatal mortality. SECONDARY OUTCOME case fatality rate (CFR) for prematurity, neonatal sepsis and asphyxia. RESULTS During the study period, a total of 25 316 neonates were admitted, of which 1853 (7.3%) died. The average inpatient mortality reduced from 8.2% during phase I to 5.7% during phase II (p=0.001). The CFR for prematurity reduced from 16.2% to 9.2% (p=0.001). There was a trend in reduction for the CFR of perinatal asphyxia from 14.9% to 13.0% (p=0.34). The CFR for sepsis had a more than a twofold increase (3%-6.8% p=0.001) between phase I and phase II. CONCLUSION Implementation of secondary and tertiary neonatal care in resource-limited settings is feasible. This study shows that these interventions can significantly reduce the neonatal mortality, with the largest impact seen in the reduction of deaths from perinatal asphyxia and prematurity. An increase in sepsis related deaths was observed, suggesting emphasis on infection control is key.
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Affiliation(s)
- Victoria Nakibuuka Kirabira
- Paediatrics, Nsambya Hospital, Kampala, Uganda
- Medicine Post Graduate School, Nkozi University, Kampala, Uganda
| | - Florence Nakaggwa
- School of Nursing and Midwifery, Clarke International University, Kampala, Uganda
| | - Ritah Nazziwa
- Medicine Post Graduate School, Nkozi University, Kampala, Uganda
| | | | | | | | | | | | | | - Malalay Ahmadzai
- UNICEF Eastern and Southern Africa Regional Office, Kampala, Uganda
| | | | | | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, UK
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Lafuente H, Olaetxea I, Valero A, Alvarez FJ, Izeta A, Jaunarena I, Seifert A. Identification of Hypoxia-Ischemia by chemometrics considering systemic changes of the physiology. IEEE J Biomed Health Inform 2022; 26:2814-2821. [PMID: 35015657 DOI: 10.1109/jbhi.2022.3142190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Perinatal asphyxia represents a major medical disorder and is related to around a fourth of all neonatal deaths worldwide. Specific thresholds for lactate or pH levels define the gold standard for detecting hypoxic-ischemic events as physiological abnormalities. In contrast to current gold standard, we analyze the systemic picture, represented by the whole set of biochemical parameters from blood gas analysis, by multiparametric machine learning algorithms. In a swine model with 22 objects, we investigate the impact of neonatal hypoxic-ischemic encephalopathy on 18 individual physiological parameters. In a first approach, we study the statistical significance of individual parameters by univariate analysis methods. In a second approach, we take the most relevant parameters as input for the development of predictive models by different hybrid and non hybrid classification algorithms. The predictive power of our multiparametric models outperforms by far the limited performance of pH and lactate as reliable indicators, despite strong correlation with hypoxic-ischemic events. We have been able to detect hypoxic-ischemic events even one hour after the episode, with accuracies close to 100% in contrast to pH or lactate-based diagnosis with 62% and 78%, respectively. By all machine learning algorithms, lactate is recognized as the main contributor due to its longer-term evidence of hypoxia-ischemia episodes. However, substantial improvement of the diagnosis is achieved by predictions based on a systemic picture of different physiological parameters. Our results prove the potential applicability of our method as a support tool for decision-making that will allow obstetricians to identify hypoxic ischemic episodes more accurately during labor.
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Umoren R, Bucher S, Hippe DS, Ezenwa BN, Fajolu IB, Okwako FM, Feltner J, Nafula M, Musale A, Olawuyi OA, Adeboboye CO, Asangansi I, Paton C, Purkayastha S, Ezeaka CV, Esamai F. eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings. BMJ Open 2021; 11:e048506. [PMID: 34433598 PMCID: PMC8390148 DOI: 10.1136/bmjopen-2020-048506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. DESIGN Randomised controlled trial with 6-month follow-up (2018-2020). SETTING Secondary and tertiary healthcare facilities. PARTICIPANTS 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. INTERVENTIONS eHBB VR simulation or neonatal resuscitation video. MAIN OUTCOMES Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. RESULTS Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. CONCLUSION eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.
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Affiliation(s)
- Rachel Umoren
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sherri Bucher
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | | | | | - John Feltner
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | | | - Olubukola A Olawuyi
- Department of Paediatrics, University of Lagos College of Medicine, Lagos, Nigeria
| | | | | | - Chris Paton
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford, UK
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana, USA
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Siddiqui MA, Butt TK. Role of Intravenous Magnesium Sulphate in Term Neonates with Hypoxic Ischemic Encephalopathy (HIE) in a Low-income Country: A Randomised Clinical Trial. J Coll Physicians Surg Pak 2021; 31:817-820. [PMID: 34271782 DOI: 10.29271/jcpsp.2021.07.817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effects of magnesium sulphate in term neonates with hypoxic ischemic encephalopathy (HIE) in reducing mortality and morbidity. STUDY DESIGN Randomised clinical trial. PLACE AND DURATION OF STUDY Department of Neonatology, Services Hospital, Lahore, Pakistan from April to December 2019. METHODOLOGY Term babies (inborn or outborn), fulfilling the operational definition of hypoxic ischemic encephalopathy, reaching within 6 hours of delivery in Nursery Department of Pediatric Medicine Unit-II, Services Hospital, Lahore, were included. Sarnat score was used for staging the severity of HIE. Cases were administered magnesium sulphate (MgSO4) as intravenous infusion. Rest of the management was similar for cases and controls. Mortality was defined as death due to birth asphyxia; whereas, morbidity was assessed by comparing the following at discharge: the grade of hypoxic ischemic encephalopathy, presence and frequency of seizures, duration of seizures, ability to suck feed and neurological problems such as abnormalities of muscle tone and neonatal reflexes. Babies with prematurity, dysmorphism comorbidities or arriving after 6 hours of birth, were excluded. Chi-square test was used for comparison; and p value <0.05 was considered significant. RESULTS Gender, mode of delivery, mode of resuscitation at birth, major risk factors (prolonged labour, premature rupture of membranes, presence of meconium-stained amniotic fluid) were comparable in both groups. The duration of seizures, ability to suck feed and presence of neurological problems at discharge were significantly better in magnesium sulphate group as compared to control group. CONCLUSION Magnesium sulphate is better in establishing earlier suck feed and reducing the duration of seizures and neurological problems in babies with birth asphyxia. Key Words: Hypoxic ischemic encephalopathy, Magnesium sulphate, Outcome, Term, Low income country.
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Affiliation(s)
| | - Tayyaba Khawar Butt
- Department of Paediatric Medicine Unit-II, Services Hospital, Lahore, Pakistan
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Rahman K, Rahman MM, Fatema K. Correlation between CT scan Findings of the Head and Motor Disturbances in Children with Cerebral Palsy. Mymensingh Med J 2021; 30:678-683. [PMID: 34226455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cerebral palsy (CP) is the commonest movement disorder in childhood. Clinical spectrum of CP is variable and CT scan of brain is an important mode of diagnosis and prognosis in recourse limited set up. This study was done to categorize the CT scan findings and correlate them with the type of motor disturbances of CP patients. This was a cross sectional study done in 100 children diagnosed as CP carried out in Pediatric Neurology unit, BSMMU from July 2009 to July 2010. The patients were randomly selected and CT scan was done in all the patients. Detailed history and clinical examination was done to find out the baseline characteristics, risk factors and topographic type of CP patients. Among 100 patients 92% had abnormal CT scan finding. Most common abnormality was cerebral atrophy. Maximum number of abnormal CT scan was found in quadriplegic CP (92%). Highest number of children was in 13-24 months (29%) and a slight male predominance was found. Commonest risk factor was perinatal asphyxia (75%). The brain lesions are often associated with a clinical phenotype where specific needs may be anticipated and addressed. This is important for the planning of intervention in the child with CP.
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Affiliation(s)
- K Rahman
- Dr Khadija Rahman, FCPS Pediatrics Student, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Alake O, Rana R, Jain A, Chakkarapani E. Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication. BMJ Case Rep 2021; 14:e237213. [PMID: 33731399 PMCID: PMC7978085 DOI: 10.1136/bcr-2020-237213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/03/2022] Open
Abstract
Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.
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Affiliation(s)
- Oluwaseyi Alake
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Reena Rana
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Anoo Jain
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ela Chakkarapani
- Regional Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda. BMC Med Inform Decis Mak 2021; 21:39. [PMID: 33541340 PMCID: PMC7863544 DOI: 10.1186/s12911-021-01406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. METHODS We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called "HBB Prompt". Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. RESULTS Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. CONCLUSIONS Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054 .
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, British Columbia Women’s Hospital, 1N55-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Hasan S. Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main Street West, HSC-2R104, Hamilton, ON L8S 4K1 Canada
| | - Niraj Mistry
- Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, 5 King’s College Road, Toronto, ON M5S 3G8 Canada
- Design Research, TD Bank Group, Toronto, ON Canada
| | - Douglas M. Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON Canada
- Neonatal Intensive Care Unit, St. Michael’s Hospital, 15014 - 30 Bond St, Toronto, M5B 1W8 ON Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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Nasrim KN, Parvin S, Hossain MA, Alam MK, Amin SE, Naher A, Islam MN, Salam A, Akhtaruzzaman M, Choudhury FH, Zaman F, Khan MI, Begum B. Neuro-developmental Outcome of High Risk Neonates in a Tertiary Level Hospital. Mymensingh Med J 2021; 30:90-100. [PMID: 33397857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An observational longitudinal study was conducted in the Department of Neonatology and Child Developmental Center, Mymensingh Medical College Hospital (MMCH), Bangladesh during the period of September 2016 to February 2018 to find out the neuro-developmental outcome of high risk neonates at the age of 6 months. Five hundred seventy six (576) high risk neonate who were admitted in the neonatology department in Mymensingh Medical College Hospital were selected as study population by Purposive sampling technique. After admission written informed consent from parents or guardians obtained and Data was collected in a pre-designed case record form. At 6th months of age total 400 baby were came to Child Development Centre and their motor, cognition and behavior development were assessed by Bayley Scale of Infant Development and severity of cognitive, motor and behavior impairment were graded. All data were compiled, tabulated and then analyzed by computer software SPSS version 20.00. Mean age was 7.2±3.3 days. Among studied newborns 18.1% were preterm and 81.9% were term. Most of the newborn were male (63.0%). Developmental delay was found in 81.5% and neuro-developmental outcome was found normal in only 18.5% newborns. Significant delayed motor performance was found in 52% newborns where 17% had mild delay. Significantly delayed mental performance was found in 57.0% and 28.52% had mildly delayed mental performance. Non-optimal behavior was found in 57.0% newborns and14% had questionable behavior. Very low birth weight, preterm very low birth weight, home delivery, perinatal asphyxia and neonatal seizure were found to have significant relation with developmental delay. Most of the high risk neonates develop developmental delay.
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Affiliation(s)
- K N Nasrim
- Dr Kamrun Nahar Nasrin, Child Health Physician, Shishu Bikash Kendro, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, 160 030, India.
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Urdal J, Engan K, Eftestøl T, Naranjo V, Haug IA, Yeconia A, Kidanto H, Ersdal H. Automatic identification of stimulation activities during newborn resuscitation using ECG and accelerometer signals. Comput Methods Programs Biomed 2020; 193:105445. [PMID: 32283386 DOI: 10.1016/j.cmpb.2020.105445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Early neonatal death is a worldwide challenge with 1 million newborn deaths every year. The primary cause of these deaths are complications during labour and birth asphyxia. The majority of these newborns could have been saved with adequate resuscitation at birth. Newborn resuscitation guidelines recommend immediate drying, stimulation, suctioning if indicated, and ventilation of non-breathing newborns. A system that will automatically detect and extract time periods where different resuscitation activities are performed, would be highly beneficial to evaluate what resuscitation activities that are improving the state of the newborn, and if current guidelines are good and if they are followed. The potential effects of especially stimulation are not very well documented as it has been difficult to investigate through observations. In this paper the main objective is to identify stimulation activities, regardless if the state of the newborn is changed or not, and produce timelines of the resuscitation episode with the identified stimulations. METHODS Data is collected by utilizing a new heart rate device, NeoBeat, with dry-electrode ECG and accelerometer sensors placed on the abdomen of the newborn. We propose a method, NBstim, based on time domain and frequency domain features from the accelerometer signals and ECG signals from NeoBeat, to detect time periods of stimulation. NBstim use causal features from a gliding window of the signals, thus it can potentially be used in future realtime systems. A high performing feature subset is found using feature selection. System performance is computed using a leave-one-out cross-validation and compared with manual annotations. RESULTS The system achieves an overall accuracy of 90.3% when identifying regions with stimulation activities. CONCLUSION The performance indicates that the proposed NBstim, used with signals from the NeoBeat can be used to determine when stimulation is performed. The provided activity timelines, in combination with the status of the newborn, for example the heart rate, at different time points, can be studied further to investigate both the time spent and the effect of different newborn resuscitation parameters.
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Affiliation(s)
- Jarle Urdal
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway.
| | - Kjersti Engan
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway.
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway
| | - Valery Naranjo
- Instituto de Investigación e Innovación en Bioingeniera (I3B), Universitat Politécnica de Valéncia, Spain
| | | | | | - Hussein Kidanto
- School of Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Hege Ersdal
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Norway; Dep. of Health Sciences, University of Stavanger, Norway
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Masereka EM, Naturinda A, Tumusiime A, Munguiko C. Implementation of the Perinatal Death Surveillance and Response guidelines: Lessons from annual health system strengthening interventions in the Rwenzori Sub-Region, Western Uganda. Nurs Open 2020; 7:1497-1505. [PMID: 32802370 PMCID: PMC7424478 DOI: 10.1002/nop2.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
Aim To determine the health facility-based perinatal mortality rate, its causes and avoidable factors using the perinatal mortality surveillance and response guidelines. Design This was an action study conducted in one of the districts in Western Uganda from 1 January-31 December 2019. Methods A total of 20 perinatal death cases were recruited consecutively. Data were collected using a Ministry of Health Perinatal Death Surveillance and Response (PDSR) questionnaire containing questions on pregnancy, delivery and immediate postnatal care. We used descriptive statistics to describe key data elements. Results We found a health facility-based perinatal mortality rate of 17.3 deaths per 1,000 live births. Birth asphyxia was the most common cause of perinatal deaths. Seven, three and ten mothers delayed seeking, reaching and receiving appropriate health care, respectively.
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Affiliation(s)
- Enos Mirembe Masereka
- Department of Nursing and MidwiferySchool of MedicineKabale UniversityKabaleUganda
- Department of Nursing and MidwiferySchool of Health SciencesMountains of the Moon UniversityFort PortalUganda
| | - Amelia Naturinda
- Infectious Diseases InstituteSchool of MedicineCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Alex Tumusiime
- Department of Nursing and MidwiferySchool of MedicineKabale UniversityKabaleUganda
| | - Clement Munguiko
- Department of Nursing and MidwiferySchool of Health SciencesMountains of the Moon UniversityFort PortalUganda
- Department of NursingSchool of Health SciencesSoroti UniversitySorotiUganda
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30
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Farzana MN, Islam MS, Sarker UK, Rahman MM, Begum M, Ara R, Neli S, Liza SP, Muktadira M, Islam M, Begum G. A Comparative Study of Craniosonogram and CT scan of Brain in CNS Complication of Perinatal Asphyxia. Mymensingh Med J 2020; 29:325-336. [PMID: 32506086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pereinatal asphyxia is one of the most important complications related with the process of birth and this complications affect not only the brain but also many other organs. The purpose of this cross sectional study is to compare the role of craniosonogram and CT scan of the brain to delineate the cerebral pathology in respondent of preterm and term infant and to assess the Kappa test for agreement. This study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of July 2015 to June 2017. A total number of 40 neonates clinically diagnosed as perinatal asphyxia referred for Craniosonogram and Computed tomography (CT) were included in this study. The test of agreement of USG in detection of neonatal cerebral pathology was calculated. Male to female ratio was 1:1.4. More than half (55.0%) patients were preterm age. The mean birth weight was found 2.3±0.6 kg and mean age was 22.7±12.7 days. Fifty five percent respondent mothers had antenatal check up and 27% had anemia, 11% had premature rupture of membrane, 9% had multiple pregnancy and 7% patient had hypertension. Cerebral pathology was found 28 and 31 cases by Craniosonogram and CT scan respectively. Germinal matrix hemorrhage/IVH (Intra ventricular hemorrhage) found 7(17.5%) in USG and 4(10.0%) in CT scan. Hypoxic ischaemic changes with mild ventriculomegaly observed 5(12.5%) in USG and 7(17.5%) in CT scan. Hypoxic ischaemic change found 4(10.0%) in USG and 5(12.5%) in CT scan. In USG evaluation of 28 patients having cerebral pathology & 16(72.7%) had in preterm group and 12(66.7%) in term group. In CT scan of brain 31 patients with cerebral pathology & 15(37.5%) in preterm group and 16(40.0%) in term group. CT scan found cerebral pathology 77.5% (31/40) cases and USG found 70.0% (28/40), with Kappa value was 0.551, which indicates that fair agreement between USG and CT scan for detection of cerebral pathology in respondent. Craniosonogram is a useful method in all neonates specially preterm to see the CNS complication of perinatal asphyxia.
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Affiliation(s)
- M N Farzana
- Dr Mir Naz Farzana, Medical Officer, Department of Radiology & Imaging, Community Based Medical College Hospital, Bangladesh (CBMCB), Mymensingh; E-mail:
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Meinich-Bache O, Austnes SL, Engan K, Austvoll I, Eftestol T, Myklebust H, Kusulla S, Kidanto H, Ersdal H. Activity Recognition From Newborn Resuscitation Videos. IEEE J Biomed Health Inform 2020; 24:3258-3267. [PMID: 32149702 DOI: 10.1109/jbhi.2020.2978252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Birth asphyxia is one of the leading causes of neonatal deaths. A key for survival is performing immediate and continuous quality newborn resuscitation. A dataset of recorded signals during newborn resuscitation, including videos, has been collected in Haydom, Tanzania, and the aim is to analyze the treatment and its effect on the newborn outcome. An important step is to generate timelines of relevant resuscitation activities, including ventilation, stimulation, suction, etc., during the resuscitation episodes. METHODS We propose a two-step deep neural network system, ORAA-net, utilizing low-quality video recordings of resuscitation episodes to do activity recognition during newborn resuscitation. The first step is to detect and track relevant objects using Convolutional Neural Networks (CNN) and post-processing, and the second step is to analyze the proposed activity regions from step 1 to do activity recognition using 3D CNNs. RESULTS The system recognized the activities newborn uncovered, stimulation, ventilation and suction with a mean precision of 77.67%, a mean recall of 77,64%, and a mean accuracy of 92.40%. Moreover, the accuracy of the estimated number of Health Care Providers (HCPs) present during the resuscitation episodes was 68.32%. CONCLUSION The results indicate that the proposed CNN-based two-step ORAA-net could be used for object detection and activity recognition in noisy low-quality newborn resuscitation videos. SIGNIFICANCE A thorough analysis of the effect the different resuscitation activities have on the newborn outcome could potentially allow us to optimize treatment guidelines, training, debriefing, and local quality improvement in newborn resuscitation.
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Petrashenko VO, Loboda AM, Smiyan OI, Popov SV, Zaitsev IE, Redko OK, Kasian SM, Shkolna II, Smiyan SA. Crystallographic investigation of urine in newborn with renal disturbance due to asphyxia. Wiad Lek 2020; 73:953-958. [PMID: 32386375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim is to increase the efficiency of diagnosis of renal injury in neonates with asphyxia by identifying of structural markers according to research facies of urine in newborns of different gestational ages. PATIENTS AND METHODS Materials and methods: The study involved 150 full-term with signs of kidney damage due to asphyxia: 75 babies with severe asphyxia, and 75 children with moderate asphyxia and 100 preterm infants: 50 children with severe asphyxia and 50 children with moderate. Comparison groups: group 1 consisted of 20 full-term infants, group 2 which included 20 preterm neonates. Material for the study - morning portion of urine, which was collected at 8-10 a.m. on 1-2 and 7-8 days of life. RESULTS Results: morphological picture of facies of newborns with asphyxia depends on the severity of pathological changes in the urine (proteinuria) and urine output. Structure of facies in babies with renal distorbance due to severe asphyxia indicates a significant loss of organic and mineral substances in the urine. The width of the peripheral zone facies, the amount of solid particles transferred depends on the severity of asphyxia, the difference in morphology facies is maintained even at the end of the early neonatal period. CONCLUSION Conclusions: Analysis of dried drops of urine in infants with renal impairment on the background of asphyxia can be used as one of the criteria for assessing kidney function and have prognostic value.
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Chen ZL. [Assessment of the criteria for the diagnosis and grading of neonatal asphyxia based on evidence]. Zhongguo Dang Dai Er Ke Za Zhi 2019. [PMID: 30675855 PMCID: PMC7390175 DOI: 10.7499/j.issn.1008-8830.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Zi-Li Chen
- Department of Neonatology, Dongguan Hospital, Affiliated to Jinan University Medical College, Dongguan 523900, China
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Manja V, Kirpalani H, Lakshminrusimha S. Factors influencing decision-making: Delayed hypothermia in a late preterm infants with hypoxic-ischemic encephalopathy. Early Hum Dev 2019; 128:102-103. [PMID: 30343955 DOI: 10.1016/j.earlhumdev.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Veena Manja
- Department of Surgery, University of California at Davis, Sacramento, CA, USA; Department of Pediatrics, University of California at Davis, Sacramento, CA, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Haresh Kirpalani
- University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Locci E, Noto A, Puddu M, Pomero G, Demontis R, Dalmazzo C, Delogu A, Fanos V, d’Aloja E, Gancia P. A longitudinal 1H-NMR metabolomics analysis of urine from newborns with hypoxic-ischemic encephalopathy undergoing hypothermia therapy. Clinical and medical legal insights. PLoS One 2018; 13:e0194267. [PMID: 29668681 PMCID: PMC5906012 DOI: 10.1371/journal.pone.0194267] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/28/2018] [Indexed: 01/21/2023] Open
Abstract
Perinatal asphyxia is an event affecting around four million newborns worldwide. The 0.5 to 2 per 1000 of full term asphyxiated newborns suffer from hypoxic-ischemic encephalopathy (HIE), which is a frequent cause of death or severe disability and, as consequence, the most common birth injury claim for obstetrics, gynaecologists, and paediatricians. Perinatal asphyxia results from a compromised gas exchange that leads to hypoxemia, hypercapnia, and metabolic acidosis. In this work, we applied a metabolomics approach to investigate the metabolic profiles of urine samples collected from full term asphyxiated newborns with HIE undergoing therapeutic hypothermia (TH), with the aim of identifying a pattern of metabolites associated with HIE and to follow their modifications over time. Urine samples were collected from 10 HIE newborns at birth, during hypothermia (48 hours), at the end of the therapeutic treatment (72 hours), at 1 month of life, and compared with a matched control population of 16 healthy full term newborns. The metabolic profiles were investigated by 1H NMR spectroscopy coupled with multivariate statistical methods such as principal component analysis and orthogonal partial least square discriminant analysis. Multivariate analysis indicated significant differences between the urine samples of HIE and healthy newborns at birth. The altered metabolic patterns, mainly originated from the depletion of cellular energy and homeostasis, seem to constitute a characteristic of perinatal asphyxia. The HIE urine metabolome changes over time reflected either the effects of TH and the physiological growth of the newborns. Of interest, the urine metabolic profiles of the HIE non-surviving babies, characterized by the increased excretion of lactate, resulted significantly different from the rest of HIE population.
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Affiliation(s)
- Emanuela Locci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Noto
- Department of Surgical Sciences, University of Cagliari, and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Melania Puddu
- Department of Surgical Sciences, University of Cagliari, and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Giulia Pomero
- Neonatal Intensive Care, Neonatology, ASO S. Croce e Carle, Cuneo, Italy
| | - Roberto Demontis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cristina Dalmazzo
- Neonatal Intensive Care, Neonatology, ASO S. Croce e Carle, Cuneo, Italy
| | - Antonio Delogu
- Neonatal Intensive Care, Neonatology, ASO S. Croce e Carle, Cuneo, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, Italy
| | - Ernesto d’Aloja
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paolo Gancia
- Neonatal Intensive Care, Neonatology, ASO S. Croce e Carle, Cuneo, Italy
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Affiliation(s)
- Ela Chakkarapani
- St Michael's Hospital, School of Clinical Sciences, University of Bristol, Bristol, UK.
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Islam MN, Hossain MA, Yeasmin L, Dutta A, Ahmad F, Khan RH. Clinical Profile and Biochemical Abnormalities of Neonatal Seizure at NICU of a Tertiary Care Hospital. Mymensingh Med J 2016; 25:445-449. [PMID: 27612889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Seizures are most common neurological emergency in the neonatal period and present as a diagnostic and therapeutic challenge to clinicians worldwide. This prospective observational study was conducted in the Neonatal Intensive Care Unit of Mymensingh Medical College Hospital from January 2015 to March 2015. Total 318 patients were enrolled in the study who presented with convulsion. Most of the patients were term (72.95%) and birth weight was normal (77.3%). Around 75% patients were delivered at home. Most common causes of convulsion were Perinatal Asphyxia (78%) followed by Septicemia, Hypoglycemia and Meningitis in order of frequency. Commonest type of seizure was subtle seizure (45.5%). Most of the patients recovered completely (73%) and 8.4% patients died due to complications.
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Affiliation(s)
- M N Islam
- Dr Md Nazrul Islam, Assistant Professor, Department of Neonatology, Mymensingh Medical Colleg, Mymensingh, Bangladesh; E-mail:
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Saha D, Ali MA, Haque MA, Ahmed MS, Sutradhar PK, Latif T, Sarkar D, Husain F. Association of hypoglycemia, hypocalcemia and hypomagnesemia in neonates with perinatal asphyxia. Mymensingh Med J 2015; 24:244-250. [PMID: 26007249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The clinical evidence of neurological menifestations associated with asphyxia is described as hypoxic ischaemic encephalopathy (HIE). A variety of metabolic problems are present in asphyxiated newborns including hypoglycemia, hypocalcemia, hypomagnesemia and others metabolic abnormalities. Some of these biochemical disturbances may trigger seizure or potentiate further brain damage. This cross sectional case-control study was done in Mymensingh Medical College Hospital, to identify the association of hypoglycemia, hypocalcemia, hypomagnesemia in neonates with perinatal asphyxia. Study period was six months. Sample size was 60. Among total sample 30 term asphyxiated newborns of <24 hours age were case and equal number term healthy newborns <24 hours age were control. The main clinical presentations were delayed cry after birth along with respiratory distress, convulsion and absence of cry in asphyxiated newborns. Major physical findings were cyanosis, convulsion and tachypnoea in asphyxiated group. The mean value of serum calcium level was significantly lower in asphyxiated newborns (7.37 ± 0.10mg/dl) than control value (8.04±0.09mg/dl). Hypocalcemia was found among 23.33% babies in case group. On the contrary, hypocalcemia was found in single baby among control group. The mean value of serum magnesium was significantly lower in asphyxiated newborns (1.83 ± 0.04mg/dl) than control value (1.96 ± 0.05mg/dl). Hypomagnesemia was found among 3(10%) newborns but none was found among control group. Hypoglycemia was found in 7(23.33%) cases though the mean value of blood glucose was higher in case group (5.72 ± 0.62mmol/l) than control group (4.87 ± 0.15mmol/l) difference was not statistically significant. Combined hypoglycemia, hypocalcemia and hypomagnesemia were found in 1(3.33%) case; combined hypoglycemia and hypocalcemia were found in 2(6.67%) cases; and combined hypocalcemia and hypomagnesemia were found in 1(3.33%) case. During the study period, 3(10.0%) cases were expired but no death occurred among control group. This study shows isolated or combined hypoglycemia, hypocalcemia, hypomagnesemia are frequently found in newborns with perinatal asphyxia. So, it is necessary to monitor blood glucose, serum calcium and also serum magnesium among asphyxiated newborns for proper management.
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Affiliation(s)
- D Saha
- Dr Dipanwita Saha, Assistant Registrar, Department of Paediatrics, Myemnsingh Medical College Hospital (MMCH), Mymensingh, Bangladesh
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Wei L, Wang J, Cao Y, Ren Q, Zhao L, Li X, Wang J. Hyperbaric oxygenation promotes neural stem cell proliferation and protects the learning and memory ability in neonatal hypoxic-ischemic brain damage. Int J Clin Exp Pathol 2015; 8:1752-1759. [PMID: 25973064 PMCID: PMC4396307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
The aim of our study was to evaluate whether hyperbaric oxygenation (HBO) was an effective therapy for neonatal hypoxic ischemic brain damage (HIBD). Seven-day-old rat pups were divided into 3 groups: sham, hypoxia-ischemia (HI) control and HI-HBO group. HBO was administered for HI rats daily. The pathologic changes in brain tissues were observed by hematoxylin-eosin (H-E) staining. The immunohistochemical staining was applied to detect the Nestin and 5-bromo-2-deoxyuridine (BrdU) positive cells in hippocampal dentate gyrus region. The learning and memory function of rats was examined by Morris water maze. The HI rats showed obvious pathologic changes accompanied by levels decreasing and disorder arrangement of pyramidal cells, glial cells proliferation in postoperative, and nerve nuclei broken, while pathologic changes of rats in sham group was approximate to that in the HI + HBO group that was opposite to the HI group. Compared with the sham group, the Nestin and BrdU positive cells in HBO + HI group at different time points increased significantly (P < 0.01). Learning and memory function of rats in HI group was poor compared with the sham/HI + HBO group (P < 0.01), while that in HI + HBO group was approximate to that in sham group (P > 0.05). HBO treatment improved the learning and memory ability of the HI rats. HBO therapy may be effective for neonatal HIBD treatment.
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Affiliation(s)
- Lixia Wei
- Department of Neurology, Children’s Medical Center, Qilu Hospital of Shandong UniversityJinan 250012, China
- Department of Pediatrics, Liaocheng People’s HospitalLiaocheng 252000, China
| | - Jinshen Wang
- Department of Pediatrics, Liaocheng People’s HospitalLiaocheng 252000, China
| | - Yuntao Cao
- Department of Neonatal, Affiliated Hospital of Zunyi Medical CollegeZunyi 563003, China
| | - Qing Ren
- Department of Pediatrics, Liaocheng People’s HospitalLiaocheng 252000, China
| | - Lili Zhao
- Department of Pediatrics, Liaocheng People’s HospitalLiaocheng 252000, China
| | - Xingang Li
- Brain Science Research Institute, Shandong UniversityJinan 250012, China
| | - Jiwen Wang
- Department of Neurology, Children’s Medical Center, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong UniversityJinan 250012, China
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Yan S, Zhu X. [Analysis of mortality rate and causes of death among children under 5 years old in Beijing from 2003 to 2012]. Zhonghua Yu Fang Yi Xue Za Zhi 2014; 48:484-490. [PMID: 25219437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To understand the age-specific and cause-specific mortality rate among children under 5 years old in Beijing from 2003 to 2012. METHODS Death surveillance data of children under the age of 5 were obtained from Beijing children mortality surveillance network from 2003 to 2012. Neonatal mortality rate (NMR), infant mortality rate (IMR), under 5-year old children mortality rate (U5MR) and the leading cause of death for under 5-year old children in urban, suburbs, and outer suburbs in Beijing were analyzed. RESULTS The NMR, IMR and U5MR in Beijing were 2.08 (253/121 747), 3.11 (379/121 747) and 3.57 (435/121 747) per 1000 live births in 2012, respectively, which declined 54.88%, 50.24% and 54.75% compared with the level in 2003 respectively. The children mortality rates showed a decreasing trend in urban, suburb, and outer suburbs during 2003 and 2012 (NMR was decreased from 0.53%, 0.42%, and 0.48% in 2003 to 0.20%, 0.19%, and 0.23% in 2012; IMR was decreased from 0.73%, 0.58%, and 0.63% in 2003 to 0.30%, 0.29%, and 0.35% in 2012; U5MR was decreased from 0.90%, 0.72%, and 0.82% to 0.33%, 0.34%, and 0.39% in 2012, P < 0.01). There was a steady decline in the U5MR due to congenital heart disease, birth asphyxia, premature birth or low birth weight and traffic accident in Beijing from 2003 to 2012. The mortality rate of congenital heart disease declined from 140.63 to 41.89 per 100 000 live births, birth asphyxia declined from 109.38 to 59.96 per 100 000 live births, premature birth or low birth weight declined from 85.94 to 52.57 per 100 000 live births, traffic accident declined from 26.04 to 6.57 per 100 000 live births (P < 0.01). The mortality rate of congenital heart disease declined remarkably from 216.56 to 52.47, from 119.75 to 23.50, and from 134.58 to 63.11 per 100 000 live births in urban, suburb, and outer suburbs(P < 0.01). Six of the top 8 leading causes of death among children under 5 years old declined remarkably in rural areas. They were congenital heart disease, birth asphyxia, premature birth or low birth weight, traffic accident, drowning, and septicemia, and the mortality rate of them declined from 134.58 to 63.11, from 127.85 to 65.54, from 100.94 to 60.69, from 33.65 to 12.14, from 33.65 to 0.00, and from 26.92 to 4.85 per 100 000 live births, respectively (P < 0.05). There was no drowning death case in rural areas in recent 4 years. The top 5 leading causes of death among children under 5 years old in Beijing in 2012 were birth asphyxia, premature birth or low birth weight, congenital heart disease, pneumonia, and accidental suffocation. The mortality rate of these top 5 leading causes were 59.96, 52.57, 41.89, 24.64, and 15.61 per 100 000 live births in 2012. CONCLUSION From 2003 to 2012, the NMR, IMR, U5MR and mortality rate of congenital heart disease declined remarkably in urban, suburb, and outer suburb areas in Beijing. There was a decrease trend for the six of the top 8 leading causes of death among children under 5 years old. The mortality rate of drowning dropped markedly in outer suburbs.
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Affiliation(s)
- Shujuan Yan
- Department of Neuropsychological Development,Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
| | - Xuena Zhu
- Department of Neuropsychological Development,Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Abstract
OBJECTIVE To investigate maternal and perinatal risk factors for childhood cancer. STUDY DESIGN Case-control analysis of linked records from the Aberdeen Maternity and Neonatal Databank with the Scottish Cancer Registry and the General Registry of Births and Deaths in Scotland was carried out. SETTING Aberdeen, Scotland. PARTICIPANTS Cases (n=176) comprised children diagnosed with cancer under 15 years or recorded as having died of cancer. Four controls per case were matched by age and gender. RISK FACTORS TESTED Maternal age, body mass index, social class, marital status and smoking as well as pre-eclampsia, antepartum haemorrhage and previous miscarriage, gestational age, birth weight and Apgar scores were compared between groups to test for association with cancer. ORs with 95% CIs were calculated using conditional logistic regression in univariable and multivariable models. RESULTS Of the maternal characteristics tested, mother's age at delivery (cases mean 28.9 (SD 5.6) years vs controls mean 30.2 (SD 4.6), p=0.002) and smoking status (38.6% smokers among cases, 29.7% among controls, p=0.034) were found to be different between groups. Of the perinatal factors tested, low Apgar score at 5 min (adjusted OR (AOR) 4.59, 95% CI 1.52 to 13.87) and delivery by caesarean section (AOR 1.95, 95% CI 1.30 to 2.92) showed statistically significant associations with childhood cancer in the multivariable model. CONCLUSIONS Younger maternal age, maternal smoking, delivery by caesarean section and low Apgar score at 5 min were independently associated with increased risk of childhood cancer. These general findings should be interpreted with caution as this study did not have the power to detect any association with individual diagnostic categories of childhood cancer.
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Affiliation(s)
- Sohinee Bhattacharya
- Epidemiology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Epidemiology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Dong Pang
- Institute of Health Research, University of Bedfordshire, Bedfordshire, UK
| | - Gary J Macfarlane
- Epidemiology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Shankaran S, Pappas A, McDonald SA, Vohr BR, Hintz SR, Yolton K, Gustafson KE, Leach TM, Green C, Bara R, Petrie Huitema CM, Ehrenkranz RA, Tyson JE, Das A, Hammond J, Peralta-Carcelen M, Evans PW, Heyne RJ, Wilson-Costello DE, Vaucher YE, Bauer CR, Dusick AM, Adams-Chapman I, Goldstein RF, Guillet R, Papile LA, Higgins RD. Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med 2012; 366:2085-92. [PMID: 22646631 PMCID: PMC3459579 DOI: 10.1056/nejmoa1112066] [Citation(s) in RCA: 508] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We previously reported early results of a randomized trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy showing a significant reduction in the rate of death or moderate or severe disability at 18 to 22 months of age. Long-term outcomes are now available. METHODS In the original trial, we assigned infants with moderate or severe encephalopathy to usual care (the control group) or whole-body cooling to an esophageal temperature of 33.5°C for 72 hours, followed by slow rewarming (the hypothermia group). We evaluated cognitive, attention and executive, and visuospatial function; neurologic outcomes; and physical and psychosocial health among participants at 6 to 7 years of age. The primary outcome of the present analyses was death or an IQ score below 70. RESULTS Of the 208 trial participants, primary outcome data were available for 190. Of the 97 children in the hypothermia group and the 93 children in the control group, death or an IQ score below 70 occurred in 46 (47%) and 58 (62%), respectively (P=0.06); death occurred in 27 (28%) and 41 (44%) (P=0.04); and death or severe disability occurred in 38 (41%) and 53 (60%) (P=0.03). Other outcome data were available for the 122 surviving children, 70 in the hypothermia group and 52 in the control group. Moderate or severe disability occurred in 24 of 69 children (35%) and 19 of 50 children (38%), respectively (P=0.87). Attention-executive dysfunction occurred in 4% and 13%, respectively, of children receiving hypothermia and those receiving usual care (P=0.19), and visuospatial dysfunction occurred in 4% and 3% (P=0.80). CONCLUSIONS The rate of the combined end point of death or an IQ score of less than 70 at 6 to 7 years of age was lower among children undergoing whole-body hypothermia than among those undergoing usual care, but the differences were not significant. However, hypothermia resulted in lower death rates and did not increase rates of severe disability among survivors. (Funded by the National Institutes of Health and the Eunice Kennedy Shriver NICHD Neonatal Research Network; ClinicalTrials.gov number, NCT00005772.).
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Affiliation(s)
- Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA.
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Onalo R, Ogala WN, Ogunrinde GO, Olayinka AT, Adama SA, Ega BA. Predisposing factors to neonatal septicaemia at ahmadu bello university teaching hospital, zaria Nigeria. Niger Postgrad Med J 2011; 18:20-25. [PMID: 21445109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The study aimed at identifying the risk factors for neonatal septicaemia in Zaria. PATIENTS AND METHODS Consecutive newborns admitted into the Special Care Baby Unit of Ahmadu Bello University Teaching Hospital, Zaria with the presumptive test diagnosis of neonatal septicaemia between 25 May, 2004 and 31 May, 2005 were studied. History of events in the antenatal and neonatal periods was obtained and physical examination was done. Blood, urine, cerebrospinal fluid and swabs of body discharges were taken for culture and sensitivity studies. The data were analysed using Epi Info version 6 software. Associations were tested using Chi square, with Yates correction, or Fisher's exact tests where appropriate, while statistical significance was set at p < 0.05. RESULTS A total of 211 neonates, consisting of 69 in-born and 142 out-born infants were studied. There were 122 (57.8%) males and 89 (42.2%) females; giving a male: female ratio of 1.4:1. Seventy-five (35.5%) of the newborns had bacteriologically proven septicaemia consisting of 54 (38.0%) of the outborn and 21 (30.4%) of the inborn babies (p = 0.3535); 42 males and 33 females (p = 0.8011). The male: female ratio of newborns with culture-proven septicaemia was 1.2:1. The predisposing factors that were associated with culture-proven septicaemia were lack of antenatal care (p = 0.0234), prolonged rupture of membranes (p = 0.0085), prolonged labour (p = 0.0032), preterm delivery (p = 0.0125) and perinatal asphyxia (p = 0.0078). CONCLUSION The risk factors in neonates with septicaemia in this study emphasise the need for timely improvement in the implementation of existing public health strategies.
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Affiliation(s)
- R Onalo
- Departments of Paediatrics, Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria Nigeria.
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Teisseyre N, Vanraet C, Sorum PC, Mullet E. The acceptability among lay persons and health professionals of actively ending the lives of damaged newborns. Monash Bioeth Rev 2010; 20:1-24. [PMID: 22032021 DOI: 10.1007/bf03351524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Euthanasia is performed on occasion, even on newborns, but is highly controversial, and it is prohibited by law and condemned by medical ethics in most countries. AIM To characterise and compare the judgments of lay persons, nurses, and physicians of the acceptability of actively ending the life of a damaged newborn. METHODS Convenience samples of 237 lay persons, 214 nurses, and 76 physicians in the south of France rated the acceptability on a scale of 0-10 of giving a lethal injection in 54 scenarios composed of all combinations of 4 within-subject factors: gestational age of 6, 7, or 9 months; 3 levels of severity of either perinatal asphyxia or of genetic disease; attitude of the parents about prolonging care unknown, favourable, or unfavourable; and decision made individually by the physician or collectively by the medical team. Overall ratings were subjected to cluster analysis and each cluster to analysis of variance and graphic representation. RESULTS Lay persons (mean acceptability rating 4.29) were significantly more favourable to euthanasia than nurses (2.84), p < .005, or physicians (2.12), p < .005. Five clusters were found with different judgment rules, i.e., how the information was integrated. More physicians (30 per cent) than nurses (14 per cent), p < .01, or lay persons (11 per cent), p < .01, rated euthanasia as never, under any condition, acceptable. Most, however, asserted that it was increasingly acceptable as the factors combined to favour it, especially when the parents desired to stop treatment. More physicians (45 per cent) and nurses (46 per cent) than lay persons (21 per cent), p < .01, used a complex conjunctive rule (level of parent's attitude x level of severity of damage x consultation with team or not) rather than a simple additive rule. CONCLUSIONS Unlike law and medical ethics, most of the lay persons, nurses, and physicians judged the acceptability of euthanasia as a function of the circumstances. Most health professionals combined the factors in a conjunctive (multiplicative), rather than additive, fashion in accordance with legislation for adults in The Netherlands and elsewhere that requires a set of criteria to be fulfilled before it is legitimate to end a patient's life.
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HALL JG. ON THE NEUROPATHOLOGICAL CHANGES IN THE CENTRAL NERVOUS SYSTEM FOLLOWING NEONATAL ASPHYXIA, WITH SPECIAL REFERENCE TO THE AUDITORY SYSTEM IN MAN. Acta Otolaryngol 2009; 188:SUPPL 188:331+. [PMID: 14146694 DOI: 10.3109/00016486409134584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhang Y, Dong WB, Li QP, Deng CL, Xiong T, Lei XP, Guo L. [Role of Omi/HtrA2 in renal tubular cells apoptosis induced by post asphyxial serum of neonate]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2009; 21:346-348. [PMID: 19570340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the mechanism of inducing apoptosis of Omi/HtrA2 in renal tubular cells with post asphyxial serum of neonate. METHODS Human renal proximal tubular cell line HK-2 cell was used as target cell. They were divided into three groups: control group, asphyxia group and Ucf-101 (Omi/HtrA2 special inhibitor) treated group. The challenge concentration of serum obtained from neonates 24 hours after asphyxia was 20%, and the treatment concentration of Ucf-101 was 10 mumol/L. The Omi/HtrA2 translocation in renal tubular cells was observed with confocal microscopy, and the rate of apoptosis was detected with flow cytometer. RESULTS It was found that Omi/HtrA2 was translocated into cytoplasm in asphyxia group, and the rate of Omi/HtrA2 translocation in HK-2 cells of asphyxia group was significantly increased [(28.1+/-3.6)% vs. (9.4+/-2.1)%, P<0.01]. Compared with the control group, after being treated with post asphyxial serum, the rate of apoptosis of HK-2 cells in asphyxia group was significantly increased [(36.3+/-4.4)% vs.(12.4+/-2.9)%, P<0.01]. Compared with asphyxia group, the rate of apoptosis in HK-2 cells in Ucf-101 treated group was significantly decreased [(27.0+/-3.9)% vs.(36.3+/-4.4)%, P<0.01]. CONCLUSION These experimental data demonstrates that post asphyxial serum of neonate can induce apoptosis of HK-2 cells, and translocation of Omi/HtrA2 from mitochondria into cytoplasm may play an important role in its intracellular signal transduction mechanism in induction of apoptosis.
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Affiliation(s)
- Yong Zhang
- Department of Newborn Medicine, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, Sichuan, China
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Zachau-Christiansen B. Complications during pregnancy, delivery and neonatal period in relation to development in the first year. Acta Neurol Scand 2009; 43:43-4. [PMID: 5583273 DOI: 10.1111/j.1600-0404.1967.tb02048.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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