Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission.

AIM: The aim of this study was to develop and validate an antepartum risk score based on maternal and obstetric characteristics to predict the requirement for neonatal intensive care unit (NICU) admission among late preterm infants. MATERIAL AND METHODS: A chart review was performed of 455 singleton late preterm deliveries at our institution between July 2010 and December 2011. Logistic regression analysis was used to develop a risk score, which was derived from ß coefficients of the significant variables. A receiver-operator curve was plotted to determine the optimal cut-off score for predicting NICU admission. Validation of the score was tested in another cohort of 450 women who delivered a singleton late preterm infant between January 2012 and June 2013. RESULTS: A total of 98 infants (21.5%) in the development cohort were admitted to the NICU. The significant factors for NICU admission included: premature rupture of membranes, antepartum hemorrhage, medical disorders during pregnancy, prenatal estimation of fetal weight, gestational age at delivery, and mode of delivery. These six variables were integrated into a risk-scoring model, which ranged from -2 to 9 points. A cut-off score of ≥1 produced the maximum area under the receiver-operator curve of 0.764. At this cut-off point, the sensitivity was 79.6% and specificity was 73.1%. When the risk score was tested in the validation cohort, similar results were demonstrated. CONCLUSION: An antepartum risk score was developed to predict the requirement for NICU admission among late preterm infants and was validated in an independent cohort.

Effectiveness of double-surface intensive phototherapy versus single-surface intensive phototherapy for neonatal hyperbilirubinemia.

OBJECTIVE: To compare the efficacy and adverse effects of double-surface intensive phototherapy (DsIPT) and single-surface intensive phototherapy (SsIPT) in term newborn infants with hyperbilirubinemia. DESIGN: Prospective randomized controlled trial. MATERIAL AND METHOD: Healthy full-term infants with nonhemolytic hyperbilirubinemia (total serum bilirubin between 13.0 to 19.9 mg/dl) were allocated randomly to two modes of phototherapy. Group 1 infants received single-surface intensive phototherapy. Group 2 infants received double-surface intensive phototherapy Serum bilirubin, body weight, body temperature and number of defecation were measured at 24 and 48 hours after phototherapy. RESULTS: Sixty infants were studied, 30 in each group. Baseline characteristics were similar in both groups. The initial mean serum bilirubin had no statistically significant difference between SsIPT and the DsIPT groups. After 24 and 48 hours of phototherapy, mean serum bilirubin in the group receiving SsIPT declined 3.5 +/- 1.7 and 6.5 +/- 2.3 mg/dl, while in the DsIPT group, the mean serum bilirubin declined 5.4 +/- 2.0 and 8.4 +/- 2.1 mg/dl respectively. The mean body temperature after 24 hours of phototherapy in the DsIPT group was higher than SsIPT group significantly. The number of defecation in the SsIPT group increased significantly after 24 and 48 hours of phototherapy, but the body weight change in both groups was not statistically significant. CONCLUSION: DsIPT was significantly more effective in reducing serum bilirubin than SsIPT in the term jaundiced infants after 24 and 48 hours of treatment. The adverse effect of DsIPT found in the present study was the increased of body temperature after 24 hours of phototherapy.