A retrospective data analysis on prevalence and risk factors for hypothermia among sick neonates at presentation to the neonatal intensive care unit of the Tamale Teaching Hospital.

Neonatal hypothermia, defined as an axillary temperature of <36.5C in a neonate, is common in neonatal intensive care units and is almost universal across all geographic and climatic regions of the world. This is even though environmental temperature is a known risk factor for its occurrence. We conducted a retrospective study in the Neonatal Intensive Care Unit of the Tamale Teaching Hospital (TTH) to document the prevalence and risk factors associated with hypothermia at presentation to the hospital. The study spanned the period from January 2019 to December 2019 and involved all neonates with axillary temperature documented at the time of admission. The prevalence of neonatal hypothermia in this study was 54.76%. Hypothermia was most common in neonates diagnosed with meconium aspiration syndrome (87/105, 82.86%), prematurity and low birth weight (575/702, 81.91%), and birth asphyxia (347/445, 77.98%). Neonates who were delivered vaginally were less likely to develop hypothermia compared to those delivered via Cesarean section. Inborn neonates (delivered in TTH) were 3.2 times more likely to be hypothermic when compared to those who were delivered at home. Neonates with low birth weight and APGAR scores < 7 at 1 and 5 minutes were more likely to be hypothermic. The dry season was found to be protective against hypothermia when compared to the rainy season. The overall mortality rate was 13.68% and the mortality in the subgroup with hypothermia at presentation was 18.87%. Our study documented a high prevalence of hypothermia with higher rates in neonates requiring intervention at birth. It is therefore crucial for perinatal care providers to adhere to the warm chain precautions around the time of birth.

Impact of perinatal factors on meconium aspiration syndrome in full-term newborns and the construction of a column chart prediction model: An observational study.

To explore the influence of perinatal-related factors on meconium aspiration syndrome (MAS) in full-term neonates and construct a nomogram prediction model for risk stratification of neonatal MAS and adoption of preventive measures. A total of 424 newborns and their mothers who were regularly examined at our hospital between January 2020 and December 2023 who had meconium-contaminated amniotic fluid during delivery were retrospectively selected as participants. Neonates were divided into MAS and non-MAS groups based on whether MAS occurred within 3 days after birth. Data from the 2 groups were analyzed, and factors influencing MAS were screened using multivariate logistic regression analysis. The R3.4.3 software was used to construct a nomogram prediction model for neonatal MAS risk. Receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the performance of the model, and its clinical effectiveness was evaluated using a decision curve. Among the 424 neonates with meconium-stained amniotic fluid, 51 developed MAS within 3 days of birth (12.03%). Multivariate logistic regression analysis showed that a low amniotic fluid index before delivery (OR = 2.862, P = .019), advanced gestational age (OR = 0.526, P = .034), cesarean section (OR = 2.650, P = .013), severe amniotic fluid contamination (OR = 4.199, P = .002), low umbilical cord blood pH (OR = 2.938, P = .011), and low neonatal Apgar 1-min score (OR = 3.133, P = .006) were influencing factors of MAS in full-term neonates. Based on the above indicators, a nomogram prediction model for MAS risk of full-term newborns was constructed. The area under the ROC curve of the model was 0.931. The model was also tested for goodness-of-fit deviation (χ2 = 3.465, P = .903). Decision curve analysis found that the model was clinically effective in predicting the net benefit of MAS risk in neonates with meconium-stained amniotic fluid. The construction of a column chart prediction model for neonatal MAS risk based on prenatal amniotic fluid index, gestational age, delivery method, amniotic fluid contamination level, newborn umbilical blood pH value, and Apgar 1-min score has a certain application value.

Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome.

BACKGROUND: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome. METHODS: This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied. RESULTS: Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them. CONCLUSIONS: Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios.

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study.

Background: The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia. Methods: A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI. Result: There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups. Conclusion: Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Meconium-stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy.

INTRODUCTION: Our objective was to study the strength of the association between meconium-stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. MATERIAL AND METHODS: This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41+0 weeks of gestation onwards with a single live fetus in cephalic presentation. This analysis excluded patients with a cesarean delivery before labor and those with bloody amniotic fluid or of unreported consistency. The principal end point was a composite criterion of severe neonatal morbidity (neonatal death, 5-minute Apgar <7, convulsions in the first 24 h, meconium aspiration syndrome, mechanical ventilation ≥24 h, or neonatal intensive care unit admission for 5 days or more). The neonatal outcomes of pregnancies with thin or thick meconium-stained amniotic fluid were compared with those with normal amniotic fluid. The association between the consistency of the amniotic fluid and neonatal morbidity was tested by univariate and then multivariate analysis adjusted for gestational age at birth, duration of labor, and country of birth. RESULTS: This study included 1274 patients: 803 (63%) in the group with normal amniotic fluid, 196 (15.4%) in the thin amniotic fluid group, and 275 (21.6%) in the thick amniotic fluid group. The neonates of patients with thick amniotic fluid had higher rates of neonatal morbidity than those of patients with normal amniotic fluid (7.3% vs. 2.2%; p < 0.001; adjusted relative risk [aRR] 3.3, 95% confidence interval [CI] 1.7-6.3), but those of patients with thin amniotic fluid did not (3.1% vs. 2.2%; p = 0.50; aRR 1.0, 95% CI, 0.4-2.7). CONCLUSIONS: Among nulliparas at 41+0 weeks onwards, only thick meconium-stained amniotic fluid is associated with a higher rate of severe neonatal morbidity.

Perinatal risk factors associated with the need for resuscitation in newborns born through meconium-stained amniotic fluid.

OBJECTIVE: The Neonatal Life Support 2020 guidelines emphasize that meconium-stained amniotic fluid (MSAF) remains a significant risk factor for a newborn to receive advanced resuscitation, especially if additional risk factors are present at the time of birth. However, these additional perinatal risk factors are not clearly identified. The purpose of this study was to evaluate the importance of additional independent ante- and intrapartum risk factors in the era of no routine endotracheal suctioning that determine the need for resuscitation in newborns born through MSAF. METHODS: This retrospective cohort study included deliveries ≥ 35 weeks' gestation associated with MSAF that occurred between January 1, 2017 and December 31, 2019. The newborns needing resuscitation (any intervention beyond the initial steps) were compared to those not needing resuscitation. Among newborns needing resuscitation, those needing advanced resuscitation (continuous positive airway pressure/ positive pressure ventilation or beyond) were compared to those not needing advanced resuscitation. RESULTS: Logistic regression analysis revealed that among various perinatal factors, primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age ≥ 42 weeks), cesarean section or shoulder dystocia independently significantly increased the odds of a meconium-stained newborn needing resuscitation. Among these factors, fetal distress, chorioamnionitis or cesarean section independently further increased the odds of needing advanced resuscitation. CONCLUSION: Risk stratification of perinatal factors associated with the need for newborn resuscitation and advanced resuscitation in the deliveries associated with MSAF may help neonatal teams and resources to be appropriately prioritized and optimally utilized.

Investigation of the outbreaks of abortions and orchitis in livestock in Namibia during 2016-2018.

This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to 2018, affecting cattle, sheep and goats. Fifty-nine questionnaires were administered, and 48 were completed giving an 81.4% return. The outbreaks were limited to Namibia's east and central regions, mainly on farms rearing cattle, sheep and goats and on farms with a mixture of these species. There was no significant difference between Khomas and other regions on abortion reporting at the farm level [X2 (1, N = 48) = 0.0002, p = 0.987851]. However, there was a significant difference in the abortions at the animal level among the three regions [X2 (2, N = 6246) = 239.8339, p = .00001]. In addition, the proportions of abortions calculated at the animal level at each farm were significantly different when the Khomas region was compared to the other regions. Seventeen cattle sera, 35 sheep sera, 52 caprine sera, 18 bovine liver samples, one caprine liver, five aborted cattle foetuses, two cattle placentas, 18 testes (one bull, eight bucks and nine rams) and ten bull sheath scrapings were collected and tested. Histopathology, microbiology, serology, immunohistochemistry, real-time PCR and mineral analytical techniques were used to establish the aetiology of the abortion and orchitis outbreaks. The gross and histopathological findings on the 18 testicles were characteristic of chronic orchitis. In aborted foetuses, significant histopathological findings included meconium aspiration, funisitis and cardiomyopathy. Placentitis and endometritis were the primary pathologies observed in cows. The bacteria isolated from microbiological samples included Enterococcus spp. (65.5% [19/29]), Enterobacter spp. (6.9% [2/29]) and Streptococcus spp. (10.3% [3/29]), Trueperella pyogenes (3.4% [1/29]), Stenotrophomonas maltophilia (3.4% [1/29]), Staphylococcus epidermidis (3.4% [1/29]), Providencia rettgeri (3.4% [1/29]) and Acinetobacter lwoffii (3.4% [1/29]), mostly opportunistic bacteria. On mineral analysis, 28%, 33%, 83%, 33% and 17% (n = 18) of cattle livers were low in copper, zinc, manganese, selenium and iron, respectively. Twenty-three percent (12/52) of the caprine sera were positive for Brucella melitensis on the Rose Bengal and complement fixation tests. Thirty-five ovine sera were tested for B. melitensis, B. ovis and Coxiella burnetii, and the prevalence for each was 2.9% (1/35). PCR tests on foetuses were all negative for Brucella spp., Coxiella burnetii, Chlamydia spp., Listeria monocytogenes, Salmonella spp., Campylobacter fetus spp., Leptospira pathogenic strains, bovine viral diarrhoea virus, Rift Valley fever virus, Anaplasma phagocytophilum and bovine herpes virus 4 Campylobacter fetus spp. and Trichomonas foetus spp. The authors concluded that Brucella spp., Enterococcus spp., Escherichia coli, Streptococcus spp., Trueperella pyogenes and Coxiella burnetii could have contributed to this outbreak. Micronutrient imbalances and pathogenic abiotic nanoparticles were also identified as possible contributors to the abortion outbreaks.

The risk of meconium aspiration syndrome (MAS) increases with gestational age at term.

OBJECTIVE: To examine the risk of meconium aspiration syndrome (MAS) by the week of gestational age in pregnancies with meconium-stained amniotic fluid (MSAF). METHODS: This is a retrospective cohort study derived from term pregnancies at a single tertiary institution over an 18-year period. Outcomes analyzed included MAS, acidemia, and Apgar scores. Univariate analysis was performed using chi-square and multivariable logistic regression was used to adjust for potential confounders. RESULTS: A total of 34,303 deliveries ≥37 weeks were included; 23.7% were complicated by MSAF. Of the total study cohort, 272 (0.7%) neonates were diagnosed with MAS; this represented 3% of all deliveries complicated by MSAF. In the presence of MSAF, the risk of MAS increased with gestational age, from 1.3% at 38 weeks to 4.8% at 42 weeks (p < .001). Similarly, the risk of acidemia increased from 3.0% at 38 weeks to 7.0% at 42 weeks (p < .001). These findings were also demonstrated in patients with MAS in the absence of MSAF. The risk for both MAS and acidemia in the presence of MSAF persisted after controlling for potential confounders (aOR 1.31 [95% CI 1.18-1.46] and 1.20 [95% CI 1.05-1.37], respectively). CONCLUSION: In women with MSAF, as gestational age increases, the risk of meconium aspiration syndrome also increases. Other factors with late-term and post-term pregnancy besides the presence of meconium may contribute to the evolution of MAS.

Prolonged exposure to meconium in cases of spontaneous premature rupture of membranes at term and pregnancy outcome.

OBJECTIVE: To evaluate the impact of prolonged exposure to meconium-stained amniotic fluid (MSAF), in women with term pre-labor spontaneous rupture of membranes (PROM), on pregnancy outcome. METHODS: A retrospective cohort study of women who gave birth in a single university-affiliated tertiary medical center (2011-2019). Eligibility was limited to singleton pregnancies at term who presented with PROM. Women with MSAF were immediately induced and were compared to low-risk pregnant women with clear amniotic fluid (CAF) at admission who underwent induction of labor 24 h after rupture of membranes. All women were stratified into 4-time frame groups from rupture of membranes to delivery: T0: 0-7 h, T1: 8-13 h, T2: 14-18 h, and T3: > 18 h for the MSAF group. The time frames for the CAF were: T0 - 24-31 h, T1: 32-38 h, T2: 40-44 h, and T3: > 44 h. The maternal adverse composite outcome included any of the following: intrapartum fever (IPF), prolonged second stage (PSS), need for manual removal of suspected retained placenta, postpartum hemorrhage, and readmission within 45 days after delivery. The adverse composite neonatal outcome included one or more of the following: meconium aspiration syndrome, neonatal asphyxia, need for respiratory support, and intracranial hemorrhage. RESULTS: Overall, 1631 women met the inclusion criteria (536 in the MSAF and 1095 in the CAF group). Both groups showed a gradual decrease in the rate of vaginal delivery over time, the vaginal delivery rate in the MSAF group was 75.7% at T0 in comparison to 61.6% at T3 (p < .001). In the CAF group, the vaginal delivery rate was 84.5% at T0 in comparison to 68.8% at T3 (p < .001). This decrease was in concomitance with an increase in the rates of prolonged second-stage and intrapartum fever. There were no significant differences in the rates of postpartum hemorrhage, suspected retained placenta, or readmission within 45 days between women with either MSAF or CAF. There was a significant gradual increase in the adverse composite neonatal outcome in the MSAF group (1.9% at T0, 5.2% at T1, 6.0% at T2, and 8.2% at T3. p = .038). No similar increase was found in the CAF group (2.5% at T0, 4.1% at T1, 2.6% at T2, and 4.1% at T3. p = .449). CONCLUSION: Prolonged rupture of membranes in the presence of meconium does not affect maternal outcomes, however, prolonged exposure to meconium lead to an increased adverse neonatal outcome.

Prediction of meconium aspiration syndrome by data available before delivery.

OBJECTIVE: To identify risk factors associated with the occurrence of meconium aspiration syndrome (MAS) among neonates. METHODS: A retrospective case-control study in a university affiliated tertiary medical center, including all neonates born with meconium stained amniotic fluid (MSAF) between March 2011 and March 2020. Patients were categorized by the occurrence of MAS. Demographic, pregnancy and delivery characteristics were compared between the two groups. Risk factors for MAS were analyzed. RESULTS: Of 90 579 singleton deliveries, a total of 11 856 with MSAF were included. Of these newborns, 78 (0.66%) were diagnosed with MAS Four factors were independently associated with MAS: delivery at <38 0/7 weeks (aOR [95% CI]: 3.48 (1.02-11.84), P = 0.046); higher body mass index (aOR [95% CI]: 1.09 (1.02-1.16), P = 0.003); lower amniotic fluid index (aOR [95% CI]: 0.99 (0.98-0.99), P = 0.032); higher white blood cell count (aOR [95% CI]: 1.11 (1.02-1.20), P = 0.009). The presence of one, two and three of the above-mentioned risk factors yielded a risk for MAS of 0.8%, 2.5% and 100%, respectively. CONCLUSION: We identified independent risk factors for MAS and developed a risk score calculator. This tool may assist physicians in the management of deliveries complicated by MSAF.

Neonates Born Through Meconium-stained Amniotic Fluid among Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: The mortality and morbidity of meconium aspiration syndrome in neonates born with meconium-stained amniotic fluid in developing countries are still high. In Nepal, few studies have estimated the prevalence of meconium-stained amniotic fluid among newborns. The study aimed to find out the prevalence of neonates born through meconium-stained amniotic fluid among deliveries in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among neonates born in a tertiary care centre from November 2021 to March 2022. Neonates born during the study period with meconium-stained amniotic fluid were studied. Ethical approval was obtained from the Institutional Review Committee. Convenience sampling method was used. With permission from the Department of the Neonatal Intensive Care Unit, the data were collected and entered in a Microsoft Excel sheet. Point estimate and 95% Confidence Interval were calculated. Results: Among 576 neonates, the prevalence of neonates born through meconium-stained amniotic fluid was 77 (13.37%) (10.59-16.15, 95% Confidence Interval). Conclusions: The prevalence of neonates born through meconium-stained amniotic fluid was found to be similar to other studies done in similar settings. Keywords: meconium; neonate; Nepal.

Meconium-stained Amniotic Fluid among Term Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Although the precise aetiology of meconium-stained amniotic fluid is still unclear, risk factors include advanced gestational age at delivery, mode of delivery, the prolonged second stage of labour, and intrauterine infection. It has been associated with poor perinatal outcomes including low Apgar scores, increased incidence of neonatal intensive care admission, and a high rate of perinatal death. The objective of the study was to find out the prevalence of meconium-stained amniotic fluid in term deliveries in a tertiary care centre. Methods: A descriptive cross-sectional study was done among term deliveries in the Department of Obstetrics and Gynaecology, in a tertiary care centre from inpatient records starting from 1 November 2019 to 1 November 2020 after obtaining ethical approval from the Institutional Review Committee (Reference number: PMG1911281316). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Out of 1699 term deliveries, meconium-stained amniotic fluid was seen in 91 (5.35%) (4.28-6.42, 95% Confidence Interval). Among these 69 (75.82%) newborns were delivered through lower segment caesarean section and 61 (67%) newborns had Grade II meconium-stained amniotic fluid. Conclusions: The prevalence of meconium-stained amniotic fluid was similar to the studies done in similar settings. Keywords: apgar score; caesarean section; gestational age; perinatal death; pregnancy.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Ovarian Cancer.

OBJECTIVE: To evaluate the outcomes of the first pregnancy after fertility-sparing surgery in patients treated for early-stage ovarian cancer. METHODS: We performed a retrospective study of women aged 18-45 years with a history of stage IA or IC ovarian cancer reported to the California Cancer Registry for the years 2000-2012. These data were linked to the 2000-2012 California Office of Statewide Health Planning and Development birth and discharge data sets to ascertain oncologic characteristics and obstetric outcomes. We included in the case group ovarian cancer patients who conceived at least 3 months after fertility-sparing surgery. The primary outcome was preterm birth, and only the first pregnancy after cancer diagnosis was considered. Secondary outcomes included small-for-gestational-age (SGA) neonates, neonatal morbidity (respiratory support within 72 hours after birth, hypoxic-ischemic encephalopathy, seizures, infection, meconium aspiration syndrome, birth trauma, and intracranial or subgaleal hemorrhage), and severe maternal morbidity as defined by the Centers for Disease Control and Prevention. Propensity scores were used to match women in a 1:2 ratio for the case group and the control group. Wald statistics and logistic regressions were used to evaluate outcomes. RESULTS: A total of 153 patients who conceived after fertility-sparing surgery were matched to 306 women in a control group. Histologic types included epithelial (55%), germ-cell (37%), and sex-cord stromal (7%). Treatment for ovarian cancer was not associated with preterm birth before 37 weeks of gestation (13.7% vs 11.4%; odds ratio [OR] 1.23, 95% CI 0.69-2.20), SGA neonates (birth weight less than the 10th percentile: 11.8% vs 12.7%; OR 0.91, 95% CI 0.50-1.66), severe maternal morbidity (2.6% vs 1.3%; OR 2.03, 95% CI 0.50-8.25), or neonatal morbidity (both 5.9% OR 1.00, 95% CI 0.44-2.28). CONCLUSION: Patients who conceived at least 3 months after surgery for early-stage ovarian cancer did not have an increased risk of adverse obstetric outcomes.

Fetal Outcome in Cesarean Versus Normal Deliveries in Pregnancy with Meconium-stained Liquor: A Cross-sectional Study.

BACKGROUND: Intrauterine meconium passage in near term or term fetuses has been associated with feto-maternal stress factors and/or infection and is contributing to the increased rate of cesarean section. This study aimed to evaluate effect of mode of delivery on fetal outcome in pregnancy with meconium-stained liquor. METHODS: A cross sectional study was done in 2019 at a tertiary care center. Data was collected from women in labor, in whom meconium was seen after rupture of membrane. Out of these, 115 cases, who underwent cesarean delivery for meconium-stained liquor were enrolled in one group; while in another group 115 cases who delivered vaginally were enrolled and the fetal outcome was compared in between these two groups. RESULTS: Out of 230 cases, most participants were from 21 to 25 years age group. Most of patients were primigravida accounting for 63%, and with mean gestational age of 39.4 weeks. Low Apgar score at one and 5 minutes, percentage of respiratory distress, perinatal asphyxia, need of bag and mask ventilation as mode of resuscitation were associated more with vaginal deliveries. Incidence of Neonatal Intensive Care Unit admission, meconium aspiration syndrome, and neonatal death were seen more in vaginal delivery in comparison to cesarean delivery. CONCLUSIONS: There was no much difference in Apgar score at 5 minutes in either mode of delivery. Incidence of respiratory distress, perinatal asphyxia, Neonatal Intensive Care Unit admission, meconium aspiration syndrome and neonatal death were higher in vaginal delivery. Fetal morbidity and mortality were seen more in moderate to thick meconium-stained liquor.

Mild Neonatal Acidemia is Associated with Neonatal Morbidity at Term.

OBJECTIVE: The aim of this study is to determine the association between mild acidemia (umbilical artery [UA] pH: 7.11-7.19) and neonatal morbidity in neonates at term. STUDY DESIGN: This is a secondary analysis of a prospective cohort of women admitted for labor at ≥37 weeks of gestation within a single institution from 2010 to 2015. Universal umbilical cord blood gas assessment was performed and validated. A composite neonatal morbidity index was created including respiratory distress, mechanical ventilation, meconium aspiration syndrome, suspected or confirmed sepsis, hypoxic-ischemic encephalopathy, need for therapeutic hypothermia, seizures and death. The cohort was stratified by UA pH into normal (≥7.20), mild acidemia (7.11-7.19), acidemia (7.00-7.10), and severe acidemia (≤7.00). A subanalysis was also performed where neonates with UA pH between 7.11 and 7.19 were further stratified into two groups (7.11-7.14 and 7.15-7.19) to determine if mildly acidotic infants at the lower end of the pH range were at increased risk of morbidity. Multivariable logistic regression was used to estimate the association between UA pH and neonatal morbidity. RESULTS: Among 6,341 participants, 614 (9.7%) had mild acidemia. These infants were more likely to experience morbidity compared with those with normal UA pH (adjusted odds ratio [aOR]: 2.14; [1.68-2.73]). Among neonates with mild acidemia, UA pH 7.11 to 7.14 was associated with increased risk of composite neonatal morbidity (aOR: 3.02; [1.89-4.82]), as well as respiratory distress and suspected or confirmed sepsis when compared with UA pH 7.15 to 7.19. CONCLUSION: These data demonstrate that term neonates with mild acidemia at birth are at higher odds for short-term morbidity compared with neonates with normal UA pH. Furthermore, among neonates with mild acidemia, those with lower UA pH had worse neonatal outcomes than those with higher UA pH. This suggests that closer evaluation of neonates with UA pH higher than traditionally used could allow for earlier detection of morbidity and possible intervention. KEY POINTS: · Neonates with mild acidemia (umbilical artery [UA] pH: 7.11-7.19) demonstrated an increased risk of composite morbidity compared with those with normal UA pH (≥7.20).. · Among neonates with mild acidemia, those with lower UA pH (7.11-7.14) had a greater risk of morbidity compared with those with higher UA pH (7.15-7.19), suggesting a progression of risk of morbidity as UA pH decreases.. · The majority of prior research has focused on severe acidemia (UA pH ≤ 7.00) using outcomes of severe neurologic morbidity and mortality. These data suggest that an increased risk of morbidity exists at higher pH values when more proximal and less severe outcomes are included, such as respiratory distress and neonatal sepsis..

Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis.

BACKGROUND: We investigated the impact of policy change in delivery room resuscitation from routine endotracheal (ET) suctioning of non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) to immediate non-invasive respiratory support. DESIGN: Single-centre cohort study. Prospective group (October 2016-September 2017)-non-vigorous neonates born through MSAF managed according to the current (2015) guidance of commencing respiratory support without prior suctioning. Retrospective group (August 2015-July 2016)-non-vigorous neonates born through MSAF who underwent routine ET suctioning. RESULTS: 1138 neonates born through MSAF were analysed. No differences in the incidence of meconium aspiration syndrome (MAS), requirement of mechanical ventilation, inhaled nitric oxide or surfactant therapy were found between groups. Less neonatal intensive care unit (NICU) admissions were necessary in the prospective cohort compared with the retrospective group (19.1% vs 55.6%, respectively; p<0.05). CONCLUSION: The policy change towards not routinely suctioning non-vigorous neonates born through MSAF at birth was not associated with an increase in the local incidence of MAS and was associated with fewer NICU admissions.

Association of Neonatal Hypothermia with Morbidity and Mortality in a Tertiary Hospital in Malawi.

OBJECTIVES: To evaluate associations with neonatal hypothermia in a tertiary-level neonatal unit (NU) in Malawi. METHODS: Neonates with a birth weight >1000 g were recruited and temperatures were recorded 5 min after birth, on admission and 4 h thereafter. Clinical course and outcome were reviewed. Data were analysed using Stata v.15 and p < 0.05 was considered statistically significant. RESULTS: Between August 2018 to March 2019, 120 neonates were enrolled, and 112 were included in the data analysis. Hypothermia at 5 min after birth was noted in 74%, 77% on admission to the NU and 38% at 24 h. Neonates who had hypothermia 5 min after birth were more likely to have hypothermia on admission to the NU compared with normothermic subjects (p < 0.01). All neonates with hypothermia on admission to the NU died (100 vs.72%, p = 0.02), but hypothermia at 5 min nor at 24 h were not associated with mortality. After adjusting for potential confounders, the odds ratio of hypothermia at 5 min for hypothermia on admission to NU was 13.31 (95% CI 4.17-42.54). DISCUSSION: A large proportion of hospitalized neonates is hypothermic on admission and has associated morbidity and mortality. Our findings suggest that a strong predictor of mortality is neonatal hypothermia on admission to the NU, and that early intervention in the immediate period after delivery could decrease the incidence of hypothermia and reduce associated morbidity and mortality.

Risk Factors of Respiratory Diseases Among Neonates in Neonatal Intensive Care Unit of Qena University Hospital, Egypt.

Background: Respiratory diseases in newborns are considered major causes of neonatal morbidity and mortality especially in developing countries. Its causes are diverse and require early detection and management. This study aimed for detection of the prevalence and risk factors of respiratory diseases in addition to outcome among neonates admitted in neonatal intensive care unit. Methods: Our study was a prospective observational study that was undertaken at the neonatal intensive care unit of Qena University Hospital, Egypt from July 2017 to July 2018. Demographic and clinical data of newborns and their mothers were evaluated and tabulated. Results: In this period, 312 neonates were admitted to the neonatal intensive care unit, out of them 145 suffered respiratory diseases giving a prevalence of (46.5%), and (55.9%) were males. The mean neonatal age at admission was 4.33 ± 7.19 days and mean gestational age was 34.49 ± 3.31 weeks. The most common detected respiratory diseases were respiratory distress syndrome (RDS; 49.6%), transient tachypnea of newborn (TTN; 22%), neonatal pneumonia (17.2%) and meconium aspiration syndrome (MAS; 6.21%). Premature rupture of membrane (PROM), maternal diabetes and fetal prematurity had the highest risk factors for respiratory diseases occurrence in neonates. Neonatal mortality rate was 26.2%, mainly due to hyaline membrane disease and pneumonia. Conclusion: Respiratory diseases constitute major part of total admission in neonatal intensive care unit especially RDS, TTN, pneumonia and MAS. Prematurity and maternal diabetes were the most important risk factors associated with respiratory diseases. Respiratory distress syndrome carried the highest risk of mortality and TTN carried the highest survival rate.