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1.
J Ayub Med Coll Abbottabad ; 32(4): 502-506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33225652

RESUMO

BACKGROUND: High mortality among premature and very low birth weight (VLBW) babies necessitates the need to formulate and use scoring systems like CRIB score to predict the mortality in this vulnerable group. Objective of the study was to determine the strength of Clinical Risk Index For Babies (CRIB) score in detecting neonatal mortality in babies presenting with very low birth weight so that timely intervention can be done. It was a cross-sectional study, conducted at NICU, Children Hospital, Pakistan Institute of Medical Sciences Islamabad (PIMS) in nine months starting from First July 2017. METHODS: A total of two hundred and fifty-four (n=254) new-borns with birth weight of between 500-1500 grams and gestational age lesser than 35 weeks were included in the study. CRIB score was calculated in all neonates and its association was assessed with mortality during NICU stay. Recorded data was analysed for demographic variables. Means and standard deviation was calculated for numeric variables. Chi-square test was applied to find p-value for the correlation between the main variables. RESULTS: 54.3% (n=138) patients were males and 45.7% (n=116) were females. Mean gestational age was 33.3 weeks±1.04 SD and mean birth weight of study population was 1129.9 grams±210.6 SD. Mean CRIB score among the study population was 6.3±3.1SD and overall mortality was found to be 54.7% (n=139). Mean CRIB score was found to be 8.27±2.1 SD among mortality group and it was 3.87±3.4 SD among newborns who were discharged (p<0.05). Mortality was present in 4.3% (n=4) of neonates with CRIB score between 1 to 5, 87.1% (n=121) who had CRIB score between 6 to 10 and 100% (n=14) of neonates who had CRIB score level 11-15 (p<0.05), so a significantly higher percentage mortality was noted among neonates with higher CRIB scores. CONCLUSIONS: According to our study mean CRIB score is a significant predictor of neonatal mortality.


Assuntos
Peso ao Nascer/fisiologia , Idade Gestacional , Nascimento Prematuro/mortalidade , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso/fisiologia , Masculino , Paquistão , Exame Físico , Gravidez , Medição de Risco
2.
Pediatrics ; 146(6)2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33203648

RESUMO

CONTEXT: Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring. OBJECTIVE: We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020. STUDY SELECTION: Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English. DATA EXTRACTION: We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses. RESULTS: Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes. LIMITATIONS: Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation. CONCLUSIONS: In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.


Assuntos
Pessoas com Deficiência , Complicações na Gravidez/mortalidade , Nascimento Prematuro/mortalidade , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Mortalidade Perinatal/tendências , Gravidez
4.
PLoS One ; 15(10): e0240465, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052937

RESUMO

BACKGROUND: Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. METHODS: A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. RESULTS: 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. CONCLUSIONS: This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.


Assuntos
Kernicterus/mortalidade , Nascimento Prematuro/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Sepse/mortalidade , Adulto , Feminino , Haiti/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Mortalidade , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto Jovem
5.
Arch Dis Child ; 105(12): 1140-1145, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32718929

RESUMO

OBJECTIVE: We sought to evaluate the association between low birth weight (LBW) and outcomes following neonatal cardiac surgery in a low-income and middle-income country setting where LBW prevalence is high and its impact on surgical outcomes is undefined. DESIGN: Single-centre retrospective cohort study. SETTING: Referral paediatric hospital in Southern India PATIENTS: All neonatal cardiac surgical cases between January 2011 and December 2018. LBW was defined as <2.5 kg. MAIN OUTCOME MEASURES: Patient demographics, corrective versus palliative surgery and postoperative outcomes were collected from the institutional database which undergoes regular audit as part of International Quality Improvement Collaborative for Congenital Heart Disease. In-hospital mortality was the primary outcome measure. RESULTS: Of 569 neonatal cardiac operations, 123 (21.6%) had LBW (mean: 2.2±0.3 kg); 18.7% <2 kg and 21.1% were preterm (<37 weeks). Surgery type (corrective vs palliative) or non-cardiac anomalies were not associated with birth weight. Birth weight did not correlate with ICU length of stay (LOS) and mechanical ventilation but was lower in those with postoperative sepsis. Overall in-hospital mortality was 7.0%; LBW neonates had higher mortality (OR 2.16, 95% CI 1.09 to 4.29, p=0.025). Multivariable analyses revealed birth weight (OR per 100 g decrease in weight: 1.12; 95% CI 1.03 to 1.22), age at surgery (OR per day increase in age of 0.93; 95% CI 0.87 to 0.99) and palliative intervention (OR 4.46 (95% CI 1.91 to 10.44) as independent predictors of in-hospital mortality. CONCLUSION: LBW adversely impacts in-hospital mortality outcomes following neonatal cardiac surgery in a resource-limited setting without increase in ICU or hospital LOS.


Assuntos
Peso ao Nascer , Países em Desenvolvimento , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar , Fatores Etários , Feminino , Humanos , Índia , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação/estatística & dados numéricos , Masculino , Cuidados Paliativos/estatística & dados numéricos , Nascimento Prematuro/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
J. obstet. gynaecol. Can ; 42(7): [ P906-917.E1], July 1, 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1117182

RESUMO

To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality.


Assuntos
Humanos , Feminino , Gravidez , Placenta Prévia/diagnóstico , Placenta Prévia/mortalidade , Cuidado Pós-Natal/organização & administração , Complicações na Gravidez/prevenção & controle , Colo do Útero/anatomia & histologia , Cesárea/instrumentação , Nascimento Prematuro/mortalidade
7.
Int J Gynaecol Obstet ; 150(1): 31-33, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32524596

RESUMO

Preterm birth is a live birth that occurs before 37 completed weeks of pregnancy. Approximately 15 million babies are born preterm annually worldwide, indicating a global preterm birth rate of about 11%. With 1 million children dying due to preterm birth before the age of 5 years, preterm birth is the leading cause of death among children, accounting for 18% of all deaths among children aged under 5 years and as much as 35% of all deaths among newborns (aged <28 days). There are significant variations in preterm birth rates and mortality between countries and within countries. However, the burden of preterm birth is particularly high in low- and middle-income countries, especially those in Southeast Asia and sub-Saharan Africa. Preterm birth rates are rising in many countries. The issue of preterm birth is of paramount significance for achieving United Nations Sustainable Development Goal 3 target #3.2, which aims to end all preventable deaths of newborns and children aged under 5 years by 2030.


Assuntos
Efeitos Psicossociais da Doença , Nascimento Prematuro/mortalidade , Criança , Pré-Escolar , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência , Desenvolvimento Sustentável
8.
Obstet Gynecol ; 135(6): 1387-1397, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459431

RESUMO

OBJECTIVE: To estimate whether improvement in outcomes from antenatal corticosteroid treatment in extremely and very preterm twins is similar to that observed in singletons, and to investigate whether antenatal corticosteroid treatment has different effects according to chorionicity or birth order. METHODS: This population-based study was based on an analysis of data collected by the Neonatal Research Network of Japan from 2003 to 2015 of neonates weighing 1,500 g or less at birth, from gestational ages of 24 0/7 to 31 6/7 weeks of gestation. After propensity score matching, univariate logistic and interaction analyses were performed to compare short-term (neonatal period) and medium-term (3 years of age) outcomes of the children of mothers who received antenatal corticosteroids with those of children of mothers who did not receive antenatal corticosteroids. We focused on differences between singletons and twins, between monochorionic and dichorionic twins and between the first and second twin. RESULTS: The study comprised 23,502 singletons and 6,546 twins. Antenatal corticosteroid treatment was associated with significant decreased short-term neurologic outcomes in both singletons and twins. However, antenatal corticosteroid treatment was associated with significantly decreased mortality (odds ratio [OR] 0.61; 95% CI 0.53-0.70), respiratory distress syndrome (OR 0.71, 95% CI 0.67-0.76), and cerebral palsy (OR 0.85, 95% CI 0.72-0.99) in singletons but not in twins (OR 0.89, 95% CI 0.68-1.17; OR 0.99, 95% CI 0.87-1.12; and OR 0.82, 95% CI 0.61-1.11, respectively). No association was found between chorionicity and the efficacy of antenatal corticosteroid treatment on outcomes. Further, no association was found between birth order and the efficacy of antenatal corticosteroid treatment on outcomes, except for periventricular leukomalacia and necrotizing enterocolitis (interaction: P=.02 and P=.04, respectively). CONCLUSION: Antenatal corticosteroid treatment in twins was associated with a beneficial effect on short-term neurologic outcomes only, without improvement in other short-term and medium-term outcomes. There was no difference related to chorionicity.


Assuntos
Corticosteroides/uso terapêutico , Doenças em Gêmeos/prevenção & controle , Gravidez de Gêmeos , Nascimento Prematuro/mortalidade , Paralisia Cerebral/prevenção & controle , Enterocolite Necrosante/prevenção & controle , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Recém-Nascido Prematuro , Japão , Leucomalácia Periventricular/prevenção & controle , Modelos Logísticos , Masculino , Morbidade , Gravidez , Nascimento Prematuro/fisiopatologia , Cuidado Pré-Natal/métodos , Sistema de Registros , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Gêmeos
9.
PLoS One ; 15(4): e0232463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353024

RESUMO

Transabdominal cerclage (TAC) is reported to be effective for preventing preterm birth in women with unsuccessful transvaginal cerclage (TVC) history. However, TAC has rarely been performed in twin pregnancy given the lack of sufficient evidence and the technical difficulty of the operation. Thus, it is unclear whether TAC is an effective procedure for twin pregnancy in women with a history of unsuccessful TVC. The aim of this study is to compare the characteristics and pregnancy outcomes after TAC in twin pregnancy versus singleton pregnancy, to examine whether twin pregnancy is a risk factor for very preterm birth (before 32 weeks) after TAC, and to determine whether TAC is effective in preventing preterm birth in twin pregnancy. This single-center retrospective cohort study included women who underwent TAC because of unsuccessful TVC history between January 2007 and June 2018. Of 165 women who underwent TAC, 19 had twins and 146 had singletons. Our results showed that the neonatal survival rate improved dramatically when TAC was performed (15.4% (prior pregnancy) vs 94.0% (after TAC) in twins, p<0.01; 22.8% (prior pregnancy) vs 91.1% (after TAC) in singletons, p<0.01). Moreover, the risk of very preterm birth was significantly decreased after TAC in both groups (36/39 (92.3%) (prior pregnancy) vs 2/19 (10.5%) (after TAC) in twins, p<0.01; 290/337 (86.1%) (prior pregnancy) vs 17/146 (11.6%) (after TAC) in singletons, p<0.01). More advanced maternal age and history of prior preterm delivery between 26+0 and 36+6 weeks were independently associated with very preterm birth, whereas the presence of a twin pregnancy was not associated with very preterm birth on multivariate logistic regression analysis. These results suggest that TAC is associated with successful prevention of very preterm birth and improved neonatal survival rates in the absence of procedure-related major complications in women with twin pregnancy and previous unsuccessful TVC history.


Assuntos
Cerclagem Cervical/métodos , Resultado da Gravidez , Gravidez de Gêmeos , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/efeitos adversos , Colo do Útero/cirurgia , Feminino , Humanos , Recém-Nascido , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Falha de Tratamento
10.
Arch Gynecol Obstet ; 301(5): 1207-1212, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32274636

RESUMO

PURPOSE: To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions are legal and available. METHODS: A retrospective cross-sectional cohort study was conducted at a tertiary referral hospital, during 2013-2016. Mid-trimester defined as gestational age 13 + 0 to 23 + 6 weeks. Rupture of membrane was defined by documentation of fluid passing through the cervix on sterile speculum examination, and a positive Nitrazine (Bristol-Myers Squibb, Princeton, NJ) or erning test. All records were evaluated for medical history, laboratory data, postnatal examination, and autopsy findings, and a database was constructed. RESULTS: A total of 61 women were hospitalized for mid-trimester PPROM during the study period. Mean maternal age was 32 ± 5.98, range 20-45 years old. The majority (50, 82%) of patients decided to terminate their pregnancy before reaching the limit of viability at 24 weeks gestation. The overall prognosis of pregnancies reaching term was better than expected, with six (9.8%) patients delivering live babies and four of them born at term (36 ± 5 to 40 ± 6 weeks gestation), all after PPROM following amniocentesis or selective fetal reduction. A total of 60% of women with hypothyroidism had unbalanced TSH levels above 4.0 mIU/L prior to their pregnancy. A notable number of women (15, 24.6%) had PPROM following a pregnancy achieved by assisted reproductive technology (ART). CONCLUSIONS: Most women with diagnosed mid-trimester PPROM opted for pregnancy termination before the limit of viability when granted the choice. Possible risk factors for early PPROM are unbalanced hypothyroidism and ART. PPROM following amniocentesis can in some cases reseal and reach term, suggesting conservative treatment is a reasonable management for those cases.


Assuntos
Feto Abortado , Ruptura Prematura de Membranas Fetais/mortalidade , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/mortalidade , Adulto , Amniocentese , Estudos Transversais , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Nascimento Vivo/epidemiologia , Idade Materna , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/etiologia , Mortalidade Perinatal , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Fatores de Risco , Natimorto/epidemiologia , Adulto Jovem
11.
PLoS One ; 15(2): e0229014, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32106249

RESUMO

Antenatal corticosteroids administered to the mother prior to birth decrease the risk of mortality and major morbidity in infants born at less than 35 weeks' gestation. However, the evidence relating to women with diabetes in pregnancy is limited. Clinical guidelines for antenatal corticosteroid administration recommend that women with diabetes in pregnancy are treated in the same way as women without diabetes, but there are no recent descriptions of whether contemporary practice complies with this guidance. This study is a retrospective review of antenatal corticosteroid administration at a New Zealand tertiary hospital in women with diabetes in pregnancy. We found that in this cohort, for both an initial course at less than 35 weeks' gestation and repeat courses at less than 33 weeks', the administration of antenatal corticosteroid to women with diabetes in pregnancy is largely consistent with current Australian and New Zealand recommendations. However, almost 25% of women received their last dose of antenatal corticosteroid at or beyond the latest recommended gestation of 35 weeks' gestation. Pre-existing diabetes and planned caesarean section were independently associated with an increased rate of antenatal corticosteroid administration. We conclude that diabetes in pregnancy does not appear to be a deterrent to antenatal corticosteroid administration. The high rates of administration at gestations beyond recommendations, despite the lack of evidence of benefit in this group of women, highlights the need for further research into the risks and benefits of antenatal corticosteroid administration to women with diabetes in pregnancy, particularly in the late preterm and early term periods.


Assuntos
Corticosteroides , Idade Gestacional , Mortalidade Perinatal , Gravidez em Diabéticas , Nascimento Prematuro/mortalidade , Cuidado Pré-Natal , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Austrália/epidemiologia , Cesárea , Feminino , Humanos , Lactente , Recém-Nascido , Nova Zelândia/epidemiologia , Gravidez , Gravidez em Diabéticas/tratamento farmacológico , Gravidez em Diabéticas/epidemiologia , Estudos Retrospectivos
13.
BMC Pregnancy Childbirth ; 20(1): 35, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931744

RESUMO

BACKGROUND: Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. METHODS: All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. RESULTS: One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%) patients. A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and transfer to the Neonatal Intensive Care Unit were 42.4 and 25.4%, respectively. Localization of the malformation was a determinant of perinatal outcome (P = .006) and preterm delivery (P = .046). CONCLUSIONS: Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.


Assuntos
Deformidades Congênitas dos Membros/mortalidade , Mortalidade Perinatal , Nascimento Prematuro/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia , Diagnóstico Pré-Natal , Estudos Retrospectivos , Centros de Atenção Terciária
14.
Aust N Z J Obstet Gynaecol ; 60(1): 158-161, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31774934

RESUMO

In recent years, significant improvements in survival and survival-free of major morbidity in babies born at 23+0 to 24+6  weeks of gestation have led to a more pro-active approach to resuscitation at these peri-viable gestations. Antenatal counselling and interventions, intrapartum care and postnatal advice should be part of the package of care provided to optimise outcomes for these babies and their families. This observational study assesses the perinatal care provided to mothers and their babies who were born at 23 and 24 weeks of gestations over a two-year period at a tertiary maternity hospital in New Zealand.


Assuntos
Lactente Extremamente Prematuro , Assistência Perinatal/normas , Nascimento Prematuro/mortalidade , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Maternidades , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Nova Zelândia , Taxa de Sobrevida
15.
J Trop Pediatr ; 66(2): 163-170, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292654

RESUMO

INTRODUCTION: Preterm birth-related complications are the leading cause of under-5 mortality globally. Bhutan does not have a reliable preterm birth rate or data regarding outcome of preterm babies. AIM: To determine the preterm birth rate at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, Bhutan, and assess their outcomes. METHODS: All live preterm births at JDWNRH from 1 January 2017 to 31 December 2017 were followed from birth till hospital discharge. Maternal demographic data, pregnancy details and delivery details were collected. Morbidity and mortality information as well as discharge outcome were collected on babies admitted to neonatal intensive care unit (NICU). RESULTS: Preterm birth rate among live births was 6.4%. Most mothers were younger than 30 years, housewives and had secondary education. Pregnancy registration rate and adequacy of antenatal visits were high. Most preterm births were singleton and the predominant mode of delivery was cesarean section. More than half of the births were initiated spontaneously, and the male:female ratio was 1.2:1. Most babies were late preterm and low birth weight. Half of them required NICU admission. Overall mortality rate was 11% and 21.6% for admitted preterm neonates. Preterm small-for-gestational-age neonates, and those born after provider-initiated preterm birth had significantly increased risk of mortality. Most preterm neonates were discharged without complications. The rate of extrauterine growth restriction was high. CONCLUSION: This is the first study on the prevalence of preterm births and their outcomes in the largest tertiary-care hospital in Bhutan.


Assuntos
Retardo do Crescimento Fetal/epidemiologia , Mortalidade Infantil , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Butão/epidemiologia , Cesárea/estatística & dados numéricos , Feminino , Retardo do Crescimento Fetal/etiologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Morbidade , Gravidez , Nascimento Prematuro/mortalidade , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos
16.
Am J Obstet Gynecol ; 222(4): 306-319.e18, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31394069

RESUMO

BACKGROUND: The management of the pregnancy after delivery of the first fetus during a second-trimester miscarriage or very early preterm birth has not been well defined. OBJECTIVE: The objective of the study was to evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy. DATA SOURCES: PubMed, MEDLINE, and Cochrane Library were systematically searched through January 2019. STUDY ELIGIBILITY CRITERIA (STUDY DESIGN, POPULATIONS, AND INTERVENTIONS): The following eligibility criteria applied: full-text original article; included at least 5 cases of delayed interval delivery for remaining fetus(es); and reported the survival rate of the first-born and the remaining fetus(es). STUDY APPRAISAL AND SYNTHESIS METHODS: K.W.C. and W.W. searched, screened, and reviewed the articles. The quality of the studies was assessed according to the Strengthening the Reporting of Observational studies in Epidemiology checklist. If possible, data were stratified for assigned chorionicity. Effect sizes were pooled through a meta-analysis. RESULTS: A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins [88%], 56 triplets [11%], 3 quadruplets and 1 quintuplets) showed that delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared with the first born (odds ratio, 5.22, 95% confidence interval, 2.95-9.25, I2 = 53%), before 20+0 weeks (odds ratio, 6.32, 95% confidence interval, 1.99-20.13, I2 = 0%), between 20+0 and 23+6 weeks (odds ratio, 3.31, 95% confidence interval, 1.95-5.63, I2 = 0%), and after 24+0 weeks (odds ratio, 1.92, 95% confidence interval, 1.21-3.05, I2 = 0%), in dichorionic twin pregnancy (odds ratio, 14.89, 95% confidence interval, 6.19-35.84, I2 = 0%), and unselected triplet pregnancy (odds ratio, 2.33, 95% confidence interval, 1.02-5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first-born and the remaining fetus(es). Serious maternal morbidity was reported in 39% of pregnancy after delayed interval delivery (71 of 183). In addition, 2 cases were managed by postpartum hysterectomy and 1 reported postoperative uterovaginal fistula. There were no recorded cases of maternal mortality. CONCLUSION: Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.


Assuntos
Aborto Espontâneo/terapia , Parto Obstétrico , Gravidez Múltipla , Nascimento Prematuro/terapia , Aborto Espontâneo/mortalidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/mortalidade , Taxa de Sobrevida , Fatores de Tempo
17.
J Thorac Cardiovasc Surg ; 159(6): 2459-2466.e5, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31866080

RESUMO

OBJECTIVES: The purpose of this article is to provide thoracic and cardiovascular surgeons with a practical step-by-step strategy to use in collaboration with a biostatistician for implementation of competing risks analysis when analyzing time-to-event data. Patients may have an outside event that precludes the event of interest. Traditional time-to-event analysis incorrectly assumes noninformative censoring in this scenario, which will lead to invalid results and conclusions. METHODS: The steps are (1) to determine whether competing risks analysis is needed, (2) to perform a nonparametric analysis, (3) to perform a model-based analysis, (4) to interpret the results, and (5) to compare to traditional survival analysis methods. We apply our approach to a hypothetical cardiovascular surgery example in determining the hazard of mortality after the stage 3 Fontan operation associated with prematurity among patients with hypoplastic left heart syndrome who had successful completion of Norwood stage 1 while incorporating mortality during the stage 2 bidirectional Glenn procedure as a competing risk. We apply nonparametric, semiparametric, and parametric methods. RESULTS: Although Cox regression establishes prematurity as a significant risk factor of mortality after stage 3 (hazard ratio, 1.26; 95% confidence interval, 1.06-1.50; P = .009), the competing risks analysis with the Fine-Gray model accounting for mortality after stage 2 determines that prematurity is not a significant predictor (hazard ratio, 1.07; 95% confidence interval, 0.90-1.27; P = .467). CONCLUSIONS: This article provides a practical step-by-step approach for making competing risks more accessible for cardiac surgeons collaborating with a biostatistician in analyzing and interpreting time-to-event data.


Assuntos
Bioestatística , Técnica de Fontan/mortalidade , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood/mortalidade , Nascimento Prematuro/mortalidade , Cirurgiões , Técnica de Fontan/efeitos adversos , Técnica de Fontan/estatística & dados numéricos , Idade Gestacional , Humanos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Procedimentos de Norwood/efeitos adversos , Procedimentos de Norwood/estatística & dados numéricos , Intervalo Livre de Progressão , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
J Matern Fetal Neonatal Med ; 33(1): 73-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886760

RESUMO

Background: A large recent study analyzed the relationship between multiple factors and neonatal outcome and in preterm births. Study variables included the reason for admission, indication for delivery, optimal steroid use, gestational age, and other potential prognostic factors. Using stepwise multivariable analysis, the only two variables independently associated with serious neonatal morbidity were gestational age and the presence of suspected intrauterine growth restriction as a reason for admission. This finding was surprising given the beneficial effects of antenatal steroids and hazards associated with some causes of preterm birth. Multivariable logistic regression techniques have limitations. Without testing for multiple interactions, linear regression will identify only individual factors with the strongest independent relationship to the outcome for the entire study group. There may not be a single "best set" of risk factors or one set that applies equally well to all subgroups. In contrast, machine learning techniques find the most predictive groupings of factors based on their frequency and strength of association, with no attempt to identify independence and no assumptions about linear relationships.Objective: To determine if machine learning techniques would identify specific clusters of conditions with different probability estimates for severe neonatal morbidity and to compare these findings to those based on the original multivariable analysis.Materials and methods: This was a secondary analysis of data collected in a multicenter, prospective study on all admissions to the neonatal intensive care unit between 2013 and 2015 in 10 hospitals. We included all patients with a singleton, stillborn, or live newborns, with a gestational age between 23 0/7 and 31 6/7 week. The composite endpoint, severe neonatal morbidity, defined by the presence of any of five outcomes: death, grade 3 or 4 intraventricular hemorrhage (IVH), and ≥28 days on ventilator, periventricular leukomalacia (PVL), or stage III necrotizing enterocolitis (NEC), was present in 238 of the 1039 study patients. We studied five explanatory variables: maternal age, parity, gestational age, admission reason, and status with respect to antenatal steroid administration. We concentrated on Classification and Regression Trees because the resulting structure defines clusters of risk factors that often bear resemblance to clinical reasoning. Model performance was measured using area under the receiver-operator characteristic curves (AUC) based on 10 repetitions of 10-fold cross-validation.Results: A hybrid technique using a combination of logistic regression and Classification and Regression Trees had a mean cross-validated AUC of 0.853. A selected point on its receiver-operator characteristic (ROC) curve corresponding to a sensitivity of 81% was associated with a specificity of 76%. Rather than a single curve representing the general relationship between gestational age and severe morbidity, this technique found seven clusters with distinct curves. Abnormal fetal testing as a reason for admission with or without growth restriction and incomplete steroid administration would place a 20-year-old patient on the highest risk curve.Conclusions: Using a relatively small database and a few simple factors known before birth it is possible to produce a more tailored estimate of the risk for severe neonatal morbidity on which clinicians can superimpose their medical judgment, experience, and intuition.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico , Doenças do Prematuro/diagnóstico , Aprendizado de Máquina , Nascimento Prematuro/diagnóstico , Adulto , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/patologia , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Morbidade , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Probabilidade , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Natimorto/epidemiologia
19.
Ethiop J Health Sci ; 29(6): 677-688, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31741638

RESUMO

Background: Low birth weight and prematurity are associated with increased morbidity, mortality and multiple short and long-term complications, exerting impacts on the individual, the families, the community and the health care system. Fetal, maternal and environmental factors have been associated with low birth weight and prematurity, based primarily on researches from high-income countries. It is unknown whether these risk factors are the same in low and middle income countries. The aims of this study are to determine the prevalence of low birth weight and prematurity and associated factors in Jimma University Specialized Hospital, Ethiopia. Methods: This observational study was conducted at Jimma University Specialized Hospital, Ethiopia, from December 2014 to September 2016. Multivariable logistic regression was used to determine the associated factors, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Results: The prevalence of low birth weight and prematurity were 14.6% and 10.2%, respectively. The mean birth weight was 2,975g (standard deviation 494). Prematurity (OR 23.54, 95%CI 15.35-36.08, p<0.001) and unmarried marital status (OR 5.73, 95%CI 1.61-20.40, p=0.007) were positively associated with low birth weight. Female sex (OR 1.69, 95%CI 1.18-2.42, p=0.004) and unmarried marital status (OR 4.07, 95%CI 1.17-14.14, p=0.027) were positively associated with prematurity. Conclusion: The prevalence of lower birth weight and prematurity in this study is lower than other studies reported from similar facilities. Prematurity and unmarried marital status are associated with LBW whereas female sex and unmarried marital status are associated with prematurity in this population.


Assuntos
Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/mortalidade , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidade , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Adolescente , Adulto , Fatores Etários , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Masculino , Idade Materna , Gravidez , Prevalência , Fatores de Risco , Adulto Jovem
20.
R I Med J (2013) ; 102(9): 15-22, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675781

RESUMO

BACKGROUND: We aimed to explore the leading causes and risk factors for infant mortality in a statewide study of infant deaths from 2005 to 2016. METHODS: Rhode Island Vital Statistics was linked with KIDSNET, a statewide-integrated child health information system. Descriptive analyses examined infant mortality rates as well as risk factors of infant, neonatal, and postneonatal death. A multivariable logistic regression model of the risk of infant mortality adjusting for risk factors was computed. RESULTS: The majority (74%) of infant deaths occurred during the neonatal period. The top cause of infant mortality was prematurity (20.4%). After adjustment, infants born <28 weeks had 38.1 higher odds of mortality compared to term infants (p<0.01). Low 5-minute Apgar score, birth defects, less than 10 prenatal visits, and low maternal weight gain were associated with higher odds of infant mortality (p<0.01). DISCUSSION: Substantial reductions in the infant mortality rate will require improving strategies to prevent preterm births as well as using factors identifiable at birth to focus prevention efforts on those at higher risk.


Assuntos
Mortalidade Infantil/tendências , Nascimento Prematuro/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Índice de Apgar , Causas de Morte , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Características de Residência , Estudos Retrospectivos , Rhode Island/epidemiologia , Fatores de Risco , Adulto Jovem
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