Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.224
Filtrar
1.
Saudi Med J ; 45(7): 710-718, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38955439

RESUMO

OBJECTIVES: To understand the prevalence and survival rates of preterm birth (PTB) is of utmost importance in informing healthcare planning, improving neonatal care, enhancing maternal and infant health, monitoring long-term outcomes, and guiding policy and advocacy efforts. METHODS: The medical records of preterm infants admitted to the Neonatal Intensive Care Unit (NICU) with a diagnosis of prematurity at the Maternity and Children's Hospital (MCH), Al Kharj, Saudi Arabia, were reviewed between January 2018 and December 2022. Data were collected on birth weight (BW), gender, number of live births, gestational age, mortality, nationality, APGAR score, length of stay in the NICU, and maternal details. RESULTS: A total of 9809 live births were identified between 2018 and 2022, of which 139 (3.9%) were born preterm. The overall mortality rate of the included sample was 7.19%, whereas the mortality rate according to BW was 38.4% of those born with extremely low birth weight (ELBW). The most common intrapartum complications were malpresentation (15.1%), placental complications (4.3%), and cord complications (3.6%). CONCLUSION: This study provides valuable insights into the prevalence of PTB in the country, particularly focusing on the vulnerability of extremely preterm babies.


Assuntos
Nascimento Prematuro , Humanos , Arábia Saudita/epidemiologia , Feminino , Nascimento Prematuro/epidemiologia , Recém-Nascido , Estudos Transversais , Masculino , Incidência , Gravidez , Idade Gestacional , Recém-Nascido Prematuro , Mortalidade Infantil/tendências , Taxa de Sobrevida , Peso ao Nascer , Lactente , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Índice de Apgar
2.
J Matern Fetal Neonatal Med ; 37(1): 2370398, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38937119

RESUMO

PURPOSE: To explore the effect of dural puncture epidural (DPE) block technique on fetal heart rate variability (HRV) during labor analgesia. METHODS: Sixty full-term primiparas who were in our hospital from April 2021 to October 2021 were selected and randomized into epidural analgesia (CEA) and dural puncture epidural analgesia (DPEA) groups (n = 30). After a successful epidural puncture, routine epidural catheter (EC) was performed in CEA group, and spinal anesthesia needle (as an EC) was used to puncture the dura mater to subarachnoid space in DPE group. Anesthetics were injected through EC. The time when the temperature sensation plane reached T10 (W1) and visual analog pain score (VAS), baseline heart rate score, amplitude variation score, cycle variation score, acceleration score, deceleration score, and total score of the first contraction after W1 were recorded. Apgar scores at 1 min, 5 min, and 10 min of neonates after delivery were recorded. RESULTS: The onset time of anesthesia in CEA group was significantly longer than that in DPEA group (p < .05). However, there are no significant differences in W1, VAS, baseline heart rate score, amplitude variation score, cycle variation score, acceleration score, deceleration score, and total score of the first contraction after W1 between the two groups (p > .05). Moreover, the Apgar scores at 1 min, 5 min and 10 min of neonates after delivery were not notably different between the two groups (p > .05). CONCLUSION: Compared with CEA, DPE block technique in labor analgesia relieves maternal pain without adverse effects on fetal HRV and newborns.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Frequência Cardíaca Fetal , Humanos , Feminino , Gravidez , Frequência Cardíaca Fetal/efeitos dos fármacos , Frequência Cardíaca Fetal/fisiologia , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Adulto , Recém-Nascido , Índice de Apgar , Medição da Dor , Dura-Máter , Trabalho de Parto/fisiologia , Trabalho de Parto/efeitos dos fármacos
3.
Cell Mol Biol (Noisy-le-grand) ; 70(6): 37-41, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38836685

RESUMO

This work compared the effects of dural puncture epidural (DPE), combined spinal epidural analgesia (CSEA) and epidural analgesia (EA) on labor analgesia for primiparae and their impacts on maternal and infant safety. A total of 204 primiparae in need of labor analgesia for vaginal delivery were allocated to DPE, CSEA and EA groups. At 10 min, 30 min and 1 h after analgesia, the DPE and CSEA groups showed lower VAS scores and quicker onset of action than EA group. There was no significant difference in the duration of analgesia and labor and fetal decelerations among the 3 groups. At 1 min and 5 min after childbirth, the neonatal Apgar scores showed no significant difference between the 3 groups. The Bromage scores of DPE and EA groups were lower than those of CSEA group. The incidence of pruritus, hypotension, and postpartum headache in DPE and EA groups were lower than those in CSEA group. To sum up, the efficacy of DPE in labor analgesia for primiparae is similar to that of CSEA, with no obvious effect on labor stage and neonatal Apgar score, no additional complications and less LLMB, pruritus, hypotension and postpartum headache.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Índice de Apgar , Trabalho de Parto , Humanos , Feminino , Gravidez , Analgesia Epidural/métodos , Analgesia Epidural/efeitos adversos , Adulto , Trabalho de Parto/efeitos dos fármacos , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efeitos adversos , Recém-Nascido , Paridade , Adulto Jovem
4.
Minerva Anestesiol ; 90(6): 491-499, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38869263

RESUMO

BACKGROUND: Epidural analgesia (EA) is well-accepted for pain relief during labor. Still, the impact on neonatal short-term outcome is under continuous debate. This study assessed the outcome of neonates in deliveries with and without EA in a nationwide cohort. METHODS: We analyzed the National Birth Registry of Austria between 2008 and 2017 of primiparous women with vaginal birth of singleton pregnancies. Neonatal short-term morbidity was assessed by arterial cord pH and base excess (BE). Secondary outcomes were admission to a neonatological intensive care unit, APGAR scores, and perinatal mortality. Propensity score-adjusted regression models were used to investigate the association of EA with short-term neonatal outcome. RESULTS: Of 247,536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89±3.2 vs. -6.15±3.2 mmol/L; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at five minutes <7 was more frequent with EA (OR 1.45; 95% CI: 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI: 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI: 0.79 to 2.25). CONCLUSIONS: EA showed no clinically relevant association with neonatal short-term outcome. Higher rates of NICU admission and APGAR score after five minutes <7 were observed with EA. The overall use of EA in Austria is low, and an investigation of causes may be indicated.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Sistema de Registros , Humanos , Feminino , Áustria/epidemiologia , Estudos Retrospectivos , Recém-Nascido , Gravidez , Analgesia Obstétrica/estatística & dados numéricos , Adulto , Índice de Apgar , Resultado da Gravidez/epidemiologia , Parto Obstétrico , Mortalidade Perinatal
5.
BMC Pregnancy Childbirth ; 24(1): 410, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849748

RESUMO

BACKGROUND: Decision-to-delivery time (DDT), a crucial factor during the emergency caesarean section, may potentially impact neonatal outcomes. This study aims to assess the association between DDT and various neonatal outcomes. METHODS: A comprehensive search of PubMed, Scopus, Cochrane Library, and Google Scholar databases was conducted. A total of 32 eligible studies that reported on various neonatal outcomes, such as Apgar score, acidosis, neonatal intensive unit (NICU) admissions and mortality were included in the review. Studies were selected based on predefined eligibility criteria, and a random-effects inverse-variance model with DerSimonian-Laird estimate of tau² was used for meta-analysis. Heterogeneity and publication bias were assessed using I² statistics and Egger's test, respectively. RESULTS: The meta-analysis revealed a significant association between DDT < 30 min and increased risk of Apgar score < 7 (OR 1.803, 95% CI: 1.284-2.533) and umbilical cord pH < 7.1 (OR 4.322, 95% CI: 2.302-8.115), with substantial heterogeneity. No significant association was found between DDT and NICU admission (OR 0.982, 95% CI: 0.767-1.258) or neonatal mortality (OR 0.983, 95% CI: 0.565-1.708), with negligible heterogeneity. Publication bias was not detected for any outcomes. CONCLUSIONS: This study underscores the association between shorter DDT and increased odds of adverse neonatal outcomes such as low Apgar scores and acidosis, while no significant association was found in terms of NICU admissions or neonatal mortality. Our findings highlight the complexity of DDT's impact, suggesting the need for nuanced clinical decision-making in cases of emergency caesarean sections.


Assuntos
Índice de Apgar , Cesárea , Humanos , Recém-Nascido , Gravidez , Feminino , Cesárea/estatística & dados numéricos , Fatores de Tempo , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Acidose/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos , Mortalidade Infantil , Resultado da Gravidez/epidemiologia
6.
BMJ Paediatr Open ; 8(1)2024 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-38906562

RESUMO

We conducted a propensity score-matched multivariable regression analysis of 1050 culture-negative neonatal sepsis cases in Malawi, where 160 (15.2%) died. Mortality among neonates with culture-negative sepsis was associated with very low birth weight (adjusted OR (AOR) 12.82, 95% CI 1.23 to 137.49), respiratory distress syndrome (AOR 13.20, 95% CI 2.58 to 83.66), a low Apgar score at 1 min (AOR 3.50, 95% CI 1.21 to 10.72) and at 5 min (AOR 4.77, 95% CI 1.94 to 12.50). Addressing maternal and perinatal factors around health and delivery of care is key to improving outcomes in the context of culture-negative sepsis in neonates from low-income country settings like Malawi.


Assuntos
Sepse Neonatal , Pontuação de Propensão , Humanos , Malaui/epidemiologia , Recém-Nascido , Sepse Neonatal/mortalidade , Feminino , Fatores de Risco , Masculino , Índice de Apgar , Recém-Nascido de muito Baixo Peso , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade
7.
Birth Defects Res ; 116(6): e2371, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38877674

RESUMO

OBJECTIVE: This retrospective study aimed to investigate how congenital heart disease (CHD) affects early neonatal outcomes by comparing Apgar scores and umbilical cord blood gas parameters between fetuses with structural cardiac anomalies and healthy controls. Additionally, within the CHD group, the study explored the relationship between these parameters and mortality within six months. METHODS: Data from 68 cases of prenatally diagnosed CHD were collected from electronic medical records, excluding cases with missing data or additional comorbidities. Only patients delivered by elective cesarean section, without any attempt at labor, were analyzed to avoid potential confounding factors. A control group of 147 healthy newborns was matched for delivery route, maternal age, and gestational week. Apgar scores at 1, 5, and 10 minutes, as well as umbilical cord blood pH, base deficit, and lactate levels, were recorded. RESULTS: Maternal age, gestational week at delivery, and birth weight were similar between the CHD and control groups. While Apgar score distribution was significantly lower at 1st, 5th, and 10th minutes in the CHD group, umbilical cord blood gas parameters did not show significant differences between groups. Within the CHD group, lower umbilical cord blood pH and larger base deficit were associated with mortality within six months. CONCLUSION: Newborns with CHD exhibit lower Apgar scores compared to healthy controls, suggesting potential early neonatal challenges. Furthermore, umbilical cord blood pH and base deficit may serve as predictors of mortality within six months in CHD cases. Prospective studies are warranted to validate these findings and integrate them into clinical practice, acknowledging the study's retrospective design and limitations.


Assuntos
Índice de Apgar , Gasometria , Sangue Fetal , Cardiopatias Congênitas , Humanos , Sangue Fetal/metabolismo , Feminino , Gasometria/métodos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Cardiopatias Congênitas/sangue , Adulto , Masculino , Estudos de Casos e Controles , Idade Gestacional , Feto , Idade Materna , Peso ao Nascer , Concentração de Íons de Hidrogênio
8.
Arch Gynecol Obstet ; 310(1): 337-344, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38829389

RESUMO

PURPOSE: To compare perinatal outcomes between active and routine management in true knot of the umbilical cord (TKUC). METHODS: A retrospective study of singletons born beyond 22 6/7 weeks with TKUC. Active management included weekly fetal heart rate monitoring(FHRM) ≥ 30 weeks and labor induction at 36-37 weeks. Outcomes in active and routine management were compared, including composite asphyxia-related adverse outcome, fetal death, labor induction, Cesarean section (CS) or Instrumental delivery due to non-reassuring fetal heart rate (NRFHR), Apgar5 score < 7, cord Ph < 7, neonatal intensive care unit (NICU) admission and more. RESULTS: The Active (n = 59) and Routine (n = 1091) Management groups demonstrated similar rates of composite asphyxia-related adverse outcome (16.9% vs 16.8%, p = 0.97). Active Management resulted in higher rates of labor induction < 37 weeks (22% vs 1.7%, p < 0.001), CS (37.3% vs 19.2%, p = 0.003) and NICU admissions (13.6% vs 3%, p < 0.001). Fetal death occurred exclusively in the Routine Management group (1.8% vs 0%, p = 0.6). CONCLUSION: Compared with routine management, weekly FHRM and labor induction between 36 and 37 weeks in TKUC do not appear to reduce neonatal asphyxia. In its current form, active management is associated with higher rates of CS, induced prematurity and NICU admissions. Labor induction before 37 weeks should be avoided.


Assuntos
Cesárea , Frequência Cardíaca Fetal , Trabalho de Parto Induzido , Cordão Umbilical , Humanos , Estudos Retrospectivos , Feminino , Gravidez , Cordão Umbilical/cirurgia , Recém-Nascido , Adulto , Trabalho de Parto Induzido/métodos , Cesárea/estatística & dados numéricos , Índice de Apgar , Unidades de Terapia Intensiva Neonatal , Morte Fetal , Resultado da Gravidez , Asfixia Neonatal/terapia
9.
Sci Rep ; 14(1): 14887, 2024 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-38937631

RESUMO

The high-dose usage of norepinephrine is thought to cause high mortality in patients with septic shock. This study aims to explores the correlation between the maximum norepinephrine (NE) dosage (MND) and mortality in neonates with septic shock. This retrospective cohort study included neonates with evidence of septic shock and those who received NE infusion. The study included 123 neonates, with 106 in the survival group and 17 in the death group. The death group exhibited significantly lower birth weight (p = 0.022), 1-min Apgar score (p = 0.005), serum albumin (p < 0.001), and base excess (BE) (p = 0.001) levels, but higher lactate (LAC) levels (p = 0.009) compared to the survival group. MND demonstrated an ROC area under the curve of 0.775 (95% CI 0.63-0.92, p < 0.001) for predicting mortality, with an optimal threshold of 0.3 µg/(kg·min), a sensitivity of 82.4%, and a specificity of 75.5%. Multivariate logistic regression indicated that an MND > 0.3 µg/(kg·min) (OR, 12.08, 95% CI 2.28-64.01) was associated with a significantly higher mortality risk. Spearman rank correlation showed a positive correlation between MND and LAC (r = 0.252, p = 0.005), vasoactive-inotropic score (VIS) (r = 0.836, p < 0.001), and a negative correlation with BE (r = - 0.311, p = 0.001). MND > 0.3 µg/(kg min) is a useful predictive marker of mortality in neonatal septic shock.


Assuntos
Norepinefrina , Choque Séptico , Humanos , Choque Séptico/mortalidade , Choque Séptico/sangue , Recém-Nascido , Norepinefrina/administração & dosagem , Masculino , Feminino , Estudos Retrospectivos , Curva ROC , Índice de Apgar
10.
Niger J Clin Pract ; 27(6): 792-799, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38943306

RESUMO

BACKGROUND: The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. STUDY AIM: To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). METHODS: The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. RESULTS: The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). CONCLUSION: serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.


Assuntos
Asfixia Neonatal , Troponina I , Humanos , Recém-Nascido , Asfixia Neonatal/sangue , Asfixia Neonatal/complicações , Troponina I/sangue , Feminino , Nigéria , Masculino , Estudos Transversais , Estudos de Casos e Controles , Hospitais de Ensino , Índice de Apgar , Biomarcadores/sangue , Hipóxia-Isquemia Encefálica/sangue , Hipóxia-Isquemia Encefálica/diagnóstico
11.
Medicine (Baltimore) ; 103(26): e38633, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38941372

RESUMO

To analyze maternal and neonatal effects of placental abruption (PA) through a novel classification in the presence of hypertension. Initial hemoglobin parameters were also compared to predict pregnancy outcomes in addition to hypertension. This retrospective cohort designed study was conducted on 115 pregnant women with PA. The main parameters scanned and recorded from the hospital database and patient medical files. Two groups were classified regarding of presence or absence of hypertension (53 hypertensive, 62 normotensive). Maternal demographical and clinical characteristics (abdominal pain, vaginal bleeding) were recorded. APGAR scores below 5 at 1st and 5th minute, fetal or neonatal death, admission and length of stay in Neonatal Intensive Care Unit were also investigated and compared between the groups. Stillborn to live-born ratio and lower APGAR scores < 5 at 5th minute were significantly higher in hypertensive group than normotensive group (P = .006 and 0.047, respectively). Poor maternal outcomes were detected in the hypertensive group than normotensive group regarding rate of blood transfusion (27/53, 50.9%; 18/62, 29%, respectively, P = .017). More abdominal pain and less vaginal bleeding were seen in PA with HT. Higher lymphocyte count, mean platelet volume, and platelet distribution width were reported in hypertensive group. Poorer maternal and neonatal outcomes of hypertensive patients with PA were detected. These patients should deserve greater attention to assess not only the possible risks associated with abruption but also the accompanying complications.


Assuntos
Descolamento Prematuro da Placenta , Índice de Apgar , Resultado da Gravidez , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Adulto , Descolamento Prematuro da Placenta/epidemiologia , Resultado da Gravidez/epidemiologia , Recém-Nascido , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão/epidemiologia
12.
Nurse Educ Today ; 140: 106294, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38944937

RESUMO

BACKGROUND: The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations. AIM: This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory. DESIGN: A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted. SETTINGS: The study was conducted at two nursing schools from July to October 2023. PARTICIPANTS: Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible. METHODS: The participants were divided into three groups: the VR group (n = 27) received contactless hand-tracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-to-face Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0. RESULTS: The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group. CONCLUSIONS: The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited.


Assuntos
Índice de Apgar , Estudantes de Enfermagem , Realidade Virtual , Humanos , Recém-Nascido , Estudantes de Enfermagem/estatística & dados numéricos , Feminino , Masculino , Bacharelado em Enfermagem/métodos , Treinamento por Simulação/métodos , Asfixia Neonatal , Enfermagem Neonatal/educação , Enfermagem Neonatal/métodos , Competência Clínica/normas , Competência Clínica/estatística & dados numéricos
13.
Neurology ; 103(2): e209571, 2024 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-38889390

RESUMO

BACKGROUND AND OBJECTIVES: For individuals with cerebral palsy (CP) and caregivers, comorbidities may be a greater challenge than neuromotor impairment. Clinicians may make assumptions regarding risk of comorbidities based simply on term vs preterm birth, but this has not been well examined. To better understand factors affecting comorbidity pattern, we investigated the relationship between gestational age (GA) and imaging pattern on the presence of specific comorbidities. METHODS: This is a cross-sectional study of data extracted from the Canadian Cerebral Palsy Registry of children with CP. Multivariable analysis was used to evaluate the relationship between brain injury, GA, and comorbidities. Comorbidities included in the analysis were communication, cognitive, visual, and auditory impairment, seizures in the past year, and gavage feeding. Each comorbidity was assessed as a separate nonexclusive outcome, with GA, MRI pattern, birth weight, postneonatal insult, 5-minute Apgar score, and male sex considered as potential modifiers. RESULTS: The only comorbidity affected by GA on multivariable analysis was seizures within the past year that were more prevalent in term children (odds ratio [OR] 1.1 95% CI 1.0-1.2) and was also affected by Apgar score (OR 0.9 95% CI 0.85-0.94), but not MRI pattern. MRI pattern appeared important for communication impairment (deep gray OR 4.2 95% CI 1.8-10.0; total brain injury OR 8.5, 95% CI 3.2-22.6; malformation OR 2.7, 95% CI 1.3-5.7) and cognitive impairment (deep gray OR 5.6, 95% CI 2.4-13.2; total brain injury OR 10.1, 95% CI 4.0-25.3; malformation OR 3.3, 95% CI 1.6-6.8; watershed OR 3.6, 95% CI 1.4-8.9). Focal injury compared with normal MRI was associated with reduced odds of visual impairment (OR 0.24, 95% CI 0.12-0.48), auditory impairment (OR 0.2195% CI 0.10-0.46) and communication impairment (OR 0.46, 95% CI 0.26-0.82), and overall number of comorbidities (coefficient -0.73, 95% CI -1.2 to -0.31). The number of comorbidities was increased by total brain injury pattern (coefficient 0.65, 95% CI 0.15-1.13) and reduced by focal brain injury (coefficient -0.73, 95% CI -1.2 to -0.31) and increasing 5-minute Apgar score (coefficient -0.11, 95% CI -0.16 to -0.07). DISCUSSION: In those with brain injuries sufficient to cause CP, development of additional comorbidities is less affected by GA at birth and more related to the underlying cause of CP as reflected by MRI patterns.


Assuntos
Paralisia Cerebral , Comorbidade , Idade Gestacional , Imageamento por Ressonância Magnética , Humanos , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/diagnóstico por imagem , Masculino , Feminino , Estudos Transversais , Prevalência , Recém-Nascido , Pré-Escolar , Criança , Lactente , Canadá/epidemiologia , Sistema de Registros , Convulsões/epidemiologia , Convulsões/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Índice de Apgar
14.
PLoS One ; 19(5): e0302489, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38739579

RESUMO

BACKGROUND: Evidence suggests that for low-risk pregnancies, planned home births attended by a skilled health professional in settings where such services are well integrated are associated with lower risk of intrapartum interventions and no increase in adverse health outcomes. Monitoring and updating evidence on the safety of planned home births is necessary to inform ongoing clinical and policy decisions. METHODS: This protocol describes a population-based retrospective cohort study which aims to compare risk of (a) neonatal morbidity and mortality, and (b) maternal outcomes and birth interventions, between people at low obstetrical risk with a planned home birth with a midwife, a planned a hospital birth with a midwife, or a planned hospital birth with a physician. The study population will include Ontario residents who gave birth in Ontario, Canada between April 1, 2012, and March 31, 2021. We will use data collected prospectively in a provincial perinatal data registry. The primary outcome will be severe neonatal morbidity or mortality, a composite binary outcome that includes one or more of the following conditions: stillbirth during the intrapartum period, neonatal death (death of a liveborn infant in the first 28 completed days of life), five-minute Apgar score <4, or infant resuscitation requiring cardiac compressions. We will conduct a stratified analysis with three strata: nulliparous, parous-no previous caesarean birth, and parous-prior caesarean birth. To reduce the impact of selection bias in estimating the effect of planned place of birth on neonatal and maternal outcomes, we will use propensity score (PS) overlap weighting (OW) and modified Poisson regression to conduct multivariate analyses.


Assuntos
Pontuação de Propensão , Humanos , Feminino , Gravidez , Ontário/epidemiologia , Estudos Retrospectivos , Recém-Nascido , Parto Domiciliar/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Adulto , Lactente , Estudos de Coortes , Mortalidade Infantil , Índice de Apgar
15.
BMC Pregnancy Childbirth ; 24(1): 387, 2024 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-38789941

RESUMO

INTRODUCTION: Labor induction is a common obstetric intervention aimed at initiating labor when spontaneous onset is delayed or deemed necessary for maternal or fetal well-being. Despite its widespread use, the practice's impact on maternal and neonatal outcomes remains a subject of ongoing research and debate. This study aims to evaluate the maternal and neonatal outcomes associated with labor induction in a tertiary hospital setting in Tanzania. METHODOLOGY: A descriptive analytical cross-sectional study was conducted over a seven-month period from January 2021 to July 2021 at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 120 pregnant women who underwent labor induction during this period were included in the analysis. Data on maternal demographics, obstetric characteristics, indications for induction, methods of induction, labor outcomes, and neonatal outcomes were collected from medical records and analyzed descriptively. RESULTS: Among 4773 deliveries during the study period, 120 women underwent labor induction, accounting for 120 (2.5%) of all deliveries. The most common indications for induction were postdate pregnancy 60 (50%), hypertensive disorders of pregnancy 38 (31.7%), and premature rupture of membranes 22 (17.5%). The majority of induced women 74 (61.7%) delivered vaginally, with 46 (38.3%) undergoing cesarean section. Maternal complications were minimal, with the most common being failed induction of labor 17 (14.2%). Neonatal outcomes were generally positive, with 120 (100%) of neonates having Apgar scores of 7 or higher at five minutes, although 10 (8.3%) required admission to the neonatal ward for further care. CONCLUSION: Labor induction at Muhimbili National Hospital demonstrated favorable maternal and neonatal outcomes, with low rates of maternal complications and positive neonatal Apgar scores. Postdate pregnancy emerged as the most common indication for induction. While the study highlights the benefits of labor induction, its retrospective nature and single-center setting limit the generalizability of findings. Prospective studies with larger sample sizes are warranted to validate these findings and inform evidence-based obstetric practices.


Assuntos
Trabalho de Parto Induzido , Resultado da Gravidez , Humanos , Feminino , Gravidez , Trabalho de Parto Induzido/estatística & dados numéricos , Tanzânia/epidemiologia , Estudos Transversais , Adulto , Resultado da Gravidez/epidemiologia , Recém-Nascido , Adulto Jovem , Cesárea/estatística & dados numéricos , Índice de Apgar , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos
16.
PLoS One ; 19(5): e0302533, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718061

RESUMO

BACKGROUND: Neonatal Sepsis remains a significant burden globally, accounting for over 2.5 million neonatal deaths annually, with low-and middle-income countries (LMIC) including Ghana disproportionately affected. The current study sought to ascertain the prevalence of neonatal sepsis and associated factors based on analysis of institutional records from Cape Coast Teaching Hospital (CCTH) in Ghana. METHODS: The study involved a retrospective cross-sectional review of randomly sampled medical records of 360 neonates CCTH from January 2018 to December 2021. Descriptive proportions and binary logistic regression analysis were conducted to estimate the prevalence of neonates with sepsis and associated factors. RESULTS: The prevalence of neonates with sepsis over the period was estimated to be 59%, with early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) accounting for about 29% and 30%, respectively. Neonatal factors associated with sepsis were low Apgar score (AOR = 1.64; 95% CI:1.01-2.67, p = 0.047) and low birth weight (AOR = 2.54; 95% CI:1.06-6.09, p = 0.037), while maternal factors were maternal education (AOR = 2.65; 95% CI:1.04-6.7, p = 0.040), caesarean deliveries (AOR = 0.45; 95% CI:0.26-0.75, p = 0.003), maternal infection (AOR = 1.79; 95% CI:1.09-2.94, p = 0.020) and foul-smelling liquor (AOR = 1.84; 95% CI:1.09-3.07, p = 0.020). CONCLUSION: The study underscores the need for improved routine care and assessment of newborns to prevent the onset of neonatal sepsis, with particular emphasis on the neonatal and maternal risk factors highlighted in the current study.


Assuntos
Sepse Neonatal , Centros de Atenção Terciária , Humanos , Gana/epidemiologia , Sepse Neonatal/epidemiologia , Recém-Nascido , Feminino , Masculino , Centros de Atenção Terciária/estatística & dados numéricos , Estudos Transversais , Estudos Retrospectivos , Adulto , Fatores de Risco , Prevalência , Gravidez , Recém-Nascido de Baixo Peso , Índice de Apgar
17.
Clin Epigenetics ; 16(1): 69, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38778395

RESUMO

Adverse neonatal outcomes are a prevailing risk factor for both short- and long-term mortality and morbidity in infants. Given the importance of these outcomes, refining their assessment is paramount for improving prevention and care. Here we aim to enhance the assessment of these often correlated and multifaceted neonatal outcomes. To achieve this, we employ factor analysis to identify common and unique effects and further confirm these effects using criterion-related validity testing. This validation leverages methylome-wide profiles from neonatal blood. Specifically, we investigate nine neonatal health risk variables, including gestational age, Apgar score, three indicators of body size, jaundice, birth diagnosis, maternal preeclampsia, and maternal age. The methylomic profiles used for this research capture data from nearly all 28 million methylation sites in human blood, derived from the blood spot collected from 333 neonates, within 72 h post-birth. Our factor analysis revealed two common factors, size factor, that captured the shared effects of weight, head size, height, and gestational age and disease factor capturing the orthogonal shared effects of gestational age, combined with jaundice and birth diagnosis. To minimize false positives in the validation studies, validation was limited to variables with significant cumulative association as estimated through an in-sample replication procedure. This screening resulted in that the two common factors and the unique effects for gestational age, jaundice and Apgar were further investigated with full-scale cell-type specific methylome-wide association analyses. Highly significant, cell-type specific, associations were detected for both common effect factors and for Apgar. Gene Ontology analyses revealed multiple significant biologically relevant terms for the five fully investigated neonatal health risk variables. Given the established links between adverse neonatal outcomes and both immediate and long-term health, the distinct factor effects (representing the common and unique effects of the risk variables) and their biological profiles confirmed in our work, suggest their potential role as clinical biomarkers for assessing health risks and enhancing personalized care.


Assuntos
Metilação de DNA , Epigenoma , Estudo de Associação Genômica Ampla , Humanos , Recém-Nascido , Feminino , Metilação de DNA/genética , Estudo de Associação Genômica Ampla/métodos , Epigenoma/genética , Gravidez , Idade Gestacional , Masculino , Fatores de Risco , Saúde do Lactente , Índice de Apgar , Idade Materna , Adulto , Epigênese Genética/genética
18.
Med J Malaysia ; 79(3): 337-341, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38817068

RESUMO

INTRODUCTION: The aim of this study was to evaluate a group of infants born to women with tuberculosis (TB) during pregnancy to determine the neonatal morbidities and its outcomes associated with tuberculosis in pregnancy. MATERIALS AND METHODS: Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score. RESULTS: Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score.


Assuntos
Centros de Atenção Terciária , Tuberculose , Humanos , Feminino , Estudos Retrospectivos , Gravidez , Recém-Nascido , Malásia/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Tuberculose/epidemiologia , Adulto , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Nascimento Prematuro/epidemiologia , Recém-Nascido de Baixo Peso , Masculino , Índice de Apgar , Estudos de Coortes
19.
Int J Med Sci ; 21(6): 978-982, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38774748

RESUMO

Background: There have been few studies comparing the effects of high- and low-dose rocuronium during cesarean section by directly measuring the concentration. Therefore, we conducted a study to examine the blood concentrations and clinical effects of both doses of rocuronium on mothers and fetuses. Methods: Eighteen patients were randomly assigned to two groups: C Group (0.6 mg/kg), and H Group, (1.0 mg/kg). The primary outcome was the comparison of umbilical vein rocuronium concentration between two groups. We assessed ease of intubation, time from rocuronium administration to some TOF points, post-anesthesia care unit (PACU) stay time, infused remifentanil dose, maternal rocuronium concentration, and Apgar scores. Results: No differences were observed in demographic data, ease of intubation, PACU stay time, 1 min Apgar scores, umbilical venous blood gas analysis between both groups. However, the time from rocuronium administration to T3 disappearance was shorter (p=0.009) and time to T1 and T2 reappearance were longer (p=0.003, p=0.009) in H group than that in C group. The administered remifentanil dose (p=0.042) was lower in the H group than in the C group. Rocuronium concentrations in the umbilical vein (p=0.004) and maternal vein before cord clamping (p=0.002) and at discharge (p<0.001) were also found to be higher in the H group than in the C group. Conclusions: We observed no prolongation of PACU stay, and no differences in Apgar scores in H group compared to C group. It suggests that 1.0 mg/kg of rocuronium has no negative effects on the fetus and mother in cesarean section.


Assuntos
Anestesia Geral , Cesárea , Fármacos Neuromusculares não Despolarizantes , Rocurônio , Humanos , Rocurônio/administração & dosagem , Cesárea/métodos , Feminino , Gravidez , Anestesia Geral/métodos , Adulto , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Remifentanil/administração & dosagem , Índice de Apgar , Relação Dose-Resposta a Droga , Androstanóis/administração & dosagem , Androstanóis/sangue
20.
Sci Rep ; 14(1): 12420, 2024 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-38816451

RESUMO

A variety of factors can predispose newborns to have a low Apgar score after delivery. Identification of the determinants of low Apgar scores is an important first step to take to apply the necessary precautions. This study aimed to identify the determinants of low fifth-minute Apgar score after a Cesarean section. An institutional-based case-control study was conducted among mothers who deliver their newborns by Cesarean section in Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Ethiopia, from July 1, 2022, to September 30, 2022. Data were collected from 70 cases and 140 controls using a semi-structured checklist. A systematic random sampling technique was used to select both charts of mothers with cases and controls. Charts of mothers with newborns Apgar score less than 7 were considered as cases; whereas a similar group of charts of mothers with newborns with fifth-minute Apgar score greater than or equal to 7 were categorized as control. Descriptive statistics and bivariable and multivariable binary logistic regression analyses were conducted to describe the mothers and newborns and identify determinants of the fifth-minute low Apgar score, respectively. Adjusted odds ratios (AOR) with their respective 95% confidence interval (CI) were used to declare the determinant factors, and the statistical significance was set at P < 0.05. In total, 140 controls and 70 cases of mothers charts were enrolled in this study. The Mean ± SD age of mothers of cases and controls were 26.9 ± 4.9 and 27.06 ± 4.1 years, respectively. General anaesthesia (AOR = 4.2; 95% CI: 1.9 ‒ 9.3), rural residence (AOR = 3.7, 95% CI, 1.7‒8.1), low birth weight (AOR = 3.2, 95% CI, 1.3‒7.8), and emergency Cesarean section (AOR = 2.6; 95% CI: 1.2 ‒ 5.8) were identified determinant factors of low fifth minute Apgar score. A fifth-minute low Apgar score was significantly associated with newborns delivered through emergency Cesarean section, low birth weight, rural residence, and delivered from mothers who had undergone Cesarean section under general anaesthesia.


Assuntos
Índice de Apgar , Cesárea , Humanos , Cesárea/estatística & dados numéricos , Etiópia , Feminino , Recém-Nascido , Adulto , Gravidez , Estudos de Casos e Controles , Adulto Jovem , Masculino , Fatores de Risco , Razão de Chances
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...