ABSTRACT
Background: Neonatal deaths account for 47% of all deaths in children younger than 5 years globally. More than a third of deaths are due to preterm related complications. Understanding the factors contributing to preterm deaths and pattern of mortality is needed to implement interventions that are essential in improving neonatal survival.Methods: This was a retrospective study done in neonatal intensive care unit, Institute of Child Health (ICH) and Hospital for Children, Chennai, a tertiary care regional center. All preterm (<32 weeks) deaths registered in the neonatal medical records from 1st of January 2018 to 31st of December 2018 were analysed. Primary causes of deaths were analysed by two consultants. When there were more than one cause contributing to responsible for death the most significant problem was taken as the cause of death.Results: Overall neonatal mortality was 312 (14.2%) of 2189 neonates. Out of 148 admissions in the study population mortality was 74.2% (26 of 35) for extreme preterm (<28 weeks) infants and 42.7% (48 of 113) for very preterm (28 to 32 weeks) infants. Predominant causes of death were sepsis 44.5% (33), prematurity-related complications 37.8% (28) followed by congenital anomalies 12.1% (9) and miscellaneous causes 2.7% (2). Respiratory Distress Syndrome (RDS) and Intra Ventricular Haemorrhage (IVH) attributed to 75% (21/ 28) of deaths among prematurity-related complications.Conclusions: This study identified sepsis; prematurity related complications were the predominant causes of mortality in the extreme to very preterm population. Understanding the specific causes of preterm mortality would help to implement interventions to promote their survival.
ABSTRACT
En recién nacidos pretérmino extremo (RNPTE) históricamente se ha utilizado la edad corregida (ECo) en la evaluación del desarrollo psicomotor (DSM). Existe controversia en la evidencia respecto de utilidad de esta práctica y riesgo de sobrecorregir. OBJETIVOS: escribir DSM a 18 meses edad cronológica (ECr) en RNPTE, y compararlo con DSM según ECo. OBJETIVO SECUNDARIO: evaluar presencia de patologías o complicaciones de prematurez, en pacientes con retraso en algún área de DSM según ECr. Pacientes y MÉTODO: Estudio de cohorte prospectivo que incluyó RNPTE nacidos en Hospital San José entre Enero y Octubre 2016 con seguimiento en Hospital Roberto del Río. Se aplicó test de Bayley III a 18 meses de ECr y se comparó resultados con ECo. El retraso en algún área según ECr implicó una evaluación clínica neurológica. RESULTADOS: Nacieron 111 pacientes RNPTE entre enero-octubre 2016, 55 participaron del estudio. Según ECr catalogaron 30 pacientes normales y 21 en riesgo. Según ECo, 46 fueron catalogados normales y 5 en riesgo. Los 4 pacientes con retraso según ECr, persistieron en retraso al evaluar según ECo. Evaluación neurológica en pacientes con retraso evidenció trastornos neurológicos que explicaban esta condición. CONCLUSIÓN: Evaluar DSM en RNPTE a 18 meses de ECr permitiría detección de pacientes con riesgo de retraso, a diferencia de lo evaluado por Eco, que es relevante para seguimiento neurológico estrecho. Todos los RNPTE con retraso de DSM en algún área presentan un trastorno neurológico severo que lo explica y no es un desarrollo "madurativo" enlentecido de la prematurez.
In extreme preterm newborns (EPN), corrected age (CoA) has historically been used to evaluate psychomotor development (PSD). There is controversy in the evidence regarding this practice's usefulness and the risk of overcorrection. OBJECTIVE: To describe PSD at 18 months of chronological age (ChrA) in EPN and compare it with CoA. SECONDARY OBJECTIVE: to evaluate the presence of pathologies or complications of prematurity in patients with delay in any area using ChrA. PATIENTS AND METHOD: Cohort prospective study that included EPN patients born in San José Hospital between January and October 2016 with follow-up in Roberto del Río Hospital. Bayley III test was applied at 18 months ChrA and its results were compared with CoA. Delay in any area according to ChrA implied a clinical neurological evaluation. RESULTS: 111 EPN were born in San José Hospital (January-October 2016), 55 participated in the study. According to ChrA, 30 patients were cataloged as normal and 21 at risk. According to CoA, 46 were classified as normal and 5 at risk. The 4 patients with delay according to ChrA persisted in this category when evaluated with CoA. Neurological evaluation in patients with delay evidenced neurological disorders that explained this condition. CONCLUSION: Assessing PSD in EPN at 18 months ChrA allows early detection of patients with risk of developmental delay, regarding the use of CoA, with importance of a neurological follow-up of this group. All patients with delay in PSD had a severe neurological disorder that explained this delay, which was not just a slow "madurative" development of prematurity. .
Subject(s)
Humans , Infant, Newborn , Child Development , Infant, Extremely Premature/growth & development , Prospective Studies , Age FactorsABSTRACT
Introducción: Con mayor aporte de proteínas y energía en la primera semana se ha observado hipofosfemia en prematuros extremos. Los menores niveles de fósforo se han presentado en prematuros con antecedentes de restricción de crecimiento intrauterino. Objetivos: Caracterizar los niveles plasmáticos bioquímicos en el cordón de prematuros extremos, nacidos adecuados (AEG) y pequeños para edad gestacional (PEG) y la relación con calcemia y fosfemia en la primera semana de vida. Pacientes y método: Estudio clínico realizado en Neonatología del Hospital Doctor Sótero del Río, en los años 2013 y 2014. Se analiza el perfil bioquímico en el cordón y la calcemia y fosfemia en los primeros 7 días de vida, registrados en la ficha clínica según fueran AEG o PEG, según las curvas de Alarcón-Pittaluga. Análisis con significación de p < 0,05. Resultados: Los niveles de colesterol, transaminasas, albúmina y creatinina fueron similares para los PEG y AEG. Los niveles de pH, fósforo, calcio, y fosfatasas alcalinas fueron menores en los PEG. El nitrógeno ureico, el ácido úrico y los triglicéridos fueron mayores en los PEG. Los PEG muestran marcada reducción de fosfemia en la primera semana, la calcemia tiende a subir proporcionalmente al descenso de la fosfemia. Conclusiones: En prematuros extremos la desnutrición intrauterina se expresa en modificación de los niveles plasmáticos de calcio, fósforo, fosfatasas alcalinas, nitrógeno ureico, ácido úrico y triglicéridos. Posnatalmente, al recibir aporte nutricional, se manifiesta una disminución de la fosfemia y un aumento de calcemia, concordante con aportes insuficientes de fósforo durante el período.
Introduction: The use of greater amounts of protein and energy during the first week of life is associated with hypophosphataemia in extreme preterm babies. The lowest phosphorus levels are described in intrauterine growth restricted (IUGR) babies. Objectives: To describe biochemistry levels in cord blood plasma in extreme premature, adequate and small for gestational age babies (AGA/SGA) and their relationship with plasma calcium and phosphorus levels during the first week of life. Patients and method: A descriptive clinical study was performed in the Neonatology Service at Hospital Dr. Sótero del Río during 2013 and 2014. A biochemical analysis of cord blood was performed on 43 premature babies, as well as plasma calcium and phosphorus levels during the first week. The adequacy for gestational age was obtained using Alarcón- Pittaluga growth curves. Statistical significance was P < .05. Results: Cholesterol, transaminases, albumin and creatinine levels were similar for both AGA and SGA babies. Levels of pH, phosphorus, calcium and alkaline phosphatase were significantly lower in SGA babies. Urea nitrogen, uric acid and triglycerides levels were higher in SGA. The analysis during the first week showed a strong reduction in phosphorus levels, as well as an increase in calcium levels in proportion to the decrease in phosphorus in the SGA sub- group. Conclusions: Intrauterine malnutrition in preterm babies is expressed in the modulation of plasma levels of calcium, phosphorus, alkaline phosphatase, urea nitrogen, uric acid and triglycerides. During post-natal life, when nutritional intake begins, a decrease in phosphorus and an increase in calcium levels appear, consistent with insufficient phosphorus intake during this period.