Forecasting the possibility of neonatal early onset sepsis based on perinatal risk factors

Background: Neonatal sepsis remains a leading cause of neonatal mortality and morbidity, diagnosis of which remains difficult due to variable presentations. With the increasing threat of antimicrobial resistance, it is important to identify perinatal risk factors which are associated with higher incidence of definite sepsis, to initiate empirical antibiotics, while awaiting blood culture reports.Methods: This was hospital based cross-sectional study done in SVPPGIP, Cuttack, Odisha during January 2019 to April 2019, enrolling all neonates  ≥37 weeks gestation and aged less than 72 hours, with suspected early onset sepsis. Neonates with TORCH infections, congenital anomalies, syndromic baby or with surgical conditions were excluded. After obtaining informed consent, blood culture was sent for all and their perinatal risk factors noted. Blood culture positive newborns were considered to have definite sepsis. Data was analysed with Chi-square test and percentages, using SPSS 18.Results: Among the 200 cases, incidence of definite sepsis was 26%. The most common risk factor was low birth weight and birth asphyxia. Majority (67%) had single or lesser risk factor and number of risk factors was significantly associated with definite sepsis. A significant association was seen between blood culture positivity with low birth weight (p=0.003), foul smelling liquor (p= 0.025), birth asphyxia (p 0.018) and premature rupture of membranes (p= 0.016). The combination of maternal fever and unclean vaginal examination was also significantly associated with the same.Conclusions: Protocols for initiating empiric antibiotics need to be formulated, taking into account the significant risk factors, in resource limited settings, to avoid resource and time wastage.

Prenatal, Perinatal and Developmental Risk Factors of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The purpose of this study was to examine the prenatal, perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD), compared to unaffected siblings (SIB), and typically developing children (TC). METHODS: Subjects with ADHD, their SIB, and TC were recruited from the child psychiatry outpatient clinic of the Asan Medical Center Children's Hospital. The parents of the children completed questionnaires on perinatal and developmental risk factors. RESULTS: Fifty-eight subjects with ADHD (41 boys, 7.7+/-1.3 years), 21 SIB (8 boys, 8.2+/-1.8 years), and 22 TC (8 boys, 8.5+/-2.1 years) were included. The ADHD group showed higher rates of maternal stress during pregnancy than the SIB group (p=.002), and the ADHD group showed higher rates of familial psychiatric history than the TC (odds ratio, 8.76 ; 95% confidence interval, 1.69 to 45.45). CONCLUSION: These findings suggest that among perinatal and developmental factors, maternal stress during pregnancy contribute to the development of ADHD. Future prospective studies will be needed in order to determine the causal relationship between perinatal risk factors and development of ADHD.

Perinatal and Developmental Risk Factors of ADHD Children Diagnosed with a Structured Interview

OBJECTIVES: The objective of this study was to examine the perinatal and developmental risk factors of attention-deficit hyperactivity disorder (ADHD) diagnosed with a structured interview among Korean children. METHODS: The current study included 924 children (6-15 years) recruited from schools in five Korean cities or a child psychiatry outpatient clinic of Seoul National University Children's Hospital. The parents of the children completed the structured diagnostic interview for attention-deficit hyperactivity disorder, as well as questionnaires on perinatal and developmental risk factors. RESULTS: Preterm delivery, severe maternal stress during pregnancy, change in primary care taker during the first three years, postpartum depression, and delayed first sentence showed a significant association with ADHD diagnosis. CONCLUSION: These findings suggest that perinatal and developmental factors contribute to development of ADHD in Korean children. Conduct of future research using a prospective design is needed in order to identify the causal relationship between observed risk factors and development of ADHD.

Perinatal and Familial Risk Factors Are Associated with Full Syndrome and Subthreshold Attention-Deficit Hyperactivity Disorder in a Korean Community Sample

OBJECTIVE: The objective of this study was to examine the effect of perinatal and familial risk factors on full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD) among Korean children and adolescents. METHODS: A sample of 2,673 students was randomly selected from 19 representative schools in Seoul, Korea. The parents of the students completed the Diagnostic Interview Schedule for Children-version IV (DISC-IV), as well as questionnaires on perinatal and familial risk factors. RESULTS: Maternal stress and alcohol use during pregnancy, parental marital discord, parental separation or divorce, changes in primary caregivers, and notbreastfeeding were significantly associated with full syndrome ADHD; however, maternal stress during pregnancy was the only variable that differentiated subthreshold ADHD from non-ADHD. CONCLUSION: Our results provide evidence the perinatal and familial risk factors contribute to the development of ADHD in Korea children and adolescents, and suggest that these perinatal and familial risk factors are more closely related to full syndrome than to subthreshold ADHD.

Perinatal and Familial Risk Factors Are Associated with Full Syndrome and Subthreshold Attention-Deficit Hyperactivity Disorder in a Korean Community Sample

OBJECTIVE: The objective of this study was to examine the effect of perinatal and familial risk factors on full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD) among Korean children and adolescents. METHODS: A sample of 2,673 students was randomly selected from 19 representative schools in Seoul, Korea. The parents of the students completed the Diagnostic Interview Schedule for Children-version IV (DISC-IV), as well as questionnaires on perinatal and familial risk factors. RESULTS: Maternal stress and alcohol use during pregnancy, parental marital discord, parental separation or divorce, changes in primary caregivers, and notbreastfeeding were significantly associated with full syndrome ADHD; however, maternal stress during pregnancy was the only variable that differentiated subthreshold ADHD from non-ADHD. CONCLUSION: Our results provide evidence the perinatal and familial risk factors contribute to the development of ADHD in Korea children and adolescents, and suggest that these perinatal and familial risk factors are more closely related to full syndrome than to subthreshold ADHD.

Clinical characteristics of cerebral palsy following preterm or term birth; 10 years' experience / 대한산부인과학회지

OBJECTIVE: To investigate the perinatal and clinical characteristics of cerebral palsy (CP) following preterm or term birth. METHODS: A total of 75 infants born and diagnosed as CP in our hospital from October 1994 to December 2004 were recruited retrospectively. Their maternal and perinatal outcomes and the type, involved lesion and severity of CP were analyzed. RESULTS: The incidence of CP was 0.23%, which showed decreasing pattern according to advancing gestational age at birth. CP was more frequent (6.7-times) in multifetal pregnancy. Male to female ratio was 1.5: 1. After excluding five infants with major congenital anomalies, 55 (79%) infants were born before 37 weeks' gestation (preterm CP) and 15 (21%) infants were born beyond 37 weeks' gestation (term CP). Eighty-six percent of preterm CP had significant neonatal morbidities, but only 6 out of 15 infants in term CP had significant perinatal events including hypoxic ischemic encephalopathy, meconium aspiration syndrome, and seizure of unknown origin. The most common type of preterm CP was spastic (95%), whereas the types of term CP were more diverse; spastic in 67%, athetoid in 20%, dystonic in 7%, and hypotonic in 7%. Regarding the involved lesions, the most common type was diplegic in preterm CP and quadriplegic in term CP. CONCLUSION: In contrast to preterm CP, term CP had significantly less perinatal risk factors, and their type and involved lesion showed more diverse patterns. These findings may implicate that more heterogenous etiologies are involved in pathogenesis of term CP.

Incidence, Timing of Screening Examinations and Perinatal Risk Factors for Retinopathy of Prematurity in Very Low Birth Weight Infants / 대한주산의학회잡지

OBJECTIVE: This study was conducted to evaluate the incidence, the optimal timing of screening examinations for retinopathy of prematurity(ROP) and to analyze perinatal risk factors associated with cryotherapy or lasertherapy(CT/LT) in ROP. METHODS: Medical records of 130 very low birth weight(VLBW) infants who admitted to the NICU of Wonkwang University Hospital from July 1997 to June 2002 were reviewed retrospectively. We evaluated the incidence and severity of ROP by gestational age(GA) and birth weight(BW). And the comparisons of perinatal risk factors between ROP with and without CT/LT have been made. RESULTS: Incidence of ROP was 36.9% and mean GA and BW were 29.1+/-1.99 weeks, 1,153+/-209 gm in VLBW infants respectively. ROP Stage II or greater was 15.4% of VLBW infants, 41.7% of ROP infants, and 27.1% of ROP infants were treated with CT/LT. All infants with BW <750gm or GA <26 weeks were developed ROP with stage II or greater and treated with CT/LT. First detection of ROP was performed at chronologic age(CA) 3 weeks, postconceptional age(PCA) 30 weeks, and first identification of threshold ROP needed with CT/LT were at CA 5 weeks and PCA 33 weeks. The perinatal risk factors with CT/LT for ROP were significant in GA, BW, Apgar score at 1 and 5 minutes and number of blood transfusion. The mean time of spontaneous regression is 13.4+/-8.8 weeks in the mild ROP infants without CT/LT. CONCLUSION: The incidence of ROP is 36.9% and the optimal timing of screening for ROP should be selected by earlier time in 2 guidelines of at 5 weeks of CA and 33 weeks of PCA in VLBW infants. And the related risk factors with CT/LT for threshold ROP were GA, BW and Apgar score at 1 and 5 minutes and number of blood transfusions.

Risk Factors of Threshold Retinopathy of Prematurity in Preterm Infants with Bronchopulmonary Dysplasia

PURPOSE: We tried to clarify perinatal risk factors that are related to the occurrence of threshold retinopathy of prematurity in preterm infants with bronchopulmonary dysplasia. METHODS: We enrolled 40 infants with bronchopulmonary dysplasia who had received ophthalmologic examination between April 1995 and May 2001. The patients were categorized into two groups; "threshold retinopathy of prematurity" group as study (n=18), and "no retinopathy of prematurity" and "prethreshold retinopathy of prematurity" group as control population (n=22), and we compared the perinatal risk factors between the two. RESULTS: Out of total 40 preterm infants with bronchopulmonary dysplasia, only prethreshold retinopathy of prematurity occurred in 6 infants (15%) and threshold retinopathy of prematurity developed in 18 infants(45%). The incidence of threshold retinopathy of prematurity decreased with longer gestation and higher birth weight. Mean gestational age was 26.3 weeks in the study group vs 29.4 weeks in control group, and mean birth weight was 868 g and 1,413 g, respectively. An increased risk of reaching threshold retinopathy of prematurity was found associated with apnea, longer use of aminophylline, hyperglycemia, and higher SNAP scores during the first 24 hours from admission to the NICU. The incidence of threshold retinopathy of prematurity was not influenced by duration of oxygen therapy, ventilator therapy, total parenteral nutrition, phototherapy, hospitalization, intraventricular hemorrhage, pneumonia, pulmonary hemorrhage, sepsis, patent ductus arteriosus, air leak syndrome, necrotizing enterocolitis, frequency of transfusion, and longer use of dexamethasone. CONCLUSION: An increased risk of reaching threshold retinopathy of prematurity in preterm infants with bronchopulmonary dysplasia was found associated with lower birth weight, younger gestational age, apnea, longer use of aminophylline, hyperglycemia, and higher SNAP scores during the first 24 hours from admission to the NICU.

Retinopathy of Prematurity and Perinatal Risk Factors

PURPOSE: The incidence of retinopathy of prematurity(ROP) which is one of the most common cause of childhood blindness has not decreased despite the restricted use of oxygen. There may be other factors responsible for ROP which could not be explained solely by improved survival of very low birth weight infants. We tried to clarify perinatal risk factors that are nrelated to the occurrence of ROP. METHODS: We enrolled 239 infants with gestational ages less than 33 wks or with birth weight less than 1,800 gm who had received ophthalrnologic examination between Jan. 1995 and Dec. 1997. The patients were categorized into two groups,' "No ROP" group as control(n=185) and ROP group as study population(n=54), and we compared the perinatal risk factors between the two. RESULTS: 54(22.6%) out of 239 infants were diagnosed as having ROP. The annual incidence of ROP decreased but the incidence of treated ROP increased. The incidence of ROP decreased with longer gestation and higher birth weight. Mean gestational age was 30.3 weeks in the study group vs 31.0 weeks in the control group, and mean birth weight was 1,390 gm and 1,586 gm, respectively. Significant factors contributing to increased incidence of ROP included: duration of oxygen therapy, ventilator therapy, total parenteral nutrition and hospitalization, frequency of hyperoxia, hypercarbia, and transfusion and respiratory distress syndrome, umbilical artery catheterization, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, use of dexamethasone and aminophylline, pneumonia, air leak syndrome, and hyperglycemia. The incidence of ROP and treated ROP was not influenced by the mode of surfactant treatment(prophylactic vs rescue) in RDS patients and the mode of dexamethasone treatment(short vs long) in BPD patients. CONCLUSION: The risk factors for retinopathy of prematurity included gestational age, birth weight and duration of oxygen, as well as other aforementioned perinatal factors. The occurrence of ROP can be decreased by preventing preterm birth, minimizing the use of oxygen, and further morbidity can be prevented by performing proper ophthalmologic examination and doing an appropriate follow-up.

Perinatal Risk factors in the Pathogenesis of Tourette Syndrome: preliminary findings of a Case-Control Study / 신경정신의학

OBJECTIVE: Tourettes Syndrome(75) is a childhood onset movement disorder that Is characterized by a chronic waxing and waning severity of motor and phonic tics. Increased rates of pre- and perinatal complications in 75 subjects have been reported. This case-control study examined three hypotheses. Compared to normal controls,75 subjects will have a higher rate of exposure to 1) hypoxic perinatal risk factors such as prolonged labor(>or=20 hours) in duration, and 2) severe maternal nausea and vomiting during the first trimester. Furthermore, 3) the presence of these perinatal risk factors will predict a more severe tic severity outcome in 75 subjects. METHOD: Twenty four 75 subjects who were loom in 8 consecutive months of 1975 and retired to the Yale Child Study Center fir the evaluation of 75, and 29 matched community controls were recruited. Subjects were interviewed in-person with Modified Schedule for Risk and Protective Factors in Early Development. Logistic regression and correlation analyses were performed. RESULTS: The rates of prolonged labor and severe nausea and vomiting during first trimester were significantly elevated in 75 subjects. Prolonged labor and forceps delivery were positively associated with worst ever tic severity. CONCLUSION: These findings support the importance of the role of perinatal risk factors including prolonged labor, severe hyperemesis during the first trimester, and forceps delivery in the pathogenesis of TS and expression of tic severity.

Incidence and Risk Factors of the Retinopathy of Prematurity

PURPOSE: Retinopathy of prematurity(ROP) continues to be a serious problem in infants who survived with neonatal intensive care. Nevertheless, there is neither available data about the incidence of ROP which may be the basis of the epidemiology, nor analysis of the risk factors of ROP in Korea. The purpose of this retrospective study was to evaluate the incidence of ROP and to analyze perinatal risk factors of ROP. METHODS: The study population was inborn neonates of Seoul National University Hospital during the three-year period, from Jan. 1991 to Dec. 1993. The total number of infants was 5,764, and the incidence of ROP was evaluated according to gestational age and birthweight. Infants with birthweight under 1,500gram or with gestational age less than 33 weeks were involved in this study, in 168 of the 242 infants, their eyes were examined. Of these, 71 developed some degree of ROP, and 12 received cryotherapy. The comparisons of perinatal risk factors of ROP between the group with and without ROP, and in the group with ROP, between with and without cryotherapy have been made. RESULTS: 1) The cumulative incidence of ROP according to gestational age was 100% in less than 28 weeks, 96.0%, 80.4%, 66.7%, 57.3%, 44.1%, 32.2%, 23.1%, 15.8%, and 10.6% in less than 29, 30, 31, 32, 33, 34, 35, 36, and 37 weeks, respectively. 2) The cumulative incidence of ROP according to birthweight was 100% in under 750gram, 90.9%, 69.8%, 56.8%, 39.1%, 26.8%, 16.0%, and 9.9% in under 1,000gram, 1,250gram, 1,500gram, 1,750gram, 2,000gram, 2,250gram, and 2,500gram, respectively. 3) The perinatal risk factors which were statistically significant were gestational age, birthweight, Apgar score at 1 and 5 minutes, duration of hospitalization, ventilation and oxygen supply, number of transfusions, acidosis, hyperoxia, maximum fraction of inspired oxygen, maximum peak inspiratory pressure, maximum frequency, and the presence of pneumonia, apnea-bradycardia syndrome, intraventricular hemorrhage, sepsis, hypocalcemia, hyperglycemia, bronchopulmonary dysplasia, administration of aminophylline or furosemide. With linear logistic regression analysis, only gestational age (OR=0.930, 95% CI=0.887-0.975) and hyperoxia (OR=1.006, 95% CI=1.003-1.009) were proved to relate to the occurrence of ROP independently. CONCLUSIONS: ROP was developed in 44.1% of infants less than 33 weeks and in 56.8% of infants under 1,500gram and the occurrence of ROP was related significantly only to gestational age and hyperoxia.