Anthropometric outcome of extremely low birth weight and very low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). The mean weight for age (Mean'SD) was 7.615'1.1092 kg with median 7.8 kg. The mean length for age (Mean'SD) was 72.6'3.74 cm with median 73 cm. The mean head circumference for age (Mean'SD) was 42.5'2.12 cm median 43 cm. Adverse neonatal outcome associated with CRIB II score ?10. Total CRIB II score with parameters of growth (<-2 Z score) like weight for age, length for age, weight for length and head circumference for age shows significant correlation (p<0.001).Conclusions: Perinatal risk factors are important determinant for future anthropometric outcome in very low and extremely low birth weight babies. They should be identified, and appropriate measures should be taken to achieve good outcome.

Comparación de escalas de predicción mortalidad neonatal (crib, crib ii, snap ii, snappe ii) entre recién nacidos prematuros y a término / Comparison of neonatal mortality prediction scales (crib, crib ii, snap ii, snappe ii) between preterm and full term infants

Objetivo: Este artículo compara 4 escalas de predicción de mortalidad y gravedad de la enfermedad (CRIB, CRIB II, SNAPPE, SNAPPE II) en recién nacidos prematuros y a términos, ingresados a las unidades de cuidaos intensivos neonatales (UCIN) para determinar cuál de ellas, tiene mayor discriminación pronostica. Métodos: es un estudio transversal, observacional, multicéntrico para comparar varias escalas de predicción de mortalidad y de la enfermedad. Se recolectaron datos de 227 recién nacidos ingresados a las UCIN de 4 hospitales desde julio a diciembre del 2018. Evaluamos las escalas CRIB, CRIB II, SNAPII y SNAP-PE score en recién nacidos prematuros y a término. El área bajo la curva (ROC) fue usada para evaluar y comparar los resultados de predicción de mortalidad y morbilidad. Resultados: Un total of 227 recién nacidos fueron evaluados (media CRIB: 7,81±3,52 media CRIB-II: 11,96±3,91; media SNAP-II: 34,99±16,83, SNAPPE II: 14,61±13,30). Se evidenció una mayor discriminación para las escalas CRIB II y CRIB en relación con SNAP-II y SNAPP II (AUC 0.94 y 0.93 vs 0.86 y 0,77). Además de cada puntuación, varias variables influyeron significativamente en la supervivencia en los modelos de regresión logística. Conclusiones: Todas las escalas de predicción de mortalidad y de gravedad de la enfermedad sirven para utilizarse en las UCIN estudiadas, siendo la escala CRIB II la de mejor rendimiento para aplicarse en nuestro medio.

Objective: This article compares 4 scales of prediction of mortality and disease severity (CRIB, CRIB II, SNAPPE, SNAPPE II) in preterm and term new borns admitted to neonatal intensive care units (NICU) to determine which of them has greater forecast discrimination. Methods: it is a cross-sectional, observational, multicenter study that compares several mortality and disease prediction scales. Data were collected from 227 newborns admitted to the NICU of 4 hospitals from July to December 2018. We evaluated the CRIB, CRIB II, SNAPII and SNAP-PE score scales in preterm and full term infants. The area under the curve (ROC) was used to evaluate and compare the prediction results of mortality and morbidity. Results: A total of 227 newborns were evaluated (mean CRIB: 7.81 ± 3.52 mean CRIB-II: 11.96 ± 3.91, average SNAP-II: 34.99 ± 16.83, SNAPPE II: 14.61 ± 13.30). There was evidence of greater discrimination for the CRIB II and CRIB scales in relation to SNAP-II and SNAPP II (AUC 0.94 and 0.93 vs 0.86 and 0.77). In addition to each score, several variables significantly influenced survival in the logistic regression models. Conclusions: All the prediction scales of mortality and severity of the disease serve to be used in the studied NICUs, being the CRIB II scale the best performance to apply in our environment.

Impacto de una intervención educativa para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante / Impact of an educational intervention to improve adherence to the recommendations on safe infant sleep

Introducción. Las campanas públicas en países desarrollados con recomendaciones para el sueño seguro del lactante lograron aumentar la adherencia a la posición supina para dormir a más del 70% y generaron, simultáneamente, una reducción del 53% en la incidencia del síndrome de muerte súbita del lactante. Objetivo. Valorar el impacto a los 60 días de vida de una intervención educativa realizada en las maternidades para mejorar la adherencia a las recomendaciones sobre sueño seguro del lactante. Población, material y métodos. Estudio de intervención con control histórico entre el 1/2 y el 30/9 de 2014, realizado en la Maternidad Meisner y el Hospital Universitario Austral. Dicha intervención se denominó "tapeta cuna" y consistió en capacitar al equipo de salud y brindar información a las familias sobre sueño seguro a través de clases, adhesivos en las cunas y material escrito. Resultados. Fueron incluidos 550recién nacidos. Se observó un incremento del 35% en la posición supina al dormir tras la intervención (p < 0,0001); la lactancia materna exclusiva se incrementó un 11% (p= 0,01); se redujo el colecho de un 31% a un 18% (p < 0,0005). No se encontraron diferencias en la cohabitación, entre convivientes fumadores ni en la utilización del chupete a los 60 días. Conclusiones. La intervención educativa resultó útil para mejorar la adherencia a las recomendaciones sobre sueño seguro a los 60 días de vida: se evidenció una mejora en la posición supina, la lactancia materna y la reducción del colecho. No existieron cambios en la proporción de convivientes fumadores, la cohabitación y el uso del chupete.

Introduction. In developed countries, public campaigns promoting recommendations on safe infant sleep increased adherence to the supine sleeping position to more than 70% and, at the same time, reduced the incidence of sudden infant death syndrome by 53%. Objective. To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep. Population, material and methods. Intervention study with historical control conducted between February 1st and September 30th of 2014 at the Maternity Center of Hospital Meisner and Hospital Universitario Austral. The intervention was called "crib card" and consisted in training health care team members and providing families with information on safe infant sleep by means of lessons, written material and using stickers on cribs. Results. Five hundred and fifty newborn infants were included. After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p < 0.0005). No differences were observed in relation to bedroom sharing, living with tobacco users, or pacifier use at 60 days of life. Conclusions. The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Periopertive nursing of children with formaral angulation deformity treated with sreminobicular crib external fixator / 现代临床护理

Objective To summarize the perioperative nursing experience in nursing children with formaral angulation deformity treated with sreminobicular crib external fixator. Method The clinical data of 15 children with formaral angulation deformity treated with sreminobicular crib external fixator were reviewed. Results All 15 children got recovered, with the femora extended by 4~9 cm. After operation, all of them were affected by knee flexion dysfunction and foot drop to varied extents, which were improved satisfactorily after systematic training. Conclusions The systematic and progressive training can prevent knee flexion dysfunction and foot drop. Careful observation and effective nursing play an important role in the treatment of formaral angulation deformity.

Aesthetic Rehabilitation of A Child With Missing Anterior Teeth And Thumb Sucking Habit Using Fixed Functional Space Maintainer In Combination With Habit Breaking Appliance.

Loss of anterior teeth is a psychological trauma both for parent as well as children. Children presenting with lost anterior teeth along with thumb sucking habit require not only attention for aesthetics, function and space maintenance but also an appliance for habit breaking. Depending on many clinical and economic factors, a course of treatment is decided by the dentist in consultation with parent and child. A new technique is presented in which a child with anterior teeth missing and concomitant ‘‘thumb sucking’’ habit was given a fixed functional space maintainer' with incorporated palatal crib.

Validation of CRIB II for Prediction of Mortality in Premature Babies.

Objective: Validation of Clinical Risk Index for Babies (CRIB II) score in predicting the neonatal mortality in preterm neonates ≤32 weeks gestational age. Design: Prospective cohort study. Setting: Tertiary care neonatal unit. Subjects: 86 consecutively born preterm neonates with gestational age ≤32 weeks. Methods: The five variables related to CRIB II were recorded within the first hour of admission for data analysis. The receiver operating characteristics (ROC) curve was used to check the accuracy of the mortality prediction. H-L Goodness of fit test was used to see the discrepancy between observed and expected outcomes. Results: A total of 86 neonates (males 59.6%; mean birthweight: 1228± 398 grams; mean gestational age: 28.3 ± 2.4 weeks) were enrolled in the study, of which 17 (19.8%) left hospital against medical advice (LAMA) before reaching the study end point. Among 69 neonates completing the study, 24 (34.8%) had adverse outcome during hospital stay and 45 (65.2%) had favorable outcome. CRIB II correctly predicted adverse outcome in 90.3% (Hosmer–Lemeshow goodness-of-fit test P=0.6). Area under curve (AUC) for CRIB II was 0.9032. In intention to treat analysis with LAMA cases included as survivors, the mortality prediction was 87%. If these were included as having died then mortality prediction was 83.1%. Conclusion: The CRIB II score was found to be a good predictive instrument for mortality in preterm infants ≤32weeks gestation.

Comparison of Outcomes According to the Hospitals of Antenatal Care in Very Low Birth Weight Infants

PURPOSE: The purpose of this study was to evaluate the differences according to the hospitals of antenatal care in premature infants. METHODS: We retrospectively reviewed the medical records of premature infants with gestational ages <37 weeks and very low birth weights who were admitted immediately after birth to the neonatal intensive care unit (NICU) at the Dongguk University Ilsan Hospital between March 2007 and February 2009. The hospitals of antenatal care were divided into two levels (primary antenatal care hospital: hospitals with less than a level 2 NICU, secondary antenatal care hospital: hospitals with a level 3 NICU) based on the level of NICU in hospitals. In addition, total infants were divided into two groups (Immediate group: infants born within 24 hours of maternal admission, Delayed group: infants born after 24 hours of maternal admission). The differences between maternal and neonatal variables in each groups were studied. RESULTS: Neonates in secondary antenatal care hospitals comprised 11.0% of the study neonates (10 of 91). We compared with two groups (primary antenatal care hospital and secondary antenatal care hospital), but there were no differences in all subjects. However, the 1 minute Apgar score (< or =3) was lower in the immediate group than the delayed group. CONCLUSION: Shorter duration of maternal admission to delivery was associated with a lower 1 minute Apgar score of neonates. These findings suggest that if maintenance of pregnancy is difficult when high-risk gravidas are transferred, clinicians must prepare for emergencies of neonates.

Early stress hyperglycemia as independent predictor of increased mortality in preterm infants / 소아과

Purpose: Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods: In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results: There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion: Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.

Recent outcome of extremely low birth weight infants: The use of CRIB(clinical risk index for babies) II score for analyzing the survival rate / 소아과

PURPOSE: The survival rate of infants weighing less than 1,000 g at birth(extremely low birth weight infants, ELBWI) has increased due to recent advances in perinatal and neonatal intensive care. The purpose of this study was to evaluate the survival rates of ELBWI born at Seoul National University Hospital during the last six years. METHODS: A total of 99 infants were divided into three groups(period I : 2000 to 2001, period II: 2002 to 2003, period III: 2004 to 2005) based on date of birth. We compared the survival rate of ELBWI over the three periods, using CRIB II score for adjustment for clinical severity. RESULTS: Overall survival rate of ELBWI was 74.7 percent. The survival rate of ELBWI increased over the three periods(period I: 60.7 percent, period II : 73.3 percent, period III: 85.3 percent). The threshold of viability(defined as survival of at least 50 percent of infants) was 25 weeks of gestation and 600 g at birth. The birth weight-specific survival rates increased considerably over the three periods for infants < 750 g at birth(period I: 10 percent, period II: 46.2 percent, period III: 70.6 percent). The survival rates of ELBWI over the three periods increased much remarkably after adjustment for clinical severity by CRIB II score. CONCLUSION: In our institution, survival rates of ELBWI during the last six years continued to improve, particularly for infants weighing < 750 g at birth. This increase in survival rates was not associated with the clinical severity of ELBWI.

Previsão da mortalidade neonatal entre recém-nascidos de baixo peso internados na UTI neonatal do Hospital Estadual Adão Pereira Nunes / Predicting neonatal mortality among infants of low birth weight neonatal ICU State Hospital Adam Pereira Nunes

O desenvolvimento do suporte intensivo para recém-nascidos de baixo peso ao nascimento vem introduzindo ao longo do tempo, escores de predição de mortalidade, baseados na análises da gravidade inicial destes pacientes...Uma vez que o peso de nascimento por si só não discrimina quais os fatores que determinarão o óbito entre pacientes em uma mesma faixa de peso, a aplicação dos escores se faz necessária para estabelecer a gravidade dos pacientes. Sendo assim, estes escores só devem ser utilizados para estudos populacionais e comparações entre serviços e não como instrumento para decidir condutas terapêuticas individualmente, simplesmente baseado em um escore inicial alto, o qual eleva o risco de mortalidade.

The Usefulness of the CRIB ( Clinical Risk Index for Babies ) Score as a Prognostic Indicator in the Very Low Birth weight Infants

PURPOSE: This study was aimed to assess the ability of CRIB score as a prognostic indicator in the very low birth weight infants (VLBWI) compared with gestational age and birth weight. METHODS: The medical records of 85 newborns <1,500 g of birth weight were reviewed retrospectively. CRIB score was calculated from six factors (birth weight, gestational age, the presence of congenital malformation, maximum base excess, minimum and maximum appropriate inspired oxygen concentration in the first 12 hours). Neurological rnorbidities such as intraventricular hemorrhage (IVH), increased periventricular echogenicity (PVE), periventricular leukomalacia (PVL) were evaluated. RESULTS: The mean birth weight was 1,152229 g, average gestational age 293.8 weeks, average CRIB scores 5.3+/-4.14 (range 0-16). Mortality rate was 32% (27/85). Neurological morbidities were detected as IVH over grade II in 35 (41%), as increased PVE in 34 (40%) and as PVL in 9 (11%). CRIB score showed significant positive relation with themortality (P<0.05), but not with IVH, PVE, and PVL. CRIB score was a little better for the prediction of mortality than birth weight and gestational age without statistical significance (ROC of 0.784 with CRIB score, 0.708 with birth weight, 0.762 with gestational age). CRIB score was as good for the prediction of neurological morbidity as birth weight and gestational age. CONCLUSION: This study revealed that CRIB score is a useful method to predict the mortality of VLBWI. It is necessary to reevaluate the usefulness of CRIB score with a larger number of VLBWI in the future.

Reversal of Optic Disc Cupping in Adults with Advanced Glaucoma

Several studies have reported that the extent of cupping reversal after reduction of intraocular pressure may decrease with the progression of glaucomatous optic nerve damage. Three cases of reversal of glaucomatous cupping occurred after mitomycin C trabeculectomy in 20 and 22-year-old patients with advanced open angle glaucoma. The magnitude of intraocular pressure reduction was 35 to 38mmHg(average 36.7mmHg), a 79.1% drop from initial pressures. An improvement in the visual field occurred in one eye after re versa 1 of cupping. The most likely mechanism to explain reversal of cupping is a reduction in the posterior bowing of the lamina cribrosa. Even in the advan ced stage of glaucoma, reversal of cupping may be possible in young adults, as seen in our cases.