Neonatal morbidity and mortality: A 5-year analysis at federal medical centre, Gusau, Zamfara State, Northwest Nigeria

OBJECTIVES: Neonatal morbidity and mortality have remained embarrassingly high in Nigeria compared to some countries in Sub-Saharan Africa. Nigeria ranked first in the burden of neonatal deaths in Africa. Therefore, there is need to know causes of newborn diseases and deaths in our neonatal unit. The objective of the study was to describe the morbidity and mortality of newborns admitted into Special Care Baby Unit of Federal Medical Centre, Gusau, Nigeria over a 5-year period. MATERIAL AND METHODS: This is a retrospective study covering January 2012 to December 2016. The case folders of all newborns admitted during this period were retrieved and the following information were extracted: Sex of babies, diagnoses, outcome in terms of discharges, deaths, referrals, and discharge against medical advice (DAMA). RESULTS: A total of 3,553 neonates were admitted during the period under review. The sex ratio for males and females was 1.4:1, respectively. The major diagnoses were neonatal sepsis (NNS) 36.5%, birth asphyxia 25.6%, and prematurity 16.1%. Mortality rate was 6.6% with major contributions from birth asphyxia (35.6%), prematurity (28.1%), and NNS (12.0%). DAMA rate was 1.7%. CONCLUSION: This study has shown that NNS, birth asphyxia, and prematurity are the dominant causes of morbidity and mortality. These are largely preventable.

Is vaginal breech delivery still a safe option? / Será o parto pélvico vaginal uma opção segura?

Abstract Objective: To determine whether there was any difference in neonatal and maternal outcomes between breech vaginal delivery and cephalic vaginal delivery. Methods: A retrospective, case-control study was conducted between January 2015 and December 2017 in a Portuguese hospital. A total of 26 cases of breech vaginal delivery were considered eligible and 52 pregnant women formed the control group. Results: Induced labor was more frequent in the breech vaginal delivery group (46% versus 21%, p = 0.022). Episiotomy was more common in the breech vaginal delivery group (80% versus 52%, p = 0.014), and one woman had a 3rd degree perineal laceration. Newborns in the study group had a lower birthweight (2,805 g versus 3,177 g, p < 0.001). There was no significant difference in the neonatal outcomes. Conclusion: The present study showed that breech vaginal delivery at term compared with cephalic presentation was not associated with significant differences in neonatal and maternal morbidity. It also suggests that breech vaginal delivery remains a safe option under strict selection criteria and in the presence of an experienced obstetrician.

Resumo Objetivo: Avaliar se existem diferenças nos desfechos perinatal e materno entre os partos pélvicos vaginais e eutócicos. Métodos: Realizou-se um estudo retrospectivo, caso controle, entre janeiro de 2015 e dezembro de 2017 em um hospital terciário em Portugal. Foram incluídos 26 casos de parto pélvico vaginal e o grupo controle foi formado por 52 grávidas. Resultados: A indução do trabalho de parto ocorreu com mais frequência no grupo do parto pélvico vaginal (46% versus 21%, p = 0.022), bem como a realização de episiotomia (80% versus 52%, p = 0.014). Verificou-se um caso de laceração perineal de 3° grau. Os recém-nascidos do grupo de estudo apresentaram um peso inferior ao nascimento (2.805 g versus 3.177 g, p < 0.001). Em relação aos desfechos perinatais, não se observaram diferenças estatisticamente significativas. Conclusão: O presente estudo mostrou que o parto pélvico vaginal no termo quando comparado com o parto eutócico não se associou a diferenças estatisticamente significativas na morbidade perinatal e materna, e sugere ainda que o parto pélvico vaginal parece ser uma opção segura em casos rigorosamente selecionados e na presença de um obstetra experiente.

Active versus expectant management for preterm premature rupture of membranes at 34-36 weeks of gestation and the associated adverse perinatal outcomes / Manejo ativo versus expectante para ruptura prematura de membranas entre 34 e 36 semanas de gestação e os resultados perinatais adversos associados

Abstract Objective: To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods: In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results: Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion: There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Resumo Objetivo: Comparar o tipo de manejo (ativo versus expectante) para ruptura prematura de membranas (PPROM, na sigla em inglês) entre 34 e 36 semanas e 6 dias de gestação e os resultados perinatais adversos relacionados, em 2 hospitais terciários do sudeste brasileiro. Métodos: No presente estudo de coorte retrospectivo, os dados foram obtidos através da revisão dos prontuários de gestantes internadas em dois centros terciários com protocolos diferentes para o seguimento da PPROM. As gestantes foram divididas em dois grupos com base no manejo da PPROM: grupo I (ativo) e grupo II (expectante). Para análise estatística, foram utilizados o teste t de Student, qui-quadrado e regressão logística binária. Resultados: Das 118 gestantes incluídas, 78 foram submetidas a tratamento ativo (grupo I) e 40 a seguimento expectante (grupo II). Comparado ao grupo II, o grupo I apresentou índice de líquido amniótico médio significativamente menor (5,5 versus 11,3 cm, p = 0,002), reação em cadeia da polimerase na admissão (1,5 versus 5,2 mg/dl, p = 0,002), tempo de antibióticos profiláticos (5,4 versus 18,4 horas, p < 0,001), tempo de latência (20,9 versus 33,6 horas, p = 0,001) e idade gestacional no parto (36,5 versus 37,2 semanas, p = 0,025). Não houve associações significativas entre os grupos e a presença de resultados perinatais adversos. A idade gestacional no diagnóstico foi o único preditor significativo de desfecho composto adverso (x2 [1] = 3,1, p = 0,0001, R2 Nagelkerke = 0,138). Conclusão: Não houve associação entre manejo ativo e expectante em gestantes com PPROM entre 34 e 36 semanas e 6 dias de gestação e resultados perinatais adversos.

Anomalías congénitas y comorbilidad en neonatos con Síndrome de Down / Congenital anomalies and comorbidities in neonates with Down Syndrome

INTRODUCCIÓN: El Síndrome de Down se presenta en 2,5 de 1.000 recién nacidos vivos chilenos. Presentan más anomalías congénitas y comorbilidades que la población general, aumentando su tasa de hospitalización. OBJETIVO: Describir las anomalías congénitas y comorbilidades de neonatos con Síndrome de Down nacidos y/u hospitalizados en la década 2008-2018. PACIENTES Y MÉTODO: Retrospectiva mente se revisaron registros de los pacientes nacidos y/u hospitalizados dentro de sus 28 días de vida entre el 1 de enero de 2008 y el 31 de diciembre de 2018. Para cada paciente se consignó: edad materna, antecedentes familiares de Síndrome de Down, antecedentes pre y perinatales y resultado de estudio genético. Se consignó la edad al ingreso, el motivo principal de ingreso, comorbilidades, días de hospitalización y fallecimiento. Se excluyeron dos pacientes con más del 50% de ficha in completa. Se exploraron asociaciones entre morbilidades, anomalías y fallecimiento. RESULTADOS: 140 de 79.506 (0,2%) recién nacidos vivos fueron diagnosticados con Síndrome de Down en el período neonatal. 24,7% fueron prematuros y 26,4% tuvieron bajo peso para su edad gestacional. Los porcentajes de morbilidad y hospitalización fueron 83,6% y 90%. La principal causa de ingreso fue la poliglobulia, y la más frecuente hiperbilirrubinemia. Fallecieron 4 pacientes (2,9%) y 70,7% presentó alguna una anomalía congénita, principalmente cardíaca. La mediana de edad materna fue de 36 años y 57,1% tenía 35 años o más. CONCLUSIONES: Esta investigación aporta información relevante para optimizar el manejo perinatal y el seguimiento de los pacientes con Síndrome de Down.

INTRODUCTION: In Chile, Down syndrome has a prevalence of 2.5 in 1,000 live births. These patients present more congenital anomalies and comorbidities than the general population, increasing their hospitaliza tion rate. OBJECTIVE: To describe congenital anomalies and comorbidities of neonates with Down syndrome born and/or hospitalized between 2008 and 2018. PATIENTS AND METHOD: We conducted a retrospective review of patient's medical records born and/or hospitalized during their first 28 days of life between January 1st, 2008, and December 31st, 2018. For each patient, we recorded maternal age, familiar cases of Down Syndrome, pre and perinatal history, genetic study result, as well as age at admission, reason for hospitalization, comorbidities, length of stay, and death. Two patients that had more than 50% of incomplete medical records were excluded. We studied the associations between comorbidities, congenital anomalies, and death. RESULTS: 140 in 79,506 newborns (0.2%) were diagnosed at our center with Down Syndrome in their neonatal period. 24.7% were born preterm and 26.4% had low birth weight for gestational age. Morbidities and hospitalizations were present in 83.6% and 90%, of the study population, respectively. The main reason for hospitalization was polycythemia and the most frequent was hyperbilirubinemia. Four patients died (2.9%) and 70.7% presented at least one congenital anomaly, mainly heart disease. Median maternal age was 36 years and 57.1% of mothers were aged 35 or older. CONCLUSIONS: This cohort of patients with Down Syndrome provides important information for the optimization of their perinatal management and follow-up.

Delayed-Iinterval delivery in dichorionic twin pregnancies: A case report of 154 latency days / Parto diferido emg ravidez gemelar bicoriônica: Um caso com 154 dias de latência

Abstract Premature delivery often complicates multifetal pregnancies, placing neonates at risk of seriousmorbidity andmortality. In select cases, pretermbirth of one sibling may not require delivery of the remaining fetus(es), which may remain in utero for a delayedinterval delivery, consequently improving neonatalmorbidity andmortality. Currently, there is no consensus on the best protocol for the optimalmanagement of these cases. We report one case of delayed-interval delivery of a dichorionic pregnancy assisted in our center. In this case, prophylactic cerclage, tocolytic therapy and administration of broad-spectrum prophylactic antibiotics enabled delivery at 37 weeks, corresponding to 154 days of latency, which is, to our knowledge, the longest interval described in the literature. The attempt to defer the delivery of the second fetus in peri-viability is an option that should be offered to parents after counseling, providing that the clinical criteria of eligibility are fulfilled. The correct selection of candidates, combined with the correct performance of procedures, as well as fetal and maternal monitoring and early identification of complications increase the probability of success of this type of delivery.

Resumo O parto pré-termo espontâneo complica frequentemente as gestações multifetais, condicionando elevada morbimortalidade perinatal. Em determinados casos, o nascimento prematuro do primeiro feto pode não requerer o nascimento do(s) feto(s) restante(s), que podem permanecer in utero, com o objetivo de diminuir a morbidade e mortalidade neonatal. Atualmente, não existe consenso quanto à melhor atitude clínica nas situações de parto diferido. Descrevemos um caso de parto diferido de gravidez bicoriônica vigiado no nosso centro. Neste caso, a realização de cerclagem, a terapêutica tocolítica e a administração de antibioticoterapia de largo espectro permitiu o parto às 37 semanas do segundo gêmeo, o que corresponde a 154 dias de latência, que, segundo o nosso conhecimento, é o intervalo de diferimento mais longo descrito na literatura. A tentativa de diferir o parto do segundo feto na periviabilidade é uma opção que deve ser oferecida aos progenitores, após aconselhamento e desde que se cumpram os critérios clínicos de elegibilidade. A seleção correta das candidatas, em conjunto com a realização de corretos procedimentos, monitorização fetal e materna e identificação precoce de complicações aumentam a possibilidade de sucesso deste tipo de parto.

A prospective observational study of fetomaternal outcome in second stage caesarean section

Background: Incidence of caesarean section is rapidly rising over last two decades and one fourth is contributed by caesarean section in second stage. The objective of this study was to study of fetomaternal outcome in second stage caesarean section.Methods: Prospective observational study was done in 80 women undergoing second stage caesarean section from December 2015 to March 2017 at Lady Hardinge Medical Collage Delhi. These women observed from labour to caesarean section in second stage of labour till post-operative period for any complication. Intraoperative and postoperative complications were observed in these women.Results: Caesarean section rate was 22% in which 3.9% were done in second stage of labour. Most common gestational age being 39-40 weeks (47%). Most common indication being deep transverse arrest (41.25%). Intraoperative complication as bladder injury (5%), extension of uterine incision (23%), PPH (33%) and need for blood transfusion (31%) and post-operative complication as wound sepsis in 58% and 20% requiring resuturing, post-operative fever, prolong hospital stay, prolonged catheterization etc. neonatal complications as severe birth asphyxia (2.5%), respiratory distress (55%), need for mechanical ventilation.Conclusions: Thus, caesarean section done in second stage of labour is associated with increased maternal and neonatal morbidity.

Morbidity and mortality pattern among babies admitted in special newborn care unit, Nellore, Andhra Pradesh, India

Background: India contributes to 25% of neonatal mortality around the world. In developing countries neonatal mortality is quite high despite of advances in perinatal and neonatal care. The establishment of Special Newborn Care Units (SNCU) has been quite essential in reducing the neonatal morbidity and mortality. This study was conducted to assess the outcome of SNCU at a newly commissioned tertiary care teaching hospital at Nellore District, Andhra Pradesh. Aim of this study the morbidity and mortality patterns in an SNCU at tertiary care teaching hospital.Methods: It was a Retrospective, Hospital based, Descriptive study which was done among neonates admitted to SNCU, Nellore District, Andhra Pradesh for a period of 1 year (January 2015-December 2015). All the neonates admitted to SNCU, Nellore District, Andhra Pradesh during the study period were included in the study. Data was recorded in a predesigned semi-structured proforma. the data was entered into excel-sheet and analyzed using SPSS software version 21.Results: A total of 1015 babies were included in the study. Almost half 592(58.32%) were born in this hospital(inborn) and 423(41.67%) babies were referred from peripheral hospitals and nursing homes (out born). about 3/4th 767(75.5%) of babies were admitted in the first 24 hours of life. Almost half (53.4%) of the study group were male and 46.6% were female. The chief causes of admission in SNCU were Respiratory Distress Syndrome (40.2%) followed by birth asphyxia (19.1%), sepsis (13.3%), Neonatal Jaundice (9.9%) and prematurity (6.6%). In our study 63.0% patients were discharged, 19.3% had left hospital against medical advice, 10.1% died and 7.6% were referred to other institutions for specialized treatment.Conclusion: Respiratory Distress Syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and HIE as the major causes of morbidity. Low Birth Weight and prematurity were the commonest contributors of death, therefore, attempts to prolong the pregnancy each week might improve the neonatal outcome considerably.

Fetomaternal outcome in caesarean section at full dilatation

Background: To study indications, intraoperative and postoperative complications and fetomaternal outcome in cesarean sections done at full dilatation.Methods: This is a prospective cross-sectional study which was conducted in the department of obstetrics and gynecology, RNT medical college, Udaipur from November 2018 to April 2019. 100 cases of caesarean sections at full dilatation which were performed during this period were analyzed for indications and maternal and fetal morbidity.Results: Among these 100 cesarean sections, majority of cases were in the age group of 21-30 years (46%), booked and  Primigravida(81%).Most common indications were cephalo-pelvic disproportion (27%) and fetal distress (21%). Most commonly baby was delivered either by vertex (44%) or by Patwardhan (31%). Intraoperative complications were higher in terms of hematuria in 41%, Atonic PPH in 35%, uterine incision extension in 28% of cases. In one case bladder injury was noticed. Increased incidence of post-operative febrile illness and wound infection were noted. 44% baby’s required nursery admission, most commonly due to birth asphyxia (16%) and RDS (11%).Conclusions: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity, Neonatal morbidity and mortality. So proper monitoring during labor and involvement of skilled obstetrician in decision making and delivery is crucial to minimize fetomaternal complications.

Vaginal progesterone in risk reduction of preterm birth in women with short cervix

Background: Preterm birth is a global health problem affecting the neonate, family and country in general. It is the leading cause of perinatal mortality and morbidity. Short cervical length detected on transvaginal ultrasound is the most practical risk factor for prediction of preterm birth. The aim of this study was to determine the efficacy and safety of vaginal progesterone in reducing the rate of preterm birth in women with a short cervix and to determine its effect on neonatal mortality and morbidity.Methods: The study was carried out in the Department of Obstetrics and Gynaecology at Assam Medical College, Dibrugarh for a period of one year. It included 128 asymptomatic women with a singleton pregnancy and a sonographic short cervix. Women were randomly divided into two groups, one of which was given placebo and the other was given vaginal progesterone and a comparative study was conducted.Results: It was observed that delivery before 37 weeks of gestation was less frequent in the progesterone group than in the placebo group (60.94% vs. 90.63%). Vaginal progesterone was also associated with a significant reduction in adverse neonatal outcomes like the rate of sepsis (6.25% vs. 18.75%), requirement of ventilator (12.5% vs. 26.56%), admission to NICU (10.94% vs. 26.56%) and birth weight ≤1.5kg (7.81% vs. 21.88%).Conclusions: Vaginal progesterone reduces the risk of preterm birth and adverse perinatal outcomes in pregnant women without any deleterious effects on the foetus or mother.

Anemia In Pregnancy: Risk Factors And Adverse Maternal And Perinatal Outcomes In Tertiary Care Hospital

BACKGROUND: Menstruation is an important milestone event in a girl's life with the beginning of reproductive life. Still, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions, particularly in rural areas leading to ignorance of adolescent girls regarding menstrual hygiene practices and its scientific facts. AIMS AND OBJECTIVES:1. To find out status of menstrual hygiene practices among adolescent girls. 2.To find out association between different socio-demographic factors and menstrual hygiene. MATERIALANDMETHOD:Across sectional study was conducted between March 2017 to September 2017 among 400 adolescent girls (10-19 years) of rural area of Katihar. Data were collected from 273 girls, who have achieved menarche, on a pre tested and pre designed questionnaire after taking parental consent and was analysed using MS Excel and Epi info 7. RESULT:Menarche was found to be achieved by the girls in age group 10-16 years, mostly in the age group 12-13 years (69.59%). Among 273 respondents, 82(30.04%) girls were aware about menstruation prior to menarche and the source of information was mostly sister (54.95%) followed by friends (19.05%) and mothers (15.75%). In my study, only 31 (11.36%) girls used sanitary pads during menstruation. Majority of them (95.24%) were using soap and water to clean external genitalia while more than half of girls (69.60%) did not possess a covered toilet. Menstrual hygiene was taken care mostly by those girls, whose mothers were literate (77.42%). Around 260 (95.23%) of the participants followed one or the other cultural restrictions and majority (76.15%) were avoiding religious functions. CONCLUSION:In our study, hygiene during menstruation is not satisfactory hence there is a need to educate the adolescent girls about healthy and hygienic practices during menstruation to prevent the reproductive tract infections.

Resultados perinatales del recién nacido con Apgar bajo en el Hospital Hipólito Unanue de Tacna, 2002-2016 / Perinatal outcome of newborns with low Apgar score, at the Hospital Hipólito Unanue Tacna-Peru, 2002-2016

Introduction: A low Apgar score at one minute is a clinical problem that contributes to neonatal morbidity and mortality. Objective: To identify adverse perinatal results of newborns with low Apgar score. Design: Retrospective, analytical, case-control study. Institution: Hipolito Unanue Hospital in Tacna, Peru. Participants: 2 176 live births with Apgar score below 7 at one minute, single pregnancy, born between 2002 and 2016, compared with 4 352 live births with Apgar score 7-10 selected by simple random sampling. We used the SIP2000 Perinatal Computer System database. Main outcome measures: Absolute and relative frequencies, averages, standard deviation, bivariate analysis, odds ratio with 95% confidence intervals. Results: The frequency of newborns with low Apgar score was 4.1 per 100 live births. Low Apgar score was associated with male sex, prematurity, low weight, small and large for gestational age, and birth by cesarean section. Adverse perinatal results were associated with higher risk of morbidity (OR=5.8), neonatal mortality (OR=41.1), perinatal infection (OR=9.4), respiratory distress syndrome (OR=7.6), congenital malformations (OR=7), birth trauma (OR=5,4), and hyperbilirubinemia (OR=4.9), Conclusion: In our hospital, newborns with a low Apgar score at one minute were at high risk of neonatal morbidity and mortality.

Introducción. El Apgar bajo al minuto de nacimiento es un problema clínico que contribuye a la morbimortalidad neonatal. Objetivo. Conocer los resultados perinatales adversos del recién nacido con Apgar bajo. Diseño. Estudio retrospectivo, analítico, de casos y controles. Institución. Hospital Hipólito Unanue de Tacna, Perú. Participantes. Se estudió 2 176 recién nacidos vivos durante los años 2002 a 2016, con Apgar al minuto menor de 7, de embarazo único, comparados con 4 352 nacidos vivos con Apgar 7 a 10 seleccionados por muestreo aleatorio simple. Se utilizó la base de datos del sistema informático perinatal SIP2000. Principales medidas de resultados. Frecuencias absolutas y relativas, promedios, desviación estándar, análisis bivariado, odds ratio con intervalos de confianza al 95%. Resultados. La frecuencia de recién nacidos con Apgar bajo fue 4,1 por 100 nacidos vivos. Se asociaron al Apgar bajo los recién nacidos de sexo masculino, prematuros, peso bajo, pequeños y grandes para la edad gestacional y nacidos por cesárea. Los resultados perinatales adversos fueron riesgo de morbilidad (OR=5,8), mortalidad neonatal (OR=41,1), infección perinatal (OR=9,4), síndrome de dificultad respiratoria (OR=7,6), malformaciones congénitas (OR=7), traumatismo al nacer (OR=5,4) e hiperbilirrubinemia (OR=4,9). Los fallecidos fueron 79,4% prematuros y 78,7% de peso bajo. Conclusión. El recién nacido con Apgar bajo al minuto en el hospital Hipólito Unanue de Tacna tiene riesgo alto de morbilidad y mortalidad neonatal.

Neonatal morbidity pattern in early term births

Background: Late preterm births are defined' as birth between 34 and 36 completed weeks gestation and term births as' born after 37 weeks of gestation. Maturation is a continuous' process till term and the severity of adverse outcomes with birth increases with decreasing gestational age. Recent studies showed increased risk of' morbidities for babies' at 37 weeks than its term counterpart babies' at 39 weeks. Considering the risk for adverse neonatal outcomes in early term births, various studies recommended that the label 'term' be redefined as early term, full term and late term designations to more accurately acknowledge deliveries occurring at or beyond 37' weeks of gestation. This designation will help precise' identification and targeting these early term' babies for early intervention and for better neonatal outcomes.Methods: This is a prospective study which included all' term births delivered during the 12-month study between January 2017 and December 2017. Babies born between 37 and 38 6/7 weeks were designated as early term and those born after 39 weeks as full-term babies. Neonatal outcomes of these babies were recorded and monitored till discharge.Results: There were 660 term live births during the study period. The incidence of early term births account for 19.7%, as compared with full term births representing 80.3 %. Compared with term babies, early term births were at risk for transitional problems such as respiratory distress (61.5% vs 38.5%), hypoglycemia (76.2% vs 23.8%), hyperbilirubinemia requiring phototherapy (53.7% vs 46.7%) and feeding' problems (59.1% vs 40.9%).Conclusions: Early term births are associated with increased risk of neonatal morbidities as compared with full term births. This indicates need for more attention towards preventing early term births.

Effect of single dose and double dose antenatal corticosteroids on respiratory distress syndrome among preterm babies

Background: Respiratory distress syndrome occurs primarily in premature infants. The increased risk of RDS is associated with lower gestational age. The length of gestation is the primary factor that influences the risk of RDS the risk for development of RDS increases with maternal diabetes, multiple births, cesarean delivery, precipitous delivery, asphyxia, cold stress, and a maternal history of previously affected infants. Antenatal corticosteroids (ACS) significantly reduced neonatal morbidity and mortality when administered to women with imminent preterm delivery Antenatal steroids accelerate development of type 1 and type 2 pneumocytes, leading to structural and biochemical changes that improve both lung mechanics (maximal lung volume, compliance) and gas exchange. Induction of type 2 pneumocytes increases surfactant production by inducing production of surfactant proteins and enzymes necessary for phospholipid synthesis. Alveolisation occurs rapidly as a result of the antenatal corticosteroids Antenatal corticosteroid is usually administered for fetal lung maturity and can be expected to induce negative maternal and fetal side-effects hence this study was conducted to know the beneficial effect of single dose antenatal corticosteroids verses double doses antenatal corticosteroids. The Objective of the present study was to observe the effect of single dose and double dose antenatal corticosteroids on respiratory distress syndrome in preterm babies born to less than 37 weeks of gestation admitted under department of pediatrics at Raja Rajeswari medical college Hospital, Kambipura, Bangalore.Methods: There were 55 babies born to mothers who received single dose of antenatal corticosteroids and delivered at 12hrs before receiving 2nd dose antenatal corticosteroids and 55 babies born to mothers who received double dose of antenatal corticosteroids. Once baby is born, they compared for the requirement of surfactant.Results: Multiple course of steroids significantly reduced Respiratory distress syndrome.Conclusions: It was concluded that there was significant reduction in RDS in babies whose mother received complete course of antenatal corticosteroids.

A comparison of maternal and perinatal outcomes and mode of delivery of twin and singleton gestations in tertiary government hospital during a 10-year period / Philippine Journal of Obstetrics and Gynecology

Background@#Multiple gestations, including twin gestations are commonly associated with adverse maternal, perinatal and neonatal outcomes compared with singleton pregnancies. Its incidence has shown a significant increase over the last decades. A retrospective cohort study was made at the Department of Obstetrics and Gynecology by review of medical records of twin pregnancies and their neonates. @*Objective@#The purpose of this study is to describe and compare the outcomes of twin gestation against singleton pregnancies, in terms of the following: the presentation of the twin gestation, chorionicity, the mode and timing of delivery and fetomaternal complications. This study aimed to determine whether an association exists between the twin gestation and adverse perinatal outcomes.@*Methodology@#The study included singletons and twin gestations admitted at a tertiary government hospital admitting section within a ten-year period, 2006-2015. Confirmation of diagnosis of multiple pregnancies was obtained by ultrasound. This retrospective cohort study conducted at a tertiary government hospital included 228 singletons and 110 twin gestations in a ten-year period.@*Results@#Results showed women with twin pregnancies had a higher incidence of preterm labor and delivery. Compared to singleton pregnancies, complications of prematurity are not uncommon in twin gestations. This should encourage prenatal and antenatal care in women who have twin gestations.@*Conclusion@#The incidence of preterm labor and delivery for twin gestation, relative to singletons, was high in the study. Twin gestations are 3-4 times more likely to present with preterm labor relative to singletons.

Morbimortalidad del recién nacido a término precoz en el hospital Hipólito Unanue de Tacna durante los años 2000 a 2014 / Morbimortality of early term newborns at Tacna's Hipólito Unanue hospital during the years 2000 to 2014

Objetivo: Determinar la frecuencia, tasa de cesárea y riesgos de morbimortalidad del recién nacido a término precoz (RNTP). Material y métodos: Estudio observacional, retrospectivo, analítico. Se incluyó a neonatos únicos vivos a término, nacidos en el hospital Hipólito Unanue de Tacna durante los años 2000 a 2014 (n=45332). Se comparó a los nacidos a termino precoz de 37 a 38 6/7 semanas (n=11276), y los nacidos a termino completo de 39 a 41 6/7 semanas (n=34056). Se utilizó frecuencia y tasa por 100 nacidos vivos, odds ratio (OR) con intervalos de confianza al 95% (IC 95%), regresión logarítmica y prueba "t" para muestras independientes. Se utilizó la base de datos del Sistema Informático Perinatal. Resultados: La frecuencia de nacidos a término precoz fue 22,5 por 100 nacidos vivos, con un crecimiento logarítmico significativo (p=0,03). Representó 24,9% de todos los recién nacidos a término. La tasa de cesárea se incrementó de 31,2% a 51,1% y su crecimiento fue similar al de los término completo. Se asoció al RNTP con mayor probabilidad de tener bajo peso al nacer (OR:5,33; IC 95%: 4,50-6,30), ser pequeño para la edad gestacional (OR:3,14; IC 95%: 2,69- 3,66), nacer por cesárea (OR: 3,15; IC 95%: 3,01-3,29), tener estancia hospitalaria de 3 días a más (OR: 1,46; IC 95%: 1,39-1,54), morbilidad respiratoria (OR: 1,81; IC 95%: 1,38-2,37) como neumonía (OR:3,02; IC 95%: 1,70-5,38), membrana hialina (OR: 4,17; IC 95%: 1,56-11,33) y taquipnea transitoria (OR: 2,95; IC 95%: 1,79-4,85); y malformaciones congénitas (OR: 1,46; IC 95%: 1,17-1,82), hiperbilirrubinemia (OR: 1,23; IC 95%: 1,02-1,49) y mortalidad neonatal (OR: 2,17; IC 95%: 1,45-3,23). Conclusión: La frecuencia de recién nacidos a término precoz en el hospital Hipólito Unanue de Tacna se incrementó en los últimos 15 años y se asoció a mayor riesgo de problemas respiratorios y mortalidad neonatal

Objective: To determine the frequency, cesarean section rate and morbidity and mortality risks for early term newborns. Material and methods: Non-experimental, cross-sectional study. We included single term live neonates born in Hipolito Unanue Hospital in Tacna from 2000 to 2014 (n= 45332). Early term newborns from 37 to 38 6/7 weeks (n= 11276), were compared with full term newborns from 39 to 41 6/7 weeks (n= 34056). We used frequencies and rates per 100 live births, odds ratios (OR) with 95% confidence intervals (95% CI), logarithmic regression and "t" test for independent samples. The Perinatal Computer System database was used. Results: The frequency of preterm infants was 22.5 per 100 live newborns, with a significant logarithmic growth (p= 0.03). This accounted for 24.9% of all full term newborns. The cesarean section rate increased from 31.2% to 51.1% and its growth was similar to that of full term newborns. It was associated with a higher risk of low birth weight (OR: 5.3; 95% CI:4.5-6.3), small for gestational age babies (OR: 3.14; 95% CI: 2.69-3.66), being born by cesarean section (OR: 3.15; 95% CI: 3.01-3.29), hospital stay of 3 days or more (OR: 1.46; 95% CI: 1.39-1,54), respiratory morbidities (OR: 1.81; 95% CI: 1.38-2.37), such as pneumonia (OR: 3.02; 95% CI: 1.70-5.38), hyaline membrane (OR: 4.17; IC 95% CI: 1.56-11.33), and transient tachypnea (OR: 2.95; 95% CI: 1.79-4.85); and congenital malformations (OR: 1.46; IC 95% CI: 1.17-1.82), hyperbilirubinemia (OR: 1.23; 95% CI: 1.02-1.49), and neonatal mortality (OR: 2.17; 95% CI: 1.45-3.23). Conclusion: The frequency of early term newborns in Hipolito Unanue Hospital in Tacna increased in the last 15 years, and it was associated with an increased risk of respiratory problems and neonatal mortality

Epidemiología de la prematuridad, sus determinantes y prevención del parto prematuro / Epidemiology of prematurity, its determinants and prevention of preterm birth

La prematuridad es un grave de problema de salud pública por la gran morbilidad y mortalidad que generan, además, de los elevados costos económicos y sociales que ocasiona su atención. A nivel mundial, aproximadamente uno de cada diez neonatos nacen prematuros. Sus determinantes son múltiples. En el parto prematuro están involucrados además de los determinantes biológicos, los que son responsabilidad del sector salud y los que son responsabilidad del estado, como son los determinantes políticos, ambientales, sociales y económicos. Es por ello que la prevención y el tratamiento de la prematuridad debe ser una política pública obligada para todas las naciones, e involucra a muchos actores. Las estrategias empleadas para prevenir y tratar al parto prematuro son amplias y van desde los cuidados preconcepcionales, hasta la atención del parto y del neonato en el periodo postnatal.

Prematurity is a serious public health problem by the high morbidity and mortality also generated high economic and social costs caused by its staff. Globally, about one in ten infants born prematurely. Its determinants are numerous. In preterm birth are involved in addition to biological determinants, which are the responsibility of the health sector and which are the responsibility of the state, such as political, environmental, social and economic determinants. That is why prevention and treatment of prematurity should be a public policy required for all nations, and involves many actors. The strategies used to prevent and treat premature birth are spacious and range from preconception care, to care delivery and newborn in the postnatal period.

Twin pregnancies: Maternal and perinatal outcome in a tertiary health centre

Background: Twin gestation brings double happiness but at the same time implies twice the unforeseen complications to the health of the mother and the fetus. Objective: To study the maternal and neonatal outcome in multi fetal pregnancy in a tertiary health centre. Materials and methods: A retrospective observational analysis of 30 twin pregnancies admitted and managed in our centre. Patients were studied for any adverse antenatal complications, mode of delivery and maternal and perinatal outcome. Results: In our study, maximum patients were in age group of 31-35 years (33.3%) and primigravida (46%), admitted with gestational age 32-37 weeks (46.6%). Commonest maternal complication observed was anemia (60%) followed by preterm labour (53.3%), premature rupture of membranes (40%), pregnancy induced hypertension (33.3%). Cesarean section was mode of delivery in maximum (60%), with common indication being Malpresentation (50%). Out of 56 live births, 51.6% were admitted in neonatal ICU for causes like prematurity (58.06%). Prematurity was the leading cause of perinatal mortality and morbidity in twin gestation. Conclusion: Twin gestation has significantly increased risk to both the mother and the fetus. Early recognition and adequate management of twin gestation can decrease associated complications and betterment of maternal and neonatal outcome.

Neonatal Near Miss: the need for a standard definition and appropriate criteria and the rationale for a prospective surveillance system

In Latin American, there is currently a regional action with the main purposes of putting the concept of severe neonatal morbidity in practice and formulating proposals for interventions. A general overview of neonatal health conditions, including morbidity and mortality, is provided to update regional knowledge on the topic. An example of the development and implementation of the concept of maternal near miss is also provided, followed by results from a systematic review covering all previously published studies on Neonatal Near Miss. Finally, some proposals for building a common concept on the topic and for launching a prospective surveillance study are presented. A Neonatal Near Miss is a neonate who had a severe morbidity (organ dysfunction or failure) but who survived this condition within the first 27 days of life. The pragmatic criteria recommended to be used are as follows: birth weight below 1700 g, Apgar score below 7 at 5 minutes of life and gestational age below 33 weeks. As a proxy for organ dysfunction, the following management criteria are also confirmed: parenteral therapeutic antibiotics; nasal continuous positive airway pressure; any intubation during the first 27 days of life; phototherapy within the first 24 h of life; cardiopulmonary resuscitation; the use of vasoactive drugs, anticonvulsants, surfactants, blood products and steroids for refractory hypoglycemia and any surgical procedure. Although this study starts from a regional perspective, this topic is clearly globally relevant. All nations, especially low and middle-income countries, could benefit from the proposed standardization.

Asociación entre morbilidad neonatal, edad gestacional y déficit de desarrollo psicomotor en prematuros moderados y tardíos / Association between neontal morbidity, gestational age and developmental delays in moderate to late preterm children

Introducción: Existe evidencia respecto a que los niños que nacen prematuros moderados y tardíos (PMT) tendrían mayor riesgo de hospitalización, morbilidad neonatal y deficiencias del desarrollo psicomotor (DSM). Objetivo: Determinar, en PMT, la asociación entre el déficit de DSM, edad gestacional y la morbilidad neonatal. Pacientes y método: Estudio caso control anidado en una cohorte de niños nacidos PMT entre los años 2006 y 2009, en una institución privada de la Región Metropolitana. Los niños fueron evaluados con la Escala de Bayley-III de desarrollo infantil a los 8 o 18 meses de edad corregida, o a los 30 meses de edad cronológica. Retrospectivamente se revisaron los registros neonatales. Se generó un modelo de análisis de asociación multivariado para conocer el efecto de la morbilidad neonatal sobre el desarrollo alcanzado. Resultados: Se estudiaron 130 PMT, 25 casos y 105 controles. El 83,8% fue hospitalizado en el periodo neonatal. Hubo diferencias estadísticamente significativas entre casos y controles solo en relación con la edad materna y la hipoglucemia sintomática (OR cruda 3,5, OR ajustada 8,18); se encontró que las variables que afectan de forma negativa el coeficiente de desarrollo son el género masculino, la gemelaridad y la menor edad gestacional. Conclusiones: La hipoglucemia sintomática es el principal factor de riesgo de déficit del DSM, mientras que la gemelaridad, el género masculino y la edad gestacional influyen en el coeficiente de desarrollo global obtenido. Es fundamental desarrollar estrategias de prevención, pesquisa y manejo precoz de esta alteración metabólica para prevenir dificultades del DSM posteriores.

Introduction: There is evidence that children born moderate-to-late preterm (MLP) have a higher risk of hospitalisation, neonatal morbidity, and developmental delay (DD). Objective: To determine the association between DD, gestational age, and neonatal morbidity in MLP children. Patients and method: A case control study design nested in a cohort of MLP children born between 2006 and 2009 at a private hospital located in the Metropolitan area of Santiago. The children were assessed with the Bayley-III Scales of Infant Development at 8 or 18 months corrected age, or at 30 months of chronological age. Neonatal records were retrospectively reviewed. A multivariate analysis was performed to determine the effect of neonatal morbidity on development. Results: A total of 130 MLP children, 25 cases and 105 controls, were studied. Most of them (83.8%) were hospitalised during the neonatal period. Significant differences between cases and controls regarding maternal age and symptomatic hypoglycaemia were observed (crude OR 3.5, adjusted OR 8.18). It was concluded that the variables that negatively affect the rate of development are male gender, being a twin, and gestational age. Conclusions: Symptomatic hypoglycaemia is the main risk factor for DD, while being a twin, male gender, and gestational age influenced the total development rate obtained. It is essential to develop strategies for prevention, screening, and early management of this metabolic disorder to prevent future DD.

Nascer em Belo Horizonte: desfechos neonatais desfavoráveis / Born in Belo Horizonte: adverse neonatal outcomes

Introdução: O Brasil tem obtido, nas últimas décadas, importantes avanços nas políticas públicas com impactos positivos na saúde materna e infantil. Embora o país já tenha alcançado a meta dos Objetivos do Desenvolvimento do Milênio para a mortalidade infantil, alguns indicadores ainda persistem em situação desfavorável, entre eles a prematuridade, o baixo peso ao nascer e morbidades resultantes dessas situações. Esses problemas tem sido associados à excessiva medicalização na atenção ao parto e nascimento, traduzida especialmente nas altas taxas de cesáreas no país. Objetivo: Analisar a ocorrência de desfechos neonatais desfavoráveis em crianças nascidas em Belo Horizonte segundo determinantes maternos, neonatais e assistenciais e identificar as variáveis que caracterizam o near miss neonatal. Métodos: Trata-se de um estudo de coorte desenvolvido em maternidades públicas e privadas de Belo Horizonte, Minas Gerais, no período de novembro de 2011 a março de 2013. A amostra foi constituída por puérperas hospitalizadas por motivo de parto hospitalar e seus conceptos vivos, independente de peso e idade gestacional, e quando mortos com peso maior que 500 gramas e idade gestacional maior que 22 semanas. Foi feita análise univariada para verificar a associação entre fatores de risco e os desfechos prematuridade, baixo peso ao nascer e desfecho neonatal desfavorável. A extração dos modelos finais foi realizada por regressão logística. Resultados: Foram avaliados 1088 recém-nascidos. Algum desfecho neonatal desfavorável foi evidenciado em mais de um terço dos recém-nascidos, com destaque para a prematuridade e o baixo peso ao nascer (cerca de 10% cada), manobras de reanimação na sala de parto (19,1%), a utilização de oxigênio após o nascimento (12%) e a internação em unidades de terapia intensiva neonatal (7,1%). No modelo da prematuridade, as variáveis número de consultas de pré-natal, parto cesáreo, filho prematuro anterior, classe econômica D ou E e intercorrência...

Introduction: Brazil has achieved in recent decades, important advances in public policy with positive impacts on maternal and child health. Although the country has already achieved the mark of the Millennium Development Goals for infant mortality, some indicators still remain at a disadvantage, including prematurity, low birth weight and morbidity resulting from these situations. These problems have been associated with excessive medicalization of childbirth care and birth, translated especially in the high cesarean rates in the country. Objective: To analyze the occurrence of adverse neonatal outcomes in children born in Belo Horizonte second determining maternal, neonatal and assistance and to identify events that characterize the neonatal near miss. Methods: This was a cohort study conducted in public and private maternity hospitals in Belo Horizonte, Minas Gerais, from November 2011 to March 2013. The sample consisted of mothers hospitalized for hospital birth of reason and its newborn regardless of weight and gestational age, and when dead weighing more than 500 grams and gestational age greater than 22 weeks. Univariate analysis was performed to assess the association between risk factors and outcomes prematurity, low birth weight and adverse neonatal outcome. The extraction of the final models was performed by logistic regression. Results: Were evaluated in 1088 newborns. Some unfavorable neonatal outcome was seen in more than a third of newborns, especially premature birth and low birth weight (about 10% each), resuscitation in the delivery room (19,1%), the use of oxygen after birth (12%) and hospitalization in units neonatal intensive care (7.1%). In the model of prematurity, the variables number of prenatal consultations, cesarean section, previous preterm infant, economy class D or E and clinical complications in the current...