Survival and Predictors of Mortality of Congenital Diaphragmatic Hernia in Newborns at a Tertiary Care Hospital in Saudi Arabia.

Background Congenital diaphragmatic hernia (CDH) is a condition where abdominal contents protrude into the chest due to defects in the diaphragm muscle. It is considered an emergency that needs urgent intervention to prevent further complications or death. Our study aimed to estimate survival and evaluate predictors of mortality in newborns with CDH using available prediction tools in the literature. Methods This retrospective cohort study included neonates with CDH in King Abdulaziz Medical City (KAMC), Jeddah, from 2000 to 2021. Prevalence, demographics, and clinical characteristics were compared between surviving and deceased infants. C-statistics were used to measure the area under the curve for the prenatal and postnatal predictor tools, and a p-value of <0.05 was considered significant. Results Between 2000 and 2021, 45 neonates with CDH were included (six per 10,000 inborn live births). The mortality rate was 51.1%. The differences in demographics were not significant among surviving and deceased patients. One prenatal predictor tool, the lung-to-head ratio, was found to be significant; in addition, three postnatal predictor tools of mortality, SNAP-II, CDHSG-probability survival, and Brindle Score, had the highest concordance (C) statistics of 0.8, 0.79, and 0.8, respectively. Conclusion Although the incidence of CDH was found to be higher in our study compared to global statistics, our mortality rates correspond with international figures. The most significant differences between predictors and prediction models of mortality were lung-to-head ratio prenatally, SNAP-II, CDHSG-probability survival, and Brindle Score postnatally. Further multicentered studies are recommended with a larger sample size.

Perception of the Accreditation of the National Commission for Academic Accreditation and Assessment at Different Health Colleges in Jeddah, Saudi Arabia.

Introduction Following the guidelines for maintaining quality set forth by the National Commission for Academic Accreditation and Assessment (NCAAA) accreditation procedure, Saudi higher education institutions, including health sciences colleges, must adhere to these guidelines. This study aims to assess the perception of personnel involved in NCAAA accreditation processes about the purpose, process, motivation, and level of involvement in the NCAAA accreditation at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). Methods The study was conducted at KSAU-HS, Jeddah. The participants included 15 administrators and 32 faculties from the College of Medicine, College of Applied Medical Sciences, and College of Nursing with experience in the NCAAA process. A questionnaire was used to determine how motivated and involved people feel about the accreditation process. Data were examined statistically with SPSS (Version 23; IBM Corp., Armonk, NY, USA), and descriptive statistics were used. Results Forty-seven participants (23 men, 24 women, ages 36 to 55) took part in the study, of which 68% were faculty members and 32% were administrators with a variety of skill sets from the three colleges. Most participants displayed a positive attitude toward the NCAAA accreditation's motive and level of commitment. Conclusions Most of the participants in the current study contended with the NCAAA process and deemed it substantial long-term improvements.

Accuracy of Umbilical Cord Complete Blood Count in Detecting Early-Onset Neonatal Thrombocytopenia.

BACKGROUND: Neonatal thrombocytopenia (NTCP) is a common hematological disorder whose platelet count falls below the normal limit of 150 x 109/L. NTCP can cause late complications if left untreated. The current study aimed to evaluate the accuracy of the umbilical cord complete blood count (UC CBC) in detecting early-onset neonatal thrombocytopenia (EO-NTCP). Further, the prevalence of NTCP was also investigated.  Methods: A cross-sectional study with a matched control was conducted on all newborns delivered at a tertiary care center in Jeddah, Saudi Arabia, between May 2016 and 2019. After exclusions, 40 neonates with EO-NTCP (cases) and 80 without EO-NTCP (controls) were included. The case-to-control ratio was 1:2. The results of UC CBC were compared with those of follow-up CBC, performed within 72 hours. A p-value of <0.05 was considered statistically significant. All data were analyzed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY). RESULTS: The prevalence of NTCP was approximately 1.02% (111/10,936). Lack of antenatal care was found in 12 (30%) neonates with EO-NTCP vs. 10 (12.5%) neonates without EO-NTCP (p = 0.02). Neonates with EO-NTCP were more likely to have experienced intrauterine growth restriction (5 (37.5%) vs. 5 (6.3%), p < 0.001) and oligohydramnios (5 (12.5%) vs. 0 (0%), p = 0.003). Neonates who developed EO-NTCP were more likely to be admitted to the NICU (34 (85%) vs. 35 (43.8%), p < 0.001) and receive antibiotics (22 (55%) vs. 25 (31.3%), p = 0.012). Also, neonates with EO-NTCP were more frequently diagnosed with neonatal sepsis (7 (17.5%) vs. 3 (3.8%), p = 0.015) and more likely to receive platelet transfusions (15 (37.5% vs. 1 (1.3%), p < 0.001). They also had a higher median length of hospital stay (13 (interquartile range (IQR) 3-28) vs. 4 (IQR 2-9) days, p = 0.006). The mortality rates of neonates with EO-NTCP and those without were 6 (15%) vs. 2 (2.5%) neonates (p = 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UC CBC were 62.50%, 97.50%, 20.40%, and 99.61%, respectively. CONCLUSION: The prevalence of EO-NTCP in King Abdulaziz Medical City is comparable to international and national figures, and it is associated with preceding maternal comorbidities, serious neonatal morbidity, and even mortality. Therefore, proper antenatal care is vital in preventing maternal and neonatal morbidities, including the risks of NTCP and its related complications. With high NPV, using UC CBC as a universal screening method could assist in safely discharging newborns. However, because of its low sensitivity, a comprehensive clinical examination with confirmatory laboratory tests are still the cornerstone in diagnosing EO-NTCP. Future trials should aim to study the cost-effectiveness of universal UC CBC and the long-term outcomes of infants diagnosed with EO-NTCP.

Screening for Neurodevelopmental Delay for Preterm Very Low Birth Weight Infants at Tertiary Care Center in Saudi Arabia.

Background Preterm infants are more susceptible to death, short-term complications, and long-term complications such as neurodevelopmental impairments. However, definitive assessment tools are not available in a resource-limited setting. Hence a screening tool is needed the Arabic-speaking population. Method Infants born at a gestational age of <32 weeks or a very low birth weight (VLBW) of less than 1500 g were recruited into a cross-sectional study. We identified infants (n = 61) admitted to the neonatal ICU at King Abdulaziz Medical City and reached 18 up to 24 months of corrected gestational age (CGA). The developmental assessment was done at 18, 20, 22, and 24 CGAs using the Ages and Stages Questionnaire third edition - Arabic version (ASQ3-A). The primary outcomes are early detection rate of neurodevelopmental delay (NDD), defined as a delay in one or more of the following: communication, gross motor, fine motor, problem-solving, and personal-social skills as per ASQ3-A. Results Sixty-one out of 92 eligible infants (36 excluded) completed the sufficient assessment. Twenty-six infants (42.6%) had at least one NDD in one of the following domains: communication skills: (11.5%), gross motor: (11.5%), fine motor: (19.7%), problem-solving skills: twelve infants (19.7%), and personal-social skills: twenty infants (23%). Perinatal events and periventricular leukomalacia (PVL) were significant independent predictors for the NDD. Conclusion This single-center study in Saudi Arabia screened preterm, VLBW infants based on ASQ3-A, twenty infants (42.6%) had an abnormal NDD at a corrected age of 18-24 months. Perinatal events and PVL were independent predictors of NDD. We recommend that all preterm VLBW infants in Saudi Arabia be evaluated by a neurodevelopmental screening tool, ASQ3-A, especially in resource-limited settings to start early intervention. Also, more extensive multicenter studies are to be carried out with definitive diagnostic tools to have a national benchmark for the long-term neurodevelopmental impairment.

Clinical Characteristics of Newborn Infants Delivered to Pregnant Women With Laboratory-Confirmed COVID-19: A Single-Center Experience From Saudi Arabia.

Introduction In Saudi Arabia and countries around the world, clinical health practice has been transformed by the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the early days of the pandemic, it was a major challenge to care for pregnant women with laboratory-confirmed COVID-19 and their newborn infants. In this article, we share our experience in the management of newborn infants delivered to mothers with laboratory-confirmed COVID-19. Methods A prospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, National Guard Health Affairs, Saudi Arabia. Data collection started in March 2020 and was completed in October 2020. The inclusion criteria included mothers with laboratory-confirmed COVID-19 and their newborn infants. Results A total of 45 pregnant women with polymerase chain reaction (PCR)-confirmed COVID-19 were included in the study. Their mean age was 30.23±5.92 years. The mode of delivery was spontaneous vaginal delivery in 27 women (60%), cesarean section in 15 women (33.3%), and assisted vaginal delivery in three women (6.7%). Three mothers (6.7%) required intensive care unit admission. A total of 45 babies were born and 25 were females (55.6%), 20 males (44.4%). None of the babies had specific symptoms related to COVID-19. All babies were tested negative on the two COVID-19 nasopharyngeal swabs. Babies were initially admitted to the NICU and one baby required prolonged NICU stay due to extreme prematurity (23 weeks), one baby died due to hypoxic-ischemic encephalopathy and respiratory distress syndrome, and the remaining babies were discharged home in a stable condition. Conclusion Our experience suggests that maternal outcomes are generally favorable and no difference between vaginal and cesarean delivery in the risk of virus transmission. With strict implementation of infection prevention measures, mother-to-infant transmission is very unlikely. Early bathing of the newborn infant is preferred to reduce the risk of transmission of infection to newborn infants and the hospital staff. Breastfeeding is safe if performed under strict infection prevention measures.

Impact of Mode of Delivery on the Survival Rate of Very Low Birth Weight Infants: A Single-Center Experience.

INTRODUCTION: Worldwide cesarean birth had increased over the past three decades and in the USA, the overall rate of cesarean birth has increased from 23.8% in 1989 to 31.9% in 2018. Moreover, the substantial increase of preterm infants delivered by cesarean section had reached anywhere from 45% to 72% for gestational age <33 weeks. There is a considerable debate on whether cesarean section confers a survival advantage for preterm infants. Published data on the relationship between mode of delivery and survival rate were inconsistent and there is a lack of large randomized controlled trials (RCTs) that have investigated this important clinical concern. Thus, the aim of this study is to evaluate the impact of cesarean section on the survival rate of very low birth weight (VLBW) infants. METHODS: This was a retrospective cohort study of ≤32 weeks VLBW infants born alive and admitted to Neonatal Intensive Care Unit (NICU) at King Abdulaziz Medical City-Jeddah (KAMC-Jeddah) between January 1, 1994, and December 31, 2019. The primary outcome of interest was the survival rate to discharge of VLBW infants delivered by cesarean section compared to delivered vaginally. Relevant demographic and clinical variables were assessed and its association to survival to discharge of VLBW infants were analyzed. RESULTS: Of the 1055 ≤32 weeks VLBW infants included in the study, 559 (53%) were delivered by cesarean section, and 496 (47%) were delivered vaginally. Cesarean delivery had increased from 44.2% to 66% between 1994-1998 and 2014-2019, respectively. The rise of cesarean delivery compared with the vaginal delivery was more profound for gestational age ≤26 weeks and birth weight ≤800 g. The VLBW infants delivered by cesarean section had a higher survival rate when compared to infants delivered vaginally (87.29% vs 71.77%, P<0.001). The survival advantage was statistically significant in extremely low birth weight (ELBW) infants (801-1000 g) and infants with birth weight ≤800 g, 86.73% vs 73.62%, P=0.018 and 58.02% vs 40.52, P=0.001, respectively. Moreover, VLBW infants ≤26 weeks gestational age delivered by cesarean section had a higher survival rate of 69.15% vs 44.5%, P<0.001. CONCLUSION: This study demonstrates that cesarean birth is associated with higher survival for VLBW infants with birth weight ≤800 g and ELBW infants and gestational age ≤26 weeks compared to vaginal birth.

Awareness of risk factors and preventive measures for neural tube defects: Perception towards pregnancy termination in the Saudi population.

BACKGROUND: Neural tube defects (NTDs) are among the most common congenital anomalies worldwide with an incidence of 300,000/year. Spina bifida, which is the most prevalent NTD, has an incidence of 1.2/1000 live births in Saudi Arabia. Our study aimed to assess the awareness of NTDs and the implementation of preventative measures against them. In addition, to gauge public opinion regarding abortion following early diagnosis of NTDs. METHODS: This was a cross-sectional study in which questionnaires were distributed using non-probability convenient sampling technique and data was collected in a face-to-face interview. Subjects were approached in an outpatient clinic and in a shopping mall in Jeddah city, Saudi Arabia. RESULTS: Out of 353 subjects, 35.7% were males, 64.3% females (33% pregnant), and the median age was 34 (IQR = 14) years. Of subjects, 66.3% were not aware of NTDs, and regarding folic acid 54% believed that it helps in preventing NTDs, and only 25% agreed on starting it before pregnancy. However, only 19% agreed on all points, which even dropped to 9% after considering planned pregnancies. Gender differences were extremely significant (p-value <0.001) as females were more aware. Interestingly, 62% would abort in early-diagnosed NTD cases. Of pregnant women, only 20% started taking folic acid before pregnancy. CONCLUSIONS: The data shows that the majority of the study's population are in favor of terminating the pregnancy in justified NTD cases. There is a need for increasing public awareness, especially to males, and should be provided through all channels of knowledge.