Risk factors for neonatal death in Recife: a case-control study

OBJECTIVE: Neonatal mortality is the main cause of infant mortality in the city of Recife. The objective of the present study was to determine the major risk factors for neonatal death in Recife in 1995. METHODS: This is a case control study. Information was obtained from the mortality and live birth databases after validation of the data set, between January and December 1995. A sample of 456 cases and 2,280 controls was obtained after using the linkage technique between the two data sets. The difference in proportion was analyzed by the chi square test. The odds ratio was calculated as a risk measure, with a 95% confidence interval. The logistic regression technique was used to adjust potential confounding factors. RESULTS: 212 deaths (46.6%) occurred in the first 24 hours of life. We found that 358 (79.7%) of the cases presented low birth weight, with a 46-fold higher risk of death (CI =33.8-59.0 P<0.001) than those weighing >/= 2,500g. The major risk factors observed in the logistic regression analyses of the measure, listed in descending order, were: birth weight < 1,500g (OR= 49.6 CI= 22.6-108.7 P<0.001), 5-minute Apgar score < 7 (OR = 44.1 CI= 25.1-77.2 P<0.001), birth weight between 1,500 and 2,500g (OR= 8.2 CI= 4.8-14.0 P<0.001), gestational age < 37 weeks (OR= 4.3 CI= 2.6-7.1 P<0.001). CONCLUSIONS: Among the studied variables, birth weight, gestational age, and Apgar score should be considered the main risk factors for the surveillance of neonatal death.     

Birth interval and risk of stillbirth or neonatal death: findings from rural north India

Short birth intervals have been associated with adverse birth outcomes. This study examines the association between preceding interval and risk of stillbirth or neonatal death in rural north India (n = 80 164). Adjusted odds ratios (OR) and 95% confidence interval (CI) of stillbirth and neonatal mortality were calculated. The odds of stillbirth were significantly greater among birth intervals of <18 months (OR 3.10; CI: 2.69-3.57), 18-35 months (OR 1.47; CI 1.30-1.68) and >59 months (OR 1.44; CI 1.19-1.73), compared with intervals of 36-59 months. Neonatal death was associated with birth intervals of <18 months (OR 4.12; CI 3.74-4.55) and 18-35 months (OR 1.78; CI 1.63-1.94), compared to births spaced 36-59 months. Previous history of either stillbirth or neonatal death was significantly associated with risk of stillbirth and neonatal death, respectively, as were multiple births.     

Histologic chorioamnionitis and severity of illness in very low birth weight newborns.

OBJECTIVE: Estimating the risk of in-hospital mortality in the neonatal intensive care unit provides important information for health care providers, and several neonatal illness severity scores have been developed. Histologic chorioamnionitis (HCA) is a known cause of neonatal morbidity and mortality. To date, the relationship between HCA and neonatal illness severity scores has not been rigorously tested. In this study, the relationships among HCA, initial illness severity, and neonatal outcomes were analyzed in very low birth weight (VLBW) newborns admitted to the neonatal intensive care unit. DESIGN: Prospective. SETTING: Neonatal intensive care unit. PATIENTS: A total of 116 VLBW inborn infants (gestational age, 28.1 +/- 2.82 wks; birth weight, 1009 +/- 312 g) were categorized as HCA-positive (n = 67) and HCA-negative (n = 49). INTERVENTIONS: Placental histology was performed to identify HCA. Illness severity evaluation included several different neonatal illness severity scores-Clinical Risk Index for Babies (CRIB), CRIB-II, Score for Neonatal Acute Physiology-II (SNAP-II), and Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II)-as well as the recording of severe morbidity and in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: HCA-positive VLBW newborns showed significantly lower gestational age (p < .0001) and birth weight (p = .0010), together with higher CRIB, CRIB-II, SNAP-II, and SNAPPE-II scores at admission to the NICU (p 5 (odds ratio [OR], 21.37; 95% confidence interval [CI], 6.24-73.21); CRIB-II > 10 (OR, 56.17; 95% CI, 6.75-467.2); SNAP-II > 22 (OR, 43.05; 95% CI, 11.9-155.7), and SNAPPE-II > 42 (OR, 48.95; 95% CI, 10.18-235.4) (all p values <.0001). CONCLUSIONS: Our findings indicate that HCA is a major predictor of morbidity and mortality in VLBW newborns.     

Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran

Intraventricular hemorrhage (IVH) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants; 80-90% of cases occur between birth and the third day of life. In a retrospective case control clinical study, files of all premature infants with birth weights <1500 grams admitted between April 2004 and October 2005 to the Neonatal Intensive Care Unit (NICU) of Akbar Abadi Hospital were reviewed. We determined risk factors that predispose to the development of high-grade IVH (grades 3 and 4) in VLBW infants. Thirty-nine infants with IVH grade 3 and 4 were identified. A control group of 82 VLBW infants were also selected. Prenatal data, delivery characteristics, neonatal course data and reports of cranial ultrasonography were carefully collected for both groups. Those variables that achieved significance (p<0.05) in univariate analysis were entered into multivariate logistic regression analysis. A total of 325 VLBW infants were evaluated. Mortality rate was 21.5%. Multivariate logistic analysis showed that the following factors are associated with greater risk of high-grade IVH occurrence: lower gestational age (OR: 3.72; 95% CI: 1.65-8.38), birth weight (OR: 3.42; 95% CI: 1.65-8.38), mechanical ventilation (OR: 4.14; 95% CI: 1.35-12.2), tocolytic therapy with magnesium sulfate (OR: 4.40; 95% CI: 1.10-24.5), hyaline membrane disease (HMD, OR: 3.16; 95% CI: 1.42-7.45), symptomatic hypotension (OR: 2.32; 95% CI: 1.06-5.42), hypercapnia (OR: 1.9; 95% CI: 1.1-3.4) and Apgar score at 5 minutes (OR: 1.58; 95% CI: 1.59-6.32).     

The Prevalence and Outcomes of Thrombocytopenia in a Neonatal Intensive Care Unit: A Three-Year Report

Neonatal thrombocytopenia is one of the most common hematologic disorders in neonatal intensive care units (NICUs). The purpose of this study was to determine the prevalence of thrombocytopenia and whether thrombocytopenia has an effect on the occurrence of intraventricular hemorrhage (IVH) ≥ grade 2 and on mortality rate. This study was carried out retrospectively in neonates admitted to NICU of Cumhuriyet University in Sivas, Turkey, between 2009 and 2012. Among 2218 neonates evaluated, 208 (9.4%) developed thrombocytopenia. The prevalence of IVH ≥ grade 2 was more in infants with thrombocytopenia (7.2%) than in those without thrombocytopenia (4.4%), although this was not statistically significant (P = .08). In univariate analysis, IVH ≥ grade 2 was higher in cases with very severe thrombocytopenia (35.7%, n = 5) than in those with mild (2.1%, n = 2), moderate (4.7%, n = 3), and severe thrombocytopenia (15.2%, n = 5) (P = .04). Multivariate logistic regression analysis showed that birth weight <1500 g (OR 6.2, 95% CI 3.4–9.8; P = .0001), gram-negative sepsis (OR 2.5, 95% CI 1.8–4.2; P = .01), very severe thrombocytopenia (OR 1.3, 95% CI 1.1–2.1; P = .03), and platelet transfusion ≥2 (OR 7.3, 95% CI 4.1–12.1; P = .001) were significant risk factors for mortality. The results of our study suggest that outcomes of neonates with thrombocytopenia depend not only on platelet count but also on decreased gestational age or birth weight, prenatal factors, and sepsis.     

Neonatal antecedents for cerebral palsy in extremely preterm babies and interaction with maternal factors

BACKGROUND: Preterm delivery is associated with an increased risk of cerebral palsy (CP). The greatest risk is for infants born <28 weeks' gestation. AIMS: To identify significant neonatal risk factors for CP and explore the interactions between antenatal and neonatal risk factors, among extremely preterm infants of 27 weeks' gestation or less. STUDY DESIGN: Nested case control design. METHODS: Infants born between 1989 and 1996, at 24-27 weeks' gestation, were evaluated: 30 with CP at 2 years corrected age and 120 control infants matched for gestation age. Neonatal variables were compared using matched analyses with the interaction between antenatal and neonatal factors being examined using logistic regression analyses. RESULTS: Risk factors for CP on matched analyses included patent ductus arteriosus requiring surgical ligation, peri-intraventricular haemorrhage, moderate to severe ventricular dilatation, periventricular leukomalacia (PVL) and need for home oxygen. Independent neonatal predictors were ventricular dilatation (OR 7.3; 95% CI 1.6, 32.3), PVL (OR 29.8; 95% CI 5.6, 159.1) and home oxygen use (OR 3.4; 95% CI 1.2, 9.4). No interaction terms in the logistic models were significant between the previously identified pregnancy risk factors of absence of antenatal steroids and intrauterine growth restriction and the neonatal risk factors. CONCLUSIONS: PVL is the most powerful independent predictor of CP in extremely preterm infants of 27 weeks' gestation or less and appears to be uninfluenced by antenatal factors.     

Risk factors for perinatal stroke in term infants: A case–control study in Australia

Aim

The aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables.

Methods

A prospective case–control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used.

Results

Sixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10 min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P < 0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09–1.99), 1-min Apgar score < 7 (OR: 1.54; 95% CI: 1.15–2.08), 10-min Apgar score < 7 (OR: 1.26; 95% CI: 1.02–1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07–2.06).

Conclusions

Perinatal stroke is associated with multiple risk factors. Exposure to smoking, 10-min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.     

Association of neonatal hyperbilirubinemia with uridine diphosphate‐glucuronosyltransferase 1A1 gene polymorphisms: Meta‐analysis

Background: Recent reports have suggested that genetic factors, including mutations in the coding region or promoter of uridine diphosphate‐glucuronosyltransferase 1A1 (UGT1A1) may increase the risk of development of neonatal hyperbilirubinemia, but the relationship has not been evaluated on systematic review or meta‐analysis. Methods: A meta‐analysis of observational studies reporting effect estimates and 95% confidence intervals (95%CI) was conducted on the association between UGT1A1 polymorphisms and neonatal hyperbilirubinemia. Results: A total of 27 eligible studies were identified. In total, 17 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 Gly71Arg polymorphisms, which indicated that these polymorphisms were associated with an increased risk of neonatal hyperbilirubinemia (A/A+G/A vs G/G: odds ratio [OR], 2.70; P= 0.00; 95%CI: 2.22–3.29; I²= 0.0%; P_{heterogeneity}= 0.55). Subgroup analyses by ethnicity validated this correlation in Asian, but not in Caucasian, populations (OR, 1.74; P= 0.10; 95%CI: 0.90–3.35; I²= 0.00%; P_{heterogeneity}= 0.67). Furthermore, 18 studies focused on the association of neonatal hyperbilirubinemia with UGT1A1 TATA promoter polymorphisms. These studies concluded that TATA promoter variants were not associated with an increased risk of neonatal hyperbilirubinemia (7/7 + 6/7 vs 6/6: OR, 1.13; P= 0.23; 95%CI: 0.93–1.37; I²= 80.0%; P_{heterogeneity}= 0.00). Conclusion: UGT1A1 Gly71Arg polymorphisms are a risk factor for developing neonatal hyperbilirubinemia in Asian, but not Caucasian, subjects. UGT1A1 TATA promoter polymorphisms were not associated with an increased risk of neonatal hyperbilirubinemia in Asian subjects, but results from the Caucasian population were conflicting and require further epidemiological investigation.     

Association Between Methionine Synthase Reductase A66G Polymorphism and the Risk of Congenital Heart Defects: Evidence From Eight Case–Control Studies

Methionine synthase reductase (MTRR) plays a major role in hyperhomocysteinemia, a risk factor related to the occurrence of congenital heart defects (CHDs). However, the associations between MTRR polymorphism and CHDs have been inconclusive. Thus, a metaanalysis of eight case–control studies was conducted to investigate 3,592 cases and 3,638 control subjects for MTRR A66G polymorphism to identify the association. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were used to assess the strength of the association. The results showed that MTRR A66G polymorphism was associated with a higher CHD risk in the allele comparison (G vs A: OR 1.163; 95 % CI 1.016–1.330; P _{heterogeneity} = 0.004), the homozygote comparison (GG vs AA: OR 1.332; 95 % CI 1.020–1.740; P _{heterogeneity} = 0.035), and the dominant model (GG/AG vs AA: OR 1.218; 95 % CI 1.001–1.482; P _{heterogeneity} = 0.001). In the subgroup analysis, this polymorphism was associated with CHDs in Asians in the homozygote comparison (GG vs AA: OR 1.427; 95 % CI 1.017–2.001; P _{heterogeneity} = 0.019) and the allele comparison (G vs A: OR 1.203; 95 % CI 1.018–1.422; P _{heterogeneity} = 0.002). In summary, the metaanalysis demonstrated that MTRR A66G polymorphism is a risk factor for CHDs. Further studies should be performed to investigate the association of plasma homocysteine levels, enzyme activity, parental genotypes, and vitamin complex intakes with the risk of CHDs.     

Low body mass index, anaemia and poor perinatal outcome in a rural hospital in eastern Sudan

BACKGROUND: The first step in improving early neonatal survival is to document rate of these deaths, identify the common causes. OBJECTIVES: the study was conducted at New Halfa hospital, eastern Sudan to investigate the prevalence and possible risk factors for a poor perinatal outcome, mainly low birth weight (LBW), APGAR score <5 at 1 min, fetal anaemia and perinatal mortality. RESULTS: LBW occurred in 15.3%, the perinatal death was 9.2%. Maternal low body mass index (BMI) was significantly associated with LBW (OR = 1.8, 95% CI = 1.0-3.2; p = 0.02), which was a risk factor for APGAR score <5 at 1 min (OR = 11.5, 95% CI = 5.9-22.5; p < 0.001) and perinatal mortality (OR = 6.5, 95% CI = 2.9-14.8, p < 0.00001). Maternal anaemia was a risk factor for fetal anaemia (OR = 2.1, 95% CI = 1.4-3.1; p < 0.001). CONCLUSION: More attention to maternal nutrition and in an attempt to prevent anaemia may lead to improvement in the perinatal outcome.     

Ethnic inequity in neonatal survival: a case-referent study in northern Vietnam

Aim: In this study from Quang Ninh province in northern Vietnam (sub‐study of the trial Neonatal Health – Knowledge into Practice, NeoKIP, ISRCTN 44599712), we investigated determinants of neonatal mortality through a case‐referent design, with special emphasis on socio‐economic factors and health system utilization. Methods: From July 2008 until December 2009, we included 183 neonatal mortality cases and 599 referents and their mothers were interviewed. Results: Ethnicity was the main socio‐economic determinant for neonatal mortality (OR 2.08, 95% CI 1.39–3.10, adjusted for mothers’ education and household economic status). Health system utilization before and at delivery could partly explain the risk elevation, with an increased risk of neonatal mortality for mothers who did not attend antenatal care and who delivered at home (OR 4.79, 95% CI 2.98–7.71). However, even if mothers of an ethnic minority attended antenatal care or delivered at a health facility, the increased risk for this group was sustained. Conclusion: Our study demonstrates inequity in neonatal survival that is related to ethnicity rather than family economy or education level of the mother and highlights the need to include the ethnic dimension in the efforts to reduce neonatal mortality.     

Impact of Prenatal Care Utilization on Infant Care Practices in Nepal: a National Representative Cross-sectional Survey

This study aimed to examine the utilization of prenatal care and its association with infant care practices using a nationally representative sample of Nepalese mothers and children. The study data was based on the 2006 Nepal Demographic and Health Survey which comprised of women age 15–49 years old who had delivered within three years prior to the survey (N?=?4,136). A multilevel logistic regression model was fitted to assess the influence of prenatal care utilization on several indicators of infant care. Neonatal mortality is still high in Nepal (46 per 1,000 live births). After taking into account several maternal and child characteristics, children of mothers with no prenatal care were at increased risk of neonatal death (OR = 2.03, 95 % CI = 1.28–3.23). Compared to women with no prenatal care, those with more than three visits were more likely to immunize their children (OR = 2.66, 95 % CI = 2.10–3.36) and more likely to initiate breastfeeding within 1 h after birth (OR = 1.25, 95 % CI = 1.02–1.54). Having skilled attendants at prenatal care and at birth was also associated with better infant care practices. Conclusion:Neonatal mortality is still high in Nepal. Adequate prenatal care utilization may represent a key preventative strategy, which, in the present study, was associated with improvement in neonatal mortality, higher likelihood of having immunization, and initiation of breastfeeding within 1 h after birth. Public health awareness programs and interventions are needed in Nepal to increase the utilization of prenatal care as well as delivery assisted by skilled attendants.     

Independent Risk Factors for Cardiac Operations in Adults With Congenital Heart Disease: A Retrospective Study of 543 Operations for 500 Patients

Adults with congenital heart disease (CHD) are an increasing population requiring cardiac operations. To date, the perioperative risk factors for this group have not been identified. This study aimed to identify clinical, morphologic, and hemodynamic risk factors for an adverse outcome. This study retrospectively analyzed a cohort of 500 patients (ages >16 years) who underwent 543 operations between January 2004 and December 2008 at a single center. The composite end point of an adverse outcome was in-hospital death, a prolonged intensive care exceeding 4 days, or both. The composite end point was reached by 253 of the patients (50.6%). Of the 500 patients, 13 (2.6%) died within 30 days after the operation. After logistic regression analysis, the following eight items remained significant: male gender (P = 0.003; odds ratio [OR] 1.8; 95% confidence interval [CI] 1.2–2.6), cyanosis (P > 0.006; OR 3.7; 95% CI 1.5–9.4), functional class exceeding 2 (P = 0.004; OR 2.2; 95% CI 1.3–3.7), chromosomal abnormalities (P = 0.004; OR 3.3; 95% CI 1.4–7.7), impaired renal function (P = 0.019; OR 3.8; 95% CI 1.2–11.5), systemic right ventricle (RV) in a biventricular circulation (P = 0.027; OR 3.3; 95% CI 1.1–9.5), enlargement of the systemic ventricle (P = 0.011; OR 1.7; 95% CI 1.1–2.6), and operation with extracorporeal circulation (P = 0.002; OR 4.3; 95% CI 1.7–11.4). Early mortality in the current adult CHD population is low. Morbidity, however, is significant and influenced by the patients’ conditions (male gender, chromosomal abnormalities), history (cyanosis, New York Hospital Association [NYHA] class), and underlying morphology (systemic RV). This information for a large cohort of patients could help progress toward more adequate counseling for adults with a congenital heart defect.     

Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era

OBJECTIVES: To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods. STUDY DESIGN AND PATIENTS: Comparative cohort study of very low birthweight (501-1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991-1994, n=1408; group II, 1995-1998, n=1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated. RESULTS: Mortality was higher for group I (63.1% v 56.7%; p=0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p=0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95% CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8% v 88.4%; p=0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95% CI 0.52 to 0.94). CONCLUSION: Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.     

Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period

Background

Neonatal seizures may persist despite treatment with multiple anti-epileptic drugs (AEDs).

Objective

To determine in term-born infants with seizures that required two or more AEDs, whether treatment efficacy and/or the underlying disorder were related to neurological outcome.

Design/methods

We included 82 children (born 1998-2006) treated for neonatal seizures. We recorded mortality, aetiology of seizures, the number of AEDs required, achievement of seizure control, and amplitude-integrated-EEG (aEEG) background patterns. Follow-up consisted of an age-adequate neurological examination. Surviving children were classified as normal, having mild neurological abnormalities, or cerebral palsy (CP).

Results

Forty-seven infants (57%) had status epilepticus. The number of AEDs was not related to neurological outcome. Treatment with three or four AEDs as opposed to two showed a trend towards an increased risk of a poor outcome, i.e., death or CP, odds ratio (OR) 2.74; 95% confidence interval (CI) 0.98-7.69; P = .055. Failure to achieve seizure control increased the risk of poor outcome, OR 6.77; 95%-CI 1.42-32.82, P = .016. Persistently severely abnormal aEEG background patterns also increased this risk, OR 3.19; 95%-CI 1.90-5.36; P < .001. In a multivariate model including abnormal aEEG background patterns, failure to achieve seizure control nearly reached significance towards an increased risk of poor outcome, OR 5.72, 95%-CI 0.99-32.97, P = .051. We found no association between seizure aetiology and outcome.

Conclusions

In term-born infants with seizures that required two or more AEDs outcome was poorer if seizure control failed. The number of AEDs required to reach seizure control and seizure aetiology had limited prognostic value.     

Apneas en lactantes con bronquiolitis: incidencia y factores de riesgo para un modelo de predicción

Introduction

The presence of apnoea in acute bronchiolitis (AB) varies between 1.2% and 28.8%, depending on the series, and is one of its most fearsome complications. The aim of this study is to determine the incidence of apnoea in hospitalised patients diagnosed with AB, and to define their associated risk factors in order to construct a prediction model.

Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery

AIM: To establish whether the timing of delivery between 37 + 0 and 41 + 6 wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. METHODS: All pregnant women who were delivered by elective caesarean delivery at term during a 3-y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. RESULTS: Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35-5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58-2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27-32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57-35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk. CONCLUSIONS: Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.     

Occurrence and severity of bronchopulmonary dysplasia and respiratory distress syndrome after a preterm birth

BACKGROUND:

Despite notable advances in neonatal care, bronchopulmonary dysplasia (BPD) remains an important complication of preterm birth, frequently resulting in prolonged hospital stay and long-term morbidity.

METHODS:

A historical cohort study of all preterm infants (gestational age younger than 37 weeks) admitted to the Montreal Children’s Hospital (Montreal, Quebec) between January 1, 1980, and December 31, 1992, was conducted. Information collected included demographic data, maternal and perinatal history, and main neonatal outcomes. Independent risk factors associated with BPD were identified by univariate analysis using one-way ANOVA, t tests or Mantel-Haenszel χ² testing. Severity of disease was studied using an ordinal multinomial logistic regression model.

RESULTS:

In total, 1192 preterm infants were admitted, of whom 551 developed respiratory distress syndrome and 322 developed BPD. For each additional week of prematurity, the risk of developing BPD increased by 54% (adjusted OR 1.54/week [95% CI 1.45 to 1.64]). For each point subtracted on the 1 min Apgar score, the risk of developing BPD was increased by 16% (OR 1.16 [95% CI 1.1 to 1.3]). BPD was also associated with the presence of patent ductus arteriosus (OR 3.5 [95% CI 2.1 to 6.0]), pneumothorax in the first 48 h (OR 9.4 [95% CI 3.6 to 24.8]) or neonatal pneumonia/sepsis in the neonatal period (OR 1.9 [95% CI 1.1 to 3.2]). Severity of BPD was associated with gestational age, 1 min Apgar score, very low birth weight and the presence of neonatal pneumonia/sepsis.

CONCLUSION:

Factors associated with BPD following a preterm birth were the degree of prematurity, birth weight, Apgar score at 1 min, and the presence of patent ductus arteriosus, pneumothorax or neonatal pneumonia/sepsis.     

新生儿呼吸机相关性肺炎的病原学和高危因素分析

目的：随着现代儿科急救医学和新生儿医学的发展, 新生儿呼吸机相关性肺炎(VAP)作为NICU内主要的医院获得性感染已日益受到重视。由于VAP发病机制的复杂性,目前国内关于VAP的高危因素研究较少。该研究旨在初步探讨VAP的发病率﹑病原学和高危因素, 为VAP的防治提供一定的理论依据。方法：回顾分析2003～2005年南昌大学第一附属医院NICU呼吸机治疗的106例危重新生儿的临床资料。结果：VAP发病率为41.7％,单因素分析发现早产儿、低体重、机械通气时间、原发肺部疾患、再插管、有无大剂量使用丙种球蛋白等因素与VAP有关(P＜0.05）。Logistic回归确定机械通气时间、原发肺部疾患、再插管、有无大剂量使用丙种球蛋白为VAP影响因素(P＜0.05）。病原菌主要是耐药性条件致病菌,以革兰阴性杆菌为主(76.9％)。结论：致病菌主要是耐药性条件致病菌;VAP的高危因素众多,其发病机制复杂,是外部环境与患者内环境因素综合作用的结果,采取综合防治措施可能是控制VAP的最佳策略。［中国当代儿科杂志,2007,9（6）：549-552］     

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

BackgroundPreterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves.MethodsWe retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <?2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves.ResultsThe infants’ median gestational age was 28 weeks (27–29) and median birth weight was 1080 g (900–1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860–2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was ?1.82±1.29 with Fenton and ?1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4–82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12–2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5–3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22–2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23–36.9), RDS (OR: 1.81, 95% CI: 1.16–2.83), LNS (OR: 2.29, 95% CI: 1.43–3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38–3.23).ConclusionThe growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.