scholarly journals Influence of Low Birth Weight and Preterm Birth on Morbidity, Mortality and Medication Use among Neonates in Resource Limited Settings: A Prospective Observational Study

2021 ◽  
Vol 13. (22) ◽  
pp. 80-85
Author(s):  
Pradeepkumar Bhupalam ◽  
Sowjanya Nalampati ◽  
CB. Jyostna Angiel ◽  
T. Gowthami ◽  
Goruntla Narayana ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Medication Use ◽  
Resource Limited Settings ◽  
Resource Limited

scholarly journals Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study (Preprint)

2018 ◽  
Author(s):  
Archana B Patel ◽  
Kunal Kurhe ◽  
Amber Prakash ◽  
Savita Bhargav ◽  
Suchita Parepalli ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Validation Study ◽  
Scoring System ◽  
Age Dating ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Care Facilities

BACKGROUND Although rates of preterm birth continue to increase globally, identification of preterm from low birth weight infants remains a challenge. The burden of low birth weight vs preterm is greatest in resource-limited settings, where gestational age (GA) prior to delivery is frequently not known because ultrasound in early pregnancy is not available and estimates of the date of the mother’s last menstrual period (LMP) may not be reliable. An alternative option is to assess GA at birth to optimize referral and care of preterm newborns. We previously developed and pilot-tested a system to measure the simplified gestational age score (SGAS) based on 4 easily observable neonatal characteristics. OBJECTIVE The objective of this study is to adapt the scoring system as a tablet app (potentially scalable approach) to assess feasibility of use and to validate whether the scoring system accurately predicts prematurity by itself, over and above birth weight in a large sample of newborns. METHODS The study is based in Nagpur, India, at the Research Unit of the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. The Android tablet app for the SGAS (T-SGAS) displays de-identified photographs of skin, breasts, and genitalia across a range of GAs and line drawings of infant posture. Each item is associated with a score. The user is trained to choose the photograph or line drawing that most closely matches the newborn being evaluated, and the app determines the neonate’s GA category (preterm or term) from the cumulative score. The validation study will be conducted in 3 second level care facilities (most deliveries in India occur in hospitals, and women known to be at risk of preterm birth are referred to second level care facilities). Within 24 hours of delivery, women and their babies who are stable will be enrolled in the study. Two auxiliary nurse midwives (ANMs) blinded to prior GA assessments will use the T-SGAS to estimate the GA status of the newborn. An independent data collector will abstract the GA from the ultrasound recorded in the hospital chart and record the date of the mother’s LMP. Eligibility for analysis is determined by the ultrasound and LMP data being collected within 1 week of each other to have a rigorous assessment of true GA. RESULTS Publication of the results of the study is anticipated in 2019. CONCLUSIONS Until GA dating by ultrasound is universally available and easy to use in resource-limited settings, and where there are restrictions on ultrasound use due to their use for sex determination and abortion of female fetuses, this study will determine whether the T-SGAS app can accurately assess GA in risk categories at birth. CLINICALTRIAL ClinicalTrials.gov NCT02408783; https://clinicaltrials.gov/ct2/show/NCT02408783 (Archived by Webcite at http://www.webcitation.org/75S2kmr3T) INTERNATIONAL REGISTERED REPORT DERR1-10.2196/11913

scholarly journals Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nan Wang ◽  
Lianlian Cui ◽  
Zhen Liu ◽  
Yan Wang ◽  
Yuhua Zhang ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Amino Acid ◽  
Low Birth Weight ◽  
Observational Study ◽  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Current Guidelines ◽  
Poor Weight Gain

Abstract Aim European Society for Clinical Nutrition and Metabolism released the guidelines on pediatric parenteral nutrition in 2018. We aimed to compare the parenteral nutrition (PN) regimen with the current guidelines, evaluate weight gain and explore the correlation of parenteral macronutrient and energy intakes with weight gain outcome in preterm infants with birth weight less than 1500 g. Methods A prospective observational study was conducted. Parenteral macronutrients and energy intakes were described. Weight gain during PN was assessed. Nutritional factors associated with weight gain outcome after PN were identified using a cox proportional hazards model. Results A total of 163 infants were included in this study, in which 41 were extremely low birth weight (ELBW) infants and 122 were very low birth weight (VLBW) infants. Average glucose, amino acid, lipid, and energy during the first postnatal week were 7.5 g/kg/d, 2.4 g/kg/d, 0.8 g/kg/d, 48 kcal/kg/d. Median maximum glucose, amino acid, lipid, and energy were 11.1 g/kg/d, 3.5 g/kg/d, 3 g/kg/d, 78 kcal/kg/d. Median days to maximum glucose, amino acid, lipid, and energy were 10, 9, 12, 11 days. The proportion of appropriate for gestational age (AGA) infants was 76.9%. The ratio of infants without poor weight gain outcome after PN was 38%. With every 0.1 g/kg/d decrease of maximum amino acid and average lipid during the first postnatal week, the probability of appropriate weight gain outcome decreased by 77.6 and 74.4% respectively. With each additional day to maximum glucose and energy, the probability of appropriate weight gain outcome decreased by 5.6 and 6.1% respectively. Conclusions Most preterm infants with birth weight less than 1500 g remain below the latest recommended nutrition goals. The poor weight gain outcome of these infants after PN is related to insufficient parenteral macronutrient and energy intakes. PN strategies should be improved according to the latest evidence-based recommendations.

scholarly journals Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants: a prospective observational study

2018 ◽  
Vol 2 (1) ◽  
pp. e000350
Author(s):  
Milena Tana ◽  
Alessandra Lio ◽  
Chiara Tirone ◽  
Claudia Aurilia ◽  
Eloisa Tiberi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Observational Study ◽  
High Frequency ◽  
Prospective Observational Study ◽  
High Frequency Oscillatory Ventilation ◽  
Extremely Low Birth Weight ◽  
Oscillatory Ventilation ◽  
High Frequency Oscillatory ◽  
Successful Extubation

ObjectiveTo evaluate if weaning from high-frequency oscillatory ventilation (HFOV) directly to a non-invasive mode of respiratory support is feasible and results in successful extubation in extremely low birth weight (ELBW) infants.DesignProspective observational study.SettingTertiary neonatal intensive care unit.PatientsOne hundred and eight ELBW infants of 26.2±1.4 weeks of gestational age (GA) directly extubated from HFOV.InterventionsAll infants were managed with elective HFOV and received surfactant after a recruitment HFOV manoeuvre. Extubation was attempted at mean airways pressure (MAP) ≤6 cm H2O with FiO2 ≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6–8 cm H2O).Main outcome measuresExtubation failure (clinical deterioration requiring reintubation) was defined as shorter than 7 days.ResultsNinety patients (83%) were successfully extubated and 18 (17%) required reintubation. No significant differences were found between the two groups in terms of birth weight, day of life and weight at the time of extubation. Multivariable analysis showed that GA (OR 1.71; 95% CI 1.04, 2.08) and higher MAP prior to surfactant (OR 1.51; 95% CI 1.06, 2.15) were associated with successful extubation.ConclusionsIn ELBW infants, direct extubation from HFOV at MAP ≤6 cm H2O with FiO2 ≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.

scholarly journals A Prospective Observational Study on the Appraisal of Common Cause and Efficacy of Continuous Phototherapy in Patients with Neonatal Jaundice

2019 ◽  
pp. 1-14
Author(s):  
V. Premsai ◽  
G. Ramya ◽  
Y. Kavya Chowdary ◽  
Syeda Zaineb Humaira Hussaini ◽  
C. Aparna
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Observational Study ◽  
Neonatal Jaundice ◽  
Prospective Observational Study ◽  
Adverse Reactions ◽  
Causality Assessment ◽  
Assessment Scale ◽  
Common Cause ◽  
Women And Children

Background: Neonatal jaundice is generally harmless, but high concentrations of unconjugated bilirubin may rarely cause kernicterus. Hyperbilirubinemia is the most common cause of neonatal readmission to the hospital, in the majority of cases. Aims: The study aims to determine incidence rate of neonatal jaundice as well as evaluate the commonest cause and determine the efficacy of continuous phototherapy. Study Design: A Prospective observational study. Place and Duration of Study: The study was conducted in Avis Ankura hospital for women and children. It is a well-recognized, authorized hospital where obstetrics and neonatal care is provided. The study was conducted between October 2018 to March 2019. Methodology: The study was conducted in Avis Ankura hospital for women and children. It is a well-recognized, authorized hospital where obstetrics and neonatal care is provided. A total of 162 neonates were considered. Informed consent was obtained from all the subject’s care takers. Subjects enrolled in the study were admitted in NICUs’. This study appraises the conventional cause of NNJ, evaluates the efficacy of continuous phototherapy and detects the phototherapy induced adverse reactions by using Naranjo’s causality assessment scale. Results: Among 162 patients, 94 patients (58%) were found to be males and 68 patients (42%) were found to be females. Low birth weight neonates (43.20%) were found to be more prone to neonatal jaundices. In this study, it was found that duration of phototherapy was longer in extremely low birth weight neonates (34 hours) in relation to birth weight and average duration of phototherapy. Based on the conventional cause, physiological cause (56.79%) was observed to be highest among other causes of neonatal jaundice. The short term adverse reactions due to phototherapy were identified using Naranjo’s Causality Assessment Scale. The TSB levels were increased before phototherapy (pre- treatment) and decreased after phototherapies (post-treatment) which were assessed by using American Academy of Pediatrics guidelines. Conclusion: From this study, it was concluded that males were more prone to develop neonatal jaundice when compared with females. Physiological jaundice contributes majority of cases   among the total cases. The use of phototherapy was inversely related to gestational age and birth weight.

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