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Tikmani SS, Saleem S, Sadia A, M. Bann C, Bozdar MH, Raza J, Dhaded SM, Goudar SS, Gowdar G, Yasmin H, McClure EM, Goldenberg RL. Predictors of Preterm Neonatal Mortality in India and Pakistan: A Secondary Analysis of Data from PURPOSe Study. Glob Pediatr Health 2024; 11:2333794X241236617. [PMID: 38487208 PMCID: PMC10938607 DOI: 10.1177/2333794x241236617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Objective. To create a prediction model for preterm neonatal mortality. Methods. A secondary analysis was conducted using data from a prospective cohort study, the Project to Understand and Research Preterm Pregnancy Outcome South Asia. The Cox proportional hazard model was used and adjusted hazard ratios (AHR) with 95% confidence intervals (95% CI) were reported. Results. Overall, 3446 preterm neonates were included. The mean age of preterm neonates was 0.65 (1.25) hours and 52% were female. The preterm neonatal mortality rate was 23.3%. The maternal factors predicting preterm neonatal death was any antepartum hemorrhage, AHR 1.99 (1.60-2.47), while neonatal predictors were preterm who received positive pressure ventilation AHR 1.30 (1.08-1.57), temperature <35.5°C AHR 1.18 (1.00-1.39), and congenital malformations AHR 3.31 (2.64-4.16). Conclusion. This study identified key maternal and neonatal predictors of preterm neonatal mortality, emphasizing the need for targeted interventions and collaborative public health efforts to address disparities and regional variations.
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Affiliation(s)
| | | | | | - Carla M. Bann
- Research Triangle Institute (RTI) International, Durham, NC, USA
| | | | - Jamal Raza
- National Institute of Child Health, Napier Quarter, Karachi, Pakistan
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Gezmu AM, Tefera E, Mochankana K, Imran F, Joel D, Pelaelo I, Nakstad B. Pulmonary hemorrhage and associated risk factors among newborns admitted to a tertiary level neonatal unit in Botswana. Front Pediatr 2023; 11:1171223. [PMID: 37388284 PMCID: PMC10306393 DOI: 10.3389/fped.2023.1171223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Pulmonary hemorrhage (PH) is a life-threatening complication seen in very sick newborns with high morbidity and mortality. There is little data on the incidence, risk factors, and ultimate survival of newborns with pulmonary hemorrhage in sub-Saharan countries, where the healthcare provision and facility differ in many ways compared to high-income countries. Hence, this study aimed to determine the incidence, identify the risk factors, and describe the outcome of pulmonary hemorrhage in newborns in a low middle income country setting. Methods and materials A cohort study with prospective data collection was conducted in a public, tertiary-level hospital in Botswana, the Princess Marina Hospital (PMH). All newborns admitted to the neonatal unit from 1 January 2020 to 31 December 2021 were included in the study. Data were collected using a checklist developed on the RedCap database (https//:ehealth.ub.ac.bw/redcap). The incidence rate of pulmonary hemorrhage was calculated as the number of newborns who had pulmonary hemorrhage per 1,000 newborns in the 2-year period. Group comparisons were made using X2 and Student's t-tests. Multivariate logistic regression was used to identify risk factors independently associated with pulmonary hemorrhage. Result There were 1,350 newborns enrolled during the study period, of which 729 were male newborns (54%). The mean (SD) birth weight was 2,154(±997.5) g, and the gestational age was 34.3 (±4.7) weeks. In addition, 80% of the newborns were delivered in the same facility. The incidence of pulmonary hemorrhage was 54/1,350 {4% [95% CI (3%-5.2%)]} among the newborns admitted to the unit. The mortality rate in those diagnosed with pulmonary hemorrhage was 29/54 (53.7%). Multivariate logistic regression identified birth weight, anemia, sepsis, shock, disseminated intravascular coagulopathy (DIC), apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, mechanical ventilation, and blood transfusion as risk factors independently associated with pulmonary hemorrhage. Conclusion This cohort study identified a high incidence and mortality rate of pulmonary hemorrhage in newborns in PMH. Multiple risk factors, such as low birth weight, anemia, blood transfusion, apnea of prematurity, neonatal encephalopathy, intraventricular hemorrhage, sepsis, shock, DIC, and mechanical ventilation, were identified as independently associated risk factors for PH.
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Affiliation(s)
| | - Endale Tefera
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Kagiso Mochankana
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Fizzah Imran
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Irene Pelaelo
- Department of Paediatrics, Princess Marina Hospital Botswana MOH, Gaborone, Botswana
| | - Britt Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatric and Adolescent Medicine, Inst Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Cardona VQ, Joshi S, Conway D, Menkiti OR. Severe Pulmonary Hemorrhage in a Neonate With Hypoxic Ischemic Encephalopathy and Sepsis Managed on Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:e106-e109. [PMID: 34264871 DOI: 10.1097/mat.0000000000001520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pulmonary hemorrhage (PH) is an infrequent and potentially fatal event in term neonates. Reports of successful management of PH on extracorporeal membrane oxygenation (ECMO) are limited, given the accentuated risk of mortality imposed by the use of heparin to prevent thrombosis on ECMO. We present a case of a term neonate with hypoxic ischemic encephalopathy undergoing controlled hypothermia who developed hypoxic respiratory failure, hemodynamic instability, Enterobacter cloacae pneumonia and sepsis complicated by severe PH who required support with veno-arterial ECMO. We describe the therapeutic strategies used on veno-arterial ECMO to successfully manage this infant, including clamping the endotracheal tube, aggressive correction of coagulopathy, and use of dornase alfa, as well as elaborate on the subtle changes in ECMO parameters during the run that preceded worsening pneumonia with sepsis.
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Affiliation(s)
- Vilmaris Quinones Cardona
- From the Division of Neonatology, Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Swosti Joshi
- From the Division of Neonatology, Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Daniel Conway
- From the Division of Neonatology, Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ogechukwu R Menkiti
- From the Division of Neonatology, Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, Pennsylvania
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Yue W, Wei H, Chen F, Chen X, Xu ZE, Hu Y. Risk factors and prediction score model for unplanned readmission among neonates with NRDS under one year of age: A retrospective cohort study. Front Pediatr 2022; 10:964554. [PMID: 36313871 PMCID: PMC9606800 DOI: 10.3389/fped.2022.964554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the risk factors and establish a prediction score model for unplanned readmission among neonates with neonatal respiratory distress syndrome (NRDS) for respiratory problems under one year of age. METHODS This retrospective cohort study enrolled 230 neonates with NRDS who were admitted between January 2020 and December 2020. The infants were classified into two subgroups based on whether they were readmitted for respiratory problems under one year of age: readmit group and non-readmit group. Readmission risk factors for NRDS were analyzed by logistic regression and a prediction score model was generated. RESULTS Among the 230 enrolled infants, 51 (22%) were readmitted, and 179 (78%) were not readmitted. In univariate analysis, compared with non-readmit group infants, readmit group infants had a significantly younger birth gestational age (31.9 ± 2.3 vs. 32.8 ± 2.5 weeks, p = 0.012), lower birth weight (1,713.7 ± 501.3 g vs. 1,946.8 ± 634.4 g, p = 0.007), older age at discharge (41.7 vs. 31.7 days, p = 0.012), higher proportion of necrotizing enterocolitis (NEC) (31% vs. 16%, p = 0.016), higher rate of blood transfusion (39% vs. 25%, p = 0.049), higher rate of postnatal dexamethasone (DEX) administration (28% vs. 9.5%, p = 0.001), and higher rate of home oxygen therapy (HOT) (57% vs. 34%, p = 0.003). Moreover, readmit group infants had significantly longer antibiotic days usage (12.0 vs. 10.0 days, p = 0.026) and a longer duration of hospital stay (41.0 vs. 31.0 days, p = 0.012) than non-readmit group infants. The multivariate logistic regression analysis showed that taking readmission as a target variable, postnatal DEX administration (OR: 2.689, 95% CI: 1.168-6.189, p = 0.020), HOT (OR: 2.071, 95% CI: 1.060-4.046, p = 0.033), and NEC (OR: 2.088, 95% CI: 0.995-4.380, p = 0.051) could be regarded as risk factors for readmission. A scoring model predicting readmission was administered with a positive predictive value of 0.651 (95% CI: 0.557-0.745, p = 0.002), with a sensitivity of 0.412 and a specificity of 0.888 at a cut-off of 3.5 points, which were evaluated on the receiver operating characteristic curve. CONCLUSIONS Postnatal DEX administration, HOT, and NEC were risk factors for readmission of NRDS. NRDS infants with a predictive score of 3.5 points or more were at high risk for unplanned readmission.
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Affiliation(s)
- Weihong Yue
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xinhong Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen-E Xu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ya Hu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Houweling TAJ, van Klaveren D, Das S, Azad K, Tripathy P, Manandhar D, Neuman M, de Jonge E, Been JV, Steyerberg E, Costello A. A prediction model for neonatal mortality in low- and middle-income countries: an analysis of data from population surveillance sites in India, Nepal and Bangladesh. Int J Epidemiol 2019; 48:186-198. [PMID: 30325465 PMCID: PMC6380321 DOI: 10.1093/ije/dyy194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In poor settings, where many births and neonatal deaths occur at home, prediction models of neonatal mortality in the general population can aid public-health policy-making. No such models are available in the international literature. We developed and validated a prediction model for neonatal mortality in the general population in India, Nepal and Bangladesh. METHODS Using data (49 632 live births, 1742 neonatal deaths) from rural and urban surveillance sites in South Asia, we developed regression models to predict the risk of neonatal death with characteristics known at (i) the start of pregnancy, (ii) start of delivery and (iii) 5 minutes post partum. We assessed the models' discriminative ability by the area under the receiver operating characteristic curve (AUC), using cross-validation between sites. RESULTS At the start of pregnancy, predictive ability was moderate {AUC 0.59 [95% confidence interval (CI) 0.58-0.61]} and predictors of neonatal death were low maternal education and economic status, short birth interval, primigravida, and young and advanced maternal age. At the start of delivery, predictive ability was considerably better [AUC 0.73 (95% CI 0.70-0.76)] and prematurity and multiple pregnancy were strong predictors of death. At 5 minutes post partum, predictive ability was good [AUC: 0.85 (95% CI 0.80-0.89)]; very strong predictors were multiple birth, prematurity and a poor condition of the infant at 5 minutes. CONCLUSIONS We developed good performing prediction models for neonatal mortality. Neonatal deaths are highly concentrated in a small group of high-risk infants, even in poor settings in South Asia. Risk assessment, as supported by our models, can be used as a basis for improving community- and facility-based newborn care and prevention strategies in poor settings.
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Affiliation(s)
- Tanja A J Houweling
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Institute for Global Health, University College London, London, UK
| | - David van Klaveren
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - Sushmita Das
- Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
| | - Kishwar Azad
- Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
| | | | | | - Melissa Neuman
- Institute for Global Health, University College London, London, UK
| | - Erik de Jonge
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Erasmus MC University Medical Center Rotterdam—Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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Lee M, Wu K, Yu A, Roumiantsev S, Shailam R, Nimkin K, Sagar P. Pulmonary hemorrhage in neonatal respiratory distress syndrome: Radiographic evolution, course, complications and long-term clinical outcomes. J Neonatal Perinatal Med 2019; 12:161-171. [PMID: 31256080 DOI: 10.3233/npm-1867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pulmonary hemorrhage (PH) is occasionally seen in premature infants after surfactant treatment for respiratory distress syndrome (RDS). These infants receive frequent chest radiographs (CXR) during and after hospitalization enabling long-term radiographic-clinical correlation. OBJECTIVE To chart the natural evolution of CXR findings of PH in RDS and correlate radiographic patterns to supplemental oxygen requirement. MATERIALS AND METHODS Retrospective review of clinical notes for gestational age (GA), birth weight (BW), intraventricular hemorrhage (IVH) and oxygen requirement were performed. CXRs were reviewed at 4 time-points; during PH, 28 days postnatal age, 36 weeks and at farthest available clinical follow-up. RESULTS 18 infants born (2003-2016), GA (24-30 weeks); BW (482-1590 grams) were included. Mean onset of PH was 1.94 (0-5) days. 9/18 (50%) had IVH. 3 died during PH; all had IVH. During PH, CXR showed whiteout 9/18 (50%); patchy opacities 5/18 (27%); diffuse haziness 1/18 (6%) and no change 3/18 (17%). At 28 days postnatal age, CXR showed fine-interstitial (FI) markings 14/15 (93%) and whiteout 1/15 (7%). At 36 weeks,12/14 (85%) had FI and 2/14 (15%) developed cystic-interstitial changes. At farthest follow-up, FI 3/13 (23%); coarse-interstitial 4/13 (30%); peri-bronchial cuffing 5/13 (38%); normal 1/13 (9%) and the majority had hyperinflation 9/13 (69%). At discharge, 9/14 (64%) required home-oxygen and 5/14 (36%) were on room-air. At farthest follow-up, 6/14 (42%) required home-oxygen and 8/14 (58%) were on room-air. CONCLUSION Premature infants that survive PH may later develop chronic lung disease of prematurity with an evolving interstitial pattern on CXR that clears overtime as they outgrow the need for supplemental oxygen.
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Affiliation(s)
- M Lee
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - K Wu
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - A Yu
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - S Roumiantsev
- Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - R Shailam
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - K Nimkin
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - P Sagar
- Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA
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