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Ikechebelu JI, Eleje GU, Onubogu CU, Ojiegbe NO, Ekwochi U, Ezebialu IU, Ezenkwele EP, Nzeribe EA, Umeh UA, Obumneme-Anyim I, Nwokeji-Onwe LN, Settecase E, Ugwu IA, Chianakwana O, Ibekwe NT, Ezeaku OI, Ekweagu GN, Onwe AB, Lavin T, Tukur J. Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria. BJOG 2024. [PMID: 38560768 DOI: 10.1111/1471-0528.17816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria. DESIGN Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme. SETTING Fifty-four consenting referral-level hospitals (48 public and six private) across the six geopolitical zones of Nigeria. POPULATION Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020. METHODS Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia. MAIN OUTCOME MEASURES Incidence, case fatality rate and factors associated with birth asphyxia. RESULTS Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre-eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%. CONCLUSIONS The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care.
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Affiliation(s)
- Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | | | - Uchenna Ekwochi
- Department of Paediatrics, ESUT Teaching Hospital, Enugu, Nigeria
| | - Ifeanyichukwu Uzoma Ezebialu
- Department of Obstetrics and Gynaecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Eziamaka Pauline Ezenkwele
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | | | - Uchenna Anthony Umeh
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Ijeoma Obumneme-Anyim
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Linda Nneka Nwokeji-Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Eugenia Settecase
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Ogochukwu Chianakwana
- Department of Medical Records, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Nkechi Theresa Ibekwe
- Department of Medical Records, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Onyebuchi Ignatius Ezeaku
- Department of Medical Records, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Gloria Nwuka Ekweagu
- Department of Medical Records, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Abraham Bong Onwe
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jamilu Tukur
- Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
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Gurtoo S, Karthikkeyan G, Behera SK, Kotimoole CN, Najar MA, Modi PK, Ks S, Pinto SM, Ab A. A comparative proteomic analysis for non-invasive early prediction of hypoxic-ischemic injury in asphyxiated neonates. Proteomics Clin Appl 2024; 18:e2200054. [PMID: 37787895 DOI: 10.1002/prca.202200054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/14/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
AIM Hypoxic Ischemic Encephalopathy (HIE) is one of the principal causes of neonatal mortality and long-term morbidity worldwide. The neonatal signs of mild cerebral injury are subtle, making an early precise diagnosis difficult. Delayed detection, poor prognosis, and lack of specific biomarkers for the disease are increasing mortality rates. In this study, we intended to identify specific biomarkers using comparative proteomic analysis to predict the severity of perinatal asphyxia so that its outcome can also be prevented. EXPERIMENTAL DESIGN A case-control study was conducted on 38 neonates, and urine samples were collected within 24 and 72 h of life. A tandem mass spectrometry-based quantitative proteomics approach, followed by validation via sandwich ELISA, was performed. RESULTS The LC-MS/MS-based proteomics analysis resulted in the identification of 1201 proteins in urine, with 229, 244, and 426 being differentially expressed in HIE-1, HIE-2, and HIE-3, respectively. Axon guidance, Diseases of programmed cell death, and Detoxification of reactive oxygen species pathways were significantly enriched in mild HIE versus severe HIE. Among the differentially expressed proteins in various stages of HIE, we chose to validate four proteins - APP, AGT, FABP1, and FN1 - via sandwich ELISA. Individual and cumulative ROC curves were plotted. AGT and FABP1 together showed high sensitivity, specificity, and accuracy as potential biomarkers for early diagnosis of HIE. CONCLUSION Establishing putative urinary biomarkers will facilitate clinicians to more accurately screen neonates for brain injury and monitor the disease progression. Prompt treatment of neonates may reduce mortality and neurodevelopmental impairment.
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Affiliation(s)
- Sumrati Gurtoo
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Gayathree Karthikkeyan
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Santosh Kumar Behera
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Chinmaya Narayana Kotimoole
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Mohd Altaf Najar
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Prashant Kumar Modi
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Sahana Ks
- Yenepoya Medical College and Hospital, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Sneha M Pinto
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Centre of Molecular Inflammation Research (CEMIR), Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology, Trondheim, Norway
| | - Arun Ab
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Yenepoya Institute of Arts Science Commerce and Management, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
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Kebede BF, Biyazin Tesfa T, Yetwale Hiwot A, Mulu KK, Adugnaw E, Mihretu E, Sewmehone E, Genie YD. Time to death and predictors of mortality among asphyxiated neonates in southwest Ethiopia, 2022: prospective cohort study. BMJ Open 2024; 14:e077943. [PMID: 38238169 PMCID: PMC10806697 DOI: 10.1136/bmjopen-2023-077943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE This study aimed to determine the time to death and predictors of mortality among asphyxiated neonates admitted to public hospitals in the southwest region of Ethiopia. DESIGN An institution-based prospective cohort study was conducted. SETTING Public hospitals in southwest Ethiopia. PARTICIPANTS A total of 144 asphyxiated neonates, who were admitted to the neonatal intensive care unit, and their mothers participated from March 2022 to 30 September 2022. Data were entered into EpiData V.4.4.2.1 and exported to STATA V.16 for analysis. The Cox proportional hazards model using bivariate (p<0.25) and multivariate (p<0.05) analyses was used to identify the predictors of mortality. The median survival time was estimated using Kaplan-Meier survival estimates. PRIMARY OUTCOME Time to death from asphyxia and its predictors in neonates. RESULTS The mortality incidence rate of asphyxiated neonates was 9.1 deaths per 1000 person-days of observation (95% CI: 7.11 to 11.52) with a median survival time of 8 days, and 45.83% (95% CI: 37.81% to 54.08%) of asphyxiated neonates died. Being male (adjusted HR (AHR) 0.32 (95% CI: 0.14 to 0.76)), neonatal sepsis (AHR 0.321 (95% CI: 0.13 to 0.77)), not receiving kangaroo mother care (AHR 0.16 (95% CI: 0. 07 to 0.39)) and vaginal delivery (AHR 0.39 (95% CI: 0.16 to 0.95)) were independent predictors of mortality of asphyxiated neonates. CONCLUSIONS In this study, asphyxiated neonates had a higher incidence of mortality with a median survival time of only 8 days. Being male, vaginal delivery, not receiving kangaroo mother care and comorbidities such as neonatal sepsis were independent predictors of mortality among asphyxiated neonates. Therefore, healthcare providers and other stakeholders should provide timely initiation of advanced diagnosis and appropriate therapeutic interventions for neonates with asphyxia to reduce neonatal mortality.
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Affiliation(s)
| | | | | | | | - Emebet Adugnaw
- Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Esmelalem Mihretu
- Pediatrics and Child Health, Debre Markos University, Debre Markos, Ethiopia
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Liu CH, Liu HY, Peng SC, Pan S, Wan ZT, Wu SY, Fang CC, Jiao R, Wang WX, Gan B, Shu-JieYang, Tan JF, Zhu XF, She PL, Fan QH, Yang M, Xie JJ, Sun J, Zeng L, Zhang LH, Xu HR, Li YN, Zhang PF, Lu W, Yang XT, Xiao XF, Li HL, Rao ZL, Gao C, Luo YH, Chen H, Yu MJ, Luan XY, Huang YR, Xia SW. Effect of birth asphyxia on neonatal blood glucose during the early postnatal life: A multi-center study in Hubei Province, China. Pediatr Neonatol 2023; 64:562-569. [PMID: 37105821 DOI: 10.1016/j.pedneo.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Birth asphyxia causes hypoxia or inadequate perfusion to the organs of newborns, leading to metabolism dysfunctions including blood glucose disorders. METHODS Neonates with and without birth asphyxia were retrospectively recruited from 53 hospitals in Hubei Province from January 1 to December 31, 2018. In summary, 875, 1139, and 180 cases in the control group, the mild asphyxia group, and the severe asphyxia group were recruited, respectively. Neonatal blood glucose values at postnatal 1, 2, 6, and 12 h (time error within 0.5 h was allowed) were gathered from the medical records. RESULTS The incidence rates of hyperglycemia in the control group, the mild asphyxia group and the severe asphyxia group were 2.97%, 7.90%, and 23.33%, respectively (p < 0.001). Additionally, the incidence rates of hypoglycemia in the three groups above were 3.66%, 4.13%, and 7.78%, respectively (p = 0.042). The blood glucose values of neonates with hypoglycemia in the asphyxia group were lower than in the control group (p = 0.003). Furthermore, the blood glucose values of neonates with hyperglycemia were highest in the severe asphyxia group (p < 0.001). There were 778 and 117 cases with blood glucose records at four predefined time points in the mild and severe asphyxia group, respectively. The incidence of blood glucose disorders in the mild asphyxia group significantly decreased from postnatal 6 h (p<0.05). However, we found no obvious changes of the incidence of glucose disorders within postnatal 12 h in the severe asphyxia group (p = 0.589). CONCLUSION Birth asphyxia is likely to cause neonatal blood glucose disorders, both hypoglycemia and hyperglycemia, during the early postnatal life. The neonates with severe asphyxia have higher incidence, worse severity and longer duration of blood glucose disorders than neonates with mild asphyxia.
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Affiliation(s)
- Chun-Hua Liu
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Neonatology, Xianning Central Hospital, First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Hong-Yan Liu
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si-Cong Peng
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Pan
- Department of Neonatology, Xianning Central Hospital, First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China
| | - Zhi-Ting Wan
- Department of Neonatology, Xianning Central Hospital, First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China
| | - Su-Ying Wu
- Department of Neonatology, University Hospital of Hubei Minzu University, Enshi, China
| | - Chao-Ce Fang
- Department of Neonatology, University Hospital of Hubei Minzu University, Enshi, China
| | - Rong Jiao
- Department of Pediatrics, Xiangyang NO.1 People's Hospital, Xiangyang, China
| | - Wen-Xiang Wang
- Department of Pediatrics, Xiangyang NO.1 People's Hospital, Xiangyang, China
| | - Bin Gan
- Department of Neonatology, The Central Hospital of Xiaogan, Xiaogan, China
| | - Shu-JieYang
- Department of Neonatology, The Central Hospital of Xiaogan, Xiaogan, China
| | - Ju-Fang Tan
- Department of Neonatology, Jingzhou Central Hospital, Jingzhou, China
| | - Xiao-Fang Zhu
- Department of Neonatology, Jingzhou Central Hospital, Jingzhou, China
| | - Ping-Li She
- Department of Neonatology, The First People's Hospital of Jingzhou, Jingzhou, China
| | - Qi-Hong Fan
- Department of Neonatology, The First People's Hospital of Jingzhou, Jingzhou, China
| | - Min Yang
- Department of Pediatrics, Children's Medical Center, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | - Ji-Jian Xie
- Department of Pediatrics, Children's Medical Center, Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | - Jie Sun
- Department of Neonatology, Huanggang Central Hospital, Huanggang, China
| | - Ling Zeng
- Department of Neonatology, Huanggang Central Hospital, Huanggang, China
| | - Lian-Hong Zhang
- Department of Neonatology, The First People's Hospital of Tianmen, Tianmen, China
| | - Hui-Rong Xu
- Department of Neonatology, The First People's Hospital of Tianmen, Tianmen, China
| | - Yan-Ni Li
- Department of Pediatrics, Xiangyang Maternal and Child Health Care Hospital, Xiangyang, China
| | - Ping-Feng Zhang
- Department of Pediatrics, Xiangyang Maternal and Child Health Care Hospital, Xiangyang, China
| | - Wei Lu
- Department of Pediatrics, Yichang Central People's Hospital, Yichang, China
| | - Xian-Tao Yang
- Department of Pediatrics, Yichang Central People's Hospital, Yichang, China
| | - Xiong-Fei Xiao
- Department of Neonatology, Tianmen Maternal and Child Health Care Hospital, Tianmen, China
| | - Hong-Li Li
- Department of Pediatrics, Hanchuan Maternal and Child Health and Family Planning Service Center, Hanchuan, China
| | - Zheng-Liang Rao
- Department of Pediatrics, Yingshan People's Hospital, Yingshan, China
| | - Chuang Gao
- Department of Pediatrics, Yingshan People's Hospital, Yingshan, China
| | - Ya-Hui Luo
- Department of Neonatology, Hanchuan People's Hospital, Hanchuan, China
| | - Hong Chen
- Department of Neonatology, Qichun People's Hospital, Qichun, China
| | - Ming-Jin Yu
- Department of Neonatology, Qichun People's Hospital, Qichun, China
| | - Xiao-Ying Luan
- Department of Pediatrics, Yunmeng Hospital of Traditional Chinese Medicine, Yunmeng, China
| | - Yu-Rong Huang
- Department of Pediatrics, Gong An County People's Hospital, Gong'an, China
| | - Shi-Wen Xia
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Darsareh F, Ranjbar A, Farashah MV, Mehrnoush V, Shekari M, Jahromi MS. Application of machine learning to identify risk factors of birth asphyxia. BMC Pregnancy Childbirth 2023; 23:156. [PMID: 36890453 PMCID: PMC9993370 DOI: 10.1186/s12884-023-05486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk of birth asphyxia is necessary. The present study used a machine learning model to predict birth asphyxia. METHODS Women who gave birth at a tertiary Hospital in Bandar Abbas, Iran, were retrospectively evaluated from January 2020 to January 2022. Data were extracted from the Iranian Maternal and Neonatal Network, a valid national system, by trained recorders using electronic medical records. Demographic factors, obstetric factors, and prenatal factors were obtained from patient records. Machine learning was used to identify the risk factors of birth asphyxia. Eight machine learning models were used in the study. To evaluate the diagnostic performance of each model, six metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity, specificity, and F1 score were measured in the test set. RESULTS Of 8888 deliveries, we identified 380 women with a recorded birth asphyxia, giving a frequency of 4.3%. Random Forest Classification was found to be the best model to predict birth asphyxia with an accuracy of 0.99. The analysis of the importance of the variables showed that maternal chronic hypertension, maternal anemia, diabetes, drug addiction, gestational age, newborn weight, newborn sex, preeclampsia, placenta abruption, parity, intrauterine growth retardation, meconium amniotic fluid, mal-presentation, and delivery method were considered to be the weighted factors. CONCLUSION Birth asphyxia can be predicted using a machine learning model. Random Forest Classification was found to be an accurate algorithm to predict birth asphyxia. More research should be done to analyze appropriate variables and prepare big data to determine the best model.
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Affiliation(s)
- Fatemeh Darsareh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amene Ranjbar
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Vahid Mehrnoush
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Mitra Shekari
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Tibebu EA, Desta KW, Ashagre FM, Jemberu AA. Prevalence of birth injuries and associated factors among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. Crossectional study. PLoS One 2023; 18:e0281066. [PMID: 36716337 PMCID: PMC9886250 DOI: 10.1371/journal.pone.0281066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 01/14/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021. METHODS Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant. RESULT The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6). CONCLUSION The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.
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Affiliation(s)
| | - Kalkidan Wondwossen Desta
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feven Mulugeta Ashagre
- School of Nursing and Midwifery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asegedech Asmamaw Jemberu
- Department of Medical Laboratory Sciences, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol 2022; 46:151630. [PMID: 35725655 DOI: 10.1016/j.semperi.2022.151630] [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] [Indexed: 11/26/2022]
Abstract
The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.
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Affiliation(s)
- Vivek V Shukla
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Susan Niermeyer
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Ruth Guinsburg
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
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Kumar N, Yadav A. Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study. JOURNAL OF MOTHER AND CHILD 2022; 26:27-34. [PMID: 35853688 PMCID: PMC10032318 DOI: 10.34763/jmotherandchild.20222601.d-22-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/29/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Birth asphyxia is a common cause of perinatal morbidity, mortality. OBJECTIVE To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. MATERIAL AND METHODS Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. RESULTS For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. CONCLUSION Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Ashu Yadav
- Department of Obstetrics and Gynecology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
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Jimma MS, Abitew KM, Chanie ES, GebreEyesus FA, Kelkay MM. Determinants of birth asphyxia among newborns in Northwest Ethiopia, 2019: Case Control Study. Heliyon 2022; 8:e08875. [PMID: 35198758 PMCID: PMC8842017 DOI: 10.1016/j.heliyon.2022.e08875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the leading causes of neonatal mortality in Ethiopia. Identifying its determinant factors is very important to prevent the problem. Therefore, this study was aimed at identifying the determinant factors of birth asphyxia among newborns at Benishangul Gumuz region hospital. Methods and materials The hospital-based unmatched case-control study was done from March 04 to July 16, 2019 in Benishangul Gumuz Region Hospitals. Total sample size is 275 with 69 cases and 206 controls. Newborns with an Apgar score of less than 7 at 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. All asphyxiated newborns were enrolled as cases, where as in every three-step non-asphyxiated newborns were taken as controls. The data was entered into Epi Info 7 and exported to SPSS for analysis. Bivariable logistic regression analysis was used. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia. Results In the current study, anemia during pregnancy [AOR = 2.95, 95% CI: (1.02, 8.54)], no ANC visit at all [AOR = 4.26, 95% CI: (1.23,14.7)], prolapsed cord [AOR = 4.52, 95% CI: (1.3, 21)], and low birth weight [AOR = 4.1, 95% CI: (1.11, 15.36] were all determinant factors for birth asphyxia. Conclusion and Recommendations: The identified determinants of birth asphyxia were anemia during pregnancy, no ANC visit at all, prolapsed cord, cesarean birth, and low birth weight. Based on our study, most of identified determinant factors of birth asphyxia were preventable so, policy makers, clinicians, and other stakeholders need to invest their maximum effort on prevention of birth asphyxia.
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Affiliation(s)
- Melkamu Senbeta Jimma
- Department of Nursing, Colleges of Health Science, Assosa University, Ethiopia
- Corresponding author.
| | - Kennean Mekonnen Abitew
- Department of Emergency Medicine and Critical Care Nursing, School of Nursing, Colleges of Medicine and Health Sciences University of Gondar, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fisha Alebel GebreEyesus
- Department of Nursing, Colleges of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Mengistu Mekonnen Kelkay
- Department of Pediatrics and Child Health Nursing, School of Nursing, Colleges of Medicine and Health Sciences University of Gondar, Ethiopia
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Ogik V, Muyingo M, Musooko M, Nankunda J. Umbilical artery lactate levels and associated maternal and newborn characteristics at Mulago National Referral Hospital: a cross-sectional observational study. BMJ Open 2021; 11:e043827. [PMID: 34446476 PMCID: PMC8395270 DOI: 10.1136/bmjopen-2020-043827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the maternal and newborn characteristics associated with high umbilical artery lactate levels at Mulago National Referral Hospital. DESIGN Cross-sectional observational study. SETTING Department of Obstetrics and Gynecology at a national referral hospital located in the capital of Uganda, Kampala. PARTICIPANTS We randomly selected 720 pregnant mothers at term who presented in labour and their newborn babies. PRIMARY OUTCOME Umbilical artery lactate level. RESULTS During the study, there were 579 vaginal deliveries (18 instrumental) and 141 caesarean sections which met the inclusion criteria. One hundred and eighty-seven neonates (187) had high arterial lactate levels. The following factors were associated with an increased likelihood of high lactate concentration: male sex (adjusted OR (aOR)=1.71; 95% CI 1.16 to 2.54; p<0.05), primigravidity (aOR=2.78; 95% CI 1.89 to 4.08; p<0.001), meconium-stained liquor (aOR=5.85; 95% CI 4.08 to 8.47; p<0.001) and administration of oxytocin (aOR=1.97; 95% CI 1.00 to 3.77; p<0.05). CONCLUSION About a fifth of the babies born in Mulago National Referral Hospital during the study period had high umbilical artery lactate. The maternal-fetal factors significantly associated with high umbilical artery lactate levels included: baby's sex, mother's gravidity, meconium-stained amniotic fluid and oxytocin administration during labour.
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Affiliation(s)
- Victor Ogik
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mark Muyingo
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Musooko
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Jolly Nankunda
- Department of Pediatrics-Neonatology, Mulago National Referral Hospital, Kampala, Uganda
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11
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Robillard PY, Hulsey TC, Bonsante F, Boumahni B, Boukerrou M. Ethnic differences in postmaturity syndrome in newborns. Reflections on different durations of gestation. J Matern Fetal Neonatal Med 2021; 34:2592-2599. [PMID: 31533500 PMCID: PMC7427839 DOI: 10.1080/14767058.2019.1670161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the prevalence, by weeks of gestation, of post-maturity signs in newborns by ethnic origins. STUDY DESIGN Observational cohort study (2001-2018), of all consecutive singleton births delivered at Center Hospitalier Universitaire Hospitalier Sud Reunion's maternity (Reunion Island, French overseas department, Indian Ocean). The presence of clinical post-maturity signs was recorded by a week of gestation using Clifford's clinical post-maturity signs in newborns (desquamation, dry skin, wrinkling fingers and cracked skin). RESULTS Of the 67,463 singleton births during the period, 58,503 newborns were from Reunion island, 5756 were of European origin (mainland France), and 4061 newborns from the archipelago of Comoros (North of Madagascar). Mean duration of gestation was 276 days in Caucasian women, 272 days in Comorian mothers and 273 days in Reunionese (p < .001). Post-maturity is defined by WHO as gestation greater than 293 days (41 weeks + 6 days). At 41 weeks (287 days) 12.1% of Caucasian babies presented post-maturity signs and 22.4% meconium-stained liquid versus respectively, 22.8 and 27.1% in Reunionese and 44 and 39.8% in Comorians (p < .001). CONCLUSION Among African (Black) pregnancies, duration of gestation was approximately 7 days shorter than in Caucasian (White) pregnancies. In the Reunionese intermixed population and Comorians, the gestation was shorter by 3-4 days. Black newborns presented severe clinical post-maturity signs beginning around 40 weeks and 4-6 days, while it was 1 week later in white infants. Consequences of these differences, with respect to clinical outcomes, are discussed.
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Affiliation(s)
- Pierre-Yves Robillard
- Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
- Centre D’Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
| | - Thomas C. Hulsey
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Francesco Bonsante
- Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
- Centre D’Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
| | - Brahim Boumahni
- Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
| | - Malik Boukerrou
- Centre D’Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre CEDEX, La Réunion, France
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12
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Kim SY, Shim GH, O'Reilly M, Cheung PY, Lee TF, Schmölzer GM. Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions. Front Pediatr 2020; 8:602228. [PMID: 33425814 PMCID: PMC7793777 DOI: 10.3389/fped.2020.602228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the "male disadvantage" remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, it is unknown if there are differences in resuscitation outcomes between males and females during different cardiopulmonary resuscitation techniques. Intervention and Measurements: Secondary analysis of 184 term newborn mixed breed duroc piglets (1-3 days of age, weighing 2.0 (0.2) kg) from seven different studies, which were exposed to 30-50 min of normocapnic hypoxia followed by asphyxia until asystole. This was followed by cardiopulmonary resuscitation. For the analysis, piglets were divided into male and female groups, as well as resuscitation technique groups (sustained inflation, 3:1 compression-to-ventilation ratio, or asynchronous ventilations during chest compressions). Cardiac function, carotid blood flow, and cerebral oxygenation were continuously recorded throughout the experiment. Main results: Regardless of resuscitation technique, there was no significant difference between males and females in the number achieving return of spontaneous circulation (ROSC) [95/123 (77%) vs. 48/61 (79%)], the time to achieve ROSC [112 (80-185) s vs. 110 (77-186) s], and the 4-h survival rate [81/95 (85%) vs. 40/48 (83%)]. Levels of the injury markers interleukin (IL)-1ß, IL-6, IL-8, and tumor necrosis factor-α in frontoparietal cortex tissue homogenates were similar between males and females. Conclusions: Regardless of resuscitation technique, there was no significant effect of sex on resuscitation outcome, survival, and hemodynamic recovery in asphyxiated newborn piglets.
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Affiliation(s)
- Seung Yeon Kim
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, Eulji University Hospital, Daejeon, South Korea
| | - Gyu-Hong Shim
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Megan O'Reilly
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Tze-Fun Lee
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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13
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La Garde RP, Cheung PY, Yaskina M, Lee TF, O'Reilly M, Schmölzer GM. Sex Differences Between Female and Male Newborn Piglets During Asphyxia, Resuscitation, and Recovery. Front Pediatr 2019; 7:290. [PMID: 31380324 PMCID: PMC6646717 DOI: 10.3389/fped.2019.00290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/27/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Male and female newborns have differences in their fetal development, fetal-to-neonatal transition, and postnatal morbidity. However, the cardiovascular fetal-to-neonatal adaption is similar between sexes. No study has examined sex differences in newborns during hypoxia, asphyxia, cardio-pulmonary resuscitation, or post-resuscitation recovery. Methods: Secondary analysis (two previous publications and two studies currently under peer-review) of 110 term newborn mixed breed piglets (1-3 days of age, weighing 2.0 ± 0.2 kg), which were exposed to 30 min normocapnic hypoxia followed by asphyxia until asystole, which was achieved by disconnecting the ventilator and clamping the endotracheal tube. This was followed by cardio-pulmonary resuscitation. For the analysis piglets were divided into female and male groups. Cardiac function, carotid blood flow, and cerebral and renal oxygenation were continuously recorded throughout the experiment. Results: A total of 35/41 (85%) female and 54/69 (78%) male piglets resuscitated achieved ROSC (p = 0.881). The median (IQR) time to achieve return of spontaneous circulation in females and males was 111 (80-228) s and 106 (80-206) s (p = 0.875), respectively. The 4-h survival rate was similar between females and males with 28/35 (80%) and 49/54 (91%) piglets surviving (p = 0.241), respectively. Conclusions: No difference between female and male newborn piglets was observed during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery.
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Affiliation(s)
- Ramin P La Garde
- Medical University of Vienna, Vienna, Austria.,Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Po-Yin Cheung
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Maryna Yaskina
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Tze-Fun Lee
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Megan O'Reilly
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, AB, Canada.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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14
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Lorente-Pozo S, Parra-Llorca A, Torres B, Torres-Cuevas I, Nuñez-Ramiro A, Cernada M, García-Robles A, Vento M. Influence of Sex on Gestational Complications, Fetal-to-Neonatal Transition, and Postnatal Adaptation. Front Pediatr 2018; 6:63. [PMID: 29740570 PMCID: PMC5924769 DOI: 10.3389/fped.2018.00063] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 12/19/2022] Open
Abstract
Fetal sex is associated with striking differences during in utero development, fetal-to-neonatal transition, and postnatal morbidity and mortality. Male sex fetuses are apparently protected while in utero resulting in a higher secondary sex rate for males than for females. However, during fetal-to-neonatal transition and thereafter in the newborn period, female exhibits a greater degree of maturation that translates into a better capacity to stabilize, less incidence of prematurity and prematurity-associated morbidities, and better long-term outcomes. The present review addresses the influence of sex during gestation and postnatal adaptation that includes the establishment of an adult-type circulation, the initiation of breathing, endurance when confronted with perinatal hypoxia ischemia, and a gender-related different response to drugs. The intrinsic mechanisms explaining these differences in the perinatal period remain elusive and further experimental and clinical research are therefore stringently needed if an individual oriented therapy is to be developed.
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Affiliation(s)
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Begoña Torres
- Neonatal Research Group, Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Antonio Nuñez-Ramiro
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Cernada
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana García-Robles
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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15
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Wallace ME, Mendola P, Kim SS, Epps N, Chen Z, Smarr M, Hinkle SN, Zhu Y, Grantz KL. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol 2017; 216:306.e1-306.e12. [PMID: 27865977 DOI: 10.1016/j.ajog.2016.11.1026] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation. OBJECTIVE The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race. STUDY DESIGN A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined. RESULTS Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms. CONCLUSION Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities.
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Affiliation(s)
- Maeve E Wallace
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Pauline Mendola
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Sung Soo Kim
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Nikira Epps
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Melissa Smarr
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Yeyi Zhu
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
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16
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Ramy N, Al Sharany W, Mohamed MA, Madani H, Saleh E, Aly H. Lipid peroxides in the serum of asphyxiated neonates. J Perinatol 2016; 36:849-52. [PMID: 27309626 DOI: 10.1038/jp.2016.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Lipid peroxides (LPOs) are released when free radicals react with unsaturated fatty acids in cell membranes during hypoxic ischemic insult in neonates. We aimed to assess LPO concentrations in the serum of asphyxiated and non-asphyxiated neonates and examine their correlation with the severity of asphyxia. STUDY DESIGN This prospective cross-sectional study was conducted on a group of asphyxiated neonates and controls. Serum LPO concentrations was measured by enzyme-linked immunosorbent assay at 4-6 h of life in all subjects. Encephalopathy was classified according to Sarnat's stages into mild, moderate and severe at 12-24 h of life. LPO was compared between groups and was correlated with severity of encephalopathy and mortality. RESULTS A total of 90 infants were enrolled; of them 45 had asphyxia. Serum LPO (nmol ml(-1)) was significantly greater in the asphyxia group (6.9±3.01 vs 1.78±1.09, P<0.001). It correlated positively with severity of encephalopathy (P<0.001) and negatively with Apgar score at 5 min (r=-0.532, P<0.001) and with initial blood gases pH (r=-0.664, P<0.001). LPO measured greater concentrations in infants who died compared with asphyxiated survivors (11.64±1.31 vs 6.18±2.48, P=0.0004). CONCLUSION LPO was increased and correlated with severity of asphyxia as well as with mortality. Further studies are warranted to examine whether it is only a marker for outcome or a contributor in the pathogenesis of hypoxic-ischemic brain injury.
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Affiliation(s)
- N Ramy
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - W Al Sharany
- Department of Pediatrics, Cairo University, Cairo, Egypt
| | - M A Mohamed
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
| | - H Madani
- Department of Clinical and Chemical Pathology, Cairo University, Cairo, Egypt
| | - E Saleh
- Department of Pediatrics, Matareya Hospital, Cairo, Egypt
| | - H Aly
- Division of Newborn Services, The George Washington University Hospital and Children's National Medical Center, Washington, DC, USA
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17
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Wang L, Kuromaki K, Kawabe A, Kikugawa A, Matsunaga S, Takagi A. Nuchal cord complication in male small for gestational age increases fetal distress risk during labor. Taiwan J Obstet Gynecol 2016; 55:568-74. [DOI: 10.1016/j.tjog.2016.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/13/2023] Open
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18
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Boskabadi H, Ashrafzadeh F, Doosti H, Zakerihamidi M. Assessment of Risk Factors and Prognosis in Asphyxiated Infants. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2006. [PMID: 26396695 PMCID: PMC4575793 DOI: 10.5812/ijp.2006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Asphyxia is considered an important cause of morbidity and mortality in neonates. This condition can affect many vital organs including the central nervous system and may eventually lead to death or developmental disorders. OBJECTIVES Considering the high prevalence of asphyxia and its adverse consequences, the present study was conducted to evaluate the risk factors for birth asphyxia and assess their correlation with prognosis in asphyxiated infants. PATIENTS AND METHODS This two-year follow-up cohort study was conducted on 260 infants (110 asphyxiated infants and 150 healthy neonates) at Mashhad Ghaem Hospital during 2007 - 2014. Data collection tools consisted of a researcher-designed questionnaire including maternal and neonatal information and clinical/laboratory test results. The subjects were followed-up, using Denver II test for 6, 12, 18, and 24 months (after discharge). For data analysis, t-test was performed, using SPSS version 16.5. P value ≤ 0.05 was considered statistically significant. RESULTS Of 260 neonates, 199 (76.5%) and 61 (23.5%) cases presented with normal neonatal outcomes and with abnormal neonatal outcomes (developmental delay), respectively. Variables such as the severity of asphyxia (P = 0.000), five-minute Apgar score (P = 0.015), need for ventilation (P = 0.000), and severity of acidosis at birth (P = 0.001) were the major prognostic factors in infants with asphyxia. Additionally, prognosis was significantly poorer in boys and infants with dystocia history (P = 0.000). CONCLUSIONS Prevalence of risk factors for developmental delay including the severity of asphyxia need for mechanical ventilation, and severity of acidosis at birth, dystocia, and Apgar score were lower in surviving infants; therefore, controlling these risk factors may reduce asphyxia-associated complications.
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Affiliation(s)
- Hassan Boskabadi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Farah Ashrafzadeh
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hassan Doosti
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad,IR Iran
| | - Maryam Zakerihamidi
- Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
- Corresponding author: Maryam Zakerihamidi, Department of Midwifery, School of Medicine, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran. E-mail:
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