Outcome of late preterm newborns in Upper Egypt

Investigation of the rates of retinopathy of prematurity and other diseases in infants born late preterm: is routine ROP examination required?

BACKGROUND/OBJECTIVES

The objective of this study was to ascertain the prevalence of ROP and other ocular diseases in late preterm infants and to evaluate the necessity of routine ROP examination in a tertiary hospital in Turkey.

SUBJECTS/METHODS

This retrospective cohort study included late preterm infants treated in the neonatal intensive care unit (NICU) and referred to the ROP outpatient clinic. Those who were discharged or died before the first screening and those who did not complete all screening sessions were excluded. The data set comprised demographic information, gestational age, birth weight, stages of ROP, treatments, and the presence of other ocular comorbidities.

RESULTS

The study cohort comprised 600 late preterm infants, with a median gestational age of 35 weeks and a mean birth weight of 2392 ± 451 g. Of the infants included in the study, 3.3% developed ROP, with one infant requiring treatment. Furthermore, 4.8% of the subjects exhibited additional ocular comorbidities. The results indicated a statistically significant correlation between lower birth weight and gestational age with an increased prevalence of ROP and other ocular pathologies.

CONCLUSIONS

ROP incidence in late preterm infants is relatively low, although comorbidities are notable. Infants born late preterm with lower birth weight and gestational age are at greater risk for ROP and additional pathologies. It is recommended that routine screening for ROP be conducted in order to ensure that ROP and other ocular conditions are diagnosed and treated in a timely manner, thus preventing severe visual impairments.

Assessing neonatal nurses: transitioning preterm infants to oral feeding - a multicenter cross-sectional study

BACKGROUND

In Egypt, approximately 10% of preterm deliveries occur between 32 and fewer than 37 weeks, leading to high neonatal intensive care unit (NICU) admissions. Preterm infants often face oral feeding difficulties due to immature development, which can lead to extended hospital stays and increased health risks.

AIM

To assess neonatal nurses' performance in terms of the transition to oral feeding in preterm infants, focusing on knowledge, practices, and attitudes.

METHODS

A descriptive, quantitative, multicenter, cross-sectional study was conducted across 16 hospitals in five governorates in Egypt from November 2023 to March 2024 involving 553 neonatal nurses. The data were collected through a self-administered questionnaire assessing knowledge and attitudes and through an observed checklist for nurses' practices. The study used statistical methods, including binary logistic regression, to analyze the data.

RESULTS

The findings revealed significant knowledge gaps among nurses, particularly in terms of oro-motor function, suck-swallow-breathe patterns, and nonnutritive sucking. A total of 64.6% of the nurses had unsatisfactory knowledge, 58.6% had unsatisfactory practices, and 45% had a negative attitude toward the oral feeding transition. Key predictors of satisfactory practices included higher education levels, full-time employment, and positive attitudes.

CONCLUSION

This study highlights critical gaps in neonatal nurses' knowledge and practices regarding the transition to oral feeding in preterm infants. Addressing these gaps through targeted educational interventions and ongoing support is essential for improving care quality and outcomes for infants. The findings revealed that a substantial proportion of nurses lacked adequate knowledge of critical areas, such as oro-motor function, the suck-swallow-breathe pattern, and nonnutritive sucking. These knowledge deficits could hinder the ability of nurses to provide optimal care during this crucial transition.

Insights into Risk: Exploring Retinopathy of Prematurity and Short-term Comorbidities in Moderate-to-Late Preterm Infants

BACKGROUND

Retinopathy of prematurity (ROP) and short-term comorbidity data moderate-to-late preterm (MLP) infants in Saudi Arabia are limited.

AIM

The present study mainly aimed to identify ROP incidence and severity in MLP infants. The secondary objective was to explore whether moderate preterm infants are more prone to systemic short-term comorbidities compared to late preterm infants.

MATERIALS AND METHODS

This retrospective study was conducted at King Abdulaziz University Hospital, a tertiary center in Jeddah, Saudi Arabia. Two-hundred and sixty-eight MLP infants born with gestational ages (GAs) of 32 to 36 + 6 weeks were included. Births were classified as moderate preterm (GA 32 to 33 + 6 weeks) and late preterm (GA 34 to 36 + 6 weeks) and the two groups were compared with an independent t-test.

RESULTS

ROP incidence was 1.5%; all cases were stage 1 and involved zone II or III. No patient had type 1 ROP requiring treatment. The short-term comorbidity incidence was high (76.1%) and included hyperbilirubinemia (n = 206, 76.7%), respiratory distress syndrome (n = 178, 66.4%), hypoglycemia (n = 32, 11.9%,), and transient tachypnea of newborn (n = 25, 9.3%). Moderate preterm infants were more likely to have lower birth weight (P < 0.001), any-stage ROP (P = 0.032), respiratory distress syndrome (P = 0.031), intraventricular hemorrhage (P = 0.038), and hyperbilirubinemia (P < 0.001) compared to the late preterm infants.

CONCLUSIONS

Any-stage ROP incidence among MLP infants was low, with no type 1 ROP cases requiring treatment. Short-term comorbidity incidence was relatively high among the moderate preterm infants. Despite the low non-type 1 ROP incidence at our center, MLP infants require proper surveillance of systemic short-term comorbidities.

Uterocervical angle versus cervical length in the prediction of spontaneous preterm birth in women with history of spontaneous preterm birth: a prospective observational study

BACKGROUND

Preterm delivery is a leading cause of neonatal mortality and morbidity. History of spontaneous preterm birth is the greatest risk factor for another preterm delivery. So, every effort should be made to prevent the recurrence of preterm delivery in this vulnerable group. This study aimed to evaluate the predictive ability of the anterior uterocervical angle and cervical length in preterm birth.

PATIENTS AND METHODS

This was a prospective cohort study that included 70 patients with a history of spontaneous preterm birth. Ultrasound measurements of cervical length and anterior uterocervical angle were set to be measured for each patient at three visits; first between 16 0/7 and 24 0/7 weeks, second between 24 1/7 and 32 0/7 weeks, and the third was between 32 1/7 and 36 6/7 weeks. The correlation between both measures and the prediction of preterm birth among study participants was the primary outcome of the study. Neonatal outcome among the study patients was a secondary measure of outcome.

RESULTS

The incidence of preterm birth among study participants was 31.41%. Cervical length and uterocervical angle showed progressive decrease and increase respectively throughout pregnancy. At the 2nd visit, the two measures were significantly different between those who delivered at term and those with preterm delivery with the cervical length being significantly shorter in the preterm arm (3.0 ± 0.49 versus 3.38 ± 0.36, p < 0.001) and uterocervical angle being significantly bigger among the same arm (110.1 ± 18.48 versus 84.42 ± 12.24, p < 0.001). A uterocervical angle > 89.8° at the second visit predicted preterm birth with 81.8% sensitivity and 70.8% specificity while cervical length ≤ 3.22 cm at the second visit predicted preterm birth with 68.1% sensitivity and 62.5% specificity. Multivariant logistic regression analysis showed that uterocervical angle > 89.8° at the second visit increased the odds ratio for preterm birth by 9.

CONCLUSION

Uterocervical angle can be a useful ultrasound marker for the prediction of preterm birth among high risk patients. A cutoff value of 89.8° can be used as a threshold above which prophylactic measures such as cervical cerclage or progesterone therapy can be provided.

TRIAL REGISTRATION

NCT05632003 (First posted date: 30/11/2022).

Incidence of Preterm Infants, Indications of Admission, Risk Factors, and Discharge Outcome: A Retrospective Study

Background:

Prematurity is still a major cause of neonatal and infant mortality and morbidity.

Aim:

This study aimed to describe the incidence of preterm infants, indications of admission, risk factors, and discharge outcome.

Materials and Methods:

A retrospective, descriptive design was used. A sample of 692 preterm infants admitted to the Neonatal Intensive Care Unit (NICU) was included. A structured sheet was used to gather the necessary data. It involved two parts: characteristics of preterm infants and their mothers and risk factors concerning preterm birth.

Results:

The study found that 49.4% of admitted neonates were preterm; among them, 48.1% died on discharge. Moreover, there were significant relations between the type of gestation (p=0.000), mothers' age (p=0.001), anemia, pregnancy-induced hypertension, preeclampsia, antepartum hemorrhage, premature rupture of membranes, obstructed labor, family history of medical diseases, and mothers' history of medical diseases with preterm infants' gestational age (p=0.01, 0.001, 0.02, 0.01, 0.000, 0.000, 0.000, 0.000, respectively). Moreover, it was observed that higher admission of preterm infants who had respiratory problems, followed by gastrointestinal problems.

Conclusion:

There was a higher prevalence with a higher mortality rate of admitted preterm infants to NICU. Likewise, the type of gestation, mothers' age, presence of complications during pregnancy, bad obstetric history, and family and medical history of diseases were the most common risk factors of prematurity. Moreover, respiratory problems were the main etiology for admission of preterm infants to NICU. Therefore, early screening of diseases and obstetric complications during pregnancy is recommended.

Implications for Nursing Practice:

Providing educational programs for pediatric nurses will increase their level of awareness regarding incidence, indications, risk factors, and discharge outcome of prematurity, thus reducing the rate of mortality and morbidity among preterm infants.

Uterocervical angle versus cervical length in the prediction of spontaneous preterm birth in singleton pregnancy

OBJECTIVE

To evaluate the predictive role of the uterocervical angle and the cervical length in preterm birth.

METHODS

This was cross-sectional analytical study, recruiting 167 women at high-risk for preterm birth (delivery before 37 weeks of pregnancy). They had transvaginal ultrasound for evaluation of the uterocervical angle and the cervical length between at 30 and 32, 32⁺¹ and 34, and 34⁺¹ and 36⁺¹  weeks of pregnancy. The primary outcome was to determine the predictive role of the uterocervical angle and the cervical length in preterm birth.

RESULTS

The mean uterocervical angle was significantly greater in those who delivered preterm (115.4° ± 9.1° versus 101.1° ± 8.3°, p < 0.001). The cervical length was insignificantly shorter in the same group (27.9 ± 4.0 and 29.1 ± 4.1 mm, respectively, p = 0.067). A uterocervical angle of 105° or more predicted preterm birth with sensitivity and specificity of 86.1% and 60.4%, respectively. A cervical length of 25 mm or less had sensitivity and specificity of 27.8% and 85.8%, respectively.

CONCLUSION

A uterocervical angle greater than 105° poses a high risk for preterm deliveries. It provides a higher diagnostic performance in high-risk patients than cervical canal length measurement.

Maternal and Perinatal Determinants of Late Hospital Discharge Among Late Preterm Infants; A 5-Year Cross-Sectional Analysis

Background: Although late preterm infants (LPIs) account for the majority of preterm births, they are mistakenly labelled and treated as "near term." Whether longer initial hospital stay improves their outcomes and lowers readmission is controversial. The aim of this study is to identify maternal and perinatal factors associated with longer hospital stay and to assess the rate of readmission. Methods: The medical records of LPIs delivered at an academic center in Jordan over a 5-year period were reviewed. They were divided according to their initial hospital stay into: Early discharge group (ED, ≤ 3 days) and late discharge group (LD, > 3 days). Maternal and perinatal factors associated with > 3-day hospital stay were reported. The rate of readmission was compared between both groups. Results: 2236 LPIs were included in the analysis representing 13% of total births and 81% of premature births. LD group constituted 54%. A thousand two hundred forty three (56%) required admission to NICU. Factors associated with longer hospital stay included maternal prolonged rupture of membranes (AOR 1.9, 95% C.I 1.5, 2.4, p 0.000), C-section delivery (AOR 2.4, 95% C.I 1.9, 3, p 0.001), <35-week gestation (AOR 3.8, 95% C.I 2.6, 5, p 0.000), small-for-gestational age (AOR 1.9, 95% C.I 1.1, 3.8, p 0.03), birthweight <2,500 g (AOR 1.3, 95% C.I 1.1, 1.6, p 0.02), NICU admission (AOR 6.3, 95% C.I 3.4, 11.5, p 0.000), RDS (AOR 2.3, 95% C.I 1.5, 3.6, p 0.005), surfactant therapy (AOR 5, 95% C.I 1.9, 13.5, p 0.001), use of CPAP (AOR 1.7, 95% C.I 1.2, 2.2, p 0.001), jaundice (AOR 11.2, 95% C.I 7.7, 16.2, p 0.000), and sepsis (AOR 10.3, 95% C.I 4.8, 22, p 0.000). Readmission rate was 19% among the LD group and 13% among the ED group. Conclusion: LPIs are at high risk for developing prematurity-related morbidities and the duration of their initial hospital stay can be anticipated based on certain predisposing maternal and perinatal factors. Late discharge of LPIs does not lower the rate of readmission.