Predicting outcome in very low birthweight infants using an objective measure of illness severity and cranial ultrasound scanning (original) (raw)
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Neonatal cranial ultrasonography as predictor of 2 year outcome of very low birthweight infants
Journal of Paediatrics and Child Health, 1989
Real time ultrasound scans using an ATL 300C sector scanner with 5-7.5 MHz transducer were performed on days 1, 4, 7 and thereafter as clinically necessary on 153 consecutively discharged very low birthweight (VLBW) infants. One hundred and forty-six long-term survivors were assessed fully at 2 years. The prevalence of cerebroventricular haemorrhage (CVH) in these survivors was 34.2% (grade 1-21.2%; grade 2-4.8%; grade 3-3.4%~; grade 4-4.8%), ventricular dilatation 19.9% (including 4.1% with ventriculoperitoneal shunt), and ischaemia go!. Impairments at 2 years were classified as nil, mild, moderate, severe or multiply severe, based on the criteria of Kitchen et a/.
Outcome of extremely preterm infants
Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.
Neonatal Morbidities of Prenatal and Perinatal Origin
Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice, 2009
Malformation Management Considerations Clefts Alternative feeding devices (e.g., Haberman Feeder a), genetics evaluation, occupational/ physical therapy Congenital diaphragmatic hernia Skilled airway management, pediatric surgery, immediate availability of mechanical ventilation, nitric oxide (ECMO) Upper airway obstruction/micrognathia Skilled airway management, otolaryngology, genetics evaluation/management, immediate availability of mechanical ventilation, tracheostomy tube placement Hydrops/hydrothorax/peritoneal effusion Skilled airway management, nitric oxide, ECMO, chest tube placement, paracentesis, immediate availability of mechanical ventilation Ambiguous genitalia Endocrinology, urology, genetic consults available for immediate evaluation; assessment of electrolytes Neural tube defects Sterile, moist dressing to cover defect and prevent desiccation; IV fluids; neurosurgery, urology, orthopedics evaluation/management Abdominal wall defects Saline-filled sterile bag to contain exposed abdominal contents and prevent desiccation, IV fluids, pediatric surgery, genetics evaluation/management Cyanotic congenital heart disease IV access, prostaglandin E 1 , immediate availability of mechanical ventilation a Athrodax Healthcare Limited, Gloustershire, United Kingdom. ECMO, Extracorporeal membrane oxygenation; IV, intravenous.
The Journal of pediatrics, 2015
To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants. We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness. BPD, serious brain ...
Clinical evaluation of the fetus and neonate
Archives of Gynecology and Obstetrics, 1993
The relation between intra-partum cardiotocography (CTG), cord blood acid-base status, Apgar score and neonatal morbidity was studied in 1228 consecutively live-born babies and in a subgroup of 200 babies (148 babies with a 1 min Apgar score <8 and 52 randomly selected babies with a 1 rain Apgar score >__9). The scores for the individual components of the 1 min Apgar score were strongly associated with each other, whereas the scores for the individual components of the 5 rain Apgar score were less strongly associated. At 1 rain the scores for muscle tone, reflex irritability and respiration but not the scores for heart rate and skin colour were associated with arterial and venous cord blood pH (low scores being associated with low pH). Out of the individual components of the Apgar score, heart rate and reflex irritability at 1 min were the best discriminators between "healthy or relatively healthy" and "severely ill" babies. Intrapartum CTG, total Apgar score and cord blood acid-base status were only weakly related. Venous cord blood pH was the best predictor of the 1 min Apgar score. Intra-partum CTG (silent pattern), 5 min Apgar score and venous cord blood pH were the best predictors of severe neonatal morbidity.
Ultrasound in Obstetrics & Gynecology, 2019
Background: Justification of prenatal screening for small for gestational age (SGA) fetuses near term is based on first, evidence that such fetuses / neonates are at increased risk of stillbirth and adverse perinatal outcome, and second, the expectation that these risks can be reduced by medical interventions, such as early delivery. However, there are no randomized studies demonstrating that routine screening for SGA fetuses and appropriate interventions in the high risk group can reduce adverse perinatal outcome. Before such meaningful studies can be undertaken it is essential that first, the best approach for effective identification of SGA neonates is determined, and second, the contribution of SGA neonates to the overall rate of adverse perinatal outcome is established. In a previous study of pregnancies that had undergone routine ultrasound examination at 35 +0-36 +6 weeks' gestation, we found that first, screening by estimated fetal weight (EFW) <10 th percentile provided poor prediction of SGA neonates and second, prediction of >85% of SGA neonates requires use of EFW <40 th percentile. Objectives: First, to examine the contribution of SGA fetuses to the overall rate of adverse perinatal outcome and second, to propose a two-stage approach for prediction of SGA neonates at routine ultrasound examination at 35 +0-36 +6 weeks' gestation. Methods: This was a prospective study of 45,847 singleton pregnancies that had undergone routine ultrasound examination at 35 +0-36 +6 weeks' gestation. First we examined the relationship between birthweight percentile and adverse perinatal outcome, defined as stillbirth, neonatal death or admission to the neonatal unit for ≥48 hours. Second, we used a two-stage approach for prediction of SGA neonates and adverse perinatal outcome; in the first stage fetal biometry was used to distinguish pregnancies at very low-risk (EFW ≥40 th percentile) and those at increased risk (EFW <40 th percentile) and in the second stage the pregnancies with EFW <40 th percentile were stratified into high-, intermediate-and low-risk groups based on the results of EFW and pulsatility index (PI) in the uterine arteries (UtA-PI), umbilical artery (UA-PI) and fetal middle cerebral artery (MCA-PI). Different percentiles in EFW and Doppler indices were used to define each risk category and the performance of screening for SGA neonates and adverse perinatal outcome in babies born at ≤2, 2.1-4 and >4 weeks after assessment was determined. We propose that the high-risk group would require monitoring from initial assessment to delivery, the intermediate-risk group would require monitoring from two weeks after initial assessment to delivery, the low-risk group would require monitoring from four weeks after initial assessment to delivery, and the very low-risk group would not require any further reassessment. Results: First, although in babies with low birthweight (<10 th percentile) the risk of adverse perinatal outcome is increased, 84% of adverse perinatal events occur in the group with birthweight ≥10 th percentile. Second, in screening by EFW <10 th percentile the predictive performance for SGA neonates is modest for those born at ≤2 weeks of assessment (83% and 69% for neonates with birthweight <3 rd and <10 th percentiles, respectively), but poor for those born at 2.1-4 weeks (61% and 45%) and >4 (40% and 30%) from assessment. Third, improved performance of screening, especially for those delivering after two weeks from assessment, is potentially achieved by a proposed new approach for stratifying pregnancies into management groups based on findings of EFW and Doppler indices (prediction of birthweight <3 rd and <10 th percentiles for deliveries at ≤ 2, 2.1-4 and >4 weeks from assessment: 89% and 75%, 83% and 74% and 88% and 82%, respectively). Fourth, the predictive performance for adverse perinatal outcome of EFW <10 th percentile is very poor (26%, 9% and 5% for deliveries at ≤ 2, 2.1-4 and >4 weeks from assessment, respectively) and this is improved by the proposed new approach (31%, 22% and 29%). * p<0.01; ** p<0.001 Characteristic Screening at 35 +0-36 +6 weeks BW ≥10 th percentile (n=40,567) BW <10 th percentile (n=5,280) Maternal age in years, median (IQR) 31.7 (27.
Prognosis of surviving very low birth weight infants: still in the dark
BJOG: An International Journal of Obstetrics and Gynaecology, 1992
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Factors associated with poor prognosis in very-low-birth-weight infants
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
To evaluate predictors of poor outcome, including the CRIB (Clinical Risk Index for Babies) score, in a local population of very-low-birth-weight (VLBW) infants, in order to provide guidelines for selection of these babies for expensive tertiary care. Two hundred and thirty-one neonates born at less than 31 weeks' gestation and/or weighing between 1001 g and 1500 g, enrolled prospectively as part of a multicentre study evaluating the CRIB score. Univariate analysis (chi-square/t-tests) and multivariate analysis (stepwise logistic regression) on the above sample to determine predictors of poor outcome. Neonatal Unit, Johannesburg Hospital. Death or impairment (namely oxygen therapy > 28 days, grade 3 or 4 intraventricular haemorrhage, or ventricular enlargement). Poor outcome was predicted by birth weight, lowest oxygen requirement in the first 12 hours (which are two components of the CRIB score), and maximum partial arterial carbon dioxide pressure (PaCO2) in the first 72 ho...
The Extremely Low Birth Weight Infant
Neonatology. Physiology and management of the …, 1999
Extremely low birth weight infants (ELBW) are defined by birth weight of less than 1000 g and are frequently born at 27 weeks' gestation (GW) or younger. The neonatologists' efforts focused on improvement of intact survival rate, especially for those born at the frontiers of viability at 22/23 GW. Survival rates of >80% for the advanced gestations and > 50% for 23-24 GW have been reported. Higher gestational age and birth weight, female gender, better maternal education, and white race have been recognized as significant predictors of decreased morbidity in ELBW infants. Although the mortality rate has significantly contracted for this group with improved technology and better understanding of pathophysiology, the proportion of surviving infants without sequelae, has not improved as noticeably. We review the short and long-term morbidities in ELBW infants and compare own and literature data. We analyze some of the specific immediate problems for this group such as: respiratory problems, infection, thermoregulation, impaired glucose homeostasis and disturbed cardiovascular and excretory functions as well as late morbidities such as bronchopulmonary dysplasia, late-onset infections, central nervous system occurrences, retinopathy and anemia of prematurity. We also deal with preventive and therapeutic strategies for improved outcome in this sensitive group of patients.
Revista de Saúde Pública, 2003
To evaluate and compare birthweight and risk scores as predictors of neonatal mortality in a Neonatal Intensive Care Unit (NICU). Methods The survey included 494 newborns admitted to the neonatal intensive care unit (NICU) of a general hospital in Porto Alegre, southern Brazil, immediately after delivery, between March 1997 and June 1998. Birthweight and scores were evaluated in terms of variable "death while in NICU". Exclusion criteria were: discharge or death less than 24 hours after admission, admission not immediately following delivery, incomplete study protocol, and congenital malformations incompatible with survival. For CRIB (Clinical Risk Index for Babies) evaluation purposes, only patients born weighing up to 1,500 g were considered. ROC (Receiver Operating Characteristic) curves were calculated for SNAP Rev Saúde Pública 2003; 37(5) Mortality risk scores in NICU www.fsp.usp.br/rsp Zardo MS & Procianov RS