Background

It remains unclear whether after changing in neonatal care over the last few decades, there has been a significant reduction in mortality and morbidity for vulnerable extremely preterm infants (EPT) (gestational age, GA <29 weeks).

Objectives

To evaluate predischarge neonatal mortality, morbidity and associated risk factors in a-15-year experience EPT infants in Songklanagarind hospital.

Methods

Retrospective cohort study of EPT infants GA < 29 week who were born and admitted in neonatal intensive care unit between January 2001 to December 2015. The study was divided into two birth year periods, from 2001-2009 and 2010-2015, the mortality rate by GA were compared by survival analysis with Kaplan-Meier method with statistically significant when p-value < 0.05.

Results

A total of133 EPT infants were enrolled. Seventy-eight infants (58%) were female. The mortality rate was 49/133 (36.8%) and was significantly higher in lower GA infants. (p-value < 0.05). The mortality rate between 2004-2009 and 2010-2015 decreased from 44% to 32.5% but was not statistically significant (p-value = 0.253). The most common cause of death in first period was respiratory distress syndrome (41%) but in the second period, neonatal sepsis (46%) was the common cause of death. Multivariate analysis showed perinatal risk factors of mortality rate were lower GA and birth weight less than 750 grams (OR= 6.8 , 95%CI 0.9,0.9, p-value = 0.001).

Conclusion

Although there was no significant trend in neonatal survival or composite morbidity over the decade but improving in survival were demonstrated with increasing GA and birth weight more than 750 grams.

Background

Antenatal corticosteroid (ACS) has been shown to decrease neonatal mortality and morbidity in preterm infants. However, the data in small for gestational age (SGA) infants is inconsistent.

Objectives

We assessed the association of ACS and neonatal outcomes of preterm SGA neonates and estimated whether the association is similar to that observed in appropriate for gestational age (AGA) neonates.

Methods

The study sample was singleton very low birth weight infants born less than 32 weeks of gestation in the Korean Neonatal Network cohort registry, collected prospectively from 2013 to December 2017. Outcomes of SGA neonates who received ACS were compared with those of SGA neonates who did not receive ACS. A similar comparison was performed between AGA neonates. The association of ACS exposure with outcomes was assessed using multivariable logistic regression between SGA and AGA groups.

Results

Of the 4,081 neonates eligible for the study, 461 (11.3%) were SGA. SGA group who was exposed to ACS had a lower rate of neonatal death (20.8% vs 34.9%, P=.01) and massive pulmonary hemorrhage (10.1% vs 21.5%, P=.008) compared with those not exposed to ACS. After adjustment for potential confounders, exposure to ACS was associated with beneficial effects among both the SGA and AGA groups for short-term outcome. However, ACS did not affect long-term outcomes in SGA infants.

Conclusion

For SGA preterm neonates, ACS reduced neonatal mortality and morbidity, with a less pronounced effect compared with AGA preterm infants. However, this study suggests that exposure of ACS resulted in few benefits on long-term outcomes in SGA infants.

Background

Current UK incidence of Cerebral Palsy (CP) is around 1 in 400 births. Approximately 1,800 children are diagnosed with CP every year. Just under half of children with cerebral palsy are born premature and the incidence increases in early premature deliveries of < 30 weeks gestation. The available evidence suggests that MgSO4 given before anticipated early preterm birth reduces the risk of cerebral palsy by 32%.

Objectives

Methods

Data was collected from Electronic Patient Record Systems; Badgernet and Euroking and all discrepant data was tallied with maternal notes. In the first part of audit 6 months data was collected and recommendations were made. A poster was made and displayed on the neonatal unit, and delivery suite, and this was used in addition to the education tools being used by the PReCEPT initiative.

Results

Conclusion

Background

In addition to prematurity and low birth weight (LBW), twin pregnancies are also complicated with discordant growth; which has been reported to be associated with increased neonatal morbidity and mortality

The lack of a standard definition for a clinically significant growth difference within a twin pair is partly a result of conflicting data on the associated adverse perinatal outcomes.

Objectives

Assess the difference in neonatal outcomes across discordant twins admitted to the NICU

Methods

A retrospective study of preterm twins, followed in NICU of Hospital of Obstetric and Gynecology, Varna, from 01. January 2015 to 31. Decembre 2018. Twins were classified as discordant when the difference in birth weight was >15%. Discordance was determined by the formula:

(birth weight of larger twin - birth weight of smaller twin)/birth weight of larger twin x 100.

Short-term outcome include asphyxia, RDS, infection, severe IVH, congenital anomalies, mortality. Other data points analyzed included birth weight, gestational age, gender, mode of delivery.

Results

Birthweight discordance is an indicator of complications that affect intrauterine growth in one of the twins, and usually cause the birth of a SGA infant. No significant difference for RDS, surfactant therapy, MV. The smaller twin show more often low Apgar score, congenital anomalies , intraventricular hemorrhage higher risk of mortality.

Conclusion

Conclusion: Incidence and outcome of discordant twins were assessed based on birth weight difference more than 20 %, releated with VLBW and VLGA. Discordant growth is a risk factor for prolonged hospitalization. The mortality rate did not differ between concordant and discordant groups.