Retinopathy of prematurity: a review of risk factors and their clinical significance

Audit of disease and mortality patterns provides essential information for health budgeting and planning, as well as a benchmark for comparison. Neonatal mortality accounts for about 1/3 of deaths < 5 years of age and very low birth weight (VLBW) mortality for approximately 1/3 of neonatal mortality. Intervention programs must be based on reliable statistics applicable to the local setting; First World data cannot be used in a Third World setting. Many neonatal units participate in the Vermont Oxford Network (VON); limited resources prevent a significant number of large neonatal units from developing countries taking part, hence data from such units is lacking. The purpose of this study was to provide reliable, recent statistics relevant to a developing African country, useful for guiding neonatal interventions in that setting. This was a retrospective chart review of 474 VLBW infants admitted within 24 hours of birth, between 1 July 2006 and 30 June 2007, to the neonatal unit of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Binary outcome logistic regression on individual variables and multiple logistic regression was done to identify those factors determining survival. Overall survival was 70.5%. Survival of infants below 1001 grams birth weight was 34.9% compared to 85.8% for those between 1001 and 1500 grams at birth. The main determinant of survival was birth weight with an adjusted survival odds ratio of 23.44 (95% CI: 11.22 - 49.00) for babies weighing between 1001 and 1500 grams compared to those weighing below 1001 grams. Other predictors of survival were gender (OR 3. 21; 95% CI 1.6 - 6.3), birth before arrival at the hospital (BBA) (OR 0.23; 95% CI: 0.08 - 0.69), necrotising enterocolitis (NEC) (OR 0.06; 95% CI: 0.02 - 0.20), hypotension (OR 0.05; 95% CI 0.01 - 0.21) and nasal continuous positive airways pressure (NCPAP) (OR 4.58; 95% CI 1.58 - 13.31). Survival rates compare favourably with other developing countries, but can be improved; especially in infants < 1001 grams birth weight. Resources need to be allocated to preventing the birth of VLBW babies outside hospital, early neonatal resuscitation, provision of NCPAP and prevention of NEC.

/pdf/determinants-of-survival-in-very-low-birth-weight-neonates-dtqqbjyyic.pdf

Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg.

Disparity still exists in the outcome of neonatal surgery between high-income countries and low-income and middle-income countries. This study reviews publications on neonatal surgery in Africa over 20 years with a focus on challenges of management, trends in outcome, and potential interventions to improve outcome. We did a literature review by searching PubMed and African Index Medicus for original articles published in any language between January 1995 and September 2014. A data extraction sheet was used to collect information, including type of study, demographics, number of cases, outcome, challenges, and suggestions to improve outcome. A total of 51 studies from 11 countries met the inclusion criteria. The 16 studies in the first 10 years (1995–2004; group A) were compared with the 35 in the last 10 years (2005–2014; group B). Nigeria (n = 32; 62.7 %), South Africa (n = 7; 13.7 %), Tanzania (n = 2; 3.9 %), and Tunisia (n = 2; 3.9 %) were the predominant sources of the publications, which were retrospective in 38 (74.5 %) studies and prospective in 13 (25.5 %) studies. The mean sample size of the studies was 95.1 (range 5–640). Overall, 4849 neonates were studied, with median age of 6 days (range 1–30 days). Common neonatal conditions reported were intestinal atresia in 28 (54.9 %) studies, abdominal wall defects in 27 (52.9 %), anorectal malformations 25 in (49.0 %), and Hirschsprung’s disease, necrotising enterocolitis, and volvulus neonatorum in 23 (45.1 %) each. Mortality was lowest ( 50 %) in emergency neonatal surgeries involving bowel perforation, bowel resection, congenital diaphragmatic hernia, oesophageal atresia, and ruptured omphalocele or gastroschisis. Overall average mortality rate was higher in group A than group B (36.9 vs 29.1 %; p < 0.001), and varied between the groups for some conditions. The major documented challenges were delayed presentation and inadequate facilities in 39 (76.5 %) studies, dearth of trained support personnel in 32 (62.7 %), and absence of neonatal intensive care in 29 (56.9 %). The challenges varied from country to country but did not differ in the two groups. Improvement has been achieved in outcomes of neonatal surgery in Africa in the past two decades, although several of the studies reviewed are retrospective and poorly designed. Cost effective adaptations for neonatal intensive care, improved health-care funding, coordinated neonatal surgical care via regional centres, and collaboration with international partners are potential interventions that could help to address the challenges and further improve outcome.

Challenges of management and outcome of neonatal surgery in Africa: a systematic review

Survival rates in extremely low birthweight infants depend on the denominator: avoiding potential for bias by specifying denominators.

Objective: This study aims to assess the utility of a scoring system as predictor of neonatal mortality rate among the neonates admitted within one year to the neonatal intensive care unit (NICU) of the Children’s Medical Center in Tehran, Iran. Material & Methods: Data were gathered from 213 newborns admitted to the NICU from September 2003 to August 2004. In addition to demographic data, Apgar scores at 1 minute and 5 minutes, history and duration of previous hospitalization, initial diagnosis and final diagnosis, and scoring system by using the score for the neonatal acute physiology-perinatal extension II (SNAP-PE II) were carried out within 12 hours after admission to the NICU. All of the parameters were prospectively applied to the admitted newborns. The exclusion criteria were discharge or death in less than 24 hours after NICU admission. Findings: 198 newborn infants met the inclusion criteria. The mean and standard deviation (SD) of the variables including postnatal age, birth weight, SNAP, and finally Apgar scores at 1 minute and 5 minutes of neonates under this study were 7.6 (0.5) days, 2479.8 (29.4) grams, 21.6 (1.1), 7.47( 0.08), and 7.71 (0.06), respectively. Twenty five of the 198 patients died (12.6%). Gestational age (P=0.03), birth weight (P=0.02), Apgar score at 5 minutes (0.001), and SNAP-PE II (P=0.04) were significantly related to the mortality rate. By Analyzing through logistic regression to evaluate the predictive value of these variables in relation to the risk of mortality, it was shown that only SNAPPE II and Apgar score at 5 minutes could significantly predict the neonatal mortality. Conclusion: According to this study SNAP-PE II and Apgar score at 5 minutes can be used to predict mortality among the NICU patients. SNAP-PE II score had the best performance in predicting mortality in this study. More studies with larger samples are suggested to evaluate all of the abovementioned parameters among neonates who are admitted to NICUs countrywide.

/pdf/neonatal-mortality-risk-assessment-in-a-neonatal-intensive-3gcdqpechx.pdf

Neonatal Mortality Risk Assessment in a Neonatal Intensive Care Unit (NICU)

Our purpose was to determine mortality and morbidity rates and selected outcome variables for infants weighing less than 1500 g, who were admitted to the neonatal intensive care unit of our hospital from 1997 to 2000. The ultimate goal of the study was to define a model for developing a regional database. Information on all very low birth weight (VLBW) admissions to a tertiary level neonatal intensive care unit (NICU) in Ankara between January 1997 and December 2000 was prospectively collected by three neonatologists using a standard manual of operation and definitions. The data consisted of patient information including sociodemographic characteristics; antenatal history; mode of delivery; APGAR scores; need for resuscitation; admission illness severity (Clinical Risk Index for Babies-CRIB) and therapeutic intensity (Neonatal Therapeutic Intensity Scoring System-NTISS); selected NICU parameters and procedures such as respiratory support, surfactant therapy, and postnatal corticosteroid therapy; and selected patient outcomes such as intraventricular hemorrhage, septicemia, necrotizing enterecolitis, retinopathy of prematurity, and chronic lung disease. The number of VLBW admissions to the NICU was 133, with 51 (28.6%) referrals from other maternity centers. The mean birth weight and gestational age of the infants were 1175 +/- 252 g and 30.3 +/- 2.9 weeks, respectively. One hundred and seventeen of 133 cases (88.7%) received at least one antenatal care visit. The median CRIB and NTISS scores were 4.5 and 31, respectively. Antenatal steroids had been given to 74 (55.6%) infants. Surfactant treatment and respiratory support were given to 33 (24.8%) and 73 (54.8%) infants, respectively. Among selected outcomes, chronic lung disease (CLD), threshold retinopathy of prematurity (ROP), severe intraventricular hemorrhage (IVH > or = grade III), nosocomial infection and necrotizing enterocolitis (NEC) were encountered in 14 (12.6%), 9 (8.1%), 3 (2.2%), 34 (25.5%) and 35 (26.3%) of the infants, respectively. Overall survival rate was 83.5% (111/133); most of the deceased cases were under 750 g (12/22). It was prospectively shown that 111 (100%) of the surviving infants could be regularly followed in a newborn follow-up clinic to provide health maintenance, developmental assessment and support. Compared with reports from other developing countries, VLBW infants at our center had higher survival rates. Compared to developed countries, survival rate was lower, especially for extremely very low birth weight infants. There is interaction between birth weight and survival rate. Among selected neonatal outcomes, chronic lung disease, threshold retinopathy, severe intraventricular hemorrhage (IVH > or = grade III) and nosocomial infection rates at this center were comparable with some reports from developed nations.

Outcomes of very low birth weight infants in a newborn tertiary center in Turkey, 1997-2000.

Yenidoganlarda, yetersiz su ve kalori alimi nedeniyle malnutrisyon ve hipernatremik dehidratasyon elisebildigi bilinmektedir. Anne sutunun az, sut sodyum iceriginin yuksek oldugunda da hipernatremik dehidratasyon gelisebilmektedir.Otuzbes yasindaki annenin sorunsuz gebeligini takiben dogan ilk bebegi, on gunlukken malnutrisyon ve hipernatremik dehidratasyon tanisiyla yenidogan yogunbakim unitesine yatirildi. Oykusunden anne sutu ile beslendigi ogrenildi. Incelemelerinde anne sutu miktari yetersiz ve sodyum duzeyi yuksek bulundu. Olguda saptanan bobrek yetmezligi ve hipernatremi uygun sivi ve elektrolit tedavisi ile duzeltildi. Bebek bir aylik oldugunda anne sutu sodyum duzeyi normale donmediginden, tekrar anne sutu ile beslenmeye baslanilamadi. Ayni durum annenin 18 ay sonra dogan ikinci bebeginde de yasandi.

/pdf/anne-sutu-ile-beslenen-bir-yenidogan-hipernatremik-42bx9y3j41.pdf

Anne Sütü İle Beslenen Bir Yenidoğan Hipernatremik Dehidratasyon

Ankara University School of Medicine, Department of Pediatrics Ankara University School of Medicine, Department of Pediatrics, Division of Neonatology Ankara University School of Medicine, Department of Pathology Aim: To asses the neonatal autopsy rate at a tertiary referral center and to investigate any discordance between the diagnosis before death and at autopsy. Materials and Methods: This retrospective study was performed at neonatal intensive care unit (NICU) of Ankara University Hospital between January 1997 and June 2003. Written parental consent was obtained prior to autopsy. Each examination was performed by a pathologist using standard techniques including bacterial cultures, macroscopic and histological examination, postmortem radiography and chromosomal analysis if necessary. Clinico-pathologic concordance was divided into four categories: (1) change in diagnosis, (2) additional findings, (3) complete confirmation and (4) inconclusive. Results: In this period 87/1876 (4.6%) neonates died and autopsy was performed in 34/87 (39%) of the cases. The studied population had a median gestational age, birth weight and a median age of 35 weeks, 1990 g. and 5 days respectively. After autopsy, diagnosis changed in 4/34 (11.7%), additional findings were found in 4/34 (11.7%), diagnosis was confirmed in 25/34 (73.5%) and diagnosis was inconclusive in 1/34 (2.9%). Conclusion: Neonatal autopsies can be suggested when the cause of death is not evident or additional information is needed. Important information can be obtained from neonatal autopsies. Clinicians can confidently advise parents of the usefulness of the neonatal autopsy in ascertaining the cause of death or for counseling their future pregnancy.

Clinical importance of neonatal autopsies

Amac: Ucuncu basamak referans merkezi olan unitemizdeki yenidogan otopsi oranini ortaya koymak ve hastalarin klinik tanisi ile otopsi yapildiktan sonra tanida ortaya cikan uyumsuzluklari belirlemek. Gerec Yontem: Bu calisma Ankara Universitesi Yenidogan Yogun Bakim Unitesi’nde Ocak 1997- Haziran 2003 arasindaki donemi kapsayan retrospektif bir calisma olarak duzenlendi. Otopsi yapilmadan once ailelerin yazili izinleri alindi. Her inceleme bakteriyel kultur, makroskopik ve histolojik incelemeyi iceren standart teknikler ile gerektiginde postmortem radyografi ve kromozomal analizi incelemelerle patologlar tarafindan yapildi. Klinikopatolojik uygunluk 4 grup altinda incelendi: Tanida degisme, ek bulgular, tam uyum ve tamamen uyumsuz. Bulgular: Bu donemde yenidoganlarin %4.6’si (87/1876) oldu ve olenlerden 34’une (%39) otopsi yapildi. Calismaya alinan olgularin median gestasyonel yas, dogum agirligi ve postnatal yasi sirasi ile 35 hafta, 1990 g. ve 5 gun olarak tespit edildi. Otopsi sonrasinda 25 olgunun (%73.5) tanisinda bir degisiklik olmadigi, 4 olguda (%11.7) ek bulgularin oldugu, 4 olguda (%11.7) taninin degistigi ve 1 olguda (%2.9) ise taninin tamamen uyumsuz oldugu saptandi. Sonuc: Olum nedeni tam olarak belirlenemeyen veya ek bilgilerin elde edilmesi gereken durumlarda otopsi gerekebilir. Yenidogan otopsileri sonrasinda onemli bilgilere ulasilabilir. Hekimler, olum nedeninin tam olarak belirlenmesi veya gelecekte planlanacak gebeliklerin risklerinin onceden belirlenebilmesi amaciyla yenidogan doneminde kaybedilen olgulara otopsi yapilmasini onermelidirler.

/pdf/clinical-importance-of-neonatal-autopsies-yenidogan-3ngtsjbdkn.pdf

Clinical importance of neonatal autopsies Yenidoğan otopsilerinin klinik önemi

TPIT is a highly cell-restricted transcription factor that is required for the expression of the propiomelanocortin (POMC) gene and for terminal differentiation of the pituitary corticotroph lineage. Its exclusive expression in pituitary POMC-expressing cells has suggested that its mutation may cause isolated deficiency of pituitary ACTH. We present a neonate with the diagnosis of congenital early onset isolated ACTH deficiency (IAD) associated with a loss of POMC function as a result of a missense mutation in the TPIT gene. A 5 day-old male infant was admitted for hypoglycemia, limpness and conjugated hyperbilirubinemia. Laboratory investigations indicated low plasma cortisol concentration (0.1 μg/dl) accompanying a very low ACTH (<5 pg/ml) concentration. An increase in plasma cortisol concentration following stimulation with low dose exogenous ACTH was observed. On replacement therapy with hydrocortisone (15 mg/m 2 /day orally), cholestatic jaundice and hypoglycemia resolved and subsequent normal growth (weight, height and head circumference, 25 t h , 10 t h and 50 t h percentile, respectively) and development was achieved without recurrence of hypoglycemic episodes.

Congenital early onset isolated adrenocorticotropin deficiency associated with a TPIT gene mutation.

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Sevim Ünal

Author Tools

Chat about Author