Fetal growth and gestational age improve outcome predictions in neonatal heart surgery
Martina A. SteurerKurt SchuhmacherJill J. SavlaMousumi BanerjeeNikhil K. ChananiAaron EckhauserJustin J. ElhoffJeffrey P. JacobsKatherine MikesellShabnam PeyvandiJennifer C. RomanoWei ZhangJ. William GaynorSarah Tabbutt
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Abstract:
Current risk adjustment models for congenital heart surgery do not fully incorporate multiple factors unique to neonates such as granular gestational age (GA) and birth weight (BW) z score data. This study sought to develop a Neonatal Risk Adjustment Model for congenital heart surgery to address these deficiencies.Cohort study of neonates undergoing cardiothoracic surgery during the neonatal period captured in the Pediatric Cardiac Critical Care Consortium database between 2014 and 2020. Candidate predictors were included in the model if they were associated with mortality in the univariate analyses. GA and BW z score were both added as multicategory variables. Mortality probabilities were predicted for different GA and BW z scores while keeping all other variables at their mean value.The C statistic for the mortality model was 0.8097 (95% confidence interval, 0.7942-0.8255) with excellent calibration. Mortality prediction for a neonate at 40 weeks GA and a BW z score 0 to 1 was 3.5% versus 9.8% for the same neonate at 37 weeks GA and a BW z score -2 to -1. For preterm infants the mortality prediction at 34 to 36 weeks with a BW z score 0 to 1 was 10.6%, whereas it was 36.1% for the same infant at <32 weeks with a BW z score of -2 to -1.This Neonatal Risk Adjustment Model incorporates more granular data on GA and adds the novel risk factor BW z score. These 2 factors refine mortality predictions compared with traditional risk models. It may be used to compare outcomes across centers for the neonatal population.Keywords:
Univariate analysis
Since 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve.A nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system.the growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.A total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method.Using GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.
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The size of the cornea is important in the diagnosis of primary infantile glaucoma. Reference values regarding eyes of premature infants are scarce. Such data are of special importance in areas such as the Middle East where infantile glaucoma is common and often evident already at birth. The authors have measured the horizontal corneal diameter of the eyes of 127 premature Saudi infants with a gestational age between 23 and 36 weeks and a birth weight ranging from 540 g to 4720 g. The corneal diameter ranged from 7.75 mm to 10 mm. The smallest diameter (7.75 mm) was found in an infant with a gestational age of 23 weeks and having a birth weight of 520 g. The largest diameter (10 mm) belonged to two infants with a gestational age of 34 and 35 weeks and a birth weight of 2250 g and 2240 g respectively. Corneal diameter was positively correlated (p < 0.001) with gestational age and birth weight. Graphs depicting the regression line of corneal diameter on gestational age and of corneal diameter on birth weight together with the 95% confidence limits for individual values are provided for reference.
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Objective: To investigate the characteristics and associated factors of early refractive parameters in premature infants. Methods: Case-control study. Premature infants who underwent the first fundus screening in the ophthalmic clinic of Xiamen children's Hospital from May 2018 to February 2019 were collected. The screening time was 4 to 6 weeks after birth or corrected gestational age from 31 to 32 weeks. The premature infants who were diagnosed with mild retinopathy of prematurity (ROP) in one eye or both eyes but did not receive any treatment were divided into ROP group and divided into zone Ⅱ subgroup and zone Ⅲ subgroup according to the region of ROP; the premature infants without ROP were divided into non-ROP group. The gestational age, birth weight, spherical equivalent, anterior chamber depth, vitreous depth, axial length, lens thickness and corneal refractive power were recorded and compared. Independent sample t-test, multiple linear regression analysis and Pearson correlation analysis were used. Results: A total of 180 premature infants, 101 males and 79 females, with gestational age of (30.82±3.10) weeks, corrected gestational age of (37.21±1.44) weeks and birth weight of (1 577.85±572.12) g were included in this study. Ninety premature infants were included in the ROP group (162 eyes, of which 85 right eyes were included in the analysis) and 90 in the non-ROP group (90 right eyes). There was no significant difference in the distribution of gestational age, birth weight and corrected gestational age between the ROP group and non-ROP group (all P>0.05), but there was significant difference in the spherical equivalent between the two groups [(1.90±1.39) D vs. (3.04±1.88) D, t=-4.653, P<0.01], and ROP group was relatively smaller. In the ROP group, the anterior chamber depth was (1.82±0.23) mm, the lens thickness was (4.54±0.18) mm, and the corneal refractive power was (43.99±0.99) D. In the non-ROP group, the anterior chamber depth was (1.91±0.94) mm, the lens thickness was (4.23±0.50) mm, and the corneal refractive power was (43.72±0.92) D. The difference between the two groups was statistically significant (all P<0.01). In ROP group, the anterior chamber depth was shallower, the lens was thicker, and the corneal refractive power was higher. In ROP group, the corneal refractive power of 48 right eyes in zone Ⅱ subgroup and 37 right eyes in Zone Ⅲ subgroup were (43.92±0.78) D and (43.39±1.05) D respectively, and the spherical equivalent were (2.08±0.95) D and (2.52±1.12) D respectively. The corneal refractive power of zone Ⅱ subgroup was higher and the spherical equivalent was smaller, and the differences were statistically significant (all P<0.05). Multiple regression analysis showed that birth weight, gestational age and corneal refractive power were the influencing factors of spherical equivalent (P<0.01). The results of Pearson correlation analysis showed that the gestational age (r=0.182), birth weight (r=0.223) and corneal refractive power (r=-0.125) of premature infants were closely related to the spherical equivalent (all P<0.05). Conclusions: In premature infants, the larger spherical equivalent is related to greater gestational age and heavier birth weight. The refractive parameters of mild ROP are characterized by shallow anterior chamber, thick lens, high corneal refractive power and small spherical equivalent. The spherical equivalent is closely related to the development of ROP. (Chin J Ophthalmol, 2021, 57: 353-357).
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Prospective observational study was conducted in a tertiary care hospital of India over 8 months to measure blood pressure (BP) in healthy term and preterm neonates using oscillometric method and explore the associations with gestational age and birth weight. Consecutive BP measurements were taken by standard oscillometric method on 1617 neonates on day 4, 7 and 14 of life. Mean birth weight was 2.7 ± 0.46 kg, and mean gestational age was 38.2 ± 2.12 weeks. The mean arterial pressure (MAP) on day 4, 7 and 14 were 59.3 ± 7.33, 63.2 ± 6.55 and 66.4 ± 6.13 mmHg, respectively. Larger and mature newborns had significantly higher BP than those who were smaller and premature. Birth weight more strongly correlated with MAP than gestational age. Predictive equations linking MAP with gestational age and birth weight were deduced, which can be used for judicious fluid inotrope management.
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Purpose: To determine relationship between head circumference, gestational age and birth weight with stage of Retinopathy of Prematurity (ROP). Study Design: Descriptive observational. Place and Duration of Study: Jinnah Postgraduate Medical Centre (JPMC), Karachi from January 2022 to June 2022. Methods: Infants born at or before 32 weeks of gestation, birth weight of less than or equal to 1500 grams at birth were enrolled. Their head circumference, gestational age and birth weight was measured and Fundoscopy was done to find out ROP. Staging of ROP was recorded four weeks after birth. The severity of ROP was correlated with head circumference, gestational age and birth weight. Results: Of the 82 infants with ROP, 44 (54%) were male and 38 (46%) were female. Mean gestational age was 30 ± 1.4 weeks (range 27-32 weeks),mean birth weight was 1275 ± 155 gram (range 800-1500), and mean Fronto Occipital Circumference (FOC) was 29 ± 1.6 cm (range 25-32 cm). Degree (stage) of ROP was as follows; 14 (17.1%) infants had stage 1 disease, 24 (29.3%) had stage 2 disease, 28 (34.1%) had stage 3 disease, 13 (15.9%) had stage 4 disease and 3 (3.7%) had stage 5 disease. There was statistically significant association of gestational age, birth weight and head circumference (FOC) with the degree of ROP (P<0.001) Conclusion: Head circumference, gestational age and birth weight had a significant association with degree of ROP (P<0.001).
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Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.9% at 29 weeks' gestation, or from 30.0% for neonates of 500 through 599 g birth weight to 91.3% for neonates of 1200 through 1250 g. The expected birth weight-specific survival advantage for female neonates and black neonates diminished when the data were controlled for gestational age, showing that certain previously reported survival advantages are based on lower birth weight for a given gestational age. Multivariate analysis showed that all tested variables were significant predictors for survival, in order of descending significance: gestational age and birth weight, sex, race, single birth, and small-for-gestational-age status. The powerful effect of gestational age on survival highlights the need for an accurate neonatal tool to assess the gestational age of very low birth weight neonates after birth.
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An estimation of the baseline value of birth weight depending on gestational age is helpful for reducing morbidity and mortality following the early diagnosis and treatment of intrauterine growth retardation. In Korea, there are established baseline values for singletons and twins. But no definite criteria exist for triplets yet. Given the above background, we obtained the baseline value of birth weight depending on the gestational age in triplets with a gestational age of 27-38 weeks using a raw data about birth records which had been obtained during a 10-yr period from 1998 to 2007. This baseline value was compared with those of singletons and twins. During the 10-yr period, the total number of newborns who were born between gestational age 27 and 38 was 1,330,822. Of these, the number of singletons, twins and triplets was 1,330,822, 90,245, and 840, respectively. A mean gestational age was 37.3+/-1.5 weeks, 36.0+/-2.0 weeks and 33.3+/-2.4 weeks in the corresponding order. A mean birth weight was 3,071+/-490 g, 2,414+/-455 g, and 1,836+/-454 g in the corresponding order. A comparison of the birth weight depending on the gestational age of triplets was made with the normal value of singletons and twins. According to this, in the overall gestational age ranging from weeks 27 to 38, it was relatively smaller as compared with the birth weight of twins and singletons. The current study was of significance in that it first obtained the normal value of birth weight of triplets in the overall gestational age ranging from weeks 27 to 38, whose results are expected to be helpful for studies or treatments of triplets.
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