New Ballard Score, expanded to include extremely premature infants.
ABSTRACT The Ballard Maturational Score was refined and expanded to achieve greater accuracy and to include extremely premature neonates. To test validity, accuracy, interrater reliability, and optimal postnatal age at examination, the resulting New Ballard Score (NBS) was assessed for 578 newly born infants and the results were analyzed. Gestational ages ranged from 20 to 44 weeks and postnatal ages at examination ranged from birth to 96 hours. In 530 infants, gestational age by last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP). For these infants, correlation between gestational age by NBS and C-GLMP was 0.97. Mean differences between gestational age by NBS and C-GLMP were 0.32 +/- 1.58 weeks and 0.15 +/- 1.46 weeks among the extremely premature infants (less than 26 weeks) and among the total population, respectively. Correlations between the individual criteria and C-GLMP ranged from 0.72 to 0.82. Interrater reliability of NBS, as determined by correlation between raters who rated the same subgroup of infants, ws 0.95. For infants less than 26 weeks of gestational age, the greatest validity (97% within 2 weeks of C-GLMP) was seen when the examination was performed before 12 hours of postnatal age. For infants at least 26 weeks of gestational age, percentages of agreement with C-GLMP remained constant, averaging 92% for all postnatal age categories up to 96 hours. The NBS is a valid and accurate gestational assessment tool for extremely premature infants and remains valid for the entire newborn infant population.
SourceAvailable from: Ryan E Wiegand[Show abstract] [Hide abstract]
ABSTRACT: Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) decreases placental parasitaemia, thus improving birth outcomes. Zambian policy recommends monthly SP-IPTp doses given presumptively during pregnancy at each antenatal examination, spaced one month apart after 16 weeks of gestation. The effectiveness of SP-IPTp was evaluated in Zambia where a recent study showed moderate prevalence of Plasmodium falciparum parasites with genetic mutations that confer SP resistance. HIV-negative women were enrolled at the time of delivery at two facilities in Mansa, Zambia, an area of high malaria transmission. Women were interviewed and SP exposure was determined by antenatal card documentation or self-reports. Using Poisson regression modelling, the effectiveness of SP-IPTp was evaluated for outcomes of parasitaemia (microscopic examination of maternal peripheral, cord, and placental blood films), maternal anaemia (Hb < 11 g/dl), placental infection (histopathology), and infant outcomes (low birth weight (LBW), preterm delivery, and small for gestational age) in women who took 0-4 doses of SP-IPTp. Participants included 435 women, with a median age of 23 years (range 16-44). Thirty-four women took zero doses of SP-IPTp, while 115, 142 and 144 women took one, two, or ≥ three doses, respectively. Multivariate Poisson regression models considering age, mosquito net usage, indoor residual spraying, urban home, gravidity, facility, wet season delivery, and marital status showed that among paucigravid women ≥ two doses of SP-ITPp compared to one or less doses was associated with a protective effect on LBW (prevalence ratio (PR) 0.33, 95% confidence interval (CI) 0.12-0.91) and any infection (PR 0.76, CI 0.58-0.99). Multivariate models considering SP-IPTp as a continuous variable showed a protective dose-response association with LBW (paucigravid women: PR 0.54, CI 0.33-0.90, multigravid women: PR 0.63, CI 0.41-0.97). In Mansa, Zambia, an area of moderate SP resistance, ≥ two doses of SP-IPTp were associated with a protective effect from malaria in pregnancy, especially among paucigravid women. Each dose of SP-IPTp contributed to a 46 and 37% decrease in the frequency of LBW among paucigravid and multigravid women, respectively. SP-IPTp remains a viable strategy in this context.Malaria Journal 12/2015; 14(1). DOI:10.1186/s12936-015-0576-8 · 3.49 Impact Factor
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ABSTRACT: Abstract Objective: To study the effect of synbiotics in reducing incidence and severity of necrotizing enterocolitis (NEC) among preterm neonates. Methods: This randomized controlled trial conducted in a tertiary care teaching hospital, south India, included 220 enterally fed preterm neonates who were randomized to receive either synbiotics or no intervention. The synbiotic contained Lactobacillus, Bifidobacterium and fructo-oligosaccharide. The demographic parameters, risk factors for NEC and outcome including incidence of NEC, its severity, sepsis and mortality were evaluated. Results: Multiple pregnancies, preeclampsia and prolonged rupture of membranes were important maternal characteristics. The average birth weight and gestational age of the preterm neonates was 1.4 kg and 31 weeks, respectively. There was a 50% reduction in the incidence of NEC of all stages in preterm infants who received synbiotics compared to the non-intervention group (7.4% versus 14.5%). Administration of synbiotics did not reduce the severity of NEC, sepsis or mortality. Conclusion: Enteral supplementation of synbiotics along with breastmilk results in a tendancy to decrease the incidence of NEC among preterm neonates.
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ABSTRACT: The association of low birth weight (LBW) with adult onset diseases like hypertension is suggested to be partially mediated by a low number of nephrons at birth. Studies have established a relation between LBW and renal volume as the latter is a surrogate marker of total nephron number. Most such studies have considered birth weight or gestational age as separate independent predictors, without taking into consideration the baby's weight with respect to its gestational age. This study aims to investigate the influence of weight for gestational age on kidney volume in newborns. Consecutive newborns delivered in the department of neonatology in a tertiary care medical college and hospital, were included in a cross-sectional study. The subjects were classified as appropriate for gestational age (AGA) and small for gestational age (SGA) as per Lubchenco's charts of weight for gestational age (WGA). Bilateral kidney dimensions were measured by a single observer and combined kidney volumes were calculated and compared between the groups. Findings : Four hundred and seventeen newborns (SGA 159; AGA 258) were included. The mean combined kidney volume (CKV) was significantly lower among SGA newborns (13.85±4.02 cm(3)) compared to that of AGA (16.88±4.53 cm(3)) (P<.001). Univariable and multivariable analyses were done for assessing the effect of demographic, anthropometric and maternal parameters on CKV. WGA, crown heel length, gestational age and postnatal age (hours of life) were independent predictors of mean CKV. An SGA newborn was expected to have a mean CKV 1.57 cm less (95% CI -2.49 cm to -0.65 cm) than that of its AGA counterpart. Considering the future implications of being SGA and having low kidney volumes at birth, it is essential to have an objective depiction of the relationship between these two vital parameters. This study from the Indian subcontinent brings forth such an association.Iranian Journal of Pediatrics 02/2014; 24(1):93-9. · 0.34 Impact Factor