Comparative Study of Early Neonatal Complications between the First and Second Twin during Twin Vaginal Deliveries at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital

Introduction: Twin birth is the expulsion of two fetuses and their appendages out of the woman’s reproductive tract. It’s a high-risk delivery because of the high frequency of maternal, fetal and neonatal complications. Few studies exist on the comparative prognoses of twins. Our objective was to compare early neonatal complications in first and second twins. Methods: We carried out a cross-sectional prospective study from January 2 to April 30, 2020 (4 months) at the Yaounde Gynaeco-Obstetric and Pediatric Hospital, and the Yaounde Central Hospital. Data collected were analyzed using IBM SPSS version 23. Descriptive statistics were done in frequencies and percentages, means and standard deviations. Paired-sample student's t-test were used to compare means. McNemar’s Chi-square and Ficher’s exact tests were used to compare proportions. Statistical significance was set at p-values less than 0.05. Results: Of a total of 2183 deliveries during the study period, 43 (1.96%) were twin vaginal deliveries. Among the 43 women, 41 consented to have their newborns participate in the study. Overall, APGAR scores were better for the first twins at the first (p = 0.004) and fifth (p = 0.031) minutes than for the second twins. Although both twins had complications and that there were 4 neonatal deads of the second twin, there was no relationship between studied complications and the rank of the twin (p = 0.310). Conclusion: As the APGAR score seemed to be better for first twins, clinicians should pay more attention during twin births, in order to improve the prognosis of the second twin.

Early neonatal complications in pregnant women with gestational diabetes mellitus and the effects of glycemic control on neonatal infection

BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.

Risk Factors of Early Neonatal Deaths in Pediatric Teaching Hospital in Bangui, Central African Republic

Background: The neonatal mortality rate in the Central African Republic (CAR) is 42.3 per 1000 live births in 2017, indicating that CAR is with the highest number of newborn deaths. Objective: The objective is to clarify the risk factors of neonatal deaths in this area. Methodology: A case-control study with retrospective data collection. Targets were newborns >7 days, hospitalized and dead (cases), and newborns admitted after the respective case during the study period and discharged before the 7th day of life. This study was carried out between 2016 and 2018 in the neonatal unit of the “Complexe Hospitalier Universitaire Pédiatrique de Bangui” (CHUPB), the only national hospital for newborns care in the CAR. Results: We included 902 newborns, with 451 cases of early neonatal death and 451 controls. 4168 newborns were admitted to the neonatology unit with 621 early death cases;a lethality rate of 14.9%. Early neonatal deaths factors were: newborns with low birth weight (OR = 22.59;95% CI [15.93 - 32.04]; P < 0.001);mothers who did not attend antenatal care (OR = 5.54;95% CI [3.95 - 7.79];P < 0.001), home delivery (OR = 0.70;95% CI [0.03 - 0.15];P < 0.001);young maternal age < 25 years (OR = 2.08;95% CI [1.58 - 2.73];P < 0.001);non-medical transport (OR = 2.14;95% CI [1.03 - 4.46];P = 0.03);origin from remote areas (OR = 5.25;95% CI [3.95 - 6.98];P < 0.001);isolated prematurity (P < 0.01);anoxo-ischemic encephalopathy (OR = 12.72;95% CI [6.54 - 34.73];P < 0.01);delivery by cesarean section (OR = 0.59;95% CI [0.41 - 0.84];P < 0.001);preterm delivery (OR = 29.36;95% CI [20.12 - 42.81];P < 0.001), and maternal lower education (OR = 5.65;95% CI [4.08 - 7.81];P < 0.001). Conclusion: The early neonatal mortality rate remains high in this area. Controlling the factors mentioned above might lead to improving the survival of newborns.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds

Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.

Profile of Newborns Hospitalized for Maternal Fetal Infection and Having a Positive CRP in the Pediatric Department of the Gabriel TouréCHU in Bamako, Mali

Objective: Early bacterial neonatal infection (INBP) or maternofetal infection (early neonatal sepsis) remains a concern of the pediatrician due to diagnostic difficulties and its increased morbidity and mortality. No study has been done in Mali on the profile of newborns admitted for INBP with positive CRP, hence the initiation of this work with the aim of studying the epidemiological, biological and bacteriological profile of newborns with a bacterial maternal-fetal infection. Method: Longitudinal study descriptive (from 27 June to 3 September 2016) which concerned all newborns aged from 0 to 72 hours of life hospitalized for confirmed early bacterial neonatal infection with a positive C-reactive protein (CRP) in the neonatal department of the CHU Gabriel Touré. INBP was defined by the presence of maternal and neonatal infectious risk factors, positivity of CRP with a germ in the blood culture. Results: During the study period we included 244 newborns for probable maternofetal infection and who benefited from the CRP assay, 43 had a positive CRP, i.e. a frequency of 17.62%. The sex ratio was 2.30. The majority had a low birth weight (<2500 g) in 69.8% of cases. Mothers were aged 18 to 35 in 93%. The majority were out of school (43.8%) and housewives in 74.4%. The main reasons for consultations were prematurity and/or low birth weight, respiratory distress and neonatal distress, i.e. 46.5%, 25.6% and 11.6% respectively. Among the 43 newborns with a positive CRP, the blood culture returned positive in 79.1% (n = 34). We deplore 2 deaths (4.7%). The main bacteria were gram-positive cocci (Staphylococcus aureus 53.01% and Streptococccus agalactiae 4.10%), gram-negative bacilli (GNB) type Enterobacteriaceae (Klebsiella pneumoniae 11.25% and E. coli at 5.70%) and non-fermentative GNBs (Pseudomonas aeruginosa 2.80% and Acinetobacter baumannii complex 2.24%). Conclusion: Maternal-fetal infection is a hospital pathology frequently encountered in the neonatal period. Its clinical presentation is dominated by respiratory distress, neurological disorders and low birth weight.