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To assess whether early total enteral nutrition (80 mL/kg/d) started on day 1 of life in hemodynamically stable preterm very-low-birth-weight (VLBW) neonates with the rapid advancement of feeds (20 mL/kg/d) help in the earlier achievement of full feeds (180 mL/kg/d). Early total enteral nutrition (intervention) group feeding was started with 80 mL/kg/d on the first day in all hemodynamically stable neonates admitted with birth weight of 1000–1499 grams, born at 29–33 wk of gestation as determined by first-trimester ultrasonography (USG) or expanded New Ballard Score (NBS) and was advanced by 20 mL/kg/d until maximum feeds of 180 mL/kg/d were achieved; while in control group feeding was started with 30 mL/kg/d on the first day and was advanced by 20 mL/kg/d until maximum feeds were achieved. Primary outcome measure was time taken to achieve full feeds; secondary outcomes were duration of hospital stay, necrotizing enterocolitis (NEC), time to regain birth weight, duration of antibiotics, and death. Sixty VLBW neonates (1000–1499 g) with comparable baseline demographics were randomized within 24 h of admission to two groups. Early total enteral nutrition intervention group (group I, n = 31) achieved the target of full enteral nutrition at median 6 d; IQR: 0 to 7.8 d, a significantly shorter time compared to the controls (n = 29) (median 10 d; IQR: 9 to 11.0 d; p = < 0.05). Early total enteral nutrition started from the first day of life results in significantly less time to achieve full feeds in hemodynamically stable preterm and VLBW infants.

Introduction. The influence of uncontrolled exposure to pain in newborns in the first days of life on the long-term consequences for both the brain and the development of the nervous system as a whole is of interest. The aim of the study was to assess the intensity of pain in preterm infants who need respiratory care in the early neonatal period and to determine its impact on the development of the child by the end of the first month of life. Materials and methods. From December 2018 to December 2019, 92 preterm infants requiring respiratory support in the early neonatal period were examined. Pain intensity was assessed on the EDIN6 scale, and neuro-muscular maturity was assessed on the J. Ballard scale. The preterm infants were divided into 2 groups: Group I – 34 children who underwent invasive ventilation (body weight 1120 [865; 1390] g, gestational age 29 [26; 31] weeks); group II – 58 newborns who used non-invasive respiratory therapy (CPAP) (body weight 1160 [875; 1400] g, gestational age 29 [28; 31] weeks). Group I newborns had a lower Apgar score at 5 minutes ( p = 0.001) and a higher Silverman score ( p = 0.001). Results and discussions. In all newborns, the maximum pain intensity score on the EDIN6 scale was registered on the 3 rd day of life: in group I, it was 9, and in group II – points ( p = 0.041), which corresponds to moderate pain. Group I children underwent more manipulations (20.8 ± 2.14 vs 17.7 ± 2.05; p = 0.016). An increase in the average airway pressure of ≥10 cm H 2 O in group I children and ≥6.5 cm H 2 O in group II patients is accompanied by an increase in the intensity of pain to severe and moderate, respectively. In both groups of children, an inverse correlation was found between the number of manipulations, head circumference ( R = –0.64; p = 0.004) and the J. Ballard score on the 28th day of life ( R = –0.57; p = 0.008). The number of painful manipulations in the early neonatal period, exceeding 21 procedures per day, increases the risk of delayed child development by more than 3.5 ( p = 0.009; OR = 3.68; CI = 1.12–8.36). Conclusion. The number of manipulations performed and the value of the average airway pressure are the main factors affecting the intensity of pain in preterm infants and determining their development in the neonatal period.

Introduction: Skin diseases can adversely affect the quality of life of an individual. Adolescence is acritical time in biophysical development and adverse skin conditions during this period can alter thegrowth in self-confidence and self-esteem and social engagement. Purpose: The present study wasdesigned to assess the burden, the pattern of skin diseases and their impact on their quality of life inadolescent students. Materials and Methods: A total of 23 schools having 3581 students between10-16 years of age were visited, out of which 3367 students were covered and screened. Skincharacteristics such as the severity of skin disease were recorded by the attended physician. Adermatology life quality index (DLQI) questionnaire was used to assess the effect of skin diseases ontheir quality of life. Results: Among the total cases 2,783 (82%) had skin diseases, of the651(19%) had two or more 2 skin diseases. Prevalence of infectious skin diseases was more in (10-12) young age groups 78.5% as compared to (13-16) later age groups of 55.2% (p

Introduction and Aim: Gestational age assessment in women with indeterminate last menstrual period has always remained an enigma. Though multiple parameters have been found useful in providing an indirect age assessment, various studies have now shown that the ultrasonographic measurement of foetal kidney length during the second and third trimester of pregnancy is a viable alternative in foetal age assessment. Methods: This prospective study was conducted among the antenatal women with singleton uncomplicated pregnancy during 18 to 40 weeks of gestation attending the outpatient department for routine ultrasound foetal biometry in a tertiary care referral institution in South India, during January 2019 to June 2019. A total of hundred and thirty-five antenatal mothers were included in this study. Data entry was done in Microsoft Excel and data analysis was done using Statistical Package for Social Sciences (SPSS). Results: There was a strong positive correlation between GA and MKL. Regression model (Model 1) for Mean kidney length showed significant correlation and regression models (Model 2) for MKL and routine foetal biometric parameters like biparietal diameter, femur length and abdominal circumference were found to be significantly correlated. Conclusion: Mean foetal kidney length can alone predict gestational age and by combining it with the other biometric indices to give a better estimation of gestational age.

According to statistical data, from 3 to 10% of women in many countries of the world abuse alcohol during pregnancy which results in the formation of fetal alcohol spectrum disorders (FASDs). The definition includes fetal alcohol syndrome (FAS); Partial Fetal Alcohol Syndrome (PFAS); Alcohol-related Neurodevelopmental Disorders (ARND) Alcohol-related Birth Defects (ARBD). According to the criteria of the Center for Disease Control and Prevention, (CDCP, USA) the major FASDs features are facial dysmorphology (smoothing of the nasolabial groove, flat upper lip, shortened eyelid openings); growth retardation (ante- or postnatal body weight or body length ≤ 10 percentiles); functional disorders of the nervous system (global cognitive deficiency, minor movement dysfunction, attention deficiency disorder and hyperactivity, sensor disorders, memory deficiency, social adaptation problems); structural disorders of the nervous system (head circumference ≤ 10 percentile (or ≤ 3 percentile for children with body weight ≤ 10 percentile) or clinically significant cerebral abnormalities found by neurovisualization). Combination of the above mentioned signs with maternal alcoholism during pregnancy in anamnesis underlies FASD diagnostics. According to the findings of certain researchers the major pathogenic links of FASDs are associated with ethanol toxic effect on the fetal metabolism, that is, activation of oxidative stress processes and decreased intensity of antioxidant protection; reduced expression of genes essential for development; activation of nerve cells apoptosis; delay of the cellular neuron migration and disorders of their proliferation against insufficiently active enzymatic system of the liver participating in ethanol neutralization. The article presents a clinical case of FASDs in a newborn girl born from ХІ pregnancy; a pregnant woman who was not registered concerning pregnancy, did not undergo screening examinations, smoked and drank regularly. The girl was born after Х physiological labor in 34 weeks of gestation after preterm rupture of the amniotic sac and anhydrous period of 160 hours. Complete antenatal prevention of respiratory distress-syndrome was performed. The body weight of the girl at birth was 1600 g, the body length – 43 cm. The child’s condition at birth was assessed as compensated by vital functions, and Apgar score was 8/8. According to the assessment of the nervous-muscular and physical maturation by the New Ballard Score the girl was estimated 25 corresponding to 33 weeks of gestation. Assessment of physical development found the body mass value lower than 10 centile, the body length and head circumference – within the range of 10-90 centile. During physical examination dysmorphic signs were determined including smoothed nasolabial groove (5 points), thin flat upper lip, and shortened eyelid openings. The course of postnatal adaptation of the neonate was complicated by neurological symptoms manifested by the signs of inhibition syndrome. After comprehensive medical aid was provided, the girl was discharged from hospital in a satisfactory condition with recommendations about the necessity of including the child into the catamnestic follow-up with careful assessment of its physical and nervous-psychic development. Diagnostics of FASDs is a complicated medical diagnostic process which is best ensured by means of a structural interdisciplinary approach of a strong clinical team consisting of specialists of various areas with mutually complementary experience, qualification and skills. An important role of a neonatologist in detection of children with FASDs is hardly overestimated concerning consistent provision of medical first aid and development of a professional diagnostic way, referral to catamnestic follow-up service and further rehabilitation.

Background: Birth asphyxia is a common neonatal problem and contributes significantly to neonatal mortality and long term morbidity. Any organ can be affected but the brain, heart, kidneys are more sensitive to hypoxic injury. Aim and Objective: To study renal parameters and serum calcium levels in birth asphyxia, to determine the incidence of renal failure in asphyxiated newborns, and to correlate the renal parameters with different severity of birth asphyxia and with different stages of hypoxic-ischemic encephalopathy. Method and material: A comparative study of 69 term newborns, appropriate for gestational age born/admitted to tertiary care Centre RDGMC Ujjain with birth asphyxia and 69 normal newborns without birth asphyxia was done. Perinatal history, physical examinations, New Ballard score, Apgar score was done. Data collected and entered in the master chart for results and analysis. Result: The study included 69 cases and 69 controls with the majority of boys. Mild, moderate, and severe birth asphyxia was7%, 29%, and 64% of all cases respectively. The incidence of acute renal failure was 57% among cases of birth asphyxia. The incidence of acute renal failure was 53% and 50% in hypoxic-ischemic encephalopathy stages III and II respectively. Incidence of renal failure with mild, moderate, and severe asphyxia was 40%, 50%, and 39% respectively Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of urea, creatinine and urine output helps in the early diagnosis and management of acute renal failure

In the study done by WHO, they have recommended that in areas where the accurate, early weighing of neonate is not feasible, community health workers should be trained to measure the Chest Circumference. Newborns with chest circumference /-29 cm but

Objectives: To find correlation between foot length and gestational age (GA) and to derive cut off value of foot length to identify preterm neonates. Design: Present study is observational, cross sectional study. Setting: Hospital based study, conducted in Swami Dayanand hospital, Delhi over a period of eight months (September 2017-May 2018). Participants: Total of 400 neonates aged 0 to 48 hours of life delivered in hospital. Inclusion criteria: All live neonates born in SDN hospital during study period, whose GA estimate was available by last menstrual period (LMP). Exclusion criteria: (1) Neonates with congenital anomalies, (2) Newborn whose mothers LMP was not reliable, (3) Difference between GA by LMP and New Ballard score was more than 2 weeks. GA was estimated by LMP and New Ballard score. LMP was considered as gold standard. Selection procedure: Convenience sample. Outcome measures: Correlation between foot length and gestational age. Results: A statistically significant positive correlation (r=0.759, p

Objective To evaluate the association between HIV antiretroviral therapy (ART) and preterm birth (PTB), when defined by gold standard antenatal ultrasound versus newborn exam. Design A secondary analysis of the PROMISE 1077BF/1077FF randomized controlled trial, which compared antiretroviral strategies to reduce perinatal HIV transmission and improve maternal health. The trial used newborn exam (i.e. New Ballard Score, NBS) to assess gestational age. This analysis included liveborn singleton pregnancies with both newborn exam and ultrasound data. The primary exposure was the trial's antiretroviral strategies: zidovudine with intrapartum nevirapine ('ZDV alone'); zidovudine/lamivudine/lopinavir-ritonavir ('ZDV-based ART'); or tenofovir/emtricitabine/lopinavir-ritonavir ('TDF-based ART'). The primary outcome was PTB less than 37 and less than 34 weeks based on the gold standard of ultrasound dating. We evaluated the association between antiretroviral strategy and PTB. We fit multivariable logistic regression models, adjusting for maternal characteristics, obstetric history, and HIV disease severity. Results Among 720 assessed pregnant women, PTB less than 37 weeks was 15.4% by NBS and 18.3% by ultrasound. The NBS was specific but not sensitive for PTB less than 37 weeks (92.0% and 48.5%). Women receiving ZDV-based and TDF-based ART had significantly higher odds of PTB less than 37 by ultrasound compared with ZDV alone (adjusted odds ratios: 1.68; 95% confidence interval 1.10-2.57, and 2.71; 95% confidence interval 1.39-5.29), as well as for PTB less than 34 weeks. These results held for ultrasounds performed less than 24 weeks, and were generally consistent with prior analyses from the PROMISE trial using the NBS. Conclusion Women starting HIV ART in pregnancy remained at higher risk of PTB when determined by ultrasound, consistent with prior data using newborn exam. However, newborn exam misclassified cases of PTB compared with gold standard ultrasound.

ObjectiveTo investigate foot length (FL), chest circumference (CHC) and mid-upper arm circumference (MUAC) as predictors of low birth weight (LBW) or prematurity, and to describe the agreement between the gestational age (GA) assessments ascertained by the New Ballard Score (NBS) and the Eregie model.MethodsA hospital-based cross-sectional study with community follow-up in a subset was conducted in Jimma University Medical Center, Ethiopia. GA (NBS and Eregie model), weight, FL, CHC and MUAC were measured at birth. Anthropometrics were repeated at 5 days of age.ResultsThe optimal cut-offs indicative of LBW were ≤7.7 cm for FL; ≤31.2 cm for CHC and ≤9.8 cm for MUAC. CHC, MUAC and FL identified LBW with sensitivities (95% CI) of 91.6 (86.9 to 95), 83.7 (77.8 to 88.5) and 84.2 (78.4 to 88.9), and specificities (95% CI) of 85.4 (83.3 to 87.4), 90.2 (88.4 to 91.9) and 73.9 (71.3 to 76.4), respectively. CHC, MUAC and FL identified prematurity with sensitivities of 83.8 (76.7 to 89.4), 83.1 (75.9 to 88.9) and 81.7 (74.3 to 87.7), and specificities of 81.1 (78.9 to 83.3), 63.4 (60.7 to 66.1) and 77.0 (74.6 to 79.3), respectively. The cut-offs identified have comparable diagnostic ability for LBW and prematurity when measurements are repeated on day 5 of age. The GA assessment by the NBS and the Eregie model gave similar results, with the mean difference of 1.2 weeks.ConclusionCHC, MUAC and FL taken on day 1 and 5 after birth could be used as diagnostic tools for LBW or prematurity. The Eregie model for GA estimation gives similar results to the NBS.

Background Preterm birth is a leading cause of death among children under five years. Previous estimates indicated global preterm birth rate of 10.6% (14.8 million neonates) in 2014. We aim to update preterm birth estimates at global, regional, and national levels for the period 2010 to 2019. Methods Preterm birth is defined as a live birth occurring before 37 completed gestational weeks, or Discussion Accurate measurement of preterm birth is challenging in many countries given incomplete or unavailable data from national administrative sources, compounded by limited gestational age assessment during pregnancy to define preterm birth. Up-to-date modelled estimates will be an important resource to measure the global burden of preterm birth and to inform policies and programs especially in settings with a high burden of neonatal mortality. Trial registration PROSPERO registration: CRD42021237861.

Background High rates of adverse pregnancy outcomes globally raise the need to understand risk factors and develop preventative interventions. The Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study) was a prospective, observational cohort study conducted from 2016 to 2017 in Blantyre, Malawi. We examine the associations between indicators of nutritional status, specifically mid-thigh circumference (MTC) and body-mass index (BMI), and adverse pregnancy outcomes, low birth weight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), in a cohort of HIV-infected and HIV-uninfected women. Methods Sociodemographic, clinical, laboratory, and maternal height, weight and MTC data were collected immediately before or after delivery at the Queen Elizabeth Central Hospital (QEHC) and 4 affiliated health centers in Blantyre, Malawi. LBW was defined as birth weight Results Data from 1298 women were analyzed: 614 HIV-infected and 684 HIV-uninfected. MTC was inversely associated with LBW (adjusted odds ratio [aOR] = 0.95, p = 0.03) and PTB (aOR 0.92, p p = 0.53). Similarly, higher BMI was significantly associated with lower odds of PTB (aOR 0.90, p p = 0.05), and SGA (aOR 0.95, p = 0.04). Conclusions We observed an inverse relationship between MTC and adverse pregnancy outcomes in Malawi irrespective of HIV infection. MTC performs comparably to BMI; the ease of measuring MTC could make it a practical tool in resource-constrained settings for identification of women at risk of adverse pregnancy outcomes.

A preliminary study at the Sriwaty Midwifery Independent Practice Clinic, the number of pregnant women in 2019 was 350-400 deliveries and 45 Premature / LBW. Prenatal yoga have never been implemented in prenatal classes.Aim and Objectives To analyze the effectiveness of prenatal yoga in pregnant women in the I-III trimester on Ballard score and anthropometry of newborns.This study is a pre-experimental study with a randomized controlled trial two group design. The sample size in the study was 40 respondents: the intervention group was 20 respondents and the control group was 20. The sampling technique was based on the consecutive sample. The statistical test is the independent t-test to determine the difference in mean Ballard score, anthropometry of newborn babies in each group. Because the sample used was

The knowledge of the gestational age of the newborn is essential for management. In the absence of a dating scan, the postnatal assessment scores have drawbacks of being difficult to learn and administer in the community. The measurement of the foot length is easy, reproducible and offers an objective assessment. The objective of this study was to determine the correlation of postnatal (

A baby's gestational age determines whether or not they are premature, which helps clinicians decide treatment. The most accurate dating methods use Ultrasound Scans, but these are expensive, require trained personnel and cannot always be deployed to remote areas. In the absence of such methods, the Ballard Score, a postnatal clinical examination, can be used. However, this method is highly subjective and results vary widely depending on the experience of the examiner. In the last decade, there have been efforts to exploit machine learning methods to create reliable postnatal methods deployable anywhere in the world. However, current state of the art methods remain influenced by the quality of their input data, which is a major issue in areas where data collection is difficult or impossible. Gathering images of newborns, especially those who are premature, is a very challenging task, due to the intrusiveness of taking photographs inside an ICU. This paper explores few-shot learning for gestational age estimation and investigates whether it can be used as an alternative way to explicitly deal with a lack of data. We compare two popular methods for few-shot learning, Model Agnostic Meta-Learning and Prototypical Networks, with a small dataset collected as part of the GesATional Project. Experimental results show that few-shot learning can be used to estimate gestational age postnatally. As a novel contribution to deal with the lack of data, models are trained with CelebFaces Attributes, to aid the procedure. We demonstrate that the novel integration of additional meta-sets improves performance by an average of 2.3% for both models comparing to just using a single dataset.

Introduction: In order to provide adequate antenatal care, accurate gestational age assessment is critical. Recent research suggests that, in addition to normal biometric indicators, kidney length should be considered when calculating the duration of pregnancy by ultrasonography. Materials and Methods: A prospective cross-sectional study of 120 pregnant women was conducted in a single centre. Kidney length was assessed at two-week intervals between 24 and 40 weeks, in addition to usual biometric measures. A total of 240 renal vertical measurements were recorded, with the average of the right and left renal lengths being used to determine the final kidney length. The mean and standard deviations for each variable were determined using descriptive analysis. Pearson regression coefficients were used to find the association between gestational age and other foetal characteristics and to evaluate which regression model provides the best fit for prediction of gestational age. Results: The length of the foetal kidneys grew longer as the pregnancy progressed (from 23.2 mm at 24 weeks to 40.1 mm at 40 weeks). The regression formula (gestational age = 2.195 + 0.942 X kidney length) demonstrated a good degree of correlation (R2 0.97, p

Knowledge of gestational age of newborn babies may modify the details of their care. Though gestational age is usually calculated from the date of mother’s last menstrual period this date is not known with certainty in large majority of pregnancy. In others there may be misleading information especially when the menstrual cycle is irregular, when conception is shortly after a previous pregnancy or when the mother was taking oral contraceptives shortly before conception. Hence the need of multiple modalities to confirm the gestational age and the reliability of modalities is a major concern. Our study is undertaken to compare the correlation of gestation age assessment by three methods viz., gestational age assessment by last menstrual period dates, gestational age assessment by last trimester ultrasound and gestational assessment by post-natal assessment of modified Ballard score. This study is a prospective study conducted in a rural medical college hospital. Total of 150 term babies were enrolled in the study. Duration of the study was two years. The gestational age of the neonates was calculated by all 3 methods and the correlation was assessed. The study concluded that the modified Ballard score overestimates the gestational age and the third trimester ultrasound underestimates the gestational age.

Birth weight has been universally used as a measure of intrauterine growth, because of its correlation with gestation, and relative ease of recording in hospital setting. Weight is the most widely used single clinical indicator of growth. However birth weight by itself is not infallible. Infants of identical race, sex, gestational age and length have been known to differ in their body weights by up to 40%. Also birth weight is the sum of fat and lean body tissue. Weight gain represents the sum of increments of different body components including muscle, skeleton, adipose tissue and water. So it is rather a non-specific measure of growth. All the singleton live born babies born in the hospital were examined within 48 hours of birth. Gestational age was calculated by enquiring into 1st day of mothers last menstrual period and will be subsequently confirmed by New Ballard Score. If any disparity of more than 2 weeks between gestational age by enquiring LMP and by NBS were excluded from the study. In the present study it was observed that the mean ± SD of Birth weight was 2800.52±446, the mean ± SD of Crown heel length was 48.75 ± 2.0, the mean ± SD of Head circumference was33.64 ± 1.4 the mean ± SD of Chest circumference was31.86 ± 2.19, the mean ± SD of Abdominal circumference was 27.42 ± 2.14, the mean ± SD of Mid arm circumference was 9.08 ± 0.83, the mean ± SD of Calf circumference was 9.9 ± 1.16, the mean ± SD of Skin fold thickness was 4.63 ± 0.64, the mean ± SD of Foot length was 8.03±0.8, and the mean ± SD of Thigh circumference was 15.16 ± 1.35.

Objective To assist clinicians in assigning gestational age based on ultrasound biometry. Outcomes To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with or without the use of ultrasound. To provide maternity health care providers and researchers with evidence-based guidelines for the assignment of gestational age. To determine which ultrasound biometric parameters are superior when gestational age is uncertain. To determine whether ultrasound gestational age assessment is cost effective. Evidence Published literature was retrieved through searches of PubMed or MEDLINE and The Cochrane Library in 2013 using appropriate controlled vocabulary and key words (gestational age, ultrasound biometry, ultrasound dating). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to July 31, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs Accurate assignment of gestational age may reduce post-dates labour induction and may improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. More accurate dating allows for optimal performance of prenatal screening tests for aneuploidy. A national algorithm for the assignment of gestational age may reduce practice variations across Canada for clinicians and researchers. Potential harms include the possible reassignment of dates when significant fetal pathology (such as fetal growth restriction or macrosomia) result in a discrepancy between ultrasound biometric and clinical gestational age. Such reassignment may lead to the omission of appropriate—or the performance of inappropriate—fetal interventions. Summary Statements 1When performed with quality and precision, ultrasound alone is more accurate than a "certain" menstrual date for determining gestational age in the first and second trimesters (≤ 23 weeks) in spontaneous conceptions, and it is the best method for estimating the delivery date (II). 2In the absence of better assessment of gestational age, routine ultrasound in the first or second trimester reduces inductions for post-term pregnancies (I). 3Ideally, every pregnant woman should be offered a first-trimester dating ultrasound; however, if the availability of obstetrical ultrasound is limited, it is reasonable to use a second-trimester scan to assess gestational age (I). Recommendations 1First-trimester crown–rump length is the best parameter for determining gestational age and should be used whenever appropriate (I A). 2If there is more than one first-trimester scan with a mean sac diameter or crown–rump length measurement, the earliest ultrasound with a crown–rump length equivalent to at least 7 weeks (or 10 mm) should be used to determine the gestational age (III B). Ideally the dating ultrasound is at least 7 weeks or 10 mm of gestation. However, in the absence of timed fertilization, clinical judgement and discretion can be applied should the only early crown–rump length scan be prior to 10 mm and 7 weeks and thus a repeat scan is not mandatory. Factors to consider include the quality of the scan, ultrasound method, and all available clinical information. 3Between the 12th and 14th weeks, crown–rump length and biparietal diameter are similar in accuracy. It is recommended that crown-rump length be used up to 84 mm, and the biparietal diameter be used for measurements > 84 mm (II-1 A). 4If a second- or third-trimester scan is used to determine gestational age, a combination of multiple biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) should be used to determine gestational age, rather than a single parameter (II-1 A). 5When the assignment of gestational age is based on a third-trimester ultrasound, it is difficult to confirm an accurate due date. Follow-up of interval growth is suggested 2 to 3 weeks following the ultrasound (III C).

Background The estimated association of maternal influenza vaccination and birth outcomes may be sensitive to methods used to define preterm birth or small‐for‐gestational age (SGA). Methods In a cohort of pregnant women in Lao People's Democratic Republic, we estimated gestational age from: (a) date of last menstrual period (LMP), (b) any prenatal ultrasound, (c) first trimester ultrasound, (d) Ballard Score at delivery, and (e) an algorithm combining LMP and ultrasound. Infants were classified as SGA at birth using a Canadian, global, and equation‐based growth reference. We estimated the association of maternal influenza vaccination and birth outcomes, by influenza activity, using multivariable log‐binomial regression and Cox proportional hazards regression with vaccination as a time‐varying exposure. Results The frequency of preterm birth in the cohort varied by method to estimate gestational age, from 5% using Ballard Score to 15% using any ultrasound. Using LMP, any ultrasound, or the algorithm, we found statistically significant reductions in preterm birth among vaccinated women during periods of high influenza activity and statistically significant increases in SGA, using a Canadian growth reference. We did not find statistically significant associations with SGA when using global or equation‐based growth references. Conclusions The association of maternal influenza vaccination and birth outcomes was most affected by the choice of a growth reference used to define SGA at birth. The association with pre‐term birth was present and consistent across multiple statistical approaches. Future studies of birth outcomes, specifically SGA, should carefully consider the potential for bias introduced by measurement choice.

INTRODUCTION: Newborn health is closely related to that of their mothers. The simple indicators of the mother like haemoglobin level, height, weight, gestational age of the mother will give the first hand information of deviated health of the neonates. MATERIAL AND METHODS: Descriptive correlation study was conducted to assess the impact of physical health status of antenatal mothers on their neonates, 170 antenatal mothers and their born neonates were selected by using purposive sampling. Semi-structured interview schedule, observation of record review and measurement of physical health parameters were used for data collection. A descriptive and inferential statistics were used to investigate the relationships between the variables of antenatal mothers with their neonates with SPSS software version 16. RESULTS: The study findings revealed that the weight of the neonates has statistically significant correlation with the maternal weight, height, hemoglobin and maternal gestational weeks; length of the neonates has statistically significant correlation with the maternal height, maternal weight and maternal age; Gestational age (Ballard score) with the maternal gestational weeks and neonates birth weight; neonates head circumference has statistically significant with the maternal height, gestational weeks and maternal weight; chest circumference of the neonates has statistically significant with the maternal height and maternal weight. CONCLUSION: The study concluded that there was a significant correlation between the selected maternal weight, height, hemoglobin and gestational weeks with neonatal weight; maternal height, weight, age with neonatal length, head circumference, chest circumference and maternal gestational weeks with neonate gestation age by Ballard score.

Objectives: The objective of the study was to compare the cord blood lipid levels in healthy newborns according to gestational age (GA), weight, and sex. Methods: This study included 1000 healthy term and preterm neonates after obtaining parental consent at birth. The GA was confirmed using New Ballard Score. Fenton’s growth charts were utilized to classify study subjects as appropriate for GA, small for GA, and large for GA at birth. Lipid profile was measured by enzymatic colorimetric method. Serum low-density lipoprotein-cholesterol (LDL-C) was calculated by Friedewald’s formula. Results: Preterm neonates with GA of 28–36 weeks had higher mean total cholesterol, LDL, very LDL, and triglycerides levels than term neonates in contrast to their mean high-density lipoprotein (HDL) levels which was significantly lower as compared to that of term neonates. A statistically significant decline in all lipid fractions was observed with an increase in birth weight from

Objectives: Blood counts are commonly performed tests in neonatal intensive care units with the results having various clinical ramifications. Interpreting blood counts as normal or abnormal requires reference ranges as per gestation. Studies on reference ranges for neonatal neutrophil counts are already scarce, and data is lacking in the Asian context. We sought to formulate gestation-wise reference ranges of neutrophil counts in an Indian setting. Methods: Healthy, newborn babies of either gender, aged between 30 to 41 weeks gestation were included in the study. Gestational age was corroborated through first trimester dating scan and postnatally by the New Ballard Score. Single venous blood samples were drawn on day three and day five for estimation of total leukocyte count, differential count (neutrophils, lymphocytes), and peripheral blood smear examination. Results: We evaluated the data of 420 newborns. The normative values were compiled week-wise for gestational ages of 30 to 41 weeks at birth. We observed a clustering of neutrophil count values below 8000 cells/μL on day three and below 5000 cells/μL on day five. No gender-based differences in counts were observed. We were able to generate reference range curves for neutrophil counts as per gestational age. Conclusions: The absolute neutrophil counts of term and preterm Indian newborns are higher than the values depicted in the standard reference chart used currently. This indicates that a different standard chart as per gestation should be used in Indo-Asian countries to differentiate ‘normal’ from ‘abnormal’.

A baby's gestational age determines whether or not they are premature, which helps clinicians decide on suitable post-natal treatment. The most accurate dating methods use Ultrasound Scan (USS) machines, but these are expensive, require trained personnel and cannot always be deployed to remote areas. In the absence of USS, the Ballard Score, a postnatal clinical examination, can be used. However, this method is highly subjective and results vary widely depending on the experience of the examiner. Our main contribution is a novel system for automatic postnatal gestational age estimation using small sets of images of a newborn's face, foot and ear. Our two-stage architecture makes the most out of Convolutional Neural Networks trained on small sets of images to predict broad classes of gestational age, and then fuses the outputs of these discrete classes with a baby's weight to make fine-grained predictions of gestational age using Support Vector Regression. On a purpose-collected dataset of 130 babies, experiments show that our approach surpasses current automatic state-of-the-art postnatal methods and attains an expected error of 6 days. It is three times more accurate than the Ballard method. Making use of images improves predictions by 33% compared to using weight only. This indicates that even with a very small set of data, our method is a viable candidate for postnatal gestational age estimation in areas were USS is not available., Highlights • New small sample learning method combines photos/quantitative data, CNN & regression. • Its application to GA estimation using newborns' photos (face/ear/foot) and weight • In-depth analysis of data collected (& its effects) and the system (& its elements) • Results improve current automatic & manual postnatal methods. • Even with small dataset, viable postnatal estimation candidate in areas without USS

Background Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. Methods Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson’s rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. Results A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6–38.8), by LMP, 38.4 weeks (95%CI: 38.0–38.9), by SFH, 38.3 weeks (95%CI: 38.2–38.5), and by BS 38.0 weeks (95%CI: 37.9–38.1) (p

Background Patent ductus arteriosus (PDA) is a common problem in preterm very low birth weight neonates. While PDA is known to have negative impact on neonates, treatment of PDA has its own complications, and not all PDAs need treatment. Therefore, echocardiographic parameters which might help in the management of PDA will be useful for clinicians. Objectives To study diagnostic accuracy of echocardiographic parameters on the third day of life in predicting spontaneous closure of ductus arteriosus in preterm very low birth weight neonates Methods A hospital-based cross-sectional descriptive study was performed in Neonatal Intensive Care Unit (NICU) of 550-bedded Children Hospital, Mandalay, over one year period (from January, 2019 to December, 2019). A total of 63 preterm neonates with birth weight ≤1.5 kg and/or gestational age ≤32 weeks, who had patent ductus arteriosus were studied. Gestational age assessment was made by using the New Ballard Scoring System. On the third day of life, echocardiographic measurement of ductal diameter and LA/Ao ratio was done by the neonatologist. The measurements made by the neonatologist were reviewed and corrected if necessary by the pediatric cardiologist. Decision to treat PDA was made by the neonatologist based on the NICU protocol. On the tenth day of life, patent ductus arteriosus was re-assessed echocardiographically. Results On the third day of life, most of the PDAs (67.6%) had ductal diameter Conclusions In this study, ductal diameter and LA/Ao ratio on the third day of life were found to have acceptable diagnostic accuracy in predicting spontaneous ductal closure on the tenth day of life.When ductal diameter and LA/Ao ratio were used in combination, diagnostic accuracy was found to improve marginally.

Introduction Gestational age is a strong determinant of neonatal mortality and morbidity. Early obstetric ultrasound is the clinical reference standard, but is not widely available in many developing countries. Methods A prospectively designed diagnostic accuracy study in a tertiary referral hospital in a developing country. Early ultrasound ( Results 106 babies were included in the study. Median age at birth was 34 weeks (interquartile range 29–36). Ballard Score and ‘End of Bed’ Assessment had a mean bias of −0.14 and 0.06 weeks respectively but wide 95% limits of agreement. The physical component of the Ballard score, the total Ballard score and Foot length’s ability to discriminate between term and preterm infants gave an area under the receiver operating characteristics curve of 0.97, 0.96 and 0.95, respectively. Discussion Although ‘End of Bed’ Assessment and Ballard score had small mean biases, the wide confidence intervals render the methods irrelevant in clinical practice. Foot length was particularly poor in Small for Gestational Age infants. None of the methods studied were superior to a non-structured clinician’s informal ‘End of Bed’ Assessment. Conclusion None of the methods studied met the a priori definition of clinical usefulness. Improving access to early ultrasound remains a priority. Instead of focusing on chronological accuracy, future research should compare the ability of early ultrasound and Ballard score to predict morbidity and mortality. Lay summary Background Gestational age describes the time interval between conception and the delivery of the baby. Babies born before 37 weeks of gestation (preterm) or after 42 weeks of gestation (post-dates) have an increased risk of death and specific illnesses. The best way to estimate the gestational age is to perform an ultrasound scan on the mother before 20 weeks. However, this is not widely available in many developing countries. Methods to estimate gestational age after birth include calculating the time from the last period, various measurements of the child (such as weight, foot length or head circumference) physical and neurological markers of maturity and examination of the blood vessels on the lens in the eye. Methods In this study, we assessed how accurate these methods were when compared with the best available method; early ultrasound. We also analyzed the clinicians own personal feeling of what the most likely gestation was, based on an informal ‘end of bed’ assessment. If a method was to be deemed clinically useful it was agreed that it would have to confidently identify the gestation to within 1 week of the true gestation. Results None of the methods studied could confidently predict the gestational age of individual babies within 1 week. Ballard scoring and the clinician’s informal ‘End of Bed’ Assessment were the most accurate and also had the smallest inter-operator variability when the results of two separate researchers were compared. Foot length performed particularly badly with babies who were small for their gestational age. Conclusion None of the methods studied confidently predicted gestational age within a week, so have little use in clinical practice. Access to early ultrasound should be improved. Further research into the relationship between maturity markers such as the Ballard score and the rates of death and specific premature related illnesses is warranted.

Background Babies born early and/or small for gestational age in Low and Middle-income countries (LMICs) contribute substantially to global neonatal and infant mortality. Tracking this metric is critical at a population level for informed policy, advocacy, resources allocation and program evaluation and at an individual level for targeted care. Early prenatal ultrasound examination is not available in these settings, gestational age (GA) is estimated using new-born assessment, last menstrual period (LMP) recalls and birth weight, which are unreliable. Algorithms in developed settings, using metabolic screen data, provided GA estimates within 1–2 weeks of ultrasonography-based GA. We sought to leverage machine learning algorithms to improve accuracy and applicability of this approach to LMICs settings. Methods This study uses data from AMANHI-ACT, a prospective pregnancy cohorts in Asia and Africa where early pregnancy ultrasonography estimated GA and birth weight are available and metabolite screening data in a subset of 1318 new-borns were also available. We utilized this opportunity to develop machine learning (ML) algorithms. Random Forest Regressor was used where data was randomly split into model-building and model-testing dataset. Mean absolute error (MAE) and root mean square error (RMSE) were used to evaluate performance. Bootstrap procedures were used to estimate confidence intervals (CI) for RMSE and MAE. For pre-term birth identification ROC analysis with bootstrap and exact estimation of CI for area under curve (AUC) were performed. Results Overall model estimated GA had MAE of 5.2 days (95% CI 4.6–6.8), which was similar to performance in SGA, MAE 5.3 days (95% CI 4.6–6.2). GA was correctly estimated to within 1 week for 85.21% (95% CI 72.31–94.65). For preterm birth classification, AUC in ROC analysis was 98.1% (95% CI 96.0–99.0; p p = 0.002). Conclusions Machine learning algorithms and models applied to metabolomic gestational age dating offer a ladder of opportunity for providing accurate population-level gestational age estimates in LMICs settings. These findings also point to an opportunity for investigation of region-specific models, more focused feasible analyte models, and broad untargeted metabolome investigation.

Introduction: Accurate gestational age assessment is important in obstetric care. Ultrasonography plays a significant role in determination of Gestational Age. The ultrasonographic parameters used for GA determination are Crown rump Length, Biparietal diameter, Head circumference, and abdominal circumference and Femur length. Fetal kidney length (FKL) is one of the emerging parameter in estimation of gestational age. Renal length in mm is identified to approximate the gestational age in weeks. The present study is aimed to corroborate that FKL as a good parameter for gestational age estimation in third trimester. Objective: Is to ascertain the precision of the ultrasonographic 'foetal kidney length' measurement as a reliable parameter for determination of GA in third trimester. Material and Methods: One year Cross-Sectional and an Observational Study was conducted on 171 antenatal women in the third trimester after corroborating the gestational age by first trimester ultra sound and GA by LMP. Ultrasound measurements of Foetal kidney length were taken and correlation with last menstrual period gestational age and with other parameters (BPD, HC, AC, FL) were evaluated. Results: This study showed a good correlation of Mean kidney length with GA by LMP of (r=0.991) than the rest of the parameters, HC(r=0.836), FL(r=0.853), AC(r=0.853), BPD (r=0.734) with p value=0.000 for all the parameters. Conclusion: This study confirms that the fetal kidney length measurement is a reliable ultrasonographic parameter for estimating the gestational age accurately in the 3rd trimester and also it is observed that the correlation is increased when used along with other parameters.

BackgroundDuring pregnancy, the vaginal microbiota is relatively stable. However, African women have more diverse vaginal microbiota than their European counterparts, in addition to high human immunodeficiency virus (HIV) prevalence and risk of adverse birth outcomes. Although HIV is associated with alterations in vaginal microbiota and inflammation in nonpregnant women, these relationships are underexplored in pregnant women.MethodsIn this study, we characterize the vaginal microbiota and immune factors in pregnant African women who were HIV-uninfected (n = 314) versus HIV-infected (n = 42). Mucosal samples were collected once at the enrollment visit (between 15 and 35 weeks of gestation) and women were followed until delivery.ResultsVaginal microbial communities of pregnant women with HIV were significantly more diverse than women without HIV (P = .004), with community structure also differing by HIV status (P = .002, R2 = 0.02). Human immunodeficiency virus infection was also associated with increased risk of preterm birth (PTB) (31% versus 15.3%; P = .066). In a multivariate analysis, HIV infection was independently associated with diverse vaginal community state type (CST)-IVA (P = .005) and CST-IVB (P = .018) as well as PTB (P = .049). No association between HIV status and cytokine concentrations was found.ConclusionsLongitudinal studies with accurate gestational age assessment would be important to confirm these relationships.

Objectives We sought to evaluate the relationship between gestational age (GA) and neonatal anthropometric parameters, namely head circumference (HC) and crown-heel length (CHL). Methods We conducted a cross-sectional study in a tertiary care hospital with 530 consecutively live-born newborns of 28-41 weeks gestation. Anthropometric parameters were measured after three days of life. We summarized the variables using descriptive statistics, including percentile values, and the strength of association was determined through correlation analysis. The correlation was strong for HC and CHL, and linear regression analysis was done to develop predictive equations. Results HC and CHL correlated well with GA with r-values of 0.863 and 0.859, respectively. The regression equations derived were GA (week) = 9.2671 + [0.8616 × HC (cm)] and GA (weeks) = 7.2489 + [0.621 × CHL (cm)]. Multiple regression gave the relationship as GA (weeks) = 4.0244 + [0.4058 × HC (cm)] + [0.4249 × CHL (cm)]. Application of this multiple regression equation to a test cohort of 30 babies for prediction of GA gave a mean margin of error of 2.9%, indicating that it is a satisfactory tool for prediction. Conclusions HC and CHL can be used as simple tools for predicting GA in babies when this is in doubt. This can help in identification of high-risk newborns at primary care level without recourse to imaging modalities.

Background: Assessment of gestational age (GA) based on the last date of menstrual period is often inaccurate. Scores to predict GA of newborns are difficult to use particularly by health workers. An accurate, easy to use the method of assessing GA, particularly in low birth weight (LBW) babies, is needed to detect and link premature newborns to the appropriate level of care. Objectives: The objectives were (1) to develop a “simplified GA score” (SGAS) by selecting items from 3 standard GA scores that significantly predict the GA as measured by the best obstetric estimate (BOE), (2) to validate the accuracy of SGAS against the BOE, (3) to compare the accuracy of SGAS to assess the GA as compared to the accuracy of GA assessment by the New Ballard Score (NBS), and (4) to assess inter rater agreement of SGAS as compared to that of NBS. Materials and Methods: Both the development and validation studies were cross-sectional studies. In the development study, two neonatology residents trained in the use of the 3 scores assessed LBW (

Optic nerve sheath diameter (ONSD) measurements with magnetic resonance imaging and ultrasonography in preterm infants are similar.We measured ultrasonographic ONSD and calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with gestational age, birth weight, head circumference, and new Ballard score.This prospective study included preterm infants admitted to the neonatal intensive care unit without intracranial pathology. Two images per eye were obtained from a linear array ultrasound transducer placed on the patient's superior eyelid. The ONSD was measured 3 mm behind the globe. The brain was considered an ellipsoid, and estimated absolute brain volumes were calculated by subtracting the volumes of the two lateral ventricles from the total brain volumes.A total of 143 preterm infants (male 74, female 69) included in the study. The mean gestational age of the study population was 29.7 weeks (23-36), and the mean birth weight was 1390 g (500-2850). There was a significant difference in ONSD between the male and female gender. A significant, strong, and positive correlation was found between ONSD measurements and gestational age (r 0.901, p 0.001), new Ballard score (r 0.946, p 0.001), birth weight, head circumference, and brain volumes.Our results suggested that ONSD measurements are highly correlated with anthropometry, and it could be a promising bedside, non-invasive objective tool for the determination of exact gestational age postnatally along with the new Ballard score.

Introduction: The gestational age of newborn is assessed by standard method New Ballard’s score but it can also be assessed by some other simple parameters which are less time consuming and significantly correlate with gestational age. Material and Methods: The study population included 209 consecutive live born singleton newborn of 28-40 weeks of gestation. Data were recorded and analyzed by applying correlation and regression analysis. Regression equation was derived to predict gestational age from foot length and mid upper arm circumference (MUAC). Result: The foot length, MUAC and nipple to umbilicus distance correlated very well with gestational age with R2=0.7843, 0.7832 and 0.6630 respectively and when used in combination i.e. foot length and MUAC as R2= 0.833.The quadratic regression equation obtained was Y=0.006X2 – 0.174X + 5.081 (Y is gestational age and X is the mean of foot length and MUAC). Conclusion: Foot length is an easy parameter and can be used as a proxy measure for New Ballard’s score. Foot length and MUAC when used in combination can be used as a better and reliable guide for gestational age assessment of newborn. Also, the foot length, MUAC and nipple to umbilicus distance at cut-off value of 7 cm, 7 cm and 8 cm respectively can be used as ready reference for gestational age assessment of newborn at 34 weeks.

Background: Gestational age (GA) estimation plays a vital role in obstetric, perinatal and neonatal care. Foot length (FL) measurement can serve as a simple, easy and cost effective parameter for estimating GA. The aim of this study was to determine correlation between foot length of new born and GA by new Ballard score and forming a percentile chart if a positive correlation was found.Methods: GA assessment of newborns born in our hospital was done by new Ballard score within 24 hours of life. FL was measured using vernier caliper. Neonates were classified as pre term, term and post term and also grouped as small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA).Results: FL measurement was strongly correlating with GA assessment by new Ballard score, with overall correlation coefficient r=0.897 (p

Background: Premature infant mortality & morbidity is influenced by intrauterine growth & maturation. In our perspective unavailability of accurate LMP from mother, early USG report or home delivered preterm baby that admitted after 4th day of postnatal age create great dilemma regarding the assessment of gestational age (GA).Objective: To validate the New Ballard Score (NBS) until 7th day of postnatal age in preterm neonate.Methods: This observational cross sectional study was conducted in pediatric ward, Rajshahi Medical College Hospital from 1st January 2009 to 31st December 2009. A total of 129 preterm neonate, GA ranging from 29wk to 35 wk, without any medical problem were included in this study. Accurate documentation of LMP of mother and USG during early pregnancy period were available for each study sample. GA of the babies were determined by NBS on 1st, 5th and 7th postnatal age and compaired with LMP & USG based GA. Various raw score was obtained from broken total score in D1 compared with D5 & D7. LMP based GA also compared with USG based GA.Results: Total NBS of D1 were tested with D5 & D7 for level of agreement & degree of correlation. For D1 with D5, r value was 0.97 and for D1 with D7, r value was 0.681. So, NBS of D1 positively correlated with NBS of D5 and D7. The total physical score also positively correlated with D1 versus D5 & D7 (r value 0.975 & 0.796). The total neurological score positively correlated with D1 versus D5 & D7 (r value 0.893 & 0.630). Neurological score were more significant than physical score. All p values were statistically significant (p value ?0.001). GA by NBS & LMP was positively correlated (r=0.94) as well as GA by NBS & USG (r=0.94). GA by NBS did not differ more than 2 weeks from LMP or USG based GA of any particular subjects.Conclusions: The tendency of over estimates the GA by NBS increased from Day 1 to Day 5 to Day 7. But the GA calculated from LMP & USG did not differ more than 2 weeks from GA by NBS. Thus NBS can be used as a clinical tool to detect GA up to Day 7 of postnatal life.Bangladesh J Child Health 2017; VOL 41 (1) :24-27

OBJECTIVE The aim of this study was to evaluate the performance of New Ballard Score (NBS) in small-for-gestational age (SGA) neonates. METHODOLOGY Neonates born at 35-40 weeks of gestation were included if accurate obstetric gestation estimate was available and birth weight was

Gestational age determination by traditional tools (last menstrual period, ultrasonography measurements and Ballard Maturational Assessment in newborns) has major limitations and therefore there is a need to find different approaches. In this study, we looked for a molecular marker that can be used to determine the accurate gestational age of the newborn. To this end, we performed reduced representation bisulfite sequencing (RRBS) on 41 cord blood and matching placenta samples from women between 25 and 40 weeks of gestation and generated an epigenetic clock based on the methylation level at different loci in the genome. We identified a set of 332 differentially methylated regions (DMRs) that undergo demethylation in late gestational age in cord blood cells and can predict the gestational age (r = -.7, P = 2E-05). Once the set of 411 DMRs that undergo de novo methylation in late gestational age was used in combination with the first set, it generated a more accurate clock (R = .77, P = 1.87E-05). We have compared gestational age determined by Ballard score assessment with our epigenetic clock and found high concordance. Taken together, this study demonstrates that DNA methylation can accurately predict gestational age and thus may serve as a good clinical predictor.

Resumo: A prevalência de nascimento pré-termo tem apresentado uma tendência crescente em vários países, inclusive naqueles desenvolvidos. Estudos no Brasil relatam que o Sistema de Informações sobre Nascidos Vivos (SINASC), até 2010, subestimava a prevalência de nascimentos pré-termo, quando comparada aos estudos baseados em dados primários. A partir de 2011, a idade gestacional ao nascer no SINASC tem sido calculada, quando disponível, pela data da última menstruação (DUM). O objetivo foi avaliar a acurácia da determinação da idade gestacional gerada pela DUM, comparando com a de outros estimadores, e correlacioná-la com o peso ao nascer. Estudo de base populacional com dados do SINASC disponíveis no Departamento de Informática do SUS entre 2011 e 2015. As definições de prematuridade, baixo peso e asfixia ao nascer foram aquelas determinadas na literatura. A adequação do peso ao nascer com a idade gestacional foi calculada baseando-se nas curvas de Fenton e Intergrowth-21. Compararam-se as médias de peso pela presença ou não de prematuridade. A estimação da idade gestacional foi realizada pela DUM em 58,5%, e 41,5% utilizaram outro método. Encontrou-se que a proporção de prematuridade foi de 12% no grupo DUM e 8,4% no grupo outro método, já o baixo peso ao nascer foi de 6,5% e 8,4%, respectivamente. A média de peso dos prematuros no grupo DUM foi maior. O uso da DUM como estimador da idade gestacional superestimou a proporção de peso maior ou igual a 2.500g nos prematuros, o que não parece compatível com a distribuição esperada para esta faixa. A DUM favoreceu a “correção” da prematuridade para os parâmetros comparáveis aos de estudos com dados primários, embora as distorções encontradas entre idade gestacional e peso ao nascer possam indicar que ainda existem problemas com este estimador. Abstract: The prevalence of preterm births has shown a growing trend in many countries, including developed ones. Studies in Brazil have shown that the Information System on Live Births (SINASC, in Portuguese), until 2010, underestimated the prevalence of preterm births, when compared with studies based on primary data. Starting in 2011, gestational age at birth has been calculated in SINASC according to the last menstrual period (LMP), when available. This study sought to evaluate the accuracy of the gestational age assessment using LMP, compared with two other estimates, and correlate it with birth weight. This is a population study with data from SINASC available from Brazilian Health Informatics Department between 2011 and 2015. Definitions of preterm birth, low birth weight and birth asphyxia were taken from the literature. Adequacy of birth weigh to gestational age was calculated based on Fenton and Intergrowth-21 curves. We compared weight means according to the presence or lack of preterm birth. gestational age assessment was based on LMP in 58.5% and 41.5% used another method. We found that the preterm proportion was 12% in the LMP group and 8.4% in the other method group, while low birth weight was 6.5% and 8.4%, respectively. Mean weight of preterm infants was higher in the LMP group. Use of LMP as a gestational age estimator overestimated the proportion of weight equal to or higher than 2,500g among preterm infants, which does not seem compatible with the expected distribution for this group. LMP favored “correction” of prematurity for the parameters that are comparable to those of primary data studies, though the distortions we found between gestational age and birth weigh may indicate that there are still problems with this estimator. Resumen: La prevalencia de nacimiento pretérmino está presentando una tendencia creciente en varios países, incluso en los desarrollados. Estudios en Brasil reflejan que el Sistema de Información sobre Nacidos Vivos (SINASC), hasta 2010, subestimaba la prevalencia de nacimientos pretérmino, cuando se compara con los estudios basados en datos primarios. A partir de 2011, la edad gestacional al nacer ha sido calculada en el SINASC, cuando se encontraba disponible, mediante la fecha de la última menstruación (DUM). El objetivo fue evaluar la precisión en la determinación de la edad gestacional generada por los DUM, comparándola con la de otros estimadores, y correlacionándola con el peso al nacer. Se trata de un estudio de base poblacional con datos del SINASC, disponibles en el Departamiento de Informática del Sistema Único de Salud entre 2011 y 2015. Las definiciones de prematuridad, bajo peso y asfixia al nacer fueron aquellas determinadas en la literatura. La adecuación del peso al nacer con la edad gestacional se calculó basándose en las curvas de Fenton e Intergrowth-21. Se compararon las medias de peso por la presencia o no de prematuridad. La estimación de la edade gestacional se realizó mediante DUM en un 58,5%, y un 41,5% utilizaron otro método. Se descubrió que la proporción de prematuridad fue de un 12% en el grupo DUM y un 8,4% en el grupo otro método, ya que el bajo peso al nacer fue un 6,5% y 8,4%, respectivamente. La media de peso de los prematuros en el grupo DUM fue mayor. El uso de la DUM, como estimador de la edad gestacional, sobreestimó la proporción de peso mayor o igual a 2.500g en los prematuros, lo que no parece compatible con la distribución esperada para esta franja. La DUM favoreció la “corrección” de la prematuridad en relación con los parámetros comparables a los de estudios con datos primarios, a pesar de que las distorsiones encontradas entre edad gestacional y peso al nacer puedan indicar que todavía existen problemas con este estimador.

textabstractBackground: A globally standardized approach in high and low and middle-income countries (LMIC) to actively monitor the safety of vaccines for pregnant women during development and implementation phases is critical. Brighton Collaboration’s (BC) Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed globally standardized case definitions (CDs) of key obstetric and neonatal terms for the assessment of safety of vaccines in pregnancy. CDs are categorized into levels of diagnostic certainty, facilitating their use in varied settings. This study evaluates the field performance of CDs in LMIC. Methods: Data from pregnant participants of RCTs for trivalent inactivated influenza vaccine conducted at Chris Hani Baragwanath Academic Hospital, South Africa (SA) between 2011 and 2013 were reviewed retrospectively for preterm birth, stillbirth and hypertension CDs and the Gestational age assessment (GA) algorithm. Data from an ongoing pneumococcal vaccine trial (conducted at MRC Unit, The Gambia) were collected prospectively for GA. Results: For GA, 600 mother-infant dyads from Gambia and 155 mother-infant dyads from SA were reviewed. Level 2B (unsure LMP and US in 2nd trimester) was the most common level seen in Gambia (63%) and level 3B1 (unsure LMP with physical examination) in SA (43%). Preterm deliveries had similar results in SA. The pregnancy-induced hypertension definition performed well, with 96% (54/56) of cases fulfilling ‘level 1’ for ‘preeclampsia with severe features’. 24 stillbirths were identified and 21 records were reviewed; 73.3% (11/15) of the stillbirths classified as antepartum by attending physicians and 83.3% (5/6) of the intrapartum stillbirths did not fulfil the criteria for any level of certainty. Conclusion: BC CDs for neonatal and maternal outcomes (preterm and hypertension) and GA were sensitive, reliable and feasible to use in RCTs in SA and Gambia. Modifications to the stillbirth CD are required to improve its usefulness in varied settings.

Preterm birth is the leading global cause of neonatal morbidity and mortality. Reliable gestational age estimates are useful for quantifying population burdens of preterm birth and informing allocation of resources to address the problem. However, evaluating gestational age in low-resource settings can be challenging, particularly in places where access to ultrasound is limited. Our group has developed an algorithm using newborn screening analyte values derived from dried blood spots from newborns born in Ontario, Canada for estimating gestational age within one to two weeks. The primary objective of this study is to validate a program that derives gestational age estimates from dried blood spot samples (heel-prick or cord blood) collected from health and demographic surveillance sites and population representative health facilities in low-resource settings in Zambia, Kenya, Bangladesh and Zimbabwe. We will also pilot the use of an algorithm to identify birth percentiles based on gestational age estimates and weight to identify small for gestational age infants. Once collected from local sites, samples will be tested by the Newborn Screening Ontario laboratory at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. Analyte values will be obtained through laboratory analysis for estimation of gestational age as well as screening for other diseases routinely conducted at Ontario’s newborn screening program. For select conditions, abnormal screening results will be reported back to the sites in real time to facilitate counseling and future clinical management. We will determine the accuracy of our existing algorithm for estimation of gestational age in these newborn samples. Results from this research hold the potential to create a feasible method to assess gestational age at birth in low- and middle-income countries where reliable estimation may be otherwise unavailable.

Preterm births (PTBs), defined as births before 37 weeks of gestation account for the majority of deaths in the newborn period. Prediction and prevention of PTB is challenging. A history of preterm labour or second trimester losses and accurate measurement of cervical length help to identify women who would benefit from progesterone and cerclage. Fibronectin estimation in the cervicovaginal secretions of a symptomatic woman with an undilated cervix can predict PTB within 10 days of testing. Antibiotics should be given to women with preterm prelabour rupture of membranes but tocolysis has a limited role in the management of preterm labour. Antenatal corticosteroids to prevent complications in the neonate should be given only when gestational age assessment is accurate PTB is considered imminent, maternal infection and the preterm newborn can receive adequate care. Magnesium sulphate for fetal neuroprotection should be given when delivery is imminent. After birth, most babies respond to simple interventions essential newborn care, basic care for feeding support, infections and breathing difficulties. Newborns weighing 2000 g or less, benefit from KMC. Babies, who are clinically unstable or cannot be given KMC may be nursed in an incubator or under a radiant warmer. Treatment modalities include oxygen therapy, CPAP, surfactant and assisted ventilation.

Background The new Ballard score (NBS) is presently consid- ered to be the most reliable method for estimating clinical gesta- tional age (GA) in newborn infants. Objective The aim of this study was to compare the NBS and Dubowitz/Finnstrom score against ultrasonography assessment of gestational age. Methods A cross sectional randomized study involving neonates born in Sanglah Hospital, Bali, June to August 2004 was carried out. Gestational age was estimated within the first 24 hour by ei- ther Dubowitz/Finnstrom score or NBS confirmed by USG (C- GLMP) as the gold standard. Results One hundred and fifty-five newborns were enrolled in this study. Subjects were randomly divided into two groups, the Dubowitz/Finnstrom score group (76 newborns) and NBS group (79 newborns). The mean age of mothers was 28.4 years old; mean birth weight was 3151.3 g (SD 596.3 g). The proportion of small for GA, appropriate for GA, and large for GA were 6%, 77% and 17%, respectively. Pearson correlation ( r ) between C-GLMP and Dubowitz/Finnstrom score was 0.71 (P

Background : Gestational age is required to determine diagnosis and optimal management of newborns. The gold standard for gestational age determination is the first day of last menstrual period (LMP). However, not all mothers remember their LMP. Another method for gestational age determination after birth is the New Ballard Score (NBS). This method measures gestational age using two main components, namely neorumuscular and physical maturity. In premature infants, surfactant deficiency leads to hypoxia which eventually leads to neuromuscular disorders. This situation may cause younger gestational age estimation when using NBS. The objective of this study was to analyze the conformity between NBS and LMP in determining gestational age in newborns with respiratory distress syndrome (RDS). Methods : A cross-sectional study was conducted on 35 newborns with RDS that were recorded in 2012 database in Dr. Hasan Sadikin General Hospital Bandung. Data on the date of birth, LMP, NBS soon after birth, sex, birth weight, type of delivery and diagnosis were collected and analyzed statistically using Wilcoxon test. Results : The study showed that there was a significant difference (p

1 (Junior Resident II, Department of Radio diagnosis, Bankura sammilani medical college, Bankura, India) 2 (Associate Professor, Department of Radio diagnosis, Bankura sammilani medical college, Bankura, India) 3 (Internee, Department of Community Medicine, Bankura sammilani medical college, Bankura, India) 4,5 (Resident medical officer, Department of Radio diagnosis, Bankura sammilani medical college, Bankura) 6 (Junior Resident III, Department of Community Medicine, Medical College, Kolkata, India)

Umbilical cord, a narrow cord of tissue that connects a developing foetus with the placenta. Umbilical cord abnormalities are numerous, ranging from false knots to vasa pravia, which often leads to foetal death. An abnormal umbilical cord coiling index includes both hypo coiled cords (cords with an umbilical cord coiling index which is 90th percentile). As per many researchers, an abnormal umbilical coiling index has been reported to be related to adverse perinatal outcomes. The study was conducted in BLDEA’s hospital and research centre, Bijapur. The sample consisted of 40 intranatal mothers who are admitted in labour ward and they were selected by Non random purposive sampling technique. An observational checklist was used to assess perinatal outcomes such as amniotic fluid, weighing machine to weigh the newborn APGAR score sheet to find the APGAR score of newborn. BALLARD score sheet to assess maturity of the baby in relation to Umbilical cord coiling Index Umbilical cord coiling was calculated among 40 intranatal mothers. The result were Hyper coil 12 (30%), Normo coil 16 (40%), Hypo coil 12 (30%) and perinatal outcomes such as LBW, Meconium stained amniotic fluid, Low Apgar score and IUGR were found. The study reveals that there is a significant correlation between Umbilical cord coiling index and perinatal outcomes.

Background: Preterm premature rupture of membranes (PPROM) refers to PROM prior to 37 weeks of gestation. Premature rupture of membranes (PROM) is one of the most common problems in obstetrics complicating approximately 5-10% of term pregnancies. The objective of this study was to know the incidence of early onset sepsis following PROM (premature rupture of membranes) more than 18 hours, mortality among neonates born to mothers with PROM more than 18 hours. Methods: The study was conducted in department of pediatrics, Dr. Panjabrao Deshmukh memorial medical college and hospital, Amravati. All neonates born to healthy mothers with PROM more than 18 hours during their hospital stay were studied. An allowable error sample size of 60 was calculated. Detailed birth history including resuscitation details, APGAR score and gestational age assessment were evaluated. In examination of the neonate, the pulse, respiratory rate, CFT and temperature were noted followed by systemic examination. Required investigations were done for the neonate and were followed during their hospital stay. All the details were fed into the preformed teacher-made proforma . Results: 51.7% of the neonates were males and 48.3% were females. 65% of the total neonates were born by normal vaginal delivery and 35% were delivered by caesarean section. 53.3% of the cases had premature rupture of membranes of 18

Background: It is important to recognise preterm babies as they have a different set of problems than term babies. Methods: Study was done over a period of 2 years.254 new-borns ranging in gestational age from 27 to 42 weeks were studied in MYH Hospital, Indore. Results: Intermammary distance and gestational age showed a positive correlation with a correlation coefficient of 0.9. SGA and AGA babies had correlation coefficient of 0.95 and 0.89 respectively. Conclusions: Intermammary distance of 69.60mm can be used to differentiate preterm and term babies. This simple measurement can be easily used by peripheral health workers at remote places to differentiate between term and preterm babies.

Preterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally. This case definition assign levels of confidence to categorisation of births as preterm, utilising assessment modalities which may be available across different settings. These are designed to enable systematic safety evaluation of vaccine clinical trials and post-implementation programmes of immunisations in pregnancy.