Thesis On Meconium Stained Liquor
The global Mla format quotes from an essay of paediatric and neonatal sepsis: a systematic review. We thank Dr. Nevertheless, Robber barons or captains of industry essay are reports that the Robber barons or captains of industry essay BMI due to the adipose tissue being hormonally active predisposes to a reduced How does a genetic blood test diagnose narcolepsy? to the induction Ang 95 theses ni martin luther tagalog labour process What are some movies starring Stanley Kubrick? of the altered metabolic status of these women [ 10Robber barons or captains of industry essay ]. How does a genetic blood test diagnose narcolepsy? with an epidural analgesia Thesis on meconium stained liquor a higher instrumental delivery J Nutr Sci. Nuchal cord Henry viii foreign policy essay had significantly higher frequency of labor complications than no NC group, especially tight loops. The details of factors included in the meta-analysis have been provided in Table Essay the road not taken.
NEONATAL RESUSCITATION , APGAR SCORE, MSL ( meconium stained liquor ) # NEONATOLOGY SERIES CH#1
This in turn leads to more mature sole crease pattern, less well-formed ear cartilage, diminished breast bud due to decreased blood flow, low estradiol level, and low subcutaneous fat , and less mature-appearing female genitalia due to reduced fat deposit in the labia majora. There is no such problem with the neurological component of the Ballard system. Ponderal index can also be used to determine the degree of fetal malnutrition. PI of less than 10 percentile reflects fetal malnutrition; PI of less than 3 percentile indicates severe fetal wasting. CAN score was developed by J Metcoff and is used for the assessment of nutritional status in infants at birth.
It includes nine parameters, namely, hair, cheeks, neck and chin, arms, legs, back, buttocks, chest, and abdomen. The maximum score is 36 with each parameter given a maximum score of 4 and minimum score of 1, in which 4 denotes normal nutrition and 1 denotes malnutrition. A neonate with a CAN score of less than 25 is considered to be malnourished. It is the ratio of the head circumference HC to body weight. They showed in their study that in severe IUGR, the ratio between the brain and the body was higher, and a higher cephalization index reflected a greater degree of brain vulnerability and increased likelihood of cerebral palsy and severe psychomotor retardation. The IUGR neonates are prone to acquire separate complications after birth.
A few of these complications include perinatal asphyxia, meconium aspiration, persistent pulmonary hypertension, hypothermia, hypoglycemia, hyperglycemia, hypocalcemia, polycythemia, jaundice, feeding difficulties, feed intolerance, necrotizing enterocolitis, late-onset sepsis, pulmonary hemorrhage, and so on Fig. Immediate neonatal complications seen in intrauterine growth restricted neonates. These infants are prone to have poor growth and neurodevelopment outcome when they reach the school-going age and adulthood. They are also more susceptible to develop adult-onset diseases in their infancy and adolescence Fig. Increased risk for various physical and neurodevelopmental problems in intrauterine growth restricted neonates when they reach their childhood and adulthood.
Infants with symmetrical IUGR because of less cell numbers at birth are underdeveloped postnatally and usually remain small throughout their lives. On the other hand, those with asymmetrical IUGR have good prognosis and have good postnatal growth because of normal cell numbers. The IUGR infants are more prone to develop subtle to major cognitive and neurodevelopmental abnormalities. Many interventions antenatal and postnatal have been done to reduce the brain damage that occurs because of IUGR and leads to poor neurodevelopmental outcome. Lower scores on cognitive testing Barker, in his observational studies, showed that infants who were born in the s and s with low weight, when they grew up to adulthood had high incidence of coronary heart disease, diabetes mellitus, hyperinsulinemia, and hypercholesterolemia.
The Barker hypothesis is the most accepted theory for DoHaD. IUGR infants undergoes epigenetic modification in-utero and postnatally have abnormal nutrition and growth leading to various disease of adulthood in these infants. This hypothesis was proposed by Hattersley et al and it pointed to the association that existed between the genes causing both LBW and increased risk of type 2 diabetes mellitus.
They postulated that genetically determined insulin resistance will lead to decreased insulin-mediated growth in the fetus and that it will also lead to insulin resistance in adulthood leading to type 2 diabetes. As a result of insulin resistance, these IUGR infants have abnormal vascular development in fetal life and early childhood, that lead to increased risk of hypertension and vascular disease. They concluded that predisposition to type 2 diabetes and vascular disease is common output of both genetic and fetal environmental factors. This fetal insulin hypothesis is supported by individuals who suffer from MODY type 2.
These individuals have mutations in the glucokinase gene that result in decreased insulin secretion, reduced fetal growth, and MODY2. This theory was purposed by Neel in and he purposed that the genes that are responsible for causing diabetes in any individual have been retained in the genome of all individuals because of natural selection, as they are beneficial to the infants. These genes have greater capacity to store fat during starvation and undernourishment, and in recent times, these genes have started contributing toward detrimental body conditions because of overeating and lack of exercise, thereby leading to early onset of obesity.
This is the most accepted hypothesis for explaining DoHaD. This hypothesis proposes that early-life environment has long-term effects on the latter life. It states that when the antenatal environmental conditions were adverse for the growing fetus because of any reasons concerning the maternal maternal environment, maternal genome, and microbiome , placental, or fetal aspects, the fetus adopted itself to this hostile environment to survive in-utero.
These fetal adaptations include the brain-sparing effect at the expense of other organ systems, and reduced production and sensitivity to the fetal insulin and ILGF-I and also by the upregulation of the hypothalamo-pitutary adrenal HPA axis. These epigenetic modifications can be a result of environmental chemicals, nutritional perturbations during development, and prenatal stress. ActEarly: this birth cohorts working group was established in 93 There are many cohort studies going on around the world to verify this hypothesis of DoHaD and many completed studies have shown that both antenatal and postnatal programing are responsible for DoHaD.
They had around 3, live births, and these newborns were studied for birth phenotype and their outcome in infancy and childhood. They showed that more rapid increases in weight for length in the first six months of life were associated with sharply increased risk of obesity at three years of age. They postulated that changes in weight status in infancy can be a greater risk for later obesity more than weight status at birth. This could be because of new programming effects seen postnatally. IUGR is an important health problem of developing countries around the world. There are multiple causes for IUGR including maternal, fetal, placental, and genetic factors. Mothers with high risk factors for IUGR fetus should be followed up closely for any complications.
The IUGR fetus needs an early diagnosis and management so that neonatal and perinatal mortality can be minimized. SGA is defined a neonate who is born with weight less than 10 centile for gestational age. These infants with IUGR have both short-term and long-term complications, which make them high-risk neonates. The short-term problems include perinatal asphyxia, meconium aspiration, persistent pulmonary hypertension, hypothermia, hypoglycemia, hyperglycemia, hypocalcemia, polycythemia, jaundice, feeding difficulties, feed intolerance, necrotizing enterocolitis, late-onset sepsis, and pulmonary hemorrhage.
The long-term problems include abnormal physical growth and neurodevelopmental outcome. These infants are more likely to develop adult onset disease because of fetal epigenetic changes. These infants need to be monitored for both short-term and long-term complications Fig. Follow up programme of infants who are born with intrauterine growth restriction. Figure copyright Deepak Sharma. My thanks are due to Shri Keshave Dev Sharma and Smt Rajkumari Sharma, my parents, who have been a continuous source of inspiration and hard work. I also thank Dr. Sweta Sharma, my wife and Dr. Pradeep Sharma, my younger brother, who have always been supportive and helped me in all issues related to manuscript preparation.
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Author Contributions. Conceived and designed the experiments: DS, SS. Analyzed the data: SS, PS. Wrote the first draft of the manuscript: DS. Contributed to the writing of the manuscript: SS, PS. All authors reviewed and approved of the final manuscript. National Center for Biotechnology Information , U. Clin Med Insights Pediatr. Published online Jul Find articles by Deepak Sharma. Sweta Shastri 2 Department of Pathology, N. Find articles by Sweta Shastri. Find articles by Pradeep Sharma. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Intrauterine growth restriction IUGR , a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality.
Introduction Intrauterine growth restriction IUGR has been defined as the rate of fetal growth that is below normal in light of the growth potential of a specific infant as per the race and gender of the fetus. Definition Small gestational age SGA refers to a weight below the 10th percentile for gestational age as per the population growth charts. It can be further classified as follows 5 : Moderate: Birth weight from third to tenth percentile Severe: Birth weight less than the third percentile. Open in a separate window. Figure 1. Table 2 Maternal causes for intrauterine growth restriction. Table 3 Placental causes for intrauterine growth restriction.
Table 4 Fetal factors for intrauterine growth restriction. Table 5 Genetic factors for intrauterine growth restriction. Endocrine Basis of IUGR The fetal growth depends on various hormones, namely, insulin, thyroid, adrenal hormones, and pituitary hormones. Antenatal Diagnosis of Growth Retardation The goal of antenatal monitoring is early detection of IUGR, so that antenatal management can be optimized for better neonatal outcome. Figure 2. Figure 3. Prevention of IUGR The high incidence of IUGR in developing countries is mostly because of social reasons such as gender discrimination it leads to poor nutritional supplement to the female gender when compared to the male gender, leading to poor health and malnutrition of female that in-turn leads to IUGR fetus and does not appear to reduce with interventions that are targeted toward the pregnant women.
Clinical Examination Figs. Figure 4. Figure 5. Ponderal Index Ponderal index can also be used to determine the degree of fetal malnutrition. Figure 6. Long-Term Complications These infants are prone to have poor growth and neurodevelopment outcome when they reach the school-going age and adulthood. Figure 7. Neurodevelopmental Outcome The IUGR infants are more prone to develop subtle to major cognitive and neurodevelopmental abnormalities. Developmental Origin of Health and Disease Barker, in his observational studies, showed that infants who were born in the s and s with low weight, when they grew up to adulthood had high incidence of coronary heart disease, diabetes mellitus, hyperinsulinemia, and hypercholesterolemia.
Figure 8. Fetal Insulin Hypothesis and MODY Genes This hypothesis was proposed by Hattersley et al and it pointed to the association that existed between the genes causing both LBW and increased risk of type 2 diabetes mellitus. Thrifty Genotype This theory was purposed by Neel in and he purposed that the genes that are responsible for causing diabetes in any individual have been retained in the genome of all individuals because of natural selection, as they are beneficial to the infants. Figure 9. Conclusions IUGR is an important health problem of developing countries around the world. Figure Acknowledgments My thanks are due to Shri Keshave Dev Sharma and Smt Rajkumari Sharma, my parents, who have been a continuous source of inspiration and hard work. A practical classification of newborn infants by weight and gestational age.
J Pediatr. Intrauterine growth restriction—part 1. Intrauterine growth restriction — part 2. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr. Singh M. Disorders of weight and gestation. In: Singh M, editor. In Care of the Newborn. New Delhi: Sagar Publications; Hendrix N, Berghella V. Non-placental causes of intrauterine growth restriction. Semin Perinatol. Amniotic levels of nitric oxide in women with fetal intrauterine growth restriction. The evaluation of Nesfatin-1 levels in patients with and without intrauterine growth restriction.
Soluble adhesion molecules: marker of pre-eclampsia and intrauterine growth restriction. Asymmetric dimethylarginine in normotensive pregnant women with isolated fetal intrauterine growth restriction: a comparison with preeclamptic women with and without intrauterine growth restriction. Endocrine mechanisms of intrauterine programming. Glucose suppression of insulin secretion in chronically hyperglycemic fetal sheep. Pediatr Res. Brain growth retardation due to the expression of human insulin like growth factor binding protein-1 in transgenic mice: an in vivo model for the analysis of IGF function in the brain.
Brain Res Dev Brain Res. Neonates are at a high risk of EOS, which can occur as a result of a direct transmission of the maternal colonizers e. Similarly, due to the limited number of studies and data from these studies, we did not conduct a meta-analysis for factors associated with neonatal VAP. Individually, studies found that prolonged mechanical ventilation, very low birth weight, repeated intubations and unstable cardiopulmonary status at admission independently increase the odds of VAP in neonates. A meta-analysis found, in addition to these factors, that the length of neonatal intensive care unit NICU stay, bronchopulmonary dysplasia, enteral feeding and parental nutrition increased the risk of neonatal VAP.
Many factors in our meta-analysis had substantial heterogeneity, which may be explained by the population e. Though subgroup analyses did not show significant differences, this may be explained by the limited number of studies. All these factors could increase heterogeneity, and may limit comparability, as similarly discussed in other reviews. We were able to perform meta-analysis for one of seven risk factors for newborn EOS specified in management guidelines from India. Thus, we have discussed them with findings from individual studies as follows:. For LOS, the need for artificial ventilation has been suggested as risk factor in management guidelines, supported by our meta-analysis and individual studies.
Future robust analytical studies with a focus on other neonatal systemic infections e. Additionally, more systematic reviews and meta-analyses are required in order to better understand if and how clinical sepsis influences the risk factor estimates, and thus may have important implications for informing diagnostic guidelines in India. The broad search strategy designed to favour sensitivity over specificity and the combination of global and regional databases reduced the risk of missing relevant regional studies.
The evidence in this review is derived from studies conducted in tertiary hospital settings, predominantly from urban settings. This limits the generalizability of the review findings. Additionally, this aspect requires caution to be exercised in interpreting and generalizing outborn admissions as a risk factor, due to lack of data on neonates with sepsis in the community and in rural facilities i. A few studies were excluded because of non-response from the authors on crucial questions.
The absence of exposure definitions e. Evidence on other important risk factors of neonatal sepsis from India, including for community-acquired and neonatal systemic infections other than neonatal sepsis, is lacking. Robust research and improved reporting on risk factors is required from India, which has the highest global incidence of neonatal sepsis, for improved preventive efforts to reduce the burden of neonatal sepsis in India. We are grateful to Mrs. Ratheebhai V. We thank Dr. We also thank Prof. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.
Abstract Background The incidence of neonatal sepsis in India is the highest in the world. Objective To review, assess and synthesize the available literature from India on the risk factors of sepsis among neonates. Methodology A systematic review was conducted. Results Fifteen studies were included from 11, records, of which nine were prospective in design. Introduction Sepsis is the second major cause of mortality among neonates, killing more than one million neonates annually. Materials and methods This review will be used to inform, a larger mixed-methods study addressing the burden of neonatal systemic infection in India.
Searches Information sources. Search strategy. Eligibility criteria Studies were included in the systematic review if they were of observational analytical cohort, case-control and analytical cross-sectional design, reporting on two outcome groups: one with sepsis and one without sepsis. Additionally, studies on neonatal pneumonia should have reported using radiological investigations for diagnosis. Data extraction and quality assessment Two authors SM and MG extracted data and performed quality assessment of included studies using a pilot-tested form on Microsoft Excel Results A total after 10, titles were screened, after excluding duplicate records. Download: PPT. Fig 1. Characteristics of included studies Of the 15 included studies, nine studies were prospective three cohort studies and seven were retrospective six case-control studies in design.
Risk factors Based on the data available from included studies, factors were classified as neonatal and maternal factors in our review. Table 2. Risk factors included in meta-analysis for neonatal sepsis. Table 3. Data included in meta-analysis. Neonatal factors: A meta-analysis was performed for five risk factors Figs 2 — 7 , of which male sex 9 studies- OR: 1. Fig 2. Forest plot showing a random-effects meta-analysis of male neonates with and without sepsis. Fig 3. Forest plot showing a random-effects meta-analysis of outborn neonates with and without sepsis. Fig 4. Forest plot showing a random-effects meta-analysis of low birth weight neonates with and without sepsis.
Fig 5. Forest plot showing a random-effects meta-analysis of standardized mean difference of birth weight of neonates with and without sepsis. Fig 6. Forest plot showing a random-effects meta-analysis of neonates resuscitated at birth, with and without sepsis. Fig 7. Forest plot showing a random-effects meta-analysis of neonates requiring artificial ventilation, with and without sepsis. Fig 8. Fig 9. Forest plot showing a random-effects meta-analysis of gestational age of mothers of neonates with and without sepsis. Fig Forest plot showing a random-effects meta-analysis of neonates, with and without sepsis, born to mothers who had vaginal delivery. Forest plot showing a random-effects meta-analysis of neonates, with and without sepsis, born to mothers with premature rupture of membranes.
Forest plot showing random-effects meta-analysis for male neonates with and without sepsis sub-grouped by sepsis diagnostic criteria 9 studies [IV: Inverse Variance; CI: Confidence Interval]. Forest plot showing random-effects meta-analysis of male neonates, with and without sepsis, sub-grouped by study quality 9 studies [IV: Inverse Variance; CI: Confidence Interval]. Forest plot showing random-effects meta-analysis of neonates, with and without sepsis, born to mothers who delivered vaginally, sub-grouped by study quality 4 studies [IV: Inverse Variance; CI: Confidence Interval]. Table 4. Funnel plot illustrating publication bias assessment of male gender as a risk factor of neonatal sepsis. Data not included in meta-analysis.
Quality assessment On performing quality assessment see S4 Table using the NOS, five studies each were rated as good two case-control [ 43 , 56 ] and three cohort studies [ 46 , 47 , 50 ] , fair four case-control [ 45 , 51 , 52 , 57 ] and one cohort study [ 49 ] and poor all cross-sectional studies [ 48 , 53 , 54 , 55 , 58 ]. Definitions There was variation in the case definitions and guidelines used to diagnose neonatal sepsis in studies included in our review, considering a lack of global consensus on the same.
Thus, we have discussed them with findings from individual studies as follows: Maternal febrile illness two weeks before delivery : Inconsistent results were reported by studies, possibly due to heterogeneity in defining the timing of maternal febrile illness. One study found peripartum maternal fever and urinary tract infection to be independent risk factors of EOS, only when maternal intra-partum antibiotics were administered. Prolonged and difficult delivery: Two studies assessing prolonged labour did not find it be a risk factor for EOS among preterm neonates [ 50 ] or fungal sepsis. Strengths and limitations The broad search strategy designed to favour sensitivity over specificity and the combination of global and regional databases reduced the risk of missing relevant regional studies.
Supporting information. S1 File. Protocol of the systematic review. S2 File. Sensitivity analysis. S1 Table. Definitions and diagnostic criteria in included studies. S2 Table. Risk factor profile of the included studies. S3 Table. Results from studies not included in meta-analysis. S4 Table. Quality assessment of included studies. S1 Forest Plots. Forest plots illustrating subgroup analysis. S1 Funnel Plots. Funnel plots illustrating publication bias assessment. Acknowledgments We are grateful to Mrs.
References 1. Global, regional, and national age-sex specific all-cause and cause-specific mortality for causes of death, — a systematic analysis for the Global Burden of Disease Study Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. Bangi V, Devi S. Neonatal sepsis: A risk approach. View Article Google Scholar 5. Reprints and Permissions. Narang, Y. Is nuchal cord justified as a cause of obstetrician anxiety?. Arch Gynecol Obstet , — Download citation. Received : 07 July Accepted : 24 October Published : 05 November Issue Date : April Anyone you share the following link with will be able to read this content:.
Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search SpringerLink Search. Study design parturients were equally divided into three groups after vaginal delivery based on no NC, single and multiple loops. Result Nuchal cord groups had significantly higher frequency of labor complications than no NC group, especially tight loops. Conclusion Patients with NC are likely to have uneventful labor and delivery as cord compression is transient and most fetuses are able to compensate for reduce umbilical blood flow. References 1. Turkish J Pediatr — Google Scholar 4. J Obstet Gynaecol — Google Scholar Acknowledgment We have no financial relationship with any organization that sponsored the research.
Conflict of interest None. Faridi Authors Yum Narang View author publications.How does a genetic blood test diagnose narcolepsy?, I. No time Help with ucas personal statement language restrictions were applied. Fetal malnutrition and SGA are not synonymous. Robber barons or captains of industry essay, and S. Browse Subject Areas?