BackgroundSince an objective description is essential to determine infant’s postnatal condition and efficacy of interventions, two scores were suggested in the past but weren’t tested yet: The Specified-Apgar uses the 5 items of the conventional Apgar score; however describes the condition regardless of gestational age (GA) or resuscitative interventions. The Expanded-Apgar measures interventions needed to achieve this condition. We hypothesized that the combination of both (Combined-Apgar) describes postnatal condition of preterm infants better than either of the scores alone.MethodsScores were assessed in preterm infants below 32 completed weeks of gestation. Data were prospectively collected in 20 NICU in 12 countries. Prediction of poor outcome (death, severe/moderate BPD, IVH, CPL and ROP) was used as a surrogate parameter to compare the scores. To compare predictive value the AUC for the ROC was calculated.ResultsOf 2150 eligible newborns, data on 1855 infants with a mean GA of 286/7 ± 23/7 weeks were analyzed. At 1 minute, the Combined-Apgar was significantly better in predicting poor outcome than the Specified- or Expanded-Apgar alone. Of infants with a very low score at 5 or 10 minutes 81% or 100% had a poor outcome, respectively. In these infants the relative risk (RR) for perinatal mortality was 24.93 (13.16-47.20) and 31.34 (15.91-61.71), respectively.ConclusionThe Combined-Apgar allows a more appropriate description of infant’s condition under conditions of modern neonatal care. It should be used as a tool for better comparison of group of infants and postnatal interventions.Trial registrationclinicaltrials.gov Protocol Registration System (NCT00623038). Registered 14 February 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0334-7) contains supplementary material, which is available to authorized users.

Intraventricular hemorrhage (IVH) is one of the major complications in premature infants, and its management is quite challenging. This review article describes the pathophysiology, risk factors, and complications of IVH. Further, it explains the current diagnosis and treatment of IVH, along with the recent advances in its management. IVH can occur due to fragility of germinal matrix vasculature, impairment of cerebral auto-regulation, coagulation disorders, genetic factors, and oxygen toxicity. Cranial ultrasonography has been the gold standard for screening in newborns for detecting abnormalities like IVH. However, the need of the hour is diagnostic techniques which not only provide information on brain anatomy, but also related to the hemodynamics. Thus, various techniques are being explored like near infra-red spectroscopy (NIRS), advanced magnetic resonance imaging (MRI) techniques, along with the use of biomarkers. Regarding management of IVH, various invasive and non-invasive methods are used for managing intracranial pressure, respiratory distress, and avoiding complications like bleeding. Nowadays, various bundles of measures are being adopted to decrease the incidence of IVH like delayed cord clamping, minimal handling for first few hours, avoiding head down position, antenatal corticosteroids etc. Establishing standard diagnostic and management practices for IVH can prove to be really helpful in its management and prevention.

No abstract

This review mainly focuses on the identification of preventable causes of negative neonatal outcomes in the NICUs, and reviews the currently available evidence on the interventions implemented to prevent these causes. Methods An extensive literature search was conducted for the English language articles in the EMBASE and MEDLINE databases. A total of 300 articles were retrieved with the keyword search. Further attempts were made to search the reference lists of retrieved articles to identify the relevant studies. An internet database search was made to include all articles. The keywords used to retrieve this data were 'quality improvement', 'quality initiatives', 'neonatal outcomes', 'health outcomes', 'care outcomes', 'neonatal intensive care unit', 'NICU', 'preterm infants', 'preterm neonates', 'low birth weight infants', 'low birth weight neonates', 'quality team', 'quality intervention', 'premature infants', 'premature neonates'.