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Anne RP, Kumar J, Kumar P, Meena J. Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:471-487. [PMID: 38314925 DOI: 10.1002/jpn3.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024]
Abstract
Various studies have shown that oropharyngeal colostrum application (OPCA) is beneficial to preterm neonates. We performed a systematic review and meta-analysis to assess whether OPCA reduces the incidence of culture-proven neonatal sepsis in preterm neonates. Randomized controlled trials comparing OPCA with placebo or standard care in preterm neonates were included. Medline, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature, Scopus, and CENTRAL were searched for studies published up to June 15, 2023. We used the Cochrane Risk of Bias tool, version 2, for risk of bias assessment, the random-effects model (RevMan 5.4) for meta-analysis, and Gradepro software for assessing the certainty of evidence. Twenty-one studies involving 2393 participants were included in this meta-analysis. Four studies had a low risk of bias, whereas seven had a high risk. Oropharyngeal colostrum significantly reduced the incidence of culture-proven sepsis (18 studies, 1990 neonates, risk ratio [RR]: 0.78, 95% confidence interval [95% CI]: 0.65, 0.94), mortality (18 studies, 2117 neonates, RR: 0.73, 95% CI: 0.59, 0.90), necrotizing enterocolitis (NEC) (17 studies, 1692 neonates, RR: 0.59, 95% CI: 0.43, 0.82), feeding intolerance episodes (four studies, 445 neonates, RR: 0.59, 95% CI: 0.38, 0.92), and the time to full enteral feeding (19 studies, 2142 neonates, mean difference: -2 to 21 days, 95% CI: -3.44, -0.99 days). There was no reduction in intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, ventilator-associated pneumonia, neurodevelopmental abnormalities, hospital stay duration, time to full oral feeding, weight at discharge, pneumonia, and duration of antibiotic therapy. The certainty of the evidence was high for the outcomes of culture-positive sepsis and mortality, moderate for NEC, low for time to full enteral feeding, and very low for feeding intolerance. OPCA reduces culture-positive sepsis and mortality (high certainty), NEC (moderate certainty), and time to full enteral feeding (low certainty) in preterm neonates. However, scarcity of data from extremely premature infants limits the generalizability of these results to this population.
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Affiliation(s)
- Rajendra Prasad Anne
- Department of Neonatology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Jogender Kumar
- Neonatal Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Neonatal Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Chowdhury R, Manapurath R, Sandøy IF, Upadhyay RP, Dhabhai N, Shaikh S, Chellani H, Choudhary TS, Jain A, Martines J, Bhandari N, Strand TA, Taneja S. Impact of an integrated health, nutrition, and early child stimulation and responsive care intervention package delivered to preterm or term small for gestational age babies during infancy on growth and neurodevelopment: study protocol of an individually randomized controlled trial in India (Small Babies Trial). Trials 2024; 25:110. [PMID: 38331842 PMCID: PMC10854034 DOI: 10.1186/s13063-024-07942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Preterm and term small for gestational age (SGA) babies are at high risk of experiencing malnutrition and impaired neurodevelopment. Standalone interventions have modest and sometimes inconsistent effects on growth and neurodevelopment in these babies. For greater impact, intervention may be needed in multiple domains-health, nutrition, and psychosocial care and support. Therefore, the combined effects of an integrated intervention package for preterm and term SGA on growth and neurodevelopment are worth investigating. METHODS An individually randomized controlled trial is being conducted in urban and peri-urban low to middle-socioeconomic neighborhoods in South Delhi, India. Infants are randomized (1:1) into two strata of 1300 preterm and 1300 term SGA infants each to receive the intervention package or routine care. Infants will be followed until 12 months of age. Outcome data will be collected by an independent outcome ascertainment team at infant ages 1, 3, 6, 9, and 12 months and at 2, 6, and 12 months after delivery for mothers. DISCUSSION The findings of this study will indicate whether providing an intervention that addresses factors known to limit growth and neurodevelopment can offer substantial benefits to preterm or term SGA infants. The results from this study will increase our understanding of growth and development and guide the design of public health programs in low- and middle-income settings for vulnerable infants. TRIAL REGISTRATION The trial has been registered prospectively in Clinical Trial Registry - India # CTRI/2021/11/037881, Registered on 08 November 2021.
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Affiliation(s)
| | - Rukman Manapurath
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Ingvild Fossgard Sandøy
- Centre for International Health, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Neeta Dhabhai
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India
| | | | - Harish Chellani
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India
| | - Tarun Shankar Choudhary
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Abhinav Jain
- Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Nita Bhandari
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India
| | - Tor A Strand
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Sunita Taneja
- Society for Applied Studies, 45 Kalu Sarai, New Delhi, India.
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Chowdhury R, Upadhyay RP, Sinha B, Taneja S, Das JK, Bhandari N. Editorial: Care during pregnancy and early childhood for growth and development in low- and middle- income countries. Front Nutr 2024; 10:1361926. [PMID: 38264194 PMCID: PMC10803586 DOI: 10.3389/fnut.2023.1361926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
| | | | | | | | - Jai K. Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
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Martin-Herz SP, Otieno P, Laanoi GM, Moshi V, Olieng'o Okoth G, Santos N, Walker D. Growth and neurodevelopmental outcomes of preterm and low birth weight infants in rural Kenya: a cross-sectional study. BMJ Open 2023; 13:e064678. [PMID: 37652593 PMCID: PMC10476111 DOI: 10.1136/bmjopen-2022-064678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE Data on long-term outcomes of preterm (PT) and low birth weight (LBW) infants in countries with high rates of neonatal mortality and childhood stunting are limited, especially from community settings. The current study sought to explore growth and neurodevelopmental outcomes of PT/LBW infants from a rural community-based setting of Kenya up to 18 months adjusted age. DESIGN Cross-sectional study. SETTING Migori County, Kenya. PARTICIPANTS Three hundred and eighty-two PT/LBW infants (50.2% of those identified as eligible) from a cluster randomised control trial evaluating a package of facility-based intrapartum quality of care interventions for newborn survival consented for follow-up. OUTCOME MEASURES Caregiver interviews and infant health, growth and neurodevelopmental assessments were completed at 6, 12 or 18 months±2 weeks. Data included sociodemographic information, medical history, growth measurements and neurodevelopmental assessment using the Ten Questions Questionnaire, Malawi Developmental Assessment Tool and Hammersmith Infant Neurological Examination. Analyses were descriptive and univariate regression models. No alterations were made to planned data collection. RESULTS The final sample included 362 PT/LBW infants, of which 56.6% were moderate to late PT infants and 64.4% were LBW. Fewer than 2% of parents identified their child as currently malnourished, but direct measurement revealed higher proportions of stunting and underweight than in national demographic and health survey reports. Overall, 22.7% of caregivers expressed concern about their child's neurodevelopmental status. Neurodevelopmental delays were identified in 8.6% of infants based on one or more standardised tools, and 1.9% showed neurological findings indicative of cerebral palsy. CONCLUSIONS Malnutrition and neurodevelopmental delays are common among PT/LBW infants in this setting. Close monitoring and access to early intervention programmes are needed to help these vulnerable infants thrive. TRIAL REGISTRATION NUMBER NCT03112018.
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Affiliation(s)
- Susanne P Martin-Herz
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Phelgona Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Grace M Laanoi
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Paediatric & Child Health, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Vincent Moshi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nicole Santos
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. Small vulnerable newborns-big potential for impact. Lancet 2023; 401:1692-1706. [PMID: 37167991 DOI: 10.1016/s0140-6736(23)00354-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/13/2023]
Abstract
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
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Affiliation(s)
- Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | - Rajiv Bahl
- Indian Council for Medical Research, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nita Dalmiya
- United Nations Children's Fund, New York, NY, USA
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy Shiffman
- Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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A comprehensive model for scaling up care for small and/or sick newborns at district level-based on country experiences presented at a WHO-UNICEF expert consultation. J Glob Health 2023; 13:03023. [PMID: 37083313 PMCID: PMC10120390 DOI: 10.7189/jogh.13.03023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
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Mocking M, Adu-Bonsaffoh K, Osman KA, Tamma E, Ruiz AM, van Asperen R, Oppong SA, Kleinhout MY, Gyamfi-Bannerman C, Browne JL. Causes, survival rates, and short-term outcomes of preterm births in a tertiary hospital in a low resource setting: An observational cohort study. Front Glob Womens Health 2023; 3:989020. [PMID: 36817873 PMCID: PMC9932588 DOI: 10.3389/fgwh.2022.989020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Background Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and long-term disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana. Materials and methods An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test. Results Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28-31 weeks), and 130 (73%) moderate to late preterm (GA 32-37 weeks) births. Most deliveries (n = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy (n = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% (n = 52/62) at six weeks corrected age in this group. Most infants (90%, n = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis. Conclusions The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.
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Affiliation(s)
- Martina Mocking
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands,Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana,Correspondence: Kwame Adu-Bonsaffoh kadu-bonsaffoh@@ug.edu.gh
| | - Kwabena A. Osman
- Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Evelyn Tamma
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Alexa M. Ruiz
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ruth van Asperen
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Samuel A. Oppong
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | | | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego, San Diego CA, United States
| | - Joyce L. Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Lim M, Carollo A, Neoh MJY, Sacchiero M, Azhari A, Balboni G, Marschik P, Nordahl-Hansen A, Dimitriou D, Esposito G. Developmental disabilities in Africa: A scientometric review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 133:104395. [PMID: 36587527 DOI: 10.1016/j.ridd.2022.104395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Developmental disabilities are disproportionately more investigated in higher-income countries. However, global prevalence of developmental disabilities indicate that a large proportion of individuals with disabilities reside in low- and middle-income nations. AIMS The present work therefore aims to conduct a scientometric review to survey available literature on developmental disabilities in low- and middle-income countries belonging to the continent of Africa. METHODS AND PROCEDURES A literature search was conducted on Scopus, where a total of 1720 relevant publications (and an accompanying 66 thousand references) were found, representing research conducted between 1950 to 2022. Then, document co-citation analysis was performed to chart significant co-citation relationships between relevant articles and their cited references. OUTCOMES AND RESULTS The generated network based on document co-citation analysis revealed a total of 14 distinct thematic research clusters and 12 significant documents that have been frequently cited in the literature on developmental disabilities in Africa. CONCLUSIONS AND IMPLICATIONS The scientometric review revealed a trend of broadening research towards systems of care, away from a medical model of disease. It is projected that future research will continue to capitalise on inter-disciplinary strengths to arrive at a more nuanced understanding of developmental disability from all levels - individuals, families, to communities.
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Affiliation(s)
- Mengyu Lim
- Psychology Program, Nanyang Technological University, Singapore 639818, Singapore
| | - Alessandro Carollo
- Department of Psychology and Cognitive Science, University of Trento, Rovereto 38068, Italy
| | | | - Marzia Sacchiero
- Department of Psychology and Cognitive Science, University of Trento, Rovereto 38068, Italy
| | - Atiqah Azhari
- Psychology Programme, School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, Singapore 599494, Singapore
| | - Giulia Balboni
- Department of Philosophy, Social Sciences and Education, University of Perugia, Perugia 06123, Italy
| | - Peter Marschik
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Anders Nordahl-Hansen
- Faculty of Teacher Education and Languages, Østfold University College, Halden, Norway
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, England
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto 38068, Italy.
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Mitku AA, Zewotir T, North D, Jeena P, Asharam K, Muttoo S, Tularam H, Naidoo RN. Impact of ambient air pollution exposure during pregnancy on adverse birth outcomes: generalized structural equation modeling approach. BMC Public Health 2023; 23:45. [PMID: 36609258 PMCID: PMC9824986 DOI: 10.1186/s12889-022-14971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/29/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Air pollution and several prenatal factors, such as socio-demographic, behavioural, physical activity and clinical factors influence adverse birth outcomes. The study aimed to investigate the impact of ambient air pollution exposure during pregnancy adjusting prenatal risk factors on adverse birth outcomes among pregnant women in MACE birth cohort. METHODS Data for the study was obtained from the Mother and Child in the Environment (MACE) birth cohort study in Durban, South Africa from 2013 to 2017. Land use regression models were used to determine household level prenatal exposure to PM2.5, SO2 and NOx. Six hundred and fifty-six births of pregnant females were selected from public sector antenatal clinics in low socio-economic neighbourhoods. We employed a Generalised Structural Equation Model with a complementary log-log-link specification. RESULTS After adjustment for potential prenatal factors, the results indicated that exposure to PM2.5 was found to have both significant direct and indirect effects on the risk of all adverse birth outcomes. Similarly, an increased level of maternal exposure to SO2 during pregnancy was associated with an increased probability of being small for gestational age. Moreover, preterm birth act a mediating role in the relationship of exposure to PM2.5, and SO2 with low birthweight and SGA. CONCLUSIONS Prenatal exposure to PM2.5 and SO2 pollution adversely affected birth outcomes after controlling for other prenatal risk factors. This suggests that local government officials have a responsibility for better control of air pollution and health care providers need to advise pregnant females about the risks of air pollution during pregnancy.
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Affiliation(s)
- Aweke A. Mitku
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa ,grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa ,grid.442845.b0000 0004 0439 5951Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Temesgen Zewotir
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Delia North
- grid.16463.360000 0001 0723 4123School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prakash Jeena
- grid.16463.360000 0001 0723 4123Discipline of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kareshma Asharam
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sheena Muttoo
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hasheel Tularam
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- grid.16463.360000 0001 0723 4123Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Tegegne KT. Determinants of cerebral palsy in children: systematic review. Sudan J Paediatr 2023; 23:126-144. [PMID: 38380410 PMCID: PMC10876278 DOI: 10.24911/sjp.106-1670589241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/26/2023] [Indexed: 02/22/2024]
Abstract
Cerebral palsy (CP) is a group of disorders of movement and postural control caused by a nonprogressive defect or lesion of the developing brain. Several prepregnancy risk factors have been described including maternal age, parity and maternal diseases including epilepsy, diabetes and thyroid disease. There are few in-depth studies on the causes of CP. In the present systematic review, databases searched were Google Scholar and PubMed to identify data on determinants of CP in the world. Studies were included if they specifically mentioned CP as an outcome, the study objective is to identify factors associated with CP in children and all quantitative observational studies. JBI Critical Appraisal Tools were used to assess the methodological quality of a study. Papers that meet the inclusion criteria were rigorously appraised by two critical appraisers. 40 consistent determinants of CP in children from 95 research articles that meet inclusion criteria are included in the review. The majority of studies (24 articles) showed that premature babies and low weight were determinants of CP in children, whereas 15 studies showed that low Apgar scores were determinants of CP in children. The commonest determinants of CP in children are premature babies and low weight, low Apgar scores, intrauterine infection, congenital brain malformations, thyroid disease, premature rupture of membrane (PROM) and placental abruption. Preventing preterm delivery, low birth weight and intrauterine infection as well as immediate neonatal resuscitation for newborns with low Apgar scores may help to prevent CP in children.
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Affiliation(s)
- Kaleab Tesfaye Tegegne
- Department of Public Health, College of Health Science, Debark University, Debark, Ethiopia
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Fentie EA, Yeshita HY, Shewarega ES, Boke MM, Kidie AA, Alemu TG. Adverse birth outcome and associated factors among mothers with HIV who gave birth in northwest Amhara region referral hospitals, northwest Ethiopia, 2020. Sci Rep 2022; 12:22514. [PMID: 36581660 PMCID: PMC9800575 DOI: 10.1038/s41598-022-27073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Adverse birth outcomes are a common cause of health problems in developing nations and have a significant negative impact on infant health as well as financial costs to families, communities, and the world. Mothers with HIV may be at increased risk of adverse birth outcomes. However, there is a limited study about adverse birth outcomes among mothers with HIV around the world including in Ethiopia. Therefore this study aimed to assess adverse birth outcomes and associated factors among mothers with HIV Facility based cross-sectional study was conducted among mothers with HIV who gave birth in northwest Amhara region referral hospitals from September 2016 to September 2019. Simple random sampling was used to select 590 mothers. Bivariable and multivariable logistic regressions were carried out to identify factors. Statistical significance was declared by using a p-value < 0.05. An adjusted odds ratio was used to show the magnitude of the association. Out of a total of 590 mothers, the prevalence of adverse birth outcomes among HIV-positive mothers was 21% (95% CI 17.8-24.6%). History of spontaneous abortion [AOR = 1.9, 95% CI (1.19, 3.70)], PROM [AOR = 3.55, 95% CI (1.72, 7.30)], opportunistic infection [AOR = 3.38, 95% CI (1.50, 8.22)], pre-pregnancy BMI of < 18.5 [AOR = 5.61, 95% CI (1.97, 15.91)], MUAC < 23 cm [AOR = 2.56, 95% CI (1.10, 5.97)], and ANC visit of < 4 times [AOR = 3.85, 95% CI (2.34, 6.55)] were significantly associated with Adverse birth outcome. The prevalence of adverse birth outcomes was high. Abortion history, MUAC, BMI, Opportunistic infection, PROM, and a number of ANC visits were associated with adverse birth outcomes. This study suggests to increase number of antenatal care follow-ups, prevent and treat opportunistic infections, and focus on early detection and treatment of pregnancy-related complication.
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Affiliation(s)
- Elsa Awoke Fentie
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, University of Gondar, Po. Box: 196, Gondar, Ethiopia
| | - Hedija Yenus Yeshita
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, University of Gondar, Po. Box: 196, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, University of Gondar, Po. Box: 196, Gondar, Ethiopia
| | - Moges Muluneh Boke
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, University of Gondar, Po. Box: 196, Gondar, Ethiopia
| | - Attitegeb Abera Kidie
- grid.507691.c0000 0004 6023 9806Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tewodros Getaneh Alemu
- grid.59547.3a0000 0000 8539 4635Department of Pediatric Nurse, School of Nursing, University of Gondar, Gondar, Ethiopia
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Rodrigues JCDL, Gaspardo CM, Linhares MBM. Development of neonatal high-risk preterm infants in comparison to full-term counterparts. APPLIED NEUROPSYCHOLOGY. CHILD 2022; 11:840-849. [PMID: 34663137 DOI: 10.1080/21622965.2021.1988601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies on preterm infants usually exclude high-risk neonatal infants with neurological problems. However, it is important to study high-risk preterm infants to better understand later developmental problems. Therefore, this cross-sectional study aimed to compare the cognitive, motor, language, and social-emotional development of high-risk preterm (PT) infants with infants born full-term (FT) with no biological vulnerabilities during early development (up to the first 15 months of age). The sample comprised 133 infants (54 born PT and 79 born FT) assessed in independent subsamples at 6-8 and 12-15 months of age, considering the corrected age for prematurity in the PT infants. Infant development (cognitive, motor, language, and social-emotional) was evaluated using the Bayley-III Scales. Medical charts were reviewed to obtain the clinical history. A multivariate analysis of variance and analysis of variance tests were performed to examine the differences between groups related to infant developmental indicators, controlling for age and socioeconomic variables. Although the PT infants performed significantly more poorly than their FT counterparts, the scores of the PT group were still within the normal range on all Bayley-III domains (cognitive, language, motor, and social-emotional) than their FT counterparts. The findings of the present study provide a better understanding of the developmental prognosis of high-risk PT infants and extend support for preventive intervention programs to improve early childhood development.
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Affiliation(s)
| | - Cláudia Maria Gaspardo
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Beatriz Martins Linhares
- Department of Neurosciences and Behavior, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Mihretie GN, Habitamu A. Pregnancy outcomes among women who gave birth at health institutions: A cross-sectional study. Health Sci Rep 2022; 5:e843. [PMID: 36189412 PMCID: PMC9498216 DOI: 10.1002/hsr2.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims Although global birth outcomes have improved considerably in the last 40 years, there are disparities in underdeveloped countries, particularly Ethiopia, remain significant. However, there was inadequate data about the adverse outcome in the study area. This study aimed to assess the proportion and associated factors of adverse birth outcomes among women who gave birth at South Gondar Health Institutions in 2021. Methods The multistage sampling technique was used to select 928 participants from December 15, 2020, to February 2, 2021. Face-to-face interviewer-administered questionnaires and card reviews were used. The data were entered into Epi-Data 4.2 and analyzed by SPSS version 23. The statistical association was determined using the odds ratio, 95% confidence interval (CI), and a p-value of less than 0.05. Results The proportion of fetal and maternal adverse birth outcomes were 26.7%, and 12.3%, respectively. Previous history of abortion (adjusted odds ratio [AOR] = 2.10, 95% CI = 1.31, 3.66), antenatal care (ANC) follow up (AOR = 3.30, 95% CI = 1.67, 6.58), premature rupture of membrane and hyperemesis (AOR = 3.27, 95% CI = 1.55, 5.89), obstructed labor and meconium-stained amniotic fluid (AOR = 2.31, 95% CI = 1.21, 4.39), and cesarean birth (AOR = 0.50, 95% CI = 0.28, 0.88) were significantly associated fetal adverse birth outcome. Antepartum hemorrhage during the latest pregnancy was associated with maternal adverse birth outcomes (AOR = 1.87, 95% CI = 1.03, 3.38). Conclusion The proportion of adverse birth outcomes in this study was high. Provide community-based health information about ANC follow-up, and community mobilization to reduce abortion. Appropriately manage premature rapture of the membrane after hospital admission.
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Affiliation(s)
- Gedefaye Nibret Mihretie
- Department of Midwifery, College of Medicine and Health SciencesDebre Tabor UniversityDebre TaborEthiopia
| | - Abirham Habitamu
- Department of Midwifery, College of Medicine and Health SciencesDebre Tabor UniversityDebre TaborEthiopia
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Sisk RA, Miraldi-Utz V, Schwartz TL, Hufnagel RB, Ahmed ZM. Long-Term Anatomic and Visual Outcomes of Planned Preterm Delivery and Treatment of Norrie Disease. Ophthalmic Surg Lasers Imaging Retina 2022; 53:464-467. [PMID: 35951720 DOI: 10.3928/23258160-20220706-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We previously reported that planned preterm delivery at 34 weeks gestational age provided an opportunity to treat Norrie disease in the vasoproliferative phase, prevented infantile retinal detachment, and preserved functional vision without further treatment after infancy. Although retinal vascularization did not proceed postnatally, after 8 years of follow-up, the retinas remained attached, and rudimentary foveal development was observed by optical coherence tomography. Best corrected visual acuity gradually improved to 20/80 with both eyes, and visual fields and real-world visual performance were remarkably functional. Global development progressed appropriately, and no long-term sequelae of premature delivery were observed. [Ophthalmic Surg Lasers Imaging Retina 2022;53:464-467.].
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Sudfeld CR, Bliznashka L, Salifou A, Guindo O, Soumana I, Adehossi I, Langendorf C, Grais RF, Isanaka S. Evaluation of multiple micronutrient supplementation and medium-quantity lipid-based nutrient supplementation in pregnancy on child development in rural Niger: A secondary analysis of a cluster randomized controlled trial. PLoS Med 2022; 19:e1003984. [PMID: 35500028 PMCID: PMC9060361 DOI: 10.1371/journal.pmed.1003984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is estimated that over 250 million children under 5 years of age in low- and middle-income countries (LMICs) do not reach their full developmental potential. Poor maternal diet, anemia, and micronutrient deficiencies during pregnancy are associated with suboptimal neurodevelopmental outcomes in children. However, the effect of prenatal macronutrient and micronutrient supplementation on child development in LMIC settings remains unclear due to limited evidence from randomized trials. METHODS AND FINDINGS We conducted a 3-arm cluster-randomized trial (n = 53 clusters) that evaluated the efficacy of (1) prenatal multiple micronutrient supplementation (MMS; n = 18 clusters) and (2) lipid-based nutrient supplementation (LNS; n = 18 clusters) as compared to (3) routine iron-folic acid (IFA) supplementation (n = 17 clusters) among pregnant women in the rural district of Madarounfa, Niger, from March 2015 to August 2019 (ClinicalTrials.gov identifier NCT02145000). Children were followed until 2 years of age, and the Bayley Scales of Infant and Toddler Development III (BSID-III) were administered to children every 3 months from 6 to 24 months of age. Maternal report of WHO gross motor milestone achievement was assessed monthly from 3 to 24 months of age. An intention-to-treat analysis was followed. Child BSID-III data were available for 559, 492, and 581 singleton children in the MMS, LNS, and IFA groups, respectively. Child WHO motor milestone data were available for 691, 781, and 753 singleton children in the MMS, LNS, and IFA groups, respectively. Prenatal MMS had no effect on child BSID-III cognitive (standardized mean difference [SMD]: 0.21; 95% CI: -0.20, 0.62; p = 0.32), language (SMD: 0.16; 95% CI: -0.30, 0.61; p = 0.50) or motor scores (SMD: 0.18; 95% CI: -0.39, 0.74; p = 0.54) or on time to achievement of the WHO gross motor milestones as compared to IFA. Prenatal LNS had no effect on child BSID-III cognitive (SMD: 0.17; 95% CI: -0.15, 0.49; p = 0.29), language (SMD: 0.11; 95% CI: -0.22, 0.44; p = 0.53) or motor scores (SMD: -0.04; 95% CI: -0.46, 0.37; p = 0.85) at the 24-month endline visit as compared to IFA. However, the trajectory of BSID-III cognitive scores during the first 2 years of life differed between the groups with children in the LNS group having higher cognitive scores at 18 and 21 months (approximately 0.35 SD) as compared to the IFA group (p-value for difference in trajectory <0.001). Children whose mothers received LNS also had earlier achievement of sitting alone (hazard ratio [HR]: 1.57; 95% CI: 1.10 to 2.24; p = 0.01) and walking alone (1.52; 95% CI: 1.14 to 2.03; p = 0.004) as compared to IFA, but there was no effect on time to achievement of other motor milestones. A limitation of our study is that we assessed child development up to 2 years of age, and, therefore, we may have not captured effects that are easier to detect or emerge at older ages. CONCLUSIONS There was no benefit of prenatal MMS on child development outcomes up to 2 years of age as compared to IFA. There was evidence of an apparent positive effect of prenatal LNS on cognitive development trajectory and time to achievement of selected gross motor milestones. TRIAL REGISTRATION ClinicalTrials.gov NCT02145000.
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Affiliation(s)
- Christopher R. Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | | | - Sheila Isanaka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Research, Epicentre, Paris, France
- * E-mail:
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Iantosca JAM, Stewart SL. Evaluation of the InterRAI Early Years for Degree of Preterm Birth and Gross Motor Delay. Front Psychol 2022; 13:788290. [PMID: 35282191 PMCID: PMC8904206 DOI: 10.3389/fpsyg.2022.788290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background The interRAI 0–3 Early Years was recently developed to support intervention efforts based on the needs of young children and their families. One aspect of child development assessed by the Early Years instrument are motor skills, which are integral for the maturity of cognition, language, social-emotional and other developmental outcomes. Gross motor development, however, is negatively impacted by pre-term birth and low birth weight. For the purpose of known-groups validation, an at-risk sample of preterm children using the interRAI 0–3 Early Years was included to examine correlates of preterm risk and the degree of gross motor delay. Methods Participant data included children and families (n = 591) from 17 health agencies in Ontario, Canada. Data were collected as part of a pilot study using the full interRAI 0–3 Early Years assessment. Correlational analyses were used to determine relationships between prenatal risk and preterm birth and bivariate analyses examined successful and failed performance of at-risk children on gross motor items. A Kruskal-Wallis test was used to determine the mean difference in gross motor scores for children born at various weeks gestation. Results Correlational analysis indicated that prenatal and perinatal factors such as maternal nicotine use during pregnancy did not have significant influence over gross motor achievement for the full sample, however, gross motor scores were lower for children born pre-term or low birth weight based on bivariate analysis. Gross motor scores decreased from 40 weeks’ gestation (mean rank = 310.77), to moderate to late preterm (mean rank = 258.96), and to very preterm (mean rank = 234.54), however extremely preterm (mean rank = 236.28) performed comparably to very preterm. Interpretation The interRAI 0–3 was evaluated to determine its efficacy and report findings which confirm the literature regarding delay in gross motor performance for preterm children. Findings confirm that pre-term and low birth weight children are at greater risk for motor delay via the interRAI 0–3 Early Years gross motor domain.
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Affiliation(s)
- Jo Ann M Iantosca
- School of Early Childhood Education, Seneca College, Toronto, ON, Canada
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Predictors of respiratory distress syndrome, sepsis and mortality among preterm neonates admitted to neonatal intensive care unit in northern Ethiopia. J Pediatr Nurs 2022; 63:e113-e120. [PMID: 34649733 DOI: 10.1016/j.pedn.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aim to identify the predictors of respiratory distress syndrome, neonatal sepsis and mortality among preterm neonates admitted to neonatal intensive care unit at Ayder Comprehensive Specialized Hospital, northern Ethiopia. MATERIALS AND METHODS An institutional-based retrospective cross-sectional study was conducted on 816 preterm neonates. An association between variables was decided at p-value ≤0.05, or AOR, 95% CI. RESULTS Neonatal sepsis was significantly associated with cesarean section (AOR = 0.62, CI (0.43-0.91)), male (AOR = 1.6, CI (1.12-2.28)), 4-6 APGAR score at 1-min (AOR = 1.67, CI (1.15-2.42)) and hospitalization for more than 14 days (AOR = 2.62, CI (1.5-4.58)) days. Also, the determinants of respiratory distress syndrome were compound fetal presentation (AOR = 2.17, CI (1-4.71)), < 28 weeks of gestational age (AOR = 3.32, CI (1.07-10.22)), 28-31 6/7 weeks of gestational age (AOR = 4.19, CI (2.39-7.33)), 1-1.49 kg birth weight (AOR = 4.22, CI (1.79-9.93)) and 4-6 APGAR score at 1-min (AOR = 2.22, CI (1.54-3.19)). Respiratory distress syndrome (AOR =12, CI (5.42-26.94)) and perinatal asphyxia (AOR = 3.42, CI (1.64-7.11)) were also associated with preterm neonatal mortality. CONCLUSION The predictors of respiratory distress syndrome were fetal presentation, gestational age, birth weight and 1st minute APGAR score. Also, neonatal sepsis was significantly associated with mode of delivery, sex, 1st minute APGAR score, respiratory distress syndrome and duration of hospitalization. Lastly, the predictors of mortality were respiratory distress syndrome, 1st minute APGAR score and perinatal asphyxia. PRACTICE IMPLICATIONS It will give clues to mobilize resources towards the main predictors of comorbidity and mortality in preterms in the health care settings.
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Madaj B, Gopalakrishnan S, Quach A, Filiaci S, Traore A, Bakusa D, Mdegela M, Yousofzai AW, Rahmanzai AJ, Kodindo G, Gami JP, Rostand ND, Kessely H, Addo SA, Abbey M, Sapali M, Omar A, Ernest A, Mtandu R, Agossou A, Ketoh GK, Furtado N, Mangiaterra V, van den Broek N. Where is the 'C' in antenatal care and postnatal care: A multi-country survey of availability of antenatal and postnatal care in low- and middle-income settings. BJOG 2022; 129:1546-1557. [PMID: 35106907 PMCID: PMC9541911 DOI: 10.1111/1471-0528.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Objective Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy‐related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care. Design Cross‐sectional survey. Setting Afghanistan, Chad, Ghana, Tanzania, Togo. Sample Three hundred and twenty‐one healthcare facilities. Methods Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component. Main outcome measure Availability of ANC PNC components. Results Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3–17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub‐Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7–86.5% of facilities. Prevention and management of TB; assessment of pre‐ or post‐term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities. Conclusions Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced. Tweetable abstract ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings. ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings. Linked article: This article is commented on by Carolyn Paul, pp. 1558–1559 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17113.
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Affiliation(s)
- Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Alexandre Quach
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Simone Filiaci
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adama Traore
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Mselenge Mdegela
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | - Hamit Kessely
- Centre de Support en Santé Internationale - Centre de Recherche en Anthropologie et Sciences Humaines (CSSI-CRASH), N'Jamena, Chad
| | | | - Mercy Abbey
- Research and Development Division, Ghana Health Services, Accra, Ghana
| | - Mary Sapali
- Ministry of Health Tanzania Mainland, Dar- es- Salaam, Tanzania
| | - Ali Omar
- Ministry of Health, Zanzibar, Tanzania
| | | | - Rugola Mtandu
- Centre for Maternal and Newborn Health, Dar-es-Salaam, Tanzania
| | | | | | - Nicholas Furtado
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), Geneva, Switzerland
| | - Viviana Mangiaterra
- The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), Geneva, Switzerland
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Survival and mortality of preterm neonates in a neonatal intensive care unit in Northern Ethiopia: a retrospective cohort study. Sci Rep 2022; 12:600. [PMID: 35022458 PMCID: PMC8755721 DOI: 10.1038/s41598-021-04521-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to assess the predictors of preterm neonatal survival in a neonatal intensive care unit (NICU). A cohort study was conducted retrospectively on 1017 preterm neonates using medical records from January 2014 through December 2018. The Kaplan–Meier model was used to estimate mean survival time and cumulative survival probability. Furthermore, Multivariable Cox regression analysis was run to identify predictors of preterm neonatal mortality using an adjusted hazard ratio (AHR) at P < 0.05 and 95% confidence interval (CI). During the follow-up period in the NICU, the mean survival time of the preterm neonates was 47 (95% CI (43.19–48.95)) days. Compound presentation (AHR = 2.29, 95% CI (1.23–4.24)), perinatal asphyxia (AHR = 2.83, 95% CI (1.75–4.58)), respiratory distress syndrome (AHR = 3.01, 95% CI (1.80–5.01)), 1-min APGAR score (AHR = 0.78, 95% CI (0.62–0.98)), and birth weight (AHR = 0.32, 95% CI (0.17–0.58)) were found to be significant predictors of time to preterm neonatal mortality. In conclusion, the survival probability of preterm neonates showed a considerable decrement in the first week of life. Fetal presentation, gestational age, birth weight, 1-min APGAR score, perinatal asphyxia and respiratory distress syndrome found as independent predictors of preterm neonatal mortality.
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Asim M, Hameed W, Saleem S. Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data. PLoS One 2022; 17:e0262323. [PMID: 34990479 PMCID: PMC8735593 DOI: 10.1371/journal.pone.0262323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. METHODS We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. RESULTS We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women's empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44-2.43) and 2.78 (95% CI 2.04-3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60-2.44) and 1.56 (95% CI 2.17-1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. CONCLUSION The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women's empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.
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Affiliation(s)
- Muhammad Asim
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Abadiga M, Mosisa G, Tsegaye R, Oluma A, Abdisa E, Bekele T. Determinants of adverse birth outcomes among women delivered in public hospitals of Ethiopia, 2020. Arch Public Health 2022; 80:12. [PMID: 34983656 PMCID: PMC8728986 DOI: 10.1186/s13690-021-00776-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. Factors such as the age of the mother, antepartum hemorrhage, history of abortion, gestational age, anemia, and maternal undernutrition have predisposed the mother to adverse birth outcome. For appropriate prevention of the adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. Therefore, this study was aimed to assess the determinants of adverse birth outcomes among women who give birth in public hospitals of western Ethiopia. Methods An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. From mothers who gave birth in public hospitals of Wollega zones, 165 cases and 330 controls were selected. Mothers with adverse birth outcomes were cases and mothers without adverse birth were controls. Data was collected by structured interviewer-administered questionnaires. In addition to the interview, the data collectors abstracted clinical data by reviewing the mother and the babies’ medical records. The collected data were entered into Epi info version 7 and exported to SPSS version 21 for analysis. Finally, multivariable logistic regression was used to identify determinants of adverse birth outcomes at P-value < 0.05. Results A total of 495 mothers (165 cases and 330 controls) were included in the study with a mean age of 28.48 + 5.908. Low ANC visit (AOR = 3.92: 95% CI; 1.86, 8.2), premature rupture of membrane (AOR = 2.83: 95% CI; 1.72,4.64), being Anemic (AOR = 2: 95% CI; 1.16,3.44), pregnancy induced-hypertension (AOR = 2.3:95% CI; 1.4,3.85), not getting dietary supplementation (AOR = 2.47:95% CI; 1.6,3.82), and physical abuse (AOR = 2.13: 95% CI; 1.05,4.32) were significantly associated with the development of the adverse birth outcome. Conclusion Low antenatal care visit, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve antenatal care follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00776-0. The adverse birth outcome is a common health problem consisting of several health effects involving pregnancy and the newborn infant. Birth outcomes are measures of health at birth and their magnitude is dramatically decreased in the past 40 years. However; there is still a large gap between developing and developed countries. Infants with one or more adverse birth outcomes are at greater risk for mortality and a variety of health and developmental problems. For appropriate prevention of adverse birth outcomes, data pertaining to determinants of adverse birth outcomes are important. An institutional-based unmatched prospective case-control study was conducted from February 15 to April 15, 2020, in selected public hospitals of western Ethiopia. In this study, low Antenatal care (ANC) visits, being anemic, premature rupture of membrane, pregnancy-induced hypertension, not getting dietary supplementation, and physical abuse were determinants of adverse birth outcomes. The clinicians should play a pivotal role to improve ANC follow up, counsel, and supplement recommended diets and minimize violence and abuse during pregnancy.
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Affiliation(s)
- Muktar Abadiga
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Getu Mosisa
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdisa
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tilahun Bekele
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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22
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Melo WSD, Sousa IES, Mariano SPS, Barbosa AS, Feitosa DSLL, Freire VECDS, Melo ESJ, Monteiro FPM. Wise Infant Development®: creation of a software for teaching in pediatric nursing education. Rev Bras Enferm 2022; 75:e20210466. [DOI: 10.1590/0034-7167-2021-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: to create a software application for nursing education on child development assessment. Methods: this is a methodological applied research developed in three stages: analysis, design, and development. Product quality characteristics from the ISO/IEC 25010 standards were adopted. The programming language used was JavaScript. The educational software was developed based on a constructivist cognitive theory. Results: it was possible to create the software from the following quality metrics: functional suitability, reliability, usability, performance efficiency, compatibility, security, maintainability, and portability. The technology addresses child development in physical, cognitive, and psychosocial domains and how this assessment should be carried out in Brazil. The software has pre and posttests, 5 learning modules, certificate issuance, support for doubts, and an administrative panel. Final Considerations: it is concluded that the software adds to the existing tools for child development monitoring, facilitating students’ knowledge acquisition in promoting child health.
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23
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Schouten E, Haupt J, Ramirez J, Sillett N, Nielsen C, Clarke A, Matkin L, Joseph A, Been J, Bolaños González I, Cheong J, Daly M, Kirpalani H, Mader S, Maria A, Matijasevich A, Mittal R, Mutesu-Kapembwa K, Vavouraki E, Webbe J, Wolke D, Zeitlin J, Flemmer A. Standardized Outcome Measures for Preterm and Hospitalized Neonates: An ICHOM Standard Set. Neonatology 2022; 119:443-454. [PMID: 35545018 PMCID: PMC9533443 DOI: 10.1159/000522318] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Approximately, one in ten infants is born preterm or requires hospitalization at birth. These complications at birth have long-term consequences that can extend into childhood and adulthood. Timely detection of developmental delay through surveillance could enable tailored support for these babies and their families. However, the possibilities for follow-up are limited, especially in middle- and low-income countries, and the tools to do so are either not available or too expensive. A standardized and core set of outcomes for neonates, with feasible tools for evaluation and follow-up, could result in improving quality, enhance shared decision-making, and enable global benchmarking. METHODS The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group, which was comprised of 14 health-care professionals (HCP) and 6 patient representatives in the field of neonatal care. An outcome set was developed using a three-round modified Delphi process, and it was endorsed through a patient representative-validation survey and an HCP survey. RESULTS A literature review revealed 1,076 articles and 26 registries which were screened for meaningful outcomes, patient-reported outcome measures, clinical measures, and case mix variables. This resulted in a neonatal set with 21 core outcomes covering three domains (physical, social, and mental functioning) and 14 tools to assess these outcomes at three timepoints. DISCUSSION This set can be implemented globally and it will allow comparison of outcomes across different settings and countries. The transparent consensus-driven development process which involved stakeholders and professionals from all over the world ensures global relevance.
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Affiliation(s)
- Esther Schouten
- Divison of Neonatology, LMU University Children's Hospital, Dr. V. Hauner, Munich, Germany
| | - Johanna Haupt
- Divison of Neonatology, LMU University Children's Hospital, Dr. V. Hauner, Munich, Germany,
| | - Jessily Ramirez
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, USA
| | - Nick Sillett
- International Consortium for Health Outcomes Measurement (ICHOM), London, United Kingdom
| | - Christina Nielsen
- International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, USA
| | - Anna Clarke
- International Consortium for Health Outcomes Measurement (ICHOM), London, United Kingdom
| | - Lucy Matkin
- International Consortium for Health Outcomes Measurement (ICHOM), London, United Kingdom
| | - Andria Joseph
- International Consortium for Health Outcomes Measurement (ICHOM), London, United Kingdom
| | - Jasper Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilein Bolaños González
- Con Amor Vencerás A.C., Mexico City, Mexico.,GLANCE (GLobal Alliance for Newborn CarE), Mexico City, Mexico
| | - Jeanie Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Mandy Daly
- Advocacy and Policymaking Institutional, Irish Neonatal Health Alliance, Co Wicklow, Ireland
| | - Haresh Kirpalani
- Emeritus, Neonatology, University Pennsylvania, Philadelphia, Pennsylvania, USA.,Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Arti Maria
- Department of Neonatology Institutional, ABVIMS &Dr RML Hospital, New Delhi, India
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Rashmi Mittal
- Department of Neonatology, K.K. Women's and Children's Hospital, Singapore, Singapore
| | - Kunda Mutesu-Kapembwa
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Eleni Vavouraki
- GLANCE (GLobal Alliance for Newborn CarE), Ilitominon, Greece
| | - James Webbe
- Section of Neonatal Medicine, Imperial College London, London, United Kingdom
| | - Dieter Wolke
- Department of Psychology and Division of Health Sciences (Warwick Medical School), University of Warwick, Coventry, United Kingdom
| | - Jennifer Zeitlin
- EPOPé, INSERM, INRA, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
| | - Andreas Flemmer
- Divison of Neonatology, LMU University Children's Hospital, Dr. V. Hauner, Munich, Germany
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24
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Michaelis IA, Krägeloh-Mann I, Mazinu M, Jordaan E. Growth of a cohort of very low birth weight and preterm infants born at a single tertiary health care center in South Africa. Front Pediatr 2022; 10:1075645. [PMID: 36741095 PMCID: PMC9889837 DOI: 10.3389/fped.2022.1075645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Very low birth weight (VLBW) and extremely low birth weight (ELBW) infants are known to be at high risk of growth failure and developmental delay later in life. The majority of those infants are born in low and middle income countries. AIM Growth monitoring in a cohort of infants born with a VLBW up to 18 months corrected age was conducted in a low resource setting tertiary hospital. METHODS In this prospective cohort study, 173 infants with a birth weight below 1,501 g admitted within their first 24 h of life were recruited and the 115 surviving until discharged were asked to follow up at 1, 3, 6, 12 and 18 months. Weight, height and head circumferences were recorded and plotted on WHO Z-score growth charts. RESULTS Of the 115 discharged infants 89 were followed up at any given follow-up point (1, 3, 6, 12 and/or 18 months). By 12 months of corrected age another 15 infants had demised (13.0%). The infants' trends in weight-for-age z-scores (WAZ) for corrected age was on average below the norm up to 12 months (average estimated z-score at 12 months = -0.44; 95% CI, -0.77 to -0.11), but had reached a normal range on average at 18 months = -0.24; 95% CI, -0.65 to 0.19) with no overall difference in WAZ scores weight between males and female' infants (p > 0.7). Similar results were seen for height at 12 months corrected age with height-for-age z-scores (HAZ) of the study subjects being within normal limits (-0.24; 95% CI, -0.63 to 0.14). The mean head circumference z-scores (HCZ) initially plotted below -1.5 standard deviations (S.D.), but after 6 months the z-scores were within normal limits (mean z-score at 7 months = -0.19; 95% CI, -0.45 to 0.06). CONCLUSION Weight gain, length and head circumferences in infants with VLBW discharged showed a catch-up growth within the first 6-18 months of corrected age, with head circumference recovering best. This confirms findings in other studies on a global scale, which may be reassuring for health systems such as those in South Africa with a high burden of children born with low birth weights.
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Affiliation(s)
| | | | - Mikateko Mazinu
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
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25
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Dhiman P, Bharadwaj B, Veena P, Rajendiran S. Polymorphisms in vitamin B12 and folate metabolising genes and their association with adverse pregnancy outcome: secondary analysis of a population based case control study. J OBSTET GYNAECOL 2021; 42:962-967. [PMID: 34907829 DOI: 10.1080/01443615.2021.1979948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitamin B12 and folate deficiency leads to accumulation of homocysteine that increases the risk of adverse pregnancy outcomes like preterm birth and low birth weight (LBW) of the neonate. We explored the association of genetic variants of key vitamin B12 and folate metabolising enzymes (MTHFR C677T and A1298C, MTR A2756G, TCN-2 C776G) with preterm birth and LBW in South Indian women. MTHFR A1298C heterozygotes (AC) were at higher risk for preterm delivery, whereas TCN-2 C776G heterozygotes (CG) were at higher risk for both preterm delivery and LBW. MTHFR C677T, A1298C and MTR A2756G haplotype CAG was protective for preterm delivery (p=.036, OR = 0.475; 95% CI: 0.233-0.97), whereas, haplotype CCG increasing the risk of preterm birth by 1.8 folds (p=.018, OR = 1.81; 95% CI: 1.09-2.98). These results underscore the significance of vitamin B12 and folate in the pathophysiology of preterm birth and LBW.Impact StatementWhat is already known on this subject? Polymorphisms of vitamin B12 and folate metabolising genes have been reported to influence preterm birth and LBW, but the reports are not consistent.What do the results of this study add? We observed a relationship of MTHFR A1298C and TCN-2 C776G with preterm birth, and significant association of TCN-2 C776G with LBW in infants.What are the implications of these findings for clinical practice and/or further research? Identification of women carrying these polymorphic risk alleles may benefit from early nutritional modifications.
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Affiliation(s)
- Pooja Dhiman
- Department of Biochemistry, JIPMER, Puducherry, India
| | | | - P Veena
- Department of Obstetrics & Gynecology, JIPMER, Puducherry, India
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26
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Yakubu IM, Banerjee S, Letam NU. Determinants of Access to Low-Cost Ultrasound Services among Pregnant Women in Rural Areas of Keffi, Nigeria. Indian J Community Med 2021; 46:570-571. [PMID: 34759515 PMCID: PMC8575217 DOI: 10.4103/ijcm.ijcm_971_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Srikanta Banerjee
- Department of Public Health, Walden University, Minneapolis, Minnesota, USA
| | - Nwi-Ue Letam
- Department of Public Health, Walden University, Minneapolis, Minnesota, USA
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27
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Amjad S, Adesunkanmi M, Twynstra J, Seabrook JA, Ospina MB. Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies. Semin Reprod Med 2021; 40:116-123. [PMID: 34500474 DOI: 10.1055/s-0041-1735847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.
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Affiliation(s)
- S Amjad
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Adesunkanmi
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J Twynstra
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - J A Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada.,Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada
| | - M B Ospina
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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28
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Perumal N, Manji KP, Darling AM, Kisenge RR, Kvestad I, Hysing M, Belinger DC, Urassa W, Strand TA, Duggan CP, Fawzi WW, Sudfeld CR. Gestational Age, Birth Weight, and Neurocognitive Development in Adolescents in Tanzania. J Pediatr 2021; 236:194-203.e6. [PMID: 33901518 PMCID: PMC8403162 DOI: 10.1016/j.jpeds.2021.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate the association between gestational age, birthweight, and birthweight adjusted for gestational age, with domains of neurocognitive development and behavioral problems in adolescents in Tanzania. STUDY DESIGN Data from a long-term follow-up of adolescents aged 11-15 years born to women previously enrolled in a randomized controlled trial of prenatal multiple micronutrient supplementation in Dar es Salaam, Tanzania, were used. A battery of neurodevelopmental tests were administered to measure adolescent general intelligence, executive function, and behavioral problems. The INTERGROWTH-21st newborn anthropometric standards were used to derive birthweight for gestational age z-scores. We assessed the shape of relationships using restricted cubic splines and estimated the associations of gestational age, birthweight, and birthweight for gestational age z-score with adolescent development using multivariable linear regressions. RESULTS Among adolescents studied (n = 421), higher gestational age (per week), birthweight (per 100 grams), and birthweight for gestational age z-score (per SD) were linearly associated with higher intelligence score (adjusted standardized mean difference, 0.05 SD [95% CI, 0.01-0.09], 0.04 SD [95% CI, 0.02-0.06], and 0.09 SD [95% CI, 0.01-0.17], respectively). Birthweight and birthweight for gestational age z-score, but not gestational age, were also associated with improved executive function. Low birthweight (<2500 g) was associated with lower intelligence and executive function scores. Associations between birthweight and executive function were stronger among adolescents born to women with higher education. CONCLUSIONS The duration of gestation and birthweight were positively associated with adolescent neurodevelopment in Tanzania. These findings suggest that interventions to improve birth outcomes may also benefit adolescent cognitive function.
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Affiliation(s)
- Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Rodrick R Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ingrid Kvestad
- Regional Center for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Center, Bergen, Norway
| | - Mari Hysing
- Department of Psychological Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway; Faculty of Medicine, Centre for International Health, University of Bergen, Bergen, Norway
| | - Christopher P Duggan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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29
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Min AM, Saito M, Simpson JA, Kennedy SH, Nosten FH, McGready R. Placental histopathology in preterm birth with confirmed maternal infection: A systematic literature review. PLoS One 2021; 16:e0255902. [PMID: 34383833 PMCID: PMC8360573 DOI: 10.1371/journal.pone.0255902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/26/2021] [Indexed: 01/12/2023] Open
Abstract
Four in five neonatal deaths of preterm births occur in low and middle income countries and placental histopathology examination can help clarify the pathogenesis. Infection is known to play a significant role in preterm birth. The aim of this systematic review is to explore the association between placental histopathological abnormality and preterm birth in the presence of confirmed infection. PubMed/Medline, Scopus, Web of Science and Embase were searched using the keywords related to preterm birth, placental histopathology and infection. Titles and abstracts were screened and the full texts of eligible articles were reviewed to extract and summarise data. Of 1529 articles, only 23 studies (13 bacterial, 6 viral and 4 parasitic) were included, and they used 7 different gestational age windows, and 20 different histopathological classification systems, precluding data pooling. Despite this, histopathological chorioamnionitis, and funisitis (when examined) were commonly observed in preterm birth complicated by confirmed bacterial or viral, but not parasitic, infection. The presence of malaria parasites but not pigment in placenta was reported to increase the risk of PTB, but this finding was inconclusive. One in three studies were conducted in low and middle income countries. An array of: definitions of preterm birth subgroups, histological classification systems, histopathologic abnormalities and diagnostic methods to identify infections were reported in this systematic review. Commitment to using standardised terminology and classification of histopathological abnormalities associated with infections is needed to identify causality and potential treatment of preterm birth. Studies on preterm birth needs to occur in high burden countries and control for clinical characteristics (maternal, fetal, labor, and placental) that may have an impact on placental histopathological abnormalities.
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Affiliation(s)
- Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - François H. Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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30
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Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, Shaik NB, Bandiya P, Nanda D, Pullattayil S. AK, Murki S, Roehr CC. ELBW and ELGAN outcomes in developing nations-Systematic review and meta-analysis. PLoS One 2021; 16:e0255352. [PMID: 34352883 PMCID: PMC8342042 DOI: 10.1371/journal.pone.0255352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Context Morbidity and mortality amongst extremely low birth weight (ELBW) and extremely low gestational age neonates (ELGANs) in developing nations has not been well studied. Objectives Evaluate survival until discharge, short- and long-term morbidities of ELBW and ELGANs in LMICs. Data sources CENTRAL, EMBASE, MEDLINE and Web of Science. Study selection Prospective and retrospective observational studies were included. Data extraction and synthesis Four authors extracted data independently. Random-effects meta-analysis of proportions was used to synthesize data, modified QUIPS scale to evaluate quality of studies and GRADE approach to ascertain the certainty of evidence (CoE). Results 192 studies enrolling 22,278 ELBW and 18,338 ELGANs were included. Survival was 34% (95% CI: 31% - 37%) (CoE–low) for ELBW and 39% (34% - 44%) (CoE—moderate) for ELGANs. For ELBW neonates, the survival for low-income (LI), lower middle-income (LMI) and upper middle income (UMI) countries was 18% (11% - 28%), 28% (21% - 35%) and 39% (36% - 42%), respectively. For ELGANs, it was 13% (8% - 20%) for LI, 28% (21% - 36%) for LMI and 48% (42% - 53%) for UMI countries. There was no difference in survival between two epochs: 2000–2009 and 2010–2020. Except for necrotising enterocolitis [ELBW and ELGANs—8% (7% - 10%)] and periventricular leukomalacia [ELBW—7% (4% - 11%); ELGANs—6% (5%-7%)], rates of all other morbidities were higher compared to developed nations. Rates of neurodevelopmental impairment was 17% (7% - 34%) in ELBW neonates and 29% (23% - 37%) in ELGANs. Limitations CoE was very low to low for all secondary outcomes. Conclusions Mortality and morbidity amongst ELBW and ELGANs is still a significant burden in LMICs. CoE was very low to low for all the secondary outcomes, emphasizing the need for high quality prospective cohort studies. Trial registration PROSPERO (CRD42020222873).
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Affiliation(s)
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
- * E-mail:
| | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Prathik Bandiya
- Department of Neonatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Debasish Nanda
- Department of Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Orissa, India
| | | | - Srinivas Murki
- Department of Neonatology, Paramitha Women and Children’s Hospital, Hyderabad, India
| | - Charles Christoph Roehr
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences, Division, University of Oxford, Oxford, United Kingdom
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, United Kingdom
- University of Bristol, Women’s and Children Division, Bristol, United Kingdom
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Unsworth S, Barsosio HC, Achieng F, Juma D, Tindi L, Omiti F, Kariuki S, Nabwera HM. Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight. Paediatr Int Child Health 2021; 41:145-153. [PMID: 33645452 DOI: 10.1080/20469047.2021.1881269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes. AIM To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya. METHODS This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data. RESULTS At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers. CONCLUSION Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..
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Affiliation(s)
- Sarah Unsworth
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool UK
| | - Hellen C Barsosio
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florence Achieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Daniel Juma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Linda Tindi
- Department of Maternal and Child Health, Homa Bay County Teaching and Referral Hospital, Homa Bay, Kenya
| | - Fred Omiti
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool UK
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Vaccaro SM, Tofighi D, Moss N, Rieger R, Lowe JR, Phillips J, Erickson SJ. The association of infant temperament and maternal sensitivity in preterm and full-term infants. Infant Ment Health J 2021; 42:374-385. [PMID: 33836096 DOI: 10.1002/imhj.21915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023]
Abstract
Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity.
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Affiliation(s)
- Suzanne M Vaccaro
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davood Tofighi
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Natalia Moss
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rebecca Rieger
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jean R Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - John Phillips
- The Mind Research Network, Albuquerque, New Mexico, 87106, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
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Do CHT, Børresen ML, Pedersen FK, Nguyen TT, Nguyen HT, Kruse AY. Poor Head Growth Is Associated with Later Mental Delay among Vietnamese Preterm Infants: A Follow-up Study. J Trop Pediatr 2021; 67:fmaa117. [PMID: 33346849 PMCID: PMC7948389 DOI: 10.1093/tropej/fmaa117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Preterm infants in low- and middle-income countries are at high risk of poor physical growth, but their growth data are still scarce. OBJECTIVES To describe the growth of Vietnamese preterm infants in the first 2 years, and to compare with references: World Health Organization (WHO) child growth standards, and healthy Southeast Asian (SEA) infants. Further, to assess the association between growth in the first year and neurodevelopment at 2 years corrected age (CA). METHODS We conducted a cohort study to follow up preterm infants discharged from a neonatal intensive care unit for 2 years. Weight, length and head circumference (HC) were measured at 3, 12 and 24 months CA. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development-3rd Edition at 24 months CA. RESULTS Over 90% of the cohort showed catch-up weight at 3 months CA. Weight and length were comparable to healthy SEA but were lower than WHO standards. HC was significantly smaller than those of WHO standards with HC Z-scores steadily decreasing from -0.95 at 3 months CA to -1.50 at 24 months CA. Each one decrement of HC Z-score from 3 to 12 months CA was associated with nearly twice an increase in odds of mental delay at 24 months CA (odds ratio 1.89; 95% confidence interval 1.02-3.50). CONCLUSION Vietnamese preterm infants exhibited early catch-up weight but poor head growth, which was associated with later delays in mental development. Our findings support the importance of HC measures in follow-up for preterm infants.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Malene Landbo Børresen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Karup Pedersen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tinh Thu Nguyen
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hung Thanh Nguyen
- Scientific Research Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Alexandra Yasmin Kruse
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
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Determinants of Preterm Birth among Mothers Who Gave Birth in Dilla University Referral Hospital, Southern Ethiopia: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7031093. [PMID: 33381578 PMCID: PMC7758120 DOI: 10.1155/2020/7031093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/11/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022]
Abstract
Globally, every year, 1.1 million newborns die due to prematurity. In Ethiopia, 320,000 preterm births occur each year; out of these, 24,400 deaths were due to preterm complications. However, there is little evidence about preterm birth in the study area. Therefore, this study provides an important direction for health professionals, health programmers, and researchers. A facility-based unmatched case-control study design was employed among 244 women (61 cases and 183 controls) who gave birth in Dilla University Referral Hospital and were selected with purposive sampling. The bivariate and multivariable logistic regression model was used to select independent predictors of preterm birth. The multivariate analysis was used, and the results were interpreted using an adjusted odds ratio at 95% confidence interval and statistically significant level at a P value less than 0.05. A total of 240 mothers (60 cases and 180 controls) were included in the study with a 98.3% response rate. Factors like attending secondary educational and above [adjusted odd ratio (aOR) = 0.07 (0.08-0.65)] and attending antenatal care [aOR = 0.41 (0.18-0.93)] were protective whereas having urinary tract infection [aOR = 3.6 (1.1-11)], having human immune virus diseases [aOR = 4.2 (0.9-18)], having a history of abortion [aOR = 2.3 (1.1-5)], having a history of preterm delivery [aOR = 5 (1.6-15)], and having hypertensive disorders of pregnancy [aOR = 5 (1.9-13)] were significantly associated risk factors for preterm birth. The main determinant factors for preterm birth are having antenatal care follow-up, attending secondary education and above, hypertensive disorders of pregnancy, having HIV/AIDS, and history of abortion. This shows a need to strengthen female education; screen mothers for HIV/AIDS, urinary tract infection, and hypertension; and strengthen nutritional counseling, during ANC visits.
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Do CHT, Børresen ML, Pedersen FK, Geskus RB, Kruse AY. Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study. BMJ Open 2020; 10:e036484. [PMID: 33020086 PMCID: PMC7537446 DOI: 10.1136/bmjopen-2019-036484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the characteristics of rehospitalisation in Vietnamese preterm infants and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm (EVP) vs moderate/late preterm (MLP)); and further to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates. DESIGN AND SETTING A cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam. PARTICIPANTS All preterm newborns admitted to the NICU from July 2013 to September 2014. MAIN OUTCOMES Rates, durations and causes of hospital admission during the first 2 years. RESULTS Of 294 preterm infants admitted to NICU (all outborn, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first 2 years CA, of whom 56% were hospital readmitted. The median (IQR) of hospital stay was 7 (6-10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p=0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older siblings were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores). CONCLUSIONS Hospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first 2 years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants is needed in low-income and middle-income countries and attempts to prevent respiratory diseases should be considered.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | | | | | - Ronald Bertus Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Lee JKF, Hern Tan LT, Ramadas A, Ab Mutalib NS, Lee LH. Exploring the Role of Gut Bacteria in Health and Disease in Preterm Neonates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6963. [PMID: 32977611 PMCID: PMC7579082 DOI: 10.3390/ijerph17196963] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/06/2020] [Accepted: 09/19/2020] [Indexed: 02/07/2023]
Abstract
The mortality rate of very preterm infants with birth weight <1500 g is as high as 15%. The survivors till discharge have a high incidence of significant morbidity, which includes necrotising enterocolitis (NEC), early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS). More than 25% of preterm births are associated with microbial invasion of amniotic cavity. The preterm gut microbiome subsequently undergoes an early disruption before achieving bacterial maturation. It is postulated that bacterial gut colonisation at birth and postnatal intestinal dysbacteriosis precede the development of NEC and LONS in very preterm infants. In fact, bacterial colonization patterns in preterm infants greatly differ from term infants due to maternal chorioamnionitis, gestational age, delivery method, feeding type, antibiotic exposure and the environment factor in neonatal intensive care unit (NICU). In this regard, this review provides an overview on the gut bacteria in preterm neonates' meconium and stool. More than 50% of preterm meconium contains bacteria and the proportion increases with lower gestational age. Researchers revealed that the gut bacterial diversity is reduced in preterm infants at risk for LONS and NEC. Nevertheless, the association between gut dysbacteriosis and NEC is inconclusive with regards to relative bacteria abundance and between-sample beta diversity indices. With most studies show a disruption of the Proteobacteria and Firmicutes preceding the NEC. Hence, this review sheds light on whether gut bacteria at birth either alone or in combination with postnatal gut dysbacteriosis are associated with mortality and the morbidity of LONS and NEC in very preterm infants.
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Affiliation(s)
- Jimmy Kok-Foo Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; (J.K.-F.L.); (L.T.H.T.); (A.R.)
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia
| | - Loh Teng Hern Tan
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; (J.K.-F.L.); (L.T.H.T.); (A.R.)
| | - Amutha Ramadas
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; (J.K.-F.L.); (L.T.H.T.); (A.R.)
| | - Nurul-Syakima Ab Mutalib
- UKM Medical Molecular Biology Institute (UMBI), UKM Medical Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Learn-Han Lee
- Novel Bacteria and Drug Discovery Research Group (NBDD), Microbiome and Bioresource Research Strength (MBRS), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; (J.K.-F.L.); (L.T.H.T.); (A.R.)
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Do CHT, Kruse AY, Wills B, Sabanathan S, Clapham H, Pedersen FK, Pham TN, Vu PM, Børresen ML. Neurodevelopment at 2 years corrected age among Vietnamese preterm infants. Arch Dis Child 2020; 105:134-140. [PMID: 31300408 PMCID: PMC7025726 DOI: 10.1136/archdischild-2019-316967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/21/2019] [Accepted: 06/02/2019] [Indexed: 12/05/2022]
Abstract
BACKGROUND Preterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce. OBJECTIVES To examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment. DESIGN AND SETTING Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam. PARTICIPANTS Infants born at <37 weeks of gestational age. MAIN OUTCOMES Bayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants. RESULTS Of 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were -6.9 (-9.1 to -4.7), -7.2 (-10.5 to -3.8) and -3.7 (-6.1 to -1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94). CONCLUSIONS Vietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Alexandra Yasmin Kruse
- Global Health Unit, Department of Paediatric and Adolescence, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Saraswathy Sabanathan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hannah Clapham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Freddy Karup Pedersen
- Global Health Unit, Department of Paediatric and Adolescence, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thanh Ngoc Pham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phuc Minh Vu
- Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Malene Landbo Børresen
- Global Health Unit, Department of Paediatric and Adolescence, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Read SK, Jibril A, Tongo O, Akindolire A, Abdulkadir I, Nabwera H, Sinha I, Allen S. Parents' perceptions of core outcomes in neonatal research in two Nigerian neonatal units. BMJ Paediatr Open 2020; 4:e000669. [PMID: 32548311 PMCID: PMC7279647 DOI: 10.1136/bmjpo-2020-000669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a scarcity of information regarding the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes by different stakeholder groups would inform the development of a core outcome set (COS) for use in neonatal research. OBJECTIVE To determine the perceptions and opinions of parents of newborn babies regarding what outcomes were most important to them in order to contribute towards development of a COS for neonatal research in sub-Saharan Africa. METHODS Semistructured interviews were undertaken with parents, mostly mothers, of babies admitted to one neonatal unit in North central and one in Southwest Nigeria. Participants were purposively sampled to include parents of babies with common neonatal problems such as prematurity. RESULTS We conducted 31 interviews. The most frequently raised outcomes were breast feeding, good health outcomes for their baby, education, growth and financial cost. Parents placed more emphasis on quality of life and functional status than health complications. CONCLUSIONS The opinions of parents need to be considered in developing a COS for neonatal research in low-resource settings. Further research should assess the opinions of families in other low-resource settings and also engage a broader range of stakeholders.
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Affiliation(s)
- Sarah Kathryn Read
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Aisha Jibril
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Olukemi Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Abimbole Akindolire
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Helen Nabwera
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Ian Sinha
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
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Developmental Outcomes of Preterm and Low Birth Weight Toddlers and Term Peers in Rwanda. Ann Glob Health 2019; 85:147. [PMID: 31871910 PMCID: PMC6923771 DOI: 10.5334/aogh.2629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay. Objectives: We aim to describe the differences in development in rural Rwandan children at 24–36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development. Methods: We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05. Findings: In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37–3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay. Conclusion: Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.
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Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:470. [PMID: 31801488 PMCID: PMC6894270 DOI: 10.1186/s12884-019-2626-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.
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Kassahun EA, Mitku HD, Getu MA. Adverse birth outcomes and its associated factors among women who delivered in North Wollo zone, northeast Ethiopia: a facility based cross-sectional study. BMC Res Notes 2019; 12:357. [PMID: 31234898 PMCID: PMC6591928 DOI: 10.1186/s13104-019-4387-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/13/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Pregnancy is a happy time for women and their families although it can also a period of concern and anxiety, for some women, lose their babies during early or late pregnancy, give birth earlier than the expected date or face low birth weight. Therefore, this study aimed to assess the prevalence of adverse birth outcomes and associated factors among women who delivered in the North Wollo zone, northeast Ethiopia. Result The prevalence of adverse birth outcomes among women who delivered in North Wollo zone was 31. 8%. Living in rural area (AOR = 1.8; 95% CI 1.13, 2.78), age ≥ 34 years (AOR = 2.2; 95% CI 1.21, 4.05), mid-upper-arm circumference < 23 cm (AOR = 3.1; 95% CI 1.90, 4.94), multigravida women (AOR = 1.8; 95% CI 1.08, 3.06), lack of antenatal care visit (AOR = 2.1; 95% CI 1.02, 4.40) and complications during pregnancy (AOR = 2.1; 95% CI 1.23, 3.55) were significantly associated with adverse birth outcomes. The prevalence of adverse birth outcomes was high and is a major public health problem in Ethiopia particularly in the study area. Hence, increasing the access to health institutions, developing strategies to prevent and treat complications, and providing focused antenatal care follow-up for pregnant women is recommended.
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Affiliation(s)
| | - Habtamu Dessie Mitku
- Department of Statistics, Faculty of Natural and Computational Sciences, Woldia University, Woldia, Ethiopia
| | - Mikiyas Amare Getu
- Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia
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Aminu M, Mathai M, van den Broek N. Application of the ICD-PM classification system to stillbirth in four sub-Saharan African countries. PLoS One 2019; 14:e0215864. [PMID: 31071111 PMCID: PMC6508706 DOI: 10.1371/journal.pone.0215864] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/09/2019] [Indexed: 01/30/2023] Open
Abstract
Objective To identify the causes and categories of stillbirth using the Application of ICD-10 to Deaths during the Perinatal Period (ICD-PM). Methods Prospective, observational study in 12 hospitals across Kenya, Malawi, Sierra Leone and Zimbabwe. Healthcare providers (HCPs) assigned cause of stillbirth following perinatal death audit. Cause of death was classified using the ICD-PM classification system. Findings 1267 stillbirths met the inclusion criteria. The stillbirth rate (per 1000 births) was 20.3 in Malawi (95% CI: 15.0–42.8), 34.7 in Zimbabwe (95% CI: 31.8–39.2), 38.8 in Kenya (95% CI: 33.9–43.3) and 118.1 in Sierra Leone (95% CI: 115.0–121.2). Of the included cases, 532 (42.0%) were antepartum deaths, 643 (50.7%) were intrapartum deaths and 92 cases (7.3%) could not be categorised by time of death. Overall, only 16% of stillbirths could be classified by fetal cause of death. Infection (A2 category) was the most commonly identified cause for antepartum stillbirths (8.6%). Acute intrapartum events (I3) accounted for the largest proportion of intrapartum deaths (31.3%). In contrast, for 76% of stillbirths, an associated maternal condition could be identified. The M1 category (complications of placenta, cord and membranes) was the most common category assigned for antepartum deaths (31.1%), while complications of labour and delivery (M3) accounted for the highest proportion of intrapartum deaths (38.4%). Overall, the proportion of cases for which no fetal or maternal cause could be identified was 32.6% for antepartum deaths, 8.1% for intrapartum deaths and 17.4% for cases with unknown time of death. Conclusion Clinical care and documentation of this care require strengthening. Diagnostic protocols and guidelines should be introduced more widely to obtain better data on cause of death, especially antepartum stillbirths. Revision of ICD-PM should consider an additional category to help accommodate stillbirths with unknown time of death.
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Affiliation(s)
- Mamuda Aminu
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Agrawal S, Rao SC, Bulsara MK, Patole SK. Prevalence of Autism Spectrum Disorder in Preterm Infants: A Meta-analysis. Pediatrics 2018; 142:peds.2018-0134. [PMID: 30076190 DOI: 10.1542/peds.2018-0134] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Evidence is emerging that preterm infants are at risk for autism spectrum disorder (ASD). OBJECTIVES To conduct a systematic review and meta-analysis to estimate the prevalence of ASD in preterm infants. DATA SOURCES Medline (via PubMed and Ovid), Embase, PsycINFO, and relevant conference proceedings were searched in May 2017. STUDY SELECTION Original studies in which researchers report on the prevalence of ASD using diagnostic tests in children born preterm were included. Studies in which researchers used only ASD screening tools were excluded. DATA EXTRACTION Relevant data were extracted independently by 3 authors. RESULTS Researchers in a total of 18 studies (3366 preterm infants) used ASD diagnostic tools. The median gestation, birth weight, and age at assessment were 28.0 weeks (range: 25.1-31.3 weeks), 1055 g (range: 719-1565 g), and 5.7 years (range: 1.5-21 years), respectively. Meta-analysis revealed that the overall prevalence rate for ASD was 7% (95% confidence interval: 4% to 9%). The funnel plot and Egger's test revealed that there was probably no evidence of publication bias. LIMITATIONS The limitations were significant heterogeneity and a lack of studies from middle- and low-income countries. CONCLUSIONS The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.
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Affiliation(s)
- Sachin Agrawal
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia
| | - Shripada C Rao
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia; .,School of Medicine, University of Western Australia, Crawley, Australia; and
| | - Max K Bulsara
- Department of Biostatistics, Institute for Health Research, University of Notre Dame, Western Australia, Australia
| | - Sanjay K Patole
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Australia; and
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Teklay G, Teshale T, Tasew H, Mariye T, Berihu H, Zeru T. Risk factors of preterm birth among mothers who gave birth in public hospitals of central zone, Tigray, Ethiopia: unmatched case-control study 2017/2018. BMC Res Notes 2018; 11:571. [PMID: 30103806 PMCID: PMC6088394 DOI: 10.1186/s13104-018-3693-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/07/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of the study was to identify the risk factors for preterm birth in public hospitals of the central zone, Tigray, Ethiopia 2017/2018. RESULT A total of 88 neonates who born preterm (cases) and 176 neonates who born term (controls) with their index mothers were included making a response rate of 100%. About 84/88 (95.5%) mothers in cases and 173/176 (98.3%) in control had antenatal care follow up. Among them, 33 (39.3%) cases and 102 (58%) controls were had antenatal care follow up four times and above. In multiple logistic regression at P-value < 0.05, mothers with ANC follow up less than four [AOR 95% CI 2.15 (1.19, 3.85)], mothers with pregnancy-induced hypertension [AOR 3.245; 95% CI (1.58, 6.67)], multiple pregnancy [AOR 2.47; 95% CI (1.14, 5.33)], fetal distress [AOR 4.0; 95% CI (1.9, 8.2)] and birth defect [AOR 3.19; 95% CI (1.22, 8.34)] were independent risk factors of preterm delivery.
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Affiliation(s)
- Girmay Teklay
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Po Box:-298, Axum, Tigray Ethiopia
| | - Tsega Teshale
- Department of Medical Laboratory, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Axum, Tigray Ethiopia
| | - Hagos Tasew
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Po Box:-298, Axum, Tigray Ethiopia
| | - Teklewoini Mariye
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Po Box:-298, Axum, Tigray Ethiopia
| | - Hagos Berihu
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Po Box:-298, Axum, Tigray Ethiopia
| | - Teklay Zeru
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Po Box:-298, Axum, Tigray Ethiopia
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Dagvadorj A, Ganbaatar D, O Balogun O, Yonemoto N, Bavuusuren B, Takehara K, Mori R, Akahira-Azuma M. Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. BMC Pediatr 2018; 18:68. [PMID: 29458342 PMCID: PMC5817794 DOI: 10.1186/s12887-018-1017-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/29/2018] [Indexed: 11/26/2022] Open
Abstract
Background Factors influencing child development are not well studied in developing settings, and especially in Mongolia. This cohort study examined the relationship between maternal socio-demographic and psychological conditions on risk of young child developmental delay. Methods A total of 150 children aged between 13 ~ 24 months old participated in this study. The participants were randomly selected from a pre-existing cohort of 1297 children who were involved in a study on infant bilirubin nomogram development conducted at a tertiary health facility in Mongolia between 2012 and 2013. Child development was evaluated using the Mongolian Rapid Baby Scale (MORBAS), a validated scale for child development. The potential factors for child developmental delay were assessed using a pre-tested questionnaire comprising of 52 questions. Fisher’s exact test and multivariable logistic regression analysis were conducted. Results Seventeen (11%) out of the 150 children that participated in the study were at risk of developmental delay. There was a negative association between the risk of child developmental delay and higher maternal education (AOR 0.15, 95% CI: 0.03–0.66). Increasing maternal age (AOR 1.12, 95%CI: 0.98–1.27), maternal depression symptoms (AOR 4.93, 95%CI: 0.93–26.10), child gender being female (AOR 0.25, 95%CI: 0.06–1.00) and being from single mother household (AOR 0.14, 95%CI: 0.01–1.11) were also predictors for risk of developmental delay – although the association was marginal. Conclusions Our findings suggest that being of underprivileged social status, and poor psychological condition of mothers in Mongolia possibly increases the risk of child developmental delays. Interventions targeting these modifiable predictors are needed to develop prevention strategies for child developmental delay.
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Affiliation(s)
- Amarjargal Dagvadorj
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Duurenbayar Ganbaatar
- Department of Pediatrics, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Olukunmi O Balogun
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Bayasgalantai Bavuusuren
- Department of Pediatrics, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Moe Akahira-Azuma
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
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Villar J, Cheikh Ismail L, Staines Urias E, Giuliani F, Ohuma EO, Victora CG, Papageorghiou AT, Altman DG, Garza C, Barros FC, Puglia F, Ochieng R, Jaffer YA, Noble JA, Bertino E, Purwar M, Pang R, Lambert A, Chumlea C, Stein A, Fernandes M, Bhutta ZA, Kennedy SH. The satisfactory growth and development at 2 years of age of the INTERGROWTH-21 st Fetal Growth Standards cohort support its appropriateness for constructing international standards. Am J Obstet Gynecol 2018; 218:S841-S854.e2. [PMID: 29273309 PMCID: PMC5807090 DOI: 10.1016/j.ajog.2017.11.564] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
Background The World Health Organization recommends that human growth should be monitored with the use of international standards. However, in obstetric practice, we continue to monitor fetal growth using numerous local charts or equations that are based on different populations for each body structure. Consistent with World Health Organization recommendations, the INTERGROWTH-21st Project has produced the first set of international standards to date pregnancies; to monitor fetal growth, estimated fetal weight, Doppler measures, and brain structures; to measure uterine growth, maternal nutrition, newborn infant size, and body composition; and to assess the postnatal growth of preterm babies. All these standards are based on the same healthy pregnancy cohort. Recognizing the importance of demonstrating that, postnatally, this cohort still adhered to the World Health Organization prescriptive approach, we followed their growth and development to the key milestone of 2 years of age. Objective The purpose of this study was to determine whether the babies in the INTERGROWTH-21st Project maintained optimal growth and development in childhood. Study Design In the Infant Follow-up Study of the INTERGROWTH-21st Project, we evaluated postnatal growth, nutrition, morbidity, and motor development up to 2 years of age in the children who contributed data to the construction of the international fetal growth, newborn infant size and body composition at birth, and preterm postnatal growth standards. Clinical care, feeding practices, anthropometric measures, and assessment of morbidity were standardized across study sites and documented at 1 and 2 years of age. Weight, length, and head circumference age- and sex-specific z-scores and percentiles and motor development milestones were estimated with the use of the World Health Organization Child Growth Standards and World Health Organization milestone distributions, respectively. For the preterm infants, corrected age was used. Variance components analysis was used to estimate the percentage variability among individuals within a study site compared with that among study sites. Results There were 3711 eligible singleton live births; 3042 children (82%) were evaluated at 2 years of age. There were no substantive differences between the included group and the lost-to-follow up group. Infant mortality rate was 3 per 1000; neonatal mortality rate was 1.6 per 1000. At the 2-year visit, the children included in the INTERGROWTH-21st Fetal Growth Standards were at the 49th percentile for length, 50th percentile for head circumference, and 58th percentile for weight of the World Health Organization Child Growth Standards. Similar results were seen for the preterm subgroup that was included in the INTERGROWTH-21st Preterm Postnatal Growth Standards. The cohort overlapped between the 3rd and 97th percentiles of the World Health Organization motor development milestones. We estimated that the variance among study sites explains only 5.5% of the total variability in the length of the children between birth and 2 years of age, although the variance among individuals within a study site explains 42.9% (ie, 8 times the amount explained by the variation among sites). An increase of 8.9 cm in adult height over mean parental height is estimated to occur in the cohort from low-middle income countries, provided that children continue to have adequate health, environmental, and nutritional conditions. Conclusion The cohort enrolled in the INTERGROWTH-21st standards remained healthy with adequate growth and motor development up to 2 years of age, which supports its appropriateness for the construction of international fetal and preterm postnatal growth standards.
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Affiliation(s)
- José Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Eleonora Staines Urias
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Francesca Giuliani
- Azienda Ospedaliera OIRM Sant'Anna Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotasl, Pelotas, Brazil
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Fernando C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotasl, Pelotas, Brazil; Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - Fabien Puglia
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | | | - Yasmin A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Enrico Bertino
- Dipartimento di Scienze Pediatriche e dell' Adolescenza, SCDU Neonatologia, Universita di Torino, Torino, Italy
| | - Manorama Purwar
- Nagpur INTERGROWTH-21(st) Research Centre, Ketkar Hospital, Nagpur, India
| | - Ruyan Pang
- School of Public Health, Peking University, Beijing, China
| | - Ann Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Cameron Chumlea
- Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michelle Fernandes
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Montealegre Pomar ADP, Sierra Andrade AP, Charpak N. El Programa Madre Canguro de Yopal, Colombia: una oportunidad de seguimiento del niño prematuro. Rev Salud Publica (Bogota) 2018; 20:10-16. [DOI: 10.15446/rsap.v20n1.67974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivo En Colombia, la incidencia de prematurez y bajo peso al nacer (BPN) es del 12,8%. El objetivo del estudio fue describir el seguimiento estandarizado hasta 12 meses de 1 138 prematuros y/o BPN, atendidos en el Programa Madre Canguro (PMC) de Yopal durante 2014 y 2015.Materiales y Métodos Estudio de cohorte prospectiva.Resultados Los pacientes eran del sistema subsidiado. El 58,2% vivía en la ciudad y 24,6% a más de dos horas de la ciudad. El 80,6% de los padres eran parejas estables y 78,9% tenía empleo. El 69% de las madres inició control prenatal desde el primer trimestre. Las patologías obstétricas más frecuentes fueron la infección urinaria y la pre-eclampsia. El 47% de los partos fueron intrahospitalarios, 55% por cesárea. La mayoría eran prematuros tardíos. El 13,3% pasaron por cuidados intensivos con 27% ventilados y 5,9% oxígeno-dependientes al egreso. A los seis meses, más del 50% tenía lactancia materna exclusiva. Se realizó tamizado de oftalmología en 54% (4,6% retinopatía), de optometría en 72% y de audiología en 70% (4,7% con déficit de audición). A los 12 meses 4,4% tenían examen neurológico anormal y 95% vacunas completas. La deserción fue de 35% y la mortalidad de 0,4%.Conclusiones Es importante implementar PMC en las ciudades intermedias de Colombia que manejan BPN y/o prematuros para asegurar un seguimiento de alto riesgo que detecte anomalías del desarrollo somático, sensorial o neuro-psicomotor y realizar intervenciones oportunas.
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Munhoz Gaiva MA, Coutinho Monteschio C, Souza Moreira M, Marques Salge A. Avaliação do crescimento e desenvolvimento infantil na consulta de enfermagem. AVANCES EN ENFERMERÍA 2018. [DOI: 10.15446/av.enferm.v36n1.62150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objetivo: Analizar la evaluación del crecimiento y desarrollo infantil en la consulta de enfermería.Metodología: Estudio descriptivo con enfoque cualitativo. Los participantes del estudio fueron cuatro enfermeros que realizaban la consulta de enfermería a los niños de manera programática en unidades de salud de familia en Cuiabá, Mato Grosso, Brasil. La recolección de los datos se llevó a cabo mediante la observación participante de 21 consultas de enfermería entre enero y febrero de 2012. Los datos se analizaron con la técnica de análisis de contenido.Resultados: A partir del análisis de los datos, surgieron las siguientes dos categorías: Evaluación del crecimiento infantil en la consulta de enfermería y Evaluación del desarrollo infantil en la consulta de enfermería. Los enfermeros evaluaron el crecimiento infantil en todas las consultas, utilizando las curvas contenidas en la libreta personal de registro médico del niño. Sin embargo, el desarrollo infantil sólo fue evaluado parcialmente en la mayoría de las consultas observadas.Conclusión: Entre los aspectos más significativos de las consultas de enfermería se destacan la evaluación del crecimiento y desarrollo en todas ellas; y el uso de la libreta personal de registro médico del niño como instrumento de orientación para las madres y como estrategia de seguimiento del crecimiento y desarrollo infantil.
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Lee JJ, Kapur K, Rodrigues EG, Ibne Hasan MOS, Quamruzzaman Q, Wright RO, Bellinger DC, Christiani DC, Mazumdar M. Anthropometric measures at birth and early childhood are associated with neurodevelopmental outcomes among Bangladeshi children aged 2-3years. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 607-608:475-482. [PMID: 28704672 PMCID: PMC5587388 DOI: 10.1016/j.scitotenv.2017.06.168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 05/31/2023]
Abstract
Among a cohort of children located in rural areas of Bangladesh affected by high levels of exposure to environmental metals, we investigated the associations between anthropometric measures, growth trajectory, and neurodevelopment at age 20-40months. Our study population included mothers and their children who participated in a longitudinal birth cohort study that took in place in the Pabna and Sirajdikhan areas of Bangladesh. Anthropometric measures including weight, length, and head circumference were measured at birth, age 12months, and age 20-40months. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development Third Edition (BSID-III) multi-scale at age 20-40months. A total of 777 mother-child pairs were included. Higher anthropometric measures at 20-40months were associated with higher cognitive, language, and motor scores on BSID-III. For example, a 1-kg increment in birthweight was associated with an increase of 2.11 for cognitive score (p<0.0001), 1.63 for language score (p=0.006), and 0.89 for motor scores (p=0.03). Greater positive changes in growth parameters, or growth trajectory, between birth and 20-40months were also associated with higher BSID-III scores. These associations remained significant after adjusting for potential confounders and prenatal exposure to environmental metals. These findings suggest that even when taking into account high environmental metal exposures, prenatal and early childhood growth have strong associations with neurodevelopmental test scores in early childhood.
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Affiliation(s)
- Jane J Lee
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Ema G Rodrigues
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | | | - Quazi Quamruzzaman
- Dhaka Community Hospital, 190/1, Wireless Railgate Bara Moghbazar, Dhaka, 1217, Bangladesh.
| | - Robert O Wright
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, NY, New York, 10029, USA.
| | - David C Bellinger
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
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Deshpande G, Jape G, Rao S, Patole S. Benefits of probiotics in preterm neonates in low-income and medium-income countries: a systematic review of randomised controlled trials. BMJ Open 2017; 7:e017638. [PMID: 29222137 PMCID: PMC5728295 DOI: 10.1136/bmjopen-2017-017638] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Although there is an overall reduction in underfive mortality rate, the progress in reducing neonatal mortality rate has been very slow. Over the last 20 years, preterm births have steadily increased in low-income and medium-income countries (LMICs) particularly in sub-Saharan Africa and South Asia. Preterm birth is associated with increased mortality and morbidity, particularly in LMICs. Based on systematic reviews of randomised controlled trials (RCTs), many neonatal units in high-income countries have adopted probiotics as standard of care for preterm neonates. We aimed to systematically review the safety and efficacy of probiotics in reducing mortality and morbidity in preterm neonates in LMICs. DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and E-abstracts from Pediatric Academic Society meetings and other paediatric and neonatal conference proceedings were searched in January 2017. ELIGIBILITY CRITERIA RCTs comparing probiotics versus placebo/no probiotic in preterm neonates (gestation<37 weeks) conducted in LMICs. RESULTS Total 23 (n=4783) RCTs from 4 continents and 10 LMICs were eligible for inclusion in the meta-analysis using fixed effect model. The risk of necrotising enterocolitis (NEC greater than or equal to stage II) (risk ratio (RR) 0.46 (95% CI 0.34 to 0.61), P<0.00001, numbers needed to treat (NNT) 25 (95% CI 20 to 50)), late-onset sepsis (LOS) (RR 0.80 (95% CI 0.71 to 0.91), P=0.0009, NNT 25 (95% CI 17 to 100)) and all-cause mortality (RR 0.73 (95% CI 0.59 to 0.90), P=0.003, NNT 50 (95% CI 25 to 100)) were significantly lower in probiotic supplemented neonates. The results were significant on random effects model analysis and after excluding studies with high risk of bias. No significant adverse effects were reported. CONCLUSION Probiotics have significant potential to reduce mortality and morbidity (eg, NEC, LOS) in preterm neonates in LMICs.
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Affiliation(s)
- Girish Deshpande
- Department of Neonatology, Nepean Hospital Sydney, Kingswood, Australia
- Sydney Medical School Nepean, University of Sydney, Kingswood, NSW, Australia
| | - Gayatri Jape
- Department of Neonatal Paediatrics, KEM Hospital for Women, Subiaco, Australia
- Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Shripada Rao
- Department of Neonatal Paediatrics, KEM Hospital for Women, Subiaco, Australia
- Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Subiaco, Australia
| | - Sanjay Patole
- Department of Neonatal Paediatrics, KEM Hospital for Women, Subiaco, Australia
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