Factors Associated with Increased Risk of Early Severe Neonatal Morbidity in Late Preterm and Early Term Infants

Maternal and neonatal factors associated with hospital readmission of newborns of adolescent mothers

OBJECTIVE

To analyze the maternal and neonatal factors in newborns of adolescent mothers associated with hospital readmission in the neonatal period.

METHOD

Quantitative cross-sectional, retrospective and analytical study, with 489 newborns of adolescent mothers, born in 2019 and 2020 in a high-complexity public hospital in southern Brazil. Data were collected through a query and analyzed in the SPSS software using the chi-square or Fisher's exact tests. To control for confounding factors, the multivariate Poisson regression model was used.

RESULTS

The prevalence of hospital readmissions for newborns of adolescent mothers was 9.2%, mainly due to respiratory conditions, being the most prevalent the diagnosis of acute bronchiolitis, at 22.3%.

CONCLUSION

Neonatal hospital readmission was associated with prematurity, 1st minute Apgar <7 and maternal origin.

The Disease Spectrum and Influencing Factors of NICU in Xiangxi, Underdeveloped Area of China: A 9-Year Retrospective Study

OBJECTIVE

Investigation of the basic conditions and disease spectrum in neonatal intensive care unit (NICU) from 2012 to 2020, in the underdeveloped area of Xiangxi, China.

METHODS

All newborns (N = 16,094) admitted to the NICU of a hospital in the Xiangxi area from 2012 to 2020 were selected for the retrospective study.

RESULTS

The average male/female ratio was 1.43:1, with 9,482 males and 6,612 females admitted to the NICU. The sample comprised 41.02% premature infants, and 56.52% had been delivered via cesarean delivery (CD). The most prevalent diseases diagnosed in the NICU were jaundice (22.01%), respiratory (18.45%) and neurological diseases (17.54%). Over the 9-year study window, the prevalence of jaundice and cardiovascular diseases increased, while respiratory and neurological diseases became less frequent. The prevalence of the remaining diseases remained unchanged. Prevalence of neonatal diseases is influenced by gender, patient sources, delivery methods, gestational age and birth weight (P < 0.05). The prevalence of neonatal diseases was significantly higher in males, infants born via CD, and in infants of lower gestational age and birth weight.

CONCLUSION

The study contributes in-depth information about infant characteristics in an NICU in an undeveloped region of China. In the past 9 years, the average proportion of premature infants in the NICU decreased to 37.38% in 2020, but this figure remains higher than the Chinese national average of 26.2%. Similarly, the CD rate is higher than the Chinese average. The spectrum of neonatal diseases in the NICU in Xiangxi area is drawn, included jaundice, respiratory and neurological diseases, primarily. Through statistical analysis, it is found that the types and prevalence of neonatal diseases are closely related to different gender, gestational age, patient sources, delivery methods, and birth weight (P < 0.05). Newborns of specific gestational age, birth weight and delivery method should be considered "at-risk" and targeted in the formulation of preventive measures. There is a great need to improve the diagnosis and treatment of neonatal diseases-and perinatal health care in general-to ensure improved outcomes for newborns admitted to NICUs in underdeveloped regions.

Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis

BACKGROUND

The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors.

METHOD

A retrospective cohort study with singleton live births (≥32 weeks' gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers' self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality.

RESULTS

Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%).

CONCLUSIONS

There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course.