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Jones AV, Manasyan A, Xue Y, Kapesa H, Mwendafilumba K, Nalwamba L, Mzumara M, Mubiana-Mbewe M, Dionne JA. Benzathine penicillin G stockouts and other barriers to documented syphilis treatment in pregnancy in Zambia. PLoS One 2024; 19:e0304576. [PMID: 38829879 PMCID: PMC11146727 DOI: 10.1371/journal.pone.0304576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE The prevalence of syphilis in Zambia remains high and is a critical public health concern. The Zambian Ministry of Health recommends universal screening and same-day treatment for syphilis in pregnancy, yet the syphilis screening rate is low, and treatment is poorly documented. The goal of this study was to document syphilis treatment rates and associated factors among pregnant women in care in Zambia. METHODS This retrospective cohort study included pregnant women diagnosed with syphilis according to rapid plasma reagin (RPR) screening during routine antenatal care (ANC) in Lusaka, Zambia in 2018-2019. The main outcome of interest was lack of documented BPG treatment during pregnancy. Additional information about pregnancy and neonatal outcomes, partner referral for therapy, and facility level stockout data were included. Patient characteristics were compared by treatment status using Pearson Chi-Square Test and logistic regression models were created to estimate the association between individual level-factors, facility type, and lack of BPG treatment. A Cochran-Mantel-Haenszel test was used to evaluate facility-level data with significance set at p<0.05. RESULTS Among 1,231 pregnant women who screened positive for syphilis at clinic, 643 (52%) lacked documented antibiotic treatment at the facility. BPG was the only antibiotic used to treat syphilis in the cohort and 8% of sex partners had evidence of referral for therapy. Preterm delivery rates were higher in women without documented BPG (43% vs 32%; p = 0.003). In adjusted models, only calendar year and hospital facility type were associated with lack of treatment. At the facility level, annual syphilis screening rates ranged from 37-65% and most (7/10) clinics reported at least one stockout of BPG. CONCLUSION Treatment rates for syphilis in pregnancy in Zambia were low and BPG medication stockouts at the facility level were common. A consistent supply of BPG at all ANC facilities is needed to facilitate timely treatment and improve birth outcomes.
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Affiliation(s)
- Anna V. Jones
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Albert Manasyan
- Department of Pediatrics, University of Alabama at Birmingham, Children’s of Alabama Hospital, Birmingham, Alabama, United States of America
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Yumo Xue
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Herbert Kapesa
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | | | - Maureen Mzumara
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Jodie A. Dionne
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, University of Alabama at Birmingham Hospital, Birmingham, Alabama, United States of America
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, University of Alabama at Birmingham Hospital, Birmingham, Alabama, United States of America
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Poulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae005. [PMID: 38756556 PMCID: PMC10986301 DOI: 10.1093/haschl/qxae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 05/18/2024]
Abstract
Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.
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Affiliation(s)
| | - Gloria Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Dorian Royal
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | | | - Tiffany Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Tyra Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Kofi Sarkodee
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Sharon Attipoe-Dorcoo
- TERSHA LLC, Alpharetta, GA 30005, United States
- Healthcare Administration Program, College of Business, Texas Woman's University, Denton, TX 76204, United States
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Gebremichael MW, Tsadik M, Abebe HT, Gebreegzabiher A, Beyene S, Aregawi AB, Weldemariam S. Trends and causes of neonatal mortality from 2010 to 2017 at a Health and Demographic Surveillance site in Northern Ethiopia. Glob Health Action 2023; 16:2289710. [PMID: 38126362 PMCID: PMC10763885 DOI: 10.1080/16549716.2023.2289710] [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: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality. OBJECTIVES To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017. METHODS A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression. RESULTS The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia. CONCLUSIONS The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.
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Affiliation(s)
| | - Mache Tsadik
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | | | | | - Selam Beyene
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | - Abera Berhe Aregawi
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
| | - Solomon Weldemariam
- College of Health Sciences, Mekelle University, Mekelle City, Tigray, Ethiopia
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Robb L, Joubert G, Walsh CM. Diet quality indexes for use during pregnancy: a scoping review. Nutr Rev 2023:nuad138. [PMID: 37897078 DOI: 10.1093/nutrit/nuad138] [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: 10/29/2023] Open
Abstract
AIMS High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy. METHODS The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model. RESULTS Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11). CONCLUSION Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries.
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Affiliation(s)
- Liska Robb
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Gina Joubert
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
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Fente BM, Asaye MM, Tesema GA, Gudayu TW. Development and validation of a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit, Northwest, Ethiopia, retrospective follow-up study. BMC Pregnancy Childbirth 2023; 23:732. [PMID: 37848836 PMCID: PMC10583360 DOI: 10.1186/s12884-023-06018-1] [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: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Prematurity is the leading cause of neonatal morbidity and mortality, specifically in low-resource settings. The majority of prematurity can be prevented if early interventions are implemented for high-risk pregnancies. Developing a prognosis risk score for preterm birth based on easily available predictors could support health professionals as a simple clinical tool in their decision-making. Therefore, the study aims to develop and validate a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit at Debre Markos Comprehensive and Specialized Hospital, Ethiopia. METHODS A retrospective follow-up study was conducted among a total of 1,132 pregnant women. Client charts were selected using a simple random sampling technique. Data were extracted using structured checklist prepared in the Kobo Toolbox application and exported to STATA version 14 and R version 4.2.2 for data management and analysis. Stepwise backward multivariable analysis was done. A simplified risk prediction model was developed based on a binary logistic model, and the model's performance was assessed by discrimination power and calibration. The internal validity of the model was evaluated by bootstrapping. Decision Curve Analysis was used to determine the clinical impact of the model. RESULT The incidence of preterm birth was 10.9%. The developed risk score model comprised of six predictors that remained in the reduced multivariable logistic regression, including age < 20, late initiation of antenatal care, unplanned pregnancy, recent pregnancy complications, hemoglobin < 11 mg/dl, and multiparty, for a total score of 17. The discriminatory power of the model was 0.931, and the calibration test was p > 0.05. The optimal cut-off for classifying risks as low or high was 4. At this cut point, the sensitivity, specificity and accuracy is 91.0%, 82.1%, and 83.1%, respectively. It was internally validated and has an optimism of 0.003. The model was found to have clinical benefit. CONCLUSION The developed risk-score has excellent discrimination performance and clinical benefit. It can be used in the clinical settings by healthcare providers for early detection, timely decision making, and improving care quality.
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Affiliation(s)
- Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health sciences, University of Gondar, Gondar, Ethiopia
| | - Mengstu Melkamu Asaye
- Department of Women’s and Family Health, School of midwifery, College of Medicine & Health sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Worku Gudayu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine & Health sciences, University of Gondar, Gondar, Ethiopia
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Hailemeskel HS, Dagnaw FT, Demis S, Birhane BM, Azanaw MM, Chanie ES, Asferie WN, Fetene MT, Mose A, Belay DM, Kefale D, Kassaw A, Tiruneh M, Tesfaw A, Tilaye BA, Arage G, Kebede AB, Tiruneh SA. Neonatal outcomes of preterm neonates and its predictors in Ethiopian public hospitals: Multicenter prospective follow-up study. Heliyon 2023; 9:e18534. [PMID: 37576212 PMCID: PMC10412993 DOI: 10.1016/j.heliyon.2023.e18534] [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: 03/01/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors. Objective This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021. Methods A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P-value less than 0.05. Result The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (β = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (β = 0.85; 95% CI: 0.49, 1.22), body mass index (β = -1.34; 95% CI: -1.87, -0.80), non-union marital status (β = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (β = -0.66; 95% CI: -0.99-0.32), multiparous (β = 0.35; 95% CI: 0.01, 0.69), hypothermia (β = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (β = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (β = -1.23; 95% CI: -1.99,-0.46) were significant predictors. Conclusion In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births.
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Affiliation(s)
- Habtamu Shimels Hailemeskel
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Ayenew Mose
- Department of Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Demewoz Kefale
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birara Aychew Tilaye
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemwork Baye Kebede
- Neonatal Intensive Care Unit, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Patawat M, Choudhary R, Jain MK, Chanchalani R, Jain A. Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study. Cureus 2023; 15:e37861. [PMID: 37223204 PMCID: PMC10204614 DOI: 10.7759/cureus.37861] [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: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Kangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methods We conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant. Results One hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. Conclusion Sets of intervention packages based on needs analysis using the PDSA cycle were able to improve the rate and duration of KMC in the hospital and at home.
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Affiliation(s)
- Meena Patawat
- Department of Pediatrics, Government Medical College, Pali, IND
| | - Ramesh Choudhary
- Department of Paediatrics, JK Lon Hospital, Sawai Man Singh (SMS) Medical College, Jaipur, IND
| | - Mahendra K Jain
- Department of Neonatology, All India Institutes of Medical Sciences (AIIMS) Bhopal, Bhopal, IND
| | - Roshan Chanchalani
- Department of Pediatrics Surgery, All India Institutes of Medical Sciences (AIIMS) Bhopal, Bhopal, IND
| | - Anubhuti Jain
- Department of Obstetrics and Gynaecology, Jain Clinic, Bhopal, IND
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Feleke SF, Anteneh ZA, Wassie GT, Yalew AK, Dessie AM. Developing and validating a risk prediction model for preterm birth at Felege Hiwot Comprehensive Specialized Hospital, North-West Ethiopia: a retrospective follow-up study. BMJ Open 2022; 12:e061061. [PMID: 36167381 PMCID: PMC9516143 DOI: 10.1136/bmjopen-2022-061061] [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: 11/03/2022] Open
Abstract
OBJECTIVE To develop and validate a risk prediction model for the prediction of preterm birth using maternal characteristics. DESIGN This was a retrospective follow-up study. Data were coded and entered into EpiData, V.3.02, and were analysed using R statistical programming language V.4.0.4 for further processing and analysis. Bivariable logistic regression was used to identify the relationship between each predictor and preterm birth. Variables with p≤0.25 from the bivariable analysis were entered into a backward stepwise multivariable logistic regression model, and significant variables (p<0.05) were retained in the multivariable model. Model accuracy and goodness of fit were assessed by computing the area under the receiver operating characteristic curve (discrimination) and calibration plot (calibration), respectively. SETTING AND PARTICIPANTS This retrospective study was conducted among 1260 pregnant women who did prenatal care and finally delivered at Felege Hiwot Comprehensive Specialised Hospital, Bahir Dar city, north-west Ethiopia, from 30 January 2019 to 30 January 2021. RESULTS Residence, gravidity, haemoglobin <11 mg/dL, early rupture of membranes, antepartum haemorrhage and pregnancy-induced hypertension remained in the final multivariable prediction model. The area under the curve of the model was 0.816 (95% CI 0.779 to 0.856). CONCLUSION This study showed the possibility of predicting preterm birth using maternal characteristics during pregnancy. Thus, use of this model could help identify pregnant women at a higher risk of having a preterm birth to be linked to a centre.
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Affiliation(s)
| | - Zelalem Alamrew Anteneh
- Department of Epidemiology and Biostatistics, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia
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Goldenberg RL, Dhaded S, Saleem S, Goudar SS, Tikmani SS, Trotta M, Hwang Jackson K, Guruprasad G, Kulkarni V, Kumar S, Uddin Z, Reza S, Raza J, Yasmin H, Yogeshkumar S, Somannavar MS, Aceituno A, Parlberg L, Silver RM, McClure EM. Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG 2022; 129:1993-2000. [PMID: 35593030 DOI: 10.1111/1471-0528.17220] [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: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology. DESIGN Prospective, observational study. SETTINGS Study NICUs in India and Pakistan. POPULATION Preterm infants delivered in study facility. METHODS A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel. MAIN OUTCOME MEASURES RDS and birth asphyxia. RESULTS Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia. CONCLUSIONS NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.
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Affiliation(s)
| | - Sangappa Dhaded
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Gowder Guruprasad
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Sunil Kumar
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - S Yogeshkumar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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10
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Lategan I, Price C, Rhoda NR, Zar HJ, Tooke L. Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa. Front Glob Womens Health 2022; 3:817817. [PMID: 35464776 PMCID: PMC9019119 DOI: 10.3389/fgwh.2022.817817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/18/2022] [Indexed: 01/13/2023] Open
Abstract
Background Preterm birth is a global public health issue and complications of preterm birth result in the death of approximately 1 million infants each year, 99% of which are in low-and-middle income countries (LMIC). Although respiratory interventions such as continuous positive airway pressure (CPAP) and surfactant have been shown to improve the outcomes of preterm infants with respiratory distress, they are not readily available in low-resourced areas. The aim of this study was to report the respiratory support needs and outcomes of preterm infants in a low-resourced setting, and to estimate the impact of a lack of access to these interventions on neonatal mortality. Methods We conducted a six-month prospective observational study on preterm infants <1,801 g admitted at Groote Schuur Hospital and Mowbray Maternity Hospital neonatal units in Cape Town, South Africa. We extrapolated results from the study to model the potential outcomes of these infants in the absence of these interventions. Results Five hundred and fifty-two infants (552) <1,801 g were admitted. Three hundred (54.3%) infants received CPAP, and this was the initial respiratory intervention for most cases of respiratory distress syndrome. Surfactant was given to 100 (18.1%) infants and a less invasive method was the most common method of administration. Invasive mechanical ventilation was offered to 105 (19%) infants, of which only 57 (54.2%) survived until discharge from hospital. The overall mortality of the cohort was 14.1% and the hypothetical removal of invasive mechanical ventilation, surfactant and CPAP would result in an additional 157 deaths and increase the overall mortality to 42.5%. A lack of CPAP availability would have the largest impact on mortality and result in the largest number of additional deaths (109). Conclusion This study highlights the effect that access to key respiratory interventions has on preterm outcomes in LMICs. CPAP has the largest impact on neonatal mortality and improving its coverage should be the primary goal for low-resourced areas to save newborn lives.
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Affiliation(s)
- Ilse Lategan
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Caris Price
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Natasha Raygaan Rhoda
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SA-MRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lloyd Tooke
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- *Correspondence: Lloyd Tooke
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11
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Meiring S, Mashau R, Magobo R, Perovic O, Quan V, Cohen C, de Gouveia L, von Gottberg A, Mackay C, Mailula MT, Phayane R, Dramowski A, Govender NP. Study protocol for a population-based observational surveillance study of culture-confirmed neonatal bloodstream infections and meningitis in South Africa: Baby GERMS-SA. BMJ Open 2022; 12:e049070. [PMID: 35135762 PMCID: PMC8830263 DOI: 10.1136/bmjopen-2021-049070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Worldwide, neonatal mortality remains high accounting for 47% of childhood deaths in 2019 and including an estimated 500 000 deaths from neonatal infections. While 42% of global neonatal deaths occur in sub-Saharan Africa, there is limited understanding of population-level burden and aetiology of neonatal infections outside tertiary-level institutions. METHODS AND ANALYSIS We aim to implement the first population-level surveillance for bloodstream infections and meningitis among neonates aged <28 days in South Africa. Tier 1 will include national surveillance of culture-confirmed neonatal infections at all public-sector hospitals describing infection incidence risk, pathogen profile and antimicrobial susceptibility by institution, province and healthcare level (2014-2021). Tier 2 (nested within tier 1) will be conducted at six regional neonatal units over 12 months, will compare the clinical characteristics of neonates with early-onset and late-onset infections and identify potentially modifiable risk factors for mortality. Through tier 2, we will determine the antimicrobial susceptibility of neonatal pathogens, evaluate the appropriateness of empiric antibiotic prescribing and determine the genomic epidemiology of multidrug resistant bacterial and fungal pathogens. ETHICS AND DISSEMINATION Ethics clearance was obtained from the Human Research Ethics Committee of the University of the Witwatersrand (M190320). Funding for the study was obtained through a grant from the Bill and Melinda Gates Foundation (OPP1208882). Baby GERMS-SA aims to impact on national policy, resource allocation and neonatal guidelines by describing the national burden of neonatal infections in South Africa. In addition, end-users in neonatal units will benefit from a facility-level dashboard displaying key indicators of the surveillance findings.
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Affiliation(s)
- Susan Meiring
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Rudzani Mashau
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Rindidzani Magobo
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Olga Perovic
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Vanessa Quan
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Linda de Gouveia
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Anne von Gottberg
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cheryl Mackay
- Department of Paediatrics and Child Health, Dora Nginza Hospital, Port Elizabeth, South Africa
| | - Mphekwa Thomas Mailula
- Department of Paediatrics and Child Health, Mankweng Regional Hospital Mankweng, Mankweng, South Africa
| | - Rose Phayane
- Department of Paediatrics and Child Health, Tembisa Provincial Hospital, Johannesburg, South Africa
| | - Angela Dramowski
- Department of Paediactrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nelesh P Govender
- National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
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12
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Michaelis IA, Krägeloh-Mann I, Manyisane N, Mazinu MC, Jordaan ER. Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa. BMJ Paediatr Open 2021; 5:e000918. [PMID: 33665373 PMCID: PMC7893654 DOI: 10.1136/bmjpo-2020-000918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed. Methods This is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality. Results 173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years. Conclusion This prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.
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Affiliation(s)
- Isabel A Michaelis
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Ingeborg Krägeloh-Mann
- Children's Hospital, Neuropaediatrics, Developmental Neurology, Social Paediatrics, Eberhard Karls University Tübingen Faculty of Medicine, Tübingen, Baden-Württemberg, Germany
| | - Ncomeka Manyisane
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Mikateko C Mazinu
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Esme R Jordaan
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
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Predominance of Atopobium vaginae at Midtrimester: a Potential Indicator of Preterm Birth Risk in a Nigerian Cohort. mSphere 2021; 6:6/1/e01261-20. [PMID: 33504666 PMCID: PMC7885325 DOI: 10.1128/msphere.01261-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Giving birth too soon accounts for half of all newborn deaths worldwide. Clinical symptoms alone are not sufficient to identify women at risk of giving birth too early, as such a pragmatic approach to reducing the incidence of preterm birth entails developing early strategies for intervention before it materializes. Preterm birth (PTB) is the largest contributor to infant death in sub-Saharan Africa and globally. With a global estimate of 773,600, Nigeria has the third highest rate of PTB worldwide. There have been a number of microbiome profiling studies to identify vaginal microbiomes suggestive of preterm and healthy birth outcome. However, studies on the pregnancy vaginal microbiome in Africa are sparse with none performed in Nigeria. Moreover, few studies have considered the concurrent impact of steroid hormones and the vaginal microbiome on pregnancy outcome. We assessed two key determinants of pregnancy progression to gain a deeper understanding of the interactions between vaginal microbiome composition, steroid hormone concentrations, and pregnancy outcome. Vaginal swabs and blood samples were prospectively collected from healthy midtrimester pregnant women. Vaginal microbiome compositions were assessed by analysis of the V3-V5 region of 16S rRNA genes, and potential functional metabolic traits of identified vaginal microbiomes were imputed by PICRUSt (phylogenetic investigation of communities by reconstruction of unobserved states) analysis, while plasma estradiol (E2) and progesterone (P1) levels were quantified by the competitive enzyme-linked immunosorbent assay (ELISA). PTB vaginal samples were characterized by increased microbial richness, high diversity, and depletion of lactobacilli compared to term delivery samples. Women who delivered preterm were characterized by an Atopobium vaginae-dominated vagitype. High relative abundance of Atopobium vaginae at the midtrimester was highly predictive of PTB (area under the receiving operator characteristics [AUROC] of 0.983). There was a marked overlap in the range of plasma E2 and P1 values between term and PTB groups. IMPORTANCE Giving birth too soon accounts for half of all newborn deaths worldwide. Clinical symptoms alone are not sufficient to identify women at risk of giving birth too early, as such a pragmatic approach to reducing the incidence of preterm birth entails developing early strategies for intervention before it materializes. In view of the role played by the vaginal microbiome and maternal steroid hormones in determining obstetric outcome, we assessed the vaginal microbiome composition and steroid hormone during pregnancy and examined their relationship in predicting preterm birth risk in Nigerian women. This study highlights a potential early-driver microbial marker for prediction of preterm birth risk and supports the notion that vaginal microbiome composition varies across populations. A knowledge of relevant preterm birth microbial markers specific to populations would enhance the development of personalized therapeutic interventions toward restoring a microbiome that optimizes reproductive health fitness, therefore reducing the incidence of preterm birth.
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15
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Caffarelli C, Santamaria F, Mirra V, Bacchini E, Santoro A, Bernasconi S, Corsello G. Advances in paediatrics in 2019: current practices and challenges in allergy, endocrinology, gastroenterology, public health, neonatology, nutrition, nephrology, neurology, respiratory diseases and rheumatic diseases. Ital J Pediatr 2020; 46:89. [PMID: 32600434 PMCID: PMC7325159 DOI: 10.1186/s13052-020-00853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
We highlight the main developments that have been published during the first semester of the last year in the Italian Journal of Pediatrics. We have carefully chosen information from numerous exciting progresses issued in the Journal in the field of allergy, endocrinology, gastroenterology, neonatology, nutrition, nephrology, neurology, public health, respiratory diseases and rheumatic diseases. The impact on the care of patients has been placed in the broader context of studies that appeared in other journals. We think that many observations can be used directly to upgrade management of patients.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ermanno Bacchini
- Unità Polispecialistica Pediatrica Centro Medi Saluser, Parma, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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The State of the Science of Preterm Birth: Assessing Contemporary Screening and Preventive Strategies. J Perinat Neonatal Nurs 2020; 34:113-124. [PMID: 32332440 DOI: 10.1097/jpn.0000000000000470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preterm birth remains a leading cause of morbidity and mortality during the perinatal and neonatal periods. Now affecting approximately 1 in 10 births in the United States, preterm birth often occurs spontaneously and without a clear etiology. Careful assessment of risk factors, however, identifies vulnerable women allowing targeted interventions such as progestogen therapy and cerclage. This article is intended to highlight preterm birth risk factors and current predictive and preventive strategies for midwives, nurse practitioners, clinical nurse specialists, and perinatal nurses.
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Curstedt T, Halliday HL, Hallman M, Saugstad OD, Speer CP. Sharing Progress in Neonatology (SPIN): Old Favorites - Bronchopulmonary Dysplasia, Patent Ductus Arteriosus, and Necrotizing Enterocolitis plus Some Global Neonatology and the Future of Clinical Trials. Neonatology 2020; 117:204-206. [PMID: 32610329 DOI: 10.1159/000506774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
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Van Wyk L, Tooke L, Dippenaar R, Rhoda N, Lloyd L, Holgate S, Alexander R, Smith J. Optimal Ventilation and Surfactant Therapy in Very-Low-Birth-Weight Infants in Resource-Restricted Regions. Neonatology 2020; 117:217-224. [PMID: 32454492 DOI: 10.1159/000506987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/19/2022]
Abstract
In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported, making the determination of effective interventions and their outcome difficult. The combination of oxygen, nasal continuous positive airway pressure (CPAP) and surfactant therapy has the potential to prevent 42% of RDS-related deaths in sub-Saharan Africa, despite the financial implications. This article provides a brief overview on the status of RDS management, mainly nasal CPAP and surfactant therapy in very-low-birth-weight infants, in resource-restricted regions of sub-Saharan Africa. Data from the public health sector, as compared to the private health sector, of the Western Cape province, South Africa, are used to illustrate what RDS management strategies are able to accomplish in a resource-restricted region. Upscaling of all components (antenatal care, antenatal corticosteroids, prevention of hypothermia and RDS management strategies) are required to decrease premature infant mortality rates in resource-restricted areas.
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Affiliation(s)
- Lizelle Van Wyk
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa,
| | - Lloyd Tooke
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Ricky Dippenaar
- NICU, N1 City and Blaauwberg Hospital, Cape Town, South Africa
| | - Natasha Rhoda
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Lizel Lloyd
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sandi Holgate
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Johan Smith
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.,Panorama Medi-Clinic, Cape Town, South Africa
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Schmidt AF, Kemp MW, Milad M, Miller LA, Bridges JP, Clarke MW, Kannan PS, Jobe AH. Oral dosing for antenatal corticosteroids in the Rhesus macaque. PLoS One 2019; 14:e0222817. [PMID: 31536601 PMCID: PMC6752828 DOI: 10.1371/journal.pone.0222817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/06/2019] [Indexed: 02/04/2023] Open
Abstract
Antenatal corticosteroids (ACS) are standard of care for women at risk of preterm delivery, although choice of drug, dose or route have not been systematically evaluated. Further, ACS are infrequently used in low resource environments where most of the mortality from prematurity occurs. We report proof of principle experiments to test betamethasone-phosphate (Beta-P) or dexamethasone-phosphate (Dex-P) given orally in comparison to the clinical treatment with the intramuscular combination drug beta-phosphate plus beta-acetate in a Rhesus Macaque model. First, we performed pharmacokinetic studies in non-pregnant monkeys to compare blood levels of the steroids using oral dosing with Beta-P, Dex-P and an effective maternal intramuscular dose of the beta-acetate component of the clinical treatment. We then evaluated maternal and fetal blood steroid levels with limited fetal sampling under ultrasound guidance in pregnant macaques. We found that oral Beta is more slowly cleared from plasma than oral Dex. The blood levels of both drugs were lower in maternal plasma of pregnant than in non-pregnant macaques. Using the pharmacokinetic data, we treated groups of 6–8 pregnant monkeys with oral Beta-P, oral Dex-P, or the maternal intramuscular clinical treatment and saline controls and measured pressure-volume curves to assess corticosteroid effects on lung maturation at 5d. Oral Beta-P improved the pressure-volume curves similarly to the clinical treatment. Oral Dex-P gave more variable and nonsignificant responses. We then compared gene expression in the fetal lung, liver and hippocampus between oral Beta-P and the clinical treatment by RNA-sequencing. The transcriptomes were largely similar with small gene expression differences in the lung and liver, and no differences in the hippocampus between the groups. As proof of principle, ACS therapy can be effective using inexpensive and widely available oral drugs. Clinical dosing strategies must carefully consider the pharmacokinetics of oral Beta-P or Dex-P to minimize fetal exposure while achieving the desired treatment responses.
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Affiliation(s)
- Augusto F. Schmidt
- Department of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | | | - Mark Milad
- Milad Pharmaceutical consulting LLC, Plymouth, Michigan, United States of America
| | - Lisa A. Miller
- California National Primate Research Center, University of California, Davis, Davis, California, United States of America
| | - James P. Bridges
- Department of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Michael W. Clarke
- Metabolomics Australia, Centre for Microscopy, Characterization and Analysis, The University of Western Australia, Perth, WA, Australia
| | - Paranthaman S. Kannan
- Department of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Alan H. Jobe
- Department of Neonatology and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America
- University of Western Australia, Perth, Australia
- * E-mail:
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