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Journal of Clinical Medicine Jun 2023Bronchopulmonary dysplasia (BPD), also known as chronic lung disease, is the most common respiratory morbidity in preterm infants. "Old" or "classic" BPD, as per the... (Review)
Review
Bronchopulmonary dysplasia (BPD), also known as chronic lung disease, is the most common respiratory morbidity in preterm infants. "Old" or "classic" BPD, as per the original description, is less common now. "New BPD", which presents with distinct clinical and pathological features, is more frequently observed in the current era of advanced neonatal care, where extremely premature infants are surviving because of medical advancements. The pathogenesis of BPD is complex and multifactorial and involves both genetic and environmental factors. This review provides an overview of the pathology of BPD and discusses the influence of several prenatal and postnatal factors on its pathogenesis, such as maternal factors, genetic susceptibility, ventilator-associated lung injury, oxygen toxicity, sepsis, patent ductus arteriosus (PDA), and nutritional deficiencies. This in-depth review draws on existing literature to explore these factors and their potential contribution to the development of BPD.
PubMed: 37445242
DOI: 10.3390/jcm12134207 -
Nature Aug 2023Alveolar epithelial type 1 (AT1) cells are necessary to transfer oxygen and carbon dioxide between the blood and air. Alveolar epithelial type 2 (AT2) cells serve as a...
Alveolar epithelial type 1 (AT1) cells are necessary to transfer oxygen and carbon dioxide between the blood and air. Alveolar epithelial type 2 (AT2) cells serve as a partially committed stem cell population, producing AT1 cells during postnatal alveolar development and repair after influenza A and SARS-CoV-2 pneumonia. Little is known about the metabolic regulation of the fate of lung epithelial cells. Here we report that deleting the mitochondrial electron transport chain complex I subunit Ndufs2 in lung epithelial cells during mouse gestation led to death during postnatal alveolar development. Affected mice displayed hypertrophic cells with AT2 and AT1 cell features, known as transitional cells. Mammalian mitochondrial complex I, comprising 45 subunits, regenerates NAD and pumps protons. Conditional expression of yeast NADH dehydrogenase (NDI1) protein that regenerates NAD without proton pumping was sufficient to correct abnormal alveolar development and avert lethality. Single-cell RNA sequencing revealed enrichment of integrated stress response (ISR) genes in transitional cells. Administering an ISR inhibitor or NAD precursor reduced ISR gene signatures in epithelial cells and partially rescued lethality in the absence of mitochondrial complex I function. Notably, lung epithelial-specific loss of mitochondrial electron transport chain complex II subunit Sdhd, which maintains NAD regeneration, did not trigger high ISR activation or lethality. These findings highlight an unanticipated requirement for mitochondrial complex I-dependent NAD regeneration in directing cell fate during postnatal alveolar development by preventing pathological ISR induction.
Topics: Animals; Mice; Alveolar Epithelial Cells; Cell Differentiation; Cell Lineage; Lung; Mitochondria; NAD; NADH Dehydrogenase; Protons; RNA-Seq; Saccharomyces cerevisiae; Single-Cell Gene Expression Analysis; Stress, Physiological
PubMed: 37558881
DOI: 10.1038/s41586-023-06423-8 -
JAMA Nov 2023Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life.
OBJECTIVE
To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum.
DESIGN, SETTING, AND PARTICIPANTS
Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months.
INTERVENTIONS
Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care.
MAIN OUTCOMES AND MEASURES
The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.
RESULTS
Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001).
CONCLUSIONS AND RELEVANCE
In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04273854.
Topics: Female; Humans; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Hypertension; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Self-Management; Adult; Postnatal Care
PubMed: 37950919
DOI: 10.1001/jama.2023.21523 -
Curationis Dec 2023Community-based postnatal care is a valuable resource in the provision of maternal and neonatal care, specifically outside the hospital environment. However, its...
BACKGROUND
Community-based postnatal care is a valuable resource in the provision of maternal and neonatal care, specifically outside the hospital environment. However, its application in maternal and neonatal care is not clearly documented in relation to the rendering of services by primary caregivers.
OBJECTIVES
This study clarifies the concept of 'community-based postnatal care' by using the concept analysis method.
METHOD
To analyse the concept, relevant literatures were reviewed and analysed using the Walker and Avant method, namely, selecting a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline, related and contrary cases, identifying antecedents and consequences and identifying the empirical referents. Characteristics that repeatedly appeared throughout the literature were noted and categorised.
RESULTS
It was established from the concept analysis that 'community-based postnatal care' was complex and experienced ethnically. The analysis included that primary caregiver participation was based on home-levelled-skilled care, community participation and mobilisation, linkages of health services and community stakeholders. The attributes were influenced by antecedents and consequences.
CONCLUSION
The empirical referents of community based can be integrated within the midwifery guidelines to measure the concept. When concepts are understood, self-care on early detection, early management and referral during early postnatal care will be enhanced.Contribution: The results of this study will foster independence, confidence and a respectful relationship between primary caregivers and the health care facility staff. The results are expected to guide future research and enhance community-based postnatal care in midwifery practice.
Topics: Female; Infant, Newborn; Pregnancy; Humans; Postnatal Care; Midwifery; Nursing Care; Hospitals; Models, Nursing
PubMed: 38111991
DOI: 10.4102/curationis.v46i1.2423 -
CMAJ : Canadian Medical Association... Aug 2023
Topics: Female; Pregnancy; Humans; Breast Feeding; Nutrition Therapy; Patients; Postnatal Care; Lactation
PubMed: 37640403
DOI: 10.1503/cmaj.230366-f -
Annals of Medicine and Surgery (2012) Apr 2024Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite... (Review)
Review
Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite advances in obstetric practices and perinatal care, MAS remains an important cause of morbidity and mortality in term and post-term newborns. Since the 1960s, there have been significant changes in the perinatal and postnatal management of infants born through MSAF. Routine endotracheal suctioning is no longer recommended in both vigorous and non-vigorous neonates with MSAF. Supportive care along with new treatments such as surfactant, inhaled nitric oxide, and high-frequency ventilation has significantly improved the outcome of MAS patients. However, determining the most appropriate approach for this condition continues to be a topic of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management, and prognosis of infants with MAS.
PubMed: 38576961
DOI: 10.1097/MS9.0000000000001835 -
SAGE Open Nursing 2023Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of...
INTRODUCTION
Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake.
OBJECTIVE
The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana.
METHODS
The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with < .05 were significantly associated with PNC. The significance level is anchored at < .05.
RESULTS
The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%).
CONCLUSION
All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.
PubMed: 37830079
DOI: 10.1177/23779608231206759 -
BMC Pregnancy and Childbirth Oct 2023Advances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of... (Review)
Review
BACKGROUND
Advances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of postnatal treatment and the clinical outcomes of affected neonates. Most studies reporting on HDFN originate from high-income countries or relatively large centers, but important differences between centers and countries may exist due to differences in prevalence and available treatment options. We therefore aimed to evaluate the postnatal treatment landscape and clinical outcomes in neonates with Rhesus factor D (Rh(D))- and/or K-mediated HDFN and to provide recommendations for future research.
METHODS
We conducted a rapid literature review of case reports and series, observational retrospective and prospective cohort studies, and trials describing pregnancies or children affected by Rh(D)- or K-mediated HDFN published between 2005 and 2021. Information relevant to the treatment of HDFN and clinical outcomes was extracted. Medline, ClinicalTrials.gov and EMBASE were searched for relevant studies by two independent reviewers through title/abstract and full-text screening. Two independent reviewers extracted data and assessed methodological quality of included studies.
RESULTS
Forty-three studies reporting postnatal data were included. The median frequency of exchange transfusions was 6.0% [interquartile range (IQR): 0.0-20.0] in K-mediated HDFN and 26.5% [IQR: 18.0-42.9] in Rh(D)-mediated HDFN. The median use of simple red blood cell transfusions in K-mediated HDFN was 50.0% [IQR: 25.0-56.0] and 60.0% [IQR: 20.0-72.0] in Rh(D)-mediated HDFN. Large differences in transfusion rates were found between centers. Neonatal mortality amongst cases treated with intrauterine transfusion(s) was 1.2% [IQR: 0-4.4]. Guidelines and thresholds for exchange transfusions and simple RBC transfusions were reported in 50% of studies.
CONCLUSION
Most included studies were from middle- to high-income countries. No studies with a higher level of evidence from centers in low-income countries were available. We noted a shortage and inconsistency in the reporting of relevant data and provide recommendations for future reports. Although large variations between studies was found and information was often missing, analysis showed that the postnatal burden of HDFN, including need for neonatal interventions, remains high.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2021 CRD42021234940. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021234940 .
Topics: Child; Female; Humans; Infant, Newborn; Pregnancy; Erythroblastosis, Fetal; Fetus; Postnatal Care
PubMed: 37853331
DOI: 10.1186/s12884-023-06061-y