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Revue Medicale de Liege Jun 2024Prematurity remains a leading cause of mortality and morbidity in neonates and children. Prevention of preterm birth and of its complications is a major public health... (Review)
Review
Prematurity remains a leading cause of mortality and morbidity in neonates and children. Prevention of preterm birth and of its complications is a major public health issue. From before conception to long term follow up, many health actors are engaged in this preventive strategy with the same goal : to give the best quality of life for these vulnerable young patients. We will review different preventive aspects during antenatal and perinatal period, during NICU (Neonatal Intensive Care Unit) stay and after discharge. Prevention of prematurity's complications requires a global approach including respiratory, nutritional and infectious aspects among others. Neuroprotective strategies are a key point of this global approach.
Topics: Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Premature; Pregnancy; Female; Premature Birth
PubMed: 38869136
DOI: No ID Found -
Wiadomosci Lekarskie (Warsaw, Poland :... 2024Aim: To predict trends in fertility, neonatal and perinatal mortality, and stillbirth rates to ascertain future perinatal care requirements during the post-war...
OBJECTIVE
Aim: To predict trends in fertility, neonatal and perinatal mortality, and stillbirth rates to ascertain future perinatal care requirements during the post-war reconstruction in Ukraine.
PATIENTS AND METHODS
Materials and Methods: The study uses the data from the Centre for Medical Statistics of the Ministry of Health of Ukraine, covering the years 2012 to 2022. The data analysis was by a univariate linear regression model. The quality of these models was evaluated using the coefficient of determination, R2.
RESULTS
Results: In 2022, the birth rate in Ukraine had declined to 2.5 times lower than that of 2011. The period was characterized by a notable increase in the incidence of premature births and in neonates with birth weights under 1000 grams and between 1000 to 2499 grams. While the neonatal mortality rate decreased by 3.7 times, there remains a statistically significant (p<0.05) increase in the mortality rates of premature infants and neonates weighing less than 1000 grams. The stillbirth rate in Ukraine remains constant; however, it exceeds that of the European Union. Predictions indicate a rise in antenatal mortality and a reduction in both intranatal and perinatal mortality. As of 2022, the perinatal mortality rate in Ukraine made up 7.72 per 1000 live births, which is significantly higher than the rate in the European Union.
CONCLUSION
Conclusions: The optimization of the network of healthcare facilities and resources should be prioritized, in response to the reliable decline in the birth rate. This necessitates improvements in the medical care for premature and low birth weight infants, and efforts for preventing stillbirths.
Topics: Humans; Ukraine; Infant, Newborn; Stillbirth; Female; Perinatal Mortality; Infant Mortality; Perinatal Care; Pregnancy; Infant; Fertility; Birth Rate; Premature Birth
PubMed: 38865628
DOI: 10.36740/WLek202404116 -
Pediatrics International : Official... 2024Bronchopulmonary dysplasia (BPD) persists as one of the foremost factors contributing to mortality and morbidity in extremely preterm infants. The effectiveness of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bronchopulmonary dysplasia (BPD) persists as one of the foremost factors contributing to mortality and morbidity in extremely preterm infants. The effectiveness of administering sildenafil early on to prevent BPD remains uncertain. The aim of this study was to investigate the efficacy and safety of prophylactically administered sildenafil during the early life stages of preterm infants to prevent mortality and BPD.
METHODS
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Ichushi were searched. Published randomized controlled trials (RCTs), non-RCTs, interrupted time series, cohort studies, case-control studies, and controlled before-and-after studies were included. Two reviewers independently screened the title, abstract, and full text, extracted data, assessed the risk of bias, and evaluated the certainty of evidence (CoE) following the Grading of Recommendations Assessment and Development and Evaluation approach. The random-effects model was used for a meta-analysis of RCTs.
RESULTS
This review included three RCTs (162 infants). There were no significant differences between the prophylactic sildenafil and placebo groups in mortality (risk ratio [RR]: 1.32; 95% confidence interval [CI]: 0.16-10.75; very low CoE), BPD (RR: 1.20; 95% CI: 0.79-1.83; very low CoE), and all other outcome assessed (all with very low CoE). The sample sizes were less than the optimal sizes for all outcomes assessed, indicating the need for further trials.
CONCLUSIONS
The prophylactic use of sildenafil in individuals at risk of BPD did not indicate any advantageous effects in terms of mortality, BPD, and other outcomes, or increased side effects.
Topics: Humans; Sildenafil Citrate; Bronchopulmonary Dysplasia; Infant, Newborn; Phosphodiesterase 5 Inhibitors; Treatment Outcome; Randomized Controlled Trials as Topic; Infant, Extremely Premature; Vasodilator Agents
PubMed: 38863262
DOI: 10.1111/ped.15749 -
JAMA Network Open Jun 2024Preterm birth (PTB) has been associated with lower income in adulthood, but associations with intergenerational income mobility and the role of family socioeconomic...
IMPORTANCE
Preterm birth (PTB) has been associated with lower income in adulthood, but associations with intergenerational income mobility and the role of family socioeconomic status (SES) as modifying factor are unclear.
OBJECTIVES
To assess whether the association between PTB and income differs according to family SES at birth and to assess the association between PTB and intergenerational income mobility.
DESIGN, SETTING, AND PARTICIPANTS
This study comprised a matched cohort of live births in Canada between January 1, 1990, and December 31, 1996, with follow-up until December 31, 2018. Statistical analysis was performed between May 2023 and March 2024.
EXPOSURE
Preterm birth, defined as birth between 24 and 37 weeks' gestational age (with gestational age subcategories of 34-36, 32-33, 28-31, and 24-27 weeks) vs early and full term births (gestational age, 37-41 weeks).
MAIN OUTCOMES AND MEASURES
Associations between PTB and annual adulthood income in 2018 Canadian dollars were assessed overall (current exhange rate: $1 = CAD $1.37) and stratified by family income quintiles, using generalized estimating equation regression models. Associations between PTB and percentile rank change (ie, difference between the rank of individuals and their parents in the income distribution within their respective generations) and upward or downward mobility (based on income quintile) were assessed using linear and multinomial logistic regressions, respectively.
RESULTS
Of 1.6 million included births (51.1% boys and 48.9% girls), 6.9% infants were born preterm (5.4% born at 34-36 weeks, 0.7% born at 32-33 weeks, 0.5% born at 28-31 weeks, and 0.2% born at 24-27 weeks). After matching on baseline characteristics (eg, sex, province of birth, and parental demographics) and adjusting for age and period effects, PTB was associated with lower annual income (mean difference, CAD -$687 [95% CI, -$788 to -$586]; 3% lower per year), and the differences were greater among those belonging to families in the lowest family SES quintile (mean difference, CAD -$807 [95% CI, -$998 to -$617]; 5% lower per year). Preterm birth was also associated with lower upward mobility and higher downward mobility, particularly for those born earlier than 31 weeks' gestational age (24-27 weeks: mean difference in percentile rank change, -8.7 percentile points [95% CI, -10.5 to -6.8 percentile points]).
CONCLUSIONS AND RELEVANCE
In this population-based matched cohort study, PTB was associated with lower adulthood income, lower upward social mobility, and higher downward mobility, with greater differences among those belonging to economically disadvantaged families. Interventions to optimize socioeconomic outcomes of preterm-born individuals would need to define target population considering SES.
Topics: Humans; Premature Birth; Income; Female; Canada; Adult; Male; Social Class; Pregnancy; Infant, Newborn; Social Mobility; Gestational Age; Cohort Studies
PubMed: 38857046
DOI: 10.1001/jamanetworkopen.2024.15921 -
Hawai'i Journal of Health & Social... Jun 2024Given the complex ethical and emotional nature of births during the periviable period for both health care providers and families, this investigation sought to identify...
Given the complex ethical and emotional nature of births during the periviable period for both health care providers and families, this investigation sought to identify strategies for improved counseling of pregnant patients facing preterm birth at the cusp of viability at a tertiary care center in Hawai'i. As part of a larger quality improvement project on periviability counseling, 10 patients were interviewed during either individual or small focus groups using a progression of hypothetical scenarios. Interviews were analyzed independently by 3 investigators to identify themes of patient experience and potential areas for improvement when counseling patients who are carrying periviable pregnancies. Several common themes emerged from the interviews. Patients expressed the desire for more information throughout the process delivered in a jargon-free manner with unified messaging from the medical teams, and emotional support. These findings add to a limited body of literature which addresses patient perceptions of interactions with health care providers in the face of uncertainty, particularly in a Pacific Islander population. The authors recommend increasing provider training and developing a more structured process to counsel pregnant women facing periviable pregnancy loss to improve the patient experience.
Topics: Humans; Female; Pregnancy; Adult; Hawaii; Needs Assessment; Interviews as Topic; Fetal Viability; Focus Groups; Counseling; Qualitative Research; Premature Birth
PubMed: 38855708
DOI: 10.62547/XATQ5707 -
International Journal of Epidemiology Apr 2024Maternal colonization by the bacterium Group B streptococcus (GBS) increases risk of preterm birth, a condition that has an important impact on the health of children....
BACKGROUND
Maternal colonization by the bacterium Group B streptococcus (GBS) increases risk of preterm birth, a condition that has an important impact on the health of children. However, research studies that quantify the effect of GBS colonization on preterm birth have reported variable estimates of the effect measure.
METHODS
We performed a simulated cohort study of pregnant women to assess how timing of exposure (GBS colonization) assessment might influence results of studies that address this question. We used published data on longitudinal maternal GBS colonization and on the distribution of preterm births by gestational age to inform parameters used in the simulations.
RESULTS
Assuming that the probability of preterm birth is higher during weeks when pregnant women are colonized by GBS, our results suggest that studies that assess exposure status early during pregnancy are more likely to estimate an association between GBS colonization and preterm birth that is closer to the null, compared with studies that assess exposure either at birth or during gestational weeks matched to preterm births. In sensitivity analyses assuming different colonization acquisition rates and diagnostic sensitivities, we observed similar results.
CONCLUSIONS
Accurate quantification of the effect of maternal GBS colonization on the risk of preterm birth is necessary to understand the full health burden linked to this bacterium. In this study, we investigated one possible explanation, related to the timing of exposure assessment, for the variable findings of previous observational studies. Our findings will inform future research on this question.
Topics: Humans; Premature Birth; Female; Pregnancy; Streptococcal Infections; Streptococcus agalactiae; Pregnancy Complications, Infectious; Gestational Age; Infant, Newborn; Cohort Studies; Time Factors; Risk Factors
PubMed: 38847782
DOI: 10.1093/ije/dyae076 -
Ugeskrift For Laeger May 2024This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality... (Review)
Review
This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality and morbidity worldwide. The incidence varies globally but remains low in the Nordic countries (5-6%). Prediction and prevention are complicated due to diverse aetiology, but obstetric history and cervical length can improve prediction. Prophylactic vaginal progesterone initiated between 12 and 24 weeks of gestation is recommended to reduce preterm birth less-than 33-35 weeks in singleton pregnancies with a history of preterm birth or with a short cervix (less-than 25 mm) and can be considered for twin pregnancies with the same risk factors.
Topics: Humans; Premature Birth; Pregnancy; Progesterone; Female; Progestins; Administration, Intravaginal; Risk Factors; Cervical Length Measurement; Cervix Uteri
PubMed: 38847312
DOI: 10.61409/V10230636 -
PloS One 2024Intrahepatic cholestasis of pregnancy (ICP) is a serious liver conditions that negatively impacts obstetric and neonatal outcomes. Elevated levels of bile acid,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intrahepatic cholestasis of pregnancy (ICP) is a serious liver conditions that negatively impacts obstetric and neonatal outcomes. Elevated levels of bile acid, particularly glycine conjugate, may compromise blood flow and cause functional hypoxia-ischemia.
AIMS
This meta-analysis aims to assess the association between ICP and key pregnancy outcomes including emergency caesarian sections (C-sections), preeclampsia, hemorrhage, preterm birth, small for gestational age, admission rate to neonatal intensive care union (NICU), gestational age, and stillbirth.
MATERIALS AND METHODS
Literature search across five databases (PubMed, Embase, Web of Science) was done to detect relevant studies published up until June 2023. Meta-analysis of the identified studies was done using a random-effects model, and the results presented as Odds ratio (OR).
RESULTS
A literature search identified 662 studies. Of them, 21 met the inclusion criteria. There was a significant association between ICP and odds of C-section (OR: 1.42, p <0.001), preeclampsia (OR: 2.64, p <0.001), NICU admission (OR: 2.1, p <0.001), and pre-term birth (OR: 2.64, p <0.001). ICP was not associated with postpartum hemmorhage (OR: 1.31, p = 0.13), small for gestational age (OR: 0.87, p = 0.07), stillbirth (OR: 1.49, p = 0.29).
CONCLUSIONS
Our results confirm the adverse effects of ICP on co-existing pregnancy complications, obstetric and neonatal outcomes. ICP in associated with severe complications including increased rates of preeclampsia, emergency C-sections, preterm births, l gestational periods and higher rates of NICU admissions. These results may assist healthcare professionals in formulating comprehensive care guidelines for expectant mothers and newborns.
Topics: Humans; Pregnancy; Cholestasis, Intrahepatic; Female; Pregnancy Complications; Infant, Newborn; Pregnancy Outcome; Premature Birth; Stillbirth; Pre-Eclampsia; Cesarean Section; Gestational Age; Infant, Small for Gestational Age
PubMed: 38833446
DOI: 10.1371/journal.pone.0304604 -
BMC Public Health Jun 2024Empirical evidence on the effects of Medicaid expansion is mixed and highly state-dependent. The objective of this study is to examine the association of Medicaid...
BACKGROUND
Empirical evidence on the effects of Medicaid expansion is mixed and highly state-dependent. The objective of this study is to examine the association of Medicaid expansion with preterm birth and low birth weight, which are linked to a higher risk of infant mortality and chronic health conditions throughout life, providing evidence from a non-expansion state, overall and by race/ethnicity.
METHODS
We used the newborn patient records obtained from Texas Public Use Data Files from 2010 to 2019 for hospitals in Texarkana, which is located on the border of Texas and Arkansas, with all of the hospitals serving pregnancy and childbirth patients on the Texas side of the border. We employed difference-in-differences models to estimate the effect of Medicaid expansion on birth outcomes (preterm birth and low birth weight) overall and by race/ethnicity. Newborns from Arkansas (expanded Medicaid in 2014) constituted the treatment group, while those from Texas (did not adopt the expansion) were the control group. We utilized a difference-in-differences event study framework to examine the gradual impact of the Medicaid expansion on birth outcomes.
RESULTS
Medicaid expansion was associated with a 1.38-percentage-point decrease (95% confidence interval (CI), 0.09-2.67) in preterm birth overall. Event study results suggest that preterm births decreased gradually over time. Medicaid expansion was associated with a 2.04-percentage-point decrease (95% CI, 0.24-3.85) in preterm birth and a 1.75-percentage-point decrease (95% CI, 0.42-3.08) in low birth weight for White infants. However, Medicaid expansion was not associated with significant changes in birth outcomes for other race/ethnicity groups. CONCLUSIONS: Our findings suggest that Medicaid expansion in Texas can potentially improve birth outcomes. However, bridging racial disparities in birth outcomes might require further efforts such as promoting preconception and prenatal care, especially among the Black population.
Topics: Humans; Texas; Medicaid; Female; Infant, Newborn; Premature Birth; Pregnancy; United States; Infant, Low Birth Weight; Adult; Pregnancy Outcome; Arkansas; Patient Protection and Affordable Care Act; Male
PubMed: 38831313
DOI: 10.1186/s12889-024-19007-6 -
Molecular Human Reproduction May 2024Preterm birth is a serious pregnancy complication that affects neonatal mortality, morbidity, and long-term neurological prognosis. Predicting spontaneous preterm...
Preterm birth is a serious pregnancy complication that affects neonatal mortality, morbidity, and long-term neurological prognosis. Predicting spontaneous preterm delivery (PTD) is important for its management. While excluding the risk of PTD is important, identifying women at high risk of PTD is imperative for medical intervention. Currently used PTD prediction parameters in clinical practice have shown high negative predictive values, but low positive predictive values. We focused on sulfated and sialylated glycocalyx changes in the uterus and vagina prior to the onset of parturition and explored the potential of electrophysiological detection of these changes as a PTD prediction parameter with a high positive predictive value. In vivo local vaginal bioelectrical impedance (VZ) was measured using two different mouse PTD models. PTD was induced in ICR mice through the subcutaneous injection of mifepristone or local intrauterine injection of lipopolysaccharide (LPS). The PTD rates were 100% and 60% post-administration of mifepristone (16-20 h, n = 4) and LPS (12-24 h, n = 20), respectively. The local VZ values (15 and 10 h after mifepristone or LPS treatment, respectively) were significantly lower in the PTD group than in the non-PTD group. Receiver operator characteristic (ROC) curve analysis of VZ at 125 kHz as a predictor of PTD showed an area under the ROC curve of 1.00 and 0.77 and positive predictive values of 1.00 and 0.86, for the mifepristone and LPS models, respectively, suggesting that local VZ value can predict PTD. Histological examination of the LPS-treated model 6 h post-treatment revealed increased expression of sulfomucins and/or sulfated proteoglycans and sialomucins in the cervical epithelium, cervical stroma and vaginal stroma. In conclusion, local VZ values can determine sulfated and sialylated glycocalyx alterations within the uterus and vagina and might be a useful PTD prediction parameter.
Topics: Animals; Female; Electric Impedance; Vagina; Pregnancy; Mice; Premature Birth; Mice, Inbred ICR; Mifepristone; Uterus; Lipopolysaccharides; Predictive Value of Tests; ROC Curve; Disease Models, Animal
PubMed: 38830032
DOI: 10.1093/molehr/gaae021