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Frontiers in Pharmacology 2024Drug trials in neonates are scarce, and the neonates may consequently be at risk of adverse drug reactions (ADRs). Spontaneous ADR reporting is an important tool for...
INTRODUCTION
Drug trials in neonates are scarce, and the neonates may consequently be at risk of adverse drug reactions (ADRs). Spontaneous ADR reporting is an important tool for expanding the knowledge on drug safety in neonates. This study explores the quality of current neonatal ADR reports and the ADR reports of the most common drugs used in neonatal departments.
METHODS
An observational cross-sectional study focused on neonates was conducted using data on spontaneous reports extracted from the U.S. Food and Drug Administration Adverse Events Reporting System (FAERS) from the third quarter of 2014 up to December 2022. Only the primary suspect drugs given to neonates or subjects aged <30 days were included in the analysis.
RESULTS
Spontaneous reports from 13 million patients of all ages, totaling 50 million ADRs, were evaluated. Information regarding the age was missing in 40% of the reports, and data on 43,737 neonates with 948 different suspected drugs were identified and included in the analysis. We report the frequency of spontaneous ADR reports in the FAERS database for the ten most frequently administered drugs in neonatal intensive care units in the USA.
CONCLUSION
Overall, neonatal ADRs are still underreported. The FAERS database in its current form discriminates insufficiently between prenatal and postnatal drug exposures. Hence, improved neonatal pharmacovigilance systems are urgently needed.
PubMed: 38903999
DOI: 10.3389/fphar.2024.1395982 -
Frontiers in Genetics 2024In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England, requiring the coordination of care from...
INTRODUCTION
In October 2020, rapid prenatal exome sequencing (pES) was introduced into routine National Health Service (NHS) care in England, requiring the coordination of care from specialist genetics, fetal medicine (FM) and laboratory services. This mixed methods study explored the experiences of professionals involved in delivering the pES service during the first 2 years of its delivery in the NHS.
METHODS
A survey ( = 159) and semi-structured interviews ( = 63) with healthcare professionals, including clinical geneticists, FM specialists, and clinical scientists (interviews only) were used to address: 1) Views on the pES service; 2) Capacity and resources involved in offering pES; 3) Awareness, knowledge, and educational needs; and 4) Ambitions and goals for the future.
RESULTS
Overall, professionals were positive about the pES service with 77% rating it as Good or Excellent. A number of benefits were reported, including the increased opportunity for receiving actionable results for parental decision-making, improving equity of access to genomic tests and fostering close relationships between FM and genetics departments. Nonetheless, there was evidence that the shift to offering pES in a clinical setting had brought some challenges, such as additional clinic time, administrative processes, perceived lack of autonomy in decision-making regarding pES eligibility and difficulty engaging with peripheral maternity units. Concerns were also raised about the lack of confidence and gaps in genomics knowledge amongst non-genetics professionals - especially midwives. However, the findings also highlighted value in both FM, obstetric and genetics professionals benefiting from further training with a focus on recognising and managing prenatally diagnosed genetic conditions.
CONCLUSION
Healthcare professionals are enthusiastic about the benefits of pES, and through multi-collaborative working, have developed relationships that have contributed to effective communication across specialisms. Although limitations on resources and variation in knowledge about pES have impacted service delivery, professionals were hopeful that improvements to infrastructure and the upskilling of all professionals involved in the pathway would optimise the benefits of pES for both parents and professionals.
PubMed: 38903755
DOI: 10.3389/fgene.2024.1401705 -
Frontiers in Public Health 2024Addressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial...
BACKGROUND
Addressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial inequalities in the use of health services among various socioeconomic strata. Therefore, the present study aimed to measure socioeconomic inequalities and the contributing factors in postnatal health checks for newborns in Ethiopia.
METHODS
We used a secondary data from the recent 2019 Ethiopia Mini Demographic and Health Survey dataset. The study includes a weighted sample of 2,105 women who gave birth in the 2 years preceding to the survey. The study participants were selected using two stage cluster sampling techniques. The socioeconomic inequality in postnatal health checks for newborns was measured using the Erreygers Normalized Concentration Index (ECI) and illustrated by the concentration curve. A decomposition analysis was done to identify factors contributing to the socioeconomic related inequality in postnatal health checks for newborns in Ethiopia.
RESULTS
The concentration curve of postnatal health checks for newborns lay below the line of equality, and the Erreygers normalized concentration index was 0.133, with a standard error = 0.0333, and a value <0.001; indicating that the postnatal health check for newborns was disproportionately concentrated among newborns with higher socioeconomic status. The decomposition analysis reported that antenatal care (ANC) visit (59.22%), household wealth index (34.43%), and educational level of the mother (8.58%) were the major contributors to the pro-rich socioeconomic inequalities in postnatal health checks for newborns.
CONCLUSION
The finding revealed that there is a pro-rich inequality in postnatal health checks for newborns in Ethiopia. To reduce the observed socioeconomic health inequality, the government needs to improve ANC visits, implement strategies to access health service for economically disadvantaged groups, and increase educational attainment among women.
Topics: Humans; Ethiopia; Female; Infant, Newborn; Adult; Socioeconomic Factors; Healthcare Disparities; Postnatal Care; Adolescent; Young Adult; Prenatal Care; Health Surveys; Middle Aged; Pregnancy
PubMed: 38903590
DOI: 10.3389/fpubh.2024.1384729 -
Cureus May 2024Arthrogryposis multiplex congenita (AMC) is a rare condition characterized by multiple joint contractures at birth, affecting two or more body areas. The clinical...
Arthrogryposis multiplex congenita (AMC) is a rare condition characterized by multiple joint contractures at birth, affecting two or more body areas. The clinical examination revealed physical abnormalities indicative of AMC, including joint contractures, clubfeet, and scoliosis. The diagnostic evaluation confirmed the clinical suspicion, and prompt management was initiated to address respiratory distress and potential sepsis. Early diagnosis and multidisciplinary care are essential for optimizing outcomes in neonates with AMC. We present the case of a one-day-old neonate who exhibited immediate respiratory distress upon birth and was born via a lower segment cesarean section (LSCS) to a 31-year-old mother. This case underscores the importance of recognizing prenatal ultrasound findings suggestive of AMC and implementing appropriate postnatal care strategies for affected neonates. Early diagnosis and multidisciplinary care are essential for optimizing outcomes in neonates with AMC.
PubMed: 38903284
DOI: 10.7759/cureus.60729 -
BMC Public Health Jun 2024Reproductive health promotion can enable early mitigation of behavioral and environmental risk factors associated with adverse pregnancy outcomes, while optimizing...
BACKGROUND
Reproductive health promotion can enable early mitigation of behavioral and environmental risk factors associated with adverse pregnancy outcomes, while optimizing health of women + (all genders that can gestate a fetus) and babies. Although the biological and social influences of partners on pregnancy are well established, it is unknown whether online Canadian government reproductive health promotion also targets men and partners throughout the reproductive lifespan.
METHODS
Reproductive health promotion, designed for the general public, was assessed in a multi-jurisdictional sample of Canadian government (federal, provincial/territorial, and municipal) and select non-governmental organization (NGO) websites. For each website, information related to environmental and behavioral influences on reproductive health (preconception, pregnancy, postpartum) was evaluated based on comprehensiveness, audience-specificity, and scientific quality.
RESULTS
Government and NGO websites provided sparse reproductive health promotion for partners which was generally limited to preconception behavior topics with little coverage of environmental hazard topics. For women + , environmental and behavioral influences on reproductive health were well promoted for pregnancy, with content gaps for preconception and postpartum stages.
CONCLUSION
Although it is well established that partners influence pregnancy outcomes and fetal/infant health, Canadian government website promotion of partner-specific environmental and behavioral risks was limited. Most websites across jurisdictions promoted behavioral influences on pregnancy, however gaps were apparent in the provision of health information related to environmental hazards. As all reproductive stages, including preconception and postpartum, may be susceptible to environmental and behavioral influences, online health promotion should use a sex- and gender-lens to address biological contributions to embryo, fetal and infant development, as well as contributions of partners to the physical and social environments of the home.
Topics: Humans; Female; Canada; Male; Reproductive Health; Health Promotion; Pregnancy; Internet; Sex Factors; Health Behavior
PubMed: 38902656
DOI: 10.1186/s12889-024-19159-5 -
Archives of Gynecology and Obstetrics Jun 2024Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to...
BACKGROUND
Postpartum readmission for preeclampsia is a difficult predicament for patients which creates financial, psychosocial, and physical stress. It is often a challenge to predict postpartum preeclampsia and therefore identify patients that may be at risk prior to discharge. This study aims to identify risk factors in patients that are at high risk for readmission due to preeclampsia. The identification of these risk factors may also lead to enhanced education and counseling prior to discharge.
METHODS
Researchers conducted a case-control study using a data set collected from 2015 to 2022 looking at obstetric readmissions within 6 weeks of delivery and then stratified these patients for preeclampsia diagnosis. A control set was created within the healthcare system's electronic medical record's search tools for patients diagnosed with preeclampsia who were not readmitted to the hospital. This study evaluates 78 patients who were readmitted with a diagnosis of preeclampsia and compared to 77 patients who were diagnosed with preeclampsia who were not readmitted. Again, the aim of this study was to investigate risk factors for readmission among patients with preeclampsia.
RESULTS
A multivariable logistic regression model was used to assess predictors which revealed that older age (OR 1.13, CI 1.03-1.24), no history of preeclampsia with or without severe features within pregnancy before delivery (OR 15.29, CI 5.56-41.98 and 13.58, CI 4.46-12.85), no aspirin use in pregnancy (OR 4.38, CI 2.02-9.48), and number of triage visits related to hypertension during prenatal care were all significant predictors for readmission due to preeclampsia.
CONCLUSION
With these risk factors in mind, better counseling and preventative surveillance can be provided to patients. Future studies are needed to evaluate the effectiveness of predictive models developed using these found risk factors.
PubMed: 38902403
DOI: 10.1007/s00404-024-07582-3 -
Pediatrics and Neonatology Jun 2024
PubMed: 38902162
DOI: 10.1016/j.pedneo.2024.06.002 -
JMIR Infodemiology Jun 2024Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol...
BACKGROUND
Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings.
OBJECTIVE
This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers' (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020).
METHODS
All thread starts mentioning alcohol in the "Pregnancy" forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic.
RESULTS
A total of 395 thread starts were analyzed, and key topics included "Asking for advice on whether it is safe to consume alcohol" or on "safe limits" and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on "Research, guidelines, and official information about alcohol in pregnancy." Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods.
CONCLUSIONS
Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers.
Topics: Humans; Pregnancy; Female; Alcohol Drinking; United Kingdom; COVID-19; Internet; Qualitative Research; Fetal Alcohol Spectrum Disorders; SARS-CoV-2; Social Media
PubMed: 38900536
DOI: 10.2196/58056 -
Pediatrics Jul 2024A seizure action plan (SAP) is a powerful tool that provides actionable information for caregivers during seizures. Guidelines have expressed the need for individualized...
OBJECTIVES
A seizure action plan (SAP) is a powerful tool that provides actionable information for caregivers during seizures. Guidelines have expressed the need for individualized SAPs. Our quality improvement team aimed to increase implementation of an SAP within a pediatric tertiary center, initially among epilepsy providers and expanded to all neurology providers.
METHODS
Process changes were implemented using Plan-Do-Study-Act cycles and data were evaluated monthly using control charts. The team focused on tracking patients who received SAPs and identified opportunities for improvement, including reminders within the electronic medical record, and standardizing clinic processes. A secondary analysis was performed to trend emergency department (ED) use among our patient population.
RESULTS
The SAP utilization rate among epilepsy providers increased from a baseline of 39% to 78% by December 2019 and reached the goal of 85% by June 2020, with a further increase to 92% by February 2022 and maintained. The SAP utilization rate among general neurology providers increased from 43% in 2018 to 85% by July 2020, and further increased to 93% by February 2022 and maintained. ED visits of established patients with epilepsy decreased from a baseline of 10.2 per 1000 to 7.5 per 1000.
CONCLUSIONS
Quality improvement methodologies increased the utilization of a standardized SAP within neurology outpatient care centers. The SAP is a simplified tool that allows patients and providers to navigate a complex health care system. The utility of an SAP may potentially extend to minimizing unnecessary ED visits.
Topics: Humans; Quality Improvement; Seizures; Emergency Service, Hospital; Child; Epilepsy; Ambulatory Care; Tertiary Care Centers; Patient Care Planning
PubMed: 38899390
DOI: 10.1542/peds.2023-061268 -
Birth (Berkeley, Calif.) Jun 2024The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge... (Review)
Review
BACKGROUND
The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care.
METHODS
We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence.
RESULTS
Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives.
CONCLUSION
This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.
PubMed: 38898696
DOI: 10.1111/birt.12841