Paediatric and perinatal epidemiology最新文献

Background: Postpartum haemorrhage (PPH) is associated with significant short-term morbidity and mortality. Whether PPH confers long-term all-cause mortality risk is unknown.

Objective: To examine the risk of long-term mortality associated with PPH.

Methods: The Collaborative Perinatal Project (CPP) Mortality Linkage Study is a prospective cohort study of pregnant persons (1959-1966) linked with vital status from the National Death Index and Social Security Death Master File for vital status through 2016. Postpartum haemorrhage was defined based on documentation of haemorrhage within or after 24 hours of delivery in obstetric records. We used Cox regression to examine associations of PPH with long-term all-cause mortality. All models adjusted for delivery characteristics, comorbid medical diagnoses, and sociodemographic characteristics. We further explored heterogeneity in all-cause mortality by sociodemographic characteristics.

Results: Of the 43,583 participants with a singleton pregnancy, 1532 (3.5%) experienced PPH, and 17,165 (39.4%) had died by 2016. The median follow-up time was 52 years (interquartile range 45-54). PPH was associated with increased all-cause mortality risk in unadjusted models (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.04, 1.21) but not in fully adjusted models (HR 1.02, 95% CI 0.94, 1.11). While HRs varied across sociodemographic subgroups, results were imprecise. We found no evidence of increased cause-specific mortality risk associated with PPH.

Conclusions: Although PPH is associated with short-term morbidity and mortality, our results are generally reassuring against the increased risk of long-term mortality associated with PPH.

Background: The New South Wales (NSW) and Australian Capital Territory (ACT) Cerebral Palsy (CP) Register is a database of clinical and demographic information from children with CP. A child with CP resulting from an insult to the developing brain sustained between 29 days and 2 years of age is classified as having post-neonatally acquired CP (PNN-CP). In clinical services, children may meet the criteria and timing for PNN-CP but have a singular diagnosis of acquired/traumatic brain injury.

Objectives: To implement and evaluate a new CP register ascertainment strategy focused on identifying children with PNN-CP attending acquired brain injury rehabilitation services.

Methods: Electronic medical records of children with an acquired brain injury attending the Sydney Children's Hospitals Network and John Hunter Hospital rehabilitation departments 2019-2024 were reviewed by researchers and rehabilitation paediatricians to identify children with PNN-CP. Children who fulfilled the criteria for CP were invited to participate in the CP Register. To evaluate this ascertainment strategy, we (i) ran descriptive statistics to analyse proportional changes of children with PNN-CP on the register and (ii) calculated temporal trends in prevalence per 10,000 live births for birth years 2003-2016, before and after the record ascertainment period.

Results: Of 1051 children with an acquired brain injury, 46 had PNN-CP (2003-2019) and had not previously been included on the register. This ascertainment strategy resulted in increased prevalence of PNN-CP in all 2-year time points between 2003 and 2016 and equated to a 31% improvement in ascertainment of children with PNN-CP on the register.

Conclusions: Ascertainment of children with PNN-CP for the NSW/ACT CP Register has been improved by systematically reviewing children with an acquired brain injury. This is now part of standard practice, and other registers should consider whether this strategy may improve ascertainment of PNN-CP in their regions.

Background: Maternal health is an important health indicator globally, and a major women's health issue. Efforts to improve maternal health can help ensure that women, their offspring, and their families reach their full potential for health and well-being.

Objectives: We analysed how social factors influence adverse maternal health outcomes and non-spontaneous delivery.

Methods: We leveraged data from the population-based Norwegian register, including use of the Medical Birth Registry of Norway (MBRN), the Norwegian Patient Registry (NPR), Statistics Norway (SSB) and the Norwegian Control and Payment of Health Reimbursements Database (KUHR), to analyse the relationships between education, income and immigrant status, and 11 adverse health and non-spontaneous delivery. The study included data from 596,306 pregnancies registered in Norway between 2009 and 2018.

Results: We found that the frequency of adverse health outcomes and of non-spontaneous delivery decreased with each increase in educational attainment and income. Compared to completion of lower secondary education or less, achieving a graduate-level education was associated with a 36% lower risk of an adverse maternal health outcome after adjusting for age, parity and county. The risk was 18% lower for the highest compared to the lowest income quintile. The highest educated group had 35% lower risk of non-spontaneous delivery than the lowest educated, with the same adjustments. The highest income group had a 16% lower risk of such deliveries than the lowest. Descendants of immigrants face higher risk of adverse health outcomes than immigrants. Higher maternal age partly mitigates the higher health risk among women with low income and education.

Conclusions: Even though access to care is more equitable in Norway than in many other countries, we still found a pattern of risk associated with social determinants of health.

Background: Globally, Down syndrome is the most common chromosomal anomaly, often co-occurring with cardiac or gastrointestinal anomalies. There is a lack of robust data on specific healthcare needs of children with Down syndrome compared to children with other major congenital anomalies.

Objectives: To quantify the healthcare needs of children with Down syndrome in the first year of life compared to children with major congenital anomalies in a large population-based cohort across Europe.

Methods: The EUROlinkCAT study was a multicentre data linkage study between congenital anomaly registries in Europe and hospital and mortality databases. Children born between 1st January 1997 and 31st December 2014 were included. Summary statistics were used to compare differences between children (those with Down syndrome compared to all major anomalies) and regions. Random-effects meta-analysis was used to pool results related to survival, need for intensive care and ventilation support.

Results: A total of 3554 children were born with Down syndrome out of 89,081 children with major congenital anomalies. The pooled 1-year survival was 95.4%. In every region, > 80% of children with Down syndrome had a hospital admission excluding the birth admission. Hospital length of stay in the first year was higher for children with Down syndrome compared to those with all anomalies (median: 14 versus 7 days). Despite having similar need for ventilation support (9.7% vs. 8.4%), children with Down syndrome had higher rates of intensive care admission than all children with anomalies (24.8% vs. 13.0%).

Conclusions: There is a high need for hospital care for children born with Down syndrome in the first year of life. Future work should continue to explore the long-term prognosis for children with Down syndrome to ensure their care needs are met.

Background: Globally, a stillbirth occurs every 17 seconds totalling almost 2 million every year. The global standard for reporting stillbirths is the stillbirth rate. While a critical and accessible summary statistic, it masks gestational age-specific trends.

Objectives: This study aimed to summarise and critique stillbirth trends and document gestational age-specific rates and risk calculations according to three published methodologies: gestational age-specific stillbirth rate (GS-SBR), foetus-at-risk (FAR) stillbirth rate, and continuity corrected foetus-at-risk (ccFAR) stillbirth rate.

Methods: We conducted a cross-sectional analysis of all births from the National Perinatal Data Collection in Australia (1998-2018). Stillbirth was defined as the birth of a baby with no sign of life from 20 weeks of gestation or weighing 400 grams at birth. Three statistical measures were applied reflecting alternate denominators: the GS-SBR measure used the number of births in a given week, the FAR used the number of foetuses in utero at the start of a week, and the ccFAR used the number of foetuses at the midpoint of the week.

Results: In Australia from 1998 to 2018, there were 39,576 stillbirths among 5.9 million births, an overall stillbirth rate of 6.7 per 1000 births. For each week of gestation (20-41+), the average GS-SBR varied from 1.0 to 790.0 stillbirths per 1000 births; FAR varied from 0.1 to 1.2 stillbirths per 1000 FAR; and ccFAR varied from 0.1 to 2.4 stillbirths per 1000 ongoing pregnancies. The three stillbirth rate calculations showed distinct trends during pregnancy, and only FAR and ccFAR reflected increased stillbirth risk as gestation advances.

Conclusions: When calculating gestational-age-specific stillbirth rates, the FAR or ccFAR approaches provide the most accurate representation of the probability of stillbirth throughout pregnancy and better enable clinicians to act on risk.