Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: To analyze and evaluate the efficacy of different blue light therapy methods and provide evidence-based recommendations for their selection in clinical practice.

Methods: Clinical randomized controlled trials (RCTs) evaluating the efficacy of various blue light therapy methods for neonatal jaundice were retrieved from both domestic and international databases. The search period covered the inception of each database until November 2023. After screening, the quality of the included studies was assessed using the Cochrane Risk of Bias tool. Literature management was conducted with NoteExpress 3.2, while data collection and extraction were performed using Excel 2003. Statistical analysis was carried out using RevMan 5.4.1. Heterogeneity was assessed using the Q test (p value), and the OR value of the combined effect was calculated using either a fixed-effects or random effects model, depending on the presence of heterogeneity. A forest plot was generated to visualize the results. Sensitivity analysis was performed by excluding the largest-weighted study, and the potential for bias in outcome indicators was assessed using a funnel plot.

Results: A total of 652 articles were retrieved, with 16 clinical RCTs meeting the inclusion criteria. The meta-analysis results indicated that, compared to continuous blue light therapy in the control group, intermittent blue light therapy achieved a higher total effective rate (OR = 1.82, 95%CI (1.25-2.64), p = .002), significantly lower serum bilirubin levels post-treatment (OR = -14.59, 95%CI (-26.11 to -3.08), p = .01), and a shorter time to jaundice resolution (OR = -2.35, 95%CI (-3.83 to -0.87), p = .002). Additionally, the incidence of adverse reactions was lower in the intermittent therapy group compared to the control group (OR = 0.27, 95%CI (0.19-0.36), p < .00001). Sensitivity analysis confirmed that the combined effect size was stable and reliable (OR (95%CI) = -16.23 (-28.67 to -3.79), p = .01). The funnel plot suggested potential publication bias.

Conclusions: Intermittent blue light therapy is effective and demonstrates significant clinical benefits, making it a valuable treatment option for neonatal jaundice in clinical practice.

The incidence for congenital heart block is estimated as high as 1 in 15,000 live births. Up to 90% of cases of congenital heart block, in which there is no anatomical abnormalities, are attributed to maternal systemic lupus erythematous or Sjögren's disease. 50% of these mothers are asymptomatic at time of diagnosis. The post-natal cardiac manifestations have been felt to be irreversible. In this article we present, to our knowledge, the first case of spontaneous conversion of immune mediate 3^rd degree heart block to sinus rhythm postnatally.

Background: Neonatal transportation, when done adequately, has been associated with reduced morbidity and mortality among referred neonates. In many developing countries, safe and specialized system for neonatal transportation has not been adequately considered and this has a contribution to a burden of neonatal morbidity and mortality specifically in sub-Saharan Africa. This study describes attributes of neonatal transportation services from primary to secondary health care facility in rural Tanzania and predictors of short-term outcome.

Methods: This was part of the larger study conducted in Iringa Regional Referral hospital conducted from April - June 2023 looking at neonatal mortality and associated factors. Participants were consecutively recruited into study including those who were referred from primary health care facilities across the region and whose parents or care giver provided a written consent. Data were collected by a structured questionnaire and inspection of the transportation vehicle used on arrival. Frequency tables were used to summarize the data with logistic regression performed to assess predictors of poor condition on arrival.

Results: Most of the participants were male neonates (61.3%) weighing more than 2500 g at birth with the gestation age of 37 weeks or more (58.7%). Upon arrival, over half of the participants (53.3%) had referral notes readily available. Majority of the neonates were transported by a public ambulance (72%) but only 1.9% of these had respiratory and cardiovascular system supporting equipment. Two-third of the escorting health personnel had no training on neonatal resuscitation and essential newborn care. Neonates who traveled for over 30 min were more likely to arrive in critical condition, AOR = 6, 95%CI (1.44-18.18) compared to those who used less time.

Conclusion: Enhancing neonatal transportation services in rural Tanzania is crucial for specialized care and safety, ultimately impacting morbidity and mortality rates.

Background: Excessive Gestational Weight Gain is a global public health problem with serious and long-term effects on maternal and offspring health. Early identification of at-risk groups and interventions is crucial for controlling weight gain and reducing the prevalence of excessive gestational weight gain. Currently, tools for predicting the risk of excessive gestational weight gain are lacking in China. This study aimed to develop a risk-prediction model and screening tool to identify high-risk groups in the early stages.

Methods: A total of 306 pregnant women were randomly selected who underwent regular obstetric checkups at a tertiary-level hospital in China between January and March 2023. Logistic regression analysis was used to construct the risk-prediction model. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test, and the predictive performance was evaluated using the area under the receiver operating characteristic (ROC) curve, calibration plots, and k-fold cross-validation. R4.3.1 software was used to create a nomogram.

Results: The prevalence of excessive gestational weight gain was 50.32%. Logistic regression analysis revealed that pre-pregnancy overweight (OR = 2.563, 95% CI: 1.043-6.299), obesity (OR = 4.116, 95% CI: 1.396-12.141), eating in front of a screen (OR = 6.230, 95% CI: 2.753 - 14.097); frequency of weekly consumption of sugar-sweetened beverages/desserts/western fast food (OR = 1.948, 95% CI: 1.363-2.785); and pregnancy body image (OR = 1.030, 95% CI: 1.014-1.047) were risk factors for excessive gestational weight gain. Parity (OR = 0.452, 95% CI: 0.275 - 0.740), protective motivation to manage pregnancy body mass (OR = 0.979, 95% CI: 0.958-1), and the time of daily moderate-intensity physical activity (OR = 0.228, 95% CI: 0.113-0.461) were protective factors against excessive gestational weight gain. The area under the ROC curve of the model was 0.885, the mean value of ten-fold cross-validation was 0.857 for AUC.

Conclusion: The nomogram model developed in this study has a good degree of discrimination and calibration, providing a valuable basis for early identification and precise intervention in individuals at risk of excessive gestational weight gain.

Objective: The aim of this study is to systematically examine the role of the pregnancy-associated plasma protein A (PAPP-A) serum biomarker in the first trimester screening of preeclampsia (PE).

Materials and methods: A systematic search of the literature was conducted on PubMed via Medline, and Cochrane Library up to 8 November 2022, for prospective studies evaluating PAPP-A serum levels in first trimester pregnant women as a screening biomarker for PE. Eligible were all prospectively designed case-control or cohort studies, published in English. Two investigators independently examined the studies and the studies' characteristics were extracted. Newcastle-Ottawa Scale (NOS) for case-control and cohort studies were applied to assess the risk of bias. For the quantitative analysis of the studies, a meta-analysis was also performed.

Results: A total of 22 studies including 33,651 pregnant women were assessed, of whom, 2001 were diagnosed with PE. A meta-analysis was performed, showing that PAPP-A levels in the first trimester were significantly lower in early onset preeclamptic women (MD: -0.24, 95% CI: -0.37, -0.11, p = .0002), late onset (MD: -0.15, 95% CI: -0.25, -0.05, p = .03), and total preeclamptic cases (MD = -0.17, 95% CI = -0.23, -0.11, p < .00001) when compared with controls.

Conclusions: Our results suggest that PAPP-A can be a promising predictor in early screening for PE; hence, women at risk can be diagnosed early in their pregnancy stage and benefit from individualized PE treatment before it progresses.

Purpose: The main objective of this study was to assess the impact of a composite quality improvement intervention on mode of birth in nullipara term singleton vertex (NTSVs).

Material and methods: This was an ambidirectional study following the implementation of the intervention to reduce cesarean section rate in NSTV by comparing two birth cohorts, pre-composite quality improvement intervention cohort (January 2013-December 2015) and post-composite quality improvement intervention cohort (January 2018-December 2020).

Results: In the studied periods, there was a total of 7713 NTSV births. Compared to pre-composite quality improvement intervention, there was a post-composite quality improvement intervention reduction in NTSV cesarean section rate from 30.89% to 13.31% (p < 0.0001). Obstetric and non-obstetric indications for elective cesarean sections decreased from 5.52% to 1.04% (p < 0.0001) and from 4.82% to 0.52% (p < 0.0001), respectively. The frequency of emergency cesarean sections in this group decreased from 20.56% to 11.75% (p < 0.0001), especially those performed for failure to progress in labor (from 13.69% to 7.30%; p < 0.0001). There has been a rising trend with regards to maternal age. However, the proportion of mothers aged 35 years and more giving birth by cesarean section reduced from 46.94% to 20.28%. These reductions in cesarean section rates occurred without any negative impact on core fetal outcomes.

Conclusions: This quality improvement study demonstrates that it is feasible to significantly reduce cesarean section rate in NTSV by adopting specific composite measures. However, this requires the understanding of the inherent problems and barriers within the unit and the involvement of all stake holders.

Background: Postpartum psychiatric disorders (PPDs) have been deemed as a significant public health concern, affecting both maternal health and family dynamics. This study aimed to examine the current status of PPDs, identify the potential risk factors of PPDs, and further develop a clinical nomogram model for predicting PPDs in Chinese women.

Method: In this retrospective cohort study, 1418 postpartum women attending the routine postpartum examination at the 42nd day after delivery in Jiangsu Women and Children Health Hospital were recruited as participants from December 2020 to December 2022. The Symptom Checklist-90 (SCL-90) was utilized to assess the status of postpartum psychiatric disorders. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The relationships between predictive factors of PPDs and SCL-90 were also evaluated using Pearson correlation analysis. The relationships between predictive factors of PPDs and SCL-90 were evaluated using Pearson correlation analysis.

Results: With the SCL-90 cutoff value of 160, the incidence of postpartum psychiatric disorders was 9.17% among Chinese urban women. The univariate and multivariate logistic regression analyses indicated that age ≤ 25 years old (OR = 10.07, 95%CI = 1.83-55.33), prenatal mood disorder (OR = 4.12, 95%CI = 1.99-8.53), invasive prenatal diagnostic procedures (OR = 4.39, 95%CI = 1.16-16.56), poor relationship with husband (OR = 2.86, 95%CI = 1.58-5.16) and poor relationship with mother-in-law (OR = 5.10, 95%CI = 2.70-9.64) were significantly associated with PPDs. A nomogram prediction model for PPDs was further constructed based on these five independent risk factors, and the area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.823 (95% CI = 0.781-0.865). The calibration curves showed remarkable accuracy of the nomogram and the DCA exhibited high clinical net benefit of the nomogram. Besides, we also explored the relationships between the five risk factors and different symptom dimensions of PPDs and found that the five risk factors were almost associated with increased levels of all symptom dimensions.

Conclusions: Five psychosocial risk factors for PPDs were identified in Chinese women and the nomogram prediction model constructed based on these five risk factors could predict the risk of PPDs intuitively and individually. Systematic screening these risk factors and further conducting psychosocial interventions earlier during the pregnancy period are crucial to prevent PPDs. For future research, we intend to incorporate additional risk factors, including blood biomarkers and facial expression indicators, to refine our risk model.