Pub Date : 2024-08-28DOI: 10.1101/2024.08.27.24312604
Aishat F. Akomolafe, Bushra M. Abdallah, Fathima R. Mahmood, Amgad M. Elshoeibi, Aisha Abdulla Al-Khulaifi, Elhassan Mahmoud, Yara Dweidri, Nour Darwish, Duaa Yousif, Hafsa Khalid, Majed Al-Theyab, Muhammad Waqar Azeem, Durre Shahwar, Madeeha Kamal, Majid Alabdulla, Salma M. Khaled, Tawanda Chivese
Background and Objective Estimates of the prevalence of the autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies in the region. Methods In this systematic review and meta-analysis, we searched PubMed, EMBASE, Scopus, and CINAHL databases for studies which assessed ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale. A bias adjusted inverse variance heterogeneity meta-analysis model was used to pool prevalence estimates from included studies. Cochran's Q statistic and the I2 statistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots. Results A total of 3075 studies were identified, 16 studies of which met the inclusion criteria and involved 3,727,731 individuals. The studies were published during the period 2007-2022, and included individuals from Iran, Oman, Libya, Egypt, Kingdom of Saudi Arabia (KSA), Lebanon, United Arab Emirates (UAE), Bahrain and Qatar. Estimates of ASD prevalence ranged from 0.01% in Oman during the period June 2009-December 2009, to a high of 2.51% in the Kingdom of Saudi Arabia during the period December 2017-March 2018. The pooled prevalence of ASD was 0.13% (95% CI: 0.01% - 0.33%), with significant heterogeneity (I2 = 99.8%). For Iran, the only country with multiple analysable studies, an overall prevalence of 0.06% (95% CI: 0.00 - 0.19, I2=97.5%, n= 6 studies) was found. A review of data from countries with repeated studies suggested that the prevalence of ASD is increasing. Conclusion Estimates of the prevalence of ASD vary widely across the MENA region, from 0.01% in Oman to 2.51% in Saudi, with an overall prevalence of 0.13%. Existing data suggests a trend towards increasing prevalence in the region. More and better-quality research is needed to provide up to date ASD prevalence estimates. Registration The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42024499837. Keywords autism spectrum disorder, prevalence, middle east and north Africa
{"title":"Estimates of the Prevalence of Autism Spectrum Disorder in the Middle East and North Africa Region: A Systematic Review and Meta-Analysis","authors":"Aishat F. Akomolafe, Bushra M. Abdallah, Fathima R. Mahmood, Amgad M. Elshoeibi, Aisha Abdulla Al-Khulaifi, Elhassan Mahmoud, Yara Dweidri, Nour Darwish, Duaa Yousif, Hafsa Khalid, Majed Al-Theyab, Muhammad Waqar Azeem, Durre Shahwar, Madeeha Kamal, Majid Alabdulla, Salma M. Khaled, Tawanda Chivese","doi":"10.1101/2024.08.27.24312604","DOIUrl":"https://doi.org/10.1101/2024.08.27.24312604","url":null,"abstract":"Background and Objective\u0000Estimates of the prevalence of the autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies in the region. Methods\u0000In this systematic review and meta-analysis, we searched PubMed, EMBASE, Scopus, and CINAHL databases for studies which assessed ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale. A bias adjusted inverse variance heterogeneity meta-analysis model was used to pool prevalence estimates from included studies. Cochran's Q statistic and the I2 statistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots. Results\u0000A total of 3075 studies were identified, 16 studies of which met the inclusion criteria and involved 3,727,731 individuals. The studies were published during the period 2007-2022, and included individuals from Iran, Oman, Libya, Egypt, Kingdom of Saudi Arabia (KSA), Lebanon, United Arab Emirates (UAE), Bahrain and Qatar. Estimates of ASD prevalence ranged from 0.01% in Oman during the period June 2009-December 2009, to a high of 2.51% in the Kingdom of Saudi Arabia during the period December 2017-March 2018. The pooled prevalence of ASD was 0.13% (95% CI: 0.01% - 0.33%), with significant heterogeneity (I2 = 99.8%). For Iran, the only country with multiple analysable studies, an overall prevalence of 0.06% (95% CI: 0.00 - 0.19, I2=97.5%, n= 6 studies) was found. A review of data from countries with repeated studies suggested that the prevalence of ASD is increasing. Conclusion\u0000Estimates of the prevalence of ASD vary widely across the MENA region, from 0.01% in Oman to 2.51% in Saudi, with an overall prevalence of 0.13%. Existing data suggests a trend towards increasing prevalence in the region. More and better-quality research is needed to provide up to date ASD prevalence estimates. Registration The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42024499837. Keywords\u0000autism spectrum disorder, prevalence, middle east and north Africa","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1101/2024.08.26.24312603
Cecilia E Rogers, Katherine E Boguszewski, Angela K.S. Gummadi, Mark R Conaway, Laura A Shaffer, Irène P Mathieu
Objectives To examine disparities in mental health diagnosis, depression screening, and depressive symptoms in pediatric primary care settings before and during the COVID-19 pandemic, and to evaluate the use of electronic health records to study temporal trends in pediatric mental and behavioral health (MBH). Methods This is an IRB-approved, retrospective study of pediatric patients (n=10,866) who visited three primary care sites at an academic medical center before (2017-2019) and during (2020-2022) the COVID-19 pandemic . We used logistic regression to compare rates of diagnoses, depression screening, and depression symptom scores among demographic groups. Results This study demonstrates an increase in both PHQ-9A screening rates and average scores from 2017-2019 to 2020-2022. There were significant disparities in common mental health diagnoses, including higher rates of psychological distress among lower income and Hispanic patients, both before and during the pandemic, despite lower rates of screening among Hispanic patients. This suggests a need for improved equity in routine MBH screening and additional research to better understand the underlying social determinants that may be driving the greater mental health burden for certain marginalized youth. This study also highlights the strengths and challenges of utilizing EHR data to characterize disparities in pediatric mental illness. Although the nature of care delivery in an academic medical center clinic and the limitations of the EHR for collecting relevant data present challenges to this measurement, the EHR is nevertheless a promising tool for measuring and tracking pediatric mental health disparities.
{"title":"Measuring Disparities in the Impact of COVID-19 on Pediatric Mental Health in Primary Care Settings","authors":"Cecilia E Rogers, Katherine E Boguszewski, Angela K.S. Gummadi, Mark R Conaway, Laura A Shaffer, Irène P Mathieu","doi":"10.1101/2024.08.26.24312603","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312603","url":null,"abstract":"Objectives\u0000To examine disparities in mental health diagnosis, depression screening, and depressive symptoms in pediatric primary care settings before and during the COVID-19 pandemic, and to evaluate the use of electronic health records to study temporal trends in pediatric mental and behavioral health (MBH).\u0000Methods\u0000This is an IRB-approved, retrospective study of pediatric patients (n=10,866) who visited three primary care sites at an academic medical center before (2017-2019) and during (2020-2022) the COVID-19 pandemic . We used logistic regression to compare rates of diagnoses, depression screening, and depression symptom scores among demographic groups. Results\u0000This study demonstrates an increase in both PHQ-9A screening rates and average scores from 2017-2019 to 2020-2022. There were significant disparities in common mental health diagnoses, including higher rates of psychological distress among lower income and Hispanic patients, both before and during the pandemic, despite lower rates of screening among Hispanic patients. This suggests a need for improved equity in routine MBH screening and additional research to better understand the underlying social determinants that may be driving the greater mental health burden for certain marginalized youth. This study also highlights the strengths and challenges of utilizing EHR data to characterize disparities in pediatric mental illness. Although the nature of care delivery in an academic medical center clinic and the limitations of the EHR for collecting relevant data present challenges to this measurement, the EHR is nevertheless a promising tool for measuring and tracking pediatric mental health disparities.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1101/2024.08.21.24312369
Melissa J Parker, Karen Choong, Alison Fox-Robichaud, Patricia C Liaw, Lehana Thabane, Canadian Critical Care Trials Group, Canadian Critical Care Translational Biology Group
Objective: The overall objective of our research is to determine in children with septic shock whether use of a fluid-sparing strategy results in improved clinical outcomes without an increased risk of adverse events compared to usual care. The specific objective of this pilot randomized controlled trial was to evaluate the feasibility of a definitive multicenter trial to answer our research question. Design: Pragmatic, 2-arm, parallel group, open label, prospective pilot randomized controlled trial including a nested biosample-based translational study. Setting: Pediatric tertiary care centre Patients: Children aged 29 days to <18 years of age presenting to the Emergency Department or admitted to an in-patient ward (including the PICU) with suspected or confirmed septic shock and a need for ongoing resuscitation. Interventions: Fluid-sparing vs. usual care resuscitation strategy continued until shock reversal. The fluid-sparing intervention comprised instructions to restrict fluid bolus therapy in conjunction with early initiation and/or preferential use of vasoactive medication support as a strategy to spare fluid while targeting the hemodynamic goals specified in the American College of Critical Care Medicine Surviving Sepsis Guidelines. The usual care strategy did not limit use of fluid bolus therapy. Measurements and Main Results: 53 were randomized to usual care (n=27) or fluid-sparing (n=26). Fifty-one participants were available for primary outcome analysis. Primary feasibility outcomes related to participant enrolment and protocol adherence. Enrolment rate was 1.8 (51/29); 95% confidence interval [CI]: 1.3-2.3 participants/month. Study procedures were implemented in 49/51 (96.1%), 95% CI: 86.5-99.5% participants within 1 hour of randomization in a median (quartile range [IQR]) of 8 (5, 15) minutes. The protocol required use of an exception to consent process and consent for ongoing participation was 48/51 (94.1%), 95% CI: 83.8-98.8%. There were no serious adverse events. Conclusions: We concluded the large multicenter SQUEEZE Trial feasible to conduct. Trial Registration: ClinicalTrials.gov [NCT01973907]
{"title":"The SQUEEZE pilot trial: a trial to determine whether septic shock reversal is quicker in pediatric patients randomized to an early goal directed fluid-sparing strategy vs. usual care","authors":"Melissa J Parker, Karen Choong, Alison Fox-Robichaud, Patricia C Liaw, Lehana Thabane, Canadian Critical Care Trials Group, Canadian Critical Care Translational Biology Group","doi":"10.1101/2024.08.21.24312369","DOIUrl":"https://doi.org/10.1101/2024.08.21.24312369","url":null,"abstract":"Objective: The overall objective of our research is to determine in children with septic shock whether use of a fluid-sparing strategy results in improved clinical outcomes without an increased risk of adverse events compared to usual care. The specific objective of this pilot randomized controlled trial was to evaluate the feasibility of a definitive multicenter trial to answer our research question. Design: Pragmatic, 2-arm, parallel group, open label, prospective pilot randomized controlled trial including a nested biosample-based translational study. Setting: Pediatric tertiary care centre Patients: Children aged 29 days to <18 years of age presenting to the Emergency Department or admitted to an in-patient ward (including the PICU) with suspected or confirmed septic shock and a need for ongoing resuscitation. Interventions: Fluid-sparing vs. usual care resuscitation strategy continued until shock reversal. The fluid-sparing intervention comprised instructions to restrict fluid bolus therapy in conjunction with early initiation and/or preferential use of vasoactive medication support as a strategy to spare fluid while targeting the hemodynamic goals specified in the American College of Critical Care Medicine Surviving Sepsis Guidelines. The usual care strategy did not limit use of fluid bolus therapy. Measurements and Main Results: 53 were randomized to usual care (n=27) or fluid-sparing (n=26). Fifty-one participants were available for primary outcome analysis. Primary feasibility outcomes related to participant enrolment and protocol adherence. Enrolment rate was 1.8 (51/29); 95% confidence interval [CI]: 1.3-2.3 participants/month. Study procedures were implemented in 49/51 (96.1%), 95% CI: 86.5-99.5% participants within 1 hour of randomization in a median (quartile range [IQR]) of 8 (5, 15) minutes. The protocol required use of an exception to consent process and consent for ongoing participation was 48/51 (94.1%), 95% CI: 83.8-98.8%. There were no serious adverse events. Conclusions: We concluded the large multicenter SQUEEZE Trial feasible to conduct. Trial Registration: ClinicalTrials.gov [NCT01973907]","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142223634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.19.24312238
Rainer Tan, Arjun Chandna, Tim Colbourn, Shubhada Hooli, Carina King, Norman Lufesi, Eric McCollum, Charles Mwansambo, Joseph L. Matthew, Clare Cutland, Shabir Ahmed Madhi, Sudha Basnet, Tor A. Strand, Kerry-Ann O'Grady, Brad Gessner, Emmanuel Addo-Yobo, Noel Chisaka, Patricia L. Hibberd, Prakash Jeena, Juan M. Lozano, William B. MacLeod, Archana Patel, Donald M. Thea, Ngoc Tuong Vy Nguyen, Marilla Lucero, Syed Mohammad Akram uz Zaman, Shinhini Bhatnagar, Nitya Wadhwa, Rakesh Lodha, Satinder Aneja, Mathuram Santosham, Shally Awasthi, Ashish Bavdekar, Monidarin Chou, Pagbajabyn Nymadawa, Jean-William Pape, Glaucia Paranhos-Baccala, Valentina S. Picot, Mala Rakoto-Andrianarivelo, Vanessa Rouzier, Graciela Russomando, Mariam Sylla, Philippe Vanhems, Jianwei Wang, Romina Libster, Alexey W. Clara, Fenella Beynon, Gillian Levine, Chris A Rees, Mark I Neuman, Shamin A Qazi, Yasir Bin Nisar, World Health Organization PREPARE Study Group
Background Hypoxemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxemia in 2-59-month-old children with pneumonia. Methods Data from 7 studies conducted in 5 countries from the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) dataset were included. Readily available clinical features and demographic variables were used to develop a multivariable logistic regression model to predict hypoxemia (SpO2<90%) at presentation to care. The adjusted log coefficients were transformed to derive the PREPARE hypoxemia risk score and its diagnostic value was assessed in a held-out, temporal validation dataset. Results We included 14,509 children in the analysis; 9.8% (n=2,515) were hypoxemic at presentation. The multivariable regression model to predict hypoxemia included age, sex, respiratory distress (nasal flaring, grunting and/or head nodding), lower chest indrawing, respiratory rate, body temperature and weight-for-age z-score. The model showed fair discrimination (area under the curve 0.70, 95% CI 0.67 to 0.73) and calibration in the validation dataset. The simplified PREPARE hypoxemia risk score includes 5 variables: age, respiratory distress, lower chest indrawing, respiratory rate and weight-for-age z-score. Conclusion The PREPARE hypoxemia risk score, comprising five easily available characteristics, can be used to identify hypoxemia in children with pneumonia with a fair degree of certainty for use in health facilities without pulse oximetry. Its implementation would require careful consideration to limit inappropriate referrals on patients and the health system. Further external validation in community settings in low- and middle-income countries is required.
背景低氧血症可预测各级医疗机构的死亡率，适当的管理可减少可预防的死亡。然而，脉搏血氧仪和氧疗在许多基层医疗机构仍无法使用。我们的目的是开发并验证一种简单的风险评分，该评分由常用的临床特征组成，用于预测 2-59 个月大肺炎患儿的低氧血症。方法纳入了肺炎研究合作评估世卫组织建议（PREPARE）数据集中 5 个国家 7 项研究的数据。利用现成的临床特征和人口统计学变量建立了一个多变量逻辑回归模型，以预测就诊时的低氧血症（SpO2<90%）。对调整后的对数系数进行转换，得出 PREPARE 低氧血症风险评分，并在一个保留的临时验证数据集中评估其诊断价值。预测低氧血症的多变量回归模型包括年龄、性别、呼吸窘迫（鼻翼扇动、呼噜声和/或点头）、下胸闷、呼吸频率、体温和体重-年龄 Z 值。该模型在验证数据集中显示出较好的区分度（曲线下面积为 0.70，95% CI 为 0.67 至 0.73）和校准性。简化的 PREPARE 低氧血症风险评分包括 5 个变量：年龄、呼吸困难、下胸闷、呼吸频率和体重-年龄 z 评分。结论 PREPARE 低氧血症风险评分包括五个容易获得的特征，可用于识别肺炎患儿的低氧血症，在没有脉搏血氧仪的医疗机构使用时具有相当的确定性。该方法的实施需要慎重考虑，以限制对患者和医疗系统的不当转诊。还需要在中低收入国家的社区环境中进行进一步的外部验证。
{"title":"Development and validation of a novel clinical risk score to predict hypoxemia in children with pneumonia using the WHO PREPARE dataset","authors":"Rainer Tan, Arjun Chandna, Tim Colbourn, Shubhada Hooli, Carina King, Norman Lufesi, Eric McCollum, Charles Mwansambo, Joseph L. Matthew, Clare Cutland, Shabir Ahmed Madhi, Sudha Basnet, Tor A. Strand, Kerry-Ann O'Grady, Brad Gessner, Emmanuel Addo-Yobo, Noel Chisaka, Patricia L. Hibberd, Prakash Jeena, Juan M. Lozano, William B. MacLeod, Archana Patel, Donald M. Thea, Ngoc Tuong Vy Nguyen, Marilla Lucero, Syed Mohammad Akram uz Zaman, Shinhini Bhatnagar, Nitya Wadhwa, Rakesh Lodha, Satinder Aneja, Mathuram Santosham, Shally Awasthi, Ashish Bavdekar, Monidarin Chou, Pagbajabyn Nymadawa, Jean-William Pape, Glaucia Paranhos-Baccala, Valentina S. Picot, Mala Rakoto-Andrianarivelo, Vanessa Rouzier, Graciela Russomando, Mariam Sylla, Philippe Vanhems, Jianwei Wang, Romina Libster, Alexey W. Clara, Fenella Beynon, Gillian Levine, Chris A Rees, Mark I Neuman, Shamin A Qazi, Yasir Bin Nisar, World Health Organization PREPARE Study Group","doi":"10.1101/2024.08.19.24312238","DOIUrl":"https://doi.org/10.1101/2024.08.19.24312238","url":null,"abstract":"Background\u0000Hypoxemia predicts mortality at all levels of care, and appropriate management can reduce preventable deaths. However, pulse oximetry and oxygen therapy remain inaccessible in many primary care health facilities. We aimed to develop and validate a simple risk score comprising commonly evaluated clinical features to predict hypoxemia in 2-59-month-old children with pneumonia.\u0000Methods\u0000Data from 7 studies conducted in 5 countries from the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) dataset were included. Readily available clinical features and demographic variables were used to develop a multivariable logistic regression model to predict hypoxemia (SpO2<90%) at presentation to care. The adjusted log coefficients were transformed to derive the PREPARE hypoxemia risk score and its diagnostic value was assessed in a held-out, temporal validation dataset.\u0000Results\u0000We included 14,509 children in the analysis; 9.8% (n=2,515) were hypoxemic at presentation. The multivariable regression model to predict hypoxemia included age, sex, respiratory distress (nasal flaring, grunting and/or head nodding), lower chest indrawing, respiratory rate, body temperature and weight-for-age z-score. The model showed fair discrimination (area under the curve 0.70, 95% CI 0.67 to 0.73) and calibration in the validation dataset. The simplified PREPARE hypoxemia risk score includes 5 variables: age, respiratory distress, lower chest indrawing, respiratory rate and weight-for-age z-score. Conclusion\u0000The PREPARE hypoxemia risk score, comprising five easily available characteristics, can be used to identify hypoxemia in children with pneumonia with a fair degree of certainty for use in health facilities without pulse oximetry. Its implementation would require careful consideration to limit inappropriate referrals on patients and the health system. Further external validation in community settings in low- and middle-income countries is required.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.18.24312174
Ajay Kevat, Rylan Steinkey, Sadasivam Suresh, Warren R Ruehland, Jasneek Chawla, Philip I Terrill, Andrew Collaro, Kartik Iyer
Study Objectives U-Sleep is a publicly-available automated sleep stager, but has not been independently validated using pediatric data. We aimed to a) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and b) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3114 polysomnograms from a tertiary center. Methods Agreement between U-Sleep and gold 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon two one-sided test (TOST). Multivariable regression and generalized additive modelling were used on the clinical dataset to estimate the effects of age, comorbidities and polysomnographic findings on U-Sleep performance. Results The median (interquartile range) Cohens kappa agreement of U-Sleep and individual trained humans relative to gold scoring for 5-stage sleep staging in the concordance dataset were similar, kappa=0.79(0.19) vs 0.78(0.13) respectively, and satisfied statistical equivalence (TOST p<0.01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa=0.69(0.22). Modelling indicated lower performance for children <2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction=0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction=0.1). Conclusion While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children <2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.
{"title":"Evaluation of automated pediatric sleep stage classification using U-Sleep - a convolutional neural network","authors":"Ajay Kevat, Rylan Steinkey, Sadasivam Suresh, Warren R Ruehland, Jasneek Chawla, Philip I Terrill, Andrew Collaro, Kartik Iyer","doi":"10.1101/2024.08.18.24312174","DOIUrl":"https://doi.org/10.1101/2024.08.18.24312174","url":null,"abstract":"Study Objectives U-Sleep is a publicly-available automated sleep stager, but has not been independently validated using pediatric data. We aimed to a) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and b) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3114 polysomnograms from a tertiary center. Methods Agreement between U-Sleep and gold 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon two one-sided test (TOST). Multivariable regression and generalized additive modelling were used on the clinical dataset to estimate the effects of age, comorbidities and polysomnographic findings on U-Sleep performance. Results The median (interquartile range) Cohens kappa agreement of U-Sleep and individual trained humans relative to gold scoring for 5-stage sleep staging in the concordance dataset were similar, kappa=0.79(0.19) vs 0.78(0.13) respectively, and satisfied statistical equivalence (TOST p<0.01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa=0.69(0.22). Modelling indicated lower performance for children <2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction=0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction=0.1). Conclusion While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children <2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.14.24312023
Sandeep Riar, Scott Gillespie, Andrew M. South
Background: It is assumed that BP decreases with repeat measurements and multiple readings are recommended. There is limited information about within-visit BP variability (BPV) in healthy children. Methods: We used NHANES data (2013-2020) to measure BPV in subjects 8-17 years old with three BP readings. During 2013 to 2016, auscultatory BP was obtained (manual protocol, MP). Subsequently, oscillometric BP was measured (automated protocol, AP). We excluded subjects with diastolic BP 'zero'. Results: We included a total 5656 subjects with 3365 (59.5%) in the MP and 2291 (40.5%) in the AP group. A ΔBP (individual-level difference between the highest and lowest of three BP readings) ≥5 mmHg was noted in 49.1% and 60.7% subjects for systolic BP (SBP) and diastolic BP (DBP) respectively. A ΔDBP ≥10 mmHg and DBP average real variability ≥10 mmHg was twice as common in the MP than AP group. A ΔBP ≥20 mmHg was noted in 1.3% and 4.4% subjects for SBP and DBP respectively. The first SBP and DBP reading was ?5 mmHg higher or lower than the averaged second and third SBP and DBP readings in 24.9% and 34.5% of subjects respectively. The first SBP and DBP reading was the highest of three BP readings in 44.2% and 42.4% subjects respectively. Conclusions: There is significant BPV in children and adolescents. Diastolic BPV is more common in MP than AP groups. Initial BP is not always the highest and inclusion of second and third BP reading may be more representative of patient's actual BP.
{"title":"Within-visit BP variability in Children & Adolescents in the NHANES (2013-2020)","authors":"Sandeep Riar, Scott Gillespie, Andrew M. South","doi":"10.1101/2024.08.14.24312023","DOIUrl":"https://doi.org/10.1101/2024.08.14.24312023","url":null,"abstract":"Background: It is assumed that BP decreases with repeat measurements and multiple readings are recommended. There is limited information about within-visit BP variability (BPV) in healthy children. Methods: We used NHANES data (2013-2020) to measure BPV in subjects 8-17 years old with three BP readings. During 2013 to 2016, auscultatory BP was obtained (manual protocol, MP). Subsequently, oscillometric BP was measured (automated protocol, AP). We excluded subjects with diastolic BP 'zero'. Results: We included a total 5656 subjects with 3365 (59.5%) in the MP and 2291 (40.5%) in the AP group. A ΔBP (individual-level difference between the highest and lowest of three BP readings) ≥5 mmHg was noted in 49.1% and 60.7% subjects for systolic BP (SBP) and diastolic BP (DBP) respectively. A ΔDBP ≥10 mmHg and DBP average real variability ≥10 mmHg was twice as common in the MP than AP group. A ΔBP ≥20 mmHg was noted in 1.3% and 4.4% subjects for SBP and DBP respectively. The first SBP and DBP reading was ?5 mmHg higher or lower than the averaged second and third SBP and DBP readings in 24.9% and 34.5% of subjects respectively. The first SBP and DBP reading was the highest of three BP readings in 44.2% and 42.4% subjects respectively. Conclusions: There is significant BPV in children and adolescents. Diastolic BPV is more common in MP than AP groups. Initial BP is not always the highest and inclusion of second and third BP reading may be more representative of patient's actual BP.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1101/2024.08.16.24312123
John Baptist Asiimwe, Earnest Amwiine, Angella Namulema, Quraish Sserwanja, Joseph Kawuki, Mathius Amperiize, Shamim Nabidda, Imelda Nmaatovu, Lilian Nuwabaine
Background Kenya is one of the African countries that have pledged to reduce neonatal death as per the World Health Organization set target by 2030. Providing high-quality newborn care is critical in minimizing neonatal mortality. The purpose of this study was to determine the factors that influence the quality of newborn care in Kenya. Methods Secondary data from 11,863 participants of the Kenya Demographic and Health Survey (KDHS) 2022 were analyzed. The participants were chosen using a two-stage stratified sampling method. The quality of newborn care was operationalized as receiving all components of newborn care after childbirth, as reported by the mother. To identify the factors associated with the quality of newborn care, multivariable logistic regression was carried out using SPSS (version 20). Results In this study, 32.7% (95% CI: 31.0-34.5) of the mothers reported that their newborns had received all components of quality neonatal care after childbirth. Mothers who subscribed to the Christian (3.60 (95%CI: 1.32-9.83) or Muslim faith (3.88 (95%CI: 1.29-11.67) compared with those from other faiths, were more likely to report that their newborns had received quality newborn care. Mothers who spent an average of one hour accessing the health facilities compared with those who spent less than half an hour were 1.33 (95%CI: 1.01-1.75) times more likely to report that their newborns had received quality newborn care. Mothers who gave birth in a non-government organization health facility were 30.37 (95%CI: 2.69-343.20) times more likely to report that their newborns had received quality newborn care compared with those who delivered from a faith-based organization. On the contrary, in terms of regions, Mothers who lived in Nyanza, Eastern, and Rift Valley provinces compared with those who lived in the coastal regions were 0.53 (95%CI: 0.34-0.82), 0.61 (95%CI: 0.39-0.94), and 0.62 (95%CI: 0.41-0.93) times less likely to report that their newborns had received quality newborn care, respectively. Finally, mothers who gave birth through cesarean section were 0.44 (95%CI: 0.32-0.61) times less likely to report that their newborns had received quality newborn care than mothers who gave birth through spontaneous vaginal delivery. Conclusion The study indicates about a third of the neonates (1 in 3) received quality newborn care. This study seems to suggest that facility-related and parental social factors are associated with receiving quality newborn care. Several stakeholders including health care providers may need to pay more attention to newborn babies whose mothers come from marginalized regions of the country, minority religious faith denominations, and those delivered by ceasearen section. Stakeholders should focus on strengthening collaborations with NGO health facilities and achieving universal health coverage to improve the quality of neonatal care. Also, the government could utilize minority faith denominations as an avenue for staging sens
{"title":"Quality of newborn care and associated factors: An analysis of the 2022 Kenya demographic and health survey.","authors":"John Baptist Asiimwe, Earnest Amwiine, Angella Namulema, Quraish Sserwanja, Joseph Kawuki, Mathius Amperiize, Shamim Nabidda, Imelda Nmaatovu, Lilian Nuwabaine","doi":"10.1101/2024.08.16.24312123","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312123","url":null,"abstract":"Background Kenya is one of the African countries that have pledged to reduce neonatal death as per the World Health Organization set target by 2030. Providing high-quality newborn care is critical in minimizing neonatal mortality. The purpose of this study was to determine the factors that influence the quality of newborn care in Kenya. Methods Secondary data from 11,863 participants of the Kenya Demographic and Health Survey (KDHS) 2022 were analyzed. The participants were chosen using a two-stage stratified sampling method. The quality of newborn care was operationalized as receiving all components of newborn care after childbirth, as reported by the mother. To identify the factors associated with the quality of newborn care, multivariable logistic regression was carried out using SPSS (version 20). Results In this study, 32.7% (95% CI: 31.0-34.5) of the mothers reported that their newborns had received all components of quality neonatal care after childbirth. Mothers who subscribed to the Christian (3.60 (95%CI: 1.32-9.83) or Muslim faith (3.88 (95%CI: 1.29-11.67) compared with those from other faiths, were more likely to report that their newborns had received quality newborn care. Mothers who spent an average of one hour accessing the health facilities compared with those who spent less than half an hour were 1.33 (95%CI: 1.01-1.75) times more likely to report that their newborns had received quality newborn care. Mothers who gave birth in a non-government organization health facility were 30.37 (95%CI: 2.69-343.20) times more likely to report that their newborns had received quality newborn care compared with those who delivered from a faith-based organization.\u0000On the contrary, in terms of regions, Mothers who lived in Nyanza, Eastern, and Rift Valley provinces compared with those who lived in the coastal regions were 0.53 (95%CI: 0.34-0.82), 0.61 (95%CI: 0.39-0.94), and 0.62 (95%CI: 0.41-0.93) times less likely to report that their newborns had received quality newborn care, respectively. Finally, mothers who gave birth through cesarean section were 0.44 (95%CI: 0.32-0.61) times less likely to report that their newborns had received quality newborn care than mothers who gave birth through spontaneous vaginal delivery. Conclusion The study indicates about a third of the neonates (1 in 3) received quality newborn care. This study seems to suggest that facility-related and parental social factors are associated with receiving quality newborn care. Several stakeholders including health care providers may need to pay more attention to newborn babies whose mothers come from marginalized regions of the country, minority religious faith denominations, and those delivered by ceasearen section. Stakeholders should focus on strengthening collaborations with NGO health facilities and achieving universal health coverage to improve the quality of neonatal care. Also, the government could utilize minority faith denominations as an avenue for staging sens","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142223635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1101/2024.08.16.24312128
Molly B Klarman, Xiaofei Chi, Youseline Cajusma, Katelyn E Flaherty, Jude Ronald Beausejour, Lerby Exantus, Valery M Beau de Rochars, Chantale Baril, Torben K Becker, Matthew J Gurka, Eric J Nelson
Objective. To evaluate a scalable pediatric telemedicine and medication delivery service (TMDS) that extends early healthcare access at households to avert emergencies. Study design. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, non-severe cases with higher clinical uncertainty to in-person exams at households with medication delivery, and non-severe cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients (≤10 years). Clinical and operational metrics were compared to a formative reference study in which all non-severe patients received an in-person exam. The primary outcomes were reported rates of clinical improvement/recovery and in-person care seeking at 10-days. Results: 1043 cases (41 severe; 1002 non-severe) were enrolled in the scalable TMDS mode and 19% (190) of the non-severe cases received an in-person exam. 382 cases (24 severe, 358 non-severe) were enrolled in the reference study and 94% (338) of the non-severe cases received an in-person exam. At 10-days, rates of improvement were similar for the scalable (97%, 897) and reference (95%, 329) modes. Rates of participants who sought follow-up care were 15% (138) in the scalable mode and 24% (82) in the reference mode. Conclusion: In the context of a five-fold reduction of in-person exams, participants in the scalable TMDS mode had non-inferior rates of improvement at 10-days. These findings highlight an innovative and now scalable solution to improve early access to healthcare at households without compromising safety.
{"title":"Evaluation of a Scalable Design for a Pediatric Telemedicine and Medication Delivery Service: A Prospective Cohort Study in Haiti","authors":"Molly B Klarman, Xiaofei Chi, Youseline Cajusma, Katelyn E Flaherty, Jude Ronald Beausejour, Lerby Exantus, Valery M Beau de Rochars, Chantale Baril, Torben K Becker, Matthew J Gurka, Eric J Nelson","doi":"10.1101/2024.08.16.24312128","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312128","url":null,"abstract":"Objective. To evaluate a scalable pediatric telemedicine and medication delivery service (TMDS) that extends early healthcare access at households to avert emergencies.\u0000Study design. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, non-severe cases with higher clinical uncertainty to in-person exams at households with medication delivery, and non-severe cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients (≤10 years). Clinical and operational metrics were compared to a formative reference study in which all non-severe patients received an in-person exam. The primary outcomes were reported rates of clinical improvement/recovery and in-person care seeking at 10-days.\u0000Results: 1043 cases (41 severe; 1002 non-severe) were enrolled in the scalable TMDS mode and 19% (190) of the non-severe cases received an in-person exam. 382 cases (24 severe, 358 non-severe) were enrolled in the reference study and 94% (338) of the non-severe cases received an in-person exam. At 10-days, rates of improvement were similar for the scalable (97%, 897) and reference (95%, 329) modes. Rates of participants who sought follow-up care were 15% (138) in the scalable mode and 24% (82) in the reference mode.\u0000Conclusion: In the context of a five-fold reduction of in-person exams, participants in the scalable TMDS mode had non-inferior rates of improvement at 10-days. These findings highlight an innovative and now scalable solution to improve early access to healthcare at households without compromising safety.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1101/2024.08.16.24311812
Claudia Rocchi, Francesca Bonetti
ABSTRACT Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviours (Hodges et al., 2020). According to the American guidelines, the impact of disability can affect the family's well-being and have consequences for the siblings and the organisation of family life, both economically and psychologically (ASHA, 2006). Given the lack of parent-focused measures to assess these aspects, Leadbitter et al. (2018) developed the Autism Family Experience Questionnaire (AFEQ), aimed at assessing priority outcomes for parents of preschool-aged children with ASD who were previously enrolled in the Pre-school Autism Communication Trial, a randomized controlled trial study on parent-mediated intervention (Leadbitter et al., 2018; Green et al., 2010). The aim of the present study was to translate and culturally adapt into Italian the AFEQ (Leadbitter et al., 2018) and to verify the main psychometric performances of the adapted version. Methods Linguistic validation and cross-cultural adaptation to the Italian context were based on the guidelines of Beaton et al. (2000). Once the direct and inverse translation phases were completed with the favourable opinion of the panel of experts recruited for the study, further tests on the psychometric properties of the adapted questionnaire were required. Following the consensus obtained from the authors of the original questionnaire and according to the recommendations of Polit et al. (2007) and Polit and Beck (2006), a second panel of selected experts determined the content validity of the adapted instrument through the calculation of the Content Validity Index (CVI), according to the indications for each item (I-CVI) and for the scale (S-CVI). Results A medical doctor and a non-medical expert, both native Italian speakers with an adequate knowledge of English, independently produced a translation. The latter were then compared and discrepancies in the translation process were resolved in a discussion. Two independent, native English-speaking translators produced reverse translations of the resulting version; neither of them had experience or knowledge of the objectives of the study nor of the healthcare sector. The two translations were similar to each other and one of them was almost identical to the original. The original questionnaire and the material obtained in the previous stages were made available to an interdisciplinary panel of experts recruited for the study. All members agreed on that T1-2 was the only accepted translated version. Analysing the I-CVI, all items exceeded the expected cut-off of >/= 0.78 except for one (I-CVI value 0.6). The S-CVI reached and exceeded the cut-off when obtained with the S-CVI/Ave calculation mode, while with the S-CVI/UA the value was 0.73 and was slightly below the cut-off. Discussion and Conclusion To the authors' knowledge, this study is the f
{"title":"The assessment of family experience and expected outcomes from early intervention in preschool children with Autism Spectrum Disorder: translation and cross-cultural adaptation of the Autism Family Experience Questionnaire (AFEQ) to the Italian context. ","authors":"Claudia Rocchi, Francesca Bonetti","doi":"10.1101/2024.08.16.24311812","DOIUrl":"https://doi.org/10.1101/2024.08.16.24311812","url":null,"abstract":"ABSTRACT\u0000Background\u0000Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviours (Hodges et al., 2020). According to the American guidelines, the impact of disability can affect the family's well-being and have consequences for the siblings and the organisation of family life, both economically and psychologically (ASHA, 2006). Given the lack of parent-focused measures to assess these aspects, Leadbitter et al. (2018) developed the Autism Family Experience Questionnaire (AFEQ), aimed at assessing priority outcomes for parents of preschool-aged children with ASD who were previously enrolled in the Pre-school Autism Communication Trial, a randomized controlled trial study on parent-mediated intervention (Leadbitter et al., 2018; Green et al., 2010). The aim of the present study was to translate and culturally adapt into Italian the AFEQ (Leadbitter et al., 2018) and to verify the main psychometric performances of the adapted version.\u0000Methods\u0000Linguistic validation and cross-cultural adaptation to the Italian context were based on the guidelines of Beaton et al. (2000). Once the direct and inverse translation phases were completed with the favourable opinion of the panel of experts recruited for the study, further tests on the psychometric properties of the adapted questionnaire were required. Following the consensus obtained from the authors of the original questionnaire and according to the recommendations of Polit et al. (2007) and Polit and Beck (2006), a second panel of selected experts determined the content validity of the adapted instrument through the calculation of the Content Validity Index (CVI), according to the indications for each item (I-CVI) and for the scale (S-CVI).\u0000Results\u0000A medical doctor and a non-medical expert, both native Italian speakers with an adequate knowledge of English, independently produced a translation. The latter were then compared and discrepancies in the translation process were resolved in a discussion. Two independent, native English-speaking translators produced reverse translations of the resulting version; neither of them had experience or knowledge of the objectives of the study nor of the healthcare sector. The two translations were similar to each other and one of them was almost identical to the original. The original questionnaire and the material obtained in the previous stages were made available to an interdisciplinary panel of experts recruited for the study. All members agreed on that T1-2 was the only accepted translated version. Analysing the I-CVI, all items exceeded the expected cut-off of >/= 0.78 except for one (I-CVI value 0.6). The S-CVI reached and exceeded the cut-off when obtained with the S-CVI/Ave calculation mode, while with the S-CVI/UA the value was 0.73 and was slightly below the cut-off. Discussion and Conclusion\u0000To the authors' knowledge, this study is the f","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Perinatal asphyxia (PNA) remains a leading, yet preventable, cause of neonatal death, disproportionately affecting low-resource settings like Ethiopia. Despite its significance, data on the burden and factors influencing survival among asphyxiated neonates in this region are scarce. This study aims to address this gap by investigating the time to death and its associated predictors in this vulnerable population. Methods: A retrospective cohort study was conducted at Wolaita Sodo University Comprehensive Specialized Hospital's Neonatal Intensive Care Unit (NICU) in southern Ethiopia. Medical records of 404 neonates diagnosed with PNA between January 2019 and December 2023 were reviewed. The study followed these neonates for a total of 2889 person-days to assess their survival outcomes. Kaplan-Meier analysis estimated the median time to death, and a Weibull regression model identified independent predictors of mortality. Results: The findings revealed the incidence density of PNA-related mortality of 30.8 per 1,000 person-days (95% CI: 25.0-37.9). Notably, nearly 72% of deaths occurred within the first critical week of life, with a median survival time of 20 days. The multivariable Weibull regression analysis identified several factors significantly associated with shorter time to death at p 0.05. These are presence of meconium-stained amniotic fluid (MSAF), low fifth-minute Apgar score (less than 7), birth weight greater than 4000gm, low admission oxygen saturation level, treatment with anticonvulsant, the use of Continuous Positive Airway Pressure (CPAP) for oxygen administration, and need for resuscitation with chest compression. Conclusion: This study highlights the significant burden of PNA-related mortality, particularly during the first week of life, in a resource-limited setting. The findings underscore the urgent need for improved PNA management strategies. Furthermore, specific treatment decisions, including the use of anticonvulsants, oxygen therapy methods, and resuscitation techniques, emerged as crucial factors influencing survival outcomes. These results call for further investigation into these specific interventions and potentially revising PNA management protocols to optimize the chances of survival for asphyxiated neonates in low-resource settings like Ethiopia.
{"title":"Time to death and its predictors among neonates with perinatal asphyxia at a tertiary hospital in southern Ethiopia","authors":"Jenenu Getu Bekele, Niguse Mekonnen Kara, Amene Abebe Kerbo, Tadiwos Utalo Urkashe","doi":"10.1101/2024.08.13.24311935","DOIUrl":"https://doi.org/10.1101/2024.08.13.24311935","url":null,"abstract":"Background: Perinatal asphyxia (PNA) remains a leading, yet preventable, cause of neonatal death, disproportionately affecting low-resource settings like Ethiopia. Despite its significance, data on the burden and factors influencing survival among asphyxiated neonates in this region are scarce. This study aims to address this gap by investigating the time to death and its associated predictors in this vulnerable population.\u0000Methods: A retrospective cohort study was conducted at Wolaita Sodo University Comprehensive Specialized Hospital's Neonatal Intensive Care Unit (NICU) in southern Ethiopia. Medical records of 404 neonates diagnosed with PNA between January 2019 and December 2023 were reviewed. The study followed these neonates for a total of 2889 person-days to assess their survival outcomes. Kaplan-Meier analysis estimated the median time to death, and a Weibull regression model identified independent predictors of mortality.\u0000Results: The findings revealed the incidence density of PNA-related mortality of 30.8 per 1,000 person-days (95% CI: 25.0-37.9). Notably, nearly 72% of deaths occurred within the first critical week of life, with a median survival time of 20 days. The multivariable Weibull regression analysis identified several factors significantly associated with shorter time to death at p 0.05. These are presence of meconium-stained amniotic fluid (MSAF), low fifth-minute Apgar score (less than 7), birth weight greater than 4000gm, low admission oxygen saturation level, treatment with anticonvulsant, the use of Continuous Positive Airway Pressure (CPAP) for oxygen administration, and need for resuscitation with chest compression.\u0000Conclusion: This study highlights the significant burden of PNA-related mortality, particularly during the first week of life, in a resource-limited setting. The findings underscore the urgent need for improved PNA management strategies. Furthermore, specific treatment decisions, including the use of anticonvulsants, oxygen therapy methods, and resuscitation techniques, emerged as crucial factors influencing survival outcomes. These results call for further investigation into these specific interventions and potentially revising PNA management protocols to optimize the chances of survival for asphyxiated neonates in low-resource settings like Ethiopia.","PeriodicalId":501549,"journal":{"name":"medRxiv - Pediatrics","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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