Journal of mother and child最新文献

Background: Peculiarities of the course of chronic viral hepatitis B in children cause an important medical and social problem of health care, despite the implementation of modern treatment and prevention protocols. Pathogenetic mechanisms of the development and progression of viral hepatitis B infection, the presence of occult poorly diagnosed form, the impossibility of completely eliminating the virus and the specificity of the immune response in children are still not fully solved scientific problems.

Material and methods: The aim of this review is to examine current strategies for the diagnosis and treatment of chronic hepatitis B in children, based on international and national guidelines.

Results: A detailed analysis of modern guidelines on the course and pathogenesis of viral hepatitis B infection confirms the fact that chronic hepatitis B is characterised by a complex interaction between the immune system of the virus and the patient, whose dynamic balance is not only responsible for the various phases of chronic viral hepatitis B infection but also leads to the result of antiviral treatment.

Conclusion: Despite the introduction of vaccination of children against hepatitis B, the level of viral hepatitis B vaccination of children in Ukraine remains insufficient, which leads to the further spread of the infection. Currently available antiviral drugs can provide functional treatment of viral hepatitis B infection in a limited number of patients, but today's Ukrainian realities have caused a change in approach to the treatment and monitoring of patients, which may negatively affect the implementation of the key goals of the World Health Organization Global Strategy on the prevention, diagnosis and treatment of viral hepatitis.

The caesarean section is a frequently performed method of delivery. Although the caesarean section is a low-risk and safe surgery, there is an increase in maternal and infant morbidity and mortality due to caesarean delivery. One of the most common infant morbidities is foetal laceration. Caesarean delivery has a 1-2% risk of laceration to the foetus. Various methods have been proposed to deal with laceration wounds. Studies have been conducted on vernix caseosa, which can heal wounds on the skin. This case series report aims to demonstrate that vernix caseosa application is a wound healing method that is highly effective, costless, and of immediate availability.

Background: Within the endocrine-paracrine signalling network at the maternal-foetal interface, the activin-inhibin-follistatin system modulates extravillous trophoblast invasion, suggesting a potential role in preeclampsia pathogenesis. This study aimed to compile the evidence published in the last decade regarding the variation in maternal serum activins, inhibin- and follistatin-related proteins in preeclamptic pregnancies compared to healthy pregnancies, and to discuss their role in predicting and understanding the pathophysiology of preeclampsia.

Material and methods: A scoping review was conducted in MEDLINE, EMBASE and LILACS databases to identify studies published within the last ten years (2012-2022).

Results: Thirty studies were included. None of the studies addressed maternal serum changes of isoforms different from activin A, inhibin A, follistatin, and follistatin-like 3. Sixteen studies evaluated the potential of these isoforms in predicting preeclampsia through the area under the curve from a receiver operating characteristic curve.

Conclusions: In preeclampsia, inhibin A is upregulated in all trimesters, whereas activin A increases exclusively in the late second and third trimesters. Serum follistatin levels are reduced in women with preeclampsia during the late second and third trimesters. However, changes in follistatin-like 3 remain inconclusive. Inhibin A and activin A can potentially serve as biomarkers of early-onset preeclampsia based on the outcomes of the receiver operating characteristic curve analysis. Further investigations are encouraged to explore the feasibility of quantifying maternal serum levels of activin A and inhibin A as a clinical tool in early preeclampsia prediction.

Background: Blood cultures remain the gold standard for the diagnosis of sepsis. However, volumes of blood submitted for cultures often do not match the recommended values. We propose a simple intervention aimed to verify the volume of blood sampled using a scale. This study was undertaken in preparation for a future, multicenter, pre- and post-intervention trial. Our primary objective was to test the feasibility (uptake and retention) of this future intervention.

Materials and methods: This study was conducted at a neonatal department in Warsaw, Poland, over a period of eight months (May to December 2020). Before starting the study, we undertook an educational intervention focused on obtaining adequate blood volumes for culture. The culture bottles that were weighed in advance were distributed in all blood collection areas. Blood volume was verified by weighing the bottle immediately after blood inoculation. The calculated value was communicated to the collecting clinician and recorded. The primary outcome measure was the percentage of blood culture submissions for which the blood volume inoculated into the bottles was determined by weighing.

Results: During the study period, 244 blood samples were collected for culture, out of which 205 samples were weighed (84.0%, CI₉₅ [78.8% to 88.4%]). This high proportion remained stable throughout the study period. We have not observed any adverse events related to the study.

Conclusions: The point-of-care verification of blood culture volume using a scale was feasible to implement. Since we have met our pre-established criterion for success, a future, definitive trial is likely to proceed.

Guillain-Barré syndrome (GBS) can occur after viral infections. Its occurrence after COVID-19 infection in the peripartum period is a very rare co-occurrence. Therefore, there are no guidelines for the management of these patients. We report the case of a 32-year-old pregnant woman who developed COVID-19-associated GBS with aspiration pneumonia, motor weakness, and ascending paralysis at 39 weeks of gestation. Preoperative plasmatic exchange (plasmapheresis) and oxygen support were very effective and allowed for a rapid recovery within five days. Because of foetal distress during labor, the patient had a caesarean section under spinal anaesthesia with no maternal complications or adverse foetal outcomes.

Introduction: In December 2019, the Chinese city of Wuhan reported the first cases of pneumonia from a new type of beta coronavirus named SARS-CoV-2. In the early days of the COVID-19 outbreak, paediatric patients were thought to be immune to the new virus; however, further studies have shown people of all ages to be susceptible to the virus.

Objective: Identify and describe the clinical and epidemiological features of COVID-19 among hospitalized children in Ukraine.

Materials and methods: Retrospective study of 171 children aged 2 months to 18 years who were hospitalized with laboratory-confirmed SARS-CoV-2.

Results: Most patients in the study had a moderate progression of the disease (77.78%, or n=133), whereas a severe course was noted in 22.22% (n=38). Across age groups, children aged 6-12 was the predominant age group affected (35.67%, or n=61). The most common symptoms were fever in 88.2% of patients, sore throat in 69.2% and cough in 60.9%. Symptoms associated with dyspnoea and cyanosis were significantly more common in children with the severe course (p<0.05). Almost half of children had at least one comorbidity, the most prevalent being chronic tonsillitis (11.8% of patients) and anemia (6.5% of patients). A positive correlation (r=0.7 p<0.05) was found between CRP levels and COVID-19 severity. X-ray changes in the lungs were present in 76.61% of examined children and ground-glass opacity symptom was registered in 50.88%.

Conclusions: COVID-19 among hospitalized children in Ukraine usually has a moderate course of illness and a good prognosis.

Background: An increase in correct usage of modern contraception is vital in reducing the maternal mortality ratio and Under-5 mortality, leading towards the achievement of Sustainable Development Goal 3. Our study examined the trends and factors affecting non-utilization of modern contraceptives over a 10-year period in Ekiti State, Nigeria.

Methodology: This study used data from three consecutive National Demographic Health Surveys (NDHS) - 2008, 2013, and 2018 - with a weighted sample size of 1,357 women of reproductive age (15-49 years). Data on contraceptive use on these women, provided by the NDHS, were extracted and analysed using IBM SPSS version 25. The sample was weighted to adjust for disproportionate sampling and non-response. Pearson's chi-square and binary logistic regression were used to assess the factors associated with non-utilization of modern contraceptives.

Results and findings: The mean age of the women was 30 years. Modern contraceptive use increased from 13.1% in 2008 to 23.0% in 2018, while unmet need for modern contraceptives decreased from 84.8% in 2008 to 75.4% in 2018. Identified predictors of non-utilization of modern contraceptive were age 20-24 years [aOR=0.33, 95%CI=0.19-0.59], 25-29 years [aOR=0.34, 95%CI=0.18-0.64], 30-34 years [aOR=0.46, 95%CI=0.22-0.94], 35-39 years [aOR=0.29, 95%CI=0.14-0.61] and 40-44 years [aOR=0.37, 95%CI=0.17-0.80] compared to age 15-19 years; living in urban areas [aOR=0.72, 95%CI=0.53-0.98] compared to in rural areas; higher level of education [aOR=0.46, 95%CI=0.21-0.98] compared to no education; and desire for more children [aOR=0.48, 95%CI=0.32-0.73] compared to not wanting more children.

Conclusion: Although contraceptive usage increased over time, the factors associated with non-utilization were being an adolescent, living in a rural area, lower level of education, and desire for more children.

Background: The purpose of this study was to determine the impact of early exposure to play materials on motor development in high-risk infants.

Materials and methods: A 1:1 parallel group randomised control study was conducted. A total of 36 participants were recruited, with 18 in each group. The intervention lasted 6 weeks for both groups, with follow-ups in the 2nd and 4th weeks. The Peabody Developmental Motor Scale 2nd Edition (PDMS-2) was used as an outcome measure. The data was analysed using the Likelihood Ratio test, Chi-square test, independent sample t-test, and paired t-test.

Results: There was no difference between the groups except for the raw reflex scores (t = 3.29, p = 0.002), raw stationary scores (t = 4.26, p < 0.001), standard stationary scores (t = 2.57, p = 0.015), and Gross Motor Quotient (GMQ) (t = 3.275, p = 0.002). Statistical significance within the experimental group was observed in the raw reflex (t = -5.16, p < 0.001), stationary (t = -10.5, p < 0.001), locomotion (t = -5.67, p < 0.001), grasp (t = -4.68, p < 0.001), and visual motor (t = -5.03, p < 0.001) scores, as well as the standard stationary (t = -2.87, p = 0.010), locomotion (t = -3.43, p = 0.003), grasp (t = -3.28, p = 0.004), and visual motor (t = -5.03, p < 0.001) scores. Quotients were the GMQ (t = -7.31, p < 0.001), Total Motor Quotient (TMQ) (t = -5.71, p < 0.001), Fine Motor Quotient (FMQ) (t = -6.48, p < 0.001). Conclusions: The current study concludes that a six-week treatment of early exposure to age-appropriate toys is advantageous in enhancing motor development in high-risk neonates.

Background: Pregnancy is an immuno-compromised state, and pregnant women with COVID-19 are at an increased risk for adverse pregnancy outcomes. Thus, the Center for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization (ACIP) have advocated for COVID-19 vaccination in pregnant women. COVAXIN and COVISHIELD were the vaccines being used in India in the first phase of vaccination, but limited data exist on pregnancy outcomes regarding SARS-CoV-2 vaccines and pregnancy and lactation.

Material and methods: A retrospective study was conducted which included only women who delivered after 24 weeks gestation. Women with an unknown vaccination status or with past or active COVID-19 infection were excluded. Demographic characteristics, maternal and obstetric outcomes, and fetal and neonatal outcomes were compared between the unvaccinated and vaccinated groups. Statistical analysis was done with Chi-square testing and the Fisher exact test using SPSS-26 software.

Results: Deliveries before a gestation of 37 weeks were significantly higher in the unvaccinated group compared to the vaccinated group. Rates of vaginal deliveries and preterm deliveries were found to be higher in the unvaccinated population. Women who had taken COVAXIN had a higher rate of adverse events compared to those who had taken COVISHIELD.

Conclusion: There were no significant differences in adverse obstetric outcomes attributed to vaccine administration between the vaccinated and unvaccinated pregnant women. The beneficial effects of the vaccines in protecting against COVID-19 infection, particularly in pregnancy, outweigh the minor adverse events associated with vaccine administration.

Introduction: High workplace/ambient temperatures have been associated with Adverse Pregnancy Outcomes (APO). Millions of women working in developing nations suffer due to the rising temperatures caused by climate change. There are few pieces of research linking occupational heat stress to APO, and fresh evidence is required.

Methodology: We used databases including PubMed, Google Scholar, and Science Direct to search for research on high ambient/workplace temperatures and their effects. Original articles, newsletters, and book chapters were examined. The literature we analysed was categorised as follows: Heat, strain, and physical activity harming both mother and fetus. After categorising the literature, it was examined to identify the major results.

Results: We found a definite association between heat stress and APOs such as miscarriages, premature birth, stillbirth, low birthweight, and congenital abnormalities in 23 research articles. Our work provides important information for future research into the biological mechanisms that create APOs and various prevention measures.

Conclusion: Our data suggest that temperature has long-term and short-term effects on maternal and fetal health. Though small in number, this study stressed the need for bigger cohort studies in tropical developing countries to create evidence for coordinated policies to safeguard pregnant women.