Journal of mother and child最新文献

Background: During NICU admission, extra-uterine growth retardation that can affect the neurodevelopmental outcome is a challenging problem in extremely preterm infants. This trial aimed to determine the effect of additional enteral protein supplementation on the growth velocity of the anthropometric parameters.

Method: In this randomized controlled trial, 77 preterm infants (gestational age ≤33 weeks and birth weight <1500 g) who reached full enteral feeding with either fortified breast milk or preterm formula were included. They were randomized to receive either 4-<5 g/kg/day protein through extra protein supplementation (intervention) or 3-<4 g/kg/day protein. Weight gain, as well as length and head circumference growth, were monitored daily and weekly, respectively. Venous blood gas, blood urea nitrogen (BUN), and albumin levels were checked weekly.

Results: Five out of 77 participants were excluded due to feeding intolerance. Analyses were conducted on 36 neonates with protein intake of 3.66 ± 0.22 gr/kg/day and 36 with extra protein intake. Baseline characteristics were similar between the groups. An additional protein supply of 0.89 gr/kg/day, resulting in an average protein intake of 4.55 ± 0.18 in the intervention group, increased the postnatal weight gain, linear growth, and head circumference growth (7.98 gr/kg/day, 0.347 cm/week, and 0.38 cm/week, respectively). The albumin levels were significantly increased, but the BUN levels were not significantly increased in the intervention group. None of the patients developed necrotizing enterocolitis or significant acidosis.

Conclusion: Protein supplementation significantly improves the growth of the anthropometric parameters. An increase in serum albumin and no increase in serum urea can indicate the anabolic effect of extra protein. Protein supplementation can add to routine feeding protocols of VLBW infants without any short-term adverse effect; however, further study for evaluation of long-term complications is needed.

Background: Some cultures have a favorable view of menstruation, consider it sacred, and respect the female body, so some local wisdom and the practice of using plant species are also attached to it. Moreover, menstruation is an integral part of reproductive health for women as mothers of a nation. However, the management of menstrual problems included in the United Nations Sustainable Development Goals (gender justice) goals in several indigenous communities around the forest has not received attention.

Objective: This study aims to explain the situation of menstrual management, predict indications of reproductive problems, and record the practice of using plants to overcome these problems in indigenous tribal communities around the forest.

Material and methods: A total of 15 youths of the Orang Rimba, one of the marginal indigenous people in Jambi Province, Sumatra Island, Indonesia, were the subjects of measurement of all variables using anthropometric measurement procedures. The 15 girls were also interviewed regarding menstrual problems, personal hygiene management, and using plant species to overcome them. Meanwhile, ten adults became respondents to the complementary primary data.

Results: No plant species were explicitly used to treat menstrual problems. Four species are used by the Orang Rimba concerning labor management (pre- and postpartum).

Conclusion: There are no significant reproductive problems despite the incidence of dysmenorrhea. However, aspects of nutrition and personal hygiene, including during menstruation, still need special attention, especially considering that the typology of Orang Rimba varies according to their Tumenggung and the characteristics of their forest habitat; It is challenging to measure their health as a group. This condition may also apply to other communities around the forest due to their limited reproductive health knowledge.

Background: Despite the current advances in antenatal care and imaging methodologies in obstetrics, cases of advanced abdominal pregnancies are still reported, mostly in low- and middle-income countries where frequently only a few perinatal checks are performed and where these methodologies are sometimes not adopted in obstetrical outpatient settings.

Case presentation: We report the video of a case of a 20-year-old I gravida Ivorian patient, sent to CHU de T reichville in Abidjan, Ivory Coast, for management of abdominal 39 weeks pregnancy after routine antenatal care. She was asymptomatic with a live foetus in transverse lie position. The anamnesis revealed four prenatal checks without ultrasound evaluation, the first one at 24 weeks of pregnancy. Emergency median longitudinal sub-umbilical laparotomy incision was performed. Foetal extraction was realized by transplacental incision due to omental placental implantation. A live female baby weighting 3350 grams was delivered, presenting bilateral clubfeet and an enlarged neck. The release of the adherent placenta required a partial omentectomy and left adnexectomy and was carefully removed following active bleeding from its detached margins. The newborn died of respiratory distress on the first day after birth. No autopsy was performed. Postoperative morbidity for the woman was minimal and she was discharged on the seventh post-operative day in good general condition.

Conclusion: Abdominal pregnancies with a normal live foetus at such an advanced gestational age are extremely rare, and there are no available videos in the extant literature of the surgical procedure performed. Standardization of treatment principles, pre-operative preparation with imaging techniques (MRI, embolization of placental vessels) and adequately equipped and staffed neonatal units are necessary to optimize the foetus-maternal outcomes.

A 29-year-old parous woman with a history of a T-shaped copper intrauterine device (IUD) insertion presented 8 months later with a complaint of the contraceptive device being missing. Computed tomography with contrast turned out to be superior to the combined abdominal and pelvic X-ray and transvaginal ultrasound in providing the detailed extrauterine location of the device between the urinary bladder and uterus. A laparoscopy was successful in the atraumatic freeing of the IUD from omental and bladder adhesions, and in its final removal.

Background: The risk of fetal anomalies (FAs) is increased in infants of diabetic mothers. FAs are closely related to the glycosylated hemoglobin (HbA1c) level in pregnancy.

Objectives: To detect the prevalence of FAs in women with gestational diabetes mellitus (GDM).

Material and methods: 157 pregnant women with GDM were included in this study, and data from 151 women were analyzed. Beyond the regular antenatal check-up, the HbA1c was checked monthly during the antenatal follow-up. Collected data after delivery were analyzed to detect the prevalence of FAs in women with GDM and the risk of FAs in relation to the pre-conceptional blood sugar and HbA1c.

Results: The FAs were recorded in 8.6% (13) of the 151 women with GDM. The recorded FAs were cardiovascular [2.6% (4)], musculoskeletal [1.3% (2)], urogenital [1.3% (2)], gastrointestinal [1.3% (2)], facial [0.7% (1)], central nervous system [0.7% (1)], and multiple FAs [0.7% (1)]. The uncontrolled pre-conceptional blood sugar significantly increased RR [RR 2.2 (95%CI: 1.7-2.9); P < 0.001], and odds of FAs [OR 17.05 (95%CI: 2.2-134.9); P = 0.007] in women with GDM. In addition, the HbA1c ≥6.5 significantly increased RR [RR 2.8 (95% CI: 2.1-3.8); P < 0.001], and odds of FAs [OR 24.8 (95% CI: 3.1-196.7); P = 0.002] in women with GDM.

Conclusion: In this study, the prevalence of FAs in women with GDM was 8.6%. Uncontrolled pre-conceptional blood sugar and HbA1c ≥6.5 in the first trimester significantly increased the relative risk and the odds of FAs.

Background: In developing countries, neonatal sepsis is one of the major causes of mortality and morbidity. Vitamin A deficiency also affects the immune system severely and is associated with various neonatal infections. We aimed to compare maternal and neonatal vitamin A levels among neonates with and without late-onset sepsis.

Material and methods: 40 eligible infants were entered into this case-control study according to inclusion criteria. The case group included 20 term or near-term infants who had late-onset neonatal sepsis from three to seven days of life. The control group consisted of 20 term or near-term infants who were icteric hospitalized neonates without sepsis. Demographic, clinical and paraclinical features, as well as neonatal and maternal vitamin A levels, were compared between the two groups.

Results: The average gestational age of the neonates was 37.1 ± 1.2, ranging from 35 to 39 days. There was a significant difference between the septic and non-septic groups in terms of white blood cell and neutrophil count, C-reactive protein, and neonatal and maternal vitamin A levels. A Spearman correlation analysis showed a significant direct correlation among maternal and neonatal vitamin A levels (correlation coefficient = 0.507; P-value = 0.001). Multivariate regression analysis showed that neonates' vitamin A level had a significant direct association with sepsis (OR: 0.541; P-value=0.017).

Conclusion: Our findings demonstrated the association of lower vitamin A levels in neonates and their mothers with an increased risk of late-onset sepsis, which emphasizes the importance of the consideration of vitamin A level evaluation and its appropriate neonatal and maternal supplementation.

Joubert syndrome (JS; MIM PS213300) is a rare genetic autosomal recessive disease characterized by cerebellar vermis hypoplasia, a distinctive malformation of the cerebellum and the so-called "molar tooth sign." Other characteristic features are hypotonia with lateral ataxia, intellectual disability/mental retardation, oculomotor apraxia, retinal dystrophy, abnormalities in the respiratory system, renal cysts, hepatic fibrosis, and skeletal changes. Such pleiotropic characteristics are typical of many disorders involving primary cilium aberrations, providing a significant overlap between JS and other ciliopathies such as nephronophthisis, Meckel syndrome, and Bardet-Biedl syndrome. This review will describe some characteristics of JS associated with changes in 35 genes, and will also address subtypes of JS, clinical diagnosis, and the future of therapeutic developments.

Background: Poor antenatal Quality of Life (QoL) is associated with adverse outcomes.

Objective: This study was performed to examine the effect of integrating midwifery counseling with spiritual content on improving the antenatal quality of life.

Method: This randomized controlled trial was performed on 60 first-time pregnant women who were referred to two childbirth preparation centers in Zanjan city, Iran in 2019. The counseling was conducted in eight sessions. The QoL SF-36 questionnaire was completed before and two months after the intervention. Data were analyzed using the chi-square test, independent t-test, and paired-samples t-test. The level of significance was p<0.05.

Results: After intervention based on an independent t-test the total score of QoL was significantly greater in the intervention group compared to the control group (p=0.001). After the intervention, the mean scores of four domains of QoL (Role-Physical, General Health, Vitality, Role-Emotional, and Mental Health) were significantly higher than the control group(p=0.001). While in terms of Physical Functioning, Bodily Pain and Social Functioning domains were not statistically significant (p>0.05).

Conclusion: Integrating midwifery counseling with spiritual content had a positive impact on improving the psychological aspect of quality of life more than the physical and social aspects. It can be used by providers for planning antenatal care programs.

Background and objective: Self-medication is considered one of the largest social, economic, and health problems in developing communities, including Iran. The present study aimed to determine the effectiveness of a child to family communication approach to self-medication based on the Health Belief Model [HBM].

Material and methods: This study is a quasi-experimental study that was conducted on 124 students in the fourth grade and their mothers in the intervention and control groups in Isfahan city, Iran. Using multi-stage simple random sampling, two primary schools were selected from each group, and then one class was selected from each primary school. Students in the intervention group attended the educational sessions. Then, the students were required to transfer their education to their families. The impact of education on mothers was evaluated two months after the last session. Data were collected before and after the intervention with a researcher-created questionnaire based on the HBM and were analysed using the SPSS 17 software package, with chi-square, Mann-Whitney U, and Wilcoxon tests.

Results: Before training, there was not a significant difference in the mean scores of the HBM constructs in terms of the demographic characteristics between the two groups. After the educational intervention, the mean of knowledge and HBM constructs were increased significantly, and the mean of perceived barriers decreased significantly in the experimental group [P < 0.001].

Conclusion: According to the present study, the child-to-family education based on the HBM was effective. It is suggested that educational interventions based on the HBM be designed and implemented to decrease self-medication in Iranian families.