Maternal health, neonatology and perinatology最新文献

Background: Mevalonate kinase deficiency is an inherited autoinflammatory disorder that can present with a wide clinical spectrum, ranging from mild forms with recurrent episodes of fever, lymphadenopathy, splenomegaly and skin rash to the much rarer severe form, which is characterized by additional occurrences of psychomotor impairment, cholestatic jaundice, ophthalmological symptoms, and failure to thrive. The few cases described with perinatal onset often showed a very severe clinical course.

Case presentation: Here, we report the case of a preterm infant born at 30 + 2 weeks of gestation with a prenatal genetic diagnosis of mevalonate kinase deficiency presenting with intrauterine bowel dilatation, mild hydrops fetalis, and microcephaly. Laparotomy on the second day of life revealed intestinal obstruction necessitating partial ileum resection and ileostomy. The neonate had recurrent inflammatory reactions with elevated C-reactive protein levels, severe cholestasis, a progressive liver dysfunction, and an increasingly distended abdomen with subsequent respiratory insufficiency. Urinary mevalonic acid was highly elevated. The patient received anti-inflammatory therapy with prednisone and anakinra. Unfortunately, the patient died at the age of 77 days due to cardiorespiratory failure.

Conclusions: This case shows that intestinal obstruction with dilated fetal bowel loops can be an initially leading clinical symptom of severe mevalonate kinase deficiency. Diagnostics should be considered at an early stage, especially in the presence of other anomalies such as hydrops fetalis, growth restriction, or microcephaly. Data on the neonatal course of severe mevalonate kinase deficiency are still scarce and further studies are needed, particularly on treatment in neonates and young infants.

Increasing heat events, due to human induced climate change have shown to affect vulnerable populations such as pregnant and postpartum women and their mental health. Moreover, consequences of heat events can be unevenly distributed, affecting communities with existing structural discrimination and socially and economically disadvantaged populations. The risk of perinatal depression might be higher in pregnant and postpartum women. In this commentary, we argue, based on the review of literature, that there is a quintessential need for scientific research to investigate the interlinkage between heat events and perinatal depression.

Background: Preterm infants experience excessive insensible water loss in postnatal period. Established practices like cling film might not be sufficient alone in reducing this loss. Being expensive, humidified incubators might not be affordable in developing countries. Hence, we tried to explore double plastic wrap (cling film attached to the bassinet wall and occlusive plastic wrap covering the baby) as a low-cost solution of increased insensible water loss in postnatal period.

Methods: In this pilot trial 63 inborn infants of less than 32 weeks of gestation or birth weight less than 1200 g were enrolled and randomized to either single wrap (only cling film attached to the bassinet wall) or double wrap (cling film covering the bassinet and occlusive plastic wrap covering the baby) group after birth. This practice was allowed in addition to radiant warmer care and other routine thermoregulatory measures followed in the unit. Intervention was continued till first 7 days of life unless they met any pre-specified withdrawal criteria. The primary outcome was a difference in total insensible water loss (g/m2) in first seven days of life between two groups. The secondary outcomes were difference in cumulative insensible water loss (g/m2) in the first 72 h of life, 4-7 days of life, average daily insensible water loss in the first week (g/m2/h), neonatal morbidities, mortality and time to event analysis.

Results: Of 63 randomized infants, 32 were allocated to single wrap and 31 to double wrap groups. Cumulative insensible water loss in first 72 h and first week were significantly lower in the double wrap group (2786.5 ± 576 g/m2 in single wrap and 2376.8 ± 626 g/m2 in double wrap, p value 0.012 for 0-3 days and 6225.48 ± 951 g/m2 in single wrap and 5260.61 ± 1091 in double wrap, p value 0.034 for 0-7 days of life respectively). Apart from increased incidence of patent ductus arteriosus in double wrap group (41.94% vs. 15.62%, p 0.027) no other clinically significant outcomes were different between 2 groups. Median times to wean off respiratory support, regain birth weight and discharge from health facility were also similar between the two groups.

Conclusion: Double plastic wrap has been found to reduce cumulative insensible water loss in first week of life compared to cling film alone in the setting of a low-to-middle income-country.

Trial registration number: CTRI/2024/03/063749.

Trial registration date: 07.03.2024. LINK TO CTRI: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTAwMzk5&Enc=&userName=CTRI/2024/03/063749 .

Background: Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context .

Methods: We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding.

Results: All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it.

Conclusion: These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings.

This article discusses the strategic vision and recent advancements of the Maternal Health, Neonatology, and Perinatology (MHNP) journal in promoting maternal and neonatal health. Emphasizing its alignment with the United Nations Sustainable Development Goals (SDG), particularly SDG3, the journal is committed to reducing maternal and neonatal mortality through rigorous peer-reviewed research. Implementation of our intelligent, AI-powered Reviewer Finder Tool within Snapp, Springer Nature's next generation peer review platform, and a diverse editorial board enhance publication quality. The journal's future goals include expanding its editorial team and focusing on emerging global health issues in maternal and neonatal health. By fostering collaborative innovation, MHNP aims to significantly impact maternal and neonatal health research and practice.

Background: Mother's own milk (MOM) is important as the first nutrition for preterm infants, but mothers often struggle to initiate milk production right after preterm birth. If antenatal breastmilk expression (aBME) does not induce preterm labor when performed before term age, it could promote nutrition with MOM right after preterm birth. In this pilot study, we aimed to investigate whether aBME induces preterm labor among healthy nulliparous women from week 34 of pregnancy, to examine if aBME promotes the availability of MOM right after birth and affects breastfeeding outcomes.

Methods: Women were randomized to aBME (10 min 2 × daily) from week 34 of pregnancy until birth or to the control group. Both groups had a breastfeeding consultation between week 33 and 34 of pregnancy and were followed until eight weeks after birth. The primary outcome was gestational age (GA) at birth. Secondary outcomes were the availability of MOM and exclusive breastfeeding rates from 24 h to eight weeks after birth. Ranksum test and a posterior plot for the probability of non-inferiority were applied to the primary outcome. The availability of MOM is reported as medians and IQR. Breastfeeding outcomes were analyzed with mixed effects logistic regression.

Results: One hundred forty-four pregnant women were eligible for participation, 51 were excluded, and 33 declined participation/did not answer inclusion phone calls. 60 women were included and randomized. Primary outcome data were available in 55 women (28 in intervention, 27 in control). We found no difference in GA at birth between the two groups: median (IQR), 40 + 1(39 + 5:41 + 2) in intervention vs. 40 + 2 (39 + 4:41 + 1) in control, p = 0.98. Antenatal expressed MOM was available at birth in most women in the intervention group (23/28, 82%), with a median of 52 mL during pregnancy. There was no statistically significant difference in breastfeeding outcomes. No adverse events were reported.

Conclusions: aBME performed by healthy nulliparous women from gestational week 34 did not induce preterm labor. In most women in the intervention group, MOM was available right after birth. The study results provide the basis for a trial among women at high risk for preterm birth.

Trial registration:

Clinicaltrials: gov (NCT05516199).

Background: Perinatal mental health conditions and substance use are leading causes, often co-occurring, of pregnancy-related and pregnancy-associated deaths in the United States. This study compares odds of hospitalization with a mental health condition or substance use disorder or both during the first year postpartum between patients with and without severe maternal morbidity (SMM) during delivery hospitalization.

Methods: Data are from the Maryland's State Inpatient Database and include patients with a delivery hospitalization during 2016-2018 (n = 197,749). We compare rate of hospitalization with a mental health condition or substance use disorder or both at 42 days and 43 days to 1 year postpartum by occurrence of SMM during the delivery hospitalization. We use multivariable logistic regression to derive the odds of hospitalization with each outcome for patients by SMM status, adjusted for patient sociodemographic characteristics, presence of mental health condition or substance use disorder diagnoses during the delivery hospitalization, and delivery outcome. All SMM, mental health conditions, and substance use disorders are identified using ICD-10 diagnosis and procedure codes.

Results: Overall, 5,793 patients (2.9%) who delivered during 2016-2018 experienced hospitalization in the year following delivery. Among these patients, 24.3% (n = 1,410) had a mental health condition diagnosis, 10.6% (n = 619) had a substance use disorder diagnosis, and 9.8% (n = 570) had co-occurring mental health condition and substance use disorder diagnoses. Patients with SMM had 3.7 times the adjusted odds (95% CI 2.7, 5.2) of hospitalization with a mental health condition diagnosis, 2.7 times the odds (95% CI 1.6, 4.4) of a hospitalization with substance use disorder diagnosis, and 3.0 times the odds (95% CI 1.8, 4.8) of hospitalization with co-occurring mental health condition and substance use disorder diagnoses during the first-year postpartum.

Conclusion: Patients who experience SMM during their delivery hospitalization had higher odds of hospitalization with a mental health condition, substance use disorder, and co-occurring mental health condition and substance use disorder in the one-year postpartum period. Treatment and support resources for mental health and substance use providers --including enhanced screening and personal introduction of providers -- should be made available to patients with SMM upon discharge after delivery, and evidence-based interventions to improve mental health and reduce substance use should be prioritized in these patients.

Objective: This study investigates correlates of maternal leukocyte telomere length (LTL) in the immediate postpartum period using a cross-sectional study design from an existing prospective longitudinal birth cohort of primarily Latina women. The study focuses on the role of maternal health and dietary habits in pregnancy and maternal education level and LTL at delivery.

Study design: Latina mothers were recruited during the immediate postpartum period prior to 24 h at two San Francisco hospitals and dried blood spots were collected for LTL analysis via quantitative polymerase chain reaction (qPCR). We used multivariable linear regression models to determine independent predictors of maternal LTL during the postpartum period.

Results: In multivariable regression models, increasing maternal age was associated with shorter LTL during the immediate postpartum period (Coeff - 0.015; p < 0.01) whereas having a high school diploma was associated with longer LTL versus not having graduated from high school (Coeff 0.12; p < 0.01).

Conclusion: Maternal education level as a potential marker of exposure to life stressors and socioeconomic status was associated with maternal LTL after adjusting for age and other potential confounders in women of reproductive age.

Multiple placental cysts are a common finding in obstetric ultrasound imaging. Although they have benign differential diagnoses, such as hydropic degeneration of the placenta or placental mesenchymal dysplasia, it's important to consider significant pathologies, such as benign gestational trophoblastic disease or hydatidiform mole. A challenging issue in obstetrics is pregnancies with a placenta that has a bipartite texture. This means that one side of the placenta is normal, but the other side is full of cystic formations, and only one fetus is visualized. The main critical concern is the presence of a molar pregnancy because of its catastrophic consequences. Here, we report a rare case in which the gravid uterus had a normal diploid fetus but had a bipartite placenta, which was triploid in the hydropic part, revealing a unique genetic pattern.

Background: Macrosomia is a forgotten health problem that directly or indirectly affects maternal and neonatal health outcomes. There is a lack of evidence on the factors that affect macrosomia in eastern Ethiopia. This study aimed to assess the determinants of macrosomia among newborns delivered in Jigjiga City, Eastern Ethiopia.

Methods: An institutional-based case-control study was conducted among 82 cases and 164 controls in Jigjiga City from June 25 to August 24, 2023. Bivariable and multivariable logistic regression were used to identify the determinants of macrosomia. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association, and the statistical significance was declared at a p-value < 0.05.

Results: This study found that lack of preconception care (AOR = 2.48, 95% CI: 1.29, 4.76); post-term pregnancy (AOR = 2.90, 95% CI: 1.16, 7.28); inadequate physical activity (AOR = 3.52, 95% CI: 1.55, 7.98), having previous macrosomia (AOR = 4.52, 95% CI: 2.18, 9.36), and gestational diabetic mellitus (AOR = 2.58, 95% CI: 1.10, 6.28) were the main risk factors of macrosomia.

Conclusion: This study indicated that failed utilization of preconception care, inadequate physical activity during pregnancy, post-term pregnancy, gestational diabetic mellitus, and having previous macrosomia were the risk factors for fetal macrosomia. Encouraging women to utilize reproductive health services and providing special care for high-risk mothers are essential to reducing and preventing the level of fetal macrosomia and its consequences.