Maternal health, neonatology and perinatology最新文献

Background: Parents of preterm infants experience stress related to uncertainty which impacts parent health outcomes. Less is known about the experience of parents whose infants are admitted for reasons other than prematurity. In this study we sought to describe (1) the experience of parents whose infants are admitted to a level IV NICU for reasons unrelated to prematurity in relation to uncertainty and (2) the effect of social and structural determinants on parent experience with uncertainty.

Methods: This single center qualitative study utilized interviews, questionnaires, and chart review at 2 time points: 2 weeks after admission and 3 months after discharge. Parents enrolled in a prospective study of parent mental health related to infant medical complexity were purposively selected to achieve a sample representative of the study NICU. Interviews occurred between July 2019 - September 2020.

Results: 49 parents of 35 infants completed initial interviews and 26 completed follow up interviews. Parents experienced uncertainty related to diagnostic and prognostic trajectory as well as experiences prior to admission and NICU process of care. Themes included: (1) Parents of infants with medically complex presentations experience significant uncertainty. (2) Lived experience of structural vulnerability helped parents manage medical uncertainty. Some parents more readily accepted uncertainty due to prior experiences though often had fewer resources for managing needs after discharge. (3) Discrimination created mistrust preventing adaptation to uncertainty. (4) Provider counseling impacted parent adaptation. Counseling accounting for families lived experiences and focusing on practical aspects of a NICU admission such as team lead, how multidisciplinary teams arrive at decisions and steps to decrease uncertainty increased parent acceptance.

Conclusion: Parents of NICU infants admitted for reasons other than prematurity experience uncertainty related to both medical and non-medical events during their NICU stay. Communication that practically guides parents through NICU uncertainty, assesses structural vulnerability, and fosters trust in the medical system may help parents adapt to NICU uncertainty.

Background: Breastfeeding continuation up to two years provides essential nutrients for children and has health benefits for both children and mothers. Despite efforts to promote breastfeeding in Ethiopia, there is limited evidence on trends and factors influencing breastfeeding continuation for up to two years. This study examined these aspects to assess the impact of past policies.

Methods: The five Ethiopian Demographic and Health Surveys (EDHS2000-2019) were used to extract data for the analysis of breastfeeding continuation for 1-year-olds (aged 12-15 months) and 2-year-olds (aged 20-23 months) children. Trend analysis and multivariable logistic regression were performed using SPSS version 27.

Results: Breastfeeding continuation rates at 1 year and 2 years have declined for the last 20 years, ranging from 92.43% in 2000 to 83.63% in 2019, and from 78.75% in 2000 to 66.42% in 2019, respectively, despite in some regions maintaining relative increases in recent times. It was strongly linked with recent survey years, residence, regions, education attainment, pregnancy status, place of delivery, and repeated utilization of antenatal care.

Conclusion: The study showed an inconsistent decline in breastfeeding continuation for up to two years and complex patterns across regions and between urban and rural areas. This suggests a need to re-evaluate current policies, devise diverse interventions. Further research is also warranted to better understand the complex trends and disparities across Ethiopia for culturally sensitive and regionally tailored strategies.

Background: Chorioamnionitis is a known independent risk factor for early-onset sepsis (EOS) in infants. In 2015, the term was redefined as "intrauterine inflammation or infection or both" (Triple-I) to improve clinical management of maternal and neonatal infections. This study evaluated the association between the Kaiser sepsis score (KSS), a tool for predicting and managing EOS in newborns, and histopathologic chorioamnionitis (HCA) and confirmed Triple-I.

Methods: This retrospective cohort study included mother-infant dyads with a gestational age of ≥ 34 weeks at birth, delivered between January 2014 and December 2019, with a maternal diagnosis of clinical chorioamnionitis. Receiver operating characteristic (ROC) curves were used to assess the association between the KSS, Triple-I, and HCA.

Results: A total of 230 mother-infant dyads were analyzed, of whom 157 (68.2%) had HCA and 86 (37.3%) had confirmed Triple-I. Infant demographic characteristics were comparable between groups, except for the KSS, which was significantly higher in the Triple-I group [1.22 vs. 0.83, p < 0.001; OR 1.21, 95% CI 1.04-1.4]. The KSS demonstrated a strong positive association with confirmed Triple-I (AUC 0.77, 95% CI 0.71-0.83), while its association with HCA was weaker (AUC 0.59, 95% CI 0.51-0.67). At the same KSS threshold, sensitivity for diagnosing Triple-I was higher than for HCA.

Conclusion: KSS showed a stronger association with confirmed Triple-I compared to HCA in mothers with clinical chorioamnionitis, suggesting that Triple-I is a better predictor of EOS risk.

Background: Posttraumatic stress disorder (PTSD) symptoms are associated with poorer direct and downstream health outcomes for reproductive-aged individuals. There is limited literature targeting treatment of PTSD symptoms during reproductive time periods, especially the preconception period, yet effective and acceptable interventions are needed.

Objective: The current study is an open pilot feasibility study that aimed to explore acceptability, feasibility, and preliminary efficacy of a 4-week virtual Acceptance and Commitment Therapy (ACT) psychotherapy group for trauma-exposed reproductive aged women with PTSD.

Methods: A trauma-exposed treatment-seeking sample (N = 8, mean age = 30, 60% White) participated in an ACT for PTSD group (two cohorts). Participants completed self-report measures assessing PTSD symptoms at baseline, 1-week post-intervention, and 1-month post-intervention.

Results: Participation in the group was feasible, with most participants (87.5%) attending most sessions (≥ 75%). Participants reported high levels of acceptability and satisfaction. The intervention demonstrated preliminary efficacy in the preconception period as participants showed clinically meaningful reduction in PTSD symptoms (≥ 10 points on PTSD Checklist for DSM-5 (PCL-5)) from baseline (M = 46.25, SD = 24.04) to post-intervention (M = 27.33, SD = 22.35, d = 0.82) and baseline to follow-up (M = 34.25, SD = 31.58, d = 0.43).

Conclusion: This is the first study to look at a group intervention to reduce PTSD for individuals in the preconception period. The protocol was acceptable, feasible, and efficacious, although there were challenges to consider for future tailoring.

Background: Women who do not gain enough weight during pregnancy had increased risk of preterm delivery, low birth weight, prematurity, a longer hospital stay, and consequently, higher health-related costs. However, research on gestational weight gain and its determinants is scarce in developing countries, including Ethiopia. Therefore, this study aimed to assess adequate gestational weight gain and its determinant factors among pregnant women who had ANC follow-up visits at public health facilities in Debre Markos town, Northwest Ethiopia.

Methods: An institutional-based cross-sectional study was conducted from January 1, 2023 to June 30, 2023. The Ethiopian National Antenatal Guideline (ENAG) was used to define Gestational Weight Gain (GWG). A systematic random sampling technique was employed to select 532 study participants. Data was entered into Epidata Version 3.1 and exported into SPSS Version 25 for statistical analysis. Bivariable and multivariable binary logistic regression analyses were conducted to examine the association between the outcome variable and independent variables. An adjusted odds ratio with a 95% confidence interval was used to report the strength of the association.

Results: This study found that 30.9% (95% CI: 27.0, 34.7) of women gained adequate gestational weight. Number of ANC visits (AOR = 5.9, 95% CI: 3.02, 14.7), Meal frequency (AOR = 3.2, 95% CI: 1.56, 6.67), and consumption of animal source foods at least once per week (AOR = 2.7, 95% CI: 1.47, 4.90) were statistically associated with adequate weight gain.

Conclusion and recommendation: Nearly one-third of pregnant women gain adequate gestational weight. Women who had frequent ANC visits, meal frequency, and consumption of animal source foods at least once per week were significantly associated with adequate gestational weight gain. Women centered nutritional counseling and support is essential to improve weight gain during pregnancy.

Background: Non-adherence to antiretroviral therapy (ART) among pregnant women poses significant challenges to effective Immunodeficiency Virus (HIV) treatment outcomes and the promotion of maternal and infant health. This study identifies factors influencing ART non-adherence among HIV-positive pregnant women attending public health facilities in Dessie Town, Ethiopia.

Methods: A facility-based case-control study was conducted with 278 participants across health institutions in Dessie Town, comprising 208 controls and 70 cases. Non-adherence to ART was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8. Data were collected through structured interviewer-administered questionnaires and by reviewing patients' medical records using pretested instruments. The collected data were coded and entered into EpiData version 4.6, then analyzed using SPSS version 25. Variables with a P-value of 0.2 in Bivariable analysis were included in a multivariable regression model, and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CI) were calculated. P-values less than 0.05 were considered statistically significant.

Results: In total, 208 controls and 70 cases were included in the study. Significant factors determining non-adherence to ART among HIV-positive pregnant women included forgetfulness to take ART (AOR = 2.414, 95% CI = 1.067-5.464, P = 0.034), non-disclosure (AOR = 2.955, 95% CI = 1.431-6.103, P = 0.003), an unplanned pregnancy (AOR = 3.045, 95% CI = 1.439-6.445, P = 0.004), those who did not participate in mother-support groups (AOR = 3.278, 95% CI = 1.611-6.672, P = 0.001), World Health Organization (WHO) clinical stages III & IV (AOR = 2.669, 95% CI = 1.279-5.569, P = 0.009), and those who did not take opportunistic infection prophylaxis (AOR = 3.873, 95% CI = 1.549-9.688, P = 0.004).

Conclusions: Key determinants included forgetfulness, non-disclosure of HIV status, unplanned pregnancies, lack of participation in mother-support groups, advanced WHO clinical stages (III & IV), and non-use of opportunistic infection prophylaxis.

Recommendations: All relevant parties, including front-line healthcare professionals, should advise women to use family planning more frequently to reduce unintended pregnancies. They should also encourage health education regarding disclosing HIV status to her spouse and ensure that all pregnant women are provided with opportunistic infection prophylaxis.

Background: There are currently no specific guidelines for neonatal dengue. The available guidelines focus on the pediatric age group. The objective of this study is to summarize the clinical presentations and management strategies, based on the available studies in literature and to report another case of neonatal dengue.

Methods: The PUBMED and Scopus databases were searched using "neonate", "dengue", and their synonyms as the search terms. We included observational studies of suspected or proven cases of neonates with dengue infection, irrespective of their gestational age and birth weight. The studies were screened for possible inclusion in the review by two independent reviewers. The neonates that died in hospital among the reported cases were compared with those that survived till discharge, for reported baseline variables, using chi-square/fisher's exact test, Wilcoxon-Rank Sum test, and multivariable logistic regression.

Results: A total of 57 observational studies on neonatal dengue were found. Of these, 41 were case reports of single cases, 15 were case series of 2 or more cases and 1 was a cohort study. These included a total of 144 cases apart from our reported case. The most common clinical manifestations were thrombocytopenia (81.69%), fever (61.97%), rash (45.07%), and organomegaly (29.58%). Supportive care with fluids and platelet transfusion for severe thrombocytopenia were the mainstay of therapy. Most neonates (94.4%), improved after a week of onset of symptoms with median and interquartile range (IQR) of 7 (6-10) days. Only 8 neonatal dengue deaths were reported in the available literature. When compared with those who survived till discharge, except for third spacing (p-value = 0.001), none of the other baseline clinical parameters were found to be significantly different. On multivariable logistic regression analysis, for those factors with p-value < 0.2 in univariate analysis, none of the factors had an independent association with the outcome of death in neonatal dengue cases. Our index case also presented with high-grade fever on day 5 of life, petechial rash and thrombocytopenia on day 6 of life and improved by day 7 of illness with supportive care.

Conclusions: Neonatal dengue has a good prognosis as per the cases reported in the literature. None of the clinical parameters were found to be independently associated with neonatal mortality in the reported cases of neonatal dengue in literature. Further prospective observational studies will be needed to find the true predictors of poor outcomes in neonates with dengue infection.

This pilot randomized trial study evaluated the effectiveness of the Pebbles of Hope Thrive Guide, an interactive educational course designed for parents of premature infants. The study assessed changes in breastfeeding practices, maternal nutrition, and use of Kangaroo Care among 50 mothers in total randomized to one of three groups: Supervised, Independent, or Control. The purpose of the study was to assess the provision of mother's breast milk, improved material nutrition behaviors, and adoption of Kangaroo Care among mothers that received access to the course compared to those that received standard education without Thrive Guide access. The primary outcome assessed was the provision of breast milk at three months post-intervention, while secondary outcomes included improvements in maternal confidence, changes in maternal nutrition behaviors, the adoption and frequency of providing Kangaroo Care, and the impact of educator supervision. Although the intervention improved mothers' confidence and knowledge, it did not significantly impact breast milk provision or maternal nutrition behaviors at 3 months. Breast milk provision declined across all groups, but the amount of decline was not statistically different between them. Similarly, no significant differences were observed in the number of nutritional improvements made between the two periods. However, Independent users exhibited a notable increase in Kangaroo Care frequency. Qualitative interviews highlighted the importance of ongoing support and addressing practical barriers to following nutritional guidelines. These findings suggest that further research is needed to explore the conditions that enhance long-term behavior change and to identify strategies that optimize the impact of educational interventions on caregiving practices.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease among U.S. children. Early weight trajectories correlate with obesity, cardiometabolic syndrome, and MASLD in children born small for gestational age.

Methods: We evaluated whether increases in weight-for-age (WAZ) score from 0 to 6 months of life, are associated with MASLD in middle childhood, in two prospective birth cohorts of healthy Latino children (n = 136).

Results: After adjusting for confounders, increases in WAZ score from 0 to 6 months of age were associated with a higher risk for MASLD in middle childhood (OR 1.54 95% CI, 1.01-2.36; p = 0.046).

Conclusions: In a prospective study of Latino children, increases in WAZ score from 0 to 6 months were associated with increased risk of MASLD in mid-childhood. This could inform early screening and counseling for MASLD.