Maternal health, neonatology and perinatology最新文献

Background: Despite decreasing overall perinatal and maternal mortality in high-income countries, perinatal and maternal health inequalities are persisting in Sub Saharan African countries. Therefore, this study aimed to determine the effects size of rates and determinants for perinatal mortality in Sub-Saharan countries.

Method: The sources for electronic datasets were PubMed, Medline, EMBASE, SCOPUS, Google, Google Scholar, and WHO data Library. Observational studies published in the English language from January 01, 2000, to May 30, 2019 were included. STROBE and JBI tools were used to include relevant articles for this review. We used a Comberehensive Meta-Analysis version 2 software for this analysis. The I² and Q- statistic values were used to detect the level of heterogeneity. The Kendall's without continuity correction, Begg and Mazumdar rank correlation and Egger's linear regression tests were used to detect the existence of significant publication bias (P <  0.10). The effects size were expressed in the form of point estimate and odds ratio with 95% CI (P <  0.05) in the random effect analysis using the trim and fill method.

Result: Twenty-one articles were included in this review. However, only fourteen studies reported the perinatal mortality rate. Among 14 studies, the observed and adjusted PMR was found to be 58.35 and 42.95 respectively. The odds of perinatal mortality among mothers who had no ANC visits was 2.04 (CI: 1.67, 2.49, P <  0.0001) as compared to those who had at least one ANC visit. The odds of perinatal mortality among preterm babies was 4.42 (CI: 2.83, 6.88, P <  0.0001). In most cases, heterogeneity was not evident when subgroup analyses were assessed by region, study design, and setting. Only perinatal mortality (P <  0.0001), antenatal care (P <  0.046) and preterm births (P <  0.034) showed a relationship between the standardized effect sizes and standard errors of these effects.

Conclusion: In general, engaging in systematic review and meta-analysis would potentially improve under-represented strategies and actions by informing policy makers and program implementers for minimizing the existing socioeconomic inequalities between regions and nations.

Background: Early initiation of breastfeeding is putting the newborn to breast within one hour after birth. This study was aimed to assess prevalence of early initiation of breastfeeding and its associated factors among mothers who delivered by cesarean section in South Gondar Zone hospitals Northwest Ethiopia, 2020.

Methods: An institutional based cross-sectional study was employed in South Gondar Zone hospitals from June 12 to July 03, 2020. A total of 356 cesarean delivered mothers were included. Data were collected using interviewer administered questionnaire and entered in to Epi Data version 4.2 and then exported to SPSS version 23.0. Logistic regression statistical analyses were used to identify factors associated with the outcome variables.

Results: The prevalence of early initiation of breastfeeding among mothers who delivered by cesarean section was 51.9%. Mothers who had intended pregnancy [AOR = 2.69, 95% CI (1.34-5.38)], had professional guidance [AOR = 2.68, 95% CI (1.18-6.10)], had breastfeeding experience [AOR = 2.25, 95% CI (1.35-3.75)], and had four and above antenatal care visits [AOR = 2.20, 95% CI (1.24-3.91)] were positively associated with early initiation of breastfeeding among mothers who delivered by cesarean section.

Conclusion: Type of pregnancy, professional guidance, had four or more antenatal care and breastfeeding experience were significantly associated with early initiation of breast feeding among mothers who delivered by cesarean section. Community based breastfeeding education and counseling to pregnant mothers and encouraging all mothers to follow recommended ANC visit is should be recommended.

Background: Mounting evidence suggests both vitamin D and the early life gut microbiome influence childhood health outcomes. However, little is known about how these two important exposures are related. We aimed to examine associations between plasma 25-hydroxyvitamin D (25[OH]D) levels during pregnancy or at delivery (cord blood) and infant gut microbiota.

Methods: Maternal and cord blood 25[OH]D levels were assessed in a sample of pregnant women. Compositional analyses adjusted for race were run on the gut microbiota of their offspring at 1 and 6 months of age.

Results: Mean prenatal 25(OH)D level was 25.04 ± 11.62 ng/mL and mean cord blood 25(OH)D level was 10.88 ± 6.77 ng/mL. Increasing prenatal 25(OH)D level was significantly associated with decreased richness (p = 0.028) and diversity (p = 0.012) of the gut microbiota at 1 month of age. Both prenatal and cord 25(OH)D were significantly associated with 1 month microbiota composition. A total of 6 operational taxonomic units (OTUs) were significantly associated with prenatal 25(OH)D level (four positively and two negatively) while 11 OTUs were significantly associated with cord 25(OH)D (10 positively and one negatively). Of these, OTU 93 (Acinetobacter) and OTU 210 (Corynebacterium), were consistently positively associated with maternal and cord 25(OH)D; OTU 64 (Ruminococcus gnavus) was positively associated with prenatal 25(OH)D but negatively associated with cord 25(OH)D.

Conclusions: Prenatal maternal and cord blood 25(OH)D levels are associated with the early life gut microbiota. Future studies are needed to understand how vitamin D and the microbiome may interact to influence child health.

[This retracts the article DOI: 10.1186/s40748-019-0111-y.].

Background: To assess the efficacy and viability of implementing Helping Babies Breathe, a neonatal resuscitation program for resource-limited environments on a small budget in two of the largest delivery centers in Zanzibar, Tanzania. The quality improvement initiative concentrated on training midwives, who directly care for neonates at birth on Helping Babies Breathe to address high rates of neonatal mortality secondary to birth asphyxia.

Methods: The convenience sample was 59 midwives working in the two delivery centers of interest in Zanzibar, Tanzania. The train-the-trainer implementation strategy with repeated measures design was used to assess knowledge and skills at three time points. Observations were completed through supportive supervision of deliveries in both facilities. A budget was kept throughout the implementation.

Results: Knowledge scores and resuscitation skills significantly improved and were sustained over a 6-month period of time, Ps < .001. 130 supportive supervision observations were completed. Eighteen times (14%) a baby did not cry at birth and needed intervention. All were appropriately intervened for and survived the Golden Minute. The budget for this implementation was 9015.50 USD. Considering in-kind donations and financial support by the Zanzibar Ministry of Health the bottom line cost was much lower.

Conclusion: Results indicate that participants retained knowledge and skills over time and were able to translate these skills into clinical practice. This initiative provides an alternative approach to implementing Helping Babies Breathe, relying on a small budget, local leadership and government support.

Trial registration: Not applicable.

Background: Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP) who counsel parents will influence decision making depending on their individual perceptions of the outcome for the baby. This paper aims to explore the knowledge and attitudes towards extremely preterm babies of HCP who care for women in pregnancy in a tertiary, regional and remote setting in North Queensland.

Methods: A cross sectional electronic survey of HCP was performed. Perceptions of survival, severe disability and intact survival data were collected for each gestational age from 22 to 27 completed weeks gestation. Free text comment enabled qualitative content analysis.

Results: Almost all 113 HCP participants were more pessimistic than the actual outcome data suggests. HCP caring for women antenatally were the most pessimistic for survival (p = 0.03 at 23 weeks, p = 0.02 at 25,26 and 27 weeks), severe disability (p = 0.01 at 24 weeks) and healthy outcomes (p = 0.01 at 24 weeks), whilst those working in regional and remote centres were more negative than those in tertiary unit for survival (p = 0.03 at 23,24,25 weeks). Perception became less negative as gestational age increased.

Conclusion: Pessimism of HCP may be negatively influencing decision making and will negatively affect the way in which parents perceive the chances of a healthy outcome for their offspring.

Objective: To determine whether there is a relationship between abnormal umbilical artery Doppler studies (UADS) and small for gestational age (SGA) birth weight and other adverse perinatal outcomes in fetuses that appear normally grown by ultrasound.

Methods: This was a retrospective study of all women who had UADS performed at or after 26 weeks of gestation at our institution between January 2005 and December 2012. Women were excluded if they had a fetal demise, a fetus with growth restriction, a fetus with congenital anomaly, or a multiple gestation. Women with missing delivery outcomes were excluded. The primary outcome was birth weight below the 10th percentile.

Results: There were 2744 women included in the study. Of those, 98 (3.6%) had an abnormal UADS, and 379 (13.8%) had an SGA neonate. Of the 2646 women who had a normal UADS, 353 (13.3%) women had an SGA neonate. Twenty-six (26.5%) of the 98 women who had an abnormal UADS had an SGA neonate. After adjusting for potential confounders, the adjusted odds ratio for an SGA neonate with an abnormal UADS was 2.2 (95% CI, 1.38-3.58; p <  0.05). In examining other adverse perinatal outcomes, neonatal intensive care unit (NICU) admission and low 5-min Apgar scores were 12.4 and 2.3%, respectively. The adjusted odds ratio for NICU admission was 1.84 (95% CI, 1.06-3.21; p <  0.05). Abnormal UADS was not associated with low Apgar scores (aOR 1.39: 95% CI 0.47-4.07; p > 0.05).

Conclusions: Our data suggest that abnormal UADS in fetuses that appear normally grown by ultrasound are associated with SGA neonates and NICU admission.

Background: Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks' postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study.

Methods: This is a population-based retrospective comparison of all live births and NICU admissions in Erie County, NY between pre-and post-ACOG IOL guideline epochs (2005-2008 vs. 2011-2014). Information on early-term, full/late/post-term births and NICU admissions was obtained. A detailed chart analysis of indications for admission to the Regional Perinatal Center was performed.

Results: During the 2005-2008 epoch, early-term births constituted 27% (11,968/44,617) of live births. The NICU admission rate was higher for early-term births (1134/11968 = 9.5%) compared to full/late/post-term (1493/27541 = 5.4%).In the 2011-2014 epoch, early-term births decreased to 23% (10,286/44,575) of live births. However, NICU admissions for early-term (1072/10286 = 10.4%) and full/late/post-term births (1892/29508 = 6.4%) did not decrease partly due to asymptomatic infants exposed to maternal chorioamnionitis admitted for empiric antibiotic therapy as per revised early-onset sepsis guidelines.

Conclusions: ACOG recommendations against elective IOL or cesarean delivery < 39 weeks PMA were rapidly translated to clinical practice and decreased early-term births in Erie County, NY. This decrease did not translate to reduced NICU admissions partly due to increased NICU admissions for empiric antibiotic therapy.