Antenatal Factors Research Articles

Antenatal factors for neonatal seizures among late preterm births**

Objective The objective of this study was to evaluate for antenatal risk factors for neonatal seizures among late preterm births. Study design This was a case control study which included late preterm births without anomaly from the United States Natality database. Cases were infants with neonatal seizures, while the controls consisted of infants without neonatal seizures. Maternal and pregnancy characteristics were compared. Multivariable logistic regression was performed to investigate risk factors for neonatal seizures. Results Of the 943,580 late preterm births, 512 (0.05%) developed neonatal seizures. Significant risk factors associated with neonatal seizures among late preterm births included number of prenatal visits (adjusted odds ratio [aOR] 0.94, 95% CI [0.92–0.96]), smoking history (aOR 1.78, 95% CI [1.41–2.25]), chorioamnionitis (aOR 4.37, 95% CI [2.65–7.21]), non-Hispanic White race (aOR 1.41, 95% CI [1.13–1.76]), and cesarean birth (aOR 2.31, 95% CI [1.91–2.80]). Conclusion Number of prenatal visits, history of smoking, chorioamnionitis, non-Hispanic white race, and cesarean birth are risk factors for neonatal seizures at late preterm gestation.

Ontogeny of circulating lipid metabolism in pregnancy and early childhood - a longitudinal population study.

There is mounting evidence that in utero and early life exposures may predispose an individual to metabolic disorders in later life; and dysregulation of lipid metabolism is critical in such outcomes. However, there is limited knowledge about lipid metabolism and factors causing lipid dysregulation in early life that could result in adverse health outcomes in later life. We studied the effect of antenatal factors such as gestational age, birth weight, and mode of birth on lipid metabolism at birth; changes in the circulating lipidome in the first 4 years of life and the effect of breastfeeding in the first year of life. From this study, we aim to generate a framework for deeper understanding into factors effecting lipid metabolism in early life, to provide early interventions for those at risk of developing metabolic disorders including cardiovascular diseases. We performed comprehensive lipid profiling of 1074 mother-child dyads in the Barwon Infant Study (BIS), a population-based pre-birth cohort and measured 776 distinct lipid features across 39 lipid classes using ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). We measured lipids in 1032 maternal serum samples at 28 weeks' gestation, 893 cord serum samples at birth, 793, 735, and 511 plasma samples at 6, 12 months, and 4 years, respectively. Cord serum was enriched with long chain poly-unsaturated fatty acids (LC-PUFAs), and corresponding cholesteryl esters relative to the maternal serum. We performed regression analyses to investigate the associations of cord serum lipid species with antenatal factors: gestational age, birth weight, mode of birth and duration of labour. The lipidome differed between mother and newborn and changed markedly with increasing child's age. Alkenylphosphatidylethanolamine species containing LC-PUFAs increased with child's age, whereas the corresponding lysophospholipids and triglycerides decreased. Majority of the cord serum lipids were strongly associated with gestational age and birth weight, with most lipids showing opposing associations. Each mode of birth showed an independent association with cord serum lipids. Breastfeeding had a significant impact on the plasma lipidome in the first year of life, with up to 17-fold increases in a few species of alkyldiaclylglycerols at 6 months of age. This study sheds light on lipid metabolism in infancy and early childhood and provide a framework to define the relationship between lipid metabolism and health outcomes in early childhood. This work was supported by the A*STAR-NHMRC joint call funding (1711624031).

Expectations of pregnant women for antenatal care services and factors affecting anxiety severity during the COVID-19 pandemic.

We aimed to evaluate the difficulties pregnant women encountered while receiving health care, their demands for antenatal care, and their mental state during the COVID-19 pandemic. A total of 447 pregnant women were included in this cross-sectional study. The data were collected through a face-to-face questionnaire, which assessed participants' demographic, individual, and obstetric characteristics, their opinions regarding the COVID-19 pandemic, expectations from their antenatal care services, and their Beck Anxiety Inventory (BAI) scores. During the COVID-19 pandemic, it was determined that 17.2% of the pregnant women participating in our study could not go to antenatal follow-ups and almost half (45.9%) demanded that their follow-ups be reduced due to the risk of coronavirus transmission. The BAI scores were found to be significantly higher in participants with low-income levels, chronic diseases, those in the third trimester, those with high-risk pregnancy either previous or current, and those who got pregnant unintentionally. Young age, unintentional conception, advanced pregnancy week, previous high-risk pregnancy, and failure to receive regular antenatal care were independent variables that predicted moderate-severe anxiety in logistic regression analysis. In order to minimize the adverse effects of the COVID-19 pandemic on the mental health of pregnant women, it is important to develop support programs that contribute to the well-being of the mother and fetus by recognizing the pregnant women at risk in the antenatal period.

Trends in percentages of gestational diabetes mellitus attributable to overweight, obesity, and morbid obesity in regional Victoria: an eight-year population-based panel study

BackgroundGestational diabetes mellitus (GDM) is the fastest growing type of diabetes in Australia with rates trebling over the past decades partially explained by rising obesity rates and maternal age among childbearing women. Percentage of GDM attributable to obesity has been documented, mostly focusing on metropolitan populations. In parts of regional (areas outside capital cities) and rural Australia where overweight, obesity and morbid obesity are more prevalent, intertwined with socioeconomic disadvantage and higher migrant communities, trends over time in adjusted percentages of GDM attributed to obesity are unknown.MethodsIn this population-based retrospective panel study, women, without pre-existing diabetes, delivering singletons between 2010 and 2017 in a tertiary regional hospital that serves 26% of Victoria’s 6.5 million Australian population were eligible for inclusion. Secular trends in GDM by body mass index (BMI) and age were evaluated. The percentage of GDM that would have been prevented each year with the elimination of overweight or obesity was estimated using risk-adjusted regression-based population attributable fractions (AFp). Trends in the AFp over time were tested using the augmented Dickey-Fuller test.ResultsOverall 7348 women, contributing to 10,028 births were included. The age of expecting mothers, their BMI, proportion of women born overseas, and GDM incidence significantly rose over time with GDM rising from 3.5% in 2010 to 13.7% in 2017, p < 0.001, increasing in all BMI categories. The incidence was consistently highest among women with obesity (13.8%) and morbid obesity (21.6%). However, the highest relative increase was among women with BMI < 25 kg/m2, rising from 1.4% in 2010 to 7.0% in 2017. Adjusting for age, country of birth, socioeconomic status, comorbidities, antenatal and intrapartum factors, an estimated 8.6% (confidence interval (CI) 6.1–11.0%), 15.6% (95% CI 12.2–19.0%), and 19.5% (95% CI 15.3–23.6%) of GDM would have been prevented by eliminating maternal overweight, obesity, and morbid obesity, respectively. However, despite the rise in obesity over time, percentages of GDM attributable to overweight, obesity, and morbid obesity significantly dropped over time. Scenario analyses supported these findings.ConclusionsBesides increasing prevalence of obesity over time, this study suggests that GDM risk factors, other than obesity, are also increasing over time.

Частота, предиктори та критерії діагностики лямбліозу в дітей

Актуальність. Поширеність лямбліозу серед дітей становить 355 випадків на 100 тис. дитячого населення, при цьому 80 % випадків інвазії припадає на дітей, молодших 14 років. Актуальність високої поширеності протозойної патології у дітей зумовлена тим, що її прояви часто маскуються під різні патологічні стани. Мета. Вивчення частоти, предикторів і критеріїв діагностики лямбліозу в дітей. Матеріали та методи. Дизайн дослідження — контрольоване рандомізоване. У дослідження включені діти, хворі на лямбліоз (n = 55), віком від 3 до 17 років. Група порівняння становила 30 практично здорових дітей. Обстеження хворих і набір матеріалу проводили на базі поліклінічного та гастроентерологічного відділень КМУ «Чернівецька обласна дитяча клінічна лікарня» впродовж 2014–2016 років. Лабораторні та інструментальні дослідження проводилися в українсько-німецькій лабораторії «Букінтермед» та лабораторії дитячого гастроентерологічного центру «Дігест». Використані непрямі (серологічний метод, макроскопія слизової оболонки ДПК при ендоскопічному дослідженні, непрямі ознаки лямбліозу в дуоденобіоптатах) та прямі (мікроскопія калу, дуоденального вмісту, виявлення вегетативних форм лямблій у дуоденобіоптатах під час гістологічного дослідження) методи дослідження. Проводилося анкетування батьків. Відмінності вважалися статистично вірогідними при досягнутому рівні значущості р ≤ 0,05. Результати. Позитивний результат отримано у 29 із 565 обстежених на лямблії осіб (5,1 %). Найчастіше потребували дообстеження на наявність лямблій діти, хворі на хронічну патологію верхніх відділів шлунково-кишкового тракту та гепатобіліарної системи, з алергічними реакціями, дисбіозом кишечника та стійкою еозинофілією крові. Діти, хворі на лямбліоз, вірогідно частіше хворіли на супутню патологію, ніж діти групи порівняння (р &lt; 0,05). У 41,4 % випадків діти проживали в умовах, що не відповідали задовільним, не завжди дотримувалися правил гігієни. Нами встановлені несприятливі фактори антенатального (стан здоров’я матері під час вагітності, перебіг вагітності, наявність професійних шкідливостей), інтранатального (передчасні пологи, стимуляція пологової діяльності та кесарів розтин, пологова травма й асфіксія у дітей) та постнатального (тривалість грудного вигодовування, супутня патологія) періодів. Усі гістологічні ознаки можуть бути використані як імовірні критерії лямбліозу в дітей, однак із найбільшою вірогідністю можна використовувати таку ознаку, як наявність ділянок десквамації епітелію ворсинок з одночасним переважанням в інфільтраті еозинофілів і тучних клітин. Висновки. Частота лямбліозу у дітей і підлітків дорівнює 5,1 %. Встановлені нами анамнестичні фактори (соціальні, гігієнічні, медико-біологічні) можна розглядати як предиктори розвитку лямбліозу в дітей. У клініці лямбліозу домінує ураження травного тракту — у 96,3 % дітей. Для підвищення точності діагностики лямбліозу в дітей необхідно використовувати комплекс прямих і непрямих методів діагностики.

Study of Influence of Antenatal, Intranatal and Neonatal Factors on NICU Admissions in a Tertiary Hospital in Marathwada Region, Maharashtra, India

Study of Influence of Antenatal, Intranatal and Neonatal Factors on NICU Admissions in a Tertiary Hospital in Marathwada Region, Maharashtra, India

Antibiotic Sensitivity Pattern in Neonatal Septicemia at Tertiary Care Hospital

Background: There is real shortage of national data on antimicrobial resistance rates in Indian neonates. A descriptive review was conducted to determine the patterns of antimicrobial resistance in isolates of blood stream infection among neonates in Jamnagar, Gujarat, India. Materials and Methods: The study was carried out in a tertiary care hospital from a period of March 1, 2014, to August 31, 2015. This is a non-randomized, prospective study in which 109 cases of suspected neonatal septicemia on the basis of antenatal high-risk factors and signs and symptoms of sepsis during this period were studied. Results: A total number of 109 neonates with clinically suspected neonatal septicemia were studied. Sixty-nine (63.3%) cases out of them were blood culture positive. Out of 69 positive cases, in one sample, two organisms were isolated. Hence, the total number of organisms was 70. Out of these 70 organisms, 44 were Gram-positive cocci, 23 were Gram-negative bacilli, and three were Candida spp. Gram-positive cocci were more sensitive to linezolid, vancomycin, and clindamycin whereas Gram-negative bacilli were more sensitive to ampicillin, ofloxacin, and amikacin. Antimicrobial sensitivity of fungal isolates was not done as the antifungal discs were not available. Conclusion: The Gram-positive organisms are the frequent cause of neonatal septicemia so when neonatal septicemia is suspected, drugs of choice for Gram-positive organisms are linezolid, vancomycin, and clindamycin and for Gram-negative organism drugs of choice are ampicillin, ofloxacin, and amikacin.

Quality of Antenatal Care Service and Factors Associated with Client Satisfaction at Public Health Facilities of Bele Gasgar District.

Background: Quality of service and client satisfaction are crucial to increase services utilization. However, there is a paucity of data in this study area. Consequently, this study aimed to assess “Quality of Antenatal Care (ANC) and client satisfaction in Public Health Facilities”. Method: Facility-based cross-sectional study was conducted from March 11 to April 19, 2019. Systematic random sampling was used to select 366 women. Data were collected through the exit interview, data extraction, and observation. Result: Quality of ANC was 30% (95% CI = 25–35). About 55% (95% CI = 50–60) of women were satisfied with the services. Iron/folic acid supplementation (AOR = 2.23, 95% CI;1.30–4.79), measuring weight (AOR = 3.61, 95% CI = 1.40–9.31), travel time >60 min (AOR = 4, 95% CI;2.3–8.16) and 60–120 min (AOR = 3.68, 95% CI = 1.61–8.38), and consultation time (AOR = 2.89, 95% CI = 1.14–7.31) were positively associated with client satisfaction, while health professional initiation to ask question never (AOR = 0.20, 95% CI = 0.08–0.43) and to ask sometimes (AOR = 0.32, 95% CI = 0.16–0.65) were negatively associated. Conclusion: Quality of ANC was low while clients’ satisfaction was moderately low. Therefore, improvement in the area of input, process, and output is recommended.

A Randomized Controlled Trial of Evaluating the Efficacy of Alternative Swaddles for Body Temperature Control of Newborns.

The critical drop of body temperature in neonatal termed "hypothermia" increases risk of morbidity and mortality. In order to minimize hypothermia during delivery room to nursery transportation, we trialed for appropriate alternative means of aluminum coated fabric (ACF), cotton swaddle, and their combination. The aim of the present study was to compare the efficacy of aluminum coated fabric, cotton swaddle, and combined method to prevent neonatal hypothermia. One hundred and seventy-four of eligible infants (birth weight more than 2,500 g) were randomized into three groups (55 infants in aluminum coated fabric, 60 in combined aluminum coated fabric with cotton swaddle, and 59 in cotton swaddle as a control). Rectal temperature was determined before swaddling and arriving at nursery. There was no significant difference in antenatal and perinatal factors. Normothermia was detected in 50, 52, and 55 infants and decrease body temperature from its baseline were evidenced in 25, 24, and 14 infants swaddling with aluminum coated fabric, combined aluminum coated fabric with cotton swaddle and cotton swaddle, respectively (p=0.425 and p=0.210). Interestingly, results indicated that the use of cotton swaddle, ACF, and their combination could reduce the number of hypothermic infants from 4, 3, and 6 to 0, 5, and 1, respectively, pointing that the use of cotton swaddle exhibited the maximum hypothermia recovery potential. The cotton swaddle showed the dominant hypothermal control over ACF and combination of cotton swaddle and ACF. These findings may benefit the development of new strategies for hypothermia prevention in newborns.

Validation of Maternal Report of Receipt of Iron–Folic Acid Supplementation during Antenatal Care in Rural Southern Nepal

BackgroundCoverage of iron–folic acid (IFA) supplementation is a key indicator for tracking programmatic progress within and across countries. However, the validity of maternal report of this information during household surveys has yet to be determined. ObjectivesThis study aimed to examine the validity of maternal recall of receipt of IFA supplementation during antenatal care (ANC) and factors associated with accuracy of maternal recall. MethodsA longitudinal cohort design was employed. The direct observation of the IFA received during all ANC visits at the 5 study health posts served as the “gold standard” to the maternal report of IFA received during the postpartum interview. Individual-level validity was assessed by calculating indicator sensitivity, specificity, and AUC. The inflation factor (IF) measured population-level bias. A multivariable log-binomial model was used to assess factors associated with accurate recall. ResultsThe majority (95.8%) of women were observed receiving IFA during pregnancy. Women overreported the number of IFA tablets received compared with what was observed during ANC visits (mean difference: 45 tablets). Maternal report of any IFA receipt was moderate (AUC = 0.60; 95% CI: 0.50, 0.71), and population bias was low (IF = 1.01). However, the individual-level validity was poor across the 7 IFA tablet count categories; the AUC for categories ranged from misleading to moderate. Driven by the trend of maternal overreport, the IF indicated that maternal report drastically underestimated the coverage of lower tablet categories and overestimated the coverage of higher tablet counts. Accuracy of maternal report was not associated with months since last ANC observation nor any maternal characteristics. ConclusionsMaternal report of the amount of IFA supplementation received during pregnancy produced extremely biased population coverage and performed poorly to moderately for individual-level validity. It is imperative to improve this indicator because it is used in global frameworks and national program planning.

Epidemiology of Rare Craniofacial Anomalies: Retrospective Western Australian Population Data Linkage Study

To describe birth prevalence of rare craniofacial anomalies and associations with antenatal and perinatal factors. All live and stillbirths in Western Australia between 1980 and 2010 were identified from the Western Australian Birth Registrations and the Midwives Notification System (also provides information on antenatal and perinatal factors). Rare craniofacial anomalies (craniosynostosis, craniofacial microsomia, and others [Pierre Robin, Van der Woude, and Treacher Collins syndrome]) were ascertained from the Western Australian Register of Developmental Anomalies and linked to other data sources. Trends in prevalence, adjusted for sex and Indigenous status, were investigated by Poisson regression and presented as annual percent change (APC). Strengths of association of related factors were assessed using multivariable log-binomial regression adjusted for sex, Indigenous status, birth year, socioeconomic disadvantage, and remoteness and reported as risk ratios with 95% CIs. There was a temporal increase in prevalence of metopic synostosis (APC 5.59 [2.32-8.96]) and craniofacial microsomia (Goldenhar syndrome) (APC 4.43 [1.94-6.98]). Rare craniofacial anomalies were more likely among infants born preterm, as twins or greater-order multiples, with growth restriction, to older parents, to mothers undertaking fertility treatments, and with pre-existing medical conditions, specifically epilepsy, diabetes, or hypothyroidism. Prenatal identification of rare craniofacial anomalies was uncommon (0.6%). Our findings indicate a steady increase over time in prevalence of metopic synostosis and craniofacial microsomia (Goldenhar syndrome). Possible associations of fertility treatments and pre-existing maternal medical conditions with rare craniofacial anomalies require further investigation.

Antenatal and perinatal factors associated with newborn behavior: A prospective cohort study

The idea that the newborn is an uncharted and therefore pliable organism, which can be formed according to the will of its parents, has long been rejected, especially after the existence of rules of behavior not only in full-term but also in marginally premature newborns, which are affected by various both prenatal and perinatal factors. The ability of newborns to determine the rules of their behavior according to the stimuli they receive from internal and external factors, has been the subject of many years of research and has led pediatricians and other health professionals to develop a model for grading these newborn abilities. Thus, the Neonatal Behavioral Assessment Scale (NBAS) was created, and it has been used by researchers for more than 40 years. It is a research tool with wide application, as many of the points it addresses, can be integrated into other means of assessing the newborn’s abilities. This scale also has an ever-evolving application as a clinical tool in parental assessment.

First-time fathers’ experience of childbirth: a cross-sectional study

ObjectivesThe purposes of this study are to report first-time fathers’ experiences of childbirth through three dimensions (professional support, worries and prenatal preparation) and to analyse the influence of sociodemographic, antenatal and obstetrical factors on the three dimensions. SettingParticipants were recruited in France and Switzerland from two university hospitals that routinely manage high-risk pregnancies (level 3 – perinatal care level), with 4,000 to 5,000 annual births each. MethodsThis is a secondary analysis of a cross-sectional study. The data initially were collected for the cross-cultural validation of the First-Time Father Questionnaire (FTFQ) into French. Descriptive statistics were used to report the participants’ characteristics and their questionnaire responses. Multivariate linear regression analysis was carried out to stress the positive or negative factors linked with fathers’ experiences of childbirth. FindingsAmong 350 first-time fathers, 160 completed the FTFQ (response rate of 45.7%). The average age of the participants was 33 years old. We observed 12 questionnaire items with more than 20% unfavourable responses, seven of which involved the measurement of the worry dimension. Antenatal education and the prenatal-preparation dimension were positive factors linked with fathers’ experiences. In addition, 57% of participants reported using one means of antenatal education, and 45% accessed information from family or friends. Conclusions and implications for practiceThe results suggest that first-time fathers need more professional support to foster positive experiences of childbirth. Their experiences of childbirth are associated with considerable worry. Antenatal classes specifically for fathers could reduce this worry and support the fatherhood process. Research should be carried out on these topics.

Case Report on Cerebral Palsy- with Ayurvedic Treatment Protocol

Cerebral palsy is a non-progressive disorder, which arising in early stages of development of child. There are many etiology factors like antenatal, natal and postnatal factors responsible for causing cerebral palsy but exact cause is still unknown. Spasticity is the main feature of cerebral palsy(). Classification of CP is too broad on the basis of physiological and topographic etc. Symptoms of spastic cerebral palsy can be corelated with Jadhata in Ayurveda. In Jadata, there is tightness of muscles occurs. Improvement can be got in children with ayurvedic treatment. Aim- To improve the quality of life of child suffered from spastic CP. Place and duration of study- Study was done in Parul Ayurved Hospital, Vadodara, Gujarat. Method- In this case study, Samavardhan ghrita() orally, snehana() with bala taila() and svedan () with dashmmola kwath () was given to child for 31 days. Results- mild improvement in spasticity and achievement of milestones have observed. Patient got discharged from IPD of hospital due to COVID 19 pandemic. Conclusion- Hence, through Ayurveda treatment, improvement in symptoms of spastic cerebral palsy can achieve and quality of life of child can increase spontaneously.

Антенатальные фак­торы, ассоциированные с уровнями нейротрофического фактора головного мозга и инсулиноподобного фактора роста-1 у недоношенных новорожденных

Антенатальные фак­торы, ассоциированные с уровнями нейротрофического фактора головного мозга и инсулиноподобного фактора роста-1 у недоношенных новорожденных

Predicting previable preterm premature rupture of membranes (pPPROM) before 24 weeks: maternal and fetal/neonatal risk factors for survival

We sought to compare maternal and neonatal risk factors in cases with previable premature rupture of membranes (pPPROM, between 14-24 weeks) for optimal counselling. Therefore, 192 pregnancies of 485 cases which met selection criteria and agreed to follow-up were retrospectively analysed. Mean gestational age at pPPROM was 20.45 weeks. Live births occurred in 171 cases, but 67 (39.2%) of them died in the neonatal period (neonatal death group) and 104 cases (60.8%) constituted surviving neonate group. Of the surviving neonates, 37 (33.7%) experienced at least one complication. Most seen maternal complications were chorioamnionitis (24.48%) and placental abruption (8.33%). Although amniotic fluid volume, length of pPPROM period, completing antibiotherapy and CRP values were significant, amniotic fluid volume and length of pPPROM showed also significance for multivariate regression analysis for maternal risk factors. Risk factors for birth were gestational age at pPPROM, gestational age at birth, new-born weight at birth, 1st and 5th minute Apgar scores, umbilical cord pH value and need for neonatal resuscitation. Furthermore, development of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and retinopathy of premature were additional risk factors for neonate. Of them, gestational age at birth, new-born weight at birth, respiratory distress syndrome and retinopathy of prematurity were also significant in multivariate regression analysis. Impact Statement What is already known on this subject? Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010). What do the results of this study add? Appropriate counselling for pPPROM cases is important especially during antenatal period (maternal factors) and postpartum period (neonatal factors). Maternal infection risk is increased with an increased latency period of PPROM. As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery. What are the implications of these findings for clinical practice and/or further research? Counselling the patient with previable PPROM about pregnancy complications and paediatric outcome is challenging because of the small size, different gestational age ranges, and retrospective nature of the multiple studies on this subject. The most important feature of our study was the relatively high number of patients compared to other series. Thus, we can counsel pregnant women with PPROM prior to 24 weeks of gestation about the maternal antenatal factors and neonatal postnatal factors with related outcomes and help make an informed decision regarding termination or conservative follow-up. Nevertheless, there is a need for larger multicentric prospective studies to validate our data and to establish the prognosis of previable PPROM for both mother and foetus.

Patterns of allergic sensitization and factors associated with emergence of sensitization in the rural tropics early in the life course: findings of an Ecuadorian birth cohort.

Introduction: There are limited data on emergence of allergic sensitization (or atopy) during childhood in tropical regions.Methods: We followed a birth cohort of 2,404 newborns to 8 years in tropical Ecuador and collected: risk factor data by maternal questionnaires periodically from birth; atopy was measured by skin prick test reactivity (SPT) to aeroallergens in parents, and aeroallergens and food allergens in children at 2, 3, 5, and 8 years; and stool samples for soil-transmitted helminths (STH) from children periodically to 8 years and from parents and household members at the time of recruitment of cohort children. Data on risk factors were measured either at birth or repeatedly (time-varying) from birth to 8 years. Longitudinal repeated-measures analyses were done using generalized estimating equations to estimate the age-dependent risk of positive SPT (SPT+) to any allergen or mite during early childhood.Results: SPT+ to any allergen was present in 29.0% of fathers and 24.8% of mothers, and in cohort children increased with age, initially to mite but later to cockroach, reaching 14.8% to any allergen (10.7% mite and 5.3% cockroach) at 8 years. Maternal SPT+, particularly presence of polysensitization (OR 2.04, 95% CI 1.49–2.77) significantly increased the risk of SPT+ during childhood, while household overcrowding at birth decreased the risk (OR 0.84, 95% CI 0.72–0.98). For mite sensitization, maternal polysensitization increased (OR 2.14, 95% CI 1.40–3.27) but rural residence (OR 0.69, 95% CI 0.50–0.94) and birth order (3rd−4th vs. 1st−2nd: OR 0.71, 95% CI 0.52–0.98) decreased the risk. Time-varying exposures to agricultural activities (OR 0.77, 95% CI 0.60–0.98) and STH parasites (OR 0.70, 95% CI 0.64–0.91) during childhood decreased while anthelmintics increased the childhood risk (OR 1.47, 95% CI 1.05–2.05) of mite sensitization.Conclusion: Our data show the emergence of allergic sensitization, primarily to mite and cockroach allergens, during childhood in tropical Ecuador. A role for both antenatal and post-natal factors acting as potential determinants of SPT+ emergence was observed.

English

BACKGROUND Antepartum haemorrhage of unknown origin (APHUO) being a diagnosis of exclusion, is a rare condition which poses dilemma in the management of pregnancy in terms of timing and mode of delivery. The purpose of this study was to evaluate antenatal factors associated with APHUO, clinical presentation and analyse its impact on pregnancy and its outcome. METHODS This is a retrospective study conducted over a period of two years in a tertiary care hospital. Pregnancy outcomes were compared between 41 cases who had APHUO versus 39 controls who never had history of bleeding in their antepartum period. Bleeding pattern, incidence of preterm labour, intra partum and postpartum complications, mode of delivery, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score of the baby and neo-natal intensive care unit (NICU) admission were analysed. RESULTS Patients with APHUO had subclinical abruption and increased risk of preterm delivery. Intrapartum and postpartum complications were similar among both the groups. The average birth weight was much lesser in the study group, but the cause was attributed to prematurity. These findings were consistent with the previous studies. CONCLUSIONS APHUO is associated with subclinical abruption and increased risk of preterm labour. Hence the patient should be counselled for delivery at a tertiary care center with adequate neonatal care. Greater incidence of NICU admission and low birth weight were attributed to prematurity among the study group. Induction of labour at term in this group is of questionable value unless there is an associated obstetric indication. KEY WORDS APHUO, Preterm Labour, Sub Clinical Abruption, Low Birth Weight

Utilization pattern of antenatal care and determining factors among reproductive-age women in Borama, Somaliland.

SummaryBackgroundAntenatal care is essential care given during pregnancy, to diagnose and treat complications that could endanger both the lives of mother and child. The risk of dying from pregnancy-related issues is often associated with a lack of access to antenatal care services. This issue is a prominent matter in developing countries such as Somaliland which has one of the highest maternal mortality rates in the world.ObjectiveThe objective of this study is to determine the frequency and timing of antenatal care utilization and factors influencing it among reproductive-age women.MethodsA population-based cross-sectional survey is conducted among 330 randomly selected mothers who gave birth in the past two years in Borama, Somaliland.ResultAlthough a significant number of women utilized antenatal care in their pregnancy only 31.1% initiated the first visit within the first trimester and 48.3% received less than the recommended four visits. Fewer antenatal care visits are significantly associated with age (OR = 3.018; CI = 1.264-7.207), gravida (OR = 3.295; CI = 1.200-9.045), and gestation age (OR = 1.737; CI = 1.013-2.979). Early marriage (OR=0.495; CI = 0.252-0.973), and large family size (OR = 3.952; CI = 1.330-11.742) are associated with delay in the commencement of the first antenatal care visit.ConclusionYoung women, women with multiple pregnancies, women married at a young age, and women with a large family size have a higher probability of delaying prenatal care and having fewer visits. Based on the findings, uplifting the socioeconomic status and literacy level of women through community-based education and developing strategies that would take the determining factors into account may contribute to improved and adequate utilization of antenatal care.

Potential Risk Factors for Ventriculoperitoneal Shunt Implantation in Paediatric Patients with Posthemorrhagic Hydrocephalus of Prematurity Treated with Subcutaneous Reservoir: An Institutional Experience.

Posthemorrhagic hydrocephalus of prematurity (PHHP) is a result of intraventricular hemorrhage (IVH). IVH occurs in 6 to 23% of the preterms in countries with advanced medical health care. Most of these patients will eventually require the use of ventriculoperitoneal shunt (VPS). The purpose of this study is to assess the risk factors of VPS implantation in patients with PHHP who have been treated with ventricular catheter with subcutaneous reservoir (VCSR). The retrospective study was conducted evaluating 35 premature patients who suffered from severe IVH. Their mean gestational age was 28 weeks. The assessment included antenatal factors such as gestational age, birth weight, and intrauterine and perinatal infection. Postparturient period factors such as the IVH grade, time between diagnosis, and VCSR implantation and body weight on VCSR implantation were also considered in the study. Postprocedural complications, such as bacterial cerebrospinal fluid (CSF) infection, sepsis, and skin lesions, were evaluated. Data were calculated with R program, version 4.04. From among 35 evaluated patients, 23 (65.71%) required a VPS. Median of birth weight was 1,190 g. Infections were observed in 11 (31.43%) cases. Mean time between IVH diagnosis and VCSR implantation was 2.6 weeks. Postprocedural complications occurred in 19 (54.29%) patients. None of the evaluated factors has proven its statistical significance (p > 0.05) for being a potential risk factor for VPS implantation. External factors seem to not affect the necessity of VPS implantation in patients after the severe IVH. Ostensibly, there seems to be no difference between the grades III and the IV of Papile's IVH scale regarding VPS implantation necessity.