Cause Of Infant Death Research Articles

Pulse Oximetry and Perfusion Index Screening for Congenital Heart Defects: A Systematic Review and Meta-analysis.

Congenital heart defects (CHDs) are the most common neonatal malformations and are a leading cause of infant death in developed countries. Finding safe and effective diagnostic methods to screen for CHDs is important. The aim of this study was to evaluate the effectiveness of pulse oximetry (PO) and perfusion index (PI) in screening CHD. We conducted a systematic review of studies in PubMed, Embase, and the Cochrane Library published on or before October 1, 2021. Studies based on PICOS were included in this systematic review. The flow chart is made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software. Five studies containing 46,965 neonates were included in this study. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.82 (95% confidence interval [CI], 0.53-0.95) and 0.97 (95% CI, 0.57-1.00), respectively. The area under the curve was 0.92 (95% CI, 0.89-0.94). The combination PO and PI was significant in CHD screening. Once diagnosed by the combined method, it means that the neonate is most likely to have a CHD. KEY POINTS: · Pulse oximetry and PI screening.. · Congenital heart defects.. · A systematic review and meta-analysis..

Geographical disparities in infant mortality in the rural areas of China: a descriptive study, 2010–2018

BackgroundThe infant mortality rate (IMR) is considered a basic measure of public health for countries around the world. The specific aim of our study was to provide an updated description of infant mortality rate among different regions in rural China, and assess the trends and causes of the IMR geographical disparities.MethodsData were collected from China’s Under-5 Child Mortality Surveillance System(U5CMSS). The annual number of deaths and causes of death were adjusted using a 3-year moving average underreporting rate based on annual national data quality control results. The average annual decline rate (AADR) and the relative risk (RR) of the IMR and cause-specific infant mortality were calculated by Poisson regression and the Cochran–Mantel–Haenszel method. Data analysis was completed by SAS software.ResultsThere was an apparent decrease in infant mortality in rural China from 2010 to 2018, at the AADR of 11.0% (95%CI 9.6–12.4), 11.2% (95%CI 10.3–12.1) and 6.6% (95%CI 6.0–7.3) in the eastern, central and western rural areas, respectively. The IMR was highest in the western rural area, followed by the central and eastern rural areas. Compared with the eastern rural area, the RR of infant mortality in the central rural area remained at 1.4–1.6 and increased from 2.4 (95%CI 2.3–2.6) in 2010–2012 to 3.1 (95% CI 2.9–3.4) in 2016–2018 in the western rural area. Pneumonia, preterm birth /LBW and birth asphyxia were the leading causes of infant deaths in the western rural area. Mortality rates of these three causes fell significantly in 2010–2018 but contributed to a higher proportion of deaths in the western rural area than in the central and western rural ares.ConclusionsOur study indicated that the infant mortality rate dropped significantly from 2010 to 2018, however, geographical disparities of IMR in rural China are still persist. Therefore, there is an urgent need for public health programmes and policy interventions for infants in western rural China.

Epidemiology and burden of Haemophilus influenzae disease in Thai children before implementation of the routine immunisation programme: A National Health Data Analysis.

To conduct the first pre-Haemophilus influenzae (Hi) type b (Hib) immunisation programme-based epidemiological study using national health data. We analysed National Health Security Office data, which cover 72% of the Thai population. The study population included children aged <18 years admitted for Hi disease from 2015 to 2019. Hi disease diagnosis and death were based on the International Statistical Classification of Diseases and Related Health Problems (10th revision) hospital discharge summary codes. We estimated the hospital cost per admission using diagnosis-related grouping with a global budget. A total of 1125 children aged <18 years were admitted for Hi disease. During the 5-year-study, the annual incidence of Hi disease varied from 1.5 to 1.9 per 100,000 children, with an overall case fatality rate (CFR) of 2%. Pneumonia was the most common clinical form, followed by meningitis and sepsis. The incidence, clinical forms and severity of Hi disease were age specific. Infant CFR was higher than that of other age groups. The incidence of Hi disease in children aged <5 years was 4.9 per 100,000 (CFR=2.0%). Sepsis was the primary cause of infant death, whereas pneumonia was the cause of death in children aged >5 years. The hospital cost ranged from 25,000 to 30,000 THB per admission. This analysis provided epidemiological data of Hi in Thai children before the Hib routine immunisation programme. The incidence of Hi disease was lower than that previously speculated. Our results could facilitate an assessment of the impact of Hib immunisation programme in Thailand.

Differences in Mortality Among Infants With Neonatal Opioid Withdrawal Syndrome

Prior studies are mixed regarding whether infants diagnosed with neonatal opioid withdrawal syndrome have a higher risk of mortality than other infants. However, these studies have not accounted for whether mothers of infants with neonatal opioid withdrawal syndrome received medication for opioid use disorder in pregnancy. Linked data from 2016‒2018 North Carolina birth certificates, maternal and infant Medicaid claims, and infant death certificates were analyzed in summer 2021 to compare mortality and causes of mortality before age 1 year among infants diagnosed with neonatal opioid withdrawal syndrome whose mothers did and did not have claims for medication for opioid use disorder in pregnancy (N=4,480). Compared with mothers with medication for opioid use disorder claims in pregnancy (45.5%), mothers without medication for opioid use disorder claims (55.5%) were younger, more likely to be Black non-Hispanic, less likely to have paternity established, and more likely to have no prenatal care. The proportion (1.3%, n=31 vs 1.0%, n=21) and rate (3.5 vs 2.9 deaths per 100,000 infant days) of mortality was higher among infants of mothers without medication for opioid use disorder claims than infants of mothers with medication for opioid use disorder claims. Sudden unexpected infant death syndrome was the primary cause of death for infants of mothers with (90.5%) and without (58.1%) medication for opioid use disorder claims. Results highlight the importance of assessing for potential differences in outcomes according to whether infants with neonatal opioid withdrawal syndrome were exposed to medication for opioid use disorder. Efforts to ensure equitable access to medication for opioid use disorder and other support services in pregnancy are needed to promote healthy maternal and infant outcomes.

Prediction of Heart Failure in Children with Congenital Heart Disease Based on Multichannel LSTM

Heart failure (HF) is a complicated clinical illness caused by a variety of primary and secondary causes, as well as increased infection pathways, that are associated with higher risk, illness, and costs. The overall incidence of congenital heart disease is approximately high and is the leading cause of death in infants and children. In this study, we present a novel computational model based on ECNN-LSTM for detecting congenital heart disease in real time and assessing its developing course objectively. The proposed model is a multiresolution singular value decomposition for congenital heart disease prediction in infants and children. Firstly, in the whole-life vibration time-domain signal of newborns and toddlers, the multiresolution singular value decomposition approach is employed to create approximation and detailed signals with different resolutions. Secondly, the health phases are split into the smooth running stage of newborns and toddlers, as well as the standard deviation of the earliest moments. Thirdly, the two-layer one-dimensional convolutional neural network structure divides the quick degradation stage, which can offer degradation information. Finally, the prediction of congenital heart disease is finished on LSTM utilizing the MSE loss function to unify the assessment scale. Validation with lifespan data demonstrates the feasibility and effectiveness of the proposed model. Moreover, the existing models have the insufficient ability for life span feature characterization in congenital heart disease prediction in infants and children.

Cas14a1-Mediated Nucleic Acid Diagnostics for Spinal Muscular Atrophy.

Spinal muscular atrophy (SMA) is the main genetic cause of infant death. In >95% of the patients with SMA, the disease is caused by a single hotspot pathogenic mutation: homozygous deletion of exon 7 of the survival motor neuron 1 gene (SMN1). Recently, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein (Cas)-based assays have been developed as a promising new option for nucleic acid detection. Here, we developed a Cas14a1-based assay combined with asymmetric PCR to establish a method for detection of the homozygous deletion of SMN1 exon 7 in SMA patients. The minimum detectable concentration of genomic DNA reached 5.26 aM with our method, and the assessment of its detection performance in 33 clinical samples revealed that the results were completely consistent with those of multiple ligation-dependent probe amplification and quantitative PCR. Thus, our novel nucleic acid diagnostics combining CRISPR/Cas14a1 and asymmetric PCR not only provides specific and sensitive testing of the deletion of SMN1 exon 7, but also holds promise for an accurate detection platform of genetic diseases and pathogens in multiple sample types.

Perinatal Risks of Neonatal and Infant Mortalities in a Sub-provincial Region of China: A Livebirth Population-based Cohort Study

BackgroundCurrent vital statistics of birth population and neonatal outcome in China lacked information and definition of deaths at delivery and during hospitalization, especially for extreme preterm (EPT) birth. This study aims to delineate the prevalence of neonatal hospitalization, neonatal and infant mortality rates (NMR, IMR) and associated perinatal risks based on all livebirths in Huai’an, an evolving sub-provincial region in eastern China.MethodsThis retrospective cohort study established a comprehensive database linking information of whole regional livebirths and neonatal hospitalization in 2015, including deaths at delivery and EPT livebirths. The primary outcomes were NMR and IMR stratified by gestational age (GA) and birthweight (BW) with 95% confidence intervals. Causes of the neonatal and infant deaths were categorized according to the International Statistical Classification of Diseases 10th version, and population attributable fractions of GA and BW strata were analyzed. Perinatal risks of infant mortalities in continuum periods were estimated by Cox regression models.ResultsAmong the whole livebirth population (59056), 7960 were hospitalized (prevalence 13.5%), with 168 (2.8‰) in-hospital deaths. The NMR was 3.6 (3.2, 4.1)‰ and IMR 4.9 (1.4, 4.5)‰, with additionally 35 (0.6‰) deaths at delivery. The major causes of infant deaths were perinatal conditions (2.6‰, mainly preterm-related), congenital anomalies (1.5‰), sudden unexpected death in infancy (0.6‰) and other causes (0.2‰). The deaths caused by preterm and low BW (LBW) accounted for 50% and 40% of NMR and IMR, with 20-30% contributed by EPT or extremely LBW, respectively. Multivariable Cox regression analysis revealed that peripartum factors and LBW strata had strong association with early- and late-neonatal deaths, whereas those of GA < 28 weeks were highly associated with postneonatal deaths. Congenital anomalies and neonatal hospitalization remained high death risks over the entire infancy, whereas maternal co-morbidities/complications were modestly associated with neonatal but not postneonatal infant mortality.ConclusionsThe NMR, IMR, major causes of deaths and associated perinatal risks in continuum periods of infancy, denote the status and quality improvement of the regional perinatal-neonatal care associated with socioeconomic development. The study concept, applicability and representativeness may be validated in other evolving regions or countries for genuine comparison and better maternal-infant healthcare.

Forensic Autopsy Findings in Determination of the Risk Factors of Sudden Infant Death Syndrome

Introduction: Sudden infant death syndrome (SIDS) occurs when a seemingly healthy newborn under the age of one year dies unexpectedly while sleeping. SIDS is often known as crib death because neonates usually die in their cribs. Even after a thorough forensic examination and death site investigation, the general diagnosis of SIDS is made when the cause of infant death cannot be determined. According to the 1969 definition, SIDS is still an excluding diagnosis. Despite the fact that this syndrome has various distinguishing characteristics, such as an age distribution that only affects children under the age of one year and an apparent incidence during sleep, there has been a reluctance to include these characteristics in the classification. The aim of the study was to better understand the risk factors of sudden infant death syndrome (SIDS). Methods: This cross-sectional analytical study was conducted at the Department of Forensic Medicine, Pabna Medical College Hospital, Pabna, from March 2020 to April 2021, and the participants of the study were 25 sudden and unidentified infant death cases at the study hospital whose guardians had given authorization for inclusion in the study. Result: The male: female ratio of the present study was 1.27:1. 60% of the participants had died while at home, and no information regarding the activity of infant at time of death was available for 56% of cases. Initial forensic analysis confirmed SIDS in 76% of the cases. Among the SIDS cases, majority had no observable risk factors, but family history of ailments and habits such as heart disorders, respiratory distress and smoking were determined as possible risk factors. Previous history of SIDS in family was also considered as a risk factor. Conclusion: The location of the infants at the time of death is very important in properly determining cause of death. Better observation of the infants can help in conducting a proper forensic analysis.

Discharge Plan for Mothers of Children Undergoing Congenital Heart Surgery

Background: Congenital heart defect is the second cause of death in infancy and childhood and is the leading cause of childhood morbidity and mortality. Congenital heart surgery corrects a heart defect that a child is born with it. Aim: This study aimed at evaluating the effect of discharge plans for mothers and their children undergoing congenital heart surgery. setting: this study was conducted at the outpatient clinic of Cardio Vascular and Thoracic Academy Ain Shams University Hospitals. Sample: 70 mothers and their children undergoing congenital heart surgery were included in this study. Tools of data collection: two different tools were used. First tool: consists of interviewing questionnaire to asssocio-demographic his characteristics of mothers and their children, knowledge, reported practices of mothers for their children undergoing congenital heart surgery, Second tool: Assessment of child health status. Result: revealed that 81.4% of the studied mothers achieved poor knowledge scores in the pre-implementation phase, it improved to 92.9% of them achieved well in the post-implementation phase. Only 18.6% & 7.1% of them achieved average in both the pre-and post-implementation phase respectively and 91.4% of the study sample's total mothers’ practice was unsatisfactory in the pre-implementation phase, but 97.1% of them were satisfactory in the post-implementation phase. Conclusion: there was a strong statistically significant correlation between the mother's total knowledge and total reported practices score on the post-test (P<0.00**). Recommendation: Comprehensive, multidisciplinary discharge planning should design early and should include the mothers and children contain education regarding congenital heart surgery care.

Mid-trimester uterine electromyography in patients with a short cervix

Preterm birth is the largest single cause of infant death in the United States. A cervical length of <2.5 cm, measured in the mid-trimester, has been shown to identify individuals at increased risk. Uterine electromyography is an emerging technology for noninvasively assessing uterine bioelectrical activity. With its ability to characterize nuanced differences in myometrial signals, uterine electromyography assessments during the mid-trimester may provide insight into the mechanisms of cervical shortening. This study aimed to characterize uterine bioelectrical activity in pregnant individuals with short cervices in the mid-trimester compared with that of pregnant individuals of the same gestational age with normal cervical lengths. This is a prospective cohort study of subjects with singleton, nonanomalous pregnancies between 16 weeks and 0 days and 22 weeks and 6 days of gestational age. Subjects with normal cervical length (≥3.0 cm) were compared with subjects with short cervical length (<2.5 cm). The short-cervical-length cohort was further stratified by history of preterm birth. Multichannel uterine electromyography recordings were obtained for ∼60 minutes using proprietary, directional electromyography sensors on the abdomen. Uterine electromyography signals were observed and classified in groups as spikes, short bursts, and bursts. Primary outcomes were relative expression of spike, short-burst, and burst uterine electromyography signals. Subgroup analyses assessed each signal percentage by cervical length, history of preterm birth, and gestational age at delivery. Differences in percentage of uterine electromyography signals according to cervical length were analyzed using nonparametric tests of significance. Of the 28 included subjects, 10 had normal and 18 had short cervical length. There were 9 subjects with short cervical length and a history of preterm birth. Spikes were the most commonly recorded signals and were higher in the normal-cervical-length cohort (96.3% [interquartile range, 93.1%-100.0%]) than the short-cervical-length cohort (75.2% [interquartile range, 66.7%-92.0%], P=.001). In contrast, median percentages of short-bursts and bursts were significantly higher in subjects with a short cervical length (17.3% [interquartile range, 13.6%-23.9%] vs 2.5% for normal cervical length [interquartile range, 0%-5.5%], P=.001 and 6.6% [interquartile range, 0%-13.4%] vs 0% for normal cervical length [interquartile range, 0%-2.8%], P=.014, respectively). Within subgroup analyses, cervical length was inversely proportional to percentage of observed short-bursts (P=.013) and bursts (P=.014). Subjects with short cervical length and history of preterm birth had higher burst percentages (12.8% [interquartile range, 9.0%-15.7%]) than those with short cervical length and no history of preterm birth (3.3% [interquartile range, 0%-5.0%], P=.003). Short-burst and burst uterine electromyography signals are observed more frequently in mid-trimester patients with short cervical lengths. This relationship provides insight into abnormal myometrial activation in the mid-trimester and offers a plausible biophysiological link to cervical shortening.

Ameliyat Olan Yenidoğanlarda Etiyoloji ve Mortalite Araştırması

Objective&#x0D; We aimed to examine the demographic characteristics, etiology and postoperative mortality rates of neonates operated on in our hospital.&#x0D; Methods&#x0D; The records of neonates who were operated in our tertiary care level university hospital between 2013 and 2019 were reviewed retrospectively. Patients with a diagnosis requiring surgical procedure, age (days), gender, anatomical region where the surgical procedure was performed, length of hospital stay and mortality rates were investigated.&#x0D; Results&#x0D; 329 neonates were included in the study of which 213 (64.75%) were male and 116 (35.25%) were female. Gastrointestinal system surgery was performed in 214 patients (65.04%), respiratory system surgery in 95 (28.87%) patients and urogenital system surgery in 17 (5.16%) patients. The mortality rate of 156 patients that were followed up in our neonatal unit in the postoperative period was 16.6%. The mortality rate of female babies (21.3%) was higher than that of male babies (13%). Considering the mortality rates of the patients according to the surgical areas, the highest mortality rate was found in respiratory system surgery (38.46%) which was trailed by gastrointestinal system surgery (12.28%) and genitourinary system surgery (7.69%), respectively.&#x0D; Conclusions&#x0D; Despite advances in neonatal care and surgical techniques, immaturity and congenital anomalies still have an important place among the most common causes of death in infants. In particular, the detection of organ dysfunctions due to congenital anomalies which are considered among the preventable causes of death in infants, efforts to correct them will be beneficial to a certain extent in reducing the mortality rates of neonates.

Recent research on the treatment of spinal muscular atrophy.

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive muscular weakness and atrophy. SMA, as an inherited disease, is the leading cause of death in infants and young children. Rapid progress has been made in the research field of SMA in recent years, and some related treatment drugs have been successfully approved for marketing. This article reviews the recent research advances in the treatment of SMA.

Cargo recognition by the dynein adaptor Bicaudal D2

The dynein adaptor Bicaudal D2 (BicD2) recognizes cargo for dynein-dependent transport and links them to the dynein motor complex. BicD2-dependent transport pathways are important for brain and muscle development, and mutations in BicD2 cause neuromuscular and neurodegenerative diseases, including spinal muscular atrophy, which is the most prevalent genetic cause of death in infants. However, the molecular mechanism for cargo selection by BicD2 is unknown. Here, in order to obtain mechanistic insights into how BicD2 selects cargo, we have characterized the interaction between cargo adaptor Nup358, which is a protein subunit of the nuclear pore complex and BicD2, by mutagenesis approaches.

Restoring SMN Expression: An Overview of the Therapeutic Developments for the Treatment of Spinal Muscular Atrophy.

Spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disorder and one of the most common genetic causes of infant death. It is characterized by progressive weakness of the muscles, loss of ambulation, and death from respiratory complications. SMA is caused by the homozygous deletion or mutations in the survival of the motor neuron 1 (SMN1) gene. Humans, however, have a nearly identical copy of SMN1 known as the SMN2 gene. The severity of the disease correlates inversely with the number of SMN2 copies present. SMN2 cannot completely compensate for the loss of SMN1 in SMA patients because it can produce only a fraction of functional SMN protein. SMN protein is ubiquitously expressed in the body and has a variety of roles ranging from assembling the spliceosomal machinery, autophagy, RNA metabolism, signal transduction, cellular homeostasis, DNA repair, and recombination. Motor neurons in the anterior horn of the spinal cord are extremely susceptible to the loss of SMN protein, with the reason still being unclear. Due to the ability of the SMN2 gene to produce small amounts of functional SMN, two FDA-approved treatment strategies, including an antisense oligonucleotide (AON) nusinersen and small-molecule risdiplam, target SMN2 to produce more functional SMN. On the other hand, Onasemnogene abeparvovec (brand name Zolgensma) is an FDA-approved adeno-associated vector 9-mediated gene replacement therapy that can deliver a copy of the human SMN1. In this review, we summarize the SMA etiology, the role of SMN, and discuss the challenges of the therapies that are approved for SMA treatment.

Infant Mortality and Maternal Risk Factors in Texas: Highlighting Zip Code Variations in 2 At-Risk Counties, 2011-2015.

IntroductionStark differences in the infant mortality rate (IMR) exist by geography in Texas. The Healthy Families initiative sought to understand how evidence-informed practices implemented in the community can improve pregnancy-related outcomes in 2 counties in Texas with a high prevalence of maternal chronic conditions. The objective of this study was to examine associations between maternal risk factors and infant deaths to inform strategies to improve outcomes.MethodsTwo counties with high prevalence of maternal chronic conditions were selected as Healthy Families sites: one with lower prenatal care usage than other counties in the state but an IMR lower than Texas, and the other with a higher IMR among minority racial and ethnic groups compared with other women in the county and Texas overall. Cohort-linked birth and infant death records from 2011 through 2015 provided by the Texas Department of State Health Services were analyzed by using logistic regression to examine associations of maternal sociodemographic and pregnancy risk factors with infant death. The data were mapped at the zip code level. Analyses were limited to births to women aged 15 to 49 years who resided in Texas from 2011 through 2015 (n = 1,942,899 births).ResultsThe Texas IMR was 5.4 per 1,000 live births, compared with 4.6 and 7.5 per 1,000 live births for Hidalgo and Smith counties, respectively. Congenital malformations were the leading cause of infant death in both counties for infants born in 2015, which was similar to Texas overall. In both counties, maternal marital status, education, multiple gestation, and cesarean delivery were significantly associated with infant mortality. Wide zip code–level variations in IMR and maternal risk factors were observed in both counties.ConclusionVariations in IMR and key maternal risk factors observed at the zip code level helped drive local strategies to maximize outreach of services to disproportionately affected communities.

Treatment for Spinal Muscular Atrophy Using Onasemnogene Abeparvovec

Spinal muscular atrophy (SMA) is the most common cause of death in infancy. Recently introduced molecular-based approaches have changed the poor prognosis, saved lives and improved the quality of life for those affected with SMA. Gene therapy uses an adeno-associated virus (AAV) to deliver and replace the mutant survival of motor neuron (SMN ) genes, SMN1 and SMN2. This review describes the development, relative safety and efficacy of intravenously delivered AAV for SMA type 1 and the intrathecal delivery for SMA type 2. For SMA, viral immunosuppressive treatment and AAV doses never used in clinical research or practice were required for success. As a prototype, the approach has greatly influenced the development of treatment for other childhood and adult diseases. Two additional pharmacologic agents, nusinersen and risdiplam, are clinically approved as alternative treatments. Both use antisense oligonucleotides and are briefly described in this review.

A New Heterocyclic Compound from Rhodiola crenulata on Severe Pediatric Pneumonia and Complete Chloroplast Genome Sequence

Severe pneumonia in children is the main cause of death in infants and young children. Rhodiola crenulata, an important medicinal herb with various biological activities, is used as traditional drug for its content of different secondary metabolites. The role of a new compound extracted from R. crenulata on hypotension after anesthesia was determined, and the internal principle was discussed simultaneously. An animal model of pediatric pneumonia was built, and next the treatment of compound. ELISA was performed to detect the level of inflammatory cytokines released into the lavage fluid of alveoli. Real-time RT-PCR was exploited, and the signaling-pathway activation for NF-κB in the epithelial cells of alveoli was examined. Neighbor-joining phylogenetic results manifested that R. crenulata was clustered with other related categories.

Urinary Orosomucoid (α-1-Acid Glycoprotein) As A Single Potential Biomarker Through PET Assay for Diagnosis of Early Onset Sepsis in Neonates: A Review

Neonatal sepsis is a condition in which bacteria are present in an infant’s sterile body fluids. It is considered one of the most common causes of infant death, with nearly one million deaths per birthday and approximately 2 million deaths in the first week of life. To aid in the early diagnosis of neonatal sepsis, a potential new biomarker for early neonatal sepsis called orosomucoid (ORM) or α1-glycoprotein (α1AGP) in urine is being evaluated because of its greater accuracy than current diagnostic tools. Combined with particle turbidity analysis (PET), neonatal sepsis can be diagnosed in an immediate, sensitive, specific and non-invasive manner. The early local increase in urinary ORM in sepsis suggests that it could be a new promising marker of sepsis and an important part of routine laboratory and clinical practice.

Characteristics Of Pulmonary Arterial Hypertension in Children with Acyanotic Congenital Heart Disease

Background: Congenital heart disease is the leading cause of death in infants related to birth defects and can cause chronic defects (1). The most common complication is pulmonary hypertension (PH). The worst manifestation of PAH is Eisenmenger syndrome. If it has manifested into Eisenmenger syndrome, the defect in CHD cannot be corrected (2,3). Research on the characteristics of PAH in CHD needs to be known for better treatment. Methods: This is a descriptive study in pediatric patients with acyanotic congenital heart disease. In this research we used medical records. Data analysis was carried out descriptively. Results: The results of this study showed that the prevalence of PAH was 7.08%, and most of the patients were toddlers (33 patients or 57.9%) and female (38 patients of 66.7%). The most common diagnosis of CHD lesions was ASD, found in 19 patients (33.3%). Most patients came with severe PAH conditions. Pharmacological therapy in the form of sildenafil was mostly given. The most common symptoms were shortness of breath and murmurs on physical examination. There was no relationship between intervention variables, pharmacological therapy, and mortality and between diagnosis of CHD and severity of PAH. Conclusion: Although the prevalence of PAH was not high in this study, the mortality rate was quite high. It is necessary to educate the parents of patients with congenital heart disease so that further complications can be prevented early on. It is also necessary to make services better to improve the nutritional status of patients. Pharmacological therapy and intervention measures need to be reviewed and improved to reduce mortality in patients.

Spatial analysis of the quality of Primary Health Care services in reducing child mortality

This study sought to analyze the correlation of the quality of Primary Health Care services in reducing child mortality, via geoprocessing. It involved an ecological study, with a cross-sectional approach, in which secondary data from all 5,565 Brazilian municipalities were used to analyze the infant mortality rate (IMR) and cause of infant death. The data related to IMR was obtained from the Mortality Information System. For the spatial analysis, 5,011 municipalities were included. The clustering analyses were performed using GEODA software and the spatial regression analyses were performed using ARCGIS 10.5 software. In Brazil, there was a 45.07% reduction in IMR between the years 2000 and 2015. The greatest reduction occurred in the northeastern region of the country, although it is still the region with the highest IMR. Of the 749 municipalities analyzed in the differential cluster for infant death, 153 had high IMR. The areas with the greatest increase in IMR were found in the North and Northeast regions. In Brazil, IMR proved to be inversely associated with the accessibility to high complexity services, health management strata and population size, reference for childbirth, live birth rate, per capita income and unemployment rate. A progressive reduction in IMR was recorded between 2000 and 2015.