Decrease In Neonatal Mortality Research Articles

Magnitude of neonatal sepsis and its associated factors among neonates admitted to the neonatal intensive care unit in Hawassa Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia, 2020

BackgroundNeonatal sepsis is one of the most common causes of disease and death among neonates globally. And it made a great contribution to neonatal admission to intensive care units. To mitigate the ongoing neonatal crisis and accomplish the goal of sustainable development through a decrease in neonatal mortality, information from various regions is needed. Despite the considerable burden of neonatal sepsis in our setting, no prior studies were conducted in the study area. So, this study aimed to assess the magnitude and associated factors of neonatal sepsis among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama Regional State, Ethiopia.MethodsA hospital-based cross-sectional study was carried out among 287 neonates from March 1, 2020, to April 25, 2020. An interviewer-administered structured questionnaire was used to collect the data. The data were cleaned, coded, and entered into Epi Data 3.1 software and exported to Statistical Package for Social Science (SPSS) software version 23.0 for analysis. Binary logistic regression analyses were performed to identify variables having a significant association with neonatal sepsis. A p-value of ≤ 0.05 was considered statistically significant during multivariable logistic regression.ResultsThe study found that the magnitude of neonatal sepsis was 56%. The mean age of neonates was 3.2(SD±2.2) days. Around two-fifths (39%) of neonates were in the gestational age of <37 completed weeks. A quarter of mothers(25.8%) were delivered through cesarean section. During labor, 251 (87.5%) mothers had ≤4 digital vaginal examinations. Moreover, the finding revealed that mothers who delivered by cesarean section [AOR = 2.13, 95% CI (1.090-4.163)]. neonates who had been resuscitated at birth [AOR = 4.5, 95% CI (2.083-9.707)], and neonates who had NG tube inserted [AOR = 4.29, 95% CI (2.302-8.004)] were found to be significantly associated with neonatal sepsis.ConclusionsThe current study shows that neonatal sepsis was prevalent among more than half of the neonates admitted to the NICU. Therefore, designing strategies to enhance the aseptic techniques of professionals in the provision of care and actively and collaboratively working with cluster health facilities is highly recommended.

HIF3A gene disruption causes abnormal alveoli structure and early neonatal death.

Transcriptional response to changes in oxygen concentration is mainly controlled by hypoxia-inducible transcription factors (HIFs). Besides regulation of hypoxia-responsible gene expression, HIF-3α has recently been shown to be involved in lung development and in the metabolic process of fat tissue. However, the precise mechanism for such properties of HIF-3α is still largely unknown. To this end, we generated HIF3A gene-disrupted mice by means of genome editing technology to explore the pleiotropic role of HIF-3α in development and physiology. We obtained adult mice carrying homozygous HIF3A gene mutations with comparable body weight and height to wild-type mice. However, the number of litters and ratio of homozygous mutation carriers born from the mating between homozygous mutant mice was lower than expected due to sporadic deaths on postnatal day 1. HIF3A gene-disrupted mice exhibited abnormal configuration of the lung such as a reduced number of alveoli and thickened alveolar walls. Transcriptome analysis showed, as well as genes associated with lung development, an upregulation of stearoyl-Coenzyme A desaturase 1, a pivotal enzyme for fatty acid metabolism. Analysis of fatty acid composition in the lung employing gas chromatography indicated an elevation in palmitoleic acid and a reduction in oleic acid, suggesting an imbalance in distribution of fatty acid, a constituent of lung surfactant. Accordingly, administration of glucocorticoid injections during pregnancy resulted in a restoration of normal alveolar counts and a decrease in neonatal mortality. In conclusion, these observations provide novel insights into a pivotal role of HIF-3α in the preservation of critically important structure and function of alveoli beyond the regulation of hypoxia-mediated gene expression.

Surfactant Therapy in Respiratory Distress Syndrome

Respiratory distress syndrome (RDS) is the leading cause of neonatal respiratory morbidity and mortality. Advancements in neonatal care, along with extended insurance coverage, have resulted in increased utilization of surfactant replacement therapy (SRT) for RDS. This has contributed to a decrease in neonatal mortality. The primary mode of respiratory support in infants with RDS has dramatically changed over the last decades, transitioning from invasive to noninvasive support. Therefore, less invasive surfactant therapy has emerged as a widely adopted approach for SRT, establishing itself as a standard method in preterm infants’ care. This review addresses pulmonary surfactant, from its discovery to application in newborns with RDS. It also reviews the history of guidelines of SRT and health insurance issues. Future studies should evaluate various emerging noninvasive respiratory support modalities along with SRT for the respiratory management of neonates, given the lack of sufficient evidence regarding these approaches.

Cigarette taxation and neonatal and infant mortality: A longitudinal analysis of 159 countries.

Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008-2018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of tobacco use, and reliance on taxation data only for the cigarette brands most sold in each country. In line with limited existing evidence conducted in HICs, we found that raising taxes on tobacco was associated with a reduction in neonatal and infant mortality globally. Implementing recommended levels of taxation in LMICs should be a priority since this is where the lowest levels of taxation and the largest potential infant mortality benefits exist.

Antenatal corticosteroids and neonatal outcomes in preterm birth in the United States.

To determine the impact of antenatal corticosteroids (ACS) on neonatal outcomes in a large United States population of preterm births. Retrospective cohort study utilizing the United States Natality Live Birth database from the Centers for Disease Control and Prevention (2016-2017). Women with singleton preterm births were eligible for inclusion. Out-of-hospital births, fetal anomalies, and cases where ACS exposure was unknown were excluded. Neonates from reported live births were divided into two groups based onwhether the mother received ACS before delivery or not.The incidence of several reported neonatal outcomes werecompared between the two groups at each gestational week. Subsequently, comparisons between three gestational age groups (23 0/7 to 27 6/7, 28 0/7 to 33 6/7, and 34 to 36 6/7weeks) were performed. Statistical analysis included use of Chi-squared test and multivariate logistic regression. Of the 588,077 live births included, 121,151 (20.6%) had been exposed to ACS. ACS use was associated with a significantly decreased odds of neonatal mortality and 5-min Apgar score <7, but an increased rate of several neonatal outcomes such as surfactant replacement therapy, prolonged ventilation, antibiotics for suspected neonatal sepsis, and neonatal intensive care unit (NICU) admissions. ACS administration prior to preterm birth is associated with a decrease in neonatal mortality and low Apgar scores, and increased odds of several adverse neonatal outcomes.

Supplementing hand washing with proper use of alcoholic hand rub in a special neonatal care unit in a large academic public health institute at Jabalpur, Madhya Pradesh, India

ObjectiveThe purpose was to increase use of alcoholic hand rub (AHR) in specialised newborn care unit (SNCU) to improve hand hygiene in order to reduce neonatal sepsis and mortality at...

The effect of female education on child mortality: evidence from Indonesia

ABSTRACT This paper examines the effect of female education on child mortality in Indonesia by exploiting a one-time change in the length of the 1978 school year as a source of exogenous variation in education. The results show that the education reform increases women’s educational attainment by 0.76 years and that one additional year of female education leads to a decrease in neonatal mortality by 0.5 percentage points. Mechanism analysis suggests that higher female education postpones the timing of marriage and of first birth, leads to higher quality of spouse and higher household wealth and increases the use of prenatal health care and mass media. However, I do not find significant impacts of female education on women’s empowerment in the household.

Cost effectiveness of a novel device for improving resuscitation of apneic newborns

BackgroundIntrapartum-related hypoxic events are a major cause of morbidity and mortality in low resource countries. Neonates who receive proper resuscitation may go on to live otherwise healthy lives. However, even when a birth attendant is present, these babies frequently receive suboptimal ventilation with poor outcomes. The Augmented Infant Resuscitator (AIR) is a low-cost, reusable device designed to provide birth attendants real-time objective feedback on measures of ventilation quality during resuscitations and is intended for use in training and at the point of care. The goal of our study was to determine the impact and cost-effectiveness of AIR deployment in conjunction with existing resuscitation training programs in low resource settings.MethodsWe developed a simulation model of the natural history of intrapartum-related neonatal hypoxia and resuscitation deriving parameters from published literature and model calibration. Simulations estimated the number of disability-adjusted life years (DALYs) averted with use of the AIR by birth attendants if deployed at the point of care. Potential decreases in neonatal mortality and long-term subsequent morbidity from disability were modeled over a lifetime horizon. The primary outcome for the analysis was the cost per DALY averted. Model parameters were specific to the Mbeya region of Tanzania.ResultsImplementation of the AIR strategy resulted in an additional cost of $24.44 (4.80, 73.62) per DALY averted on top of the cost of existing, validated resuscitation programs. Per hospital, this adds an extra $656 to initial training costs and averts approximately 26.84 years of disability in the cohort of children born in the first year, when projected over a lifetime. The findings were robust to sensitivity analyses. Total roll-out costs for AIR are estimated at $422,688 for the Mbeya region, averting approximately 9018 DALYs on top of existing resuscitation programs, which are estimated to cost $202,240 without AIR.ConclusionOur modeling analysis finds that use of the AIR device may be both an effective and cost-effective tool when used as a supplement to existing resuscitation training programs. Implementation of this strategy in multiple settings will provide data to improve our model parameters and potentially confirm our findings.

Impacto en la calidad atención generada en el área de Neonatología del hospital Luis Gabriel Dávila

La neonatología tiene como base fundamental el cuidado del recién nacido y su vínculo neonato-materno por lo que podría ser un inconveniente muy serio si estos lazos se ven interrumpidos o afectados de alguna manera, ya sea por descompensación materno- infantil o por falta de experticia materna para el adecuado cuidado y crianza del recién nacido, por ello este trabajo investigativo tiene como objetivo dar a conocer la importancia del cuidado neonatal y la labor de la neonatología a nivel mundial; esto se lo puede evidenciar, con las tasas de morbi-mortalidad infantil las cuales están estrictamente relacionadas con la mortalidad neonatal, esta investigación hace referencia a la disminución de la mortalidad neonatal en la región norte del país y la trascendencia de contar con un servicio de salud en beneficio de la colectividad. Este estudio se basa en la comparación de cifras de mortalidad infantil, demostrando la significativa disminución de la mortalidad neonatal en el Carchi y específicamente en la ciudad de Tulcán, finalmente se estableció una hipótesis que asegura que se han reducido las cifras de mortalidad infantil y neonatal en el periodo investigado, observando cifras de mortalidad infantil inferiores en comparación a años anteriores y ello deja ventanas abiertas para que profesionales de la salud investiguen posteriormente afirmando o negando ésta hipótesis, Destacando que el trabajo médico y de enfermería se lo realiza con mayor técnica científica para beneficio de la salud neonatal en el Cantón Tulcán.

Causes of Neonatal Mortality in Neonatal Care Units AL-Diwaniya Province –Iraq 2013

Background: Neonatal mortality refers to death of a new born within the first 28 days of life. A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time before his or her first birthday.&#x0D; Methods: A cross sectional study was conducted to review records of neonatal deaths that took place in all neonatal care units in AL- Daiwynia province during the year 2013. Data collection form was designed to collect the demographic data, data concerning pregnancy and delivery and any complication during pregnancy, delivery and perperium, mode of delivery, place of delivery and causes of neonatal death. Result: respiratory distress syndrome was the highest among causes of neonatal deaths (55.2%), followed by birth asphyxia (16.5%), sepsis (15%), neonatal jaundice and its complications (7.1%), pneumonia (2.5%), cold injury (1.8%) and diarrhea (0.8). Preterm delivery was noticed in (55%) of the deceased neonates, 37.5% of them were with normal birth weight, 32% with low birth weight, 17.5% with very low birth weight and 13% were with extremely low birth weight. Conclusion: The most common causes of neonatal deaths were respiratory distress syndrome, birth asphyxia and sepsis. Prevention of prematurity and low birth weight as major cause for respiratory distress syndrome will lead to a decrease in neonatal mortality and morbidity

Predicted effect of regionalised delivery care on neonatal mortality, utilisation, financial risk, and patient utility in Malawi: an agent-based modelling analysis

SummaryBackgroundHealth-care regionalisation, in which selected services are concentrated in higher-level facilities, has successfully improved the quality of complex medical care. However, the effectiveness of this strategy in routine maternal care is unknown. Malawi has established a national goal of halving its neonatal mortality by 2030. In this study, we aimed to assess the effect of obstetric service regionalisation in pregnant women and their newborn babies in Malawi.MethodsIn this analysis, we assessed regionalisation through the use of an agent-based simulation model. We used a previously estimated utilisation function, incorporating both patient-specific and health-facility-specific characteristics, to inform patient choice. The model was validated against known utilisation patterns in Malawi. Four regionalisation scenarios were compared with the status quo: scenario 1 restricted deliveries to facilities currently capable of providing caesarean sections; scenario 2 had the same restrictions as scenario 1, but with selected facilities upgraded to provide caesarean sections; scenario 3 restricted delivery to facilities that provided five or more basic emergency obstetric and neonatal care services in the preceding 3 months; and scenario 4 had the same restrictions as scenario 3, but with selected facilities upgraded to provide at least five basic emergency obstetric and neonatal care services. We assessed neonatal mortality, utilisation, travel distance, median out-of-pocket expenditure, and proportion of women facing catastrophic expenditure. The effects of upgrading the obstetric readiness of all facilities, of removing all user fees, and of upgrading without restriction were considered in scenario analyses. Heterogeneity and parameter uncertainty were incorporated to create 95% posterior credible intervals (PCIs).FindingsScenarios restricting women to give birth in facilities with caesarean section capabilities reduced neonatal mortality by 11·4 deaths per 1000 livebirths (scenario 1; 95% PCI 9·8–13·1) and 11·6 deaths per 1000 livebirths (scenario 2; 10·2–13·1), whereas scenarios restricting women to facilities that provided five or more basic emergency obstetric and neonatal care services did not affect neonatal mortality. Similarly, the caesarean section rate in Malawi, which is 4·6% under the status quo, was predicted to rise significantly in scenario 1 (14·7%, 95% PCI 14·5–14·9; p<0·0001) and scenario 2 (10·4%, 10·2–10·6; p<0·0001), but not in scenarios 3 and 4. Women were required to travel longer distances in scenario 1 (increase of 7·2 km, 95% PCI 4·5–9·9) and in scenario 2 (4·4 km, 1·5–7·2) than in the status quo (p<0·0001). Out-of-pocket costs tripled (p<0·0001; status quo vs scenario 1 and scenario 2), and the risk of catastrophic expenditure significantly increased from a baseline of 6·4% (95% PCI 6·1–6·6) to 14·7% (14·5–14·9) in scenario 1 and 11·3% (11·0–11·5) in scenario 2. This increase was especially pronounced among the poor (p<0·0001; status quo vs scenario 1 and scenario 2).InterpretationPolicies restricting women to give birth in facilities with caesarean section capabilities is likely to result in significant decreases in neonatal mortality and might allow Malawi to meet its goal of halving its neonatal mortality by 2030. However, this improvement comes at the cost of increased distances to care and worsening financial risks among women.FundingBill & Melinda Gates Foundation, Damon Runyon Cancer Research Foundation.

Evaluation of retention of knowledge, skill and competency of health workers one year after completion of the Helping Babies Breathe training program in South Sudan

Introduction: The aim of the study is to evaluate the long-term retention of knowledge, skill and competency of health workers who completed Helping Babies Breathe (HBB) training and effect on newborn mortality. Methods: The study employed pre-post-interventions study and participants were selected based on their previous training on HBB protocols. Health workers were assessed for knowledge, skill and competency pre, post training in March, and 3 months in June 2017 and 1-year post implementation in September 2018. Health workers were scored on knowledge, skill and competency. The mean score was obtained and repeated ANOVA, chi-squared test and Pearson’s test was used to compare pre- and post-intervention and one-year implementation. Retention of health worker’s knowledge, skill and competency was assessed using the HBB questionnaires, checklist, practical skill and drills, and were scored on knowledge, skill and competency. The scores were computed into percentages, mean scores and mean differences, and compared against scores at 3 months and 1 year. Impact on management of newborn asphyxia was conducted using a review of delivery registry at maternity and children ward scores were group into percentages, averages means, computed using the Chi-square test. Results: Helping Babies Breathe has shown a significant increase in knowledge, skill and competency post-test and three months. Despite the improvement in knowledge, skills and competency of the health within the three months of training, there was marked decline over 1-year period. Conclusions: Immediate evaluation of the health workers after Helping Babies Breathe training resulted into significant increase in knowledge, skills and competency in neonatal resuscitation although this declined over period of one year. The training also resulted into decrease in neonatal mortality.

Is the decline in neonatal mortality in northern Ghana, 1996–2012, associated with the decline in the age of BCG vaccination? An ecological study

ObjectiveTo examine the association between early Bacille Calmette-Guerin (BCG) vaccination and neonatal mortality in northern Ghana.MethodsThis ecological study used vaccination and mortality data from the Navrongo Health and Demographic Surveillance...

Impact of fee subsidy policy on perinatal health in a low-resource setting: A quasi-experimental study

BackgroundA national subsidy policy was introduced in 2007 in Burkina Faso to improve financial accessibility to facility-based delivery. In this article, we estimated the effects of reducing user fees on institutional delivery and neonatal mortality, immediately and three years after the introduction of the policy.MethodsThe study was based on a quasi-experimental design. We used data obtained from the 2010 Demographic and Health Survey, including survival information for 32,102 live-born infants born to 12,474 women. We used a multilevel Poisson regression model with robust variances to control for secular trends in outcomes between the period before the introduction of the policy (1 January, 2007) and the period after. In sensitivity analyses, we used two different models according to the different definitions of the period “before” and the period “after”.ResultsImmediately following its introduction, the subsidy policy was associated with increases in institutional deliveries by 4% (RR = 1.04, 95% CI: 0.98–1.10) in urban areas and by 12% (RR = 1.12, 95% CI: 1.04–1.20) in rural areas. The results showed similar patterns in sensitivity analyses. This effect was particularly marked among rural clusters with low institutional delivery rates at baseline (RR = 1.44, 95% CI: 1.33–1.55). It was persistent for 42 months after the introduction of the policy but these increases were not statistically significant. At 42 months, the delivery rates had increased by 26% in rural areas (RR = 1.26; 95% CI: 0.86–1.86) and 13% (RR = 1.13; 95% CI: 0.88–1.46) in urban areas. There was no evidence of a significant decrease in neonatal mortality rates.ConclusionThe delivery subsidy implemented in Burkina Faso is associated with short-term increases in health facility deliveries. This policy has been particularly beneficial for rural households.

Poorly Understood Maternal Risks of Pregnancy in Women With Heart Disease.

One of the most significant accomplishments of modern medicine worldwide is the dramatic 28% decrease in neonatal mortality during the past 20 years. However, although neonatal survival is improving and, for most of the world, maternal mortality is decreasing, this trend has not been seen in the United States. Neonatal survival has improved in the United States, whereas maternal mortality has increased from 7.2 deaths per 100 000 in 1989 to 17 deaths per 100 000 in 2013. In fact, the United States is the only developed nation with a rising maternal mortality rate. Maternal mortality is even higher for black women, approaching 4-fold that of their white, Asian, or Hispanic counterparts. Although cardiac disease complicates a small number of all pregnancies, it has become a leading cause of maternal morbidity and mortality, surpassing both hemorrhage and embolic events. Understanding the causes of this worrisome trend must become a research priority with plans to develop novel interventions to improve maternal outcomes, particularly as the birthrate in women >35 years of age and the associated comorbidities that go along with advanced maternal age continue to increase. Before the widespread institution of penicillin, rheumatic heart disease was the most common form of heart disease encountered in pregnancy. Marked improvements in treating congenital heart disease have led to more women with congenital cardiac malformations reaching reproductive age and …

Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks' gestation.

The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability. A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated. A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation. The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.

Verbal/social autopsy study helps explain the lack of decrease in neonatal mortality in Niger, 2007-2010.

BackgroundThis study was one of a set of verbal/social autopsy (VASA) investigations undertaken by the WHO/UNICEF–supported Child Health Epidemiology Reference Group to estimate the causes and determinants of neonatal and child deaths in high priority countries. The study objective was to help explain the lack of decrease in neonatal mortality in Niger from 2007 to 2010, a period during which child mortality was decreasing.MethodsVASA interviews were conducted of a random sample of 453 neonatal deaths identified by the 2010 Niger National Mortality Survey (NNMS). Causes of death were determined by expert algorithm analysis, and the prevalence of household, community and health system determinants were examined along the continuum of maternal and newborn care, the Pathway to Survival for newborn illnesses, and an extended pathway for maternal complications. The social autopsy findings were compared to available data for survivors from the same cohort collected by the NNMS and the 2012 Niger Demographic and Health Survey.FindingsSevere neonatal infection and birth asphyxia were the leading causes of early neonatal death in the community and facilities. Death in the community after delayed careseeking for severe infection predominated during the late neonatal period. The levels of nearly all demographic, antenatal and delivery care factors were in the direction of risk for the VASA study decedents. They more often resided rurally (P < 0.001) and their mothers were less educated (P = 0.03) and gave birth when younger (P = 0.03) than survivors’ mothers. Their mothers also were less likely to receive quality antenatal care (P < 0.001), skilled attendance at birth (P = 0.03) or to deliver in an institution (P < 0.001). Nearly half suffered an obstetric complication, with more maternal infection (17.9% vs 0.2%), antepartum hemorrhage (12.5% vs 0.5%) and eclampsia/preeclampsia (9.5% vs 1.6%) than for all births in Niger. Their mothers also were unlikely to seek health care for their own complications (37% to 42%) as well as for the newborn’s illness (30.6%).ConclusionsNiger should scale up its recently implemented package of high–impact interventions to additional integrated health facilities and expand the package to provide antenatal care and management of labor and delivery, with support to reach a higher level facility when required. Community interventions are needed to improve illness recognition and careseeking for severe neonatal infection.

The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth

Data regarding the effects of antenatal corticosteroids in twin pregnancies are limited because of the insufficient number of women with twins enrolled in randomized controlled trials on antenatal corticosteroids. Furthermore, the interpretation of available data is limited by the fact that the interval from the administration of antenatal corticosteroids to delivery is greater than 7 days in a large proportion of twins, a factor that has been shown to affect the efficacy of antenatal corticosteroids and has not been controlled for in previous studies. The objective of the study was to compare neonatal mortality and morbidity in preterm twins receiving a complete course of antenatal corticosteroids 1-7 days before birth to those who did not receive antenatal corticosteroids and to compare these outcome effects with those observed in singletons. We performed a retrospective cohort study using data collected on singleton and twin neonates born between 24(0/7) and 33(6/7) weeks' gestational age and were admitted to tertiary neonatal units in Canada between 2010 and 2014. A comparison of neonatal outcomes between twin neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n= 1758) and those who did not receive antenatal corticosteroids (n= 758) and between singleton neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n= 4638) and those did not receive antenatal corticosteroids (n= 2312) was conducted after adjusting for gestational age, sex, hypertension, outborn status, small for gestational age, parity, and cesarean birth. Adjusted odds ratios and 95% confidence intervals for various neonatal outcomes were calculated. Administration of a complete course of antenatal corticosteroids within 1-7 days before birth in both twins and singletons was associated with similar reduced odds of neonatal death (for twins adjusted odds ratio 0.42 [95% confidence interval, 0.24-0.76] and for singletons adjusted odds ratios, 0.38 [95% confidence interval, 0.28-0.50]; P= .7 for comparison of twins vs singletons), mechanical ventilation (for twins adjusted odds ratio, 0.47 [95% confidence interval, 0.35-0.63] and for singletons adjusted odds ratio, 0.47 [95% confidence interval, 0.41-0.55]; P= .9), respiratory distress syndrome (for twins adjusted odds ratio, 0.53 [95% confidence interval, 0.40-0.69], and for singletons adjusted odds ratio, 0.54 [95% confidence interval, 0.47-0.62]; P= .9) and severe neurological injury (for twins adjusted odds ratio, 0.50 [95% confidence interval, 0.30-0.83] and for singletons adjusted odds ratio, 0.45 [95% confidence interval, 0.34-0.59]; P= .7). Administration of a complete course of antenatal corticosteroids was not associated with a reduced odds of bronchopulmonary dysplasia, severe retinopathy of prematurity, or necrotizing enterocolitis in both twins and singletons. Administration of a complete course of antenatal corticosteroids 1-7 days before birth in twin pregnancies is associated with a clinically significant decrease in neonatal mortality, short-term respiratory morbidity, and severe neurological injury that is similar in magnitude to that observed among singletons.

Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality.

Path to impact: A report from the Bill and Melinda Gates Foundation convening on maternal immunization in resource-limited settings; Berlin – January 29–30, 2015

Global initiatives such as the Millennium Development Goals have led to major improvements in the health of women and children, and significant reductions in childhood mortality. Worldwide, maternal mortality has decreased by 45% and under-five mortality has fallen by over 50% over the past two decades [1]. However, improvements have not been achieved evenly across all ages; since 1990, under-five mortality has declined by ∼5% annually, but the average decrease in neonatal mortality is only ∼3% per year.Against this background, the Bill and Melinda Gates Foundation (BMGF) convened a meeting in Berlin on January 29–30, 2015 of global health stakeholders, representing funders, academia, regulatory agencies, non-governmental organizations, vaccine manufacturers, and Ministries of Health from Africa and Asia. The topic of discussion was the potential of maternal immunization (MI) to achieve further improvements in under-five morbidity and mortality rates in children, and particularly neonates and young infants, through targeting infectious diseases that are not preventable by other interventions in these age groups. The meeting focused on effective and appropriately priced MI vaccines against influenza, pertussis, and tetanus, as well as against respiratory syncytial virus, and the group B Streptococcus, for which no licensed vaccines currently exist.The primary goals of the BMGF 2015 convening were to bring together the global stakeholders in vaccine development, policy and delivery together with the Maternal, Newborn and Child Health (MNCH) community, to get recognition that MI is a strategy shared between these groups and so encourage increased collaboration, and obtain alignment on the next steps toward achieving a significant health impact through implementation of a MI program.