High Infant Mortality Research Articles

Debuting an innovative model for integrated child health care in the Southeast region, Bulgaria

Abstract Background Demographic indicators are fundamental drivers for health policy action. The Southeast Region (SER) is the largest statistical region (NUTS 2) in Bulgaria (BG), distinguished by the highest Infant mortality rates (IMR) and teenage crude fertility rates across the European Union (EU). For instance, the 2022 statistics reveal an IMR of 8.2 per 1000 live births in SER, notably higher than Bulgaria’s average of 4.8 and the EU’s average of 3.3. This disparity highlights the critical need for region-specific health initiatives aimed at curtailing IMR and harmonizing health outcomes throughout the EU territories. This report outlines such an initiative under the project code BG16FFPR003-2.001-012, recently funded by the EU. The novel SER initiative: This is the first presentation of the concept of integrated territory investments (CITI) and the innovative model for integrated child health care in SER, BG. The project impacts child health care across the four districts of SER - Burgas, Sliven, Yambol, Stara Zagora. The municipalities have collaboratively submitted 24 project proposals with educational bodies, NGOs, public institutions, and the Ministry of Health. The theoretical frame of the project’s model is underpinned by three foundational pillars: 1) Prevention in primary healthcare; 2) Child health care in hospitals; 3) Development of human resources, providers of health care. The forthcoming infrastructural, organisational, and capacity-building interventions will remain adaptable yet aligned with the overarching CITI framework. Conclusions A current phase of public discourse on the CITI concept and the innovative integrated model in SER is underway. Stakeholders are actively encouraged to provide input either through discussions or by participating in designated online surveys. Community engagement is instrumental in evaluating and prioritizing these initiatives, which aim to fundamentally transform the SER by leveraging its unique territorial potential. Key messages • Demographic indicators drive health policy. Project BG16FFPR003-2.001-012 targets EU disparities, lowering IMR and balancing fertility rates. • This is the first presentation of the “Innovative model for integrated child health care in SER”. The EPH Conference provides an ideal platform for sharing and discussion.

Prediction model for early diagnosis of late-onset sepsis in preterm newborns.

Late-onset neonatal sepsis has a high mortality rate in premature infants. To date, no single test in the evaluation of neonatal sepsis has been demonstrated to be both sensitive and specific enough to assist in timely decision making. The aim of our study is to develop a predictive model that can be applied to all premature babies, using clinical and laboratory findings in premature babies, to recognize late-onset neonatal sepsis. 65 premature patients diagnosed with culture-proven late-onset neonatal sepsis and hospitalized in Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital neonatal intensive care unit between January 2018 and December 2020, and 65 premature newborns of similar age and gender who did not have sepsis were included in the study retrospectively. In our study, feeding difficulties, worsening in clinical appearance and fever were found to be significant among clinical findings, while thrombocytopenia and high C-reactive protein among laboratory findings are the strongest data supporting late-onset neonatal sepsis. In multiple regression analysis, thrombocytopenia, mean platelet volume, C-reactive protein, lymphocyte count and feeding difficulties had the highest odds ratio (p < 0.05). By converting these data into a scoring system, a nomogram was created that can be easily used by all clinicians. In our study, we developed a scoring system that can be easily applied to all premature patients by evaluating the clinical and laboratory findings in late-onset neonatal sepsis. We think that it will help in recognizing late-onset neonatal sepsis and strengthening the treatment decision. Predicting the individual probability of sepsis in preterm newborns may provide benefits for uninfected newborns to be exposed to less antibiotics, not to be separated from mother and baby, and to reduce healthcare system expenditures. The nomogram can be used to assess the likelihood of sepsis and guide treatment decision.

Child health in the first 100 years of Republic of Türkiye: a story of hope, labor and success.

The Republic of Türkiye commemorated its 100th year in 2023. Within one century, a battle weary, poor country has changed into a powerful, game changing leader in the world. This was accomplished by the motivation and overwork of the Turkish nation and a great leader, Mustafa Kemal Atatürk. The status of child health in 1923 can be summarized as high infant and under-five mortality rates, epidemic diseases and hardly any healthcare facilities and health-care professionals. Since a healthy, well educated workforce was one of the main requirements for the development of the young republic, child health was given a great emphasis. With the efforts of the whole nation, many children's hospitals were established, infant mortality decreased, and malaria, neonatal tetanus, polio and diphtheria were eradicated. In this article, the progression of child health in the first 100 years of the Republic of Türkiye will be reviewed.

Fatalism or vigilance? Exposure to infant and maternal deaths and subsequent use of maternal health services in Malawi

In developing contexts, where formal health services are still expanding, understanding what factors discourage individuals from using health services is critical to advance population health. A long theorized, but rarely investigated, conjecture is that in high-mortality contexts, exposure to death can beget fatalism, or even foster distrust of formal healthcare, locking families into cycles of low use of health services. A counter perspective, however, suggests exposure to death can encourage individuals’ health vigilance, corresponding with their higher use of health services. We test these competing ideas by analyzing the associations between women’s intimate exposure to death in the context of pregnancy and delivery via (1) a sister’s maternal death and (2) an infant child’s neonatal death, and their subsequent use of maternal health services. We focus on the context of Malawi, a setting that features high maternal and infant mortality rates, similar to those observed across much of sub-Saharan Africa, as well as persistent gaps in service use. Specifically, we use Malawi Demographic and Health Survey (2015–16) data to examine if a sister’s maternal death or a child’s neonatal death corresponds with a woman’s odds of attending full antenatal care during a subsequent pregnancy or delivering the pregnancy at a formal health facility. Given the qualitatively distinct nature of losing one’s only or first child, we also assess if the effect of a child’s neonatal death varies by birth order. The results show that maternal and neonate death exposures correspond generally with women’s higher use of maternal health services, challenging the notion that exposure to death fosters fatalism or distrust. Although the results vary in significance, the nuanced findings highlight women’s vigilance in the face of health threats, emphasizing their resilience amid a high burden of familial loss.

Analisis performa inkubator grashof dengan menggunakan lampu LED sebagai pemanas

The high infant mortality rate that occurs between the time after the baby's birth and the time when the baby is not exactly one year old is due to hypothermia/hypertermia, insufficient access to doctors and inability to pay for the use of pre-natal care equipment. Research has been conducted on the analysis of the performance of grashof incubators using LED lamps and copper fiber as heaters to determine the efficiency of LED lights when used for heating in a baby incubator (grazhof inkubator). The results of the research show that 20 watt LED lamp with the addition of fibre as a medium for the heating of air inside incubators is more efficient in tempering the air to reach a temperature of 35oC compared to a 25 watt fiber lamp that does not use a heater fiber. Temperature testing in a baby incubator is measured using a K-type thermocouple due to good accuracy and high sensitivity to temperature changes that need to be monitored in real time. From the results of the analysis of energy efficiency and heating speed (free convection) obtained results that show that with the addition of copper syrup as a heating medium in the incubator has a real influence on the speed of heating air inside the incubators.

What about sex, race(ism), and social determinants of health in neonatal outcomes?

Neonatal outcomes encompass a range of outcome measures, including mortality rates, physical and mental health morbidities, and long-term neurodevelopmental statistics. These outcomes are influenced by non-modifiable factors, such as sex and race, and modifiable factors, such as social determinants of health and racism. There is a known bias toward worse outcomes for male infants in terms of preterm birth, low birth weight, and mortality, with several biological and physiological factors contributing to these sex-related differences. In relation to racial disparities, wherein race is a social construct, maternal and infant healthcare continues to lag behind for minority populations compared with the white population, despite advances in medical care. Infants born to Black women have higher infant mortality rates and lower birth weights than infants of white women. These differences can be largely attributed to social and environmental factors, rather than racial and ethnic differences. Furthermore, we emphasize the role of social determinants of health in neonatal outcomes. Factors such as economic stability, education access and quality, healthcare access and quality, the physical neighborhood environment, and the social and community context all contribute to these outcomes. Overall, this article highlights the complex interactions between sex, race(ism), and social determinants of health in neonatal outcomes. It underscores the need for a comprehensive understanding of these factors to improve maternal-neonatal care and reduce disparities in outcomes. Healthcare providers, policymakers, and communities need to work together to combat these complex issues and improve neonatal outcomes for all infants, while understanding the complex interplay between sex, racism, and/or social determinants of health.

Age and Sex Structure of the Population of the Potapovo and Sintashta Cultures in the Late Bronze Age Based on the Materials of Funerary Monuments from the Volga-Ural Region

The paper analyzes the gender and age structure of the population of the Potapovo and Sintashta cultures in the late Bronze Age based on anthropological materials from a cemetery in the Volga-Ural region. According to archaeological data, both of them belong to a single cultural block; nevertheless, issues of their correlation and primacy in the time of origin are still debatable. 336 markers of gender and age definition in the individuals were applied. Calculations of the main demographic indicators were carried out; histograms of the ratio of age and gender groups were constructed for each culture under consideration. Using the principal components method, an intergroup comparison was carried out on demographic indicators of 31 series in the south of Eastern Europe and Transcaucasia. The indicators of the Potapovo and Sintashta groups have high infant mortality. At the same time, more even ratios of sex and age classes were noted for the Sintashta group of the Trans-Urals. In contrast to Potapovo, a more favorable external and internal social situation for the Sintashta population is assumed. A comparison of demographic indicators against a broader geographical and chronological background demonstrates, firstly, the convergence of the Potapovo and Sintashta groups, the manifestation of similar trends among subsequent series of log culture in the same region, and, on the contrary, sharp differences with the data of the previous pastoral Yamno-Poltavka population. Thus, the demographic indicators of the Potapovo and Sintashta cultures can symbolize the transition to new ethno-cultural living conditions, to the beginning of the formation of stationary geographical points, to the gradual settling of collectives.

Centralisation of extremely preterm births and decreased early postnatal mortality in Sweden, 2004-2007 versus 2014-2016.

We evaluated the increased centralisation of extremely preterm (EPT) births in Sweden in relation to the changes in mortality and morbidity. Population-based data covering Swedish live births from 22 + 0 to 26 + 6 weeks of gestation during 2004-2007 and 2014-2016 were analysed for associations between time-period, birth within (inborn) or outside (outborn) regional centres, and outcomes. Among 1626 liveborn infants, 703 were born in 2004-2007 and 923 in 2014-2016. Birth outside (vs. within) regional centres was associated with a higher infant mortality even after adjustment for birth cohort, gestational age, birthweight standard deviation score and infant sex (adjusted odds ratio 2.01, 95% confidence interval 1.31-3.07, p = 0.001). The higher 1-yearmortality in outborn infants was mainly due to more deaths within 24 h after birth. Outborn infants had a higher incidence of intraventricular haemorrhage grade 3-4 than inborn infants (22% vs. 14% in 2004-2007, and 22% vs. 13% in 2014-2016, both p < 0.05). While survival to 1 year without major morbidity increased in inborn infants (33%-40%, p = 0.008), it remained unchanged in outborn infants (29% vs. 30%, p = 0.88). Centralisation of EPT births contributed to a lower 1-year mortality in 2014-2016 than that in 2004-2007, attributed to a decrease in deaths before 24 h among inborn infants.

Neonatal Infectious Disease: A Major Contributor to Infant Mortality Requiring Advances in Point-of-Care Diagnosis.

Neonatal infectious disease continues to result in high rates of infant morbidity and mortality. Early- and late-onset disease represent difficult to detect and difficult to treat illnesses, particularly when antimicrobial resistant pathogens are present. Newborns are immunodeficient and are at increased risk of vertical and horizontal infection, with preterm infants increasingly susceptible. Additional risk factors associated with infection include prolonged use of a central catheter and/or ventilation, congenital abnormalities, admittance to intensive care units, and the use of broad-spectrum antibiotics. There is increasing recognition of the importance of the host microbiome and dysbiosis on neonatal infectious disease, including necrotising enterocolitis and sepsis in patients. Current diagnostic methods rely on blood culture, which is unreliable, time consuming, and can result in false negatives. There is a lack of accurate and reliable diagnostic tools available for the early detection of infectious disease in infants; therefore, efficient triage and treatment remains challenging. The application of biomarkers, machine learning, artificial intelligence, biosensors, and microfluidics technology, may offer improved diagnostic methodologies. Point-of-care devices, such diagnostic methodologies, may provide fast, reliable, and accurate diagnostic aids for neonatal patients. This review will discuss neonatal infectious disease as impacted by antimicrobial resistance and will highlight novel point-of-care diagnostic options.

High early lactational synchrony within baboon groups predicts increased infant mortality.

Social group composition can have fitness implications for group members by determining opportunities for affiliative and competitive interactions. Female-female competition may be particularly acute when many groupmates have young infants at the same time, with potential consequences for infant survival. Here, we used decades of data on wild baboons (Papio sp.) in Amboseli, Kenya, to examine the effects of 'early lactational synchrony' (here, the proportion of females in a group with an infant <90 days old) on female-female agonistic interactions and infant survival. Because early lactation is an energetically demanding time for mothers and a risky time for infants, we expected early lactational synchrony to produce intensified competition for food and/or male protectors, resulting in more frequent female-female agonistic interactions and high infant mortality. In support of these predictions, we found that the frequency of female-female agonistic interactions increased with increasing early lactational synchrony. Reproductive state affected this relationship: while females in all states (cycling, pregnant, and postpartum amenorrhea) initiated more agonistic interactions when early lactational synchrony was high, only females in postpartum amenorrhea (including, but not limited to, females in early lactation) received more agonistic interactions. Furthermore, while high early lactational synchrony was rare, it strongly predicted infant mortality. This association may result from both aggression among adult females and infanticidal behavior by peripubertal females. These findings provide novel evidence that social dynamics may shape reproductive phenology in a nonseasonal breeder. Specifically, both competition among reproductive females and harassment from nonreproductive females may select against synchronous reproduction.

Parent Narratives Provide Perspectives on the Experience of Care in Trisomy 18.

Trisomy 18 syndrome, also known as Edwards syndrome, is the second most common autosomal chromosome syndrome after Down syndrome. Trisomy 18 is a serious medical disorder due to the increased occurrence of structural defects, the high neonatal and infant mortality, and the disabilities observed in older children. Interventions, including cardiac surgery, remain controversial, and the traditional approach is to pursue pure comfort care. While the medical challenges have been well-characterized, there are scant data on the parental views and perspective of the lived experience of rearing a child with trisomy 18. Knowledge of the parental viewpoints can help clinicians guide families through decision-making. Our aim was to identify parents' perspectives by analyzing a series of narratives. In this qualitative study, we collected 46 parent narratives at the 2015 and 2016 conferences of the Support Organization for Trisomy 18 & 13 (SOFT). The participants were asked to "Tell us a story about your experience." Inductive content analysis and close reading were used to identify themes from the stories. Dedoose, a web-based application to analyze qualitative data, was used to code themes more systematically. Of the identified themes, the most common included Impact of trisomy 18 diagnosis and Surpassing expectations. Other themes included Support from professionals, A child, not a diagnosis, and Trust/lack of trust. We examined the voice and the perspectives of the parents in their challenges in caring for their children with this life-limiting condition. The exploration of the themes can ideally guide clinicians in their approach to the counseling and care of the child in a shared decision-making approach.

Experiences of central child health services teams regarding a special governmental investment in child health services

BackgroundHistorically marked by a high infant mortality rate, Sweden’s healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0–5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.MethodsCCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement’s implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke’s framework. Participants represented a cross-section of Sweden’s varied healthcare regions.ResultsThree main themes emerged from the thematic analysis: “Easy come, easy go,” highlighting funding uncertainties; “What are we supposed to do?” expressing dilemmas over project prioritization and partner collaboration; and “Building castles on sand,” focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.ConclusionsThis study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

Identify Affecting Factors on Total Fertility Rate: A Systematic Review

Background: The total fertility rate (TFR) is a key indicator of population dynamics and health. It shows the average number of children a woman would have in her lifetime, based on the current fertility rates for different age groups. Various factors affect the TFR, such as social, economic, political, technological, environmental, and health factors. By analyzing these factors and how they influence the TFR, policymakers and planners can design and implement interventions to achieve optimal population and health outcomes. Methods: We searched PubMed, Scopus, ISI Web of Science, and ProQuest databases, as well as the Google Scholar search engine systematically. We searched for studies from 13 December 2021 - 20 May 2022, without time limits. We included studies that described at least one driver of TFR. We applied the STEEPH framework (social, technology, environmental, economic, political, and health) method to analyze the qualitative data. Results: We included 64 studies from 26 countries. We identified 410 drivers of TFR, and classified 181 drivers into six main categories: Social, technological, environmental, economic, political, and health. The main factors that lower the fertility rate are education, aging, poverty, postponing marriage (social), exposure of women to mass media (technology), type of residence and living in urban areas, road accidents (environmental), income and economic situation (recession and inflation), unemployment, debt, women’s employment (economic), government policies (political), use of anti-fertility drugs (health). The main drivers that raise the fertility rate are having first child girls, women’s proximity to their workplace (social), use of assisted reproductive technology (technology), living in rural areas and natural and unnatural disasters (environmental), improvement in men’s labor market conditions, employment opportunities (economic), increased parental leave (political), high infant mortality (health). Conclusions: We identified a comprehensive list of effective drivers that have increased or decreased TFR in different parts of the world. It is necessary to review these drivers considering the specific conditions and social, cultural, economic, and political coordinates of each country. This review should inform policymakers' actions in this area.

Prevalence, patterns and determinants of unmet needs of contraception among married women in Imphal East district of Manipur: a cross-sectional study

Background: In many countries, unmet need for family planning among pregnant women is a main reason of closely spaced births, child bearing at a very early age, unsafe abortions or physical abuse, all of which are considered as main co-factors to high maternal and infant mortality. Understanding the unmet need of contraception and contraceptive behaviour among married women will help in enhancing the service provision among them. The study was done with the objective to estimate the prevalence of unmet need of contraception and patterns of contraceptive usage among currently married women and to determine the association between unmet need of contraception and some selected variables. Methods: A cross-sectional study was conducted using pre-tested, semi-structured questionnaire among currently married women. Bivariate and multivariate logistic regression analyses were used to identify factors associated with the unmet need of contraception. A p value of &lt;0.05 was taken as statistically significant. Results: Out of 300 respondents, more than half (165, 55.0%) had unmet needs of contraception. Age of the participant AOR=1.057 (1.013-1.103), self-employed AOR=0.433 (0.222-0.844), pregnant at present AOR = 7.693 (2.868-20.635), discussing about FP with husband AOR=0.534 (0.305-0.936) and those ever received FP services AOR=2.794 (1.579-4.944) were significantly associated with unmet need of contraception. Conclusions: Five out of ten women were found to have unmet need for contraception. Awareness programs regarding importance of family planning and various family planning services available at health facilities should be conducted from time to time among the public.

Assessment of agricultural residue potential for electrification of off-grid communities in the Sawla-Tuna-Kalba District of Ghana

BackgroundThere is a close link between the lack of electricity access and poverty indicators such as illiteracy, high infant mortality, lack of access to health care and malnutrition among others. Most rural farming communities in Ghana lack access to electricity due to the high cost of extending the grid to these communities. This lack of access tends to worsen the gap between urban and rural inhabitants regarding access to education, healthcare and development.MethodsThis study assessed the technical and theoretical potential of agricultural residues in providing electricity to off-grid communities. The study used crop production figures of maize, cassava, millet and groundnut in the Soma and Goyiri farming communities in the Sawla-Tuna-Kalba District to conduct an assessment of the theoretical and technical potential of residues from the crops. The production figures of these crops were obtained from the District Office of the Ministry of Food and Agriculture. Expected electricity demand of households, schools and health centers in the study communities were collected and employed for the projected load demand estimates.ResultsThe study found that 312.23 MWh/day of electricity could be generated from the combined residues of maize, cassava, millet and groundnut from the two communities. This amount of electricity is capable of providing ~ 202 to 263 times the peak electricity demand of the studied communities. Out of the total electricity demand of the two communities, only about 91 kWh/day is needed for use in a school and Community Health Promotion and Services (CHPS) compound, implying that the electricity from crop residues can also help to improve education and health provision in the rural communities.ConclusionIt is concluded that the potential of crop residues in meeting the electricity demand of off-grid communities is enormous. Hence, it must be considered in Ghana’s energy development plans to achieve universal electricity access.

Investigating Low Birth Rates and High Infant Mortality Rate in Developing Countries: The Rising Infant Mortality Rate

Investigating Low Birth Rates and High Infant Mortality Rate in Developing Countries: The Rising Infant Mortality Rate

Public Health Financing and Population Health: What Role Do Institutions Play?

ABSTRACTThis study investigates the multifaceted interactions among public health financing, institutions, and population health. It also sought to determine whether the efficacy of government health interventions to reduce child mortality and improve life expectancy in Africa's most populous country had been hampered by its institutional framework. The research analyzed the links among institutional, socioeconomic, and health variables using the autoregressive distributed lag estimator across a 37‐year period (1984–2020). The findings show that short‐term public health spending in Nigeria has a significant negative effect on health outcomes, whereas long‐term spending has a significant positive effect. Although public health financing significantly impacted long‐run life expectancy, its short‐run impact is statistically insignificant. Moreover, public health financing is positively linked with lower infant mortality in the long run but directly associated with higher rates in the short run. It further discovered that weak institutional framework is responsible for low life expectancy and high infant mortality. Institutions exert an unconditional significant negative impact on short‐ and long‐term health outcomes. Findings also show that both the short‐ and long‐term net effects of government health financing and institutions on the health outcomes are negative and statistically significant. So, institutions and public health financing are substitutes, with institutions unable to adequately improve their role in the public finance–health outcomes relations. Furthermore, the thresholds at which short‐ and long‐term institutional settings will modulate direct links between public finance and health outcomes are 5.01 and 2.62, respectively. Hence, the empirical findings validate the defective nature of the Nigerian institutional settings. Policy prescriptions for improving health outcomes are recommended based on the findings.

Analisis Faktor-Faktor yang Memengaruhi Penggunaan IUD Pasca Plasenta

High maternal mortality rate and infant mortality rate in Indonesia can be suppressed by increased coverage of MKJP methods. The aim of the research was to analyze the factors that influence the use of post-placental contraceptives with IUD methods in Praya RSUD. Research design used analytical observation with case control study. The results of the research obtained the level of knowledge of the WUS and the promotion or KIE activities given by the health personnel are significantly related to the use of post-placental IUDs in RSUD Praya with a P-value of 0,000. However, the health care competence factor is not related to the use of post-placental IUDs in Praya RSUD with a P-value of 0.715. Conclusion The level of knowledge and promotional activities/KIE by health care personnel has been linked to the use of post placental IUD in RSUD Praya. Whereas health care competence has nothing to do with it.

Parthanatos initiated by ROS-induced DNA damage is involved in intestinal epithelial injury during necrotizing enterocolitis

Necrotizing enterocolitis (NEC) involves intestinal epithelial damage and inflammatory response and is associated with high morbidity and mortality in infants. To improve therapeutic prospects, elucidating underlying molecular mechanisms of intestinal epithelial damage during NEC is of the essence. Poly (ADP-ribose) polymerase 1 (PARP1)-dependent parthanatos is a programmed inflammatory cell death. In the present study, the presence of parthanatos-associated proteins PARP1 and poly (ADP-ribose) (PAR), along with high expression of DNA damage-associated biomarkers, 8-hydroxy-2’-deoxyguanosine (8-OHdG) and phosphorylation of histone H2AX (γH2AX), were discovered in the intestinal tissues of NEC infants. Additionally, the upregulated expression of PARP1 and PAR in NEC intestinal tissues correlated distinctly with clinical indices indicative of NEC incidence and severity. Furthermore, we demonstrated that inhibiting the expression of parthanatos-associated proteins, by either pharmacological blockage using 3-aminobenzamide (3-AB), an inhibitor of PARP1, or genetic knockout using Parp1-deficient mice, resulted in substantial improvements in both histopathological severity scores associated with intestinal injury and inflammatory reactions. Moreover, in an in vitro NEC model, reactive oxygen species (ROS)-induced DNA damage promoted the formation of PAR and nuclear translocation of apoptosis-inducing factor (AIF), thus activating PARP1-dependent parthanatos in Caco-2 cells and human intestinal organoids. Our work verifies a previously unexplored role for parthanatos in intestinal epithelial damage during NEC and suggests that inhibition of parthanatos may serve as a potential therapeutic strategy for intervention of NEC.

Birth Intention Status and Infant Mortality: Fixed‐Effects Analysis of 60 Countries

AbstractMost studies on the impact of birth intentions on children's well‐being do not separate risks of infant mortality associated with pregnancy intention status from the risks that are associated with sociodemographic characteristics. There is a lack of studies taking a multicountry comparative perspective. We analyzed 60 Demographic and Health Surveys in Asia, the Americas, and Africa to examine the association between birth intentions and infant mortality using sibling fixed‐effects linear probability models accounting for confounding due to time‐invariant maternal characteristics. Compared to wanted births, the probability of infant mortality was higher after an unwanted or mistimed birth, or both, in 41 countries. Particularly in West Africa, mostly mistimed pregnancies were associated with infant mortality, whereas in the Americas unwanted pregnancies mattered more. These differences could be partly due to contextual variation in the concept of birth intentions and in the importance of birth spacing and limiting. We show that the risk of infant mortality after an unwanted/mistimed pregnancy was higher in countries with low human development index and high overall infant mortality rate, highlighting the importance of taking context into account rather than pooling data. To the best of our knowledge, this is the first large‐scale, cross‐regional, and cross‐country comparative study to analyze the association between birth intentions and infant mortality using a fixed‐effects approach.