LBW Infants Research Articles

Associations between maternal microbiome, metabolome and incidence of low-birth weight in Guatemalan participants from the Women First Trial.

Low birth weight (LBW; <2,500 g) affects approximately 15 to 20 percent of global births annually and is associated with suboptimal child development. Recent studies suggest a link between the maternal gut microbiome and poor obstetric and perinatal outcomes. The goal of this study was to examine relationships between maternal microbial taxa, fecal metabolites, and maternal anthropometry on incidence of LBW in resource-limited settings. This was a secondary analysis of the Women First trial conducted in a semi-rural region of Guatemala. Maternal weight was measured at 12 and 34 weeks (wk) of gestation. Infant anthropometry measures were collected within 48 h of delivery. Maternal fecal samples at 12 and 34 weeks were used for microbiome (16S rRNA gene amplicon sequencing) and metabolomics analysis (34 wk). Linear mixed models using the MaAslin2 package were utilized to assess changes in microbiome associated with LBW. Predictive models using gradient boosted machines (XGBoost) were developed using the H2o.ai engine. No differences in β-diversity were observed at either time point between mothers with LBW infants relative to normal weight (NW) infants. Simpson diversity at 12 and 34 weeks was lower in mothers with LBW infants. Notable differences in genus-level abundance between LBW and NW mothers (p < 0.05) were observed at 12 weeks with increasing abundances of Barnesiella, Faecalibacterium, Sutterella, and Bacterioides. At 34 weeks, there were lower abundances of Magasphaera, Phascolarctobacterium, and Turicibacter and higher abundances of Bacteriodes, and Fusobacterium in mothers with LBW infants. Fecal metabolites related to bile acids, tryptophan metabolism and fatty acid related metabolites changed in mothers with LBW infants. Classification models to predict LBW based on maternal anthropometry and predicted microbial functions showed moderate performance. Collectively, the findings indicate that alterations in the maternal microbiome and metabolome were associated with LBW. Future research should target functional and predictive roles of the maternal gut microbiome in infant birth outcomes including birthweight.

Theophylline impact on weaning in oxygen-dependent infants followed in an outpatient Kangaroo Program.

Theophylline was an orally administered xanthine used for treatment of apnea of prematurity and Bronchopulmonary Dysplasia in ambulatory follow-up of Low-Birth-Weight infants (LBWI) with oxygen-dependency in the outpatient Kangaroo Mother Care Program (KMCP). Theophylline's main metabolic product is caffeine; therefore, it was an alternative due to the frequent lack of ambulatory oral caffeine in low and middle-income countries. To assess the effectiveness of oral theophylline in decreasing days with oxygen and to describe frequency of adverse related events. Quasi-experiment before and after withdrawal of theophylline given systematically to LBWI with ambulatory oxygen in two KMCPs. 729 patients were recruited; period 1: 319 infants when theophylline was given routinely and period 2: 410 infants when theophylline was no longer used. The theophylline cohort had less gestational age, less weight at birth, more days in Neonatal Intensive Care Unit, more days of oxygen-dependency at KMCP admission, and more frequencies of Intrauterine Growth Restriction and apneas. After adjusting with propensity score matching, multiple linear regression showed that nutrition was associated with days of oxygen-dependency, but theophylline treatment not. No differences were found in frequencies of readmissions up to 40 weeks, intraventricular hemorrhage or neurodevelopmental problems. Participants in period 2 had more tachycardia episodes. We did not find association between oral theophylline treatment and the reduction of days with ambulatory oxygen. For the current management of oxygen-dependency in LBW infants, the importance of nutrition based on exclusive breast feeding whenever possible, is the challenge.

LITERATURE REVIEW: THE EFFECTIVENESS OF TELEHEALTH-BASED HEALTH EDUCATION OF MOTHERS TREATING LOW BIRTH WEIGHT INFANTS

Background: Knowledge and skills of mothers and families in the care of low birthweight babies are very important to prevent mortality and morbidity, because LBW babies are at risk of experiencing health problems. Care is therefore required from when the baby is hospitalized until the baby is discharged. Purpose: To determine the effectiveness of using telehealth-based health education to increase the knowledge and skills of mothers in caring for LBW infants. Methods: This literature review was conducted based on the search for data sources and selection of articles with references used, namely Google Scholar and PubMed. The keywords used are telehealth OR miHealth OR app health AND low birth weight AND knowledge AND skills. The inclusion criteria for articles taken were those published in full text, in the period 2012-2021, quantitative research types, as well as articles with the main content being the use of health education media regarding the care of LBW babies. The search results contained 38 articles that had been adjusted to the inclusion criteria, there were 6 remaining articles. Results: knowledge and skills of mothers in caring for babies can increase after being given telehealth-based health education compared to conventional health education, namely leaflets and demonstrations. Conclusion: Health education based on telehealth is effective in increasing knowledge and skills so that mothers can care for LBW babies.

Predictors of time to full enteral feeding in low birth weight neonates admitted to neonatal intensive care unit: a prospective follow up study

BackgroundSurvival of LBW infants has increased in recent years because of novel perinatal interventions, but the introduction and advancement of enteral feeds for low birth weight infants is challenging. In Ethiopia the proportion of low birth weight infants is thought to be 17.3%. The purpose of this study was to determine the time to full enteral feeding (FEF) and its predictors in LBW neonates admitted to neonatal intensive care unit in selected hospitals of Addis Ababa, Ethiopia.MethodAn institutional based prospective follow up study was conducted from March 15 to June 15, 2022 among 282 LBW neonates admitted to six randomly selected hospitals. Both primary and secondary data was used by interviewing mothers and prospective medical chart review of neonates. The Cox regression model was used and variables having a p-value less than 0.05 with 95% CIs in a multivariable analysis were declared as statistically significant association with time to full enteral feeding.ResultOut of 282 neonates involved in this study, 211 (74.8%) of them reached at FEF. The overall median time to full enteral feeding was 5 days. Predictors significantly associated with time to full enteral feeding were educational level, birth weight, cesarean delivery, hospital acquired infection, being on antibiotics, age at initiation of trophic feeding, routine gastric residual evaluation and NICU location (hospital).ConclusionsThis study demonstrated the difficulty of understanding which low birth weight neonate will attain FEF in a timely manner and factors that affect time to FEF. There is a delay in full enteral feeding achievement among low birth weight neonates and there is a great deal of heterogeneity of practice among health care providers regarding feeding of infants as it was evidenced by a variation in feeding practice among hospitals. Nutrition should be considered as part of the management in neonatal intensive care units since low birth weight neonates are developing edematous malnutrition while they are in the NICU. There should be standard feeding protocol to avoid heterogeneity of practice and additional study should be conducted for each categories of GA and BW with long follow up time.

HUBUNGAN BERAT LAHIR DENGAN KADAR ARAKIDONAT ACID PADA ASI DARI IBU MENYUSUI BAYI 1-4 BULAN DI KOTA MAKASSAR

Human milk is the most perfect food for babies, ideally breast milk is the only source of nutrition for six months at the beginning of life. This study aimed to assess the correlation levels of Arhacidonat Acid of breast milk in nursing mothers by birth weight (LBW and normal) in Makassar. Research conducted at the health center area of ​​Makassar. This type of research is observational analytic with cross-sectional design. How the sample selection using purposive sampling of 30 people, where the first group of 15 lactating mothers of normal birth weight babies and a second group of 15 mothers breastfeeding LBW infants. Levels of Arhacidonat Acid is checked by HPLC (Hight Performance Liquid Chromotography). Data were analyzed using SPSS using independent t-test to see relations birth weight infants with higher levels of essential fatty acids in milk both groups. Average levels of AA breastfed babies with normal birth weight lower than the levels of AA breastfeeding LBW infants (0.098 ± 0.006 mg / ml appeal of 0.085 ± 0.024 mg / ml) but the relationship was not significant (P&gt; 0.05). It was concluded that there was no association between birth weight infants with higher levels of Arhacidonat Acid breast milk in lactating mothers of infants aged 1-4 months in Makassar.

Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania

BackgroundLow birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings.MethodsThis study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach.ResultsAll participants believed that mother’s own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance.ConclusionThis study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system.

Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana

BackgroundLow birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.MethodsA constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.ResultsEmerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.ConclusionA coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.

The Effect of Pre-Feeding Oral Stimulation on The Sucking Ability of LBW Babies in The NICU Room

Introduction: The inability to drink in LBW is caused by weak sucking muscle ability and unstable oral ability and swallowing and breathing on LBW babies influenced by maturity of the structure of the brain and cranial nerves. The LBW babies taken care does not suck directly on the mother's breast, this is because the mother and baby are taken care for separately. Objective: To analyze the effect of Pre-Feeding Oral Stimulation on the sucking ability of LBW Babies in the NICU Room at Harapan Insan Sendawar General Hospital. Method: This study used experimental research with one group pre-test and post-test. The population in this study were all LBW infants who were treated in the NICU room. Results and Discussion: The result of research was gained that the average of baby's sucking ability before oral stimulation was 2.67 where the lowest value of sucking ability is 0 and the highest value of sucking ability was 6. The average of baby's sucking ability after oral stimulation is 3.73 where the lowest value of sucking ability was 1 and the highest value of sucking ability was 7. The Statistical test results by conducting Wilcoxon T test were found that the P value was 0.01. So, the p-value (0.01) is smaller than the alpha value (0.05), it means that the null hypothesis is rejected. Conclusion: There is an effect of Pre-Feeding Oral Stimulation on the Sucking Ability of LBW Babies in the NICU Room at Harapan Insan Sendawar General Hospital in the year 2022.

Hubungan Asupan Makanan dan BBLR dengan Kejadian Malnutrisi pada Balita Usia 1-5 Tahun di Wilayah Puskesmas Darul Imarah Aceh Besar

Malnutrition is an imbalance between food intake and the body's needs to fulfill specific functions of the body. Intake of macronutrients is needed by toddlers in growth and development. The imbalance in the level of consumption of macronutrients against the body's needs can affect tissue and body mass which has an impact on malnutrition. Children born with LBW have a 3.34 times greater risk of experiencing poor nutritional status compared to children who are not LBW. Objective: To determine the relationship between food intake and LBW with the incidence of malnutrition in toddlers aged 1-5 years. This research is descriptive analytic with a case control design with a total sample consisting of 31 cases and 31 controls. The research variables were food intake and LBW. This research was conducted in October 2021 at the Darul Imarah Health Center. Data analysis used Chi square test with 95% confidence level. In the case group, toddlers had adequate energy intake, mostly 22 people (44.9%), adequate carbohydrate intake 23 people (51.1%), adequate protein intake 27 people (47.4%), and fat intake deficit 31 people. (56.4%). The incidence of malnutrition in the case group was mostly experienced by 17 LBW infants (53.1%). There was a relationship between fat intake and the incidence of malnutrition (p &lt; 0.05), while the intake of energy, carbohydrates, protein and low birth weight had no relationship with the incidence of malnutrition (p &gt; 0.05).

Building a predictive model of low birth weight in low- and middle-income countries: a prospective cohort study

BackgroundLow birth weight (LBW, < 2500 g) infants are at significant risk for death and disability. Improving outcomes for LBW infants requires access to advanced neonatal care, which is a limited resource in low- and middle-income countries (LMICs). Predictive modeling might be useful in LMICs to identify mothers at high-risk of delivering a LBW infant to facilitate referral to centers capable of treating these infants.MethodsWe developed predictive models for LBW using the NICHD Global Network for Women’s and Children’s Health Research Maternal and Newborn Health Registry. This registry enrolled pregnant women from research sites in the Democratic Republic of the Congo, Zambia, Kenya, Guatemala, India (2 sites: Belagavi, Nagpur), Pakistan, and Bangladesh between January 2017 – December 2020. We tested five predictive models: decision tree, random forest, logistic regression, K-nearest neighbor and support vector machine.ResultsWe report a rate of LBW of 13.8% among the eight Global Network sites from 2017–2020, with a range of 3.8% (Kenya) and approximately 20% (in each Asian site). Of the five models tested, the logistic regression model performed best with an area under the curve of 0.72, an accuracy of 61% and a recall of 72%. All of the top performing models identified clinical site, maternal weight, hypertensive disorders, severe antepartum hemorrhage and antenatal care as key variables in predicting LBW.ConclusionsPredictive modeling can identify women at high risk for delivering a LBW infant with good sensitivity using clinical variables available prior to delivery in LMICs. Such modeling is the first step in the development of a clinical decision support tool to assist providers in decision-making regarding referral of these women prior to delivery. Consistent referral of women at high-risk for delivering a LBW infant could have extensive public health consequences in LMICs by directing limited resources for advanced neonatal care to the infants at highest risk.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi-site observational study.

Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding. A formative, multi-site, observational cohort study using convergent parallel, mixed-methods design. Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania. Moderately low birthweight infants (MLBW; 1.50-2.49 kg). We assessed infant feeding and care practices through: (1) assessment of in-facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1-year follow-up of 1114 MLBW infants. Focus group discussions and in-depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders. The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system-level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants. Hospital-level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in-facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age. Enrolment and follow-up of this vulnerable population required additional effort from researchers and the community. Using a mixed-methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence-based planning of targeted large-scale interventions. Multi-site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.

What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis

ObjectiveWe examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents. MethodsWe searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis. Results222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff. ConclusionAlthough parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families.Practice Implications:This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.

P07-039-23 Nutritional Predictors of Early Child Development Outcomes at 24 Months of Age Among a Cohort of Moderately LBW Infants in India and Tanzania: A Prospective Cohort Study

P07-039-23 Nutritional Predictors of Early Child Development Outcomes at 24 Months of Age Among a Cohort of Moderately LBW Infants in India and Tanzania: A Prospective Cohort Study

Socioeconomic risk factors for low birth weight newborns: A population-based study.

Data was collected from a 4-year maternal-newborn registry. There were 5,316 LBW and 54,029 normal birth weight (NBW). The prevalence of LBW was 9%. The Native women in the LBW group compared to non-native women were 10.4% (1784/5316) vs. 8.4% (3532/5316) with a P-value of 0.001. There were more illiterate mothers in the LBW compared to the NBW, respectively: 8.1% (1597/19497) vs. 7.5% (1763/23230) with a P-value of 0.001. Working mothers tend to have more LBW infants compared to mothers with NBW, 8.4% (1588/17217) vs. 7.9% (2532/31891) and P-value 0.001. Young mothers (<20 years old) with early childbearing had more LBW compared to older mothers, respectively 12.7% (180/1414) vs. 8.9% (5149/52919) P-value <0.001. Women with no antenatal care reported a high rate of LBW compared to women with regular antenatal care: 14.2% (516/3696) vs. 8.6% (4741/55691) P-value <0.001. LBW babies were born more from assisted conception pregnancies (38% compared to 8.4% of normal pregnancies) P-value <0.001. Smoking mothers scored higher with LBW at 13.6% vs. 8.3% and a P-value of 0.001. There were no differences between the two groups regarding religion, consanguinity, marital status, or family income. Risk factors for low birth weight can be improved by providing antenatal care, smoking cessation, optimizing high-risk pregnancy care, and governing assisted reproduction regulations.

Hubungan Paritas dan Usia Ibu dengan Kejadian Berat Badan Lahir Rendah di Rumah Sakit Umum Bali Royal Hospital

Infant Mortality Rate is the main problems facing the world, because the success of health services can be measured and determined based on the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). The purpose of the study was to determine the relationship between parity and maternal age with the incidence of low birth weight at Bali Royal General Hospital in 2021. This type of research was an analytical correlation study using a cross sectional approach. The study was conducted in April-May 2022 using a non-probability sampling technique with the type of purposive sampling. The sample size used is 48 respondents. Data collection by taking data on the mother's age, parity, diagnosis and birth weight of the baby from the register or medical record. Analysis of the relationship between parity and LBW data using the coefficient contigency and analysis of the relationship between age and the incidence of LBW using chi-square. The results of the study were large respondents were mothers with moderate risk (58.3%), 95.8% low parity, as many as 29.2% occurred LBW. The conclusion is that there is no relationship between parity and the incidence of LBW infants at Bali Royal Hospital in 2021 with a p value of 0.081, there is a relationship between maternal age and the incidence of infant birth weight at Bali Royal Hospital in 2021 with a p value of 0.000. For research sites to provide more information and education to prospective pregnant women and pregnant women about the dangers of LBW risks.

What more can be done? Prioritizing the most promising antenatal interventions to improve birth weight

BackgroundLow birth weight (LBW) is associated with neonatal mortality and sequelae of lifelong health problems; prioritizing the most promising antenatal interventions may guide resource allocation and improve health outcomes. ObjectiveWe sought to identify the most promising interventions that are not yet included in the policy recommendations of the World Health Organization (WHO) but could complement antenatal care and reduce the prevalence of LBW and related adverse birth outcomes in low- and middle-income settings. MethodsWe utilized an adapted Child Health and Nutrition Research Initiative (CHNRI) prioritization method. ResultsIn addition to procedures already recommended by WHO for the prevention of LBW, we identified six promising antenatal interventions that are not currently recommended by WHO with an indication for LBW prevention, namely: (1) provision of multiple micronutrients; (2) low-dose aspirin; (3) high-dose calcium; (4) prophylactic cervical cerclage; (5) psychosocial support for smoking cessation; and (6) other psychosocial support for targeted populations and settings. We also identified seven interventions for further implementation research and six interventions for efficacy research. ConclusionThese promising interventions, coupled with increasing coverage of currently recommended antenatal care, could accelerate progress toward the global target of a 30% reduction in the number of LBW infants born in 2025 compared to 2006-10.

Safety and Protective Effects of Influenza Vaccination in Pregnant Women on Pregnancy and Birth Outcomes in Pune, India: A Cross-Sectional Study.

Maternal influenza vaccination provides effective protection against influenza infections in pregnant women and their newborns. In India, the influenza vaccine has not yet been offered through immunization programs, owing to the lack of sufficient safety data for pregnant Indian women. This cross-sectional observational study enrolled 558 women admitted to the obstetrics ward of a civic hospital in Pune. Study-related information was obtained from the participants through hospital records and interviews using structured questionnaires. Univariate and multivariable analysis was used, and the chi-square test with adjusted odds ratio was estimated to account for vaccine exposure and the temporal nature of each outcome, respectively. Women not vaccinated against influenza during pregnancy had a higher risk of delivering very LBW infants, and possible protective effects were suggested (AOR 2.29, 95% CI 1.03 to 5.58, p = 0.03). No association was observed between maternal influenza vaccination for Caesarean section (LSCS) (AOR 0.97, 95% CI, 0.78, 1.85), stillbirth (AOR 1.8, 95% CI 0.18, 24.64) and NICU admission (AOR, 0.87, 0.29 to 2.85), and congenital anomaly (AOR, 0.81, 0.10 to 3.87). These results show that the influenza vaccine administered during pregnancy is safe and might lower the risk of negative birth outcomes.

EFFECT OF SUBCLINICAL HYPOTHYROIDISM ON MATERNAL AND PERINATAL OUTCOME

Background:Adverse maternal outcomes and perinatal complications are closely associated with overt maternal hypothyroidism, but whether these complications occur in women with subclinical hypothyroidism (SCH) during pregnancy remains controversial.The aim of this study was to evaluate the effects of SCH on maternal and perinatal outcomes during pregnancy. Methods:This retrospective cohort study was conducted by examining the pregnant women who applied to the Gynaecology Department of Hind Institute of Medical Sciences and Hospital at their 6th to 14th gestational weeks and had antenatal follow-ups between February 1, 2021 and December 31, 2022. Results: The TSH concentration was significantly lower in the first trimester than in the third trimester (P,0.001). The fT4 concentration was higher in the first trimester than in the second and third trimesters (P,0.001). The incidences of GH and PROM were significantly higher in women with SCH than in euthyroid women (5% vs. 1.57%, P= 0.020 10% vs. 5%, P= 0.002).IUGR was more frequent in women with SCH than in euthyroid women (7.5% vs. 1.3%, P,0.001). More LBW infants were delivered in the SCH group than in the euthyroid group (12.5% vs. 5%, P,0.001). Conclusion:The results of this study indicate that pregnant women with SCH had increased risks of GH and PROM, and their foetuses and infants had increased risks of IUGR and LBW. Thus, routine maternal thyroid function testing is necessary to improve maternal and perinatal outcomes.

Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study.

Introduction Kangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methods We conducted a before-and-after intervention hospital-based, single-centerstudy in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time periodof five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant. Results One hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day.According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22%long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles.The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. Conclusion Sets of intervention packages based on needs analysis using the PDSA cyclewere able to improve the rate and duration of KMC in the hospital and at home.

Normal range and predictors of serum erythroferrone in infants.

Erythroferrone (ERFE) has been identified as a hepcidin-regulating hormone synthetized by erythroblasts correlating to the erythropoietic activity and the needs for iron substrate in bone marrow of adults. The present study aimed to assess the ERFE serum concentrations and its predictors in infants. ERFE was explored at 4 time points during the first year of life in 45 healthy, breastfed, normal birth weight (NBW) infants, and 136 marginally low birth weight infants (LBW, 2000-2500 g) receiving iron (N = 58) or placebo (N = 78) between 6 weeks and 6 months of age. ERFE concentrations were low at birth, increasing gradually during the first year of life. In NBW infants, reference ranges (5th to 95th percentile) were at 6 weeks <0.005-0.99 ng/mL and at 12 months <0.005-33.7 ng/mL. ERFE was higher in LBW infants at 6 weeks but lower at 12 months compared to NBW and minimally affected by iron supplementation among LBW infants. Correlations of ERFE with erythropoietic and iron status markers were weak and inconsistent. The role of ERFE in the crosstalk of erythropoiesis and iron homeostasis remains unclear in infants and further studies on ERFE in infants and older children are warranted within the framework of the erythropoietin-ERFE-hepcidin axis. Normal range of erythroferrone in healthy infants is described for the first time. Erythroferrone in infants lacks correlation to iron status and markers of erythropoiesis. The findings indicate differences in infant regulation of iron homeostasis as compared to adults. The findings point to a need to study infant erythropoiesis separately from its adult counterpart. The findings may have clinical impact on management strategies of iron-loading anemia in infancy.