Neonatal Length Research Articles

Impact of Technology on Neonatal Intensive Care Unit Admissions and Length of Stay: A Retrospective Study.

Background Neonatal intensive care units (NICU) provide essential medical care to neonates; however, they are associated with hospital-acquired infections, less maternal-newborn bonding, and high costs.Implementing strategies to lower NICU admission rates and shorten NICU length of stay (LOS) is essential.This study uses causal-inference methods to evaluate the impact of care managers using new technology to identify and risk stratify pregnancies on NICU admissions and NICU LOS. The NICU LOS willdecreaseas a result of the use of new technology by care managers. Study design This retrospective study utilized delivery claims data of pregnant women from the CareFirst BlueCross BlueShield Community Health Plan District of Columbia from 2013 to 2022, which includes the pre-intervention period before the use of new technology by care managers and the post-intervention period with the use of new technology by care managers.Our sample had 4,917 deliveries whose maternal comorbidities were matched with their neonate's outcomes. Methods To evaluate the impact of the technological intervention, both Generalized Linear Models (GLMs) and Bayesian Structural Time-Series (BSTS) models were used. Results Our findings from the GLM models suggest an overall average reduction in the odds of NICU admissions of 29.2% and an average decrease in NICU LOS from 7.5%-58.5%.Using BSTS models, we estimate counterfactuals for NICU admissions and NICU LOS, which suggest an average reduction in 48 NICU admissions and 528 NICU days per year. Conclusion Equipping care managers with better technological tools can lead to significant improvements in neonatal health outcomes as indicated by a reduction in NICU admissions and NICU LOS.

Low gestational weight gain (+2.0 to 4.9 kg) for singleton-term gestations associated with favorable perinatal outcomes for all prepregnancy obesity classes

Previous studies that evaluated low gestational weight gain or weight loss among prepregnancy obesity classes have not determined the amount of gestational weight gain associated with the lowest risk of adverse perinatal outcomes and neonatal morbidity among singleton term births. This study aimed to evaluate the relationship of specific gestational weight gain categories of weight loss, stable weight, and low gain considered below the 2009 Institute of Medicine guidelines to perinatal outcomes and neonatal morbidity for singleton, term live births among prepregnancy obesity classes. This was a retrospective cohort study of 18,476 women among 3 classes of prepregnancy obesity, based on measured prepregnancy weight, and delivering a live singleton pregnancy at ≥37 weeks of gestation at a Kaiser Permanente Northern California hospital (2009-2012). Variables from electronic medical records included perinatal outcomes, sociodemographics, and measured prepregnancy and delivery weights to calculate total gestational weight gain, used to define 5 gestational weight gain categories: weight loss (<-2.0 kg), stable weight (-2.0 to +1.9 kg), low gain (+2.0 to 4.9 kg), gain within guidelines (+5.0 to 9.1 kg; referent), and gain above guidelines (>9.1 kg). Logistic regression models estimated adjusted odds ratios and 95% confidence intervals of maternal and newborn perinatal outcomes (hypertensive disorders, cesarean delivery, size for gestational age, length of stay, neonatal intensive care unit admission) associated with gestational weight gain categories stratified by prepregnancy obesity classes 1, 2, and 3. Low gain occurred in 8%, 12%, and 13% of women in obesity class 1 (body mass index, 30.0-34.9), class 2 (body mass index, 35.0-39.9), and class 3 (body mass index, ≥40), respectively. Compared with gestational weight gain within Institute of Medicine guidelines, low gain was associated with similar or improved maternal and newborn perinatal outcomes for all obesity classes without increased odds of neonatal intensive care unit admission, neonatal length of stay ≥3 days, or small for gestational age. The percentages of small for gestational age for the low gain category were 4.4%, 3.0%, and 4.3% among prepregnancy obesity classes 1, 2, and 3, respectively, and comparable with the gestational weight gain within the guideline category (P>.05). The adjusted odds ratios of small-for-gestational age were not statistically significant for all obesity classes; class 1 (1.16; 95% confidence interval, 0.79-1.71) , class 2 (1.05; 95% confidence interval 0.58-1.93), and class 3 (2.03; 95% confidence interval 0.97-4.27). Lower gestational weight gain of +2.0 to 4.9 kg showed the most favorable perinatal outcomes, without higher small for gestational age or neonatal morbidity for all obesity classes.

1193-P: GDM Treatment, Diagnosis Timing, and Glycemic Control—Associations with Newborn Outcomes in the SWIFT Study

Suboptimal glycemic control in GDM increases risk of adverse perinatal outcomes. We evaluated GDM treatment type (glyburide vs diet), timing of diagnosis (&amp;lt;20w gestation: early (E) vs. &amp;gt;20w: standard (S), glycemic control (optimal vs suboptimal), and perinatal outcomes. In a diverse cohort of 902 GDM mother-infant dyads (77% Hispanic, Asian, or Black; 23% White), prenatal glycemic control was measured by self-home glucose monitoring and categorized as optimal (≥80% of tests met target, fasting glucose ≤95 mg/dL and 1h post-prandial ≤140 or 2h ≤120) or suboptimal (&amp;lt;80% of tests met target). Compared to the S diagnosis and diet treatment group, the E diagnosis and glyburide treatment group was older, more likely to have prior GDM, and higher prepregnancy BMI and glucose levels on the 3h 100 g prenatal OGTT. Glyburide treatment was associated with suboptimal control (P&amp;lt;0.001). Multivariable logistic regression estimated odds ratios (OR, 95%CI) of perinatal outcomes associated with GDM treatment type, timing of diagnosis, and glycemic control vs. the referent group with S diagnosis and optimal control on diet treatment alone, adjusted for pre-pregnancy BMI, infant sex and gestational age. Among E and S diagnosis groups with suboptimal control both before and after glyburide treatment, ORs, 95%CI were higher for neonatal length of stay ≥3 days: (E 3.6, 1.6-8.1; S 2.0, 1.1-3.6), neonatal hypoglycemia (E 2.4, 1.0-5.9; S 1.9, 1.0-3.6) and large-for-gestational age (LGA) birthweight (E 4.1, 1.8-9.1; S 2.8, 1.6-4.9). For E diagnosis with suboptimal control before, and optimal control after glyburide, the odds of LGA were elevated (2.8, 1.2-6.6) similar to the S diagnosis with suboptimal control after glyburide. Associations did not affect Cesarean delivery or NICU admission. These findings show that even with post-glyburide optimal glycemic control, odds of LGA development associated with exposure to GDM from early gestation may be only partially ameliorated by glyburide treatment. Disclosure J.L.Josefson: None. B.Sun: None. A.Xiang: None. M.Greenberg: None. L.Greenspan: None. J.C.Lo: None. J.N.Davis: None. E.P.Gunderson: None. Funding National Institutes of Health (R01DK122700)

Regional references vs. international standards for assessing weight and length by gestational age in Lithuanian neonates.

There is no global consensus as to which standards are the most appropriate for the assessment of birth weight and length. The study aimed to compare the applicability of regional and global standards to the Lithuanian newborn population by sex and gestational age, based on the prevalence of small or large for gestational age (SGA/LGA). Analysis was performed on neonatal length and weight data obtained from the Lithuanian Medical Birth Register from 1995 to 2015 (618,235 newborns of 24-42 gestational weeks). Their distributions by gestation and sex were estimated using generalized additive models for location, scale, and shape (GAMLSS), and the results were compared with the INTERGROWTH-21st (IG-21) standard to evaluate the prevalence of SGA/LGA (10th/90th centile) at different gestational ages. The difference in median length at term between the local reference and IG-21 was 3 cm-4 cm, while median weight at term differed by 200 g. The Lithuanian median weight at term was higher than in IG-21 by a full centile channel width, while the median length at term was higher by two channel widths. Based on the regional reference, the prevalence rates of SGA/LGA were 9.7%/10.1% for boys and 10.1%/9.9% for girls, close to the nominal 10%. Conversely, based on IG-21, the prevalence of SGA in boys/girls was less than half (4.1%/4.4%), while the prevalence of LGA was double (20.7%/19.1%). Regional population-based neonatal references represent Lithuanian neonatal weight and length much more accurately than the global standard IG-21 which provides the prevalence rates for SGA/LGA that differ from the true values by a factor of two.

MT47 Does the Use of New Technology By Care Managers Have an Impact on Neonatal Intensive Care Unit (NICU) Admissions and Length of Stay?

Neonatal intensive care units (NICU) provide essential medical care to neonates; however, they are associated with hospital-acquired infections, less maternal-newborn bonding, and high costs. Implementing strategies to lower NICU admission rates and shorten NICU length of stay (LOS) is essential. This study uses causal-inference methods to evaluate the impact of care managers using new technology to identify and risk stratify pregnancies on NICU admissions and NICU LOS.

Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes

ObjectiveTo evaluate the choice of antibiotic used for intrapartum Group B Streptococcus (GBS) prophylaxis in pregnant individuals with reported penicillin allergies compared to those without reported penicillin allergies and investigate whether there are associated differences in neonatal outcomes.Study DesignThis retrospective cohort study included mother-infant dyads of GBS positive pregnant individuals who labored and delivered newborns ≥ 35 weeks of gestation at a high-volume urban hospital (2005–2018). The type of antibiotic administered to the mothers for GBS prophylaxis (beta-lactam prophylaxis defined as penicillin-class drug or cefazolin; alternative prophylaxis defined as vancomycin or clindamycin) was compared between those with a penicillin allergy documented in their medical record versus those who did not. Neonatal outcomes included number of postnatal blood draws, antibiotic administration, neonatal intensive care unit (NICU) admission, bacteremia, and hospital length of stay and were compared between groups. Bivariable and multivariable analyses were performed.ResultsOf 11,334 mother-infant pairs, 1170 (10.3%) mothers had a penicillin allergy documented in their medical record. Of them, 49 (4.2%) received a penicillin, 259 (22.1%) received cefazolin, 449 (38.4%) received clindamycin, and 413 (35.3%) received vancomycin. Patients with a reported penicillin allergy were significantly more likely to receive alternative GBS prophylaxis compared to those without penicillin allergy (73.7% vs. 0.2%, p < 0.01). Neonates of patients who received alternative GBS prophylaxis were significantly more likely to undergo a postnatal lab draw compared to neonates of patients who received beta-lactam antibiotics (20.8% vs. 17.3%, OR 1.25 (95% CI 1.08–1.46)). This significant association persisted after adjusting for potential confounders (aOR 1.23, 95% CI 1.06–1.43). There were no other significant differences seen in other newborn outcomes.ConclusionPregnant individuals who report a penicillin allergy were more likely to receive alternative antibiotics for GBS prophylaxis compared to those without a penicillin allergy. This was associated with an increased frequency of postnatal blood draws among neonates of mothers with a reported penicillin allergy.Brief summaryAdministration of alternative intrapartum antibiotic prophylaxis with vancomycin or clindamycin is common in individuals with self-reported penicillin allergy, and maternal alternative antibiotic administration may impact neonatal care, particularly via increased lab draws.

Combined Toxicity of Glyphosate (Faena®) and Copper to the American Cladoceran Daphnia exilis—A Two-Generation Analysis

Glyphosate and copper are common pollutants in water and soil. Glyphosate is the most used herbicide worldwide; despite being claimed to be a low-toxicity pesticide and easily degraded, several studies have demonstrated glyphosate’s occurrence and toxicity in freshwater ecosystems. Copper is an essential micronutrient; however, at high concentrations, it becomes toxic, and it is a persistent contaminant discharged from agricultural and industrial activities. Both glyphosate and Cu are agrochemicals that can occur in aquatic environments and produce stress in aquatic biota. Cladocerans are important zooplankters, and their sensitivity to chemical stressors has been widely documented. In this study, the North American cladoceran Daphnia exilis was exposed to glyphosate (Faena®) and Cu mixtures. The effects were assessed in two generations to determine toxicity impairment in the parental (P1) and filial (F1) generations. The 48 h median lethal concentration (LC50) of both chemicals was determined. After this, the generations P1 and F1 were exposed for 21 days to three concentrations of glyphosate and Cu mixtures (1.04 mg L−1 + 2.45 μg L−1, 1.24 mg L−1 + 3.09 μg L−1, and 1.57 mg L−1 + 4.31 μg L−1), starting from neonates. Survival and reproduction were recorded, and macromolecule content and the size of neonates were measured in the progeny. The LC50 was 4.22 mg L−1 for Faena® and 13.45 μg L−1 for copper. Exposure to glyphosate and copper reduced fecundity and the number of clutches per female, delayed age at first reproduction, and increased the number of aborted eggs; these effects were more evident in the F1 than in the P1. In both generations, the concentration of carbohydrates and lipids was significantly reduced. The treatment and the brood number influenced the total length of neonates, but the total length did not differ significantly, whereas body length and body width decreased in F1. Glyphosate and copper mixtures significantly increased toxicity in D. exilis in the F1 generation, probably because the parents produced impaired progenies. Results warn about transgenerational effects in planktonic species chronically exposed to pollutants.

Characteristics of infants requiring mechanical reventilation in those previously ventilated during the neonatal period

Background. Factors predisposing ventilated neonates to the risk for reventilation during infancy are largely unknown.Objective. To identify factors that predispose previously mechanically ventilated neonates to reventilation.Methods. Mechanically ventilated infants at the Inkosi Albert Luthuli Central Hospital paedicatric intensive care unit (PICU), SouthAfrica, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls whowere not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation andoutcomes of the ICU admission were collected and analysed using descriptive and comparative statistics.Results. Thirty-one reventilated index cases were identified at the PICU over a 15-month period and were matched with 31non-reventilated controls. Ex-preterm babies (n=26; 84%), males (n=19; 61.3%), chronic lung disease (CLD) of infancy (n=5; 16.7%)and prolonged neonatal length of stay (LOS) were common neonatal factors in reventilated neonates. Pneumonia (n=22; 71%), sepsis(n=11; 35.5%) and upper airway obstruction (UAO) (n=8; 25.8%) were common reasons for reventilation in neonates. There were noHIV-positive cases. Of the 31 reventilated cases, 5 (16.1%) demised and 15 (57.6%) survivors had morbidities, commonly seizures (n=8;30.8%) and short bowel syndrome (n=3; 11.5%).Conclusion. Pre-term birth, male, CLD of infancy and prolonged LOS were associated with an increased risk for mechanical reventilationin infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.

Investigating the Relationship Between Body Shape and Life History Traits in Toothed Whales: Can Body Shape Predict Fast-Slow Life Histories?

A widespread pattern in vertebrate life-history evolution is for species to evolve towards either fast or slow life histories; however, the underlying causes of this pattern remain unclear. Toothed whales (Odontoceti) are a diverse group with a range of body sizes and life histories, making them an ideal model to investigate potential drivers of this dichotomy. Using ancestral reconstruction, we identified that certain groups of odontocetes evolved more-streamlined, presumably faster, body shapes around the same time that killer whales (Orcinus orca) evolved into whale predators approximately 1 Mya during the Pleistocene. This suggests that the evolution of a streamlined body shape may have been an adaptation to escape killer whale predation, leading to longer life-history events. To test this hypothesis, we performed a cluster analysis of odontocete whales and confirmed the dual pattern of life-history traits, with one group referred to as ‘reproducers’ characterized by early age of maturity, short gestation, short interbirth interval, and short lifespan, and the other group referred to as ‘bet-hedgers’ exhibiting the opposite pattern. However, we found that life history grouping was relatively unrelated to whale shape (i.e., more streamlined or less streamlined). Therefore, we incorporated principal component results into mixed effects models, and the model results indicated that body shape was positively related to neonate length (a measure of investment in progeny), but not significantly related to the temporal life-history traits. Thus, whale body shape is not a sufficient explanation for the evolution of fast-slow life histories in odontocete whales.

Modified NEOMOD score as a neonatal mortality prediction tool in a medium-income country: A validation diagnostic test study.

Multiple organ dysfunction (MOD) is a potentially reversible physiological disorder that involves two or more systems. Modified NEOMOD (Neonatal Multiple Organ Dysfunction score) scale could be a useful instrument to measure MOD and predict mortality. Our aim was to validate modified NEOMOD in patients from a neonatal intensive care unit (NICU) of a middle-income country. Diagnostic test study. Preterm newborns admitted NICU were included. Daily values were collected from birthday to Day 14. MOD was defined as at least one point in two or more systems. The lowest score is 0 and the maximum is 16. The outcome variable was mortality. Secondary outcomes were bronchopulmonary dysplasia, retinopathy of prematurity (ROP), late-onset neonatal sepsis (LONS), intraventricular hemorrhage (IVH) and length of hospital stay. Area under the curve (AUC) and Hosmer-Lemeshow test were calculated to evaluate scale discrimination and calibration. Logistic regression was used to estimate the association between daily modified NEOMOD score and death. We included 273 patients who met the inclusion criteria. MOD incidence was 74.4%. The median gestational age in patients with MOD was 30 (interquartile range[IQR]: 27-33) and in patients without MOD it was 32 (IQR: 31-33) (p < 0.001). There were 40 deaths (14.6%), 38 (18.7%) from the MOD group and 2 (2.9%) from non-MOD group. On accumulated Day 7, AUC was 0.89 (95%confidence interval[CI]: 0.83-0.95). Modified NEOMOD had good calibration (X 2 = 2.94, p = 0.982). DBP (12.8% vs. 2.9%,p = 0.001),ROP (3.9% vs. 0%,p = 0.090),IVH (33% vs. 12.9%,p < 0.001), and LONS (36.5% vs. 8.6%, p < 0.001) frequency was higher in the MOD group than non-MOD group. Length of hospital stay also was higher in MOD group (median 21 days [IQR 7-44] vs. median 5 days [IQR 4-9], p = 0.004). Modified NEOMOD scale presents good discrimination and calibration for death in preterm children. This scale could help in clinical decision-making in real-time.

Toxicity of fipronil and 2,4-D pesticides in Daphnia similis: a multiple endpoint approach

In Brazil, among the pesticides widely applied simultaneously in sugarcane monocultures are the Regent® 800 WG insecticide (active ingredient (a.i.) fipronil) and the DMA® 806 BR herbicide (a.i. 2,4-D). Thus, this study aimed to investigate, through different endpoints, the effects of the fipronil and 2,4-D pesticides, isolated and as mixtures, on the cladoceran Daphnia similis. To do this, acute toxicity tests were carried out with the compounds acting in isolation and in mixture, where the survival of the organisms was evaluated, and chronic toxicity tests with the isolated compounds, where reproduction and maternal and neonatal body length were evaluated. In this study, the physiological endpoints of D. similis were also analyzed, through the analysis of feeding rates (filtration and ingestion) in exposure and post-exposure scenarios, in order to verify the cladoceran food recovery capacity. In addition, D. similis data were compared with other species when exposed to the studied pesticides, using species sensitivity distribution curves. Acute toxicity tests of the fipronil and 2,4-D showed an average EC50-48h of 66.68μg a.i./L and 327.07mg a.i./L, respectively. In both cases, D. similis showed lower sensitivity compared to other species. For the mixture test, the evaluation by the IA model (independent action) and deviation DR (dose ratio dependent) indicated the occurrence of mostly antagonistic effects. The chronic test with fipronil showed a decrease in the fecundity of the organism at a concentration of 16μg a.i./L, a concentration already found in aquatic environments. For 2,4-D, no significant differences were observed for reproduction at the concentrations tested. Regarding the maternal body length, there were no significant changes when D. similis were exposed to both fipronil and 2,4-D, but these differences were observed in the body length of the neonates only for 2,4-D. There were no significant changes in the feeding rates of the organisms when exposed to both pesticides.

The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study.

To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05-0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44-4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

Birth growth curves of neonates in high-altitude areas: A cross-sectional study.

Since the current commonly used birth growth curves are unsuitable for neonates in high-altitude areas; this study aimed to establish birth growth curves for full-term neonates residing at 2,000-3,000 m. This cross-sectional study retrospectively analyzed the physical measurement data of 1,546 full-term neonates delivered at the Red Cross Hospital of Qinghai province, China, from July 2021 to April 2022. The percentile curves of birth weight, length, and head circumference of neonates of different gestational ages and genders were developed using curve fitting. The newly developed birth-weight percentile reference was compared with the INTERGROWTH-21st Neonatal Growth Curve (International Standard) and the Chinese Neonate Growth Curve (Chinese Standard). The median birth weight, length, and head circumference of the study population were 3,200 g, 52.0 cm, and 32.8 cm, respectively, except for the group with a gestational age of 37 weeks. The growth indicators of male infants in all groups were higher than those of the female infants (P < 0.05). We found differences between the newly developed birth-weight percentile curves in the high-altitude areas and the International and Chinese Standards. Establishing birth growth curves corresponding to altitude may be more suitable than the existing standards for local medical staff to conduct health assessments of neonates.

The Association of Maternal Sleep Quality with Newborn Health

Sleep disturbances in pregnancy according to the literature, they can affect newborn outcomes also can impact the growth and development of the baby.This study evaluated the effect of maternal sleep quality with newborn health. The research design was a cross-sectional study.The sample of this study were mothers who gave birth by cesarean delivery method with gestational age ≥ 37 weeks without complications, totally 78 pregnant women. The maternal sleep quality were assessed by PSQI questionnaire. Newborn Health (neonatal birth weight, body length and APGAR SCORE) were assessed by neonatal medical record. BDNF levels checked using the ELISA. Data were analyzed by Independent T-test and Mann-Whitney Test. There was no significant association between Maternal Sleep Quality with neonatal birth weight (p= 0,177).There were significant association between Maternal sleep quality with body length and APGAR SCORE of neonates with p value &lt;0.05 (p = 0.025)(p=0,002). There was also a significant relationship between maternal sleep quality and neonatal cord blood BDNF levels (p=0.00). Sleep disturbances can impact obstetric conditions and newborn health. In this study there was no significant relationship between maternal sleep quality with neonatal birth weight.

Maternal and neonatal safety of COVID-19 vaccination during the peri-pregnancy period: A prospective study.

To investigate the safety of inactivated COVID-19 vaccine in Chinese pregnant women and their fetuses when inoculated during the peri-pregnancy period. Eligible pregnant women were prospectively collected and divided into a vaccine group (n = 93) and control group (n = 160) according to whether they had been vaccinated against COVID-19 within 3 months before their last menstruation period (LMP) and after pregnancy. Demographic data of couples, complications during pregnancy and delivery of pregnant women, and data of newborns at birth were collected. Sixty-six women were vaccinated with a median time of 35.5 (range = 0-91) days before LMP, and 27 women were vaccinated with a median time of 17 (range = 1-72) days after LMP. The incidence of premature rupture of membrane (PROM) in the vaccine group was significantly higher than that in the control group (16.13% vs. 6.88%, p = 0.019). Multivariate logistic regression analysis revealed that maternal peri-pregnancy COVID-19 vaccination was not an independent risk factor for PROM (odds ratio: 2.407, 95% confidence interval: 0.932-6.216, p = 0.069). There was no difference in the incidence of other complications during pregnancy and delivery between the two groups. A total of 253 neonates were delivered, including two cases with congenital abnormalities in each group. The incidence of congenital abnormalities between the two groups was similar (2.15% vs. 1.25%, p = 0.626). There was no difference in neonatal length, weight, head circumference, and Apgar score between the two groups (p > 0.05), but the incidence of neonatal jaundice in the vaccine group was significantly higher than that in the control group (20.43% vs. 7.5%, p = 0.002). Multivariate logistic regression analysis revealed that maternal peri-pregnancy vaccination, postpartum blood loss, cesarean section, 1-min Apgar score, and paternal smoking were independent risk factors for neonatal jaundice. It is safe for pregnant women and their fetuses to be inoculated the inactivated COVID-19 vaccine during the peri-pregnancy period, but attention should be paid to neonatal jaundice.

Clinical and economic evaluation of a proteomic biomarker preterm birth risk predictor: cost-effectiveness modeling of prenatal interventions applied to predicted higher-risk pregnancies within a large and diverse cohort

Objectives Preterm birth occurs in more than 10% of U.S. births and is the leading cause of U.S. neonatal deaths, with estimated annual costs exceeding $25 billion USD. Using real-world data, we modeled the potential clinical and economic utility of a prematurity-reduction program comprising screening in a racially and ethnically diverse population with a validated proteomic biomarker risk predictor, followed by case management with or without pharmacological treatment. Methods The ACCORDANT microsimulation model used individual patient data from a prespecified, randomly selected sub-cohort (N = 847) of a multicenter, observational study of U.S. subjects receiving standard obstetric care with masked risk predictor assessment (TREETOP; NCT02787213). All subjects were included in three arms across 500 simulated trials: standard of care (SoC, control); risk predictor/case management comprising increased outreach, education and specialist care (RP-CM, active); and multimodal management (risk predictor/case management with pharmacological treatment) (RP-MM, active). In the active arms, only subjects stratified as higher risk by the predictor were modeled as receiving the intervention, whereas lower-risk subjects received standard care. Higher-risk subjects’ gestational ages at birth were shifted based on published efficacies, and dependent outcomes, calibrated using national datasets, were changed accordingly. Subjects otherwise retained their original TREETOP outcomes. Arms were compared using survival analysis for neonatal and maternal hospital length of stay, bootstrap intervals for neonatal cost, and Fisher’s exact test for neonatal morbidity/mortality (significance, p < .05). Results The model predicted improvements for all outcomes. RP-CM decreased neonatal and maternal hospital stay by 19% (p = .029) and 8.5% (p = .001), respectively; neonatal costs’ point estimate by 16% (p = .098); and moderate-to-severe neonatal morbidity/mortality by 29% (p = .025). RP-MM strengthened observed reductions and significance. Point estimates of benefit did not differ by race/ethnicity. Conclusions Modeled evaluation of a biomarker-based test-and-treat strategy in a diverse population predicts clinically and economically meaningful improvements in neonatal and maternal outcomes.

Evaluation of the impact of kangaroo mother care on neonatal mortality and hospitalization: A meta-analysis.

The kangaroo mother care (KMC) technique for preterm and low-birthweight (LBW) neonates, which consists of skin-to-skin contact, is thought to have a beneficial impact on clinical outcomes. Hence, the current meta-analysis aims to evaluate the influence of KMC on neonatal mortality and length of hospitalization compared with conventional care. A systematic literature search of studies published between 1988 and 2021 found 24 trials involving 19,980 participants, of which 10,354 received KMC and 9626 were controls under conventional care. To measure the impact of applying KMC in preterm LBW neonates on mortality and the length of hospital stay, statistical analysis using dichotomous and continuous analysis methods was performed employing fixed and random models to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). Compared to the control group, the application of KMC in preterm LBW neonates resulted in significantly lower mortality (OR: 0.65, 95% CI: 0.44-0.97, p = 0.03) in a short term (within 2 months, I2 = 71%) and long term (3-12 months) (OR: 0.72, 95% CI: 0.59-0.87, p = 0.0007, I2 = 0%), and had no significant impact on the length of hospital stay (OR: -1.43, 95% CI: -2.88-0.02, p = 0.05, I2 = 86%). In comparison with the control group, the implementation of KMC in preterm LBW neonates resulted in significantly lower mortality but had no significant impact on the length of hospitalization. More studies are needed to confirm the current findings.

Association of Traffic-Related Air Pollution with Newborn’s Anthropometric Indexes at Birth

BACKGROUND AND AIM: The evidence suggested many adverse health effects due to exposure to traffic-related air pollution (TRAP). However, the evidence on neonatal anthropometric measurements (NAPM) in low and middle-income countries is very scarce yet. Therefore, we investigate the association of prenatal exposure to indicators of traffic and ambient particulate matter (PM) with NAPM. METHODS: This cross-sectional study was based on hospital medical records of 4053 mother-neonate pairs (2016-2018). PMs were estimated at residential addresses based on validated spatiotemporal models. Moreover, total street length in 100, 300 and 500m buffers around the home, residential distance to the ring road, major roads, heavy-traffic lights, gas station, motorway junction, bank, square, bus terminal, public parking and industrial land-use were calculated as indicators of traffic. The head circumference (HC), birth weight (BW) and birth length (BL) of neonates were collected as NAPM. Multivariate regression models were applied to evaluate the relationship between PMs and indicators of traffic with NAPM, controlled for relevant covariates. RESULTS: The adjusted models revealed that higher exposure to PM2.5 and PM10 was significantly related with lower BW and BL. Similarity results were observed for total street length in a 100 m buffer around maternal home with BW and BL. Moreover, higher distance to heavy traffic lights was significantly associated with higher BW and BL. An IQR increase in PM10 was significantly related to lower HC (95% CI: -0.11, -0.01, P-value = 0.03). An increase in distance from residential address to heavy traffic lights, ring roads, bus terminal, and transportation land-use was associated with higher HC. CONCLUSIONS: This is the first study on the association of prenatal exposure to ambient PMs and different indicators of traffic with NAPM. Overall, our findings suggested that higher prenatal exposure to TRAP was related with lower BW, BL and HC. Keywords: Infant, Maternal, Neonates

Maternal and Neonatal Vitamin D Binding Protein Polymorphisms and 25-Hydroxyvitamin D Cutoffs as Determinants of Neonatal Birth Anthropometry.

Background: Vitamin D-binding protein (VDBP) is a vital regulator of optimal vitamin D homeostasis and bioavailability. Apart from its well-documented role as a key component in vitamin D dynamic transfer and circulation, it has a myriad of immunoregulatory functions related to innate immunity, which becomes particularly critical in states of increased immunological tolerance including pregnancy. In this regard, VDBP dyshomeostasis is considered to contribute to the development of several fetal, maternal, and neonatal adverse outcomes. However, precise physiological pathways, including the contribution of specific VDBP polymorphisms behind such phenomena, are yet to be fully deciphered. Our aim was to assess the combined effect of maternal and neonatal VDBP polymorphism heterogeneity in conjunction with different maternal and neonatal 25(OH)D cutoffs on the neonatal anthropometric profile at birth. Methods: The study included data and samples from a cohort of 66 mother–child pairs at birth. The inclusion criterion was full-term pregnancy (gestational weeks 37–42). Neonatal and maternal 25(OH)D cutoffs were included according to vitamin D status at birth and delivery. Concentrations of 25(OH)D2 and 25(OH)D3 were measured using liquid chromatography–tandem mass spectrometry. Results: The upper arm length of neonates with 25(OH)D ≤ 25 nmol/L was higher in neonate CC carriers for rs2298850. The upper thigh neonatal circumference was also higher in the ones with either 25(OH)D ≤ 50 or ≤75 nmol/L in rs2298850 CG + GG or rs4588 GT + TT carriers. We did not observe any significant effect for maternal VDBP polymorphisms nor for birth maternal 25(OH)D concentrations, on birth neonatal anthropometry. Conclusions: Our findings emphasize a potential role for neonatal VDBP genotypes rs2298850 and rs4588, in conjunction with specific neonatal 25(OH)D cutoffs, in the range of sufficiency on neonatal growth and development.

Neonatal and Maternal Risk Factors for Indirect Hyperbilirubinemia: A Cross-Sectional Study from Bahrain.

Results Out of 555 records, 404 neonates were included. Among those, 209 (51%) were males and 275 (68.1%) were Bahraini. The median indirect bilirubin level at presentation was 218 (interquartile range, 174-270) μmol/L. ABO incompatibility was the commonest risk factor for neonatal indirect hyperbilirubinemia (n = 152, 37.6%) followed by glucose-6-phosphate dehydrogenase (G6PD) deficiency (n = 130/400, 32.5%). Age (>25 years) was the commonest maternal risk factor (n = 331, 81.9%) followed by cesarean delivery (n = 137, 33.9%). Neonates with ABO incompatibility had a significantly higher mean indirect bilirubin level compared to those with other risk factors (234.9 ± 68.5 versus 225 ± 82.2 mmol/L, respectively) (P = 0.04). Phototherapy use significantly increased along with the rise of bilirubin level (P < 0.0001). Intravenous immunoglobulins (IVIG) and exchange transfusion were used in 44 (10.9%) and 14 (3.5%) patients, respectively. Neonates who received IVIG had significantly higher bilirubin levels than those who did not (P = 0.005). Male newborns (P = 0.008), Bahrainis (P = 0.001), those with reticulocytosis (P = 0.001), and those who received IVIG (P = 0.001) were more prone to have associated risk factors. Conclusion ABO incompatibility, G6PD deficiency, and older maternal age were the commonest neonatal and maternal risk factors for developing neonatal indirect hyperbilirubinemia. Bahraini, male newborns, reticulocytosis, and IVIG use were associated with these factors. Early detection of such factors through screening can aid in immediate management to prevent serious complications of this common condition.