Low Birth Weight Research Articles

Effects of Early Enteral to Parenteral Protein Ratios on Brain Volume and Somatic Growth in Very Low Birth Weight Infants

To evaluate whether a higher proportion of enteral vs. parenteral protein (E:P ratio) in the first 28 days after birth is associated with increased brain volume and somatic growth in very low birth weight (VLBW; birth weight <1500g) infants. This was a retrospective analysis of a sub-cohort of VLBW infants (N=256, gestational age mean 28.07 [SD 2.17] weeks, birth weight 1038.80 [SD 262.95] grams) from the Cincinnati Infant Neurodevelopment Early Prediction Study (CINEPS), a regional prospective study of infants born at ≤32 weeks' gestation. Brain MRI was obtained at term-equivalent age. Macronutrient intake and growth metrics for the first 28 days were collected retrospectively. The primary outcome was total brain tissue volume. The relationships between E:P ratio, total and regional brain tissue volumes, and somatic growth were analyzed by multivariable linear regression models; composite variables were used to adjust for potential confounders including pregnancy risk factors and initial severity of illness. Higher E:P ratio was associated with increased total brain tissue volume but was not associated with change in head circumference z-score. In secondary analyses, higher E:P ratio was associated with increased weight velocity. There were no significant associations between E:P ratio and change in weight or length z-scores or regional brain volumes. Higher E:P ratio in the first 28 days was positively associated with total brain volume and weight gain. Promoting the provision of enteral over parenteral protein may improve brain and somatic growth in VLBW infants.

The effectiveness of low-dose aspirin for the prevention of hypertensive disorders of pregnancy in a sub-Saharan Africa Country: A randomized clinical trial

ObjectiveTo evaluate whether a daily dose of low-dose aspirin (LDA) can prevent hypertensive disorders of pregnancy (HDP), including preeclampsia, among pregnant women in a South African cohort, and to assess its impact on related maternal and fetal outcomes, such as preterm birth and neonatal complications. Study designThis single-center, open-label, parallel-group randomized controlled trial (RCT) was conducted at a regional hospital in Durban, KwaZulu-Natal, South Africa, from May 2021 to March 2024. A total of 423 pregnant women, aged 18 years or older with singleton pregnancies between 12 and 20 weeks of gestation, were randomized to receive either 162 mg of LDA daily or standard care. The primary outcome was the incidence of HDP, while secondary outcomes included early-onset preeclampsia (EOPE), preterm birth, low birth weight (LBW), and neonatal death. Data analysis used relative risk (RR) and 95 % confidence intervals (CIs). ResultsOf the 423 women, 209 were in the LDA group and 214 in the control group. The incidence of HDP was significantly lower in the LDA group (6.2 % vs. 25.2 %; RR = 0.25, 95 % CI [0.14–0.44], p < 0.001), corresponding to a 75 % reduction in HDP risk, with an absolute risk reduction (ARR) of 19 % and a number needed to treat (NNT) of 5.3. EOPE was reduced (2.4 % vs. 14.0 %; RR = 0.17, 95 % CI [0.07–0.41], p < 0.001), as was preterm birth (6.7 % vs. 26.2 %; RR = 0.26, 95 % CI [0.15–0.45], p < 0.001). There were no significant differences for LBW or neonatal death. Sensitivity analysis confirmed the importance of initiating LDA before 16 weeks, showing continued reductions in HDP incidence with early initiation. ConclusionLDA significantly reduces the risk of HDP, EOPE, and preterm birth, particularly when initiated before 16 weeks of gestation. These findings support the use of LDA for preventing hypertensive disorders of pregnancy in low-resource settings and underscore the value of early intervention for improved maternal and fetal outcomes.

Pregnancy outcomes by hyperemesis gravidarum severity and time of diagnosis: A retrospective cohort study.

With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity. A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes. The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18-1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16-1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09-1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69-0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31-0.93, among mild cases only). A dose-response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11-1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31-3.19, for severe cases). Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose-response manner and when diagnosed during the second trimester.

Necrotizing Enterocolitis among Very Low Birthweight Neonates: A Systematic Review and Meta-Analysis.

Necrotizing Enterocolitis among Very Low Birthweight Neonates: A Systematic Review and Meta-Analysis.

Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study

ABSTRACTObjectiveTo quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).DesignProspective cohort study.SettingThe Japan Environment and Children's Study.PopulationA total of 79 703 pregnant Japanese women without chronic disease.MethodsMaternal lifestyle before pregnancy was assessed using a self‐administered questionnaire. A healthy lifestyle score (HLS, 0–5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high‐quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log‐binomial regression model.Main Outcome MeasuresComposite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small‐for‐gestational‐age, transcribed from medical records.ResultsA total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose–response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61–0.74) lower risk of APOs than those with the lowest HLS (0–1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1‐point increase of HLS could have reduced APO cases by 6.6%.ConclusionsA higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.

A multilevel analysis of factors associated with wasting in children one to two years old in Hamadan city

AbstractThe study aimed to identify risk factors for childhood wasting in 1–2 year-olds in Hamadan city, focusing on this age group due to infection and malnutrition risks. Unlike previous cross-sectional studies on children under 5 years old, this longitudinal study tracked weight-to-height changes over time. Data were analyzed from 455 mother-child pairs, aged 1–2 years, collected from health centers and recorded in the Integrated Electronic Health System (SIB). The weight-for-height index, an ordinal response with three categories (wasting, normal, and overweight), was measured several times. A two-level longitudinal ordinal model was used to identify factors associated with wasting. The analysis of data from 230 girls and 225 boys identified several factors associated with wasting: lower birth weight (Adjusted Odds Ratio (AOR) = 0.77), age 12–15 months (AOR = 1.15), lack of health insurance (AOR = 3.09), mother-child residence (AOR = 3.80), maternal height (AOR = 0.92), and age at pregnancy &lt; 24 years (AOR = 4.71). The results of this study showed that most of the factors contributing to childhood wasting can be controlled and prevented. Therefore, implementation of targeted policies and appropriate interventions for mothers before, during, and after pregnancy could reduce the burden of childhood wasting.

Gambaran Faktor Risiko Kejadian Stunting pada Ibu dengan Anak Balita Stunting di Wilayah Kerja Puskesmas Baregbeg

Stunting is one of the main nutritional issues that Indonesian toddlers face. The prevalence of stunting in toddlers (children under five years old) was 30.8% in 2018, according to the Basic Health Research (Riskesdas) results. This dropped to 27.67% in 2019 (Indonesian Nutrition Status Survey (SSGI), 2019), and then increased to 24.4% in 2021 (SSGI, 2021). The purpose of this study is to identify the risk factors for stunting in women in the Ciamis Regency working area of the Baregbeg Community Health Center who have stunted children under five in 2024. Descriptive research using a cross-sectional design was the methodology employed. Using a questionnaire, the study's population composed of all the mothers of 36 kids with stunting in the Baregbeg Health Center's working area. The majority of stunted toddlers had a history of exclusive breastfeeding (80.56%), middle class mothers in a middle educational level (55.56%), low parental income (86.11%), low birth weight babies (86.11%), infectious diarrheal diseases (86.11%), poor diet (77.78%), and an unvarried diet (88.88%), based to the research's results. To help to prevent potential problems with the child's growth and development, it is advised that moms of stunted children give their children greater care.

Post‐term births as a risk factor for small for gestational age births and infant mortality in Brazil, Mexico, and Palestinian refugees: An analysis of electronic birth records

AbstractBackgroundPost‐term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High‐income countries have responded to this risk by widely adopting labour induction protocols in late‐term, but many low‐ and middle‐income countries have not. However, understanding underlying mechanisms linking post‐term births to adverse newborn and infant outcomes remains limited.ObjectiveTo investigate the (a) prevalence of post‐term, (b) the risk factors associated with post‐term (c) the association between post‐term births and the risk of small‐for‐gestational‐age (SGA) neonates and of infant mortality in middle‐income settings.MethodsWe used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post‐term birth and SGA and infant mortality.ResultsWe analysed 21,335,033 live births in Brazil (2011–2018), 23,416,126 in Mexico (2008–2019), and 966,102 in Palestinian refugees (2010–2020) (N = 45,717,261). Post‐term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post‐term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post‐term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post‐term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates.ConclusionsThese findings emphasise the critical significance of implementing induction strategies to prevent post‐term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH‐21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post‐term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention.

Abnormal AFI and Its Implications on Fetomaternal Outcome

Background: The AFI is directly associated with adverse outcomes for both the mother and the foetus; oligohydramnios (AFI ≤8 cm) and polyhydramnios (AFI ≥25 cm) are considered ‘abnormal’. The aim of this study was to compare the maternal and foetal complications in full-term pregnancies with abnormal AFI, as well as to assess the effectiveness of ultrasound and Doppler in identifying possible threats that may affect delivery plans. Methods: The current observational study was conducted in a hospital context at Paropakar Maternity and Women’s Hospital located in Kathmandu, Nepal between October 2019 and February 2020. This study investigates the maternal and fetal outcomes associated with polyhydramnios and oligohydramnios in 60 cases of pregnancy. Data on maternal and foetal results, including the type of birth, problems, and neonatal APGAR ratings, were collected and evaluated. Continuous variables were described as mean ± SD, while categorical data were expressed in percentage. Results: The prevalence of polyhydramnios was 2% and oligohydramnios was 5.33%. Common maternal complications included preeclampsia, postpartum hemorrhage, and gestational hypertension, while fetal outcomes included low APGAR scores, low birth weight, and NICU admissions. Oligohydramnios was found to be predominantly associated with post-term pregnancies (36.36%) and preterm premature rupture of membranes (13.63%), which led to a higher frequency of caesarean sections (70.46%) when compared to polyhydramnios cases. Conclusion: Our findings suggest that ultrasound and Doppler assessments are crucial in identifying high-risk pregnancies and making appropriate delivery decisions to improve maternal and fetal outcomes."

Outcome of single-ventricle patients supported with extracorporeal membrane oxygenation

Background: Single ventricle heart disease can be left or right ventricle dominant congenital heart disease mostly associated with other risk factors like low birth weight, Preterm, chromosomal abnormality and all these risk factor associated with increase mortality. Methods: A retrospective chart review of paediatric patients from neonatal age to 14 years since 2012 to 2021, with supported by extracorporeal membrane oxygenation (ECMO) including both single ventricle heart physiology and biventricular heart, admitted in paediatric cardiac surgical intensive care unit in our hospital was conducted. All data were compared between single ventricle heart physiology and biventricular heart. Data was performed using commercially available software (SPSS), with statistical significance set p&lt;0.05. Results: We enrolled total 124 patients who underwent ECMO cannulation. 68 children had single ventricle, while 56 being biventricular heart. Most children acquired ECMO cannulation in CICU 63 (50.8%). Male to female ratio was 74:50. 70.2% children got the ECMO cannulation when they had already been operated for surgical repair. Conclusions: Paediatric ECMO utilization in SV is valuable and recently its utilization has been increased in it with improve survival.

Hemoglobin concentrations in early pregnancy and their associations with adverse pregnancy outcomes in Western China: a population-based study.

Despite the global standardization of hemoglobin (Hb) testing in early pregnancy, the impact of first trimester Hb concentrations on pregnancy outcomes remains inadequately understood. Also, the early pregnancy Hb concentrations have not been well documented in Western China. Therefore, this study aimed to assess the Hb concentrations during early pregnancy and their associations with adverse pregnancy outcomes in Western China. This cross-sectional study used data from the Chengdu Maternal and Child Health Information System for pregnant women who delivered between January 1, 2019, and December 31, 2023. A total of 454,815 Chinese females aged 15 to 49 years with available first trimester Hb data, including those with singleton or multiple gestations, were included in the analysis. Multivariable logistic regression models were performed to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between Hb categories and adverse pregnancy outcomes. The average first trimester Hb concentration was 126.0 (SD 10.5) g/L, with 5.8% of pregnant women experiencing anemia during early pregnancy. Multivariable logistic regression analyses revealed significantly increased odds of developing gestational diabetes mellitus (GDM) and gestational hypertensive disorders (GHD) across increasing Hb concentration categories. Compared to Hb concentrations of 110-119g/L, Hb ≥ 140g/L was associated with elevated risk of GDM (aOR: 1.57, 95% CI: 1.52, 1.62) and GHD (aOR: 1.87, 95% CI: 1.79, 1.96). Moreover, both Hb ≤ 99g/L (aOR: 1.15, 95% CI: 1.03, 1.29) and Hb ≥ 140g/L (aOR: 1.20, 95% CI: 1.13, 1.26) were associated with higher odds of preterm birth compared to Hb concentrations of 110-119g/L. In addition, the restricted cubic spline demonstrated a U-shaped relationship for cesarean delivery, low birthweight and small for gestational age (p < 0.001). However, no significant associations were found between first trimester Hb concentrations and the odds of stillbirth, Apgar score < 7 at 5min, or Apgar score < 7 at 10min (p > 0.05). Our research findings suggest associations between first trimester Hb concentrations and various adverse pregnancy outcomes. We recommend interventions for early pregnancy anemia, particularly moderate to severe cases, and emphasize monitoring females with high Hb concentrations to reduce adverse outcomes.

Prenatal homelessness, food insecurity, and unemployment and adverse infant outcomes in a California cohort, 2007-2020.

Characterize the relationship between infant outcomes and prenatal homelessness, food insecurity and unemployment. California live births between 22- and 44-weeks' gestation comprised 6,089,327 pregnancies (2007-2020). Data were collected from linked Vital Statistics and hospital discharge records. Prenatal homelessness, food insecurity, and unemployment were classified as health-related social needs (HRSN) using International Classification of Disease codes in delivery records. Risk ratios for preterm birth, low birthweight, small for gestational age, neonatal intensive care unit admission, emergency department admission, rehospitalization, and death were estimated using log-linear Poisson regression adjusted for birthing person race, payer, and education. 65.7 per 100,000 births had HRSN. These infants had a higher risk of preterm birth (aRR 2.7), low birthweight (aRR 2.7), SGA (aRR 1.5), NICU admission (aRR 3.5), and death (aRR 3.0). HRSN increase the risk of infant morbidity and mortality but remain underreported in administrative records, making definitive conclusions difficult.

Hypothermia-Prevalence and risk factors in neonates admitted to a neonatal unit in Tanzania.

We aimed to study the prevalence of hpyothermia among neonates, the association between admission temperature and neonatal mortality, and the impact of radiant warmers. In an observational prospective study, we included 1988 neonates born at Haydom Lutheran Hospital, Tanzania, and admitted to the neonatal unit from 1 January 2018 to 31 December 2022. We explored risk factors for hypothermia (<36.0°C, primary outcome) and newborn mortality by admission temperature (secondary outcome) with adjusted odds ratios (aOR) and 95% confidence intervals (CI) for birth weight and bag and mask ventilation. Hypothermia was present in 47.0% (n = 935) at admission, 46.9% (n = 932) were normothermic or mildly hypothermic (36.0-37.5°C), and 6.1% (n = 121) hyperthermic. Of those admitted to the neonatal unit, 217 (10.9%) died. For every 1°C increase in temperature, neonatal mortality decreased by 31% (aOR 0.69, 95% CI 0.59-0.82). Admission temperature <34.5°C was strongly associated with mortality (aOR 3.56, 1.87-6.79). Mild hypothermia (36.0-36.5°C) was not associated with mortality (aOR 1.30, 0.72-2.37). Risk factors for hypothermia were bag and mask ventilation (aOR 2.53, 2.07-3.11) and low birth weight. The introduction of radiant warmers from 1 May 2022 was associated with a decrease in hypothermia (aOR 0.54, 0.41-0.72). Hypothermia is prevalent even in tropical settings and maintaining normothermia after birth is critical and achievable for reducing neonatal mortality.

Insights into fetomaternal outcomes in pre-eclampsia: A tertiary care center descriptive study

Preeclampsia and eclampsia remain significant challenges in both maternal and perinatal health worldwide, with a pronounced impact in regions such as India, where access to comprehensive maternal care can be limited. The objective of this study was to examine the outcomes for both mothers and babies, along with the complications linked to severe cases of preeclampsia and eclampsia, within a tertiary healthcare facility situated in South India. : Sixty-five pregnant women diagnosed with severe preeclampsia or eclampsia were enrolled in this descriptive observational study conducted at a tertiary care teaching hospital, Chennai, spanning from March 2023 to December 2023. Inclusion criteria comprised women with singleton pregnancies exhibiting severe preeclampsia (defined by blood pressure ≥160/110 mmHg and 1+ or more albuminuria) or eclampsia. Exclusion criteria included chronic hypertension, multiple pregnancies, chronic renal disease, connective tissue disorder, neurological complications, and refusal of consent. Data on sociodemographic variables, obstetric characteristics, maternal symptoms, and complications were collected using a structured questionnaire. Maternal and fetal well-being were assessed through biochemical, radiological, and nonstress tests.: The results revealed that 80% of the study population with severe preeclampsia or eclampsia fell within the age group of 21-30 years, with 49.2% aged between 26-30 years. Majority (60%) were primigravida. Common maternal symptoms included headache (60%), oedema (76.9%), with fewer experiencing epigastric pain (3.1%) and vaginal bleeding (15.4%). Complications observed were HELLP syndrome (12.35%), placental abruption (7.7%), and eclampsia (10.8%). Perinatal outcomes included intrauterine fetal death (4.6%), fetal growth retardation (23.1%), low birth weight (30.8%), respiratory distress syndrome (4.6%), and stillbirth (1.5%), with 35.4% being normal births.This study emphasises the substantial impact of severe preeclampsia and eclampsia on the health of both mothers and fetuses, underscoring the importance of thorough antenatal care, prompt identification of risk factors, and timely interventions to minimise negative consequences. There is a clear call for additional research to investigate and implement effective strategies for prevention and management, aiming to decrease the morbidity and mortality rates associated with these hypertensive disorders during pregnancy.

Tuberculosis Preventive Treatment for Pregnant People With Human Immunodeficiency Virus in South Africa: A Modeling Analysis of Clinical Benefits and Risks.

Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH. We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis). Tuberculosis during pregnancy confers 250% and 81% higher modeled risks of stillbirth and LBW, respectively. In lower-risk or higher-risk scenarios, immediate TPT confers 38% lower or 92% higher risks of stillbirth and 16% lower or 35% higher risks of LBW. Immediate TPT would minimize deaths among PPWH. When TPT confers higher stillbirth and LBW risks, immediate TPT would produce the most combined maternal and fetal/infant deaths, even with low maternal CD4 cell count and high tuberculosis incidence. If immediate TPT yields a <4% or <20% increase in stillbirth or LBW, immediate TPT would produce fewer combined deaths than deferred TPT (sensitivity analysis range, <2%-22% and <11%-120%, respectively). If APO risks are below identifiable thresholds, TPT during pregnancy could decrease combined maternal and fetal/infant deaths. Given uncertainty around isoniazid's risks, and the low threshold at which APO risks could outweigh benefits from tuberculosis deaths averted, studies of newer TPT regimens among PPWH are warranted to inform guidelines.

A 5-years cross-sectional study of risk-factors feto-maternal outcomes in placenta accreta spectrum at single tertiary care centre in South India

: PAS is an abnormal placental trophoblastic invasion into the myometrium, serosa and surrounding structures causing severe maternal morbidity and mortality due to massive obstetric hemorrhage (MOH). The incidence of PAS is on the rise due to increasing rate of Cesarean Section (CS) worldwide. : This study aimed to assess the risk factors associated with Placenta accreta spectrum (PAS) and to compare the feto-maternal outcomes in elective and emergency delivery in PAS.This is a 5 years single centre cross-sectional study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included. A total of 38 cases of PAS were studied. Chi-square test and T-test were used to compare the categorical variables with p value 0f &amp;#60;0.05 as statistically significant.The incidence of PAS was 1.85/1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors. MOH was the commonest complication. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Prematurity and low birth weight were the most important perinatal outcomes. Adequate blood and blood products prior to surgery is important as even in expert hands blood loss can be massive. Early referral and specialized regional team to manage PAS at tertiary care are needed. Future studies should emphasize on easy and early detection of PAS.

EARLY DETECTION AND LONGITUDINAL OUTCOMES OF HEARING IMPAIRMENT IN NICU GRADUATES AT SDM COLLEGE OF MEDICAL SCIENCES AND HOSPITAL

Objective: Hearing impairment is a prevalent congenital anomaly, particularly in neonates in NICUs, due to various risk factors. Early detection through screening programs is crucial for developmental outcomes. Methods: A prospective observational study was conducted at SDM College of Medical Sciences and Hospital, involving 425 neonates. Otoacoustic Emissions (OAE) testing was used for early detection and longitudinal outcome assessment. Results: Out of 425 neonates, 95.3% passed the initial OAE screening. However, 4.7% failed, necessitating further evaluation. Notable risk factors included neonatal jaundice and perinatal asphyxia, particularly impacting neonates with lower birth weights. Conclusion: The study underscores the importance of early and universal hearing screening in NICU settings, emphasizing the need for tailored protocols to address specific neonatal risks.

ASSESSMENT OF RISK FACTORS AND FOLLOW-UP OUTCOMES FOR HEARING LOSS IN HIGH-RISK NEONATES

Objective: Hearing loss in neonates, particularly those in high-risk categories such as NICU graduates, can significantly impede speech, cognitive, and psychosocial development. Early detection and management are pivotal to mitigating these risks. Methods: A prospective observational study was conducted on 425 neonates at SDM Medical College and Hospital, utilizing Otoacoustic Emissions (OAE) for initial auditory screening. This study assessed the incidence of hearing loss in relation to neonatal risk factors, including birth weight, ABO incompatibility, and maternal health conditions. Results: A majority of the neonates (58.82%) were screened within 3-7 d post-birth. Notable risk factors impacting hearing outcomes included low birth weight, with 11.53% of neonates weighing between 1.0 and 1.50 kg. The initial failure rates in OAE screenings were low, with 2.59% failing in the right ear, 1.18% in the left, and 0.94% in both ears. Conclusion: The study underscores the efficacy of early hearing screenings in identifying potential hearing loss in neonates, especially those exposed to multiple risk factors. Continuous and comprehensive monitoring is crucial for these high-risk groups to facilitate timely and effective interventions.

Association between maternal dietary diversity during pregnancy and birth outcomes: evidence from a systematic review and meta-analysis.

Maternal nutrition is a key factor influencing birth and offspring health outcomes in later life. Dietary diversity (DD) is a proxy for the macro/micronutrient adequacy of an individual's diet. There is inadequate comprehensive evidence regarding maternal nutrition during pregnancy, measured through DD and birth outcomes. This study aimed to provide extensive evidence on maternal DD during pregnancy and birth outcomes. A comprehensive search was performed using PubMed, HINARI, and Google Scholar databases up to January 17, 2024. Studies conducted among pregnant mothers and measuring maternal DD with an evaluation of birth outcomes (low birth weight, small for gestational age, preterm birth), in the global context without design restriction were included. The Newcastle Ottawa Scale and the Cochrane Risk of Bias tool were used to assess the risk of bias. The results are summarized in a table, and odds ratios were pooled where possible. Between-study heterogeneity was evaluated using I2 statistics. Potential publication bias was assessed using a funnel plot and Egger's regression test. To explore the robustness, a leave-one-out sensitivity analysis was conducted. Thirty-three studies were used to synthesize narrative evidence (low birth weight: 31, preterm birth: 9, and small for gestational age: 4). In contrast, 24 records for low birth weight, eight for preterm birth, and four for small for gestational age were used to pool the results quantitatively. Of the 31 studies, 17 reported a positive association between maternal DD and infant birth weight, 13 studies reported a neutral association (not statistically significant), and one study reported a negative association. Overall, inadequate DD increased the risk of low birth weight OR = 1.71, 95% CI; (1.24-2.18), with I2 of 68.7%. No significant association was observed between maternal DD and preterm birth. Inadequate DD was significantly associated with small for gestational age (OR = 1.32, 95% CI; 1.15-1.49, and I2 = 0.0%). Inadequate maternal DD is associated with an increased risk of low birth weight and small for gestational age but not preterm birth, underscoring the importance of promoting adequate DD during pregnancy. To address these issues, it is essential to implement and expand nutritional programs targeted at pregnant women, especially in low-resource settings, to ensure they receive diverse and adequate diets. Further research is needed to address the current limitations and to explore the long-term implications of maternal nutrition on child health. The study was prospectively registered on PROSPERO (registration number CRD42024513197). No funding was received for this study.

Trends in the Prevalence and Factors Associated with Undernutrition in Tunisian Children Aged 0–23 Months

Background: In recent years, undernutrition has remained a significant public health issue in Tunisia, increasing the risk of illness and mortality in young children. Therefore, this study aims to analyse the prevalence and factors contributing to undernutrition among Tunisian children aged 0–23 months. Methods: The study included 3265 children aged 0–23 months from the 2011–2023 Tunisia Multiple Indicator Cluster Surveys (MICS). Trends and logistic regression analyses were used to determine the prevalence and predictors of undernutrition. Results: The prevalence of stunting, wasting, and underweight in infants and children aged 0–23 months has increased by 3.3%, 0.5%, and 2.1%, respectively. Stunting and underweight were more common among infants aged 0–5 months (11.8% for stunting, 8.9% for underweight, p &lt; 0.01), and first-time mothers (8.3% for stunting, 4.1% for underweight, p &lt; 0.01). In 2023, compared to 2011, the odds of stunting, wasting, and being underweight had increased by 22%, 16%, and 70%, respectively. Infants aged 0–5 months had higher odds of undernutrition in all three indices. Children of obese or overweight mothers, and those who started breastfeeding late, were more likely to be stunted. Boys had significantly higher odds of wasting and underweight. Children with low birth weight, and duration of breastfeeding &gt; 12 months, had significantly higher odds of being underweight. Conclusions: This study shows that infants aged 0–5 months, first-time mothers, boys, and children from poor households in Tunisia are at a higher risk of undernutrition. To address the growing issue of undernutrition in Tunisian children, enhancing maternal and child health and nutrition services, improving parental education, and implementing community-based programs that provide breastfeeding and nutritional education to infants born to new mothers and mothers with high/low BMI is recommended.