Low Birth Research Articles

Unveiling China's Fertility Dilemma: Analyzing Risk Factors and Their Global Implications

Abstract: The National Bureau of Statistics of China has announced in 2021 that the country has formally entered the stage of low fertility rate, reaching a historically low of 1.3. Such low birth is far below the replacement level of 2.1 which is needed for maintaining a sustainable population, implying the possibility for China to start a significant demographic shift. Several key factors have contributed to this decline. Factors behind the problem includes Chinas historical policy implementation, socioeconomic factors including the rise of housing price and cost of upbringing and social factors including waning of social norms and ascent of gender equity. Such phenomenon serves as also valuable insights for analyzing global fertility intention for countries like Switzerland, the United States and South Korea. As all global policymakers seek to address the problem of unstable and declining fertility rates and waning fertility intention, the Chinese case could provide intriguing example as supportive evidence.

Analysis of Characteristics of Health Status Based on Assessment of Cognitive Function in the Elderly in Indonesia

Introduction: Various challenges will arise due to the increase in elderly people yearly. In Indonesia, the effect of the demographic transition can be seen in the low birth and death rates, and the rise in life expectancy is indirectly the way to increase the number of the elderly; from sharing the problems that arise among the elderly, one of the things that need to be concerned is how to maintain cognitive function so that the elderly can maintain their health status. Objectives: to determine the relationship between characteristics and the health status of the elderly based on the results of cognitive function assessment. Methods: This study is a type of observational analytical research using a cross-sectional study design and was carried out in Gowa Regency, South Sulawesi Province, Indonesia, from August to December 2023, involving 64 older adults with the criteria of elderly people who are 60-75 years old, do not have mental disorders and can read and write. Cognitive function uses the Montreal Cognitive Assessment Indonesia version (MoCA-Ina) and is a variable to be analyzed. Results: There was a significant relationship between sex p<0.030, age p<0.027, education level p<0.001, occupation p<0.045, prayer activity p<0.001 with cognitive function, while marital status was not related to cognitive function p>0.193. Conclusion: The characteristics of the elderly in this study are related to health status based on the value of cognitive function in the elderly.

Cohort profile: the Environmental Reproductive and Glucose Outcomes (ERGO) Study (Boston, Massachusetts, USA) — a prospective pregnancy cohort study of the impacts of environmental exposures on parental cardiometabolic health

PurposePregnancy and the postpartum period are increasingly recognised as sensitive windows for cardiometabolic disease risk. Growing evidence suggests environmental exposures, including endocrine-disrupting chemicals (EDCs), are associated with an increased risk...

Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda

IntroductionNeonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings...

Zinc Supplementation Initiated Prior to or During Pregnancy Modestly Impacted Maternal Status and High Prevalence of Hypozincemia in Pregnancy and Lactation: The Women First Preconception Maternal Nutrition Trial

BackgroundData regarding effects of small-quantity-lipid-based nutrient supplements (SQ-LNS) on maternal serum zinc concentrations (SZC) in pregnancy and lactation are limited. ObjectivesThe objectives of this study were to evaluate the effect of preconception compared with prenatal zinc supplementation (compared with control) on maternal SZC and hypozincemia during pregnancy and early lactation in women in low-resource settings, and assess associations with birth anthropometry. MethodsFrom ∼100 women/arm at each of 3 sites (Guatemala, India, and Pakistan) of the Women First Preconception Maternal Nutrition trial, we compared SZC at 12- and 34-wk gestation (n = 651 and 838, respectively) and 3-mo postpartum (n = 742) in women randomly assigned to daily SQ-LNS containing 15 mg zinc from ≥3 mo before conception (preconception, arm 1), from ∼12 wk gestation through delivery (early pregnancy, arm 2) or not at all (control, arm 3). Birth anthropometry was examined for newborns with ultrasound-determined gestational age. Statistical analyses were performed separately for each time point. ResultsAt 12-wk gestation and 3-mo postpartum, no statistical differences in mean SZC were observed among arms. At 34-wk, mean SZC for arms 1 and 2 were significantly higher than for arm 3 (50.3, 50.8, 47.8 μg/dL, respectively; P = 0.005). Results were not impacted by correction for inflammation or albumin concentrations. Prevalence of hypozincemia at 12-wk (<56 μg/dL) was 23% in Guatemala, 26% in India, and 65% in Pakistan; at 34 wk (<50 μg/dL), 36% in Guatemala, 48% in India, and 74% in Pakistan; and at 3-mo postpartum (<66 μg/dL) 79% in Guatemala, 91% in India, and 92% in Pakistan. Maternal hypozincemia at 34-wk was associated with lower birth length-for-age Z-scores (all sites P = 0.013, Pakistan P = 0.008) and weight-for-age Z-scores (all sites P = 0.017, Pakistan P = 0.022). ConclusionsDespite daily zinc supplementation for ≥7 mo, high rates of maternal hypozincemia were observed. The association of hypozincemia with impaired fetal growth suggests widespread zinc deficiency in these settings.This trial is registered at clinicaltrials.gov as #NCT01883193.

Association of serum levels of inflammatory cytokines with retinopathy of prematurity in preterm infants.

Retinopathy of prematurity (ROP) is a retinal vascular developmental disease associated with risks factors such as supplementary oxygen use or low birth weight/early gestational age. Multiple studies have reported associations between ROP and systemic inflammation. In this study, we investigated serum cytokines associated with ROP development and severity and assessed their applicability as potential biomarkers of ROP. This prospective study was conducted at an institutional referral center between 2019 and 2021. To measure the serum levels of 40 inflammatory cytokines in eligible premature patients, we collected their serum samples during the enrollment of patients or the intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents and after 2 and 4 weeks. Fifty patients were enrolled. In patients with type 1 ROP who received anti-VEGF agents (n = 22), the levels of serum intercellular adhesion molecule-1 decreased significantly (p < 0.05) at 4 weeks compared with the baseline level, whereas those of serum granulocyte-macrophage colony-stimulating factor increased significantly (p < 0.05). In patients with ROP who did not require any treatment (n = 14), no significant change was noted in the level of any of the 40 inflammatory cytokines. In control infants without ROP (n = 14), the serum levels of tumor necrosis factor-α, interleukin (IL)-15, and IL-12p40 increased significantly (p < 0.05) at 4 weeks. The changes in the levels of serum inflammatory cytokines did not vary significantly among the aforementioned three groups. A generalized estimating equation indicated that zone 1 ROP, stage 3 ROP, older postmenstrual age, respiratory distress syndrome, necrotizing enterocolitis, and sepsis were associated with the changes in serum cytokine levels. Although significant changes (compared with baseline) were observed in the serum levels of certain inflammatory cytokines in patients with type 1 ROP and infants without ROP, no significant difference in cytokine level fluctuations were noted among the three groups. Changes in serum inflammatory cytokine levels may not predict ROP development or severity. Additional comprehensive studies are warranted to establish their definitive role and significance in ROP, emphasizing the need for continued research in this area.

A retrospective analysis of the safety of tacrolimus use and its optimal cut-off concentration during pregnancy in women with systemic lupus erythematosus: study from two Japanese tertiary referral centers

BackgroundTacrolimus is one of the major treatment options for systemic lupus erythematosus (SLE) and is considered to be a pregnancy-compatible medication. Since little is known about tacrolimus safety during pregnancy complicated by SLE, this study was designed.MethodsWe included SLE pregnant patients who were followed up at two Japanese tertiary referral centers. We performed multivariate logistic regression analysis to assess each adverse pregnancy outcome (APO) risk. Moreover, we assessed the influence of tacrolimus on the APO ratio in pregnant patients with lupus nephritis, and the impact of combined tacrolimus-aspirin therapy on the APO ratio relative to patients exclusively administered tacrolimus.ResultsOf the 124 pregnancies, 29 were exposed to tacrolimus. Multivariate analysis showed no statistical difference in APO ratio. (overall APO: adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.23–2.03; p = 0.50; maternal APO: aOR, 1.17; 95% CI, 0.36–3.83; p = 0.80; neonatal APO: aOR, 1.10; 95% CI, 0.38–3.21; p = 0.86; PROMISSE APO: aOR, 0.50; 95% CI, 0.14–1.74; p = 0.27).Blood pressure and estimated glomerular filtration rate (eGFR) during pregnancy and after delivery did not differ between the two groups. Receiver operating characteristic (ROC) curve showed that tacrolimus concentration > 2.6 ng/ml was related to reduced preterm birth rate. (AUC = 0.85, 95% CI: 0.61–1.00, sensitivity: 93% and specificity: 75%).Regarding effect of tacrolimus on lupus nephritis during pregnancy, tacrolimus showed no increased risk of APO, blood pressure or eGFR during pregnancy and after delivery. (overall APO: OR, 1.00; 95% CI, 0.25–4.08; p = 0.98; maternal APO: OR 1.60, 95% CI, 0.39–6.64; p = 0.51; neonatal APO: OR, 0.71; 95% CI, 0.17–3.03; p = 0.65, PROMISSE APO: OR, 0.50; 95% CI, 0.08–3.22; p = 0.47).Tacrolimus-aspirin combination therapy showed a protective tendency against hypertensive disorders during pregnancy, preeclampsia and low birth weight.ConclusionsTacrolimus use during pregnancy with SLE and lupus nephritis showed no significant influence on APO, blood pressure, or renal function; therefore tacrolimus may be suitable for controlling lupus activity during pregnancy. In addition, when using tacrolimus during pregnancy, we should aim its trough concentration ≥ 2.6 ng/ml while paying careful attention to possible maternal side effects of tacrolimus.Trial registrationRetrospectively registered.

A comparative analysis of gastrointestinal tract barrier function and immune markers in gilt vs. sow progeny at birth and weaning.

Progeny born to primiparous sows (gilt progeny; GP) have lower birth, weaning and slaughter weights than sow progeny (SP). GP also have reduced gastrointestinal tract (GIT) development, as evidenced by lower organ weights. Therefore, the aim of this experiment was to quantify changes in GIT barrier function that occur in birth and weaning, representing two major challenges to the young piglet. The effects of parity (GP vs. SP) in GIT barrier integrity function were quantified at four timepoints: birth (~0h), 24h after birth (24h), 1-d preweaning (PrW), and 1-d postweaning (PoW) in commercially reared piglets. Due to inherent differences between newborn and weanling pigs, the results were analyzed in two cohorts, birth (0 vs. 24h, n = 31) and weaning (PrW vs. PoW, n = 40). Samples of the stomach, jejunum, ileum, and colon were excised after euthanasia and barrier integrity was quantified by measuring transepithelial resistance (TER), macromolecular permeability, the abundance of inflammatory proteins (IL-8, IL-1β, and TNF-α) and tight junction proteins (claudin-2 and -3). Papp was characterized using a dual tracer approach comprising 4 KDa fluorescein isothiocyanate (FD4) and 150kDa tetramethyl rhodamine isothiocyanate (T150)-labeled dextrans. Characteristic effects of the initiation of feeding and weaning were observed on the GIT with the initiation of feeding, such as increasing TER and reducing Papp at 24h, consistent with mucosal growth (P = 0.058) This was accompanied by increased cytokine abundance as evidenced by elevations in TNF-α and IL-1β. However, GP had increased IL-8 abundance (P = 0.011 and 0.063 for jejunum and ileum respectively) at birth than 24h overall. In the weaning cohort, jejunal and ileal permeability to FD4 was higher in GP (P = 0.05 and 0.022, respectively) while only higher ileal T150 was observed in GP (P = 0.032). Ileal claudin-2 abundance tended to be higher in SP overall (P = 0.063), but GP ileal claudin-2 expression was upregulated weaning while no change was observed in SP (P = 0.043). Finally, other than a higher jejunal TNF-α abundance observed in SP (P = 0.016), no other effect of parity was observed on inflammatory markers in the weaning cohort. The results from this study indicate that the GIT of GP have poorer adaptation to early life events, with the response to weaning, being more challenging which is likely to contribute to poorer postweaning growth.

Vaccination against pertussis in Latin American preterm and low-birth weight infants: experts opinion position for a neglected childhood age group

ABSTRACTBackgroundPertussis remains as one of the oldest leading vaccine-preventable diseases of childhood, despite many decades of primary vaccine doses’ and boosters’ implementation. Although the epidemiology is well understood in infants and children, premature babies and low-birth weight infants remain a special group where the disease incidence is unknown, severity of the disease is considerable, and specific vaccination recommendations are scarce.Research design and methodsA retrospective review of the available evidence of pertussis vaccination in premature and low birth weight infants was analyzed from January 2000 to December 2022 in six selected countries: Argentina, Mexico, Colombia, Panamá, Costa Rica, and Chile.ResultsChile had reports of adverse effects associated with vaccination of premature infants with the pentavalent vaccine, and their rationale to switching to the hexavalent vaccine. Colombia had reports of the justification for the use of hexavalent vaccine in prematures in the Neonatal Units and Kangaroo Mother Programs throughout the country. Mexico had selected publications of the vaccination status in prematures and low-birth weight infants.ConclusionDespite its importance, increased morbidity, and highest risk of complications in premature babies, there is a paucity of information of vaccine recommendations and coverage rates among selected Latin American infants.

Comparison of massage and prone position on heart rate and blood oxygen saturation level in preterm neonates hospitalized in neonatal intensive care units

BackgroundMany years ago, it was proposed that prone positioning and infant massage would benefit preterm and babies with low birth weight.Aim of the workEvaluating the effectiveness of massage therapy and the neonatal prone position on the heart rate (HR) and blood oxygen saturation level (SPO2) of premature neonates in neonatal intensive care units.Subject and methodsOur study was conducted as a single-center, randomized controlled clinical trial at the NICUs of Menoufia University Hospital. After enrollment, the (240) cases were divided into group A: (80) infants with prone position, group B: (80) infants with massage therapy (as intervention groups), group C: (80) infants as a control group (without intervention).ResultsRegarding group A, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group B, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group C, there was no significant difference between the First and last days of intervention regarding HR at 15, 30, 45, and 60 min.ConclusionProne position and infant’s massage equally reduce Heart Rate and increase preterm babies' blood oxygen saturation level neonates admitted in NICU.

Reproductive Efficiencies and Productive Potentials of Female Nigerian Indigenous Goat Breeds

Purpose: The overall objective of this study was to examine the reproductive and productive abilities of three Nigerian indigenous goat breeds.&#x0D; Methodology: The study covered 108 primiparous does and nine bucks from Sahel (SH), Red Sokoto (RS), and West African dwarf (WAD) goat breeds. In different pens, the animals were bred in various combinations: RS x RS, WAD x WAD, SH x SH, RS x SH, RS x WAD, SH x RS, and SH x WAD. WAD x SH, WAD x RS. Estrus synchronization was done using prostaglandins. Mating occurred naturally when animals were on heat. Dams were given special care throughout pregnancy. The study measured dams' weights, litter size, and pre-weaning mortality rates in kids. The total kid crop and sexes were also assessed. We measured dam lactation weight loss, birth weight, and weaning weight. SPSS, ANOVA, and the Turkey statistical test were used for data analysis.&#x0D; Findings: The result showed that there was a significant (P&lt;0.05) difference in the weight of does at kidding. The weight of does at weaning varied significantly (P&lt;0.05). Litter size significantly (P&lt;0.05) affected the birth weight and weaning weight of kids. An increase in litter size per birth resulted in a significant (P&lt;0.05) rise in kid mortality rates. Breed type significantly (P&lt;0.05) affected doe production efficiency and weaning weight ratio. Although WAD x WAD goats had lower birth and weaning weights, hybrid vigour (birth and weaning weights) improved significantly (P&lt;0.05) when cross-bred with SH or RS breeds. When crossed with SH or WAD goat breeds, RS breeds had the greatest positive effect on hybrid vigour (heterosis), followed by SH breeds. Both SH x RS and RS x SH progenies recorded higher hybrid vigour than the other nine bred line progenies.&#x0D; Unique contribution to theory, practice and policy: This study found that Nigerian indigenous goat breeds had great reproductive efficiency and breeding potential if properly managed. Genetic variations observed in the study could improve Kids crop, birth weight, litter size, hybrid vigour, and pre-weaning survivorship due to their broad variety. This study recommends a careful selection and crossbreeding of Nigerian indigenous goat breeds with suitable pedigree in order to increase their productivity.

Barbara C Morden. The Life of Mark Akenside: The Breakthrough to Modernity

Of particular delight in Barbara C. Morden’s latest book, The Life of Mark Akenside, are the frequent and often highly resonant Akensidean echoes detected in the works of Coleridge, Wordsworth, Shelley and Keats. J. M. W. Turner’s paintings, too, carry palpable inflections of the Novocastrian poet’s night-sky verses and poetics of liberty. Anna Laetitia Barbauld was perhaps the most prominent advocate for Akenside’s talents, and this connection is meaningfully if briefly explored. Intriguingly, so I learned from Morden’s literary biography, Charles Lamb even coined the term ‘akensidise’ to denote a rejection of classical poetics; notwithstanding the persistence of classicism in Akenside’s practice, that askance angle presents tantalizing opportunities for further scholarly investigation into contemporary responses to his complex poetics. I also learned of Akenside Syndrome, a description of someone who denies their provincial origins, an unfortunate misnomer if we endorse Morden’s efforts in reclaiming Akenside as a proud Northerner. Even now an information board outside the Church of All Saints on Butchers Bank (also known as Akenside Hill) enshrines the persistent myth of the poet’s rejection of his natal home. Christopher Bucke, Akenside’s first biographer, seems to be the perpetrator of the myth, though he fixates on the poet’s apparent shame of his low birth as the son of a butcher rather than the large and culturally diverse region itself. This is not merely biographical detail. Such assumptions run counter to Akenside’s poetic identity. As he writes in ‘Ode on the Winter Solstice’: ‘Old Tyne shall listen to my tale, / And Echo, down the bord’ring vale, / The liquid melody prolong’.

Fetal Growth Restriction Impairs Lung Function and Neurodevelopment in an Early Preterm Rabbit Model.

We previously reported the multi-system sequelae of fetal growth restriction, induced by placental underperfusion, in near-term born rabbits, in the immediate neonatal period and up to pre-adolescence. Herein, we describe the pulmonary and neurodevelopmental consequences of FGR in rabbits born preterm. We hypothesize that FGR has an additional detrimental effect on prematurity in both pulmonary function and neurodevelopment. FGR was induced at gestational day (GD) 25 by placental underperfusion, accomplished by partial uteroplacental vessel ligation in one uterine horn. Rabbits were delivered by cesarean section at GD 29, and placentas were harvested for histology. Neonates underwent neurobehavioral or pulmonary functional assessment at postnatal day 1, followed by brain or lung harvesting, respectively. The neurodevelopmental assessment included neurobehavioral testing and multiregional quantification of cell density and apoptosis in the brain. Lung assessment included functional testing, alveolar morphometry, and airway histology. FGR was associated with higher perinatal mortality, lower birth and placental weight, and a similar brain-to-body weight ratio compared to controls. Placental underperfusion decreased labyrinth and junction zone volumes in FGR placentas. FGR impaired pulmonary function, depicted by higher parenchymal resistance, damping, and elastance. Alveolar morphometry and airway smooth muscle content were comparable between groups. Neurobehavioral tests showed motoric and sensorial impairment in FGR rabbits. In FGR brains, cell density was globally reduced, with higher apoptosis in selected areas. In conclusion, in preterm-born rabbits, placental underperfusion leads to higher mortality, FGR, and impaired lung and brain development in early assessment. This study complements previous findings of placental, pulmonary, and neurodevelopmental impairment in near-term born rabbits in this model.

MHealth in Sub-Saharan Africa and Europe: Context of current health, healthcare status, and demographic structure.

The advent of digital systems and global mobile phone availability presents an opportunity for better healthcare access and equity. However, the disparity in the usage and availability of mHealth systems between Europe and Sub-Saharan Africa (SSA) has not been explored in relation to current health, healthcare status, and demographics. This study aimed to compare mHealth system availability and use in SSA and Europe in the above-mentioned context. The study analyzed health, healthcare status, and demographics in both regions. It assessed mortality, disease burden, and universal health coverage. A systematic narrative review was conducted to thoroughly assess available data on mHealth availability and use, guiding future research in the field. SSA is on the verge of stages 2 and 3 in the demographic transition with a youthful population and high birth rate. Communicable, maternal, neonatal, and nutritional diseases contribute to high mortality and disease burden, including child mortality. Europe is on the verge of stages 4 and 5 in the demographic transition with low birth and death rates. Europe's population is old, and non-communicable diseases (NCDs) pose major health challenges. The mHealth literature adequately covers cardiovascular disease/heart failure, and cancer. However, it lacks approaches for respiratory/enteric infections, malaria, and NCDs. mHealth systems in SSA are underutilized than in Europe, despite alignment with the region's demographics and major health issues. Most initiatives in SSA lack implementation depth, with only pilot tests or small-scale implementations. Europe's reported cases highlight actual implementation and acceptability, indicating a strong implementation depth of mHealth systems.

Pregnancy Outcomes in Women With Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease affecting multiple joints and can also be a systemic widespread, affecting major organs. Rheumatoid arthritis is associated with greater adverse maternal and neonatal outcomes in comparison to the general obstetric population. This systematic review and meta-analysis aims to investigate the pregnancy outcomes in RA patients in comparison to the general pregnant population.Nine studies involving 11,999 RA patients met the eligibility criteria with 9,921,808 controls. Rheumatoid arthritis patients were compared with their control counterparts according to random-effects model statistical analysis.We searched databases from inception to September 8, 2021. Eligible studies reported maternal outcomes (preeclampsia, cesarean delivery, and preterm delivery) and/or neonatal outcomes. Data were pooled across using random-effects model. Subgroup analysis was conducted on RA patients alone. The review was registered prospectively with PROSPERO (CRD42021250521).In terms of maternal outcomes, there was an increased rate of cesarean delivery (odds ratio [OR], 1.55), preeclampsia (OR, 1.61), and preterm delivery (OR, 1.83) in RA patients compared with their control counterparts. In terms of neonatal outcomes, a higher rate of lower gestational weight (mean difference [MD], -0.19 kg), requirement for neonate intensive care unit admission (OR, 1.34), and stillbirths (OR, 1.99) were observed in RA patients compared with the controls. A subgroup analysis of 4 studies involving only RA patients (n = 3761) was conducted. A total of 33.2% of patients had a cesarean delivery, 7.3% had preeclampsia, 14.8% had a preterm delivery, and 9.5% of neonates had low birth weight.Compared with the general pregnant population, women with RA tend to have a higher risk of maternal and neonatal complications. As a result, this study hopes to increase awareness into the importance of counseling and managing RA patients.

Changes in the tax structure and their impact on economic growth in the Republic of Croatia based on the VAR model

In Croatia, the social security system is based on generational solidarity, i.e. payment of contributions, which is known as pay as you go (PAYG), but the balance of its functioning is permanently and significantly disturbed by long-term unfavourable demographic processes. Projections show that the worrying demographic situation will deteriorate even further and that, with low birth and fertility rates and negative natural growth, negative net migration will contribute to further depopulation. In addition, contributions directly burden labour, i.e. they increase labour costs for employers and reduce their competitiveness in the marketplace, affecting economic growth. The paper reviews empirical research on the impact of different tax structures on economic growth, the sublimated conclusion of which is that direct taxes have a negative effect on growth, while indirect taxes are neutral. The Croatian tax system, with VAT as the main factor in the tax structure, is focused on taxing consumption, but is also characterized by a high level of levies. In this paper, the authors use the vector autoregression model to analyse the relationship between economic growth and the changed tax structure of the Republic of Croatia, in which the role of indirect taxes would be more emphasized. Data in model are consist of different types of taxes, GDPpc, population growth, gross fixed capital formation, unemployment rate and cover the time period from 2004 to 2019. The authors prove that the reduction of the tax burden through direct taxes has positive economic, demographic and fiscal effects.

The Need for Interdisciplinary Framework for Management of Dysphagia

The World is in the midst of transition characterized by low birth and death rates, resulting in the rising population of geriatric persons. India is also facing this situation and will become the country with the second largest number of persons in the World. According to Ministry of Health and Family Welfare the number of 60+ in India will increase to 100 million in 2013 to 198 million in 2030 1. Ageing population need not be a drain of social and economic resources. The National Program for The Care of the Elderly (NPHCE) wants initiatives and interventions from the aspect of Preventive, Curative and rehabilitative aspects in the geriatric field. Many medical conditions that commonly affect the elderly can cause dysphagia or difficulty in swallowing which impacts nutritional state and frailty. This is more so after the devastating pandemic which has caused swallowing difficulty in many post Covid 19 patients. It is a hidden disability and it is important and essential that a multidisciplinary approach be formulated and guidelines be established to have effective interventions in place to help this rapidly growing vulnerable population. Recognizing this important initiative and the need for setting guidelines for the care of these vulnerable patients, IAPEN INDIA launched the Dysphagia Core Group or Special Interest Groups which consists of voluntary members of Doctors in the specialty of Neurologists, onco surgeons, ENT specialists along with experts in the academic field teaching speech language pathology, practicing clinical dietitians, swallow therapists and Speech language Pathologists in August 2019. Keywords: IAPEN INDIA, Nutrition, Speech Language pathologists, Dysphagia, Covid 19, Core Group, Swallow Therapists, Clinical Dietitian, oncology

Pattern of Neonatal Admissions and Care Outcomes in Special Care Newborn Unit of Cox’s Bazar District Hospital, Bangladesh

Background: Neonatal morbidity and mortality contribute significantly to under‑five morbidity and mortality. A substantial reduction in neonatal mortality is therefore necessary to achieve the Sustainable Development Goals targets.&#x0D; Aims: Assessed the pattern of neonatal admission and care outcomes.&#x0D; Place and Duration of Study: Special Care Newborn Unit of Cox’s Bazar District hospital, Bangladesh conducted in September 2022.&#x0D; Methodology: Hospital-based retrospective study. Data extracted from the admission register and the records of 3982 newborns admitted between August 2021 and July 2022. Bivariate analysis using the Chi-square test, was performed to determine factors associated with neonatal mortality and p value was set at significant level of 5%.&#x0D; Results: 3982 neonates were admitted, 2426 (61%) were male and 1556 (39%) were female with1071 (27%) from the hospital and 2911(73%) from outside the hospital. Birth asphyxia was the commonest morbidity,49% followed by Low Birth Weight/prematurity (18%) and neonatal sepsis 17%. 3,225 (81.4%) of the neonates admitted survived while 538 (13.5%) died and 203(5.1%) were discharged against medical advice. There was significant association between birth weight, morbidity pattern and mortality p&lt;0.05) with most deaths associated with prematurity/LBW. There was significant association between neonatal mortality and the place of delivery, death among outborn was 16% compared with 7% among inborn (p&lt;0.05) but no significant association between neonatal mortality and gender.&#x0D; Conclusion: There was a high burden of neonatal care at the hospital and majority of causes of neonatal morbidity and mortality were preventable. There is need for holistic approach to pregnancy, delivery and newborn care to reduce neonatal morbidity and mortality in the district.

Morbidity, Mortality Patterns and Factors Associated With Mortality among Neonates Admitted in Wajir County Referral Hospital

Background: Neonatal morbidity and mortality is a global burden despite management measures that has been developed. Approximately 75% of all newborn deaths occur in the first week of life. In 2018 alone, around 2.5 million neonates died globally as a result of preventable causes such as prematurity, complications at birth, infections, and congenital abnormalities. Objective: The objective of the study was to determine neonatal morbidity and mortality patterns, and factors associated with mortality among neonates admitted in Wajir County Referral Hospital. Methodology: A hospital-based retrospective cross-sectional study was conducted among all neonates admitted to the New Born Unit of the WCRH from 01 January 2019 to 31 December 2020. A consecutive sampling technique based on the inclusion criteria was used. A data abstraction tool was used to extract data from the medical records of neonates admitted to the New Born Unit of the hospital. Results: A total of 615 neonates were included in the study. There were 336 (54.6%) male and 279 (45.4%) female neonates. Almost all the deliveries 566 (92.0%) were performed at the health facility with a minority of about 49 (8%) delivered at home. The home deliveries and referrals admissions from tertiary hospitals together were 66 (10.7%). Neonatal morbidity included birth asphyxia 335 (54.5%), neonatal sepsis 144 (23.4%), 57 (9.3%) meconium aspiration syndrome and 52 (8.5%) low birth weight/preterm. Overall mortality in 2019 at the health facility was 45 (12.97%) and in 2020, 35 (13.06%) presenting no significant difference. The deaths that occurred in the first 24 hours of life was 36 (45%). Bivariate and multivariate analysis produced a significant association between the factors associated with neonatal mortality. The multivariate analysis with day of admission (OR 2.872, 95% CI 1.293, 6.375), Sex, (OR 1.02, 95% CI 1.0.627, 1.66) and Birth weight, (OR 0.936, 95% CI 0.423, 2.068) at p&lt;0.05. The logistic regression model was statistically significant, χ2(7) = 20.770, p &lt;0.001. The model explained 27% (Nagelkerke R2) of the variance in discharge outcome and correctly classified 87% of cases. The male gender were 1.02 times more likely to die than females while the place of delivery was 0.572 times likely to result in death. Conclusions: Birth asphyxia was found to be the leading cause of admission, followed by neonatal sepsis and meconium aspiration syndrome respectively. The leading cause of death was birth asphyxia and neonatal sepsis. The mortality rate at the facility was 13%. Neonatal fatality of the newborns admitted to NBU is high in Wajir County. Since majority of the deaths are from preventable causes, this offers chances to improve newborn survival. Key Words: Morbidity, Mortality, Neonates, Asphyxia

Perinatal deaths in Bursa Province, Turkey: an analysis by applying the International Classification of Diseases-perinatal mortality (ICD-PM) system

Objectives: The International Classification of Diseases for Perinatal Mortality (ICD-PM) system is a globally used classification based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Moreover, it focuses on the time of death and maternal conditions. Here, we analyzed perinatal deaths by using the ICD-PM system. Methods: This is a retrospective study, performed between January 1, 2020, and March 30, 2022, in Bursa. Perinatal characteristics and the causes of perinatal deaths were recorded. The perinatal deaths were classified according to the ICD-PM system and descriptives were given. Results: The majority of perinatal death cases (119 cases) occurred in the antepartum period. The leading cause of antepartum deaths was unspecified causes (62.2%) followed by fetal growth disorders (9.3%). A total of 63 (53.7%) mothers were healthy (M5) while 27 (22.7%) mothers had medical or surgical conditions (M4). Acute intrapartum events (33.4%) were the commonest cause of intrapartum deaths followed by unspecified causes (26.6%). When neonatal deaths were analyzed, low birth weight/prematurity constitute 59.6% of neonatal deaths. The largest proportion of mothers was healthy in the intrapartum (40%) while maternal complications of pregnancy (M2) was the most commonest classification for neonatal deaths. Conclusions: ICD-PM is a globally used system for classifying perinatal deaths. The time of perinatal death used in this system provides focus on interventions in perinatal care and it encourages comparison between perinatal care centers. We suggest that we might use resources truly to prevent perinatal deaths in our country by using this system.