Low Birth Research Articles

Predicting Productive Performance in Grow-Finisher Pigs Using Birth and Weaning Body Weight.

Simple SummarySmaller than average sized pigs requiring extra time to reach target slaughter weight are often referred to as slow growing pigs. This subset of pigs poses a management challenge and may have economic implications for pig producers. The aims of this study were to investigate the effect of birth and weaning body weight on performance of grow-finisher pigs and to estimate cut-off values for birth and weaning body weight in order to identify slow growing pigs early in life. Pigs with low birth and weaning weight grew slower compared to pigs with higher birth or weaning weight, although feed conversion efficiency was similar for both groups. Pigs weaned at approximately 28 days weighing less than 3.7 kg would be identified as slow growing pigs within a batch. Moreover, a cut-off value of 1.1 kg of body weight at birth and 6.4 kg of body weight at weaning would allow pig producers to identify the pigs that are likely to reach target slaughter weight at 22 weeks of age. In conclusion, birth body weight does not always determine subsequent growth performance, and the cut-off values identified could be used on farm to design new management and nutritional strategies for slow growing pigs.This study aimed to (1) investigate the effect of birth and weaning body weight (BW) on performance indicators of grow-finisher pigs and (2) estimate birth and weaning BW cut-off values in order to identify slow growing pigs (SGP). Pigs (n = 144) were classified as SMALL (0.9 ± 0.13 kg) or BIG (1.4 ± 0.20 kg) at birth and re-classified as SMALL (5.4 ± 1.6 kg) or BIG (6.3 ± 1.91 kg) at weaning. Individual BW was recorded bi-weekly, and feed intake was recorded on a daily basis. Average daily gain (ADG) and feed intake, feed conversion ratio (FCR) and days to target slaughter weight (TSW) were calculated. SMALL–SMALL pigs had lower ADG (p < 0.05) requiring 167.1 days (i.e., 14.2 extra days) to TSW (p < 0.05) compared with BIG pigs at birth and/or weaning. However, FCR was similar between groups (p > 0.05). Pigs weaned at <3.7 kg BW would likely be SGP. Pigs born at ≥1.1 kg BW or weaned at ≥6.4 kg BW are more likely to reach TSW at 22 weeks of age. The results suggest that birth BW might not be the best predictor for subsequent performance, as some small-born pigs were able to catch up with their bigger counterparts. The cut-off values identified could be used to design specific management and nutritional strategies for SGP.

Congenital dengue in a Saudi neonate: A case report

Dengue fever is a mosquito-borne viral illness with 100 million new cases occurring worldwide. The vectors involved are mainly Aedes aegypti and Aedes albopictus. Dengue infection is associated with maternal as well as fetal morbidities, like stillbirth, preterm birth, and low birth weight. We report a case of dengue fever occurring during early pregnancy and subsequent congenital neurologic malformation in the neonate as a result of vertical transmission. To our knowledge, this is the first case of confirmed congenital dengue in Saudi Arabia. Dengue infection is not commonly associated with congenital anomalies and no biologic mechanism has yet been established for its teratogenicity. Congenital dengue in neonates can be confirmed by identification of the dengue virus in cord blood samples. The positive dengue serology within the first week of life, together with the confirmed maternal dengue infection during pregnancy, supports the diagnosis of vertical transmission in the presence of clinical manifestations. A high index of suspicion, early diagnosis, and close monitoring is needed in these cases.

The impacts of pill contraceptive low-dose on plasma levels of nitric oxide, homocysteine, and lipid profiles in the exposed vs. non exposed women: as the risk factor for cardiovascular diseases

BackgroundConsuming oral contraceptive pills is one of the methods for preventing pregnancy worldwide. As using the pills has always caused the greatest concern for the likelihood of developing cardiovascular diseases and also given the limited conducted studies in this regard, this study was carried out to determine the impacts of low dose birth control pills on plasma levels of nitric oxide, homocysteine, and lipid profiles in the exposed vs. non exposed women as the risk factors for cardiovascular diseases.MethodsThis was a combined cohort study conducted on 100 women, having the age range 20–35 years and normal menstrual cycles, referred to the health care centers in Yazd, Iran. The demographic data were obtained through face to face interviews performed by the researcher. Anthropometric indexes were measured and biochemical factors were determined by testing blood samples. Then, using SPSS 16 and statistical independent t-test and Chi- square, the data were analyzed.ResultsThe mean ± standard deviations of plasma levels of homocysteine, nitric oxide, cholesterol, triglyceride, Low Density Lipoprotein, and High Density Lipoprotein levels in the group consumed low dose contraceptive pills were 3.84 ± 2.35 μmol/l, 181.36 ± 90.44 μM, 180.7 ± 38.28 mg/dl, 129.82 ± 47.92 mg/ dl, 101.42 ± 30.66 mg/dl, and 56.46 ± 8.42 mg/dl, There were significant statistical differences between those consuming the pills and those not consuming the pills regarding cholesterol (P < 0.05).ConclusionConsuming Low Dose contraceptive pills can increase the plasma levels of cholesterol, triglyceride, and Low Density Lipoprotein levels; i.e. this condition is called dyslipidemia. On the other hand, there were no changes in the levels of homocysteine and nitric oxide in the healthy women consuming the pills; therefore, the pills may not develop cardiovascular diseases in healthy women. Accordingly, it is recommended that the health care providers prescribe the pills for the women with cautions.

Investigating the Association Between Using Night Braces and Sleep Habits of Children with Cerebral Palsy and Parental Quality of Life

To examine the sleep habits of children with cerebral palsy (CP) and use of night braces and to investigate their association with parental quality of life. The study included 114 children aged 3–6 (57 with typical development (TD) and 57 with CP). The children with CP were grouped according to the Gross Motor Function Classification System (GMFCS) and night brace use (NBU). “Children’s Sleep Habits Questionnaire-Abbreviated Form” and “Short-Form Health Survey” were used to investigate the children’s sleep habits and the parents’ quality of life, respectively. Results were compared for children with CP and TD, and for NBU and non-use (NNBU) in children with CP. All children had sleeping problems, but night waking was more prevalent among children with CP (p 0.05). The quality of life of the parents of children with CP and TD was significantly different (p < 0.05). NBU children with CP had lower birth weeks. NBU neither caused sleeping problems in children with CP nor impaired their parents’ quality of life and general health.

The Feasibility of All-Blastocyst-Culture and Single Blastocyst Transfer Strategy in Elderly Women: A Retrospective Analysis.

Objective To investigate the feasibility and clinical outcome of the all-blastocyst-culture and single blastocyst transfer strategy in women aged ≥35 years. Methods A retrospective analysis of patients aged ≥35 years undergoing IVF/ICSI was performed from January 2017 to April 2019 in the reproductive center of the Second Affiliated Hospital of Wenzhou Medical University. A total of 155 cases treated with ovarian hyperstimulation by prolonged protocol and implemented single (84 cases) or double (71 cases) blastocyst transfer were collected. Then, patients were further divided into <38 yr. group and ≥38 yr. group, and the laboratory and clinical outcomes were compared between the groups. Results The double-blastocyst-transfer (DBT) group showed higher clinical pregnancy rate and multiple pregnancy rate and lower neonatal birth weight than those in the single-blastocyst-transfer (SBT) group (P < 0.05). However, there were no statistically significant differences between the groups in the embryo implantation rate, biochemical pregnancy rate, miscarriage rate, preterm delivery rate, and term birth rate. For patients < 38 yr., SBT significantly reduced the multiple pregnancy rate and increased the neonate birth weight without significant reduction in the clinical pregnancy rate. While in the ≥38 yr. group, there are no differences in pregnancy outcomes between SBT and DBT. Logistic regression analysis showed that the number of MII oocytes was positively correlated with the live birth rate (OR = 1.18) and negatively correlated with the miscarriage rate (OR = 0.844), suggesting that elderly patients with relatively normal ovarian reserve would obtain better prospect in pregnancy. The number of fetal heart beat in pregnancy was negatively correlated with the live birth rate (OR = 0.322) and positively correlated with the preterm birth rate (OR = 7.16). Conclusion The strategy of all-blastocyst-culture and single blastocyst transfer is feasible, safe, and effective for elderly patients with normal ovarian reserve, which would reduce the multiple pregnancy rate.

Delivery of cesarean section tends to reduce umbilical zinc levels in healthy newborns

Background: Indonesia is estimated to be among countries with deficiencies in zinc intake. Zinc deficiency increase the risk of immune deficiency, preterm birth, retarded fetal growth, duration of infection healing, and stunting. Umbilical cord zinc levels can reflect zinc levels of newborns. Research on newborn zinc in Indonesia is still limited.Objective: Look for factors related to zinc levels of the newborns umbilical cord. The factors studied included maternal/newborn characteristics, and mode of delivery.Methods: A Cross sectional study of 88 healthy newborns at term pregnancy with their healthy mothers. Zinc samples were taken from cord blood immediately after birth. Measurement of zinc levels with Atomic Absorption Spectrophotometer. Chi-Square test was used to prove the relationship between low zinc levels (&lt; 65μ/dl) with characteristics of both mother and newborn. The Mann-Whitney test was used to prove differences in zinc levels between groups according to characteristics, mode of delivery, and birth weight. Software SPSSstatistic 21.Results: There was no significant relationship between mother and newborn characteristics with low umbilical cord zinc levels (&lt;65μg/dl), with a p value &gt; 0.05. There was a significant difference in mean umbilical cord zinc levels between the two groups (p=0.015), that cesarean section delivery had a mean rank of lower zinc levels (41.5μg/ dl) median 79.8 (min.50.9-max.140.3 μg/dl) compared to spontaneous vaginal delivery (59.3μg/dl) median 97.7 (min.57.6-max.132.9μg/dl). Umbilical cord zinc levels from 2500 - &lt; 2800 g birth weight group have lower mean rank (37.7μg/dl) compared to 2800 - 3900 g birth weight group (48.2μg/dl), with a p value = 0.028.Conclusions: There is a tendency to decrease zinc levels in healthy newborns from cesarean delivery. Decreased zinc levels in healthy newborns may cause lower birth weight.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 298-304

Endometrial Thickness and IVF Cycle Outcomes: A Meta-analysis

Abstract Research question In this meta-analysis, the association between endometrial thickness (EMT) and cycle outcomes after IVF is explored. Associations between EMT and cycle outcomes according to study and individual characteristics were also assessed. Design Studies evaluating associations between EMT and pregnancy, implantation, miscarriage, live birth or ongoing pregnancy and ectopic pregnancy rates in individuals after IVF were identified on PubMed, Embase and the Cochrane Library (from their inception up to December 2018). Pooled odds ratios with 95% confidence intervals, calculated using the random-effects model, were used. Results Nine prospective and 21 retrospective studies, including a total of 88,056 cycles, were retrieved. The summary odds ratios indicated that women with lower EMT were associated with lower pregnancy rates than those with higher EMT (n = 30, OR 0.61; 95% CI 0.52 to 0.70; P Conclusions Lower EMT was associated with lower pregnancy, implantation and live birth or ongoing pregnancy rates.

Prevalence of herpes simplex virus type 2 antibodies among pregnant women attending Federal Teaching Hospital, Ido-Ekiti, Nigeria

Herpes simplex virus type 2 (genital herpes) is mostly asymptomatic except if the immune system is compromised. However, infections could lead to preterm delivery, low infant birth weight, still birth, hydrops, cystic brain degeneration, and fetal growth retardation. Record of the prevalence of the viral infection is scanty among pregnant women in Ekiti State, Nigeria. This study was conducted to determine the prevalence of herpes simplex virus type 2 antibodies among pregnant women attending Federal Teaching Hospital Ido-Ekiti. Structured questionnaires were administered to obtain information such as age, incidence of miscarriages, marital status and number of pregnancies among the women who were examined. Ninety (90) pregnant women were examined for the presence of herpes simplex virus type 2 (HSV-2) IgG and IgM antibodies using enzyme linked immunosorbent assay (ELISA) technique. Prevalence of HSV-2 IgG and IgM antibodies among pregnant women was 64.4 % and 2.2 % respectively. A significant (p0.05) difference between the prevalence of HSV-2 IgG antibody across age ranges, number of miscarriages, marital status and number of pregnancies. There may be need for antenatal screening of pregnant women for this virus in Ekiti State and perhaps generally in pregnancy to rule out the presence of genital herpes. With the risk of infection to fetus in mind, health policy makers may campaign against genital herpes to avert transmission of the virus to fetus before birth or after child birth.

The risk of twin pregnancies should be minimized in patients with a unicornuate uterus undergoing IVF-ET

Unicornuate uteri are associated with infertility, miscarriage, preterm delivery and even uterine rupture. The aim of this research was to investigate the effects of unicornuate uterine anomaly on twin pregnancies after in vitro fertilization-embryo transfer (IVF-ET). A total of 206 women with unicornuate uteri (A singleton, B selective reduction (SR) of twins to a singleton, C twins) and 314 women with normal uteri (D SR of twins to a singleton, E twins) who delivered at ≥22 weeks were included. C was associated with a significantly lower live birth rate (adjusted odds ratio (aOR) 0.08, 95% confidence interval (CI), 0.01–0.69) and higher risks of preterm delivery (aOR 11.63, 95% CI, 4.85–27.92), perinatal mortality (aOR 11.43, 95% CI, 1.44–90.57) and low birth weight (aOR 5.92, 95% CI 1.94–18.06) than A, a 15-fold greater risk of preterm delivery (aOR 15.54, 95% CI 3.09–78.28) than B and a greater risk of preterm delivery (aOR 2.76, 95% CI 1.33–5.73) than E. After SR to a singleton, the perinatal outcomes were statistically similar between B and D. These results showed that the risk of twin pregnancies should be minimized in patients with unicornuate uterine anomaly undergoing IVF-ET.

İzole ve Komplike Kolestazlı Gebe Kadınların Perinatal Sonuçlarının Karşılaştırılması

Abstract Introduction: Intrahepatic cholestasis in pregnancy encounters the risks of increased development retardation, preeclampsia and gestational diabetes. The aim of our study is to compare the perinatal outcomes in women diagnosed with isolated cholestasis or with cholestasis complicated with accompanying diseases. Material and Method: In our studies performed in a tertiary center, women applying to the antenatal clinic and diagnosed with cholestasis within a period of 2 years. Women with additional diseases were included in group 1, and those with isolated cholestasis were included in group 2. Maternal characteristics, laboratory results and perinatal outcomes were compared between these two groups. Findings: Cholestasis was found in 117 pregnant women in the 25101 births given within the study period (0,46%). Of these, cholestasis picture was found mild in 57 (48,8%), medium level in 38 (32,4%) and serious in 22 (18,8%). ICP (intrahepatic cholestasis of pregnancy) was found as isolated in 79 of these women (59%), of the remaining women, 38 had comorbidities (32,4%), 10 ha gestational diabetes (8,5%), 11 had preeclampsia (13,6%), and 21 had intrauterine growth retardation (17,9%). Meconium-stained amniotic fluid and premature labor rate were higher in pregnant women with determined cholestasis, and therefore, birth weeks and birth rate were lower. In the follow-up, the rates of the highest liver enzymes and fasting bile acid values, lower birth weeks, meconium-stained amniotic fluid and admission of the neonatal in the neonatal intensive care unit were found higher in pregnant women with complicated cholestasis as compared to the pregnant women with isolated cholestasis. Conclusion: Perinatal mortality and morbidity were found higher in pregnant women with cholestasis complicated with accompanying additional diseases. Therefore, closer follow-up and early termination of pregnancy can be proper in this complicated subgroup.

Anemia among 6 - 59 months children in a rural area of Bareilly district: a cross sectional study

Background: Anemia is a global health problem affecting mostly in developing countries. Iron deficiency anemia is a significant health problem and especially in developing countries. It’s the most neglected micronutrient deficiency disorder among under-five children. The objective of the study was to assess the prevalence and determinants of anemia among under-five children and to suggest suitable remediable measures to prevent and control of anemia.Method: This is a cross-sectional study. Household survey carried out in twelve villages in a rural practice area Dhaura, Bareilly. A total of 396 children were contacted for obtaining blood samples by taking 33 children from each village. Blood samples were taken from all children between the 6th month to 59 months of age using simple random sampling. After the collection, data will be analyzed using the SPSS software version 20.Result: A total of 47.5% of the children were found to have anemia. Among them 25.5% had mild, 63.3% had moderate and 11.2% had severe anemia. The majority of them were male 269 (67.9%). The mean age of participating children was 17.351±7.785 months. 48.2% of anemic children were low birth weight.Conclusion: High prevalence could be due to deficiency in iron nutrition among under-five children associated with poor food availability, due to lack of nutritional education and other sociodemographic conditions, child’s age and worse household conditions also contributed to the prevalence of anemia.

Does Placental Weight Affects Perinatal Outcome? A Prospective Case-control Study

Background: Placenta plays a very important role in the growth and development of fetus. Objective: To know the correlation between placental weight and perinatal outcome in term antenatal women. Methods: Present prospective case-control study was conducted in the rural tertiary center of Northern India over one year (January-December 2018) on 1,118 term (≥37-≤42 weeks) antenatal women with singleton pregnancy fulfilling inclusion criteria with 559 women with high-risk pregnancy as cases and 559 low-risk pregnant women as controls. Placental weight, birth weight was measured immediately after delivery and compared between the two groups along with gestation, parity, fetal gender, and neonatal outcome. Statistical analysis was done using SPSS 22 version. Results: Mean placental weight [481.98±67.83 gm vs. 499.47±59.59 gm (p=.000)] and birth weight [2.68±0.53 Kg vs. 2.88±0.4 Kg (p=.000)] was significantly lower in high risk as compared to lowrisk participants, whereas placental birth weight ratio was higher in high-risk cases [18.35±2.37 vs. 17.41±1.38 (p=.000)] respectively. Placental weight was positively correlated with birth weight and placental weight and birth weight increased with increasing gestation in both cases and controls. Male neonates had higher placental weight [492.74±68.24 gm vs. 488±58.8 gm (p=0.224)] and birth weight [2.81±0.5 Kg vs. 2.74±0.45 Kg (p=0.033)] as compared to females. Neonatal Intensive Care Unit admission was significantly associated with low placental and birth weight (p=.000). Conclusion: There is a significant correlation between placental weight, birth weight and neonatal outcome, hence placental weight can be used as an indirect indicator of intrauterine fetal growth.

Characteristics of Amino Acid, Micronutrient and Probiotic Isolated from Dadih and Their Benefits for Pregnant Mothers and Outcomes in West Sumatra, Indonesia

Dadih is a traditional fermented buffalo milk consumed by the Minangkabau people in West Sumatera Province, Indonesia, especially in Bukittinggi, Padang Panjang, Solok, Lima Puluh Kota, and Tanah Datar districts. The objective of this study was to identify amino acid and strain of acid lactic bacteria isolated from dadih and to evaluate the benefit of dadih intervention during pregnancy on the nutritional status of an infant&amp;#39;s birth. This study was initiated with DNA extraction from bacterial cultures, Ribosomal DNA amplification, and sequencing, analysis of amino acid using UPLC. The intervention was conducted in two districts on 138 pregnant mothers for 6 months. A prospective cohort study was conducted on a follow up of a previous randomized controlled trial. This study was conducted in two districts in West Sumatera Province from April 2018 to July 2019. Spontaneous probiotic species of dadih strain were identified in this study: Lactobacillus Plantarum, Lactobacillus casei, Lactobacillus durans, Leuconostoc pseudo mesentoroides, and Lactobacillus cactis. Glutamic acid was the highest quantity of non-essential amino acid in dadih (16.28 mg/g), while Lysine and Leucine were the highest essential amino acids (7.22 and 6.42 mg/g). The study revealed that after a 6-month intervention, about 66.7% of infants birth weight &amp;gt; 3000 grams and only 2.1% of infants having birth weight &amp;lt; 2500 grams for Dadih Group and about 60.0% had infant birth weight &amp;gt; 3000 grams and 4.4% infants with low birth in Control Group. The result of this study shows that there are more benefits in pregnant mothers&amp;#39; weight gain and infants&amp;#39; birth weight until a six-month follow up from pregnant mothers in Dadih Group than Control Group. The results of the follow-up study show that infants from mothers supplemented with Dadih Zinc Group have significantly less undernutrition status as compared to the Control Group (p&amp;lt;0,05). The results also show that dadih has a sufficient amount of protein to fulfill the nutritional need for pregnant mothers and the outcomes.

Outcomes of twin neonates and association with chorionicity and modes of conception

Objective To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates. Methods This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods. Results Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups. Conclusions The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones. Key words: Pregnancy, twin; Pregnancy outcome; Premature birth; Infant, newborn, diseases; Incidence; Fertilization in vitro; Embryo transfer

Determinants of anaemia among children aged under-five years in Meghalaya, India

Childhood anaemia poses serious threats to public health and may impair growth, cardiac function and cognitive and physical development. It also causes increased susceptibility to infections. Statistical analysis was performed on the cross-sectional data of 2957 children from 2015-2016 National Family Health Survey (NFHS-IV), using binary logistic regression model, to assess the significance of some risk factors of child anemia. Anemia was diag-nosed by WHO cut-off points on hemoglobin level. The mean haemoglobin concentration was 114.19 g/dl (95% CI, 113.55-114.83) with the prevalence of child anaemia as 60.4% in Meghalaya. Of the 7 districts in Meghalaya (as per the seven-district classification used in NFHS-4), the highest prevalence was found in West Garo Hills (70.4 per cent), followed by Ri- Bhoi (67.7 per cent) and East Garo Hills (66.4 per cent) and the least prevalence was found in East Khasi Hills (45.6 per cent). The results of binary logistic risk factors showed higher likelihood of anaemia for lower age groups and higher birth orders (p &lt;0.05).

Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis.

Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes. To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana. A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider's perspective. Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched. TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana. Authors received no external funding for the study.

Safety of MenACWY-CRM vaccine exposure during pregnancy

BACKGROUND Although the meningococcal conjugate MenACWY-CRM vaccine is not approved for use in pregnant women, unintentional exposure during pregnancy can occur, especially during early pregnancy among women of child-bearing age. This study provides safety information about inadvertent MenACWY-CRM vaccination during pregnancy. METHODS The evaluated population consisted of pregnant female members of Kaiser Permanente Southern California who inadvertently received MenACWY-CRM at 11-21 years of age during 09/30/2011-06/30/2013 within 28 days prior to conception or during pregnancy. Chart abstraction was conducted to identify pregnancy and birth outcomes, including spontaneous and induced abortions, preterm births, low weight births, and major congenital malformations (MCMs). RESULTS There were 92 women who received MenACWY-CRM during the pregnancy exposure period, mainly during the first trimester (76.1%). Hispanics represented the largest race/ethnicity category (68.5%). Among the known pregnancy outcomes (n = 66; excluding induced abortions and unknown pregnancy outcomes), the prevalence of spontaneous abortions was 18.2% (n = 12). Among live born infants (n = 55; from 54 pregnancies), 14.5% (n = 8) were born preterm (<37 weeks gestation) and 9.1% (n = 5) had a low birthweight (<2500 g). The prevalence rate of MCMs among live born infants (n = 55) was 1.8% (n = 1). CONCLUSIONS This study provides baseline prevalence estimates of spontaneous abortions, preterm births, low weight births, and MCMs among women inadvertently exposed to MenACWY-CRM during the pregnancy period. These estimates appear to be comparable with U.S. background prevalence estimates.

저출산·고령화 시대의 중등학교 죽음교육 현황과 과제 : 불교종립학교를 중심으로*

저출산·고령화 시대의 중등학교 죽음교육 현황과 과제 : 불교종립학교를 중심으로*

Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery

BackgroundTo compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight.MethodsOne hundred and ninety-four CHD children, aged 6 months to 2 years, weighting 5 to 10 kg, were selected for this study. The 94 boys and 100 girls with the American Society of Anesthesiologists (ASA) physical status III and IV were randomly divided into two groups each consisting of 97 patients, and were subjected to ultra-fast-track and conventional anesthesia for cardiac surgery. For children in UFTA group, sevoflurane was stopped when cardiopulmonary bypass (CPB) started and cis-atracurium was stopped at the beginning of rewarming, and remifentanil (0.3 μg/kg/mim) was then infused. Propofol and remifentanil were discontinued at skin closure. 10 min after surgery, extubation was performed in operating room. For children in conventional anesthesia group, anesthesia was given routinely and they were directly sent to ICU with a tracheal tube. Extubation time, ICU stay and hospital stay after operation were recorded. Sedation-agitation scores (SAS) were assessed and adverse reactions as well as other anesthesia –related events were recorded.ResultsThe extubation time, ICU stay and hospital stay were significantly shorter in UFTA group (P < 0.05) and SAS at extubation was lower in UFTA group than in conventional anesthesia group, but similar in other time points. For both groups, no airway obstruction and other serious complications occurred, and incidence of other anesthesia –related events were low.ConclusionsUFTA shortens extubation time, ICU stay and hospital stay for children with CHD and does not increase SAS and incidence of adverse reactions.

The study of Wilson disease in pregnancy management

IntroductionPregnancy management in women with Wilson disease (WD) remains an important clinical problem. This research was conducted to investigate how to avoid worsening of WD symptoms during pregnancy and increase pregnancy success in women with WD by identifying the best pregnancy management approaches in these patients.Patients and methodsThe clinical data of 117 pregnancies among 75 women with WD were retrospectively analyzed. Related information of the fetus was also recorded and analyzed. At the same time, regression analysis was performed for data of 22 pregnant women without WD, as normal controls.ResultsOf a total of 117 pregnancies among the 75 women with WD and 31 pregnancies among the 22 control womenincluded in this study, there were 108 successful pregnancies and 9 spontaneous abortions. Among the 108 successful pregnancies, 97 women a history of copper chelation therapy before pregnancy; all 97 women stopped anti-copper therapy during pregnancy. The nine women with spontaneous abortion had no pre-pregnancy history of copper displacement therapy. The incidence of lower limb edema was higher in the WD group than in normal controls (P = 0.036). Compared with the control group, there was a higher proportion in the WD group of male infants (P = 0.022) and lower average infant birth weight (t = 3.514, P = 0.001).ConclusionIt is relatively safe for women with WD patients to become pregnant. The best management method for pregnancy in women with WD may be intensive pre-pregnancy copper chelation therapy and no anti-copper treatment during pregnancy.