Infant Mortality Research Articles

The Impact of Postoperative Albumin Levels on Furosemide Efficacy in Infants with Congenital Heart Disease

Postoperative fluid overload is associated with increased mortality and morbidity in infants with congenital heart disease (CHD). Loop diuretics, such as furosemide, are commonly used to prevent fluid overload in the postoperative period. This study aimed to investigate the effect of postoperative albumin levels on the efficacy of furosemide after surgery in infants with CHD. From 1 January 2017 to 31 December 2022, postoperative albumin levels, total furosemide doses, and three-day postoperative diuresis levels were retrospectively analyzed in 186 patients aged 0–1 years who underwent cardiopulmonary bypass at the Pediatric Intensive Care Unit, Diyarbakır Gazi Yaşargil Training and Research Hospital. Demographic and clinical parameters, along with urine output in the first 6 h, first 24 h, 24–48 h, and 48–72 h postoperatively, were recorded. Patients were divided into two groups based on their albumin levels: normal albumin (≥30 g/dL) and hypoalbuminemia (<30 g/dL). A common protein interaction network for albumin and furosemide was constructed using Cytoscape software (version 3.10.2). Of the 186 patients, 79 (42.5%) were male and 107 (57.5%) were female, with a median age of 97.5 days (range 1–360 days). Furosemide doses were higher in hypoalbuminemic patients on postoperative days 1 and 2 compared to normoalbuminemic patients. On postoperative day 1, hypoalbuminemia was more prevalent in patients with oliguria, whereas normoalbuminemia was significantly higher in patients with normouria and polyuria. Furosemide doses were significantly higher in patients with oliguria than in those with normouria in the first 6 h and lower in patients with polyuria compared to those with normouria. A positive correlation was observed between albumin levels and furosemide efficacy on postoperative day 2. Additionally, a positive correlation existed between albumin levels on postoperative day 1 and urine output in the first 6 and 24 h postoperatively. Furosemide efficacy and urine output were positively correlated in the postoperative period. Mortality risk was significantly higher in hypoalbuminemic patients on postoperative days 1 and 2, as well as in patients with oliguria in the first 6 and 24 h postoperatively. Network analysis revealed that albumin was directly involved in furosemide’s target network, along with six other proteins within the common interaction network. Diuresis levels were significantly lower in hypoalbuminemic patients. We suggest that the effectiveness of furosemide is reduced because it cannot bind to albumin at sufficient levels. The effective management of albumin levels may enhance furosemide efficacy and improve postoperative outcomes in infants with CHD.

Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development.

Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = -6.8, 95% CI: -11.7 to -1.8; and β = -6.3, 95% CI: -10.4 to -2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.

DETERMINE THE POLICY TARGET TO INCREASE INSTITUTIONAL DELIVERY AMONG INDONESIAN FEMALE WORKERS

Introduction: Indonesia continues to face a significant challenge in terms of maternal and infant mortality. The government is working to promote the use of health facilities for childbirth to mitigate maternal mortality. Aim: The study aims to determine the policy target to increase the rate of institutional delivery among female workers in Indonesia. Methods: The study analyzed secondary data from the 2023 Indonesian Health Survey. It conducted cross-sectional research on 30,173 female workers. In addition to institutional delivery as the dependent variable, we examined eight independent variables: residence, age, education, marital status, wealth, insurance, antenatal care (ANC), and parity. The analysis involved bivariate method followed by binary logistic regression in the last stage. Results: Approximately 70.6% of female workers had institutional delivery. Female workers in urban areas were 1.157 times more likely than rural workers to perform institutional delivery (95%CI 1.153-1.161). Three worker characteristics (age, education, and marital status) were related to institutional delivery. Wealthier workers had a greater the possibility of executing institutional delivery. Insured workers were more likely than the uninsured ones to deliver in health facilities. Female workers with adequate ANC were 1.210 times more likely than those with inadequate ANC to execute institutional delivery (95%CI 1.166-1.256). Additionally, women with fewer childbirths had a higher probability of performing an institutional delivery. Conclusion: The policy target to increase institutional delivery was women workers in rural areas who were older, had poor education, were divorced/widowed, were the poorest, had inadequate ANC, were uninsured, and were grand multiparous. Keywords: institutional delivery, institutional birth, maternal health, female worker, public health.

Reproductive Justice &amp; Women’s Human Rights

This paper argues that women must have as much sovereignty over their own bodies, and decisions effecting their health and well-being as men have over theirs. Conditions for reproductive justice are foundational for women’s human rights. Reproductive justice includes access to abortion, and to pre- and post-natal care, decisions regarding the spacing of pregnancies and whether or not to have children, reductions in infant and maternal mortality, and appropriate conditions for the successful and healthful care and raising of children. From this point of view reproductive justice and women’s human rights are intertwined with the abolition of colonialism, neo-colonialism, racism, poverty, and war, and a recognition of women’s full humanity.

Совершенствование маршрутизации в системе расширенного неонатального скрининга для диагностики первичных иммунодефицитов

Expanded neonatal screening (ENS) system is a crucial invention that was aimed at reducing infant mortality by enabling the early detection and treatment of severe and life-threatening conditions. Since its Russia-wide implementation in 2023 ENS had successfully identified hundreds of cases of newborns at risk allowing further timely medical intervention that often happened even at a pre-symptomatic stage. However, further optimization of patient routing algorithms within ENS is necessary in order to enhance the identification of newborns at risk and expedite their diagnosis and treatment. This manuscript focuses on optimizing of the routing algorithms specifically for newborns with suspected adenosine deaminase (ADA) deficiency, a severe form of primary immunodeficiency. Given the unique therapeutic and preventive measures required for these patients, the proposed guidelines expand the criteria for referring newborns for confirmatory diagnostics based on nucleoside metabolism data obtained from tandem mass spectrometry of dried blood spots. These improvements are aimed to the earliest detection and targeted treatment of newborns with ADA deficiency thereby enhancing the overall efficiency of primary immunodeficiency screening in Russia.

Socio-Demographic Determinants of Mortality in Bangladesh: A Time Series Analysis

Understanding the factors influencing the death rate in Bangladesh is essential for effective policy-making and addressing demographic challenges. This study aims to examine both the short-term dynamics and long-term equilibrium relationships between socio-demographic factors and the death rate of Bangladesh over a given period. It focuses on four key factors: adolescence fertility rate (AFR), life expectancy rate at birth, birth rate, and infant mortality rate (IMR). Taking an annual time series dataset from 1975 to 2021 from the World Bank (WB), the study uses the Johansen co-integration test, vector error correction model (VECM), and Granger causality test to analyze the relationships between these factors and death rate. The findings reveal short-term and long-term equilibrium links between the socio-demographic parameters and death rate. A substantial negative correlation exists between death rate and AFR and life expectancy. Additionally, a positive correlation is observed between the death rate and birth rate, and IMR. These findings provide valuable insights for decision-makers to address the death rate in Bangladesh, bridging a research gap and guiding effective socio-demographic policies. International Journal of Statistical Sciences, Vol. 24(2), November, 2024, pp 35-54

Men as Midwifery Professionals: A Scoping Review.

Midwives provide skilled, primary, reproductive, and sexual health care to women, adolescent girls, and infants throughout the perinatal period, promoting health and safeguarding against obstetric emergencies and maternal and infant mortality. In many cultures, midwifery has been a predominantly female profession. However, in emerging research, the proportion of male midwives is growing to augment shortages of female midwives, prompting a need for further research that explores the contributions of male midwives in maternal and child health. The objective of this scoping review was to synthesize key findings from the literature regarding the growing, global workforce of male midwives. Specifically, we aimed to evaluate (1) the temporal nature of the publications, (2) the geographic distributions of the emerging literature, and (3) the key findings regarding male midwives' training and work experiences. We used Semantic Scholar and Google Scholar to identify relevant, peer-reviewed articles using the keywords "gender," "male," "men," "midwifery," and "nurse midwives," that met the inclusion criteria: (1) primary research papers, (2) published in the English language (for ease of understanding by the multinational, interdisciplinary authorship team), (3) explored male midwives' experiences during training/education and working, and (4) published between 2000 and 2023. Papers were excluded if they exclusively focused on females or nurses or other health professionals. Our initial search yielded 57 articles, with an additional nine obtained by reviewing the references. After excluding duplicates and reviewing based on inclusion criteria, 26 papers were included in the scoping review. All 26 articles were published between 2011 and 2023, with the majority (65%, n = 17) of articles focused on populations in the African region (Aims 1 and 2). Key findings (Aim 3) were as follows: 1. Training experiences of male midwives: Compared to other regions, male midwifery students in African, Middle Eastern, and Asian settings reported challenging training conditions, possibly influenced by sociocultural factors and gendered expectations of men in these settings. 2. Pregnant/birthing persons' delivery experiences and gendered preferences for their attending midwife: A significant number of birthing persons would choose female midwives over male midwives for their care, despite acknowledging similar skill sets. However, younger clients, urban residents, and non-traditional men expressed a need for gender equity and greater acceptance of men as midwifery professionals. 3. Professional work environment: Many of the male midwives faced professional challenges, often stemming from societal and professional prejudices, leading to feelings of alienation and marginalization within the midwifery profession. Despite these challenges, they remained dedicated to the profession and felt supported by their family, friends, and coworkers. Male midwives represent a growing proportion of the global obstetric workforce and provide an important contribution to addressing maternal morbidity and mortality. Further attention to providing equitable training opportunities, navigating caregiving within settings with strong cultural and religious influences, integrating cultural, geographic, and religious diversity into the midwifery curriculum, and providing male midwives with mentorship and role model support to grow and sustain their careers are urgently needed for improving maternal and infant health outcomes.

Progressive Status of Antenatal Care Visits in Bangladesh: A Comparison Study

Antenatal care (ANC) visits is a proven way to reduce the maternal as well as infant mortality and WHO recommended four or more ANC visits during pregnancy. This study aimed to observe the progressive status of antenatal care visits (ANC) by exploring the trend of 1+ANC, WHO recommended 4+ANC visits and determine the factors of ANC visits frequency over the periods 2004 to 2018. Data on ANC were taken from Bangladesh Demographic and Health Surveys. This research used descriptive statistics (mean, median and prevalence) to observe the changes (%) of ANC visits. ANOVA, Kruskal-Walis, chi-square (bivariate analysis) test and mixed hurdle negative binomial regression were performed to identify the determinants of ANC visits frequency. The mean and prevalence (%) were increased for ANC over the periods however, 4+ANC visits was much lower than 1+ANC visits across the factors. Poorest rural women who living in Chittagong, Sylhet division had significant negative impacts on increasing the1+ANC visits frequency and are less likely to receive 4+ANC. On the other hand, wealthiest educated women with educated husband in Khulna, Rangpur region having more chances to get 4+ANC visits and positively effects on 1+ANC visits frequency for 2004 to 2018. Pregnancy wanted, Birth order number, and Last birth a C-Section are also the significant variable for 1+ and 4+ ANS. Although 1+ ANC visits have gradually increased in Bangladesh, the progress in achieving 4+ ANC visits has been much slower than expected. Therefore, the government and policymakers should focus their attention and prioritize interventions targeting the specific groups of women identified in this study. International Journal of Statistical Sciences ISSN 1683-5603 Vol. 24(2), November, 2024, pp 55-71

Dissecting the Effect of Public Health Expenditure on Infant and Maternal Mortality: A Case of Nigeria

This study investigates the relationship between government health expenditure and health outcomes in Nigeria from 1980 to 2022. This period was selected to capture the evolving dynamics and recent changes within the health sector. Data were sourced from the Central Bank of Nigeria (CBN) statistical bulletins and World Development Indicators (WDI). Using the Autoregressive Distributed Lagged (ARDL) technique, key findings reveal that neither infant nor maternal mortality rates Granger cause government health expenditure, nor does government health expenditure Granger cause these mortality rates. Additionally, past trends of infant mortality significantly influence current rates, indicating a positive association. The study also finds that increased government health expenditure has a marginally negative effect on infant mortality, reducing it by 0.001 to 0.002 units, although its impact on maternal mortality is statistically insignificant. The findings suggest that while government health spending has a limited effect on reducing mortality rates, the relationship between health inputs and outcomes remains complex. The study underscores the need for adopting advanced healthcare technologies to effectively reduce infant mortality in Nigeria.

Women’s Perspectives on Black Infant Mortality in the United States

Although global neonatal mortality rates have significantly decreased, Black infant mortality in the US continues to be a major issue. This study identifies, assesses, and illustrates women’s views on infant mortality and the resources needed to address the problem. Women of diverse demographic backgrounds were recruited via purposive sampling, with 91 participating. Seventy percent of participants were aged 18 to 39 (n = 64), and forty three percent lived in Indiana (n = 39). Access to care, sleeping issues, supporting breastfeeding, awareness, affordability challenges, healthcare provider factors, and creating sustainable programs and policies to address infant mortality emerged as prominent themes in the data. This study highlights the importance of cultural congruency in addressing maternal and child health issues, emphasizing the need for stakeholder involvement to ensure interventions are acceptable, practical, and sustainable.

Persistent Racial Disparities in US Infant Mortality, 1995-2017

In the United States, black babies are significantly more likely to die at birth than white babies. In order to determine the relationship between the risk of neonatal death and race, this research conduct a national-based study of 89.7 million live singleton births between 1995 and 2017. We assessed whether the racial/ethnic disparity in infant mortality narrowed, persisted, or widened over these years, which coincides with a period of substantial improvements in neonatal care. Our study contributes to a growing literature on racial disparities in infant mortality.

Polygenic Selection and Environmental Influence on Adult Body Height: Genetic and Living Standard Contributions Across Diverse Populations.

We analyzed whole-genome sequencing (WGS) data from 51 populations and combined WGS and array data from 89 populations. Multiple types of polygenic scores (PGS) were employed, derived from multi-ancestry, between-family genome-wide association study (GWAS; MIX-Height), European-ancestry, between-family GWAS (EUR-Height), and European-ancestry siblings GWAS (SIB-Height). Our findings demonstrate that both genetic and environmental factors significantly influence adult body height between populations. Models that included both genetic and environmental predictors best explained population differences in adult body height, with the MIX-Height PGS and environmental factors (Human Development Index [HDI] + per capita caloric intake) achieving an R2 of .83. Our findings shed light on Deaton's 'African paradox', which noted the relatively tall stature of African populations despite poor nutrition and childhood health. Contrary to Deaton's hypotheses, we demonstrate that both genetic differences and environmental factors significantly influence body height in countries with high infant mortality rates. This suggests that the observed tall stature in African populations can be attributed, in part, to a high genetic predisposition for body height. Furthermore, tests of divergent selection based on the QST (i.e., standardized measure of the genetic differentiation of a quantitative trait among populations) and FST (neutral marker loci) measures exceeded neutral expectations, reaching statistical significance (p < .01) with the MIX-Height PGS but not with the SIB-Height PGS. This result indicates potential selective pressures on body height-related genetic variants across populations.

Midwives' perspectives on rural birthing experiences and newborn survival in Ghana

BackgroundAccess to essential and emergency newborn care services remains a challenge in low- and middle-income countries (LMICs), especially in rural and remote areas where various factors increase maternal and newborn vulnerability. The scarcity of midwives on a global scale further strains obstetric and neonatal services, as midwives work at the forefront in many LMICs. In Ghana, neonatal deaths at birth and within 24 h contribute significantly to infant mortality rate, with midwives caring as frontline health workers. However, there is limited exploration of midwives' experiences in managing these situations. This study aimed to unveil the meanings and articulate the experiences of midwives who face newborns with respiratory distress at birth in rural southern Ghana.MethodsInterpretive Phenomenological approach was used to explore thirteen (13) midwives’ experiences of managing newborns in respiratory distress in rural birth settings amidst scare life saving resources, skilled staff shortage and limited advanced health care. The midwives were purposively sampled from the Shai-Osudoku district and data were collected through face-to-face interviews. Content analysis was conducted on the interview transcripts and rich narratives developed in the research report.ResultsRural midwives have limited access to newborn lifesaving equipment, adequate training, skill staff support, and timely advance care for newborns. These issues are driving factors for newborn referral in rural health care, but transportation gaps impede timely advance care delivery. Rural midwives’ inadequate psychosocial support and lack of enabling work environment engender moral distress with emotional burden requiring sustained attention from national leadership, as well as midwifery professional networks and regulatory bodies.ConclusionNewly qualified midwives require sustainable support as they struggle in birth spaces where ethical questions emerge as family members are engaged as support persons in neonatal resuscitation. Future research is needed to investigate Chiefs, Queen Mothers and Community Elders’ engagement in community-based interventions to support timely access to quality care and midwives’ heroic practices of saving maternal/newborn lives in rural Ghana to help achieve SDG 3.2.

Community-Level Strategies for Addressing Disparities in Healthy People 2030 Leading Health Indicators.

The Healthy People 2030 Leading Health Indicators (LHIs) offer a select set of measurable objectives to help community-based organizations focus their efforts to improve health equity and reduce health disparities across the lifespan within the populations they serve. Disparities are observed across LHIs, including infant mortality, maternal mortality, and food insecurity, and reducing these disparities is a key strategy for improving health and well-being for all. This study was designed to answer the following research questions: (1) What programs and initiatives are organizations implementing to address the LHIs of focus - infant mortality, maternal mortality, and food insecurity? (2) How do organizations determine which programs and initiatives they will implement? NORC conducted 9 qualitative interviews with Healthy People 2030 Champions, organizations dedicated to furthering Healthy People goals and objectives, who are working to address disparities within infant mortality, maternal mortality, and food insecurity through a variety of strategies, interventions, and programs. Wraparound services, doula programs, and education and advocacy emerged as common strategies for addressing disparities in maternal and infant mortality. Organizations that are working to reduce household food insecurity and hunger implemented food pharmacies and support participant enrollment in federal food assistance programs. Interviewees shared strategies for determining programs to implement and continued program improvement including assessing community needs, leveraging partnerships, and measuring program success. Healthy People Champion organizations are using several multidimensional strategies to address infant mortality, maternal mortality, and food insecurity in their communities. These strategies, and the community-based organizations that implement them, are critical for addressing disparities in priority health outcomes among the people who have the greatest need. These findings offer insights into how local communities are tackling national priorities and underscore opportunities for more rigorous evaluation to demonstrate progress toward addressing disparities in the LHIs.

Arterial hypertension in pregnant women – diagnosis and features of therapy

Hypertension in pregnancy is one of the most common pathology in the structure of extragenital deseases in pregnant women. Cardiovascular diseases, including strokes, account for approximately half of all cases of maternal mortality. In addition, hypertension and its complications are significant cause of fetal and infant mortality. The prevalence of this pathology increase over the past few decades. Hypertension and its complications significantly worsen the prognosis for both the mother and the fetus and newborn. Hypertension in pregnancy also causes the cardiovascular pathology in the future. Early diagnosis and adequate therapy of hypertension at all stages of preparation and the pregnancy can significantly improve the prognosis for the mother and fetus/newborn, as well as prevent possible cardiovascular diseases and complications in women in the future.

Sepsis Epidemiology and Outcomes in Pediatric Intensive Care Unit of Alkhadra Hospital, Tripoli, Libya

Despite the various interventions and therapies that have been implemented to improve the quality of life for children with sepsis, the prevalence and death rates continue to increase. This issue is a major public health problem that requires the continuous improvement of the guidelines and the identification of new strategies. The aim of the study was to identify the prevalence and outcomes of severe sepsis among children admitted to the Pediatric Intensive Care Unit (PICU). This study was conducted in PICU of Alkhadra Hospital in 2023 as a hospital-based retrospective study. All children who were admitted to the PICU from 2017 to 2022 were included. Data was collected from hospital file records, which included the following: age of patient, gender, comorbidities of patients, and source of admission; origin of sepsis; type of PICU admission; primary site of infection; organ dysfunction present at screening; and patient outcomes. Of the 1284 total admissions to the PICU, 128 patients (9.96%) met the definition of sepsis. Most patients (78.9%) were less than 6 years old. Respiratory problems and congenital malformations were the most common co-morbidities, with reported rates of 18.8% and 10.2%, respectively. The emergency department was the most common source of admission (67.2%). Nearly all patients had good overall performance, whereas (21.1%) of the patients were in a coma. 77.3% discharged during the study, and 22.7% died. Although decreasing the incidence through preventive measures is ideal, early recognition and treatment of sepsis will decrease both short- and long-term complications and related mortality of at-risk infants and children.

Impact of the COVID-19 pandemic on growth determinants in premature neonates: observational study in a secondary health service in Carapicuíba, São Paulo (2020-2023).

Prematurity is a factor that contributes to the increase in infant morbidity and mortality and is associated with factors determining child growth, such as nutritional deficits, mainly during the COVID-19 pandemic. To evaluate the factors determining the growth of premature neonates treated at a secondary health service during the COVID-19 pandemic. Observational retrospective and prospective cohort study of premature patients followed at the follow-up clinic in the municipality of Carapicuíba from February 2020 to December 2023. Through a review of medical records, anthropometric data were collected from birth to corrected gestational age, approximately six months, and nutritional and non-nutritional data with direct or indirect influence on growth. Statistical analysis with tests for quantitative and qualitative variables was carried out with the SPSS Statistics software version 27.0 (SPSS et al., USA). The study analyzed a sample of 302 newborns, predominantly male (51.7%) and classified as moderately preterm (47.4%), with an average gestational age of 32.4 ± 2.8 weeks. Prenatal complications occurred in 59.3% of cases, while neonatal complications, such as extrauterine growth restriction (EUGR, 30.8%) and use of parenteral nutrition (36.1%), were common, with an average hospital stay of 30.2 ± 26.1 days. Most newborns were artificially fed (51%) Moreover, they received multivitamins (71.9%). At six months, the newborns showed healthy growth with an average weight of 6.718.2 ± 1.346.5 g. Multiple linear regression analysis revealed significant associations between EUGR and negative Z scores for weight, length, and head circumference at six months. Complications such as anemia and congenital abnormalities also negatively impacted these scores. Comparatively, the newborns in the group pre-vaccination against COVID-19 had more significant growth at six months and more prevalence of newborns born large for gestational age (LGA), while complications such as gastroesophageal reflux disease and viral bronchiolitis was more common in the post-vaccination group. During the COVID-19 pandemic, non-nutritional factors, especially EUGR, significantly influenced the anthropometry of premature babies. This condition highlighted the need for more effective therapeutic strategies and public health measures to improve the growth and development of premature infants.

A new birth weight chart and optimal birth weight percentiles for predicting infant mortality

Prescriptive BW charts can facilitate discrimination between normal and abnormal birthweight. This study aimed to develop a prescriptive BW chart specific to Asian populations and assess its utility in predicting infant mortality. A retrospective cohort study was conducted using data from Taiwan National Health Insurance Research Database and National Birth Reporting Database. This study included 2 956 475 live-born singleton infants born to healthy mothers with uncomplicated pregnancies in Taiwan from January 1, 2004, to December 31, 2019. BW percentiles were estimated from GA 24–42 weeks by ranking the data in ascending order and calculating the percentile values based on the relative position of each observation within the dataset. Infant mortality rates were calculated for different GA groups, and optimal BW percentile cutoffs for predicting mortality were determined. A total of 2,255,989 infants (77.6%) from low-risk pregnancies were included in the development of the BW chart. Sex-specific BW percentiles were calculated. Optimal cutoff for predicting mortality were identified as follows: below the 22nd percentile or above the 96th percentile for extremely preterm infants (GA: 24–27 + 6 weeks), below the 11th percentile or above the 98th percentile for very preterm infants (GA: 28–31 + 6 weeks), below the 9th percentile or above the 99th percentile for moderately preterm infants (GA: 32–33 + 6 weeks), below the 8th percentile or above the 98th percentile for late preterm infants (GA: 34–36 + 6 weeks), and below the 7th percentile or above the 100th percentile for term infants (GA: > 37 weeks). A prescriptive BW chart was developed using data from a large population of Asian infants from low-risk pregnancies. BW percentiles were determined to predict infant mortality. Clinicians can utilize this approach to provide effective consultations to parents and improve decision-making processes.

Implementation of Health Insurance System in Independent Practice Midwives (Bpm) in the Framework of Maternal and Child Health According to Law Number 40 Year 2004 (Study in Surabaya City)

Abstract Introduction to the Problem: Health is a basic right guaranteed by the Indonesian constitution. The government, through BPJS Kesehatan, seeks to provide access to health services for all, including mothers and children. However, Independent Practitioner Midwives (BPM) often face obstacles in cooperation with BPJS. Purpose/Study Objectives: This study examines the implementation and constraints of the BPM health insurance system according to Law No. 40 of 2004. Design/Methodology/Approach: Primary data was obtained through observation and interviews with independent practicing midwives (BPM) in Surabaya. Secondary data came from legislation and legal literature. The analysis is done qualitatively by integrating empirical data and literature study to get a systematic conclusion. Findings: The health insurance system in independent midwives (BPM) provides access to maternal and child health in accordance with Law No. 40 Year 2004. BPMs are obliged to cooperate with BPJS Health to ensure affordable and quality health services. However, BPMs often face administrative and technical obstacles in establishing cooperation with BPJS, affecting the effectiveness of services.The implementation of the health insurance system in Independent Practitioner Midwives (BPM) in accordance with Law No. 40/2004 has improved access to maternal and child health in Indonesia. BPMs that cooperate with BPJS Health help reduce maternal and infant mortality rates. However, administrative, technical and financial constraints remain. Solutions include simplifying administration, improving facilities, and improving the claims payment system. Paper Type: Research Article

Nonhuman primate models of pediatric viral diseases.

Infectious diseases are the leading cause of death in infants and children under 5 years of age. In utero exposure to viruses can lead to spontaneous abortion, preterm birth, congenital abnormalities or other developmental defects, often resulting in lifelong health sequalae. The underlying biological mechanisms are difficult to study in humans due to ethical concerns and limited sample access. Nonhuman primates (NHP) are closely related to humans, and pregnancy and immune ontogeny in infants are very similar to humans. Therefore, NHP are a highly relevant model for understanding fetal and postnatal virus-host interactions and to define immune mechanisms associated with increased morbidity and mortality in infants. We will discuss NHP models of viruses causing congenital infections, respiratory diseases in early life, and HIV. Cytomegalovirus (CMV) remains the most common cause of congenital defects worldwide. Measles is a vaccine-preventable disease, yet measles cases are resurging. Zika is an example of an emerging arbovirus with devastating consequences for the developing fetus and the surviving infant. Among the respiratory viruses, we will discuss influenza and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We will finish with HIV as an example of a lifelong infection without a cure or vaccine. The review will highlight (i) the impact of viral infections on fetal and infant immune development, (ii) how differences in infant and adult immune responses to infection alter disease outcome, and emphasize the invaluable contribution of pediatric NHP infection models to the design of effective treatment and prevention strategies, including vaccines, for human infants.