Low Birth Weight Neonates Research Articles

Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds.

Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re-emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre- and post-fortifier inclusion. Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10-14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1-6 based on increasing solidification. Lower gestational age was correlated with more solid contents on the pre-fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non-rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94-0.99) on still images. This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non-rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non-irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.

Perception and Practices Related to Breast Milk Donation and Acceptance among Donor and Recipient’s Mothers of a Breast Milk Bank at a Tertiary Care Hospital in South India

Background: Human Milk Banks (HMB) ensure the availability of pasteurized donor breast milk for small forgestational age babies, low birth weight infants, sick new born and infants of mothers with failed lactation.Objectives: To assess the perception, practices and associated factors of breast milk donation and acceptanceamong donor and recipient’s mothers registered with the breast milk bank.Methodology: This hospital based cross-sectional study was conducted between July to September 2019 among70 donors and 70 beneficiaries who were mothers of children under 6 months of age, registered at the breast milkbank at a tertiary care hospital in Chennai. Data was collected by interview of the mothers with a predesignedsemi-structured questionnaire.Results: Only 74% of them were aware of breast milk bank services. Almost 47 (67.1%) had received more thantwice from breast milk bank. Proportion of recipient’s mothers who had complications during their delivery andproportion of children who were treated in NICU were significantly higher among the recipients (p &lt; 0.001).Conclusion: Awareness on breast milk bank services is required especially among the mothers of prematurebabies, low birthweight neonates, and newborn receiving treatment in NICU.

Effect of low-cost kitchen with improved cookstove on birthweight of neonates in Shahjadpur, Bangladesh: a cluster-randomised controlled trial

Smoke from biomass fuels used for cooking in traditional cookstoves contains a variety of health-damaging pollutants. Inhalation of these pollutants by pregnant women has been linked to abnormal foetal development and adverse pregnancy outcomes, including low birthweight (LBW). There is a dearth of data on environmental interventions that have the potential to reduce exposure to biomass fuel during pregnancy and improve birth outcomes. International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) therefore, designed a low-cost kitchen with an improved cookstove and examined the impact of this intervention on the birthweight of neonates. icddr,b conducted a cluster-randomised controlled trial of a 'low-cost kitchen with improved cookstove' intervention among 1,267 pregnant women who used traditional cookstoves in a rural sub-district of Bangladesh. All participants were enrolled during the first trimester of pregnancy among 104 randomly selected clusters after obtaining informed consent. The model kitchens were installed in 628 participants' households of the intervention group, and 639 participants continued to use traditional cookstoves as the control group. The primary outcome was the proportion of LBW neonates between the intervention and control groups. The study also examined if the intervention would reduce CO exposure, measured by the differences in maternal blood carbon monoxide saturation (SpCO) levels and prevalence of LBW in neonates. We performed a generalized structural equation model for jointly assessing the simultaneous relationships of biomass fuel exposure to LBW of neonates and the relationships of LBW of neonates to maternal blood SpCO level. This trial was registered with ClinicalTrials.gov (NCT02923882). We found that in the intervention group using 'low-cost kitchen with improved cookstove', the risk of LBW reduced by 37% (adjusted risk ratio: 0.63, 95% CI [0.45, 0.89]). Between the second and third trimester, the mean maternal blood SpCO level was significantly reduced from 10.4% to 8.9% (p-value <0.01) in the intervention group but remained unchanged in the control group (11.6% and 11.5%). Of the total effects of the intervention on the risk of LBW, 48.3% was mediated through maternal blood SpCO level. The risk of LBW among rural neonates was reduced in the intervention group using 'low-cost kitchen with improved cookstove', which may be attributed to the reduction in maternal blood SpCO level. Additional research is needed to identify other mechanisms through which biomass fuel exposure might lead to adverse pregnancy outcomes. Grand Challenges Canada: Rising Stars in Global Health Programme.

Evaluation of the Predictors of Mortality in Very Low Birth Weight Neonates in Neonatal Intensive Care Unit – A Hospital-based Prospective Observational Study

Abstract Introduction: Very low birth weight (VLBW) neonates are defined by birth weight ≤1500 g. They constitute 4%–7% of all neonates but contribute &gt;30% of all neonatal deaths. Assessment of factors predicting mortality in such infants, both maternal and neonatal, can help us prioritize our resources and improve our health structure. Aim: The aim was to study factors affecting neonatal mortality in VLBW neonates in the neonatal intensive care unit (NICU). Materials and Methods: This hospital-based prospective observational study was conducted on neonates ≥26 weeks and birth weight ≤1500 g admitted in the NICU. Predesign structured pro forma was made for history and data collection. Detailed antenatal and natal history was taken, neonates were examined along the course of treatment, and the outcome was recorded in the form of discharge and death. All tests were performed at a 5% level of significance; thus, an association was significant if P &lt; 0.05. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. Results: One hundred newborns were enrolled, of which 32 expired. Respiratory distress syndrome followed by sepsis was the major cause of death. Univariate analysis showed that primigravida, history of premature rupture of membrane, anemia, meconium-stained liquor, maternal fever, use of antenatal steroids, fetal distress, resuscitation requirement, gestational age, Apgar score, need for surfactant, and delayed capillary refill time were found to be directly linked with neonatal mortality. On multivariate analysis, requirement of resuscitation (P = 0.001), gestational age ≤30 weeks (P = 0.032), the need for surfactant (P = 0.036), anemia (P = 0.019), maternal fever (P = 0.003), use of antenatal steroid (P = 0.031), and fetal distress (P = 0.02) were found to be significant predictors of neonatal mortality. Conclusions: Most of the predictors can be managed by following proper treatment protocols and implementing newer policies. Therefore, emphasis should be given to prevention, early anticipation, and management of these predictors and building better health infrastructure.

Time to Reach Full Enteral Feeding and Its Predictors among Very Low Birth Weight Neonates Admitted in the Neonatal Intensive Care Unit: A Follow-Up Cohort Study.

Feeding is crucial for very low birth weight neonates to grow and develop properly. This study aims to determine the time to achieve full enteral feeding and predictors among neonates admitted at Felege Hiwot Comprehensive Specialized Hospital. An institutional retrospective follow-up study design was conducted among 332 very low birth weight neonates from July 1, 2018, to June 30, 2021. Samples were selected through a computer-generated simple random sampling method, and the data were entered into Epi data version 4.6 and then exported to STATA version 16 for analysis. Kaplan-Meier with the log-rank test was used to test for the presence of difference in survival among predictor variables. Model goodness of fit and assumptions were checked by the Cox-Snell residual and the global test, respectively. Variables with p value <0.25 in the bi-variable analysis were fitted to the multivariable Cox-proportional hazard model. Finally, the adjusted hazard ratio (AHR) with 95% CI was computed, and variables with a p value less than 0.05 in the multivariable Cox regression analysis were considered significant predictors of time to reach full enteral feeding. A total of 332 neonates were followed for 2,132 person days of risk time and 167 (50.3%) of very low birth weight neonates started full enteral feeding. The overall incidence rate of full enteral feeding was 7.8 per 100 person day observations. The median survival time was 7 days. Very low birth weight neonates delivered from pregnancy-induced hypertension-free mothers (AHR: 2.1; 95% CI: 1.12, 3.94), gestational age of ≥33 weeks (AHR: 5,; 95% CI: 2.29, 11.13), kangaroo mother care initiated (AHR: 1.4; 95% CI: 1.01, 2.00), avoiding prefeed residual aspiration (AHR: 1.42; 95% CI: 1.002-2.03), and early enteral feeding (AHR: 1.5; 95% CI: 1.03, 2.35) were significant predictors of full enteral feeding. According to this study, the time to achieve full enteral feeding was relatively short. Therefore, healthcare professionals should emphasize achieving full enteral feeding and address hindering factors to save the lives of VLBW neonates.

Effect of multi-strain bifidobacteria supplementation on intestinal microbiota development in low birth weight neonates: a randomized controlled trial.

Single-strain Bifidobacterium species are commonly used as probiotics with low birth weight neonates. However, the effectiveness and safety of multi-strain Bifidobacterium supplementation are not well known. Thirty-six neonates weighing less than 2,000 g (558-1,943 g) at birth and admitted to a neonatal intensive care unit were randomly assigned to receive a single strain or triple strains of Bifidobacterium with lactulose enterally for 4 weeks from birth. The relative abundances of Staphylococcus and Bifidobacterium in the fecal microbiota at weeks 1, 2, and 4 were investigated. Based on the study results, no significant difference was detected between the two groups in the abundance of Staphylococcus; however, the triple-strain group had significantly high abundances of Bifidobacterium at weeks 2 and 4. The fecal microbiota in the triple-strain group had significantly lower alpha diversity (Bifidobacterium-enriching) after week 4 and was different from that in the single-strain group, which showed a higher abundance of Clostridium. No severe adverse events occurred in either group during the study period. Although no significant difference was detected between single- and multi-strain bifidobacteria supplementation in the colonization of Staphylococcus in the fecal microbiota of the neonates, multi-strain bifidobacteria supplementation contributed toward early enrichment of the microbiota with bifidobacteria and suppression of other pathogenic bacteria, such as Clostridium spp.

The prebiotic effect of 1-kestose in low-birth-weight neonates taking bifidobacteria: a pilot randomized trial in comparison with lactulose.

Probiotics such as bifidobacteria have been given to low-birth-weight neonates (LBWNs) at risk for a disrupted gut microbiota leading to the development of serious diseases such necrotizing enterocolitis. Recently prebiotics such as lactulose are used together with bifidobacteria as synbiotics. However, faster and more powerful bifidobacteria growth is desired for better LBWN outcomes. The prebiotic 1-kestose has a higher selective growth-promoting effect on bifidobacteria and lactic acid bacteria in vitro among several oligosaccharides. Twenty-six premature neonates (less than 2,000 g) admitted to a neonatal intensive care unit (NICU) were randomly assigned to receive Bifidobacterium breve M16-V with either 1-kestose or lactulose once a day for four weeks from birth. A 16S rRNA gene analysis revealed similar increases in alpha-diversity from 7 to 28 days in both groups. The most dominant genus on both days was Bifidobacterium in both groups, with no significant difference between the two groups. Quantitative PCR analysis revealed that the number of Staphylococcus aureus tended to be lower in the 1-kestose group than in the lactulose group at 28 days. The number of Escherichia coli was higher in the 1-kestose group at 7 days. The copy number of total bacteria in the 1-kestose group was significantly higher than that in the lactulose group at 3 time points, 7, 14, and 28 days. No severe adverse events occurred in either group during the study period. l-Ketose may offer an alternative option to lactulose as a prebiotic to promote the development of gut microbiota in LBWNs.

Pericardial Effusion and Superficial Abdominal Abscess as Complications of Malposed PICC Line in a Preterm Neonate: A Case Report

In neonatal critical care units, peripherally inserted central catheter lines are frequently used to provide venous access for continuous parenteral nutrition and medications in newborns. In this case report, a male neonate weighing 1270 grams was on Continuous Positive Airway Pressure (CPAP) for hyaline membrane disease and initially received Total Parenteral Nutrition (TPN) through a Peripherally Inserted Central Catheter (PICC) in the left long saphenous vein on the second day. The baby developed tachycardia, respiratory distress requiring mechanical ventilation, and erythematous swelling over the paraumbilical region. A diagnosis of pericardial effusion and superficial abdominal abscess secondary to a malposed PICC line in a preterm, very low birth weight neonate was made. Suspecting a misplaced line, it was immediately removed, and the patient showed improvement over the next 24 hours. Within the next 48 hours, the patient was extubated to CPAP. Therefore, daily inspection by an expert, as well as confirmation of the central line tip, will aid in preventing delays in detecting complications.

Multimodal Sensory Stimulation among Very Low Birth Weight Preterm Newborns: A Quasi-experimental Study at a Tertiary Care Hospital in Agartala, Tripura, India

Introduction: There is a continuous search for an effective intervention to help preterm low birth weight neonates overcome their poor growth and developmental outcomes. Most researchers have examined the effect of Oromotor Stimulation (OMS) on feeding performance. Studies exploring Multimodal Sensory Stimulation (MSS) on various outcome parameters are sparse and reveal inconsistent results. Aim: To analyse the effectiveness of MSS in improving weight gain, length of hospitalisation, and feeding performance in preterm Very Low Birth Weight (VLBW) neonates. Materials and Methods: This quasi-experimental study was conducted between June 2021 and December 2022 in the Paediatrics Department of Agartala Government Medical College, Agartala, Tripura, India. A total of 104 hospitalised neonates with gestational age from 28 to less than 37 weeks and birth weight from 1000 to less than 1500 grams (VLBW) were included in the study. All neonates received standard care and Kangaroo Mother Care (KMC). On the advice of some faculties, several of them also received MSS. All neonates were divided into two groups: those who received MSS and those who did not, and they were monitored until discharge. Mean hospitalisation length, weight gain, and transition time were derived and statistically analysed using Chi-square and Mann-Whitney U tests. Results: In the present study, the mean gestational age was 32.04±1.75 and 32.679±1.19 weeks, and the M:F ratio was 1.43:1 and 1.30:1 in the MSS-given and MSS-not given groups, respectively. Mean weight gain was significantly higher in the MSS-given group (97.00±123.09 g versus- 23.42±43.96 g). Mean hospitalisation length was longer in the MSS-given group, but transition time did not differ significantly across the groups. Conclusion: Multimodal sensory stimulation is effective in promoting weight gain in preterm VLBW neonates.

Prevalence and Risk Factors of Low Birth Weight among Neonates Delivered in Health Facilities in Makurdi, Benue State, Nigeria

Abstract Background: Low birth weight (LBW) is an important marker of fetal health that is predictive of mortality in childhood, stunting, and adult-onset chronic conditions globally. Approximately 20 million LBW births occur every year globally with 96.5% of them in developing countries. LBW contributes to 60%–80% of all neonatal deaths globally and the rates have remained high in developing countries such as Nigeria. This study therefore aimed to determine the prevalence and risk factors of LBW among neonates delivered in health facilities in Makurdi, Benue State, Nigeria. Materials and Methods: A cross-sectional study was carried out in eight selected health facilities at different levels of care within the Makurdi metropolis. A total of 206 neonates were recruited, weighed, and examined within the first hour of life while sociodemographic data were collected using a pretested interviewer-administered questionnaire and analyzed using SPSS 23. Results: Out of the 206 neonates studied, 24 (11.7%) were LBW. Among the 24 LBW neonates, 75% (18) were term while 25% (6) were preterm. The mean weight of the LBW neonates was 2.18 ± 0.18 kg. The mean gestation was 38.52 ± 1.61 weeks. The factors that were significantly associated with LBW were; gestational age at birth (P = 0.028), type of gestation (P = 0.004), socioeconomic class of the baby (P = 0.036), nonbooking for antenatal care (ANC) (P = 0.040), place of ANC (P = 0.028), and hypertension in pregnancy (P = 0.033). Conclusion: The prevalence of LBW was lower than the national prevalence and not booking for ANC was found to be associated with increased risk for LBW. Hence, early and adequate ANC is recommended.

Proportion and risk factors of low birth weight among neonates delivered at Omdurman Maternity Hospital, Sudan.

Low birth weight (LBW) is a major predictor of child mortality and morbidity. The objectives of this study are to determine the proportion and risk factors of LBW. A matched case-control study was conducted at Omdurman Maternity Hospital, Sudan. The study population consisted of all babies delivered in August 2016 excluding stillbirths, multiple births, and babies with insufficient data. All LBW neonates were selected using total coverage sampling as cases and matched on babies' gender with randomly selected normal birth weights as controls. The sample size was 350 babies; 175 test cases and 175 control cases. Data were collected from hospital records and six risk factors were tested: mother age, parity, gravidity, mode of delivery, hypertensive disorders, and diabetes mellitus. The proportion of LBW was 10.8% of the total number of delivered neonates which is 2,938. The bivariate analysis identified that younger mother age (p = 0.03) and hypertension (p = 0.02) were significantly associated with LBW while other factors were found statistically insignificant. Multivariable conditional logistic regression revealed that hypertensive disorders in pregnancy increase the risk for LBW almost three times [Adjusted OR = 2.98 (95% CI: 1.23-7.22), p = 0.02]. We found that hypertension is an independent risk factor for LBW. The proportion of LBWcan be reduced if hypertension is controlled by providing simple measures like proper antenatal care and health education for pregnant women.

Current Research on Opioid Use Disorder (OUD) in Pregnancy with Emphasis on Medication Assisted Treatment (MAT)

Substance use disorder in pregnancy is a major obstetric issue, with significant maternal and fetal morbidity and mortality. The incidence of opioid use disorder has risen substantially in the United States, with overdose now a leading contributor to pregnancy related deaths. Medication assisted treatment for opioid use disorder can improve pregnancy outcomes, with Methadone, and more recently Buprenorphine becoming the mainstays of treatment. There is decreased incidence of neonatal abstinence syndrome with maternal Buprenorphine use, as well as possible decreased association with neonatal low birth weight. Despite the known benefits of treatment, there remain barriers to medication assisted treatment, including clinician stigma and lack of familiarity with pharmacology. The American College of Obstetrics and Gynecology maintains a firm stance on the benefits of treatment during pregnancy, in order to avoid the known adverse outcomes associated with substance abuse during pregnancy. Pregnancy is period when most women routinely seek healthcare, and thus allows the opportunity for obstetrical providers to optimize maternal well-being. The goals during pregnancy remain the same as those outside of pregnancy: For medication treatment to assist in the prevention of a chronic and remitting condition that can result in overdose, and provide a gateway towards long-term recovery.

Health Disparities in Developmental Status of One-year-old Neonates With Low and Normal Birth Weight: A Comparative Study

Background and Purpose: Low birth weight (LBW) neonates usually experience delays in developing gross and fine motor skills. Studies in Iran reveal a prevalence of growth retardation ranging from 7% to 26.3% among Iranian children. Recognizing the significance of complications associated with LBW, this study aims to scrutinize the developmental status of LBW infants at one year of age and juxtapose it with that of normal birth weight (NBW) neonates. Materials and Methods: This retrospective cohort study involved 105 one-year-old children in Shirvan City, Iran. Participants were selected through a census, and their information was extracted from the SIB system (the integrated health record system). Data collection utilized the 12-month version of the ages and stages questionnaire (ASQ) and a demographic questionnaire. Statistical analyses, including the t-test, Pearson correlation coefficient, and linear regression, were performed using SPSS software, version 26. Results: The ASQ questionnaire revealed that the dimensions of problem-solving and individual-social skills had the lowest and highest mean scores, respectively. A comparison of developmental domains between the two groups did not yield any significant differences. However, when considering gender, a noteworthy relationship emerged in both groups, particularly in communication and gross motor skills, as well as individual-social development and problem-solving. Conclusion: Noteworthy disparities were identified between LBW and NBW infants at birth, encompassing factors such as breastfeeding and maternal educational levels. Consequently, public health policies should prioritize initiatives to enhance mothers’ and infants’ health and nutritional well-being before and during pregnancy and early childhood.

Clinico-Bacteriological Study of Sepsis in VLBW Neonates in Tertiary Care NICU in Central India: A Descriptive Observational Study

Introduction: Low birth weight (LBW) is one of the most serious challenges in maternal and child health in developing countries. Neonatal sepsis is responsible for about 30-50% of the total neonatal deaths in developing countries. Given the high prevalence of Very Low Birth Weight (VLBW) neonates and the increasing incidence of sepsis in this population, there is a need to study the clinical and bacteriological profile of sepsis. Aim: To study the clinico-bacteriological profile of neonatal sepsis in VLBW neonates (Birth weight &lt;1500 gm) in a tertiary care NICU in central India. Materials and Methods: The descriptive observational study was conducted among VLBW neonates with clinically suspected sepsis admitted to the NICU of Indira Gandhi Government Medical College and Mayo Hospital in Nagpur, Maharashtra, India, from November 2019 to October 2021. All 160 VLBW neonates with clinically suspected sepsis and positive sepsis screen consisting of four parameters {Absolute Neutrophil Count (ANC), Total Leucocyte Count (TLC), Immature/Total Neutrophil Ratio (I/T Ratio), C-Reactive Protein (CRP)+} and whose mothers provided informed consent were included in the study within 24 hours of admission. Details such as demographic data, maternal risk factors and type of delivery, clinical signs of sepsis presentation, any Central Nervous System (CNS) signs, day of onset of sepsis, sepsis screen parameters (CRP, TLC, ANC, I/T Ratio), blood culture, and Cerebro-spinal Fluid (CSF) examination findings were studied. Continuous variables were evaluated using the student t-test, and categorical variables were evaluated using the chi-square test. Results: There were 96 (60%) males and 64 (40%) females. In the sepsis screen parameters, the majority of the neonates were CRP positive 148 (92.3%) followed by TLC positive among 119 (74.38%) neonates. Lethargy was the most common clinical presentation among 147 (91.88%) neonates followed by difficulty in feeding among 121 (75.63%) neonates. Blood culture was positive among 61 (38.13%) neonates, and Escherichia coli was the most common organism isolated among 21 (34.43%) neonates. Conclusion: The most common clinical presentation of neonatal sepsis was lethargy followed by difficulty in feeding. In the present study, the most common organism isolated was E.coli.

An Unusual Cause of Factor 7 Deficiency Causing Subgaleal Bleed in a Preterm Extremely Low Birth Weight Neonate

Intracranial hemorrhage is a known complication in preterm neonates. We present an unusual etiology of subgaleal bleeding in a preterm extremely low birth weight neonate secondary to factor 7 deficiency. The neonate had unexplained subgaleal bleeding at the time of birth and developed a life-threatening pulmonary bleed subsequently and expired before the administration of definitive therapy.

Multivariable modeling: A retrospective cohort study exploring the impact of socioeconomic status and distance to a rural academic center on all-cause preterm delivery.

Hospital-based labor and delivery units are closing at increasing rates in the rural US, significantly impacting maternal and newborn health. The objective of this study to determine if rurality-measured as distance from the hospital-and socioeconomic status-measured as insurance payor-impact both spontaneous and medically indicated preterm birth incidence at a single rural academic institution. This was a retrospective cohort study using electronic medical records of patients with singleton pregnancies delivering at a single rural academic institution between 2016-2018. The primary outcome was preterm delivery (PTD) and secondary outcomes included low birth weight (LBW) and intensive care nursery (ICN) admission. The primary exposures included (1) travel time from a patient's address to the hospital and (2) insurance carrier as a proxy for socioeconomic status. Bivariate analyses indicated that travel time, insurance status, race, ethnicity, marital status, number of prenatal visits, gravida and para, and smoking status were significant predictors of all outcomes (LBW, ICN admission, and PTD). Therefore, these predictors were included in the multivariable logistic models. Within the multivariable logistic model, patients traveling 1-1.5 hours had approximately twice the odds of PTD (Odds Ratio, OR: 2.08, 95% Confidence Interval CI, 1.32, 3.29, p = .002), birth of a LBW neonate (OR: 2.15; 95% CI: 1.29-3.58, p = .005), and infant admission to the ICN (OR 1.83, 95% CI: 1.22-2.76, p = .004) compared to patients traveling under 30 minutes,. Insurance carrier status was not associated with increased odds of PTD, LBW, or ICN admission. Patients living 1-to-1.5 hours from the hospital had an increased risk for LBW, ICN admission, and PTD, despite living in zip codes with less social deprivation than zip codes further away from the hospital.

Exploring the association between atmospheric pollutants and preterm birth risk in a river valley city.

To investigate the association between exposure to atmospheric pollutants and preterm birth in a river valley-type city and its critical exposure windows. A retrospective cohort study was used to collect data from the medical records of preterm and full-term deliveries in two hospitals in urban areas of a typical river valley-type city from January 2018 to December 2019. A total of 7,288 cases were included in the study with general information such as pregnancy times, the number of cesarean sections, occupation, season of conception and regularity of the menstrual cycle. And confounding factors affecting preterm birth were inferred using the chi-square test. The effects of exposure to each pollutant, including particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (O3), during pregnancy on preterm birth and the main exposure windows were explored by establishing a logistic regression model with pollutants introduced as continuous variables. Maternal age, pregnancy times, number of births, number of cesarean sections, season of conception, complications diseases, comorbidities diseases, hypertension disorder of pregnancy and neonatal low birth weight of the newborn were significantly different between preterm and term pregnant women. Logistic regression analysis after adjusting for the above confounders showed that the risk of preterm birth increases by 0.9, 0.6, 2.4% in T2 and by 1.0, 0.9, 2.5% in T3 for each 10 μg/m3 increase in PM2.5, PM10, NO2 concentrations, respectively. The risk of preterm birth increases by 4.3% in T2 for each 10 μg/m3 increase in SO2 concentrations. The risk of preterm birth increases by 123.5% in T2 and increases by 188.5% in T3 for each 10 mg/m3 increase in CO concentrations. Maternal exposure to PM2.5, PM10, NO2, CO was associated with increased risk on preterm birth in mid-pregnancy (T2) and late pregnancy (T3), SO2 exposure was associated with increased risk on preterm birth in mid-pregnancy (T2).

Gastric perforation in neonates: Our experience

Background: Neonatal gastric perforation (NGP) is a life-threatening condition with a high mortality rate. It accounts for 7% of all gastrointestinal tract (GIT) perforations. The number of NGP cases has been increasing due to the rise in premature and low birth weight neonates. In this study, we present our experience with gastric perforation in neonates. Methods: This retrospective study analyzed all cases of gastric perforation in neonates that were treated at Loma Linda University Medical Center's Neonatal Intensive Care Unit (NICU) between the years 2000 and 2023. The study looked at several variables including patient demographics, birth weight, age at admission and surgery, comorbidities, use of non-steroidal anti-inflammatory drugs (NSAIDs) and steroids, and mortality rate. Results: We treated 15 patients with neonatal gastric perforation (NGP) during the study tenure. The median age at admission was 2 days, with 67% admitted within that timeframe. Surgery occurred at a median age of 5.5 days, and the median birth weight was 2.075 kg, with 26.67% below 1 kg. Males comprised 67%, and 60% had patent ductus arteriosus. Steroids were given to 46.66%, and 30-day mortality was 26.67%, with higher rates among males. Idiopathic cases were common, with notable etiologies including ischemia, necrosis, and congenital anomalies. Primary surgical repair was the main modality, and perforations occurred at various locations. Two cases had necrotizing enterocolitis. Six patients had favorable outcomes, while others experienced mild to moderate complications. Conclusion: Our research supports the idea that males have a worse outcome in terms of both prevalence and survival rates in neonatal gastric perforation (NGP) patients. However, our findings did not confirm the notion that NGP mortality risk is higher in neonates with low birth weight. We also discovered that the median time between admission and surgery in our study group was 1.5 days, emphasizing the importance of early detection of NGP in neonates. Early diagnosis can lead to better decision-making regarding treatment options and surgical intervention.

CHARACTERIZATION OF NEONATAL THROMBOCYTOPENIA AT TEACHING HOSPITAL OF RAHIM YAR KHAN

Objective: To determine the prevalence and characterization of thrombocytopenia in neonates and the pattern of illnesses in these thrombocytopenic neonates. Material and Methods: A cross sectional study was conducted on 400 neonates in Pathology and Pediatric departments of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2022 to July 2023. Analysis of data was done by using SPSS 23. Results: Out of 400 studied neonates, males made up 238 (59.5%), while females were 162 (40.5%). Thrombocytopenic neonates were 76(19%) while 324(81%) neonates had normal platelet count. Out of the 76 thrombocytopenic neonates, 42(10.5%) neonates had mild thrombocytopenia, 25(6.25%) had moderate thrombocytopenia and 9 (2.25%) had severe thrombocytopenia. Degree of thrombocytopenia revealed that 46 (11.5%) of neonates had thrombocytopenia in late onset phase while 30 (7.5%) had early onset thrombocytopenia. Correlation of thrombocytopenia with several disorders displayed that neonatal sepsis and anemia were significantly linked with thrombocytopenia, followed by birth asphyxia, neonatal birth in preterm and full-term neonates, low birth weight and Neonatal jaundice, furthermore, the p-value for bleeding in neonates allied with thrombocytopenia was found significant with value of 0.03. Conclusion: The current study discovered that mild thrombocytopenia among neonates is frequent followed by moderate and severe. Thrombocytopenia has strong correlation with neonatal sepsis, anemia, birth asphyxia, neonatal birth (pre term, full term) and bleeding. Severe thrombocytopenia can be used as a prognostic indicator in sick neonates. Hence thrombocytopenia is a frequent challenge for neonatologists to cope the serious consequences of neonatal health. Keywords: Neonatal thrombocytopenia, Platelet, Low birth weight neonates, Sepsis, Asphyxia.

Vitamin D Deficiency in Pregnancy: A Systematic Review

Vitamin D deficiency (VDD) is a common problem in reproductive-aged women and has become a major public health problem worldwide. Adverse health outcomes such as preeclampsia, low birthweight, neonatal hypocalcemia, poor postnatal growth, bone fragility, and increased incidence of autoimmune diseases have been linked to low vitamin D levels during pregnancy and infancy. A systematic literature search was performed on September 6th – 21st, 2022 using respected database. The identified articles were screened using the chosen eligibility criteria. Literature selection was performed with rest time restriction from January 1, 2017, and September 22, 2022 and restricted to only published in English articles. Three papers were evaluated in full-text after duplicates were removed. Tammo et al, Mansur et al and Moralez et al were the three studies that remained following full-text screening utilizing eligibility criteria and quality assessment showing a significant proof regarding this review. Vitamin D deficiency had wide variety of effects in pregnancy as it may increased risk of multisystem disorders in pregnancy such as preeclampsia, low birth weight in neonates, insulin resistance, gestational diabetes mellitus (GDM), and a higher risk of primary cesarean delivery. Optimal level of 30 ng/mL or more before conception and throughout the entire pregnancy with different dosages available, avoiding levels below 20 ng/ml.