Neonatal Morbidity Research Articles (Page 1)

Antenatal corticosteroids (ACS) can improve the outcomes of preterm infants and have been widely adopted as the standard practice in managing pregnancies at high risk of preterm delivery between 22+0 and 33+6 weeks. Due to their significant benefit for the majority of pregnant women, several guidelines also state that maternal diabetes is not a contraindication for the use of ACS. However, no such evidence has been obtained from diabetic pregnancies. The Chinese Neonatal Network (CHNN), a national multicenter cohort study, recruited 31,915 very preterm infants (VPIs) from 79 NICUs. The outcomes were mortality and morbidity in hospital. Logistic regression models were employed to calculate the odds ratios (ORs) and its 95% confidence intervals (CIs) to estimate the associations between ACS and these outcomes. Stratification and sensitivity analyses were conducted to test the robustness of the results in different population. A total of 4337 VPIs born to diabetic mothers enrolled in the present study: 3605 VPIs were exposed to ACS and 732 were not. ACS was associated with a lower risk in the combined outcome (death or any severe morbidity) (adjusted OR [aOR] 0.66, 95% CI 0.54-0.79), in-hospital death (aOR 0.55, 95% CI 0.41-0.73), severe bronchopulmonary dysplasia (BPD, aOR 0.69, 95% CI 0.55-0.85), low Apgar score (aOR 0.76, 95% CI 0.61-0.96), respiratory distress syndrome (RDS, aOR 0.79, 95% CI 0.66-0.94), or the need for invasive ventilation (aOR 0.62, 95% CI 0.52-0.73). However, a significantly higher risk of maternal chorioamnionitis (aOR 2.09, 95% CI 1.61-2.72) was observed in the ACS group. Similar results were observed in stratification and sensitivity analyses. Conclusions:In VPIs of diabetic mothers, ACS exposure was associated with lower mortality and reduced risks of BPD, low Apgar score, RDS, and invasive ventilation, but with higher odds of maternal chorioamnionitis. What is Known: • Antenatal corticosteroids (ACS) are standard care for reducing neonatal morbidity and mortality in pregnancies at high risk of preterm birth between 22+0 and 33+6 weeks. • However, recommendations for ACS use in pregnant women with diabetes at risk of preterm delivery remain inconsistent due to limited evidence. What is New: • This large, national multicenter cohort study provides the first specific evidence that ACS administration in diabetic pregnancies is associated with significantly lower risks of neonatal mortality, bronchopulmonary dysplasia, respiratory distress syndrome, and the need for invasive ventilation. • Our findings support the benefit of ACS in this understudied population, demonstrating a favorable risk-benefit profile.

To determine whether administration of antenatal corticosteroids to patients with twin gestations at risk for late preterm delivery is associated with reduced risk for neonatal respiratory morbidity compared with unexposed twins. This was a multicenter, retrospective cohort study in a large, urban health network (2013-2022) of patients with twin gestations at risk for preterm delivery between 34 0/7 and 36 6/7 weeks of gestation. Patients were excluded if they received antenatal corticosteroids before 34 weeks of gestation or had pregestational diabetes, single-twin death before 34 weeks, or oral steroid exposure during pregnancy. Neonates were excluded if they had major congenital anomalies. The primary outcome was a composite of neonatal respiratory morbidity requiring respiratory support within 72 hours of birth, including continuous positive airway pressure (CPAP) or high-flow nasal cannula for 2 hours or more, supplemental oxygen of 30% for 2 hours or more, extracorporeal membrane oxygenation, mechanical ventilation, and fetal or neonatal death. Secondary outcomes included neonatal hypoglycemia and indications for neonatal intensive care unit (NICU) admission. Adjusted and unadjusted relative risks with 95% CIs were calculated. During the study period, 366 twin gestations and 722 patient-neonate dyads were included: 162 gestations (321 neonates) in the exposed group and 204 (401 neonates) in the unexposed group. There was no difference in the composite outcome of respiratory morbidity in those exposed to antenatal corticosteroids (23.4% vs 20.4%, P=.40, adjusted relative risk [RR] 1.00, 95% CI, 0.71-1.42). The composite was driven mostly by rates of CPAP use (21.2% vs 18.5%, P=.41, adjusted RR 1.05, 95% CI, 0.73-1.53) and high-flow nasal cannula use (6.2% vs 2.2%, P=.02, RR 2.77, 95% CI, 1.16-6.66). Antenatal corticosteroid exposure was associated with a lower risk of need for supplemental oxygen (0.6% vs 3.5%, P=.02, RR 0.18, 95% CI, 0.04-0.79) and mechanical ventilation (0.6% vs 3.2%, P=.03, RR 0.19, 95% CI, 0.04-0.87). Although antenatal corticosteroids exposure was not associated with higher rates of hypoglycemia (44.2% vs 41.7%, P=.57, adjusted RR 0.99, 95% CI, 0.82-1.19), exposure was associated with a higher risk of having hypoglycemia as the only indication for NICU admission (10.3% vs 5.2%, P=.03, RR 1.96, 95% CI, 1.07-3.59). In a large, multicenter, network-wide retrospective cohort study of patients with twin gestations at risk for late preterm birth, antenatal corticosteroid use was not associated with a decrease in overall respiratory morbidity but was associated with a decreased risk of need for supplemental oxygen and mechanical ventilation, as well as a higher risk of NICU admission for hypoglycemia. These results underscore the ongoing need to elucidate the risks and benefits of late preterm antenatal corticosteroids for patients with twin gestations at risk for late preterm birth.

Background: Sepsis remains a significant cause of neonatal mortality and morbidity. Early diagnosis remains challenging due to nonspecific clinical presentation and limitations of current diagnostic approaches. Base excess (BE), derived from routine blood gas analysis, has emerged as a potential rapid biomarker reflecting metabolic disturbances associated with sepsis. We aim to evaluate the diagnostic and prognostic utility of BE in neonatal sepsis.Methods: A literature search was conducted across PubMed/MedLine, Scopus, Cochrane Library, EBSCOHost, and gray literature repositories from inception to July 2025. We included studies reporting BE measurement in neonatal sepsis. Two-by-two data were pooled using bivariate random-effects models to estimate sensitivity, specificity, and area under the curve (AUC). Mortality risk was assessed using odds ratios. This study followed the PRISMA guideline, and evidence certainty was evaluated using the GRADE methodology. The protocol has been registered in the PROSPERO (CRD42024601108).Results: Six studies were included in this meta-analysis. BE threshold ≤-5mEq/L from arterial/capillary blood demonstrated a pooled sensitivity of 85.8% (95% CI: 59.9%-96.1%), a specificity of 82.9% (95% CI: 46.2%-96.5%), and an AUC of 0.909. Cord blood BE ≤ -10mEq/L showed high specificity (96.7%, 95% CI: 91.5%-98.8%) but low sensitivity (10.3%, 95% CI: 6.5%-15.7%). Decreased BE levels were associated with increased mortality risk (OR 3.14; 95% CI: 1.34-7.36). The certainty of evidence was low.Conclusion: BE shows potential as a biomarker for neonatal sepsis. However, the low-certainty evidence underscores the need for further prospective validation and exploration of BE's role within combined biomarker algorithms before widespread clinical implementation.

This study aimed to compare the patterns of fetal heart rate tracings (FHRTs), and outcomes among individuals with small (birth weight [BW] <10% for gestational age [GA]; SGA) versus appropriate (BW at 10-89% for GA; AGA) newborns at term (≥37.0 weeks).Our retrospective cohort study included consecutive deliveries over 15 months at a level IV center. FHRTs were reviewed by obstetricians blinded to maternal and neonatal outcomes. The inclusion criteria were non-anomalous singletons, cataloged as SGA or AGA birth weight using Alexander et al's nomogram. In 20-minute segments, the last 120 minutes of tracing were characterized. Rates of cesarean delivery (CD) and composite neonatal adverse outcomes (CNAOs) were compared.Of 5,160 deliveries, 3,029 (58.7%) met the inclusion criteria, and among them, 422 (13.9%) were SGA and 2,607 (86.1%) AGA. There were no differences in FHRT baseline, variability, or accelerations. Compared to AGA, SGA was more likely to have prolonged decelerations (11.8 vs. 8.4%, p = 0.021), and recurrent decelerations with ≥50% of contractions (21.3 vs. 16.5%, p = 0.014). Overall, the presence of category II FHRT or not was similar between the SGA (91.2%) and AGA (88.5%; p = 0.097). Persistent category II FHRT was significantly more common among SGA (37.4%) than AGA (28.1%; aOR = 1.47; 95% CI: 1.47-1.82) newborns. The rate of CD for non-reassuring FHRT was similar among the two groups. CNAO occurred in 1.4% in both SGA and AGA neonates (p = 0.95).In our cohort of those with fetal monitoring prior to delivery at ≥37 weeks, persistent category II FHRT at the end of labor was significantly more common in SGA compared to AGA neonates; however, composite neonatal morbidity did not differ between the two groups. Our analysis provides data for shared decision-making that among SGA newborns, abnormalities of FHRT are not linked with adverse outcomes. · There were no differences in FHRT baseline, variability, or accelerations between AGA and SGA.. · SGA was more likely to have prolonged decelerations and recurrent decelerations with ≥50% of contractions.. · Persistent category II FHRT before delivery is significantly more common with SGA than AGA.. · FHRT abnormalities, however, were not associated with CD for non-reassuring FHRT, or adverse outcomes..

To assess the association of maternal pre-pregnancy body mass index (BMI) and neonatal respiratory morbidities, including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN) and bronchopulmonary dysplasia (BPD). This was a cross-sectional study utilized linked mother-infant records from the Korean National Health Insurance Service for birth cohorts spanning 2014-2021. Maternal BMI measured within three years prior to delivery was collected and categorized as < 18.5, 18.5-22.9 (reference), 23.0-24.9, 25.0-29.9, and ≥ 30kg/m2. Relative risks (RRs) and 95% confidence intervals (CIs) for respiratory morbidities were calculated. Inverse probability of treatment weighting (IPTW) was applied using propensity scores, and weighted generalized linear models were used adjusting for maternal and newborn characteristics. Among 2,285,943 live births, 779,091 neonates were selected for analysis. After adjusting for confounders, infants born to mothers with a BMI ≥ 30 had a higher risk of RDS (RR 2.598; 95% CI 2.523-2.676), TTN (RR 1.154; 95% CI 1.126-1.182), and moderate-to-severe BPD (RR 6.070; 95% CI 3.687-9.994) compared to those born to mothers with normal BMI (18.5-22.9). Conversely, maternal underweight (BMI < 18.5) was associated with reduced risk of RDS (RR 0.873; 95% CI 0.842-0.906), TTN (RR 0.951; 95% CI 0.927-0.975) and BPD (RR 0.371; 95% CI 0.263-0.523). Pre-pregnancy maternal BMI was associated with an increased risk of neonatal respiratory morbidities, highlighting the importance of maternal weight management before and during pregnancy as a potential strategy to enhance neonatal health outcomes.

Kangaroo Mother Care (KMC) is an effective intervention shown to significantly lower neonatal morbidity and mortality, especially among low-birth-weight (LBW) infants. Despite its success, many families struggle to implement KMC effectively post-discharge. This qualitative study employed a hermeneutical-phenomenological approach to explore the experiences of mothers and families practicing KMC after discharge from the hospital in South India. In-depth, semi-structured interviews were conducted with eight mothers, fathers, and grandmothers, focusing on their experiences with community KMC (cKMC) and their challenges in maintaining cKMC at home. All the data were transcribed verbatim and reflexive thematic analysis was done to identify the enablers and barriers to practice cKMC. Three main themes emerged from the analysis: Breast Feeding - Persevering Despite Initial Difficulties, Kangaroo Mother Care - Seeing benefits but struggling to practice, and Family Boon or Bane - Family as a crucial context for cKMC practice. While encountering challenges, participants expressed a strong commitment to breastfeeding, persevering to breastfeed by expressing breast milk, getting donor milk and using skin-to-skin contact to increase the milk flow. KMC was adopted positively and benefitted from support by the healthcare team and infrastructure during hospital stay, but continuation at home was difficult due to inadequate counselling, lack of community follow-up and challenging home environment. Family emerged both as a support system and a source of a tension to KMC practice. While fathers and grandmothers actively supported KMC in hospital settings, post-discharge traditional gender norms and domestic responsibilities hindered continuity at home. To promote sustained family-inclusive cKMC practices, there is a need for structured education to empower all caregivers, including grandmothers and fathers. Adoption of gender inclusive terminology such as "Kangaroo Family Care" can help to dismantle gender-oriented perceptions and encourage participation of all family members. Engaging grandparents as champions of KMC can promote intergenerational support for families and improve the outcome of LBW newborns. Community health teams should strengthen through tailored training on antenatal counselling and post-discharge support.

Background: Advances in heart transplant (HTx) have increased the number of reproductive-aged women with grafts considering pregnancy. However, this remains a high-risk scenario due to maternal morbidity, graft rejection, hypertensive disorders such as preeclampsia, and adverse neonatal outcomes. Current literature on comprehensive pregnancy outcomes and long-term graft implications remains limited. Objective: Evaluate maternal, and neonatal morbidity outcomes among HTx recipients. Methods: A meta-analysis was conducted using data from 1982 to 2022, derived from multiple database searches that included 7 retrospective cohort studies. Outcomes assessed included maternal and neonatal mortality, preeclampsia, neonatal preterm, low birth weight, graft rejection in pregnancy, miscarriage, chronic and gestational hypertension (HTN), congenital malformation, cesarians, unplanned pregnancy, and maternal infection within a 15 years follow-up time. Prevalences were pooled using events per 100 observations, along with 95% confidence intervals (CIs), and I2 for heterogeneity, employing a random-effects model. Results: Among 653 pregnancies and 477 pregnant women studied in 7 observational studies, preeclampsia occurred in 20.10% and was associated with increased maternal mortality (12.15%). Preterm birth (38.34%; median 35.1 weeks), and lower birth weights (37.58%; median 2490 g), were expressive. Congenital malformations were identified in 6.44%, while neonatal mortality proportion was 0.00%. However, low rates of graft loss during pregnancy 3.57% were observed. HTN was presented as a chronic manifestation in 30.56%, whether gestational 19.74%. Cesarians were performed in 47.76% patients and the data of unplanned pregnancy reached 47.12%. Conclusion: Pregnancy after HTx is feasible but high-risk, with elevated rates of HTN, preterm birth, neonatal complications, and maternal morbidity. Preeclampsia significantly worsens neonatal outcomes but does not impair short-term graft survival. Multidisciplinary care, individualized immunosuppressive management, and rigorous preconception counseling are crucial for optimizing outcomes. These findings inform clinical decision-making and reproductive planning for HTx women.

Prior studies have not identified if continuous glucose monitoring (CGM) metrics at a critical gestational age window can discriminate risk of adverse pregnancy outcomes. We evaluated late second- and third-trimester CGM metrics by gestational age associated with pregnancy outcomes in gravidas with type 1 diabetes (T1DM). Dexcom G6 CGM data from a retrospective cohort of singleton gestations with T1DM (2018-2022) at an academic medical center were analyzed. Time in, above, and below range 63 to 140 mg/dL (TIR, TAR, TBR), glycemic variability, and mean glucose concentration were computed in two-week CGM intervals from 240 to 396 weeksdays. Adverse pregnancy outcomes were hypertensive disorders of pregnancy (HDP), large-for-gestational age (LGA), and neonatal hypoglycemia. Linear mixed-effects models were fitted on CGM metrics computed from two-week CGM intervals, with gestational age, adverse pregnancy outcomes (i.e. presence/absence of HDP, LGA, and/or neonatal hypoglycemia), and their interaction as fixed effects. In 87 gravidas with preconception median hemoglobin A1c 6.5% (IQR 6.0, 7.1) and maternal body mass index 24.8 kg/m2 (IQR 21.9, 27.1), 71% had at least one adverse pregnancy outcome. Between weeks 240 and 376, gravidas with HDP had higher TAR and mean glucose and lower TIR (P < .05). Gravidas with LGA had lower TBR between weeks 240 and 356. TIR, TAR, and mean glucose evolution differed by HDP status, with greatest divergence between groups at 280 to 296 weeks' gestation (P ≤ .001). CGM metrics in the late second to early third trimester, a period of peak insulin resistance, may help to distinguish risk of HDP and LGA in gravidas with T1DM.

In Lebanon, disadvantaged pregnant women show poor maternal outcomes due to limited access to antenatal care (ANC) and a strained health care system, compounded by ongoing conflicts and a significant refugee population. Despite substantial efforts to improve maternal health, the provision of maternal health services in primary health care centers (PHCs) still faces significant challenges. Mobile health (mHealth) interventions, particularly those using artificial intelligence (AI) and gamification, are proving effective in addressing gaps in maternal health services by offering scalable and accessible care. This study aimed to evaluate the effects of an AI-based gamified intervention, Gamification and Artificial Intelligence and mHealth Network for Maternal Health Improvement (GAIN MHI), on maternal health outcomes and uptake of ANC services among disadvantaged populations in Lebanon. The study was a community interventional trial with historical controls, conducted across 19 randomly allocated PHCs in 5 Lebanese governorates. Participants included pregnant women in their first trimester visiting PHCs. The intervention used mHealth tools, including educational mobile-based messages, appointment reminders, and the GAIN MHI app, which provided AI-driven and gamified learning for health care providers (HCPs). Data collected covered demographics, medical history, and maternal and neonatal health outcomes. Key outcome measures included uptake of health care services (eg, ANC visits, supplement intake, ultrasound completion, lab tests) and maternal and neonatal outcomes (eg, term delivery, normal delivery, abortion rate, neonatal morbidity, maternal complications). This study included 3989 participants, divided between a control group (n=1993, 50%) and an intervention group (n=1996, 50%). Regression models adjusting for demographics, health, and obstetric characteristics showed significantly higher odds in the intervention group for completing 4 or more ANC visits (odds ratio [OR] 1.569, 95% CI 1.329-1.852, P<.05), completing lab tests (OR 1.821, 95% CI 1.514-2.191, P<.05), 2 or more ultrasound screenings (OR 7.984, 95% CI 6.687-9.523, P<.05), urine analysis (OR 4.399, 95% CI 3.631-5.330, P<.05), and supplement intake (OR 3.508, 95% CI 2.982-4.128, P<.05). Regarding outcomes, the intervention group had 29.5% increased odds of a term delivery (OR 1.295, 95% CI 1.095-1.532, P=.002) and 58% increased odds of avoiding neonatal morbidity (OR 1.580, 95% CI 1.185-2.108, P=.002). However, both groups showed decreased odds of normal delivery (intervention: OR 0.774, 95% CI 0.657-0.911; control: OR 0.823, 95% CI 0.701-0.964) and increased odds of maternal complications (intervention: OR 0.535, 95% CI 0.449-0.637; control: OR 0.586, 95% CI 0.474-0.723; P<.05). The GAIN MHI intervention effectively improves uptake of ANC and maternal and neonatal outcomes. Our findings highlight the potential of mHealth interventions to enhance health care delivery. To sustain these improvements, future research should focus on integrating mHealth with other interventions that address socioeconomic and contextual factors. This approach will further optimize maternal and neonatal health outcomes among disadvantaged populations.

Introduction: Placental dysfunction is an emerging contributor to neonatal morbidity and mortality in pregnancies complicated by fetal congenital heart disease (CHD). Previous work in mouse models of CHD and examination of human placental pathology indicates that the maternal-fetal interface, specifically the syncytiotrophoblast layer, can be dysmorphic in fetal CHD-affected pregnancies. We hypothesized that gene expression in a subset of placentas affected by fetal CHD would show differences in genes required for syncytiotrophoblast differentiation and function. Methods: Placentas from pregnancies affected by fetal CHD were sampled and stored as formalin-fixed paraffin embedded blocks per pathology core standard protocol. A subset of fetal CHD cases affected by left ventricular outflow tract obstruction (LVOTO) without genetic diagnoses or major extracardiac anomalies were selected for transcriptomic analysis. Results: Placentas affected by fetal LVOTO (n=20) demonstrated markedly reduced expression of genes associated with terminally differentiated syncytiotrophoblasts compared to controls (n=10). Specifically, aromatase (p&lt;0.0001), placental growth hormone (p&lt;0.0001), and multiple chorionic gonadotropin subunits and pregnancy specific glycoproteins were downregulated. Transcription factor GCM1, a master regulator of trophoblast differentiation, was also downregulated (p&lt;0.0001). Syncytin-1, a product of syncytiotrophoblasts that facilitates their formation from cytotrophoblasts, was downregulated (p&lt;0.0001) and syncytin-1 receptor expressed on cytotrophoblasts was upregulated (p&lt;0.0001) in the LVOTO affected placentas. Abundance of cytotrophoblasts did not differ between groups, which showed similar expression of cytotrophoblast markers including E-cadherin and cytokeratins. Conclusions: Dysregulation of the heart-placenta axis in fetal CHD may be a result of altered syncytiotrophoblast differentiation, resulting in decreased functional surface area at the maternal-fetal interface.

Glucocorticoids are essential for fetal organ maturation and form the basis of antenatal corticosteroid therapy that has significantly reduced preterm-related morbidity such as respiratory distress syndrome (RDS). However, neonatal morbidity remains a clinical challenge regardless of antenatal corticosteroid therapy. Currently, it is thought that adverse intrauterine environments dysregulate glucocorticoid receptor (GR) homeostasis, yet the biological mechanisms remain poorly understood. Therefore, we aimed to study ex vivo glucocorticoid sensitivity in cord blood immune cells from two independent preterm cohorts to identify associations with neonatal morbidity and uncover potential mechanisms of dysregulated glucocorticoid homeostasis. In the first cohort, thawed cord blood mononuclear cells were exposed to betamethasone in the presence of lipopolysaccharides (LPS) for 4 h. In the second cohort, freshly isolated white blood cells were treated with dexamethasone under unstimulated and LPS-stimulated conditions for 48 h. GR isoform expression and regulation of transactivated and transrepressed genes were assessed via qPCR, immunoblotting, flow cytometry, and ELISA. In both cohorts, reduced GR expression, particularly of the GRα isoform, was observed in neonates with morbidity, but only with culture time and not in freshly isolated cells. Ex vivo impaired glucocorticoid-mediated transrepression of proinflammatory genes IL6 and TNF was also observed in the morbidity groups. In contrast, all samples were comparable in basal immune cell distributions and transactivation of glucocorticoid response element (GRE)-dependent genes GILZ and FKBP5, irrespective of neonatal morbidity. These findings suggest that neonates that develop morbidities experience an early postnatal GR dysfunction that is potentially programmed in utero. Moreover, under conditions of decreased GR abundance, classical transactivation functions appear to be preserved at the expense of more complex regulatory mechanisms such as transrepression.

Gestational diabetes mellitus (GDM) is associated with significant maternal and neonatal morbidity. Timely diagnosis and appropriate management of GDM decreases adverse maternal and neonatal outcomes. This study sought to assess prevalence and management of GDM in an underserved federally qualified health center (FQHC) setting in Rhode Island using a care cascade framework. A three-year retrospective chart review of patients who initiated obstetrical care between 2019 and 2021 was conducted. Of this sample, 16.81% patients met criteria for a GDM diagnosis, two-thirds of whom ultimately required pharmacotherapy. In the analysis of care cascade outcomes, 96.8% of patient underwent the recommended screening for GDM and 79.5% were linked to care. This FQHC cares for high-risk obstetrical patients through a specialist supported primary care model and this study demonstrates that this model can facilitate appropriate GDM care in high-risk populations.

Background Neonatal hypothermia is a major cause of neonatal morbidity and death in the world, especially in low-income countries like Ethiopia. In Ethiopia, despite many studies being conducted on neonatal hypothermia, the reported findings are inconsistent. Therefore, the main aim of this study is to assess the pooled prevalence and factors associated with neonatal hypothermia in Ethiopia. Objectives This study aims to assess the pooled prevalence and factors associated with neonatal hypothermia in Ethiopia. Methods An extensive systematic review and meta-analysis were performed to extract studies on the pooled prevalence of neonatal hypothermia in Ethiopia. The PubMed, Medline, Google, Google Scholar, CINAL, and EMBASE were systematically searched. Nine articles assessed the pooled prevalence of neonatal hypothermia and associated factors in Ethiopia were included. Articles selected and extracted using a Microsoft Excel spreadsheet and exported to Stata version 14 for analysis. I-squared was used to assess the heterogeneity of the included papers, while Egger’s regression test and the funnel plot were used to check publication bias. Results A total of nine primary articles that going well together the inclusion criteria with a total population of 4075 were included in this meta-analysis. The pooled prevalence of neonatal hypothermia in Ethiopia was found to be 61.81% (95% CI: 57.21%, 66.41%). Neonates who had delayed initiation of breast feeding (Odds Ratio: 3.1; 95% CI: 2.37, 4.05), neonates who had no skin to skin contact (Odds Ratio: 4.4; 95% CI: 3.08, 6.27), neonates delivered at night time (Odds Ratio: 2.99; 95% CI: 1.90, 4.69), being low birth weight (Odds Ratio: 3.61; 95% CI: 2.35, 5.54) and neonates who had early bathing (Odds Ratio: 5.27; 95% CI: 2.73, 10.17) were factors significantly associated with hypothermia. Conclusion We found that the pooled prevalence of neonatal hypothermia was high. Thus, The concerned stakeholders should work to strengthen the neonatal care practice to include the possible significant factors of neonatal hypothermia.

Impact of the 2018 French National College of Gynecologists and Obstetricians recommendations for clinical practice on maternal and neonatal morbidity and mortality in cases of premature rupture of membranes before 32weeks of amenorrhea at the University Hospital of Strasbourg.

Maternal ‘Near Misses’: A Concept Analysis – Part 1

Obstetric Transport and Factors Associated With Transport to the Intensive Care Unit.

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with significant maternal complications and increased neonatal morbidity and mortality. The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of ICP, highlighting the discrepancies in key areas. A descriptive review of 6 national guidelines from the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Society of Obstetric Medicine of Australia and New Zealand, the Chinese Medical Association, and the Working Group on Obstetrics and Prenatal Medicine of Germany was conducted along with a comparison of their recommendations regarding this pregnancy complication. There is an overall agreement among the reviewed guidelines regarding the definition and the diagnosis of ICP, although minor discrepancies exist with regard to the bile acid cutoff levels. They also highlight the importance of a detailed history and physical examination to exclude other potential causes of maternal pruritus and recommend the evaluation of liver function and the appropriate counseling on the associated maternal and neonatal complications following diagnosis. Ursodeoxycholic acid is recommended by all guidelines (except from the Royal College of Obstetricians and Gynecologists) as first-line treatment for symptoms relief. However, the recommendations regarding the classification of ICP, the frequency of bile acid monitoring, the necessity of fetal surveillance, and the optimal timing of delivery are inconsistent. Obstetrics cholestasis is a severely pruritic form of reversible cholestasis of unknown pathophysiology that is associated with significant fetal risks and no definitive treatment. The variations among the existing guidelines reflect the heterogeneity of available evidence, while highlighting the necessity for further research. Obstetricians and gynecologists, family physicians. After participating in this activity, the learner should be better able to explain the process of differential diagnosis when ICP is suspected; identify the ICP-associated fetal and maternal risks on which affected individuals should be counseled; and describe the medical treatment options and the optimal timing of delivery.

Cord blood-derived cell therapies for preterm brain injury.

Optimizing antenatal corticosteroid therapy: Balancing benefit and risk in the era of precision medicine.

Multidrug-resistant Klebsiella pneumoniae in critically ill neonates: evidence from a Brazilian cohort.