Neonatal Survival Research Articles

Demographic, clinical profile and short-term outcome of neonates referred for mechanical ventilation: experience in a referral neonatal intensive care centre in Southern Nigeria

Background: The use of mechanical ventilation (MV) in NICU is not widespread in Nigeria. Although a life-saving tool in neonates, MV is associated with potentially high morbidity and mortality rate. There are various factors which impact the outcome of MV in neonates. The aim of this study is to assess outcome, demographics and clinical profile of babies who received MV in the region. Methods: This was a retrospective study, involving 20 infants, who were all referred from other Health care centres. Results: The overall survival rate of ventilated babies in this study was 30.0%; however, relative survival rate compared to non-survival group was 53.8%. Although, the mean weight and mean gestational age (GA) of those who survived were higher than that in those who did not survive, this difference was not statistically significant. However, a significantly higher proportion (87.3%) of those who were ventilated for 1-3 days survived, compared to those ventilated for less than 24 hours or more than 3 days. Conclusions: The survival of neonates referred for MV in our study was comparable to that seen in other developing countries. Duration of MV (DMV) was the only significant factor affecting the outcome of MV in our study.

Acute Aortic Dissection during Pregnancy: Hideous Clinical Quandaries with Young Lives on the Line—The Role of Hereditary Genetic Syndromes

Objective: Acute aortic dissection is a rare but frequently fatal aortic catastrophe with high morbidity and mortality. Especially in pregnant patients, acute dissection is often misdiagnosed putting two lives on the line. Due to its scarcity, only case reports have been reported. The aim of this study is to analyze the time of aortic dissection during the course of pregnancy and the outcome of emergency surgery in pregnant women with and without hereditary connective tissue disorder. Methods: We retrospectively reviewed all acute aortic dissections (type A and B) who underwent emergency aortic surgery at our institution between 1994 and 2022 and identified 13 patients with acute aortic dissection during pregnancy or directly postpartum. Mann–Whitney U and Fisher’s exact tests were used for statistical analysis. Results: Of the 13 included patients, 5 had a genetic syndrome. These patients were significantly younger at the time of dissection and at an earlier stage of pregnancy (second trimester). Even though operative and in-house mortality was zero, we lost one patient on postoperative day 14 due to rupture of the aortic root after transfer to another hospital. Survival of neonates was 77% including two aborted pregnancies. Conclusions: Surgical treatment of acute aortic dissection during pregnancy can be performed with excellent operative mortality for the mothers and satisfying survival of their neonates. In patients with genetic syndrome, dissection occurs during the early second trimester, whereas non-syndromic patients experience acute dissection in the late third trimester. Long-term follow-up is essential for timely re-intervention, if needed.

The need for assisted ventilation corroborates the effectiveness of antenatal corticosteroid therapy in preventing premature lamb mortality

In premature births, deficiency and/or inactivation of surfactant and incomplete development of lung occur, leading to pulmonary complications and greater need for ventilatory interventions. Prenatal corticosteroid therapy is used to improve neonatal lung function and, thus, may reduce mortality and lower incidence and severity of lung injury. Therefore, this study aimed to assess the need for ventilatory support in preterm lambs subjected or not to prenatal betamethasone treatment, and to evaluate the effectiveness on neonatal survival. Lambing was induced and 13 premature lambs were assigned to Corticosteroid Group (n = 8; lambs from ewes subjected previously to 0.5 mg/kg betamethasone, IM, at 133 days of pregnancy) and Control Group (n = 5; non-treated lambs). Lambs were evaluated for vitality, neurologic reflexes, vital functions and birth weight. Three ventilatory modalities were preconized for critical lambs, according to specific criteria: mask oxygen therapy, self-inflating bag with tracheal tube and mechanical ventilation. Non-treated lambs had lower vitality score, muscle tonus and respiratory rate compared to Corticosteroid Group. Ventilatory support was needed for 3 Control lambs and only 1 Corticosteroid neonate. Corticosteroid lamb required significant less time-frame between birth and onset of ventilatory assistance and remained under ventilation for a shorter time. Percentage of ventilated non-treated lambs correlated negatively with birth weight, muscle tone, heart and respiratory rate. In conclusion, antenatal betamethasone treatment reduces the need for ventilatory assistance in premature lambs. Additionally, mortality is low when a protocol for inducing pulmonary maturity (maternal corticosteroid therapy) and/or ventilatory interventions are employed, ensuring the survival of premature lambs.

Maternal behaviors influence survival of ungulate neonates under heavy predation risk.

Predators impose top-down forces on prey populations, with the strength of those effects often varying over space and time and among demographic groups. In ungulates, predation risk is typically greatest for neonatal offspring, with some suggesting that predators can key in on adult activity to locate hidden neonates. However, few field studies to date have been able to directly assess the influence of maternal care on ungulate neonate survival. Using a population of white-tailed deer under heavy coyote predation pressure, we tested the maternal dispersion hypothesis, which suggests the dispersion of maternal activity temporally and spatially attenuates risk of predation for ungulate neonates during this vulnerable altricial phase. We compared support for this hypothesis with more commonly tested hypotheses regarding the influence of habitat conditions and intrinsic factors on neonatal survival. Fawn survival to 16 weeks was 27.7%, with coyotes accounting for 59% of fawn mortalities. In support of our maternal temporal diffusion hypothesis, we found that neonatal survival decreased as more maternal visits (proportionally) occurred at night. The only other significant (p < .1) predictor of fawn survival was birth timing, with fawn survival decreasing as the season progressed. Given that fawn survival declined as the proportion of nighttime visits increased, and that wild pig presence and human disturbance can push doe and fawn activity toward nocturnal hours, additional research is needed to determine whether managing pig and human disturbance can decrease fawn mortality. More broadly, given the importance of recruitment in ungulate population dynamics, our finding opens a potentially important new line of inquiry on how maternal behaviors influence predation risk in large animal predator-prey ecology.

Time to recovery of asphyxiated neonates and its’ predictors among newborns admitted to neonatal intensive care unit at Debre Berhan Comprehensive Specialized Hospital, Ethiopia

BackgroundNeonatal asphyxia is a leading cause of early neonatal mortality, accounting for approximately 900,000 deaths each year. Assessing survival rates, recovery time and predictors of mortality among asphyxiated neonates can help policymakers design, implement, and evaluate programs to achieve the sustainable development goal of reducing neonatal mortality to 12/1,000 live births by 2030. The current study sought to ascertain the survival status, recovery time, and predictors of neonatal asphyxia.MethodsA retrospective follow-up study conducted in Debre Berhan Comprehensive Specialized Hospital, which carried out from May 20th to June 20th, 2023 using records of asphyxiated babies in NICUs from January 1st, 2020 to December 31st, 2022, involving a sample size of 330. Pre-structured questionnaires created in Google Form were used to collect data, and STATA Version 14.0 was utilized for data entry and analysis, respectively. The Kaplan–Meier survival curve, log rank test, and median time were calculated. A multivariable Cox proportional hazards regression model was fitted in order to determine the predictors of time to recovery. Variables were statistically significant if their p-value was less than 0.05.ResultsThree hundred thirty admitted asphyxiated neonates were followed a total of 2706 neonate -days with a minimum of 1 day to 18 days. The overall incidence density rate of survival was 9.9 per 100 neonates’ days of observation (95% CI: 8.85–11.24) with a median recovery time of 9 days (95% CI: 0.82–0.93). Prolonged labor (Adjusted hazard ratio (AHR: 0.42,95%CI:0.21–0.81), normal birth weight (AHR:2.21,95% CI: 1.30–3.70),non-altered consciousness (AHR:2.52,CI:1.50–4.24),non-depressed moro reflex of the newborn (AHR:2.40,95%CI: 1.03–5.61), stage I HIE (AHR: 5.11,95% CI: 1.98–13.19),and direct oxygen administration via the nose (AHR: 4.18,95% CI: 2.21–7.89) were found to be independent predictors of time to recovery of asphyxiated neonates..ConclusionIn the current findings, the recovery time was prolonged compared to other findings. This implies early diagnosis, strict monitoring and provision of appropriate measures timely is necessary before the babies complicated into the highest stage of hypoxic –ischemic encephalopathy(HIE) and managing complications are the recommended to hasten recovery time and increase the survival of neonates.

Maternal and fetal factors for determining the cesarean section type (scheduled/emergency) in bitches

One hundred and forty bitches and their offspring (689 puppies) were involved in this study. The influence of different maternal features such as age, breed (brachycephalic/non-brachycephalic), previous births (primiparous/multiparous), health status (complete/incomplete) and litter size over the type of cesarean sections (scheduled/emergency), the neonatal survival, and the incidence of congenital malformations were also examined. Scheduled cesareans were predominant (104/140), of which 90 % were brachycephalic breeds and females were mostly between 2 and 4 years old (54.8 %), multiparous (88.4 %) and with a correct health status (67.3 %). Emergency cesarean sections mainly involved non-brachycephalic breeds (80 %) and were carried out mostly in females under 4 years of age (72.2 %), primiparous (77.7 %), with incomplete health status and a large litter size (47.2 %). Perinatal mortality was notably higher in emergency C-sections (3.25 % and 13.3 %, scheduled and emergency C-sections, respectively); the highest incidence of neonatal mortality was recorded in young females (<2, 2–4 years old), primiparous and with incomplete health status. Congenital anomalies were observed in 4.50 % (31/689) of the puppies, with anasarca (38.71 %) and cleft palate (29.03 %) being the most frequently observed malformations. A higher incidence of congenital malformations was detected in puppies from dams with incomplete sanitary health and from inbreeding cross. Overall, the study provides valuable insights into the complex interplay between maternal characteristics and cesarean outcomes. Appropriate genetic selection, good sanitary health conditions, and the age of the reproducers, are pivotal factors in planning for gestation and improving the survival of neonates.

The case of the neonate vs. LMIC medical academia-a jury-style systematic review of 32 years of literature without significant mortality reduction.

The high neonatal mortality rate in low- and middle-income countries (LMICs) such as Nigeria has lasted for more than 30 years to date with associated nursing fatigue. Despite prominent hard work, technological improvements, and many publications released from the country since 1990, the problem has persisted, perhaps due to a lack of intervention scale-up. Could there be neglected discoveries unwittingly abandoned by Nigerian policymakers over the years, perhaps locked up in previous publications? A careful review may reveal these insights to alert policymakers, inspire researchers, and refocus in-country research efforts towards impactful directions for improving neonatal survival rates. The focus was to determine the prevailed effectiveness of LMIC medical academia in creating solutions to end the high neonatal mortality rate. An unconventional systematic review protocol structure following the PRISMA 2020 checklist was designed and registered at INPLASY (registration number: INPLASY202380096, doi: 10.37766/inplasy2023.8.0096). A jury of paediatricians was assembled and observed by a team of legal professionals. The jury searched the literature from 1990 to the end of 2022, extracted newborn-related articles about Nigeria, and assessed and debated them against expected criteria for solution creation, translation, scale-up, sustainability, and national coverage. Each juror used preset criteria to produce a verdict on the possibility of a published novel idea being a potential game-changer for improving the survival rate of Nigerian neonates. A summation of the results showed that 19 out of 4,286 publications were assessed to possess potential strategies or interventions to reduce neonatal mortality. Fourteen were fully developed but not appropriately scaled up across the country, hence denying neonates proper access to these interventions. Nigeria may already have the required game-changing ideas to strategically scale up across the nation to accelerate neonatal survival. Therefore, LMIC healthcare systems may have to look inward to strengthen what they already possess. https://inplasy.com/, identifier (INPLASY202380096).

Pregnancy conditions and outcomes of Chinese women with mild, moderate and severe pulmonary arterial hypertension.

Pregnancy is normally contraindicated in pulmonary arterial hypertension (PAH). Thanks to medical advances, the prognosis for pregnancy in patients with PAH has improved. The aim of our study was to investigate pregnancy conditions and outcomes in patients with mild, moderate and severe PAH. We searched PubMed, Embase, CNKI, Wanfang and Weipu databases for studies published before May 2024. Data from 29 included studies from 1898 references were pooled and analyzed. We calculated the rates for each group as well as the risk ratio (RR) and 95% confidence interval (CI) between pairwise. There was no statistical difference in maternal and neonatal survival between the mild and moderate groups. Maternal survival in the mild, moderate and severe groups was 100.0%, 99.7% and 88.8%, respectively, and neonatal survival was 100.0%, 99.7% and 96.0%, respectively. The incidence of NYHA class III-IV, pregnancy loss, intensive care unit (ICU) admission, fetal growth restriction, and neonatal asphyxia was lowest in patients with mild PAH and highest in patients with severe PAH (P < 0.001). The incidence of vaginal deliveries and term pregnancies was highest in the mild group and lowest in the severe group (P < 0.001). In conclusion, pregnant women with mild PAH can safely deliver a newborn. Given similar survival rates but greater economic and medical burdens, caution is advised in the moderate group. Pregnancy in the severe group is considered contraindicated.

Role of Telomere Length in Radiation Response of Hematopoietic Stem & Progenitor Cells in Newborns

Objective Wide inter-individual variations in ionizing radiation (IR) responses of neonatal hematopoietic system calls for identifying reliable biomarkers to effectively estimate radiation exposure damages in neonates. Methods Association between telomere length (TL) at birth and radiation sensitivity of cord blood hematopoietic stem cells (HSC) from 166 healthy newborns were investigated by assessing their clonogenic differentiation. TL was determined as terminal restriction fragment (TRF) by Southern blot method. Results TL correlated with surviving fractions of total progenitor colony forming cell (CFC) content at 0.75 Gy (p < 0.05), granulo-macrophagic lineage colony forming units (CFU-GM) at 0.75 Gy (p < 0.05) and erythroid burst forming unit (BFU-E) at 0.75 Gy (p < 0.05) & at 3 Gy (p < 0.05) of newborns. Conclusion Our results indicate risks for HSC clonogenic survival in neonates with shorter telomeres after IR exposure. These observations might aid in considering TL at birth as an assessment factor for radiation related hematopoietic challenges in children.

Obstructive or non-obstructive megacystis: a prenatal dilemma.

Diagnosis of prenatal megacystis has a significant impact on the pregnancy, as it can have severe adverse effects on fetal and neonatal survival and renal and pulmonary function. The study aims to investigate the natural history of fetal megacystis, to try to differentiate in utero congenital lower urinary tract obstruction (LUTO) from non-obstructive megacystis, and, possibly, to predict postnatal outcome. A retrospective single-center observational study was conducted from July 2015 to November 2023. The inclusion criteria were a longitudinal bladder diameter (LBD) >7 mm in the first trimester or an overdistended/thickened-walled bladder failing to empty in the second and third trimesters. Close ultrasound follow-up, multidisciplinary prenatal counseling, and invasive and non-invasive genetic tests were offered. Informed consent for fetal autopsy was obtained in cases of termination of pregnancy or intrauterine fetal demise (IUFD). Following birth, neonates were followed up at the same center. Patients were stratified based on diagnosis: LUTO (G1), urogenital anomalies other than LUTO ("non-LUTO") (G2), and normal urinary tract (G3). This study included 27 fetuses, of whom 26 were males. Megacystis was diagnosed during the second and third trimesters in 92% of the fetuses. Of the 27 fetuses, 3 (11.1%) underwent an abortion, and 1 had IUFD. Twenty-three newborns were live births (85%) at a mean gestational age (GA) of 34 ± 2 weeks. Two patients (neonates) died postnatally due to severe associated malformations. Several prenatal parameters were evaluated to differentiate patients with LUTO from those with non-LUTO, including the severity of upper tract dilatation, keyhole sign, oligohydramnios, LBD, and GA at diagnosis. However, none proved predictive of the postnatal diagnosis. Similarly, none of the prenatal parameters evaluated were predictive of postnatal renal function. The diagnosis of megacystis in the second and third trimesters was associated with live births in up to 85% of cases, with LUTO identified as the main cause of fetal megacystis. This potentially more favorable outcome, compared to the majority reported in literature, should be taken into account in prenatal counseling. Megacystis is an often misinterpreted antennal sign that may hide a wide range of diagnoses with different prognoses, beyond an increased risk of adverse renal and respiratory outcomes.

A fine-scale examination of parturition timing in temperate ungulates.

Parturition timing has long been a topic of interest in ungulate research. However, few studies have examined parturition timing at fine scale (e.g., <1 day). Predator activity and environmental conditions can vary considerably with diel timing, which may result in selective pressure for parturition to occur during diel times that maximize the likelihood of neonate survival. We monitored parturition events and early-life survival of elk (Cervus canadensis) and mule deer (Odocoileus hemionus) in Utah, USA to better understand diel timing of parturition in temperate ungulates. Diel timing of parturition was moderately synchronous among conspecifics and influenced by environmental variables on the date of parturition. For elk, parturition events were most common during the morning crepuscular period and generally occurred later (i.e., closer to 12:00) when a relatively large proportion of the moon was illuminated. For mule deer, parturition events were most common during the diurnal period and generally occurred later (i.e., closer to 15:00) on cold, wet dates. Diel timing of parturition did not influence neonate survival, but larger datasets may be required to verify the apparent lack of influence. Although additional work could evaluate alternative variables that might affect parturition timing, our data provide an improved and finer scale understanding of reproductive ecology and phenology in ungulates.

Maternal and Neonatal Outcomes of Labor Induction in Parous Women in a Selected Hospital in Sudan

Background: Induction of labor (IOL) initiates labor artificially, aiming to prevent potential risks for both mother and fetus. However, data on IOL outcomes for parous women in the developing countries are scarce. Objectives: This study evaluates maternal and neonatal outcomes in parous women undergoing IOL at a Sudanese hospital. Methods: A descriptive cross-sectional study included 75 parous women undergoing IOL at Haj-Alsafi Teaching Hospital. Demographic data, reasons for IOL, and maternal and neonatal outcomes were recorded. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 26, with P values &lt; 0.05 considered statistically significant. Results: Of 600 women, 75 (12.5%) underwent IOL over 6 months. Main indications were hypertensive disorders (21.3%) and postterm pregnancy (17.3%). Successful vaginal delivery (88%) predominated, with 12% requiring instrumental delivery. Maternal complications included postpartum hemorrhage (8%) and ruptured uterus (1.3%), while 69.7% had no complications. The neonatal survival rate was 91%, with 30.7% admitted to the Neonatal Intensive Care Unit (NICU) for further care. Among the NICU admissions, the mortality rate was 17.4%, all were preterm neonates. Conclusion: IOL is associated with successful VD in 88% and low rate of complications among the parous women; however, greater efforts are needed to prevent serious outcomes among the neonates.

Investigating the Challenges, Successes, and Strategies of Implementing Advanced Neonatal Care Interventions in Low-Resource Settings: A Clinical Study.

Neonatal care interventions are crucial for reducing infant mortality rates, particularly in low-resource settings where access to advanced medical facilities is limited. Implementing these interventions poses significant challenges due to resource constraints and infrastructural limitations. This clinical study investigated the challenges, successes, and strategies involved in implementing advanced neonatal care interventions in a low-resource setting. A retrospective analysis was conducted on the data collected from a neonatal care unit in a resource-limited area over a period of two years. The study assessed the availability of medical equipment, healthcare personnel training, and the efficacy of interventions in improving neonatal health outcomes. The analysis revealed that despite resource constraints, significant strides were made in implementing advanced neonatal care interventions. Availability of essential medical equipment increased by 30%, and healthcare personnel received targeted training programs resulting in a 25% improvement in neonatal survival rates. Strategies such as task-shifting and community outreach programs played a pivotal role in overcoming infrastructural limitations. Implementing advanced neonatal care interventions in low-resource settings is challenging but feasible with targeted strategies. While resource constraints remain a barrier, innovative approaches such as task-shifting and community involvement can significantly improve neonatal health outcomes. Continued investment in infrastructure, training, and community engagement is essential for sustainable progress in reducing neonatal mortality rates in resource-limited areas.

Microplastics impair the reproductive behavior and life history traits of the amphipod Parhyale hawaiensis

We investigated the distribution and effects of waterborne microplastic (MP) (polyethylene microspheres, 53–63 um) on the emergent model for ecotoxicology, the amphipod Parhyale hawaiensis, during 30 days of exposure. The following life-history traits were measured: (1) survival, (2) specific growth rate (SGR), (3) reproductive performance (precopulatory pairing behavior, fecundity, and time to release neonates), (4) molting frequency, (5) F1 newborn offspring survival and (6) MP bioaccumulation. No significant mortality or molt was seen in any of the treatments. MP caused a reduction in SGR, being more pronounced in females. The time for precopulatory pairing was 3-fold longer in amphipods exposed to MP. Fecundity decreased by 50 %, and the time to release juveniles was 6.7 days longer for amphipods exposed to MP. Finally, neonate survival decreased by 80 % after ten days of release. MP disrupts the reproductive mechanisms and triggers adverse effects on life history traits in P. hawaiensis.

Genetic identification of medullary neurons underlying congenital hypoventilation.

Mutations in the transcription factors encoded by PHOX2B or LBX1 correlate with congenital central hypoventilation disorders. These conditions are typically characterized by pronounced hypoventilation, central apnea, and diminished chemoreflexes, particularly to abnormally high levels of arterial PCO2. The dysfunctional neurons causing these respiratory disorders are largely unknown. Here, we show that distinct, and previously undescribed, sets of medullary neurons coexpressing both transcription factors (dB2 neurons) account for specific respiratory functions and phenotypes seen in congenital hypoventilation. By combining intersectional chemogenetics, intersectional labeling, lineage tracing, and conditional mutagenesis, we uncovered subgroups of dB2 neurons with key functions in (i) respiratory tidal volumes, (ii) the hypercarbic reflex, (iii) neonatal respiratory stability, and (iv) neonatal survival. These data provide functional evidence for the critical role of distinct medullary dB2 neurons in neonatal respiratory physiology. In summary, our work identifies distinct subgroups of dB2 neurons regulating breathing homeostasis, dysfunction of which causes respiratory phenotypes associated with congenital hypoventilation.

PeRinatal, neOnatal, and Maternal OuTcomEs with azithromycin prophylaxis in pregnancy and labour (PROMOTE-PROPHYLAXIS): systematic review and meta-analysis

Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86-1.20, I 2 =0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65-2.42, I 2 =0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35-1.56, I 2 =43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67-3.91, I 2 =0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. None.

Patient perspectives and preferences on cerclage and preterm birth: a focus group study

AimThis qualitative focus group study aims to asses cerclage-related symptoms, the impact of a cerclage on daily functioning and patient perspectives of their healthcare experience. This study extends beyond the current focus on surgical and obstetric outcomes of a cerclage, thereby contributing to a more comprehensive understanding of the challenges faced by individuals in the context of extreme preterm birth and fetal loss and the impact of a cerclage on multiple facets in life.MethodsParticipants were recruited from the Amsterdam University Medical Center, Amsterdam, the Netherlands or via the website of a Dutch patient organization for (extreme) preterm birth. Eligible participants were ≥ 18 years old with a previous vaginal and/or abdominal cerclage with a subsequent delivery at ≥ 34 weeks of gestation with neonatal survival. Two focus group discussions (FGD) were performed. A predefined format was used, which was identical for both the vaginal and abdominal cerclage group. The International Classification of Functioning, Disability and Health (ICF-DH) was used to provide structure. Outcomes were a broad range of participants reported perspectives on physical, emotional, and social-related quality of life.ResultsIn the Vaginal Cerclage Group (VCG) and Abdominal Cerclage Group (ACG), respectively, 11 and 8 participants were included. Fear for a subsequent pregnancy loss was the most limiting factor to perform daily activities during pregnancy in all participants with a cerclage. Fear to conceive again because of prior second-trimester fetal loss was experienced by 27% in the VCG and 13% in the ACG. The majority of participants experienced a reduction in anxiety after placement of their cerclage (VCG = 64%, ACG = 75%). Decreased mobility/bedrest (VCG = 100%, ACG = 75%) and blood loss (VCG = 55%, ACG = 13%) were frequently mentioned complaints during pregnancy with cerclage. Other aspects mentioned in both groups were social isolation, the lack of societal participation, and the perceived need to quit work and sports. All participants in the abdominal cerclage group reported a lack of comprehensible and unambiguous information about obstetric management and expectations during pregnancy in secondary care hospitals. Clear communication between secondary and tertiary care hospitals about obstetric management following an abdominal cerclage, for example, about the need for cervical length measurements by ultrasound, the need for bedrest or advice concerning sexual activity was missing (63%). Psychologic support was desired in half of all participants, but was not offered to them.ConclusionsThe fear of a subsequent pregnancy loss was reported as the most limiting factor in daily life by all participants. Cerclage placement resulted in the reduction of anxiety. Participants mentioned a significant impact of bedrest and activity restriction during pregnancy with cerclage on social participation and daily activities. Unfortunately, no high level evidence is available on this matter. Patients might even benefit from appropriate levels of physical activity throughout their pregnancy to promote their overall well-being. More evidence is needed to determine the optimal level of physical activity. There is a need for clear and unambiguous patient information about obstetric management.

Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis.

Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47-9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76-13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention.

Knowledge of Neonatal Danger Signs among Postnatal Mothers at Women and New born Hospital - University Teaching Hospitals in Lusaka Zambia.

Purpose: The awareness and identification of neonatal danger signs by mothers play a significant role in a neonate's survival and future health. The survival of neonates is thought to be increased by providing a clear understanding of neonatal danger signs. This study aimed to assess postnatal mothers' knowledge of neonatal danger signs and associated factors. Methodology: A cross-sectional analytical study design was used to conduct a study at Women and Newborn Hospital UTH in Lusaka Zambia with a total number of 150 participants. Participants recruited in the study included all mothers aged 18 and above seeking care at UTH from day six today twenty-eight after delivery. Data was collected using the validated Neonatal Danger Signs Knowledge and Practices Questionnaire (NDSKQ) tool and SPSS version 26 was used to analyse data. A Binary logistic regression analysis was done to identify factors associated with Neonatal danger signs. Findings: Slightly above half (53%) of the respondents had poor knowledge on neonatal danger signs. Age, marital status, educational level, parity, antenatal care attendance and family support system were associated with knowledge on neonatal danger signs with all p values of less than or equal to 0.05. Younger mothers (18-20 years) (56.5%) were more likely to have poor knowledge compared to older mothers. Married mothers (68%) and those who were divorced or widowed (60%) were more likely to have better knowledge compared to single mothers, mothers with tertiary education (60%) had better knowledge compared to those with none/primary education (58%), mothers with more children (66.7%) were less likely to have poor knowledge compared to those with their first child (50%), mothers who attended antenatal care six times or more (67.1%) had better knowledge compared to those who attended five times or less (53.8%) and mothers with a family support system (75%) were more likely to have good knowledge compared to those without (53%) all the associations were statistically significant. Unique contribution to theory, policy and practice: There is need to focus on training in maternal identification of neonatal danger signs. Personalised education for mothers, considering age and education level, and integrating family involvement and cultural competence into care delivery are crucial. Nursing education should advance through specialized curricula, utilizing advanced simulation training and interdisciplinary collaboration to enhance clinical skills in identification of neonatal danger signs and promote maternal awareness of neonatal dangers signs, ultimately improving neonatal health.

Long-Term Outcomes, Including Fetal and Neonatal Prognosis, of Renal Oligohydramnios: A Retrospective Study over 22 Years

To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death. This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed. Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (odds ratio 1.16, 95% confidence interval (CI) 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (odds ratio 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, one case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death. Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.