Newborn Birth Research Articles

Congenital Heart Disease in a Tertiary Care NICU; Pattern, Risk Factors and Outcome

Background: Identification of congenital heart disease (CHD) is increasing, may be due to advancement of diagnostic technology and availability of trained man power. Several studies have been conducted in Bangladesh to identify the prevalence and pattern of CHD but paucity of data regarding etiology and outcome. Objective: The aim of this study is to identify the frequency and risk factors of so that preventive measures can be taken. Methods: This retrospective case control study was conducted in the neonatal intensive care unit (NICU), BSMMU, Dhaka from January 2021 to June 2022. All admitted neonates in NICU with the diagnosis of CHD were considered as cases. Twice number of newborn having gestational age and birth weight matched neonates diagnosed other than CHD in NICU were considered as control. Data were extracted from the Medical records of patient files and computer electronic data records of “Newborn Birth Defect (NBBD) surveillance in Bangladesh.” The level of significance was set at 5% (P <0.05). Result: Total 914 patient were admitted during the study period among them 119 patient were CHD (frequency rate 13%). Mean birth weight and gestational age of CHD group were 2376±783.85g & 35.80±3.26 weeks respectively. About 85.7% had acyanotic CHD, among them most prevalent were atrial septal defect (42%) then patent ductus arteriosus (11.8%). Cyanotic CHD were 17 (14.3%). Maternal DM significantly increase the risk of developing CHD, Odd’s ratio 1.971 (CI: 1.182 - 3.285). Death were more in CHD group (34.5%) than control group (20.4%), p values = 0.005. Conclusion: Frequency (13%) of congenital heart disease was high. Maternal diabetes mellitus increases the risk of developing CHD of their baby. Death were more among babies with CHD. BANGLADESH J CHILD HEALTH 2022; VOL 46 (3) : 122-129

Exploring Prenatal Exposure to Halogenated Compounds and Its Relationship with Birth Outcomes Using Nontarget Analysis.

Halogenated organic compounds (HOCs) are a class of contaminants showing high toxicity, low biodegradability, and high bioaccumulation potential, especially chlorinated and brominated HOCs (Cl/Br-HOCs). Knowledge gaps exist on whether novel Cl/Br-HOCs could penetrate the placental barrier and cause adverse birth outcomes. Herein, 326 cord blood samples were collected in a hospital in Jinan, Shandong Province from February 2017 to January 2022, and 44 Cl/Br-HOCs were identified with communicating confidence level above 4 based on a nontarget approach, covering veterinary drugs, pesticides, and their transformation products, pharmaceutical and personal care products, disinfection byproducts, and so on. To our knowledge, the presence of closantel, bromoxynil, 4-hydroxy-2,5,6-trichloroisophthalonitrile, 2,6-dibromo-4-nitrophenol, and related components in cord blood samples was reported for the first time. Both multiple linear regression (MLR) and Bayesian kernel machine regression (BKMR) models were applied to evaluate the relationships of newborn birth outcomes (birth weight, length, and ponderal index) with individual Cl/Br-HOC and Cl/Br-HOCs mixture exposure, respectively. A significantly negative association was observed between pentachlorophenol exposure and newborn birth length, but the significance vanished after the false discovery rate correction. The BKMR analysis showed that Cl/Br-HOCs mixture exposure was significantly associated with reduced newborn birth length, indicating higher risks of fetal growth restriction. Our findings offer an overview of Cl/Br-HOCs exposome during the early life stage and enhance the understanding of its exposure risks.

Birth Body Mass Index (Bmi) of Late Preterm and Early-Term Newborns

Introduction: the nutritional status and the growth achieved by the newborn until birth have been used as a marker/indicator of early risks of morbidity and mortality. Even though BMI is a good marker of adiposity and is commonly used in older children and adults, there are still gaps in knowledge and there are few studies on the behavior of BMI according to gestational age.
 Objective: to analyze the Body Mass Index (BMI) at the birth of late preterm newborns (34th to 36th week of gestational age) and early-term newborns (37th to 38th week of gestational age) and according to gestational age.
 Methods: this is a descriptive, analytical, and quantitative study with 2,486 newborns, developed from the project’s database “Biometric characteristics at birth, of young adult women’s babies, in a municipality with a high human development index.” After collection, data consistency was verified. The analysis evaluated measures of central tendency and dispersion of values, in addition to correlations and regressions of their evolution according to gestational age.
 Results: BMI scores Z distribution wasn’t different between male and female late preterm newborns as in early-term newborns. The same was observed concerning gestational ages. In terms of absolute BMI values, it was observed that late preterm newborns had a lower BMI (12.6 kg/m2) than early-term newborns (13.6 kg/m2). However, considering their gestational age, late preterm newborns were proportionally bigger than early-term newborns. A proportionally higher rate of BMI growth was observed in late preterm newborns, with a tendency to slow down in early-term newborns. As for weight gain, from the 37th week of gestational age, it tends to decrease compared to the reference values.
 Conclusion: Regarding the BMI reference values, early-term and late-preterm newborns are equivalent. Late-preterm newborns have the same BMI Z-scores as reference values as early-term newborns.

Confluence of newborn's sex and their mother's characteristics resulting in fetal macrosomia among Indian neonates

BackgroundA newborn's birth weight ≥4000 g is defined as fetal macrosomia, which is recognized as a reproductive and serious child health concern. ObjectivesOur study aims to reveal existence of any connection between maternal factors and newborn sex in giving birth to newborn ≥4000 g in an Indian context. MethodsData were drawn from the fifth round of National Family Health Survey (NFHS-5). A cross-sectional observational study was carried out with a total of 152,827 children born to women in reproductive age group (15–49) who had most recent live birth in the five years preceding the survey. Descriptive analyses, cross-tabulation, test of association and multivariate logistic regression analyses were performed. ResultsIn India, the prevalence of macrosomia was found in 3.8% of the total study participants. Considering newborn characteristics, fetal macrosomia was more prevalent among male neonates than female (AOR: 0.730; 95% CI: 0.687–0.775). Regarding maternal characteristics, overweight (AOR: 1.468; 95% CI: 2.042–2.559) and obese (AOR: 2.764; 95% CI: 2.394–3.192) motherswith gestational diabetes (AOR: 1.731, 95% CI: 1.385–2.164) and hypertension (AOR: 1.288, 95% CI: 1.116–1.488) were more likely to giving birth of macrosomic babies. Multiparous mothers (AOR: 1.207, 95% CI: 1.128–1.293) and women who did not undergo proper antenatal care (ANC) follow up had also greater risk of developing fetal macrosomia. Muslim women (AOR: 1.223, 95% CI: 1.119–1.338), and women belonging to a tribe (AOR: 1.476, 95% CI: 0.922–2.361) were significantly associated with the risk of having newborn ≥4000 g. ConclusionEmphasis should be given on counseling for mothers for desired weight management before and during pregnancy, gestational diabetes and hypertension screening, physical activity during pregnancy, adequate ANC follow up and balanced dietary intake among pregnant women.

Risk factors and management of perinatal genital hematoma: A single, tertiary medical center retrospective study in China.

The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes. This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data. A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower. Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.

Small size, big problems: insights and difficulties in prenatal diagnosis of fetal microcephaly.

Microcephaly is a sign, not a diagnosis. Its incidence varies widely due to the differences in the definition and the population being studied. It is strongly related to neurodevelopmental disorders. Differences in definitions and measurement techniques between fetuses and newborns pose a great challenge for the diagnosis and prognostication of fetal microcephaly. A false positive diagnosis can result (in countries where it is legal) in erroneous termination of pregnancy, where a false negative diagnosis might lead to the birth of a microcephalic newborn. Microcephaly in growth restricted fetuses deserves special attention and separate evaluation as it is an important prognostic factor, and not necessarily part of the general growth retardation. Several genetic syndromes incorporating microcephaly and intrauterine growth retardation (IUGR) are discussed. Deceleration of the head circumference (HC) growth rate even when the HC is still within normal limits might be the only clue for developing microcephaly and should be considered during fetal head growth follow up. Combining additional parameters such as a positive family history, associated anomalies, and new measurement parameters can improve prediction in about 50% of cases, and thus should be part of the prenatal workup. Advances in imaging modalities and in prenatal genetic investigation along with the emergence of new growth charts can also improve diagnostic accuracy. In this article, we review the different definitions and etiologies of fetal microcephaly, discuss difficulties in diagnosis, investigate the reasons for the low yield of prenatal diagnosis, and provide improvement suggestions. Finally, we suggest an updated algorithm that will aid in the diagnosis and management of fetal microcephaly.

Correlations of Aflatoxin Exposure from Cooking Oil and Dietary Foods During Pregnancy with Birth Weight and Gestational Age at Birth in Guangxi, China.

Cooking oil and dietary foods are easily contaminated by aflatoxins (AFs) in Guangxi, China where low birth weight and preterm birth were prevalent. However, there are no data on AF exposure in pregnant women or their impact on newborn birth outcomes. This study aims to measure the levels and correlations of AFs in cooking oil, estimated dietary intake (EDI) of AFs in dietary foods, and serum AFB1 albumin adducts (AFB1-alb) with newborn birthweight and gestational age at birth. A prospective study was conducted among 126 pregnant women in Guangxi, China. All recruited women were interviewed for demographic data and behavior and obstetric information and then followed up until giving birth. AF measurements were obtained from cooking oil, dietary foods, maternal serum, and cord blood and the correlations of AF levels with newborn birthweight and gestational age at birth were tested using correlation analysis. The median EDI of AFs in cooking oil was 2.61 ng/kg.bw/day and in dietary foods 2.95 ng/kg.bw/day. High positive correlations among EDI of aflatoxin B1 (AFB1) from cooking oil and dietary foods were found (r > 0.7). Low positive correlations of AFB1-alb in maternal serum and cord blood and both EDI of AFB1 in both cooking oil and dietary foods were shown (r ≈0.3). Significant correlations between AF levels in both cooking oil and dietary foods with birth weight were found, but very low negative correlations (r = - 0.244 ~ -0.285). AFB1 levels in foods, maternal serum and cord blood levels were high in pregnant women with newborn low birth weight and preterm birth. The EDIs of AFB1 from both cooking oil and dietary foods were significantly correlated with AFB1-alb in maternal serum and cord blood. Negative correlations of AFs from cooking oils and foods with newborn birth weight should be paid more attention.

Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population.

We prospectively evaluated the association of the insulin resistance of third-trimester Nigerian pregnant women with their newborn infants' insulin resistance and birth size. Pregnancy-associated insulin resistance (IR), often assessed with homeostatic model assessment of IR (HOMA-IR), is associated, especially among women with gestational diabetes (GDM), with abnormal neonatal birth size and body composition, predisposing the baby to metabolic disorders like diabetes and obesity. The associations of maternal IR with neonatal IR, birth size and body composition are less studied in nondiabetic pregnant women, especially in sub-Saharan settings like Nigeria. We originally recruited 401 third trimester, nondiabetic pregnant women to a prospective cohort study, followed up until birth. Blood samples of mothers and babies were obtained, respectively, at recruitment and within 24 hours postbirth for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was calculated as [(FSI × FSG)/22.5)]. Complete data for 150 mother-baby dyads was analysed: the mothers, with a mean (standard deviation [SD]) age of 31.6 (4.5) years, had live births at a mean (SD) gestational age of 39.2 weeks. The proportions of infants with wasting, stunting, impaired fetal growth (either wasting or stunted), small-for-gestation-age, large-for-gestational-age, low birthweight, and macrosomia were 4.2% (95% confidence interval, 1.1-10.3), 19.7% (12.9-28.0), 23.1% (15.8-31.8), 10.1% (5.3-17.0), 12.6% (7.2-19.9), 0.8% (0.02-4.5), and 5.0% (1.8-10.5), respectively. Maternal HOMA-IR was not associated with neonatal HOMA-IR (p=0.837), birth weight (p=0.416) or body composition measured with weight-length ratio (p=0.524), but birth weight was independently predicted by maternal weight (p=0.006), body mass index (p=0.001), and parity (p=0.012). In this nondiabetic/non-GDM cohort, maternal HOMA-IR was not associated with neonatal IR, body size or body composition. Larger studies are required to confirm these findings, with addi-tional inclusion of mothers with hyperglycaemia for comparison.

Epidemiology of Congenital Cholesteatoma: Surveys of the Last 17 Years in Japan.

(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.

Efficient administration of a combination of nifedipine and sildenafil citrate versus only nifedipine on clinical outcomes in women with threatened preterm labor: a systematic review and meta-analysis

BackgroundPreterm labor (PTL) is a common and serious pregnancy disorder that can cause long-term neurological issues in the infant. There are conflicting studies concerning whether sildenafil citrate (SC) reduces preterm labor complications. Therefore, the meta-analysis aimed to examine the clinical outcomes in women with threatened PTL who received nifedipine plus SC therapy versus only nifedipine.MethodsFor the original articles, six databases were searched using relevant keywords without restriction on time or language until January 13, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and GRADE determined the quality of our evidence. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1.ResultsSeven studies with mixed quality were included in the meta-analysis. The study found that combining nifedipine and SC resulted in more prolongation of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine alone, p = 0.02), and the risk ratio of admission to the neonatal intensive care unit (NICU) was significantly lower (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high for prolongation of pregnancy, delivery rate 24–72 h after admission, and NICU admission, but low for newborn birth weight.ConclusionsGiven the effectiveness of SC plus nifedipine in increased prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd days after hospitalization, and NICU admission, Gynecologists and obstetricians are suggested to consider this strategy for PTL management, although additional article rigor is required to improve the quality of the evidence.

Association between maternal blood or cord blood metal concentrations and catch-up growth in children born small for gestational age: an analysis by the Japan environment and children’s study

BackgroundCatch-up growth issues among children born small for gestational age (SGA) present a substantial public health challenge. Prenatal exposure to heavy metals can cause adverse effects on birth weight. However, comprehensive studies on the accurate assessment of individual blood concentrations of heavy metals and their effect on the failure to achieve catch-up growth remain unavailable. This study aimed to evaluate the effects of uterine exposure to toxic metals cadmium, lead, and mercury and essential trace metals manganese and selenium at low concentrations on the postnatal growth of children born SGA.MethodsData on newborn birth size and other factors were obtained from the medical record transcripts and self-administered questionnaires of participants in the Japan Environment and Children’s Study. The blood concentrations of lead, cadmium, mercury, selenium, and manganese in pregnant women in their second or third trimester were determined by inductively coupled plasma mass spectrometry. These heavy metal concentrations were also assessed in pregnant women’s cord blood. Furthermore, the relationship between each heavy metal and height measure/catch-up growth in SGA children aged 4 years was analyzed using linear and logistic regression methods. These models were adjusted for confounders.ResultsWe studied 4683 mother–child pairings from 103,060 pregnancies included in the Japan Environment and Children’s Study. Of these, 278 pairs were also analyzed using cord blood. At 3 and 4 years old, 10.7% and 9.0% of children who were born below the 10th percentile of body weight had height standard deviation scores (SDSs) below 2, respectively. Cord blood cadmium concentrations were associated with the inability to catch up in growth by 3 or 4 years old and the height SDS at 3 years old. In maternal blood, only manganese was positively associated with the height SDS of SGA children aged 2 years; however, it was not significantly associated with catch-up growth in these children.ConclusionCadmium exposure is associated with failed catch-up development in SGA children. These new findings could help identify children highly at risk of failing to catch up in growth, and could motivate the elimination of heavy metal (especially cadmium) pollution to improve SGA children’s growth.

The current status of Group B Streptococcus infection in the reproductive tract of late-pregnancy women and its impact on pregnancy outcomes.

Analyze Group B Streptococcus (GBS) infection in late-pregnancy pregnant women in Shanghai, the risk factors of GBS infection, and its impact on pregnancy outcomes, providing guidance for early prevention and treatment in clinical practice. We selected 12,132 late-pregnancy pregnant women admitted from January 2022 to December 2022 as the research subjects. Based on the GBS test results of reproductive tract secretion samples from pregnant women, 210 cases of GBS positive pregnant women were randomly selected as the observation group, and 200 cases of GBS negative pregnant women were selected as the control group. The risk factors of infection and the impact on pregnancy outcomes were compared between the two groups. The GBS colonization rate of pregnant women in this study was 6.52%; the incidence of Vaginal delivery and Neonatal infection in GBS positive group was significantly higher than that in GBS negative group (P < 0.05); with Neonatal infection as the dependent variable, and the GBS infection, Vaginal delivery and GDM of the elderly and women in late pregnancy as independent variables, the results showed that GBS infection of women in late pregnancy was an independent risk factor for Neonatal infection. Clinical practice should attach great importance to GBS infection in late pregnancy, strengthen GBS screening in late pregnancy, and actively implement the strategy of intrapartum antibiotic intervention (IAP), which is of great significance in reducing the vertical infection rate of maternal and infant GBS and improving the quality of newborn birth.

Association of Altered Ratio of Maternal Folic Acid and Vitamin B12 during Pregnancy with Newborn Birth Weight, Head Circumference, and Chest Circumference

Objective This study evaluated the effect of an altered ratio of maternal RBC folate (MRF) to serum vitamin B12 (MB12) on pregnancy and newborn outcomes. Methods Blood samples were collected from pregnant women and the umbilical cord at the time of delivery. Estimations of RBC folate and serum vitamin B12 from maternal and cord blood samples and total homocysteine (HCY) were performed. Maternal and newborn anthropometric parameters like placental weight (PW), head circumference (HC), chest circumference (CC), and body weight (BW) were measured in offsprings after birth. We stratified the pregnant women into six groups (a) vitamin B12 normal and folic acid normal (BNFN)-control group, (b) vitamin B12 normal and folic acid elevated (BNFE), (c) vitamin B12 normal and folic acid deficient (BNFD), (d) vitamin B12 deficient and folic acid normal (BDFN), (e) vitamin B12 deficient and folic acid elevated (BDFE) and (f) vitamin B12 deficient and folic acid deficient (BDFD) based on their levels of RBC folate (MRF) and vitamin B12 (MB12). The expression of the one-carbon metabolism genes (methionine synthase (MS), glycine N-methyltransferase (GNMT), and cystathionine β-synthase (CBS) was also studied in placental tissue by using real-time PCR. Results Cord blood RBC folate was significantly reduced in groups BDFE and BDFD as compared to the control group (BNFN). The cord blood vitamin B12 levels were also reduced in the BDFE group as compared to the BDFD. All the newborn parameters viz. PW, HC, CC, and BW, were reduced in the altered MRF/MB12 ratio (low & high vs. normal ratio). Total HCY was significantly elevated in the groups with (BDFE & BDFN) an imbalance of maternal RBC folate and serum vitamin B12 as compared to the control group. Downregulation of one-carbon metabolism genes like MS (p < 0.001), GNMT (p < 0.05), and CBS (p < 0.01) in placental tissue was observed in the high MRF/MB12 ratio group as compared to the normal ratio group. A strong positive correlation was also observed between MRF, MB12, and newborn parameters. Conclusions The altered ratio of folate to vitamin B12 in the maternal blood is associated with adverse growth and development of the newborn.

The timing of 40% oral dextrose gel administration after birth does not influence the incidence of hypoglycemia in at-risk infants

BackgroundHypoglycemia is the most common metabolic disorder seen in newborns and can cause long-term neurological damage, developmental disorders and poor later school performance. In recent years, the use of oral dextrose gel is widely used as a first-line treatment for prevention of asymptomatic neonatal hypoglycemia. Primary aim of our study was to evaluate the effects of oral administration of 40 % dextrose gel at 30 or 60 min of life on the incidence of hypoglycemia in at-risk infants born by vaginal or cesarean delivery in the first 48 h of life. Secondary aim was to evaluate if the oral administration of 40 % dextrose gel can decrease the use of formula milk. MethodsA retrospective observational study was conducted at the Buon Consiglio Fatebenefratelli Hospital. Newborns birth by vaginal or Caesarean section and that assumed 40 % dextrose gel at 30 or 60 min after birth were respectively divided in 4 groups (Group A, Group B, Group C and Group D). Glycemic monitoring was then carried out with serial measurements at 2, 4, 6, 12 and 48 h of life. ResultsNo statistically significant differences were found in the reduction of the incidence of hypoglycemia with respect to the timing of administration of the dextrose gel (χ2(3)=0,450; p = 0,930). The use of formula milk was higher in newborns born by Caesarean section that assumed dextrose gel at 30 min of life than other groups (χ2(3)=11,616; p = 0,009; OR (95 %CI)= 3,033 (1,286–7,153). ConclusionsThe use of 40 % oral dextrose gel is a useful strategy for the prevention of hypoglycemia especially in infants at risk, independently to mode of delivery. Timing of administration of dextrose gel did not have effect on the incidence of hypoglycemia among groups. Newborns born by Caesarean section and that assumed 40 % oral dextrose gel at 30 min of life assume more formula milk compared to other groups.

A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey.

The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use. It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use. The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001). We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.

Newborn screening analytes and structural birth defects among 27,000 newborns.

Emerging evidence suggests newborn screening analytes may yield insights into the etiologies of birth defects, yet no effort has evaluated associations between a range of newborn screening analytes and birth defects. This population-based study pooled statewide data on birth defects, birth certificates, and newborn screening analytes from Texas occurring between January 1, 2007 and December 31, 2009. Associations between a panel of thirty-six newborn screening analytes, collected by the statewide Texas Newborn Screening Program, and the presence of a birth defect, defined as at least one of 39 birth defects diagnoses recorded by the Texas Birth Defects Registry, were assessed using regression analysis. Of the 27,643 births identified, 20,205 had at least one of the 39 birth defects of interest (cases) as identified by the Texas Birth Defects Registry, while 7,438 did not have a birth defect (controls). Among 1,404 analyte-birth defect associations evaluated, 377 were significant in replication analysis. Analytes most consistently associated with birth defects included the phenylalanine/tyrosine ratio (N = 29 birth defects), tyrosine (N = 28 birth defects), and thyroxine (N = 25 birth defects). Birth defects most frequently associated with a range of analytes included gastroschisis (N = 29 analytes), several cardiovascular defects (N = 26 analytes), and spina bifida (N = 23 analytes). Several significant and novel associations were observed between newborn screening analytes and birth defects. While some findings could be consequences of the defects themselves or to the care provided to infants with these defects, these findings could help to elucidate mechanisms underlying the etiology of some birth defects.

A multilevel analysis of the predictors of health facility delivery in Ghana: Evidence from the 2014 Demographic and Health Survey.

Health facility delivery has the potential to improve birth and general health outcomes for both newborns and mothers. Regrettably, not all mothers, especially in low-and-middle income countries like Ghana deliver at health facilities, and mostly under unhygienic conditions. Using data from the 2014 Ghana Demographic and Health Survey, we fitted both weighted single-level and random intercept multilevel binary logistic regression models to analyse predictors of a health facility delivery among mothers aged 15-49 years and to quantify unobserved household and community differences in the likelihood of health facility delivery. We analysed data on 4202 mothers residing in 3936 households and 427 communities. Of the 4202 mothers who delivered, 3031 (75.3%-weighted and 72.1%-unweighted) delivered at the health facility. Substantial unobserved household only (Median Odds Ratio (MOR) = 5.1) and household conditional on community (MOR = 4.7) level differences in the likelihood of health facility delivery were found. Mothers aged 25-34 (aOR = 1.4, 95%CI: 1.0-2.1) and 35-44 (aOR = 2.9, 95%CI: 1.7-4.8), mothers with at least a secondary education (aOR = 2.7, 95%CI: 1.7-4.1), with health insurance coverage (aOR = 1.6, 95%CI: 1.2-2.2) and from richer/richest households (aOR = 8.3, 95%CI: 3.6-19.1) and with piped water (aOR = 1.5, 95%CI: 1.1-2.1) had increased odds of health facility delivery. Mothers residing in rural areas (aOR = 0.3, 95%CI: 0.2-0.5) and with no religion (aOR = 0.5, 95%CI: 0.3-1.0) and traditional religion (aOR = 0.2, 95%CI: 0.1-0.6), who reported not wanting to go to health facilities alone as a big problem (aOR = 0.5, 95%CI: 0.3-0.8) and having a parity of 2 (aOR = 0.4, 95%CI: 0.3-0.7), 3 (aOR = 0.3, 95%CI: 0.2-0.6) and ≥4 (aOR = 0.3, 95%CI: 0.1-0.5) had reduced odds of health facility delivery. Our predictive model showed outstanding predictive power of 96%. The study highlights the need for improved healthcare seeking behaviours, maternal education and household wealth, and bridge the urban-rural gaps to improve maternal and newborn health outcomes.

Relations between maternal height, shoe size, and the success of vaginal delivery in birth weight over 4000 g

ObjectiveMacrosomia is associated with increased risk of fetal and maternal complications such as trauma during birth, cesarean delivery, postpartum hemorrhage, and shoulder dystocia. Sonographic estimation of fetal weight is imprecise particularly in excessively large fetuses, prompting the need for additional measures to assess the feasibility of vaginal delivery of a macrosomic newborn and thus improve prenatal consultation. Materials and methodsThis retrospective case–control study included women who delivered a singleton macrosomic newborn (birth weight>4,000 g), either vaginally (N = 762) or by urgent cesarean delivery during labor (N = 109). Using multivariable analysis, we examined correlations of maternal height≥170 cm and shoe size≥40 with successful vaginal delivery. ResultsWomen who delivered vaginally had lower mean intrapartum BMI (p < 0.001) and lower rate of gestational diabetes (p = 0.003). Women with a shoe size≥40 were 2.2 times more likely to give birth vaginally. Cesarean section rate was 5.9 % among women with height≥170 cm and shoe size≥40; and 16.5 % among women with height<170 cm and shoe size<40. Multivariable analysis, adjusted for gestational diabetes, parity, and BMI, revealed that shoe size≥40 and maternal height≥170 cm correlated with success in vaginal delivery, OR = 3.1 (95%CI 1.3–7.3, p = 0.009). ConclusionShoe size and maternal height may help predict success of vaginal birth of the macrosomic newborns.

The prevalence and risk factors of intracranial non-traumatic hemorrhage in newborns

To assess the prevalence rate of intracranial hemorrhage in newborns and to detect the size of the relative risk for different characteristics of the background of intrauterine development according to the materials of the Republican Prenatal Center. The study was conducted on the basis of the Republican Prenatal Center of the Azerbaijan Republic. All newborns (996 children) (birth weight - 500 grams or more, gestational age - over 22 completed weeks) have been examined by a neuropathologist. If there were signs of any neurological abnormalities, an ultrasound examination of the brain was performed. The prevalence rate of intracranial non-traumatic hemorrhage (INTH) among newborns was 15.66% (4.8% among full-term, 48.8% among premature). Depending on mother's age the prevalence rate of INTH changed from 12.7% (mother's age 20-24 years) to 23.0% (mother's age 35 years or more). The risk of INTH statistically significantly increased with maternal age 35 years or more, with 4 or more births, with the birth of a fetus weighing up to 2500 and more than 4000 grams, with a gestational age of less than 37 weeks, with multiple pregnancies and with vaginal delivery.

Relationship Between Hemoglobin Concentration in Pregnancy and Birth Weight of the Newborn

Background: Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as infant birth weight. The weight of the newborn is considered a crucial factor for the morbidity and mortality of newborns. The mother's hemoglobin fluctuates significantly during pregnancy. Objective: The aim of the the study was to assess the relationship between the mother's hemoglobin concentration during pregnancy and the birth weight of the newborn. Methods: Design-retrospective analysis of 672 pregnancies with recorded maternal hemoglobin concentration and newborn birth weight recorded in the pregnancy database in the delivery department of the Velika Kladuša Health Center in Bosnia and Herzegovina in the period from 2009 to 2010. Results and Discussion: The maximum mean birth weight was achieved with a hemoglobin concentration of 85-95 g/l. If the optimal drop in hemoglobin concentration does not occur during pregnancy, this condition is associated with an increased risk of giving birth to children with a lower birth weight for gestational age. Conclusion: The optimal drop in hemoglobin concentration during pregnancy is associated with the birth weight of the newborn. Hemoglobin deficiency below 105 g/l indicates an increased risk of low birth weight of the newborn.