Newborn Outcomes Research Articles

Microbial Pattern in Amniotic Fluid from Women with Premature Rupture of Membranes and Meconium-Stained Fluid.

Intra-amniotic infection (IAI), also known as chorioamnionitis, is a major cause of maternal and neonatal infection that occurs during pregnancy, labor and delivery, or in the postpartum period. Conditions such as meconium-stained amniotic fluid (MSAF) and premature rupture of membranes (PROMs) are recognized risk factors for amniotic fluid infection. This study identifies the microbial patterns in the amniotic fluid of women with PROMs and MSAF to determine the presence and types of bacterial growth. It also identifies trends in antibiotic use through descriptive statistics. Conducted as a descriptive observational study with prospective data collection, this research included maternal patients with PROMs lasting more than 12 h and those with MSAF, along with their infants. Of 30 cultured amniotic fluid samples, bacterial growth was observed in 13 cases, with Escherichia coli being the most prevalent (40%). Infants born with PROMs accompanied by MSAF were 5.5 days, significantly longer than those born with PROMs alone (3.19 days) or MSAF alone (3.91 days), with a significant difference between groups (p = 0.003). In addition, Escherichia coli isolates in this study are resistant to ceftriaxone, a third-generation cephalosporin antibiotic. Understanding these microbial patterns is critical for guiding clinical decisions, particularly in managing the risk of infection in pregnant women with PROMs and MSAF and ensuring better outcomes for both mothers and newborns.

Determinant of adverse early neonatal outcomes following emergency cesarean section in North West, Ethiopia: institutional-based case-control study

BackgroundThe World Health Organization recommends a cesarean delivery rate of 5–15%, which is thought to be within the range that can reduce infant morbidity and mortality. Various investigations have shown that those poor newborn outcomes are influenced by a variety of maternal and fetal factors and are more prevalent in emergencies than planned cesarean deliveries. Ethiopia is one of the five nations that account for 50% of all neonatal fatalities worldwide. Sub-Saharan African countries account for 38% of all infant deaths worldwide.AimTo know the determinants of adverse early neonatal outcomes after emergency cesarean delivery.Method and materialA multicenter case-control study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 318 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. The measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.ResultsMaternal age over 35, the presence of danger signs during pregnancy, and non-reassuring fetal heart rate were significantly associated with increased risk of adverse fetal outcomes following emergency cesarean section. Women aged over 35 were 3.6 times more likely to experience adverse fetal outcomes compared to younger women (AOR: 3.6, 95% CI: 1.1, 9.7). Women with danger signs during pregnancy were 3.5 times more likely to have adverse fetal outcomes compared to those without (AOR = 3.5, 95% CI: 2.4, 36). Similarly, cases with non-reassuring fetal heart rate were associated with a 5.2 times higher risk of adverse newborn outcomes (AOR = 5.2, 95% CI: 1.1, 26).ConclusionThis study identified advanced maternal age (over 35 years old), pregnancy complications, and non-reassuring fetal heart rate as significant risk factors for adverse neonatal outcomes following emergency cesarean section.

Conceiving during the first postoperative year after bariatric surgery: a retrospective study of pregnancy outcomes

BackgroundAn increasing number of childbearing-aged women have undergone bariatric surgery (BS). Although pregnancy outcomes generally improve after BS, concern remains over the impact of rapid weight loss and the catabolic state that occurs soon after BS. At least a 12-month surgery-to-conception time (SCT) is recommended, though the reasoning behind this has been questioned. This retrospective study was conducted to compare post-BS pregnancies with SCTs of less (Group 1) or more (Group 2) than 12 months.MethodsThe Hospital Register and Finnish Medical Birth Register were queried for data on BS and subsequent pregnancies. The characteristics of women at surgery and maternal and newborn outcomes in post-BS pregnancies were collected.ResultsBetween 2010 and 2022, 113 women gave birth after BS. This included 17 and 96 patients in Groups 1 and 2. The mean SCTs were 8.0 ± 2.7 and 39.0 ± 24.3 months (p < 0.001), respectively. At BS, the characteristics of age (p = 0.316), weight (p = 0.718), body mass index (BMI) (p = 0.114) and surgical technique used (p = 0.648) were similar. During pregnancy, the mean age of Group 1 women was significantly lower (p = 0.005). With no difference in weight (p = 0.961) or BMI (p = 0.567), the incidence of gestational diabetes mellitus (GDM, p = 0.039) was higher in Group 2. The mean gestational age at delivery (p = 0.206) and incidence rates of preterm (p = 0.645), post-term (p = 1.00) and caesarean deliveries (p = 1.00) in the groups were similar. A significantly higher incidence of delivery induction (p < 0.001 was detected in Group 2. The mean newborn weight in Group 1 was lower (p = 0.038), but the mean birth weight standard deviation (p = 0.883) and incidences of low birth weight (< 2500 g, p = 0.345) and small-for-gestational-age newborns (p = 0.469) were similar. The 1- (p = 0.191) and 5-min (p = 0.174) Apgar points in the groups were similar, and no associations between pregnancy outcomes and surgery technique were detected.ConclusionsThe outcome in pregnancies with an SCT 12 months, postponing pregnancy may not always improve pregnancy outcomes. Therefore, all risks should be weighed when counselling women regarding the optimal time of pregnancy after BS.

Reforming early intervention for premature infants: insights into integrated nursing and medical care in Western China.

Premature births has imposed substantial burdens on medical resources. Consequently, a specialized team was established and a model focused on early intervention, namely the Delivery Room Intensive Care Unit (DICU) emphasizing "care, support, and treatment" was introduced and its impact on the morbidity and mortality outcomes of newborns was assessed. Additionally, we aimed to develop a nomogram model for predicting the risk of intraventricular hemorrhage (IVH) in preterm infants. A retrospective study involving 2,788 infants was conducted to compare the characteristics and outcomes of infants admitted following the transition from the previous "neonatal intensive care unit (NICU)-centered" approach to the current early "care, support, and treatment" model. Clinical and laboratory data were recorded from birth until their discharge. The primary outcome was IVH, with additional evaluation of mortality and morbidities related to the neurological, respiratory, circulatory, and digestive systems. The DICU approach significantly declined the incidence of IVH [OR: 0.16, 95% CrI (0.11,0.23)], hypothermia [OR: 0.33, 95% CrI (0.21,0.50)], apnea [OR: 0.60, 95% CrI (0.47,0.75)], perinatal respiratory diseases [OR: 0.63, 95% CrI (0.52,0.75)] and metabolic acidosis [OR: 0.24, 95% CrI (0.16,0.34)]. Five predictors were selected: DICU exposure, gestational age, birth weight, ventilation mode within seven days, and ibuprofen use (d). The model built by these predictors displayed good prediction ability with the area under the ROC curve of 0.793 in the training set and 0.803 in the validation set. The standardized DICU model had significantly reduced the incidences of morbidities. The risk nomogram is useful for prediction of IVH risk in eligible infants, with a high accuracy, sensitivity, consistency, and practicability. This study emphasizes the shift in early intervention concepts and team collaboration sets "neonatologists, neonatal nurse practitioners, and respiratory therapists", which advocates for standardized decision-making for treatment from the delivery room to improve the success rate of resuscitation and enhance the prognosis of these infants.

Development of Multimodal Training Tool for Preterm Infant Care.

Comprehensive packages for training healthcare professionals who care for premature newborns are scarce. AIIMS WHO CC, New Delhi, partnered with India Association of Neonatal Nurses (IANN) and National Neonatology Forum (NNF) and 35 national leaders in the field of newborn care to develop a multimodal educational package for preterm infants. Findings from evaluation of four representative special newborn care units in the state of Madhya Pradesh informed the content of the package. Each of the ten modules developed had pre-defined lesson plan with learning objectives, self-reading text, short videos, webinars, posters and job aids, and knowledge check. The entire package was converted into a printed format, loaded onto a self-directed, web-based E-learning platform, and made available as a smart phone app. Six 3-day back-to-back dissemination workshops were held for 208 participants, who completed designated E-modules and generated a completion certificate before attending the face-to-face workshop. A five-point Likert's scale and open-ended comments were used to assess users' satisfaction with the modules, and the quality and readability of materials. Of the total, 188/208 (90%) attendees provided dissemination workshop feedback. When asked to rate their proficiency, 34% rated themselves as 'proficient or expert' before the workshop while 92% afterwards. Nearly 80% of participants felt that the quality of the information, content organization, and case scenarios were excellent to exceptional. The "preterm baby package" is a comprehensive, acceptable, need-based educational package for training staff who manage small and sick newborns with local facilitators for Indian context. There is a need of implementation studies evaluating its efficacy in improving newborn outcomes.

Developing and evaluating human-centered design solutions for enhancing maternal health service utilization among vulnerable pregnant women in Oromia, Ethiopia: Study protocol for a quasi-experimental study.

Disproportionate uptake of and access to maternal and child health services remain significant challenges across and within countries. Differing geographic, economic, environmental, and social factors contribute to varying degrees of vulnerabilities among individuals, which manifest as disparities in maternal and newborn health outcomes. Designing solutions according to need is vital to improve maternal and child health outcomes. In this paper, we describe our study protocol on developing and evaluating the effectiveness of human-centered design (HCD) solutions to improve maternal health service uptake among vulnerable pregnant women in rural areas of Ethiopia. Disproportionate uptake of and access to maternal and child health services remain significant challenges across and within countries. Differing geographic, economic, environmental, and social factors contribute to varying degrees of vulnerabilities among individuals, which manifest as disparities in maternal and newborn health outcomes. Designing solutions according to need is vital to improve maternal and child health outcomes. In this paper, we describe our study protocol on developing and evaluating the effectiveness of human-centered design (HCD) solutions to improve maternal health service uptake among vulnerable pregnant women in rural areas of Ethiopia. Our sequential approach to evaluating initial solutions, which in turn will inform the enhancement of solutions, will provide practical insights into how solutions are accepted among vulnerable women and how they can be better integrated into women's lives and health systems. This will inform equity-focused practice and policies targeting populations experiencing greater barriers to accessing care and provide insights into system strengthening in rural areas. Our findings will be disseminated to the Ethiopian Ministry of Health and its partners to inform large-scale implementation at the national level.

Analysis of pregnancy and neonatal outcomes in 100 pregnant women with Rh-negative blood type

BackgroundThis study aimed to explore variations in prenatal care, delivery methods, influencing factors, and neonatal outcomes among Rh-negative pregnant women, so as to improve pregnancy healthcare for this demographic, raise the quality of maternal–fetal management, and safeguard the health of both mother and infant.MethodsThis study included 200 women who received routine prenatal care, exhibited no other pregnancy complications, and were admitted for delivery. They were divided into an observation group (100 Rh-negative blood type) and a control group (100 Rh-positive blood type). The study examined differences in pregnancy management, clinical characteristics and pregnancy outcomes between the two groups.ResultsThe results indicated that singleton pregnancies in Rh-negative mothers are associated with significantly higher rates of postpartum blood loss (305.1 ± 183.8 vs. 246.1 ± 84.9 mL, P = 0.004), neonatal hyperbilirubinemia (39% vs. 23%, P = 0.014), low birth weight (11% vs. 2%, P = 0.01), and NICU admission (30% vs. 18%, P = 0.046) compared to the control group. Among Rh-negative mothers, subgroup analysis by ethnicity revealed a higher incidence of fetal distress in the other ethnic groups compared to the Han and Zhuang groups (16.7%, 0, 6.5%, respectively, P = 0.025). Subgroup analysis based on ABO blood type within Rh-negative mothers did not show any statistical significance in various outcomes (all P > 0.05). Infants with neonatal hyperbilirubinemia born to Rh-negative mothers experienced a quicker resolution of hyperbilirubinemia compared to those whose mothers did not receive intramuscular anti-D immunoglobulin [1.0 (1.0, 1.5) vs. 5.0 (1.5, 10.0), P = 0.002].ConclusionsThe Rh-negative blood type is linked to higher risks of neonatal hyperbilirubinemia, low birth weight, and increased postpartum hemorrhage, resulting in detrimental pregnancy outcomes. Administering anti-D immunoglobulin speeds up the resolution of neonatal hyperbilirubinemia. Thus, prudent and efficient use of anti-D immunoglobulin can mitigate adverse outcomes for both mothers and newborns.

Vitamin D Status in Roma Mothers and Newborns: Socioeconomic Factors and Impact on Neonatal Outcome.

The Roma are a socioeconomically disadvantaged, marginalized community with reduced access to education, social services, and healthcare. Despite the known health risks they are exposed to, we have limited data about a wide range of health outcomes in this population, including vitamin D deficiency. The aim of this study was to investigate prevalence of vitamin D deficiency and its impact on the anthropometric outcomes of newborns in a group of Roma mothers and their infants in Romania. In total, 131 Roma women and 131 newborns were included in the study. Vitamin D levels in both mothers and newborns, as well as the birth weight, length, and head circumference of newborns, were recorded at birth. We also assessed socioeconomic factors, including education, employment status, income, and living conditions, as well as factors that influence vitamin D status, including sun exposure, use of sunscreen, fish consumption, and skin type. All mothers and almost all newborns had vitamin D insufficiency or deficiency, with 25-hydroxivitamin D levels below 30 ng/mL. Maternal vitamin D status was significantly correlated with neonatal vitamin D levels (p < 0.01) but not with anthropometric outcomes such as birth weight (p = 0.57), birth length (p = 0.53), or head circumference (p = 0.96). Most study participants had a low socioeconomic status, reporting severe deficiencies in education, employment status, household income, and living conditions. Vitamin D deficiency is a significant public health issue among Roma women and their newborns, which may be compounded by the socioeconomic challenges of this vulnerable population.

Association between the early or late onset of gestational diabetes mellitus with neonatal adverse outcomes: a retrospective cohort study

BackgroundThe literature has been evolving to standardize gestational diabetes mellitus (GDM) diagnosis and terminology. The significance of timing in diagnosing hyperglycemia during pregnancy is underlined by evidence that women diagnosed at 24 weeks of gestation or earlier are at a higher risk of developing postpartum prediabetes, but its association with adverse outcomes for the newborn is controversial. We aimed to investigate the association between early-onset GDM and adverse outcomes in newborns and neonates, comparing it with the late-onset GDM model.MethodsIt was a retrospective cohort study conducted at the Perinatal Diabetes Research Center in Assis/SP, affiliated with the Botucatu Medical School-UNESP in Brazil. The group composition was as follows: early-onset participants had fasting glucose levels ≥ 92 mg/dL and < 126 mg/dL before 20 weeks of gestation, while late-onset participants had a negative first-trimester screening and a positive 75g-OGTT at 24–28 weeks. For early-onset GDM, a fasting glucose level of ≥ 92 mg/dL is a recognized threshold associated with an increased risk of adverse pregnancy outcomes, while < 126 mg/dL ensures the exclusion of overt diabetes. The criteria for late-onset GDM, involving a negative initial screening and a positive OGTT at 24–28 weeks, align with the standard diagnostic timeframe when insulin resistance typically peaks due to placental hormone secretion. The maternal baseline characteristics included pre-pregnancy body mass index (BMI; kg/m2) and pregnancy weight gain (kg), calculated as the difference between the final pregnancy weight (36 gestational weeks or more) and pre-pregnancy maternal weight, classified according to the pre-pregnancy BMI. Additionally, the perinatal outcomes evaluated in this study included gestational age (GA) at birth, birth weight (BW) categorized according to GA as adequate, large, or small and Apgar scores at the first and 5th minutes.ResultsEight hundred eighty pregnant women were selected, of whom 203 (23.07%) presented GDM and were eligible from December 2016 to December 2021. Based on the timing onset of GDM, 89 (43.8%) were in the early-onset group, and 114 (56.2%) were in the late-onset group. The fasting plasma glucose values in the first trimester were higher in the early-onset group. The 75-g OGTT values were higher in the late-onset group. The final BMI was higher in the early-onset group. Univariate linear regression was performed to determine the relationship between late-onset and maternal and neonatal outcomes; however, no significant relation was detected.ConclusionPregnant women with early-onset GDM showed a higher BMI during pregnancy, but there was no difference between early and late-onset GDM concerning neonatal adverse outcomes.

Maternal and neonatal outcomes in women with COVID-19: A retrospective cohort study

Background: Considering the conflicting evidence that exists regarding the effect of the coronavirus disease 2019 (COVID-19) on pregnancy and newborn outcomes, it is necessary to conduct this research during the first year in the north of Iran, a highly visited and trafficked place, which increases the possibility of contracting the virus and severity of the infection. Objective: This study aimed to compare maternal and neonatal outcomes in pregnant women with and without COVID-19. Materials and Methods: In this retrospective cohort study, data from 160 pregnant women referred to 3 hospitals in Mazandaran, Iran from April 2020 to March 2021 were extracted from their medical records using checklists. Participants were divided into 2 groups: group A) 80 pregnant women with COVID-19 and group B) 80 noninfected pregnant women. All information related to maternal and neonatal outcomes were extracted and compared from the files of the 2 groups. The results obtained from comparing 2 groups of pregnant women from the result of the reverse-transcription polymerase chain reaction test were analyzed. Results: The most common symptoms in the COVID-19 group were fever and cough. Pregnancy complications such as abortion, pre-eclampsia, and premature birth were not significant between groups (p = 0.4, 0.45, 0.45, respectively). No statistically significant difference was observed between groups regarding maternal and neonatal outcomes. Conclusion: Despite the peak and severity of the COVID-19 disease in the first year of the pandemic, it seems that it had no effect on maternal and neonatal outcomes in each trimester of pregnancy in affected women.

Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial.

Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305. DERR1-10.2196/63454.

Optimizing Pregnancy Outcomes: The Importance of Pre-Marital and Preconception Care

Premarital and preconception care are essential components in improving maternal and newborn health outcomes. This community service aims to evaluate the importance of premarital and preconception counseling, with a focus on its role in reducing the risks associated with unplanned pregnancy, complications during pregnancy, and adverse neonatal outcomes. Although the benefits of premarital and preconception care are clear, access and awareness are still limited in Indonesia, especially among couples planning to marry. This community service was carried out through a national webinar attended by midwifery students, midwives and midwifery/health lecturers. The number of participants was 815 people. Based on the questionnaire that we gave to the midwives, only a few received preconception visits even though the implementation of premarital and preconception care can significantly improve reproductive health outcomes, reduce maternal and infant mortality, and help prospective couples plan a healthy pregnancy. The results of this activity identified barriers to accessing these services, including lack of awareness and education. The hope from this activity is that midwives can expand health education programs aimed at increasing community awareness of the benefits of premarital and preconception care in creating healthier family planning outcomes

Decentralizing and task sharing within the primary health system improved access and quality of ANC services in Amhara and Oromia regions: pre-post health facility data

BackgroundImproved access to quality antenatal care (ANC) promotes healthy behaviors and early complication management, enhancing maternal and newborn outcomes. The Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health (ENAT) intervention in Ethiopia aimed to increase newborn birth weight by improving ANC utilization and quality. ENAT task shared and decentralized ANC services to facilitate early contact and point of care (POC) testing and management of maternal infections and anemia. This study assessed if task sharing and decentralization improved utilization and quality of ANC services at primary health care facilities.MethodsThe study assessed changes in ANC coverage and quality before and after the ENAT intervention, in 65 health centers and 303 health posts across Amhara and Oromia regions of Ethiopia. The intervention task shared ANC services at health centers (Augst 2018-January 2021) and then decentralized services to health posts (February 2021-February 2022). Using descriptive analyses, this study assessed, between baseline and endline, changes in coverage in the proportion of women who: enrolled early into ANC; had at least one ANC contact; and had four or more ANC contacts. Similarly, the study separately assessed each quality indicator through changes in the proportion of iron and folic acid supplementation, and deworming tablets, and POC testing and treatment for anemia, syphilis, and asymptomatic bacteriuria at baseline, phase I and phase II.ResultsANC utilization and quality improved in the 368 sites. Between baseline and endline the proportion of women having an ANC contact before 16 weeks of gestational age increased from 6 to 37%, while those receiving at least one ANC contact and four or more ANC contacts increased from 74 to 91% and 45–57%, respectively. Iron and folic acid supplementation and deworming increased from 44 to 97% and from 44 to 79%, respectively. In the final 12 months of the intervention, 87%, 80%, and 87% of pregnant women attending ANC received POC testing for anemia, syphilis, and asymptomatic bacteriuria, respectively.ConclusionsOur findings suggest that bringing ANC services closer to communities can increase early ANC contact and enhance the coverage and quality of services, leading to better maternal and newborn health outcomes.

The association of prenatal volatile organic compounds exposure and newborn anthropometrics: A cross-sectional study

BackgroundSeveral studies have associated prenatal exposure to volatile organic compounds (VOCs) with adverse health outcomes among newborns. However, little is known about the associations of VOCs at relatively low concentrations with newborn outcomes. Hence, this study aimed to investigate the potential associations between prenatal exposure to VOCs and VOC mixtures with newborn anthropometric measures. MethodsIn this cross-sectional study, 883 mother–term infant pairs who lived in urban areas in Israel and were admitted to the delivery rooms of two major hospitals between 2016 and 2020 were recruited. Associations between VOC metabolites detected in maternal urine samples on the day of delivery with weight, length, and head circumference at birth were estimated using single-exposure linear models and weighted quantile sum (WQS) approach. ResultsToluene, ethylbenzene/styrene, and xylene metabolites were detected in most samples at levels comparable to OECD populations. In male newborns, higher levels of phenylglyoxylic acid (PGA), a metabolite of ethylbenzene/styrene, were associated with lower birth weight (β = −0.08, 95% CI: 0.14, −0.01; P = 0.03). WQS models suggested PGA as the most prominent contributor to this association. ConclusionThis study suggests that moderate exposure to ethylbenzene/styrene may be associated with reduced birth weight in male newborns. The sex-specific finding requires further research for the potential endocrine-disrupting mechanisms of these compounds. While the effect size was small, these results highlight the need to better understand the associations of frequent VOC exposures in levels similar to those common in OECD countries with fetal and child development.

Biologics Use for Psoriasis during Pregnancy and Its Related Adverse Outcomes in Pregnant Women and Newborns: Findings from WHO Pharmacovigilance Study

Introduction: The safety of biologics, other than TNF-α inhibitors, during pregnancy has not been sufficiently established. To assess the risk of pregnancy-related adverse outcomes of biologics used for psoriasis, compared to TNF-α inhibitors, we utilized the WHO global pharmacovigilance database (1968–2024). Methods: We utilized the World Health Organization’s global pharmacovigilance database from 1968 to 2024. From over 140 million reports from more than 170 countries, we extracted 6,518 reports of pregnancy-related adverse outcomes associated with the biologics of interest. These biologics included TNF-α inhibitors (e.g., etanercept, infliximab, adalimumab, certolizumab pegol), IL-12/IL-23 inhibitor (e.g., ustekinumab), IL-17 inhibitors (e.g., secukinumab, brodalumab, ixekizumab, bimekizumab), and IL-23 inhibitors (e.g., guselkumab, tildrakizumab, risankizumab). Each biologic was compared to TNF-α inhibitors and certolizumab pegol in two separate disproportionality analyses. The reporting odds ratio (ROR) was calculated for maternal, fetal, and neonatal outcomes, categorized into seven major groups. Multivariable and sensitivity analyses were conducted to validate the primary results. Results: The disproportionality analysis showed that, compared to TNF-α inhibitors, most biologics had a lower frequency of pregnancy-related adverse outcomes, with the exception of brodalumab. Specifically, ROR and 95% confidence intervals (CIs) were as follows: ustekinumab (ROR, 0.27; 95% CI: 0.21–0.35), secukinumab (0.17; 0.13–0.22), brodalumab (0.20; 0.02–2.21), ixekizumab (0.05; 0.03–0.08), bimekizumab (0.10; 0.01–0.71), guselkumab (0.09; 0.05–0.15), tildrakizumab (0.02; 0.00–0.14), and risankizumab (0.38; 0.25–0.58). However, risankizumab was reported with a higher frequency of abortion and stillbirth (1.87; 1.32–2.63). These findings were consistent when compared to certolizumab pegol, as well as in multivariable and sensitivity analyses. Furthermore, when comparing other TNF-α inhibitors to certolizumab pegol, infliximab showed a lower frequency of pregnancy-related adverse outcomes (ROR, 0.71; 95% CI: 0.55–0.92), etanercept showed a comparable frequency (1.00; 0.77–1.31), and adalimumab showed a higher frequency (1.42; 1.11–1.81). Conclusions: Biologics used for psoriasis, with the exception of brodalumab, exhibit a lower frequency of pregnancy-related adverse outcomes compared to TNF-α inhibitors and certolizumab pegol, suggesting their potential to be safe options during pregnancy. However, further studies are necessary to evaluate the safety of these biologics during pregnancy, accounting for confounding factors.

Novel maternal risk factors for preeclampsia prediction using machine learning algorithms

&lt;div align="center"&gt;&lt;table width="590" border="1" cellspacing="0" cellpadding="0"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td valign="top" width="387"&gt;&lt;p&gt;Preeclampsia and eclampsia are the most common obstetric disorders associated with poor outcomes for women, fetuses, and newborns throughout the perinatal period. The study’s primary objective was to assess the accuracy of novel high-risk factors using MLA in predicting preeclampsia. The study included 400 pregnant women and used 27 novel high-risk factors to predict preeclampsia. The target variables for predicting preeclampsia are systolic and diastolic blood pressures. Various algorithms, including DT, RF, Gradient Boosting, SVM, K-Neighbors, LGBM, MLP, Ada Boost Classifier, and Extra Trees Classifier are used in the analysis. The accuracy and precision of the LGBM Classifier (0.85 and 0.9583 with F1 0.7188), Support Vector Classifier (0.8417 and 0.92 with F1 0.7077), Decision Tree (0.825 and 0.913 with F1 0.6667), and Extra Trees (0.8167 and 0.9091 with F1 0.6452) are found to be better algorithms for prediction of preeclampsia than those of the other models used in the study. According to the novel high-risk factors score, 17.5% of pregnant women were identified as being at high risk for preeclampsia during the first trimester, which increased to 18.7% in 3rd trimester; in addition, 16% of pregnant women had a BP of 140/90 mmHg and the above. Novel, high-risk scores and MLA can effectively predict preeclampsia at an early period.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;

Service availability and readiness to provide maternal and newborn healthcare services in Kilimanjaro region, Tanzania: a cross sectional study

ObjectiveTo assess service availability and readiness of health facilities to provide maternal and newborn care in the Kilimanjaro region, northern Tanzania: a study conducted between August to October 2022.DesignThe study...

Microbial landscape in the neonatal care intensive unit

Improvement of the clinical outcomes of newborns with hospital-acquired infections requires microbiological monitoring to ensure timely initiation of appropriate empirical therapy. In our study we investigated the patterns of pathogens responsible for hospital-acquired infections in neonatal intensive care units and assessed the levels of antibiotic resistance among these pathogens. The study included 4,891 samples from newborns. Gram — positive microflora was found in 55.9% of the samples and gram-negative — in 44.1%. The antibiotic resistance profile revealed high resistance to penicillin-based antibiotics among staphylococci. Gram-negative microorganisms remained sensitive to most antibacterial drugs.

Evaluating predictive values of umbilical cord arterial lactate for adverse newborn outcomes among term-births in northern Uganda: A cross sectional analytical study.

Birth asphyxia is one of the leading causes of death for neonates worldwide. Lack of an objective cost effective test to predict poor newborn outcomes at birth affects the ability to respond appropriately. This study determined predictive values of umbilical cord arterial lactate in relation to adverse neonatal outcomes. This was a cross-sectional analytical study conducted between March 2018 and March 2019 at two hospitals in Northern Uganda. A total of 2655 women admitted for birth and their newborns were recruited. At birth, umbilical cord arterial blood was tested for lactate using the Nova Biomedical StatStrip Xpress meter. Apgar scores were assessed at 5 min by trained research midwives. Area under the receiver operator characteristics curve (AUROC) was calculated relating umbilical arterial lactate (UAL) levels and four outcomes. We modeled the best lactate cutoff level associated with the highest AUROC for the four outcomes. The estimated AUROC for lactate was: 88.42% for Apgar score <7 at 5 min, 83.35% for resuscitation with bag and mask, 84.55% for oxygen therapy after resuscitation and 87.72% for admission to neonatal care unit. The UAL cutoff value of 5.5 mmol/L was associated with the best AUROC of between 75.81% to 81.75% for the four adverse outcomes with no significant differences when adjusted for infectious disease parameters. The sensitivity, specificity, PPV, and NPV were; 78.95%, 86.48%, 23.54%, and 98.73% for Apgar scores <7 at 5 min, 64.40%, 88.11%, 36.59%, and 95.87% for resuscitation with bag and mask, 67.17%, 87.20%, 30.23%, and 96.99% for oxygen therapy after resuscitation, and 77.17%, 86.15%, 22.27%, and 98.65% for admission to the special care unit, respectively. Umbilical cord lactate point-of-care (POC) estimate of ≥5.5 mmol/L predicts adverse neonatal outcomes. This test may be used to trigger early interventions and intensified neonatal care complementing the clinical Apgar score assessment in settings like Uganda.

Is It Possible to Perform Quality Neonatal CPR While Maintaining Skin-to-Skin Contact? A Crossover Simulation Study.

Background: This study aimed to assess the feasibility and quality of resuscitation maneuvers performed on a newborn over the mother's body while maintaining SSC and delayed cord clamping. Methods: A randomized crossover manikin study compared standard cardiopulmonary resuscitation (Std-CPR) and cardiopulmonary resuscitation during SSC (SSC-CPR). Nursing students (n = 40) were recruited and trained in neonatal CPR. The quality of the CPR, including compression and ventilation variables, was evaluated using Laerdal Resusci Baby QCPR® manikins. Findings: No significant differences were found in the compression variables between the Std-CPR and the SSC-CPR. The quality variables demonstrated comparable results between the two techniques. The quality of the compressions showed medians of 74% for the Std-CPR and 74% for the SSC-CPR (p = 0.79). Similarly, the quality of the ventilations displayed medians of 94% for the Std-CPR and 96% for the SSC-CPR (p = 0.12). The overall CPR quality exhibited medians of 75% for the Std-CPR and 82% for the SSC-CPR (p = 0.06). Conclusions: Performing CPR on a newborn over the mother's body during SSC is feasible and does not compromise the quality of resuscitation maneuvers. This approach may offer advantages in preserving maternal-newborn bonding and optimizing newborn outcomes. Further studies are needed to address the limitations of this research, including the use of simulations that may not fully replicate real-life conditions, the lack of analysis of different types of labor, and the unpredictability of the maternal response during resuscitation.