Neonatal Morbidity Rates Research Articles

Informing the Spectrum of Approaches: Institutional Review of Placenta Accreta Spectrum Disorders Management.

Placenta accreta spectrum (PAS) is a condition defined by abnormal adherence of the placenta. Cesarean hysterectomy is the preferred management, but practice patterns vary based on local resources and expertise. We retrospectively reviewed the clinical course of patients diagnosed antenatally with PAS who underwent surgical management in our centre. We conducted a retrospective records review involving patients with an antenatal diagnosis of PAS between 2014 and 2019. The primary outcome was a composite score of maternal morbidity, and secondary outcomes were total estimated blood loss and composite neonatal morbidity. Patients were stratifiedbased on the presence or absence of PAS on final pathology. Antenatal diagnosis by ultrasound and magnetic resonance imaging (MRI) was compared with final histologic diagnosis. A total of 34 patients were diagnosed with PAS antenatally and managed at our institution. Final histology confirmed PAS in 29 patients. The overall composite morbidity rate was 44%, with no significant difference between patients with and without PAS on pathology (P= 0.355). Intraoperative blood loss was similar between the 2 groups (2374 ± 2212 mL vs. 1080 ± 852 mL; P=0.232). The rate of composite neonatal morbidity was 47%. Ultrasound achieved a high positive predictive value in the diagnosis of PAS (96%) and more accurately predicted pathology than MRI. PAS is associated with high rates of morbidity. Dissemination of our local experience serves to inform best practices in the management of this complex condition.

Association between morbidity among term newborns and low‐risk caesarean delivery rates

To examine the association between county-level caesarean delivery (CD) rates among women at low risk and morbidity among term newborns. Cross-sectional study. Population-based study of US county-level birth data from 2015 to 2017. Nulliparous women with term, singleton, vertex-presenting infants (NTSV) at low risk for morbidity. The primary exposure was county-level CD rates. The outcome was morbidity among the low-risk NTSV cohort, categorised as severe (5-minute Apgar score of ≤3, assisted ventilation for ≥6 hours, severe neurologic injury or seizure, transfer or death) or moderate (5-minute Apgar score of <7 but >3, administration of antibiotics or assisted ventilation at delivery). We used linear regression models to determine the association between county NTSV CD and neonatal morbidity rates with cluster robust standard errors. The analysis included data from 2 753 522 births in 952 counties from all 48 states. The mean NTSV CD rate was 23.6% (standard deviation 4.8%). The median severe and moderate neonatal morbidity rates were 15.2 (interquartile range, IQR 9.4-23.6) and 52.5 (IQR 33.4-75.7) per 1000 births, respectively. In the unadjusted analysis using the risk-adjusted exposure and outcome, every percentage point increase in the CD rate of a county was associated with 0.6 (95% CI -0.9, -0.3) and 2.3 fewer (95% CI -3.4, -1.1) cases of severe and moderate neonatal morbidity per 1000 live births. After adjustment for other county factors, the relationships remained significant. These findings were tested in multiple sensitivity analyses. Lower county-level NTSV CD rates were associated with a small increase in morbidity among term newborns in the USA. Lower county-level caesarean delivery rates were associated with an increase in morbidity among term newborns in the USA.

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes.

Background: Streptococcus agalactiae (also known as group B streptococcus, GBS) is associated with high mortality and morbidity rates in infants, especially those with complicated GBS sepsis, defined as those with meningitis, severe sepsis and/or septic shock. We aimed to characterize the clinical and molecular characteristics and risk factors for adverse outcomes of neonates with invasive GBS diseases. Methods: From 2003 to 2020, all neonates with invasive GBS diseases who were hospitalized in a tertiary-level neonatal intensive care unit (NICU) were enrolled. The GBS isolates underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. We compared cases of complicated GBS sepsis with uncomplicated GBS bacteremia. Results: During the study period, a total of 188 neonates (aged less than 6 months old) with invasive GBS diseases were identified and enrolled. Among them, 119 (63.3%) had uncomplicated GBS bacteremia and 69 (36.7%) neonates had complicated GBS sepsis, including meningitis (25.5%, n = 48) and severe sepsis or septic shock. Among neonates with complicated GBS sepsis, 45 (65.2%) had neurological complications, and 21 (42.0%) of 50 survivors had neurological sequelae at discharge. The overall final mortality rate was 10.1% (19 neonates died). Type III/ST-17 GBS isolates accounted for 56.5% of all complicated GBS sepsis and 68.8% of all GBS meningitis, but this strain was not significantly associated with worse outcomes. The antimicrobial resistance rate among the invasive GBS isolates was obviously increasing in the past two decades. After multivariate logistic regression analysis, neonates with thrombocytopenia and respiratory failure were independently associated with final adverse outcomes. Conclusions: a total of 36.7% of all neonatal invasive GBS diseases were associated with complicated sepsis with/without meningitis. Given the high mortality and morbidity rates in neonates with complicated GBS sepsis, further studies for early identification of specific strains, risk factors or genetic mechanisms that will cause complicated GBS sepsis are urgently needed in the future.

Outcomes in relation to early parenteral nutrition use in preterm neonates born between 30 and 33 weeks’ gestation: a propensity score matched observational study

ObjectiveTo evaluate whether in preterm neonates parenteral nutrition use in the first 7 postnatal days, compared with no parenteral nutrition use, is associated with differences in survival and other important...

1013How has change in gestational diabetes diagnosis affected pregnancy outcomes?

Abstract Background Gestational diabetes mellitus (GDM) incidence is increasing in Australia, influenced by new diagnostic criteria gradually implemented from 2011. We aimed to identify whether the change was associated with increased obstetric intervention and/or improved outcomes. Methods Linked perinatal, hospital and deaths data from New South Wales identified singleton births, 33-41 weeks, 2006-2015. Adjusted Poisson modelling predicted the GDM incidence trajectory post-2011 without the diagnostic change and estimated the post-2011 “additional GDM” cases. Actual rates of interventions and outcomes for GDM-diagnosed pregnancies were compared with predicted scenarios where the “additional GDM” group was assumed to have the same rate as (ie clinically same as): (A) the “previous GDM” group &amp;lt;2011; (B) the “non-GDM” group &amp;lt;2011; or (C) the “non-GDM” group ≥2011. Results GDM incidence more than doubled over the study period. Actual planned birth, Caesarean and macrosomia rates were consistent with Scenario A, ie higher intervention rates, but lower macrosomia than B and C. Neonatal hypoglycaemia was lower than Scenario A, closer to B and C. Actual perinatal deaths were lower than predicted by all scenarios, showing improvement for all with GDM, not only “additional” cases. Maternal and neonatal morbidity rates were within the confidence bounds for all three predicted scenarios. Conclusions Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower macrosomia rates but with no clear impacts on maternal or neonatal morbidity. Key messages A diagnostic criteria change has identified more GDM pregnancies without clear benefit for outcomes.

Determinants of postnatal care service utilization among mothers of Mangochi district, Malawi: a community-based cross-sectional study

BackgroundPostnatal care (PNC) service is a neglected yet an essential service that can reduce maternal, neonatal and infant morbidity and mortality rates in low and middle-income countries. In Malawi, maternal and infant mortality rates remain high despite numerous efforts by the government and its partners to improve maternal health service coverage across the country. This study examined the determinants of PNC utilization among mothers in Mangochi District, Malawi.MethodsA community based cross-sectional study was conducted among 600 mothers who gave birth in the past 2 years preceding January 1–31; 2016. A multistage sampling technique was employed to select respondents from nine randomly selected villages in Mangochi district. A transcribed semi-structured questionnaire was pre-tested, modified and used to collect data on socio-demographic characteristics and maternal related factors. Data was coded in EpiData version 3.1 and analysed in Stata version 12. A multivariable logistic regression adjusted for confounding factors was used to identify predictors of PNC utilization using odds ratio with 95% confidence interval and p-value of 0.05.ResultsThe study revealed that the prevalence of PNC service utilization was 84.8%. Mother’s and partner’s secondary education level and above (AOR = 2.42, CI: 1.97–6.04; AOR = 1.45, CI: 1.25–2.49), partner’s occupation in civil service and business (AOR = 3.17, CI: 1.25, 8.01; AOR =3.39, CI:1.40–8.18), household income of at least MK50, 000 (AOR = 14.41, CI: 5.90–35.16), joint decision making (AOR = 2.27, CI: 1.13, 4.57), knowledge of the available PNC services (AOR = 4.06, CI: 2.22–7.41), knowledge of at least one postpartum danger sign (AOR = 4.00, CI: 2.09, 7.50), health facility delivery of last pregnancy (AOR = 6.88, CI: 3.35, 14.14) positively associated with PNC service utilization.ConclusionThe rate of PNC service utilization among mothers was 85%. The uptake of PNC services among mothers was mainly influenced by mother and partner education level, occupation status of the partner, household income, decision making power, knowledge of available PNC services, knowledge of at least one postpartum danger signs, and place of delivery. Therefore, PNC awareness campaigns, training and economic empowerment programs targeting mothers who delivered at home with primary education background and low economic status are needed.

Delayed cord clamping in small for gestational age preterm infants

Infants with restricted growth for age are frequently exposed to insufficient placental circulation and are more likely to develop postnatal complications. Delayed cord clamping at birth for these infants requires further exploration. This study aimed to compare the short-term neonatal outcomes of delayed cord clamping with that of early cord clamping in small for gestational age preterm infants and to explore whether the effects of delayed cord clamping in small for gestational age preterm infants are different from that in non-small for gestational age preterm infants. We conducted a national retrospective cohort study, including infants born at <33 weeks' gestation and admitted to the Canadian Neonatal Network units between January 2015 and December 2017. Small for gestational age infants (birthweight of <10th percentile for gestational age and sex) who received delayed cord clamping ≥30 seconds were compared with those who received early cord clamping. In addition, non-small for gestational age infants who received delayed cord clamping were compared with those who received early cord clamping. The main study outcomes included composite outcome of mortality or major morbidity, neonatal morbidity rate, mortality rate, peak serum bilirubin, and number of blood transfusions. Multivariable logistic and linear regression models with a generalized estimation equation approach were used to account for the clustering of infants within centers. Overall, 9722 infants met the inclusion criteria. Of those infants, 1027 (10.6%) were small for gestational age. The median (interquartile range) gestational age was 31 weeks (range, 28-32 weeks). After adjusting for potential confounders, delayed cord clamping in small for gestational age infants was associated with a reduction in the composite outcome of mortality or major morbidity (adjusted odds ratio, 0.60; 95% confidence interval, 0.42-0.86) compared with early cord clamping. There was no difference between the 2 groups in peak serum bilirubin. Many associated benefits of delayed cord clamping in small for gestational age infants were similar to those in non-small for gestational age infants. Delayed cord clamping in small for gestational age preterm infants was associated with decreased odds of mortality or major morbidity. Many of the benefits of delayed cord clamping in the small for gestational age preterm infants were similar to those identified in the non-small for gestational age preterm infants.

The impact of COVID-19 in pregnancy: Part I. Clinical presentations and untoward outcomes of pregnant women with COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019, COVID-19) is a pandemic disease with rapidly and widely disseminating to the world. Based on experiences about the H1N1, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) coronavirus pandemics, pregnant women who are infected are disproportionately more likely to develop severe illness and need more hospitalizations, intensive care, and finally die of diseases compared with those nonpregnant counterparts or those pregnant women without infection. Although more than one half of pregnant women with COVID-19 are asymptomatic, and as well as their symptoms are frequently mild, this observation presents a further challenge regarding service provision, prevention, and management, in which this may result in overlooking the risk of COVID-19 during pregnancy. As predictable, despite much advance in critical care in recent decades, during the 2020 COVID-19 pandemic, pregnant women with COVID-19 are really at higher risk to progress to severe illness; require hospitalization; need intensive care, such as the use of mechanical ventilation as well as extracorporeal membrane oxygenation (ECMO), and of most important, die than their nonpregnant counterparts and pregnant women without COVID-19. The magnitude of the risk to pregnant women further extend to their newborn from COVID-19 with resultant significantly increasing perinatal and neonatal morbidity and mortality rates. The heightened risk of untoward outcomes in pregnant women emphasizes an urgent need of national or international recommendations and guidelines to optimize prevention and management strategies for COVID-19 in pregnancy. Active and passive prevention of COVID-19 is approved as effective strategies for women who attempt to be pregnant or during pregnancy. Understanding that pregnant women who are a vulnerable population is essential to improve the care in the novel and urgent COVID-19 pandemic. The current review is a part I to summarize the up-to-date information about the impact of laboratory-confirmed SARS-CoV-2 infection on pregnant women and focus on clinical presentations and untoward pregnancy outcomes of these pregnant women infected with SARS-CoV-2.

The Association of Antenatal Steroids and Hypoglycemia in Preterm Neonates

Objective Antenatal steroids have shown to decrease the rate of neonatal complications and morbidity; however, neonates are predisposed to significant hypoglycemia resulting in invasive interventions and prolonged nursery admissions. The risk of hypoglycemia in the preterm has been well studied, but the association of antenatal steroids and hypoglycemia in preterm neonates has not been well explored. Thus, we sought to determine the association of antenatal steroids given to mothers who delivered prematurely and the development of neonatal hypoglycemia. Methods A cross-sectional study using chart review was done on mother–preterm neonate pairs admitted in the charity obstetrical ward of The University of Santo Tomas Hospital from January 1, 2018 to December 31, 2019. The subjects were mothers either given or not given antenatal steroids before preterm delivery and their respective neonates. The provision of antenatal steroids was the primary exposure, while neonatal hypoglycemia was the primary outcome. Measurement of association was done using odds ratios. Univariate and multivariate logistic regression analyses were done. Results Of the 69 preterm neonates included in the study, hypoglycemia was observed in 14 neonates, among which 8 neonates were exposed to antenatal steroids. After examining the association using Fisher’s exact formula and controlling for potential confounders, neonatal hypoglycemia was not significantly higher among neonates exposed to antenatal steroids. Conclusion Antenatal steroids given to mothers who delivered preterm were not associated with the development of neonatal hypoglycemia. A prospective study model, larger population size and longer study coverage should be made to strengthen the outcome of the study.

Neonatal morbidity in a low volume forceps practice

Background Currently, the use of FE is decreasing and neonatal adverse outcomes following FE are underreported. We aimed to evaluate the rate of neonatal adverse outcomes in current obstetric practice at two university hospitals with a low FE volume. Methods A multicentre retrospective study. All singleton pregnancies delivered by forceps extraction between 2011 and 2020 were analyzed. The characteristics of the deliveries with a composite neonatal adverse outcome (CNAO) were analyzed and compared with those without. Results The study cohort included 861 neonates delivered by FE. The CNAO was recorded in 131 (15.2%). Women in the CNAO group gained less weight during pregnancy (mean 13 kg vs. 15 kg, p = .014). Factors found to be associated with CNAO were preterm delivery (gestational age < 37°/7) (26 (19.8%) vs. 44 (6.0%), OR [95% CI]: 3.86 (2.28–6.52), p < .001), low birth weight (23 (17.6%) vs. 44 (6.0%), OR [95% CI] 3.32 (1.92–5.71), p < .001), and smaller head circumference (329 vs. 331 mm, OR [95% CI] 0.79 (0.67–0.93), p = .035). In a multivariate analysis, gestational age (adjusted OR [95% CI] 0.672 (0.546–0.826), p < .001) and maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.950 (0.904–0.998), p = .042), were both negatively associated with CNAO. Among term deliveries, the only factor found to be independently associated with CNAO was maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.951 (0.910–0.994), p = .025). Conclusions In the setting of low volume FE, this mode of delivery is associated with a relatively low rate of neonatal morbidity. Synopsis Performance of forceps extraction in the setting of low volume practice is associated with a relatively low rate of neonatal morbidity.

Association of adherence to guidelines for cervical cerclage with perinatal outcomes and placental inflammation in women with cervical length ≥2.0 cm

ObjectivesCerclage operation is one of the most common obstetric controversies. The aim of this study was to compare the perinatal outcomes and placental inflammation of cerclage performed adherent and non-adherent to international guidelines. Material and methodsThis study included all consecutive women with singleton deliveries who underwent cerclage. According to the current American College of Obstetricians and Gynecologists (ACOG) guideline, we designated our study population into two groups: the adherent-to-guideline and non-adherent groups. Each group was categorized into two groups according to cervical length (CL) at the time of cerclage (<2.0 cm vs. ≥2.0 cm). We evaluated the reasons for cerclage, maternal characteristics, perioperative variables, pregnancy and neonatal outcomes, and placental inflammatory pathology according to the criteria proposed by the Society of Pediatric Pathology. ResultsAmong 310 women with cerclage, we excluded patients (n = 21) with indicated preterm delivery (PTD), major fetal anomaly, fetal death in-utero, and missing information for reason of cerclage. We also excluded patients who underwent physical examination-indicated cerclage (n = 53) and with missing information of CL at the time of cerclage (n = 52). A total of 184 women were eventually analyzed. In women with CL < 2.0 cm, the non-adherent group showed similar PTD (<28 weeks, <34 weeks) and neonatal composite morbidity rates compared to the adherent-to-guideline group. However, in women with CL ≥ 2.0 cm, the non-adherent group manifested significantly higher PTD (<28 weeks; 16.7% vs. 4.4%, p = 0.04, <34 weeks; 23.8% vs. 5.8%, p = 0.006) and neonatal composite morbidity (20.5% vs. 5.9%, p = 0.028) rates than the adherent-to-guideline group despite similar perioperative variables and lower PTD history rates. The non-adherent group with CL ≥ 2 cm at the time of cerclage was also associated with severe histologic chorioamnionitis (p = 0.033). ConclusionCerclage performed beyond the current guidelines in pregnant women with CL ≥ 2.0 cm may confer an additional risk of perinatal complications in association with severe placental inflammation.

The Role of Long Non-Coding RNAs in Trophoblast Regulation in Preeclampsia and Intrauterine Growth Restriction.

Preeclampsia (PE) and Intrauterine Growth Restriction (IUGR) are two pregnancy-specific placental disorders with high maternal, fetal, and neonatal morbidity and mortality rates worldwide. The identification biomarkers involved in the dysregulation of PE and IUGR are fundamental for developing new strategies for early detection and management of these pregnancy pathologies. Several studies have demonstrated the importance of long non-coding RNAs (lncRNAs) as essential regulators of many biological processes in cells and tissues, and the placenta is not an exception. In this review, we summarize the importance of lncRNAs in the regulation of trophoblasts during the development of PE and IUGR, and other placental disorders.

Prospective risk of stillbirth and neonatal complications for monochorionic diamniotic and dichorionic diamniotic twins after 24 weeks of gestation.

Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin-twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age-specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity. Three hundred seventy-eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p=0.05), composite neonatal morbidity (p=0.01), preterm delivery (p < 0.01), and low birth weight (p < 0.01). The prospective risk of IUFD was 0.6% and 0.4% for MCDA and DCDA twins, respectively after 34 weeks' gestation. No NND occurred among deliveries after 30 weeks. The risk of neonatal morbidity of MCDA twins fell from 22.7% at 34 weeks to 2.7% at 37 weeks (p < 0.01). For DCDA twins, the risk of morbidity fell insignificantly from 36 to 38 weeks (4.0% vs. 3.4%, p=0.60). Logistic regression analysis suggested that the increased risk of perinatal morbidities was related to the higher rate of preterm delivery in MCDA twins rather than chorionicity. With close fetal monitoring, the risk of late IUFD in twin pregnancies without major complications is low. Perinatal morbidity can be minimized by avoiding late preterm deliveries in twin pregnancies.

Are neonatal outcomes of triplet pregnancies different from those of singletons according to gestational age?

Multiple pregnancies sustain the high pace of extreme prematurity. Little evidence is available about triplet gestation given the evolution in their management during the last decades. The aim of the study was to compare the neonatal outcomes of triplets with those of matched singletons in a cohort study. An observational retrospective cohort study of triplets and matched singletons born between 2004 and 2017 matched by gestational age was conducted. Additionally, the investigation performed in regard to data from the overall Greek population of interest. The primary outcome was mortality or severe neonatal morbidity based on pregnancy type. A total of 237 triplets of 24-36 weeks' gestation and 482 matched singletons were included. No differences in the primary outcome between triplets and singletons were found. Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. A threshold of 1000gr for birthweight and 28 weeks' gestation for gestational age determined survival on triplets [OR: 0.08 (95% CI: 0.02-0.40, p=0.0020) and OR: 0.13 (95% CI: 0.03-0.57, p=0.0020) for gestational age and birthweight respectively]. In Greece stillbirths in triplets was 8 times higher than that of singletons (OR: 8.5, 95% CI: 6.9-10.5). From 3,375 triplets, 94 were stillborn, whereas in singletons, 4,659 out of 1,388,273. In our center 5 times more triplets than the expected average in Greece were delivered with no significant difference in stillbirths' rates. No significant differences were identified in mortality or major neonatal morbidities between triplets and matched singletons highlighting the significance of prematurity and birthweight for these outcomes.

Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus: A Randomized Controlled Trial.

To evaluate differences in short-term perinatal outcomes between the two prominent screening strategies for gestational diabetes mellitus, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan. In this single-site, blinded, randomized, comparative effectiveness trial, participants received a nonfasting 50-g oral glucose tolerance test and, if less than 200 mg/dL (less than 11.1 mmol/L), were randomized to further screening with either IADPSG or Carpenter-Coustan criteria. Gestational diabetes treatment occurred per routine clinical care. The primary outcome was incidence of large-for-gestational-age (LGA) neonates. Prespecified secondary outcomes included small-for-gestational-age (SGA) neonates, cesarean birth, and neonatal and maternal composites of adverse perinatal outcomes. Assuming a 15% incidence of LGA neonates in the Carpenter-Coustan group, 782 participants provided more than 80% power to detect a 7% absolute risk reduction with the use of IADPSG; planned recruitment was 920 for anticipated attrition. From June 2015 to February 2019, 1,016 participants were enrolled and 921 were randomized to IADPSG (n=461) or Carpenter-Coustan (n=460) groups. Gestational diabetes incidence (14.4% vs 4.5%, P<.001) and diabetes medication use (9.3% vs 2.4%; P<.001) were more common in the IADPSG group; there were no differences in LGA neonates, either overall (risk reduction 0.90, 97.5% CI 0.53-1.52) or among women without gestational diabetes (risk reduction 0.85, 97.5% CI 0.49-1.48). Those screened with IADPSG had higher rates of neonatal morbidity but fewer study-related adverse events. Rates of SGA neonates, cesarean birth, and maternal morbidity composite did not differ significantly between study groups. The IADPSG screening criteria resulted in more women diagnosed and treated for gestational diabetes than Carpenter-Coustan without reducing the incidence of LGA birth weight or maternal or neonatal morbidity. ClinicalTrials.gov, NCT02309138.

Individual and community-level determinants of poor tetanus toxoid immunization among pregnant women in Ethiopia using data from 2016 Ethiopian demographic and health survey; multilevel analysis

BackgroundTetanus is a vaccine-preventable disease that can occur in all populations, with neonates and pregnant women being at the most risk. Ethiopia has the highest maternal and neonatal tetanus morbidity and mortality rates. Besides, only 49% of mothers get vaccinated with adequate tetanus toxoid in Ethiopia which is below the world health organization recommendation. To date, there is limited evidence on the individual and community level determinants of poor tetanus toxoid (TT) immunization. Therefore, this study aimed to assess individual and community-level factors associated with poor TT immunization coverage in Ethiopia.MethodSecondary data analysis was conducted using the 2016 Ethiopian demographic and health survey. A total of 7043 pregnant women were included in the current study. A multilevel logistic regression model was used to identify individual and community level determinants of poor tetanus toxoid immunization. Finally, the adjusted odds ratio with a 95% confidence interval was reported.ResultsIn the multilevel logistic regression model adjustment, having no Antenatal care visit (AOR = 5.64; 95% CI:2.48,7.30) and having one to three antenatal care visit (AOR = 1.50; 95% CI: 1.19–1.82); poor wealth index (AOR = 1.26; 95% CI: 1.03, 1.54); not being exposed to media (AOR = 1.29; 95% CI: 1.10, 1.51); maternal unemployment (AOR = 1.15; 95% CI: 1.10, 1.31); rural residence (AOR = 1.13; 95% CI: 1.08, 1.72); and high community illiteracy (AOR = 1.28; 95% CI: 1.03, 1.58) were associated with higher odds of poor tetanus toxoid immunization. Whereas, iron uptake during pregnancy (AOR = 0.59; 95% CI: 0.51, 0.68), was associated with lower odds of poor tetanus toxoid immunization.ConclusionIn this study tetanus toxoid (TT) vaccine utilization was affected by both community and individual-level factors. Therefore, focusing on antenatal care services especially encouraging pregnant women to have at least four visits, consulting women to be exposed to media, improving community literacy and maternal employment will help to minimize TT underutilization.

Influence of Training Program Implementation on Nurses' Performance Regarding Neonates Invasive Mechanical Ventilation

Background: Mechanical ventilation plays an important role in reducing neonatal mortality and morbidity rate. Nurses caring for neonates on ventilator must be competent to provide an effective nursing care for such group of patients, Effective training program for nurses' will increase their quality of nursing care and improving health and wellbeing of neonates undergoing mechanical ventilation. So, the aim of this Study was to evaluate the influence of training program implementation on nurses' performance regarding neonates invasive mechanical ventilation. Research Design: A quasi-experimental design was utilized. Study settings: the study conducted at Neonatal Intensive Care Unit of Assuit University Children Hospital/Egypt. Research Subject: Convenient sample was included 59 nurses from the previously mentioned setting and 59 neonates under invasive mechanical ventilation. Two tools were used for data collection: tool 1; Predesigned questionnaire consisted of three parts: nurses' demographic characteristics, demographic and clinical data of neonates and nurses’ knowledge about mechanical ventilation. Tool two; Observational Checklists were used pre and post program implementation Results: revealed that there was a statistical significant difference between nurses’ performance at pretest and post program regarding the neonates with invasive mechanical ventilation Conclusion: Training program implementation had a significant effect on nurse’s performance regarding the neonates with invasive mechanical ventilation. Recommendation: implementing the training program for improvement nurses' performance regarding the neonates with invasive mechanical ventilation to all nurses in all neonatal intensive care units in Egypt.

Determine the Outcome of Newborn in Post-Term Pregnancy

Objective: The objective of this study was to assess the outcome of newborn among pregnant females who deliver after prolonged pregnancy. Study Design: Descriptive study Place and Duration: Obstetrics &amp; Gynaecology department of Shahida Islam Teaching Hospital, Lodhran for duration of six months from September 2020 to February 2021. Materials and Methods: 100 patients with pregnancy of &gt;40 weeks were included in study. The patients were not included in this study with medical disorders, intrauterine demise or pregnancy complications. Identification of parameters regarding poor neonatal outcome was done. Variable e.g. gestational age, parity, fetal movement, age, mode of delivery, ultrasound, admission cardiotocogram (CTG) and past prolonged pregnancy were studied. Results: Most of the patients i.e. 39 (39%) were between twenty to twenty five years of age. In this study group multigravida were found in 60 (60%). Emergency caesarean section 65 (65%). Most of babies 64% were admitted to neonatal intensive care unit (ICU). Meconium aspiration syndrome was most general among complications which were found in 67 (67%). No fetal mortality was observed. Conclusion: Pregnancy should be managed before 42 weeks of gestation and should not allow to go post-term due to high rate of neonatal mortality and morbidity. Key words: Neonate, Post-term Pregnancy, Gestational Age, Meconium Aspiration, NICU, Mortality

Effects of Environmental Crude Oil Pollution on Newborn Birth Outcomes: A Retrospective Cohort Study.

The World Health Organization encourages countries to improve birth outcomes to reduce rates of neonatal mortality and morbidity. This study was designed to examine the effect of environmental crude oil pollution on newborn birth outcomes in Rivers State, Nigeria. A retrospective cohort design was used to examine the effects of exposure to oil pollution on birth outcomes using facility-based records. K-Dere (an oil-polluted community) served as the exposure group, whereas birth records from Iriebe served as the comparison group. A sample size of 338 systematically selected birth records was examined (169 records for each arm of the study). A data extraction sheet was used for data collection. Data were analyzed using descriptive and inferential statistics at p < .05. The risk of preterm birth was significantly higher in the exposed group (16% vs. 7.7%, relative risk = 2.08, 95% CI [1.11, 3.89], p = .018). At 6 weeks after birth, newborns in the exposed group weighed significantly less (4.64 ± 0.82 vs. 4.85 ± 0.92 kg, p = .032) and reported significantly higher incidence of morbidity compared with the newborns in the comparison group (relative risk = 3.03, 95% CI [2.20, 4.19], p < .001). The oil-polluted area examined in this study was found to have a higher risk of preterm birth, a slower rate of newborn growth, and a higher rate of newborn morbidity than the non-oil-polluted area at 6 weeks after birth. Stakeholders should sustain efforts to remediate the environment in polluted regions and prevent oil pollution. Future research should investigate the mechanisms of the observed toxicological effects and the targeted protection of vulnerable groups in oil-polluted communities.

Syphilis and pregnancy: Review

Syphilis is a disease that has not been eradicated in part due to inadequate management of antibiotic therapy which is selected according to the stage of the disease and to the misuse of the type of penicillin. Treatment of this disease should be done to prevent it´s chronic complications, to avoid infecting sexual partners and the fetus in a pregnant woman. Syphilis in pregnancy causes increase in the rate of recurrent abortions and neonatal morbidity and mortality, that´s the main reason why early detection and treatment without delay is extremely important. Pregnancy alters immunity, so the serological diagnosis can provide false positives, with the use of inverse algorithms these results may decrease, by increasing the sensitivity of the tests. Today, after 69 years since the advent of penicillin, it has become the drug of choice for any stage of syphilis and in pregnant women; if the patient has allergy, desensitization is indicated either orally or intravenously and other antibiotic shouldn´t be used because of the security offered by penicillin in the cure rate and in the reduction of congenital syphilis. Keywords: Syphilis; Pregnancy; Inverse algorithms.