Hospital Outcomes Among Infants With Interrupted Aortic Arch With Simple and Complex Associated Heart Defects.

There is a lack of current, multi-institutional data regarding hospital outcomes of infants with interrupted aortic arch (IAA). We analyzed the Pediatric Health Information System database to identify infants with IAA who underwent repair during 2004 to 2019. We classified patients as simple or complex based on associated heart defects. We evaluated factors associated with hospital mortality and complications related to 22q11.2 deletion syndrome (22q11.2del) using mixed logistic regression, accounting for hospital clustering. In 1,283 infants included (904 simple, 379 complex), mortality was higher in the complex group (11.7% vs 4.4%, p <0.001). Factors associated with mortality in the simple group were low birth weight (adjusted risk ratio [aRR] 3.77, 95% confidence interval [95% CI] 1.83 to 7.77), non-22q11.2del genetic conditions (aRR 6.44, 95% CI 1.73 to 23.96), and gastrointestinal anomalies (aRR 8.47, 95% CI 3.12 to 22.95), whereas surgery between 2012 and 2015 (aRR 0.36, 95% CI 0.13 to 0.99) was protective. In the complex group, factors associated with mortality were male (aRR 2.32, 95% CI 1.10 to 4.24) and central nervous system anomalies (aRR 3.73, 95% CI 1.62 to 8.59). Compared with their nonsyndromic counterparts, infants with simple IAA and 22q11.2del were at higher risk of sepsis (aRR 1.63, 95% CI 1.02 to 2.39) and gastrostomy tube placement (aRR 3.18, 95% CI 2.13 to 4.74), and infants with complex IAA and 22q11.2del were at higher risk of gastrostomy tube placement (aRR 2.42, 95% CI 1.20 to 4.88). In conclusion, presence of complex cardiac lesions is associated with increased mortality after IAA repair. The co-occurrence of extracardiac congenital anomalies and non-22q11.2del genetic conditions elevates mortality risk. Presence of 22q11.2del is associated with hospital complications.

Prevention of Mother-to-child HIV Transmission in Nigeria: Six Years' Experience from a Tertiary Institution.

BACKGROUND: In line with global standards and progress made in Prevention of Motherto- Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards zero Human immunodeficiency Virus (HIV) infection among children. OBJECTIVES: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. METHODS: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery in the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main outcomes for the study were Early infant diagnosis positivity for HIV at 6 weeks and risk factors for positivity. RESULTS: Of the 1,514 infants studied, early infant diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI (1.85- 3.57)), who had mixed feeding (aPR = 12.06, 95%CI (9.86- 14.70)), and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI (16.04- 25.71)) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis were 95% and 74%, respectively, less likely to be infected with HIV. CONCLUSION: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis, and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.

Risk of Stillbirth after Infertility Treatment in the United States: 2014-2017.

To estimate the risk of stillbirth following infertility treatment in the United States (US), we analyzed data from the US Natality and Fetal Death files from 2014 to 2017. We built Cox proportional regression models to generate adjusted hazard ratios (HR) for the risk of stillbirth among women who utilized various modalities of infertility treatment within the study period. Women who used any infertility treatment and, specifically, assisted reproductive technology (ART), had an elevated risk of stillbirth (HR: 1.21, 95% CI:1.09 -1.33) compared to women who did not use ART. We concluded that in this population, the risk of stillbirth was elevated among women using infertility treatment.

Trends in Stillbirths and Stillbirth Phenotypes in the United States: An Analysis of 131.5 Million Births.

We examined the trends in stillbirth across gestational age in the United States (US).We conducted a trend analysis using the U.S. Natality and Fetal Death datasets covering 1982 and 2017. We compared the incidence and rates of stillbirth for term, all preterm, moderate-to-late preterm, very preterm, and extreme preterm phenotypes. The incidence of stillbirth decreased for the entire birth cohort over the 36-year period. The rates of overall, term, all preterm, very preterm and moderate-to-late preterm stillbirth decreased from 1982 to 2017; however, the rates for extreme preterm stillbirth increased by about 7.6% over the same study period.

Stillbirths among Advanced Maternal Age Women in the United States: 2003-2017.

The aim of the study was to evaluate the association between fetal stillbirth and advanced maternal age in the United States (US). This was a population-based study using the Natality and Fetal Death datasets for the years 2003-2017. We built Cox proportional regression models to examine the likelihood of stillbirth among women aged ≥40 years. Out of a total of 57,273,305 births, stillbirth was observed in 302,522, yielding a stillbirth rate of 5 per 1000. After adjusting for confounders, women of advanced age (≥40 years) had a 40-50% greater risk of stillbirth compared to women 20-29 years of age.

Influence of Sexual and Reproductive Health Literacy on Single and Recurrent Adolescent Pregnancy in Latin America.

STUDY OBJECTIVE: Latin America ranks second in adolescent birth rate globally. Teenage pregnancy often leads to adverse outcomes, affecting the health of the mother and the child in various ways. We examined the association between sexual and reproductive literacy and teenage pregnancy in Latin America. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We analyzed Demographic and Health Survey data for Honduras, the Dominican Republic, Colombia, Peru, and Guatemala. Adolescents were asked about their sexual and reproductive health and their experiences of teenage pregnancy. We measured single and recurrent pregnancy risks according to various classes of sexual and reproductive health literacy using prevalence ratios and adjusted for covariates. We estimated the burden of "preventable" single and recurrent teen pregnancy at various effectiveness levels of sexual and reproductive health literacy interventions. RESULTS: The prevalence of teenage pregnancy for all 5 countries was 19.1%. A positive dose-response relationship was observed between sexual and reproductive health illiteracy and teenage pregnancy; an adolescent who reported complete sexual and reproductive health illiteracy showed 44% increased prevalence of experiencing pregnancy compared with an adolescent who reported accurate sexual and reproductive health literacy. Effective sexual and reproductive health interventions in all 5 countries was associated with 56,006 fewer single and 147,771 fewer recurrent teenage pregnancies. CONCLUSION: Sexual and reproductive health illiteracy is a risk factor for teenage pregnancy. Complete sexual and reproductive health literacy is associated with substantial reduction in teenage pregnancy in Latin America. Comprehensive sexual and reproductive health education and counseling could potentially avert a significant number of teenage pregnancies in these settings.