Third-trimester cervical length assessment for the prediction of spontaneous late preterm birth.

BACKGROUND: The usefulness of cervical length (CL) measurement in asymptomatic pregnancies in the third trimester of pregnancy is not certain. Therefore, the objective of this study was to assess the performance of CL measurement at 31-34 gestational weeks for the prediction of spontaneous late preterm birth (PTB). MATERIALS AND METHODS: This was a prospective study of women with a singleton pregnancy, who had their routine third-trimester scan at 31-34 weeks. The CL was measured transvaginally and was tested, together with maternal demographic and obstetric parameters, for the prediction of late PTB (34 to 36 weeks), using logistic regression and ROC curve analysis. RESULTS: Overall, from a population of 1003 women that consented to participate in the study, 42 (4.2%) delivered at 34-36 gestational weeks. A significant association was identified between gestational age at birth and CL (rho = 0.182, p < .001), and there were significant differences in the CL between cases of late preterm and term births (p < .001). Cervical length alone could predict 17% of late PTB for a 10% false positive rate, corresponding to 22 mm. A model combining CL with parity and method of conception can identify 35% of pregnancies resulting in late PTB, at a false positive rate of 10% (AUC: 0.750; 95% CI: 0.675-0.824). CONCLUSIONS: CL assessment at 31-34 gestational weeks may contribute to the prediction of late PTB when combined with maternal characteristics.

Immediate birth for women between 34 and 37 weeks of gestation with prolonged preterm prelabour rupture of membranes and detection of vaginal or urine group B streptococcus: an economic evaluation.

OBJECTIVE: What are the costs, benefits and harms of immediate birth compared with expectant management in women with prolonged preterm prelabour rupture of membranes (PPROM) at 34+0 -36+6  weeks of gestation and detection of vaginal or urine group B streptococcus (GBS)? DESIGN: Mathematical decision model comprising three independent decision trees. SETTING: UK National Health Service (NHS) and personal social services perspective. POPULATION: Women testing positive for GBS with PPROM at 34+0 -36+6  weeks of gestation. METHODS: The model estimates lifetime costs and quality-adjusted life years (QALYs) using evidence from randomised trials, UK NHS data sources and further observational studies. Simulated events include neonatal infections, morbidity associated with preterm birth and consequences of caesarean birth. Deterministic and probabilistic sensitivity analyses (PSAs) were performed. MAIN OUTCOME MEASURES: QALYs, costs and incremental cost-effectiveness ratio (ICER). RESULTS: In this population, immediate birth dominates expectant management: it is more effective (average lifetime QALYs, 24.705 versus 24.371) and it is cheaper (average lifetime costs, £14,372 versus £19,311). In one-way sensitivity analysis, results are robust to all but the odds ratio estimating the relative effect on incidence of infections. Threshold analysis shows that the odds of infection only need to be >1.5% with expectant management for the benefit of avoiding infections to outweigh the disadvantages of immediate birth. In PSA, immediate birth is the preferred option in >80% of simulations. CONCLUSIONS: Neonatal GBS infections are expensive to treat and may result in substantial adverse health consequences. Therefore, immediate birth, which is associated with a reduced risk of neonatal infection compared with expectant management, is expected to generate better health outcomes and decreased lifetime costs. TWEETABLE ABSTRACT: For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management.

Pre-induction cervical assessment using transvaginal ultrasound versus Bishops cervical scoring as predictors of successful induction of labour in term pregnancies: A hospital-based comparative clinical trial.

OBJECTIVE: To evaluate the association between transvaginal ultrasound scan of cervix and Bishop's score in predicting successful induction of labour, cut-off points and patients' tolerability and acceptance for both procedures. DESIGN: A comparative clinical trial. SETTING: A tertiary hospital in Selangor, Malaysia. PARTICIPANTS: 294 women planned for elective induction of labour for various indications were included. All women had transvaginal ultrasound to assess the cervical length and digital vaginal examination to assess the Bishop cervical scoring by separate investigators before induction of labour. PRIMARY OUTCOME MEASURE: To evaluate the association of the cervical length by transvaginal ultrasound scan and Bishop score in predicting successful induction of labour. SECONDARY OUTCOME MEASURE: Variables associated with successful induction of labour and patients' tolerability and acceptance for transvaginal ultrasound scan of cervix. RESULTS: There was no statistically significant difference among the vaginal and Caesarean delivery groups in terms of mean maternal age, height, weight, body mass index, ethnicity and gestational age at induction. Vaginal delivery occurred in 207 women (70.4%) and 87 women (29.6%) delivered via Caesarean section. There was a high degree of correlation between the cervical length and Bishop score (r-value 0.745; p <0.001). Sonographic assessment of cervical length demonstrated a comparable accuracy in comparison to Bishop score. Analysis using ROC curves noted an optimal cut-off value of ≤27mm for cervical length and Bishop score of ≥ 4, with a sensitivity of 69.1% vs 67%, specificity 60.9% vs 55%, and area under the curves (AUCs) of 0.672 and 0.643 respectively (p <0.001). Multivariate logistic regression analysis demonstrated that parity (OR 2.70), cervical length (OR 0.925), Bishop score (OR 1.272) and presence of funnelling (OR 3.292) were highly significant as independent predictors of success labour induction. Women also expressed significantly less discomfort with transvaginal ultrasound compared with digital vaginal examination. CONCLUSION: Sonographic assessment of cervical measurement predicts the success of induction of labour with similar diagnostic accuracy with conventional Bishop score.

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals.

OBJECTIVE: There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. STUDY DESIGN: We solicited cases of mother-infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. RESULTS: Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. CONCLUSION: In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. KEY POINTS: · Birth hospitalizations were uncomplicated for late preterm and term infants with maternal COVID-19.. · Nursery management of dyads affected by COVID-19 varied between hospitals.. · Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.. · Breastfeeding rates were lower for dyads roomed separately than those who were colocated..

Epidemiology of Surgical Procedures, Anesthesia, and Imaging Studies by Gestational Age during the First Year of Life in Medicaid-Insured Infants.

OBJECTIVES: To evaluate the rate of surgical procedures, anesthetic use, and imaging studies by prematurity status for the first year of life we analyzed data for Texas Medicaid-insured newborns. STUDY DESIGN: We developed a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 4 subcohorts: extremely premature, very premature, moderate/late premature, and term. RESULTS: In 1 102 958 infants, surgical procedures per 100 infants were 135.9 for extremely premature, 35.4 for very premature, 15.5 for moderate/late premature, and 6.5 for term. Anesthetic use was 62.0 for extremely premature, 20.8 for very premature, 11.1 for moderate/late premature, and 5.6 for the term subcohort. The most common procedures in the extremely premature were neurosurgery, intubations, and procedures that facilitated caloric intake (gastrostomy tubes and fundoplications). The annual rates for the first year of life for chest radiograph ranged from 15.0 per year for the extremely premature cohort to 0.6 for term infants and for magnetic resonance imaging (MRI) from 0.3 to 0.01. MRI was the most common imaging study with anesthesia support in all maturity levels. MRIs were done in extremely premature without anesthesia in over 90% and in term infants in 57.2%. CONCLUSIONS: Surgical procedures, anesthetic use, and imaging studies in infants are common and more frequent with higher a degree of prematurity while the use of anesthesia is lower in more premature newborns. These findings can provide direction for outcome studies of surgery and anesthesia exposure.

Establishing reference ranges of cord blood: point-of-care hemostatic function assessment in preterm and term neonates.

BACKGROUND: Thrombelastometry, allowing timely assessment of global hemostatic function, is increasingly used to guide hemostatic interventions in bleeding patients. Reference values are available for adults and children, including infants but not neonates immediately after birth. METHODS: Neonates were grouped as preterm (30 + 0 to 36 + 6 weeks/days) and term (37 + 0 to 39 + 6 weeks/days). Blood samples were drawn from the umbilical cord immediately after cesarean section and analyzed by thrombelastometry. Reference ranges were determined for the extrinsic and intrinsic coagulation pathways, fibrin polymerization, and hyperfibrinolysis detection. RESULTS: All extrinsically activated test parameters, but maximum lysis (P = 0.139) differed significantly between both groups (P ≤ 0.001). Maximum clot firmness in the fibrin polymerization test was comparable (P = 0.141). All intrinsically activated test parameters other than coagulation time (P = 0.537) and maximum lysis (P = 0.888) differed significantly (P < 0.001), and so did all aprotinin-related test parameters (P ≤ 0.001) but maximum lysis (P = 0.851). CONCLUSIONS: This is the first study to identify reference ranges for thrombelastometry in preterm and term neonates immediately after birth. We also report differences in clot initiation and clot strength in neonates born <37 versus ≤40 weeks of gestation, mirroring developmental hemostasis. IMPACT: Impact: This prospective observational study is the first to present reference ranges in preterm and term infants for all types of commercially available tests of thrombelastometry, notably also including the fibrin polymerization test. IMPORTANCE: Viscoelastic coagulation assays such as thrombelastometry have become integral to the management of perioperative bleeding by present-day standards. Reference values are available for adults, children, and infants but not for neonates. Key message: Clot initiation and formation was faster and clot strength higher in the term than in the preterm group. Parameters of thrombelastometry obtained from cord blood do not apply interchangeably to preterm and term neonates.

Transperineal ultrasound assessment of fetal head elevation by maneuvers used for managing umbilical cord prolapse.

OBJECTIVE: To assess objectively the degree of fetal head elevation achieved by different maneuvers commonly used for managing umbilical cord prolapse. METHODS: This was a prospective observational study of pregnant women at term before elective Cesarean delivery. A baseline assessment of fetal head station was performed with the woman in the supine position, using transperineal ultrasound for measuring the parasagittal angle of progression (psAOP), head-symphysis distance (HSD) and head-perineum distance (HPD). The ultrasonographic measurements of fetal head station were repeated during different maneuvers, including elevation of the maternal buttocks using a wedge, knee-chest position, Trendelenburg position with a 15° tilt and filling the maternal urinary bladder with 100 mL, 300 mL and 500 mL of normal saline. The measurements obtained during the maneuvers were compared with the baseline measurements. RESULTS: Twenty pregnant women scheduled for elective Cesarean section at term were included in the study. When compared with baseline (median psAOP, 103.6°), the knee-chest position gave the strongest elevation effect, with the greatest reduction in psAOP (psAOP, 80.7°; P < 0.001), followed by filling the bladder with 500 mL (psAOP, 89.9°; P < 0.001) and 300 mL (psAOP, 94.4°; P < 0.001) of normal saline. Filling the maternal bladder with 100 mL of normal saline (psAOP, 96.1°; P = 0.001), the Trendelenburg position (psAOP, 96.8°; P = 0.014) and elevating the maternal buttocks (psAOP, 98.3°; P = 0.033) gave modest elevation effects. Similar findings were reported for HSD and HPD. The fetal head elevation effects of the knee-chest position, Trendelenburg position and elevation of the maternal buttocks were independent of the initial fetal head station, but that of bladder filling was greater when the initial head station was low. CONCLUSIONS: To elevate the fetal presenting part, the knee-chest position provides the best effect, followed by filling the maternal urinary bladder with 500 mL then 300 mL of fluid, respectively. Filling the bladder with 100 mL of fluid, the Trendelenburg position and elevation of the maternal buttocks have modest effects. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Protease Amplification of the Inflammatory Response Induced by Commensal Bacteria: Implications for Racial Disparity in Term and Preterm Birth.

Decidual macrophages secrete proteases that activate protease-activated receptor 1 (PAR-1). We hypothesized that activation of the inflammatory response by bacteria is amplified by proteases, initiating labor. In addition, we hypothesized that commensal bacteria trigger an inflammatory response by activating NF-κB and TET methylcytosine dioxygenase 2 (TET2), a DNA de-methylase, via a protease amplified PAR-1, RhoA kinase (ROCK) pathway. To evaluate these hypotheses, we compared responses of mononuclear cells with Lactobacillus crispatus, prevalent in the vaginal microbiome of women of European ancestry, with L. iners and Fusobacterium nucleatum, which are more prevalent in vaginal samples collected from African-American women. Decidual tissue was collected at term not-in-labor (TNL), term labor (TL), spontaneous preterm labor (sPTL), and infected preterm labor (iPTL) and immunostained for PAR-1, TET2, and CD14. Mononuclear cells and THP-1 macrophage cells were treated with bacteria and elastase, a known activator of PAR-1. The inflammatory response was monitored by confocal microscopy of TET2 and the p65 subunit of NF-κB, as well as IL-8 production. Decidual staining for PAR-1, TET2, and CD14 increased TNL < TL < sPTL < iPTL. All treatments stimulated translocation of TET2 and p65 from the cytosol to the nucleus and increased IL-8, but L. iners and F. nucleatum caused more robust responses than L. crispatus. Inhibition of PAR-1 or ROCK prevented TET2 and p65 nuclear translocalization and increases in IL-8. Our findings demonstrate that proteases amplify the inflammatory response to commensal bacteria. The more robust response to bacteria prevalent in African-American women may contribute to racial disparities in preterm birth.

Birth Mode after Primary Cesarean among Hispanic and non-Hispanic Women at One U.S. Institution.

BACKGROUND: Despite a lower percentage of primary cesareans than non-Hispanic White and Black women, Hispanic women in the United States had the highest rate of repeat cesarean deliveries (RCD) in 2016; it is unclear if reasons for differences are due to known risk factors. Our study examined the association between ethnicity/race and RCD among women with one previous cesarean and whether demographic (age, marital status, education, language, and delivery year), anthropomorphic (height, prepregnancy body mass index), obstetrical/medical (parity, gestational age, infant birth weight, gestational diabetes, labor induction or augmentation, vaginal birth after cesarean delivery history), or health system (delivery day/time, payer source, provider gender) factors accounted for any observed differences by ethnicity/race. METHODS: Our retrospective cohort study used logistic regression to evaluate the relationship between ethnicity/race and RCD based on data from electronic delivery and prenatal records from 2010 to 2016, including 1800 births to Hispanic and non-Hispanic women with one previous cesarean at a District of Columbia hospital. RESULTS: Statistically significant differences by ethnicity/race were noted after adjustment for obstetric/medical factors, particularly parity and use of induction or augmentation methods. Hispanic (adjusted odds ratio, 2.48; 95% confidence interval, 1.03-6.01) and Black women (adjusted odds ratio, 2.83; 95% confidence interval, 1.67-4.81) had higher odds of RCD than White women. CONCLUSIONS: Adjustment for parity and use of induction or augmentation methods revealed higher odds of RCD for Hispanic and Black women than White women. Demographic and anthropometric factors did not alter these results. Our work is a first step in creating effective public health policy and programs that target potentially preventable RCD by highlighting the need to evaluate risk factors beyond those included in the literature to date.

Cost Minimization Analysis of Same-Day Long-Acting Reversible Contraception for Adolescents.

Importance: Long-acting reversible contraception (LARC) is considered first-line contraception for adolescents but often requires multiple clinic visits to obtain. Objective: To analyze Indiana Medicaid's cost savings associated with providing adolescents with same-day access to LARC. Design, Setting, and Participants: An economic evaluation of cost minimization from the payer's (Medicaid) perspective was performed from August 2017 through August 2018. The cost model examined the anticipated outcome of providing LARC at the first visit compared with requiring a second visit for placement. The costs and probabilities of clinic visits, devices, device insertions and removals, unintended pregnancy, and births, according to previously published sources, were incorporated into the model. The participants were payers (Medicaid). Main Outcomes and Measures: The outcomes were the cost of same-day LARC placement vs LARC placement at a subsequent visit in US dollars, and rates of unintended pregnancy and abortion. One-way sensitivity analysis was done. Results: Same-day LARC placement was associated with lower overall costs ($2016 per patient over 1 year) compared with LARC placement at a subsequent visit ($4133 per patient over 1 year). Compared with the return-visit strategy, same-day LARC was associated with an unintended pregnancy rate of 14% vs 48% and an abortion rate of 4% vs 14%. Conclusions and Relevance: Providing same-day LARC could save costs for Medicaid, largely by preventing unintended pregnancy. Expected cost savings could be used to implement policies that make this strategy feasible in all clinical settings.

Health economic aspects of late preterm and early term birth.

Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. The article highlights the limited perspective and time horizon of most studies of economic costs in this area; the limited evidence surrounding health economic aspects of early term birth; the gaps in current knowledge; and it discusses directions for future research in this area, including the need for validated tools for measuring preference-based health-related quality-of-life outcomes in infants that will aid cost-effectiveness-based decision-making.

The Baby Moves smartphone app for General Movements Assessment: Engagement amongst extremely preterm and term-born infants in a state-wide geographical study.

AIM: The Baby Moves smartphone application is designed for parents to video their infants' spontaneous movement for remote General Movements Assessment (GMA). We aimed to assess the engagement with Baby Moves amongst high- and low-risk infants' families and the socio-demographic variables related to engagement. METHODS: Families of extremely preterm (EP; <28 weeks' gestational age) or extremely low-birthweight (ELBW; <1000 g) infants and term-born controls from a state-wide geographical cohort study were asked to download Baby Moves. Baby Moves provided reminders and instructions to capture videos of their infants' general movements. Parents were surveyed about Baby Moves' usability. RESULTS: The parents of 451 infants (226 EP/ELBW; 225 control) were recruited; 416 (204 EP/ELBW; 212 control) downloaded Baby Moves, and 346 (158 EP/ELBW; 188 control) returned at least one scorable video for remote GMA. Fewer EP/ELBW families submitted a scorable video than controls (70 vs. 83%, respectively; odds ratio (OR) 0.48, 95% confidence interval (CI) 0.3-0.79, P = 0.003), but the difference diminished when adjusted for socio-demographic variables (OR 1.09, 95% CI 0.59-2.0, P = 0.79). Families who received government financial support (OR 0.28, 95% CI 0.1-0.78, P = 0.015), who spoke limited English at home (OR 0.39, 95% CI 0.22-0.69, P = 0.001) or with lower maternal education (OR 0.38, 95% CI 0.21-0.68, P = 0.001) were less likely to return a scorable video. Surveyed parents responded mostly positively to Baby Moves' usability. CONCLUSIONS: Most parents in this study successfully used Baby Moves to capture infant movements for remote GMA. Families of lower socio-demographic status used Baby Moves less.

Assessment of left ventricular function using the Myocardial Performance Index in term fetuses that develop intrapartum compromise.

OBJECTIVE: To investigate the relationship between the prelabour left ventricular Myocardial Performance Index (LVMPI) and intrapartum fetal compromise (IFC) in low-risk term pregnancies. METHODS: A blinded, prospective observational cohort study at the Mater Mother's Hospital, Brisbane, Australia. A cohort of 284 women with uncomplicated singleton pregnancies underwent fortnightly ultrasound from 36 weeks until delivery. The LVMPI was assessed by conventional Doppler ultrasound and correlated with intrapartum outcomes. The LVMPI was also correlated with other Doppler indices of fetal wellbeing. RESULTS: Two hundred and seventy-three women were included in the final analysis, the median LVMPI was higher in fetuses that required any emergency operative delivery for IFC (0.56, 0.52-0.60 versus 0.54, 0.50-0.58, p = .007). The left ventricular cardiac output (LVCO) and cerebroplacental ratio (CPR) were lower in fetuses that required any emergency operative delivery for IFC compared to those that did not (164 ± 19 ml/min/kg versus 181 ± 30 ml/min/kg, p < .001) (1.63 + 0.30 versus 1.90 + 0.50, p < .001), respectively. The LVMPI was inversely correlated with the CPR (r = -0.20, p < .01), MCA PI (r = -0.29, p < .01), and LVCO (r = -0.22, p < .01). CONCLUSIONS: Higher global LVMPI is associated with a higher risk for IFC and poorer condition of the newborn.

Evaluating services for perinatal asphyxia and low birth weight at two hospitals in Ghana: a micro-costing analysis.

BACKGROUND: Neonatal mortality has been decreasing slowly in Ghana despite investments in maternal-newborn services. Although community-based interventions are effective in reducing newborn deaths, hospital-based services provide better health outcomes. OBJECTIVE: To examine the process and cost of hospital-based services for perinatal asphyxia and low birth weight/preterm at a district and a regional level referral hospital in Ghana. METHODS: A cross-sectional study was conducted at 2 hospitals in Greater Accra Region during May-July 2016. Term infants with perinatal asphyxia and low birth weight/preterm infants referred for special care within 24hours after birth were eligible. Time-driven activity-based costing (TDABC) approach was used to examine the process and cost of all activities in the full cycle of care from admission until discharge or death. Costs were analysed from health provider's perspective. RESULTS: Sixty-two newborns (perinatal asphyxia 27, low-birth-weight/preterm 35) were enrolled. Cost of care was proportionately related to length-of-stay. Personnel costs constituted over 95% of direct costs, and all resources including personnel, equipment and supplies were overstretched. CONCLUSION: TDABC analysis revealed gaps in the organization, process and financing of neonatal services that undermined the quality of care for hospitalized newborns. The study provides baseline cost data for future cost-effectiveness studies on neonatal services in Ghana. FUNDING: Authors received no external funding for the study.

[Full-term low birth weight and its relationship with the socioeconomic conditions of municipalities in Antioquia: Spatio-temporal analysis].

INTRODUCTION: Low birth weight is one of the main health predictors for childhood and adulthood. It is highly prevalent in developing countries and in children from poorer social classes. OBJECTIVE: To analyze the geographical distribution and the trends of full-term low birth weight in the 125 municipalities of the department of Antioquia and their association with the socioeconomic conditions of the municipalities between 2000 and 2014. MATERIALS AND METHODS: We conducted a longitudinal ecological study. The dependent variable was the prevalence of full-term low birth weight in 125 municipalities. The socioeconomic conditions of the municipalities were evaluated using the Human Development Index and the unsatisfied basic needs index. RESULTS: Between 2000 and 2014, the prevalence of full-term low birth weight in Antioquia was 2.7 per 100 live births; this prevalence decreased steadily over time. This trend was also observed between regions, with the exception of the Occidente and Urabá regions, which showed increases of approximately 20.0%. The results also showed a reduction in geographical differences between the 125 municipalities, with the coefficient of variation decreasing from 20.6% to 13.72% over the 14-yearperiod. Finally, we found a positive social gradient between the full-term low birth weight prevalence and the level of development in the municipalities. CONCLUSION: Full-term low birth weight prevalence decreased between 2000 and 2014, with some regions showing greater reductions than others. Paradoxically, less developed and poorer areas had a lower prevalence, which may be a result of underreporting of birth weight information in these municipalities.

Full-term low birth weight and its relationship with the socioeconomic conditions of municipalities in Antioquia: Spatio-temporal analysis / Bajo peso al nacer en niños nacidos a término en Antioquia y su relación con las condiciones socioeconómicas de los municipios, un análisis espacio-temporal

Abstract Introduction: Low birth weight is one of the main health predictors for childhood and adulthood. It is highly prevalent in developing countries and in children from poorer social classes. Objective: To analyze the geographical distribution and the trends of full-term low birth weight in the 125 municipalities of the department of Antioquia and their association with the socioeconomic conditions of the municipalities between 2000 and 2014. Materials and methods: We conducted a longitudinal ecological study. The dependent variable was the prevalence of full-term low birth weight in 125 municipalities. The socioeconomic conditions of the municipalities were evaluated using the Human Development Index and the unsatisfied basic needs index. Results: Between 2000 and 2014, the prevalence of full-term low birth weight in Antioquia was 2.7 per 100 live births; this prevalence decreased steadily over time. This trend was also observed between regions, with the exception of the Occidente and Urabá regions, which showed increases of approximately 20.0%. The results also showed a reduction in geographical differences between the 125 municipalities, with the coefficient of variation decreasing from 20.6% to 13.72% over the 14-year period. Finally, we found a positive social gradient between the full-term low birth weight prevalence and the level of development in the municipalities. Conclusion: Full-term low birth weight prevalence decreased between 2000 and 2014, with some regions showing greater reductions than others. Paradoxically, less developed and poorer areas had a lower prevalence, which may be a result of underreporting of birth weight information in these municipalities.

Resumen Introducción. El bajo peso al nacer es uno de los principales indicadores predictores de la salud en la infancia y la adultez, y su prevalencia es elevada en los países en desarrollo y en niños de clases sociales pobres. Objetivo. Analizar la distribución geográfica y la tendencia del bajo peso al nacer de niños nacidos a término en los 125 municipios de Antioquia, y su asociación con las condiciones socioeconómicas de los municipios entre el 2000 y el 2014. Materiales y métodos. Se hizo un estudio ecológico longitudinal. La variable dependiente fue el bajo peso al nacer a término en los 125 municipios; las condiciones socioeconómicas de los municipios se evaluaron según sus índices de desarrollo humano y de necesidades básicas insatisfechas. Resultados. La prevalencia de bajo peso al nacer a término en Antioquia fue de 2,7 por 100 nacidos vivos entre 2000 y 2014, con una reducción constante. Esta tendencia se observó en todas las subregiones, excepto en las de Occidente y Urabá, en las cuales el incremento fue de 20 %. Los resultados evidenciaron una reducción de las brechas geográficas entre los 125 municipios. Además, en todos los trienios se evidenció un gradiente social positivo en la asociación entre el bajo peso al nacer a término y las condiciones socioeconómicas de los municipios. Conclusión. Se observó una mayor tendencia decreciente del bajo peso al nacer a término en unas subregiones. Paradójicamente, se registró una menor prevalencia de bajo peso al nacer a término en las regiones menos desarrolladas y más pobres, lo que posiblemente se explica por el subregistro del peso al nacer.

The possibilities of a portable low-budget three-dimensional stereophotogrammetry system in neonates: a prospective growth analysis and analysis of accuracy.

BACKGROUND: With the technical development, portable three-dimensional (3D) photogrammetry systems are becoming more en vogue because of cost-effectiveness and comparable accuracy to common stationary 3D systems. The purpose of the study was to evaluate the feasibility and accuracy of a low-budget portable system for 3D image acquisition with special regard to the gracile nasal region in neonates. Furthermore, the study aimed to establish a 3D data set of the first 180 days post partum. METHODS: Thirty-three healthy, full-term newborn were enrolled and 3D photographs were prospectively taken monthly with a portable low-budget 3D stereophotogrammetry system (FUEL3D® SCANIFY®) for six months. In the third month, age-matched and corresponding 3D models were acquired by taking an impression of the perinasal area. The resulting plaster models were scanned (3Shape D700, 3Shape® A/S, Denmark). Three examiners analyzed independently 21 defined landmarks of the generated Standard Tessellation Language files with regard to accuracy by using 3dMDvultus™ software. A semi-automatic 3D best-fit analysis of 3D photo and plaster models were performed by using Geomagic® and the Root Mean Squared (RMS) errors were calculated. RESULTS: Statistically significant changes of midfacial distances and angles with a focus on nasal growth during the first 180 days postpartum could be specified in absolute and relative dimensions. Best-fit analysis in the third month revealed a RMS error of 0.72 ± 0.22 mm with a mean standard deviation of 0.71 ± 0.21 mm. CONCLUSIONS: The analyzed portable 3D stereophotogrammetry system is a feasible methodology with good accuracy, even in newborn. A description of the growth as well as the establishment of a 3D data set was performed. Its implementation for basic documentation for example in cleft patients is possible and might reduce the need for impressions and facilitate the communications with parents and the interdisciplinary team.

Preterm infants are less likely to have a family-centered medical home than term-born peers.

OBJECTIVE: The family-centered medical home (FCMH) is the recommended healthcare delivery model for children. It is unknown how frequently preterm (PT) children receive care in a FCMH and how this affects health services use. STUDY DESIGN: We studied 18,397 children aged 0-3 years in the 2010/2011 National Survey of Children's Health. We compared PT (<37 weeks) and full-term (FT) children on rates of FCMH and receiving prescribed health services. Regression models included sex, race, income, insurance status, and having a special health care need (SHCN). RESULTS: PT children were significantly less likely to have a FCMH (57% vs. 66%) compared to FT peers despite higher rates of SHCN (16% vs. 5%). PT children were less likely to receive prescribed services (aOR 0.34, 95% CI 0.34, 0.34); lacking a FCMH explained 69% of this effect. CONCLUSIONS: Ensuring PT children have access to medical homes may decrease unmet service needs post-hospital discharge.

Language Trajectories of Children Born Very Preterm and Full Term from Early to Late Childhood.

OBJECTIVE: To identify distinct language trajectories of children born very preterm and full term from 2 to 13 years of age and examine predictors for the identified trajectories. STUDY DESIGN: A cohort of 224 children born very preterm and 77 full term controls recruited at birth were followed up at ages 2, 5, 7, and 13 years. The number of distinct language trajectories was examined using latent growth mixture modeling allowing for linear and quadratic time trends. Potential predictors in the neonatal period (eg, birth group, sex, and medical risk) and at 2 years (ie, social risk and use of allied health services) for the language trajectories were tested using multinomial logistic regression. RESULTS: Five distinct language trajectories were identified across childhood: stable normal (32% of study cohort), resilient development showing catch-up (36%), precocious language skills (7%), stable low (17%), and high-risk (5%) development. The very preterm group was 8 times more likely to have a language trajectory that represented poorer language development compared with full term controls (very preterm, 40%; full term, 6%). Greater social risk and use of allied health services were associated with poorer language development. CONCLUSIONS: Variable language trajectories were observed, with a substantial proportion of children born very preterm exhibiting adverse language development. These findings highlight the need for monitoring language skills in children born very preterm before school entry and across middle childhood.