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1.
Rev Paul Pediatr ; 40: e2020486, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35544903

RESUMO

OBJECTIVE: To analyze the socioeconomic, demographic, environmental, reproductive, behavioral, and health-care factors associated with preterm birth. METHODS: Case-control study, with case group composed of preterm infants and the control group by full term live births. Each case was paired with two controls according to sex and date of birth. Interviews were carried out with the mothers, as well as analysis of medical records. A logistic regression model was used for data analysis following the hierarchical order of entry of the blocks. RESULTS: 221 live births were allocated in the case group and 442 in the control group. After analysis adjusted for other factors under study, the highest chances of prematurity were associated with being the first child (OR 1.96; 95%CI 1.34-2.86; p=0.001); mothers with the highest income (OR 2.08; 95%CI 1.41-3.08; p<0.001), mothers with previous preterm births (OR 3.98; 95%CI 2.04-7.79; p<0.001), mothers that suffered violence during pregnancy (OR 2.50; 95%CI 1.31-4.78; p=0.005) and underwent cesarean section (OR 2.35; 95%CI 1.63-3.38; p<0.001). Live births to mothers who had more than six prenatal consultations had a lower risk of prematurity (OR 0.39; 95%CI 0.26-0.58; p<0.001). CONCLUSIONS: The factors associated with a higher chance of prematurity were: higher family income, previous preterm child, primiparity, violence against pregnant women and cesarean section. Having attended more than six prenatal visits was associated with a lower chance of premature birth. Violence against pregnant women showed a strong and consistent association, remaining in all final models, and should serve as an alert for the population and professionals.


Assuntos
Complicações na Gravidez , Nascimento Prematuro , Estudos de Casos e Controles , Cesárea , Criança , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Nascimento Prematuro/epidemiologia , Fatores de Risco
2.
Environ Health ; 21(1): 47, 2022 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-35513869

RESUMO

BACKGROUND: Most U.S. studies that report racial/ethnic disparities in increased risk of low birth weight associated with air pollution exposures have been conducted in California or northeastern states and/or urban areas, limiting generalizability of study results. Few of these studies have examined maternal racial/ethnic groups other than Non-Hispanic Black, non-Hispanic White and Hispanic, nor have they included paternal race. We aimed to examine the independent effects of PM2.5 on birth weight among a nationally representative sample of U.S. singleton infants and how both maternal and paternal race/ethnicity modify relationships between prenatal PM2.5 exposures and birth outcomes. METHODS: We used data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a longitudinal nationally representative cohort of 10,700 U.S. children born in 2001, which we linked to U.S.EPA's Community Multi-scale Air Quality (CMAQ)-derived predicted daily PM2.5 concentrations at the centroid of each Census Bureau Zip Code Tabulation Area (ZCTA) for maternal residences. We examined relationships between term birthweight (TBW), term low birthweight rate (TLBW) and gestational PM2.5 pollutant using multivariate regression models. Effect modification of air pollution exposures on birth outcomes by maternal and paternal race was evaluated using stratified models. All analyses were conducted with sample weights to provide national-scale estimates. RESULTS: The majority of mothers were White (61%). Fourteen percent of mothers identified as Black, 21% as Hispanic, 3% Asian American and Pacific Islander (AAPI) and 1% American Indian and Alaskan Native (AIAN). Fathers were also racially/ethnically diverse with 55% identified as White Non-Hispanic, 10% as Black Non-Hispanic, 19% as Hispanic, 3% as AAPI and 1% as AIAN. Results from the chi-square and ANOVA tests of significance for racial/ethnic differences indicate disparities in prenatal exposures and birth outcomes by both maternal and paternal race/ethnicity. Prenatal PM2.5 was associated with reduced birthweights during second and third trimester and over the entire gestational period in adjusted regression models, although results did not reach statistical significance. In models stratified by maternal race and paternal race, one unit increase in PM2.5 was statistically significantly associated with lower birthweights among AAPI mothers, -5.6 g (95% CI:-10.3, -1.0 g) and AAPI fathers, -7.6 g (95% CI: -13.1, -2.1 g) during 3rd trimester and among births where father's race was not reported, -14.2 g (95% CI: -24.0, -4.4 g). CONCLUSIONS: These data suggest that paternal characteristics should be used, in addition to maternal characteristics, to describe the risks of adverse birth outcomes. Additionally, our study suggests that serious consideration should be given to investigating environmental and social mechanisms, such as air pollution exposures, as potential contributors to disparities in birth outcomes among AAPI populations.


Assuntos
Recém-Nascido de Baixo Peso , Adulto , Peso ao Nascer , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Material Particulado/efeitos adversos , Gravidez , Adulto Jovem
3.
Artigo em Inglês | PAHO-IRIS | ID: phr-55935

RESUMO

[ABSTRACT]. Objective. To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, preeclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods. We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results. Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions. The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.


[RESUMEN]. Objetivo. Estimar la prevalencia puntual y los rangos probables de hipertensión provocada por embarazo, preeclampsia, diabetes gestacional, peso bajo al nacer y parto prematuro en América Latina y el Caribe, y evaluar la heterogeneidad de las estimaciones. Métodos. Se llevó a cabo una revisión sistemática y metanálisis de los estudios de observación que notificaron la prevalencia de resultados adversos perinatales y maternos en poblaciones de América Latina y el Caribe, publicados entre los años 2000 y 2019 en inglés, español o portugués. Se realizaron búsquedas en PubMed, Embase y LILACS. Se estimó la prevalencia puntual y se evaluó la heterogeneidad general y, en los análisis de subgrupos, la heterogeneidad según el diseño del estudio y nivel de sesgo. Resultados. De 1 087 registros recuperados, se incluyeron 50 artículos en la revisión: 2 sobre los trastornos hipertensivos en el embarazo, 14 sobre preeclampsia, 6 sobre la diabetes gestacional, 9 sobre peso bajo al nacer y 19 sobre parto prematuro. No se pudo realizar ningún metanálisis de los trastornos hipertensivos del embarazo debido al número reducido de estudios. Las estimaciones de prevalencia puntual y los intervalos de confianza (IC) del 95% para la preeclampsia, la diabetes gestacional, el peso bajo al nacer y el parto prematuro fueron: 6,6% (IC de 95%: 4,9%, 8,6%), 8,5% (IC de 95%: 3,9%, 14,7%), 8,5% (IC de 95%: 7,2%, 9,8%) y 10,0% (IC de 95%: 8,0%, 12,0%), respectivamente. Se observó una heterogeneidad significativa en general, así como según el diseño del estudio. No se advirtieron grandes diferencias en las estimaciones según el nivel del sesgo. Conclusiones. Los resultados de este estudio ofrecen cálculos actualizados de algunos de los resultados adversos perinatales y del embarazo con mayor prevalencia en América Latina y el Caribe. Estos resultados ponen de manifiesto que existe una gran heterogeneidad en las estimaciones de prevalencia, que podría reflejar la diversidad de la población de la región.


Assuntos
Hipertensão , Pré-Eclâmpsia , Diabetes Gestacional , Recém-Nascido de Baixo Peso , Nascimento Prematuro , América Latina , Região do Caribe , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Diabetes Gestacional , Recém-Nascido de Baixo Peso , Nascimento Prematuro , América Latina , Região do Caribe , Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Recém-Nascido de Baixo Peso , Nascimento Prematuro , Região do Caribe
4.
J Health Econ ; 83: 102622, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512609

RESUMO

We estimate the impact of a cash transfer targeting new mothers on their subsequent children's health outcomes at birth. We exploit the unexpected introduction of a generous, universal child benefit in Spain in 2007. Using population-wide, individual-level, high-quality administrative data from birth records and a regression discontinuity approach, we find that women who received the benefit were much less likely to have low-birth-weight children in the future (while their subsequent fertility was unaffected). The overall effect is driven by poor women, unmarried women, and women with low education, and by births taking place relatively soon after the benefit receipt. The €2500 transfer led to a 0.7 percentage-point decline in the fraction of children born under 1500 g in poorer households in the following five years, an 83% reduction. We explore the underlying channels, and find evidence supporting faster intrauterine growth, possibly driven by better maternal health, nutrition, and behaviors. Gestation length, family structure, and parental employment do not seem to play a role. Recent research suggests that targeting pregnant women may be more effective than later interventions (such as cash transfers to families with children), given the strong persistence of fetal health effects. Our results suggest that the impact may be stronger if women are targeted even earlier, before conception.


Assuntos
Saúde do Lactente , Estado Nutricional , Criança , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Cuidado Pré-Natal
5.
PLoS One ; 17(4): e0267357, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476806

RESUMO

BACKGROUND: It has been shown that small intestine development in low birth weight (LBW) piglets is impaired. Glutamine (Gln) has been reported to improve piglet health and intestinal function in weaned piglets, but data is scarce in suckling piglets. This study was conducted to investigate the effects of oral Gln supplementation compared to Alanine (Ala) on jejunal development and function in 5 and 12 d old male LBW and normal birth weight (NBW) suckling piglets. RESULTS: Gln had no effect on the jejunal morphology, development, tissue and digesta amino acid profiles and mRNA abundance of genes involved in amino acid transport, metabolism, glutathione synthesis in LBW piglets when compared to Ala supplementation and birth weight controls at 5 and 12 d. Only the concentration of Gln in jejunal tissue was higher in NBW piglets supplemented with Gln compared to Ala at 5 d (P < 0.05). A comparison of the birth weight groups showed no differences between LBW and NBW piglets at 5 and 12 d in any parameter. Jejunal crypt depth, villus height / width, tunica muscularis thickness, number of goblet and IgA positive cells, the ratio of jejunal RNA to DNA and the concentration of DNA, protein and RNA changed (P < 0.05) from 5 compared to 12 d. The concentrations of several free, and protein bound amino acids as well as amino metabolites differed between age groups in jejunal tissue but the digesta concentrations were affected to a lesser extent. CONCLUSIONS: Oral Gln supplementation to suckling male piglets over the first 12 d of life was not associated with changes in jejunal parameters measured in this study. The absence of effects may indicate that Gln is absorbed as well as metabolized in the upper intestinal tract and thus could benefit intestinal development at a more proximal location.


Assuntos
Aminoácidos , Glutamina , Animais , Peso ao Nascer , Suplementos Nutricionais , Glutamina/farmacologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , RNA Mensageiro/genética , Suínos
6.
BMC Public Health ; 22(1): 829, 2022 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-35468779

RESUMO

BACKGROUND: Comparing health inequalities between countries helps us to highlight some factors specific to each context that contribute to these inequalities, thus contributing to the identification of courses of action likely to reduce them. This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal (in general population, natives-born mothers, and immigrant mothers). METHODS: A population-based study examining associations between SES and pregnancy outcomes was conducted in each city, using administrative databases from Belgian and Quebec birth records (N = 97,844 and 214,620 births in Brussels and Montreal, respectively). Logistic regression models were developed in order to estimate the relationship between SES (maternal education and income quintile) and pregnancy outcomes, in each region. The analyses were first carried out for all births, then stratified according to the mother's origin. RESULTS: For the general population, SES is associated with LBW and preterm birth in both regions, except for income and preterm birth in Brussels. The association is stronger for mothers born in Belgium and Canada than for those born abroad. The main difference between the two regions concerns the magnitude of inequalities in perintal health, which is greater in Montreal than in Brussels among the general population. For native-born mothers, the magnitude of inequalities in perinatal health is also greater for mothers born in Canada than for those born in Belgium, except for the association between income and preterm birth. The socioeconomic gradient in perinatal health is less marked among immigrant mothers than native mothers. CONCLUSION: Significant differences in inequalities in perinatal health are observed between Brussels and Montreal. These differences can be explained by : on the one hand, the existence of greater social inequalities in Montreal than in Brussels and, on the other hand, the lower vulnerability of immigrants with low SES in Brussels. Future studies seeking to understand the mechanisms that lead to inequalities in health in different contexts should take into account a comparison of immigration and poverty contexts, as well as the public policies related to these factors.


Assuntos
Nascimento Prematuro , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Parto , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Classe Social
7.
Rev Paul Pediatr ; 40: e2020416, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35442267

RESUMO

OBJECTIVE: To assess different ways of caring for preterm infants' development and for their families in neonatal units, with emphasis on the studies by André Bullinger. DATA SOURCE: A review of the literature in the databases PubMed, SciELO, and the Cairn.info portal, which publishes reviews in human sciences in French. Also, the books and articles of André Bullinger, available only in French, were reviewed. DATA SYNTHESIS: This review includes the Kangaroo Method, which is based on skin to skin contact and the encouragement of breastfeeding; the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synaptic Developmental Theory and aiming to positively change the neonatal environment, having the preterm newborn as the actor of their own development and the mother as a regulator; and the Bullinger Approach, which uses a sensory-motor perspective to approach child development, including preterm infants' development. CONCLUSIONS: The Kangaroo Method has changed child developmental care in countries with limited financial resources. NIDCAP was shown to be efficient, although only a few long-term studies have been conducted on the subject. The Bullinger Approach is well diffused in European neonatal units, with promising results for the prevention of neurodevelopmental disabilities, especially those related to orality.


Assuntos
Doenças do Prematuro , Método Canguru , Aleitamento Materno , Criança , Desenvolvimento Infantil , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal
8.
Midwifery ; 109: 103332, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35397257

RESUMO

OBJECTIVE: To explore the maternal and neonatal factors associated with premature birth and low birth weight in an Ecuadorian tertiary hospital. DESIGN: Cross-sectional study. SETTING: The Calderón General Teaching Hospital (CGTH). Maternal and delivery characteristics were obtained from medical records. PARTICIPANTS: All live births from April 2017 to October 2020 were considered as the source population. FINDINGS: The study included 13,407 reported births. The proportion of low birth weight neonates was 12.4%. The frequencies of neonates with gestational ages of less than 34 and from 34 to 37 weeks were 1.8% and 8.8%, respectively. According to INTERGROWTH-21st standards, 14% and 5.5% of the neonates were classified as small- (<10th centile) and large-for-gestational-age (>90th centile), respectively. A higher proportion of low birth weight was observed among newborns of illiterate mothers, younger mothers, and with gestational hypertension. The proportion of small-for-gestational-age infants was lower among younger mothers, while large-for-gestational-age infants were more frequent among older mothers. Maternal obesity (proportion ratio [PR] 2.80, 95%CI 1.69 - 4.64), and gestational diabetes (PR 3.24, 95%CI 2.12 - 4.96) were associated with an increased percentage of large-for-gestational-age births. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The proportion of low birth weight in Calderón General Teaching Hospital is large compared to those found in studies conducted in Latin America, and the preterm birth rate is close to that estimated in less developed countries. Despite the advances in maternal and child health observed in Ecuador, the present study shows that interventions are still needed in this population.


Assuntos
Doenças do Recém-Nascido , Nascimento Prematuro , Criança , Estudos Transversais , Equador/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Centros de Atenção Terciária
9.
Pan Afr Med J ; 41: 82, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432694

RESUMO

Preeclampsia is a pregnancy-specific multisystem disorder that is a leading cause of maternal and foetal/neonatal morbidity and mortality. Thus this systematic review aims to identify the neonatal outcomes of preeclamptic patients. A systematic literature review of works published between January 2015 and March 2021 written in the English language and freely accessed online were used considering the PRISMA guidelines. The results from the search were managed using the endnote X7 software and extracted data from the full articles were documented in Microsoft Word. The neonatal outcomes of preeclampsia identified are; preterm birth, stillbirth, low birth weight (LBW), low Apgar score, intrauterine growth reduction (IUGR), neonatal intensive care unit (NICU) admission are foetal/neonatal outcomes of preeclampsia and were subsequently classified into six groups according to the similarities of their outcome; group 1: death related neonatal outcomes, group 2: weight-related neonatal outcomes, group 3: prematurity related neonatal outcomes, group 4: respiratory related neonatal outcomes, group 5: injury-related neonatal outcomes, and Group 6: internal organ related outcome. The magnitude of occurrence of the classified neonatal outcomes is; respiratory-related neonatal outcome, death-related neonatal outcome, weight-related neonatal outcome, prematurity related neonatal outcome, internal related neonatal outcome and injury-related outcome in that sequence. All round interventions to improve neonatal morbidity and mortality of preeclamptic mothers should be targeted in addition to adequate provision of health/ medical resources for the tending of preterm neonates.


Assuntos
Doenças do Recém-Nascido , Doenças do Prematuro , Pré-Eclâmpsia , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia
10.
BMC Pregnancy Childbirth ; 22(1): 283, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382792

RESUMO

BACKGROUND: Low birth weight (LBW) remains a major health problem that affects newborns worldwide. However, there has been growing evidence that antenatal care (ANC) is associated with LBW. Yet, there is a dearth of research investigating the association between ANC attendance and LBW in sub-Saharan Africa (SSA). This study examined the association between the number of ANC visits and LBW using data from 10 sub-Saharan African countries. METHODS: This study pooled data from the recent Demographic and Health Survey (DHS) of 10 sub-Saharan African countries conducted from 2018 to 2020. A total of 33,585 women aged 15-49 who had live births in the five years preceding the survey were included in this study. Bivariable and multivariable multilevel regression models were fitted to show the association between the number of ANC visits and LBW. Crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs) were used in presenting the results of the regression analysis. RESULTS: The pooled prevalence of LBW was 5.7%. The highest prevalence of LBW was recorded in Gambia (7.2%) with the lowest found in Sierra Leone (2.9%). In terms of eight or more ANC visits, the overall prevalence was 14.5%. Nigeria had the highest prevalence of eight or more ANC visits (43.5%) with the lowest in Rwanda (0.2%). We found a statistically significant association between the number of ANC visits and LBW. Mothers who had eight or more ANC visits were less likely to have LBW children compared to mothers who had less than eight ANC visits [cOR = 0.66; CI = 0.55 - 0.79] and this persisted after controlling for the covariates [aOR = 0.68; CI = 0.56 - 0.82]. Covariates associated with LBW were maternal age, marital status, level of education, age of child, and wealth index. CONCLUSION: This study has shown a statistically significant association between ANC and LBW in SSA, with women who had eight or more ANC visits being at lower risks of giving birth to children with LBW. We found that eight or more ANC attendance was a protective factor against LBW in SSA. Therefore, it is important for sub-Saharan African countries with low prevalence of eight or more ANC attendance and high LBW prevalence to channel their efforts towards promoting more ANC attendance.


Assuntos
Recém-Nascido de Baixo Peso , Cuidado Pré-Natal , Adolescente , Adulto , África ao Sul do Saara/epidemiologia , Criança , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Mães , Parto , Gravidez , Adulto Jovem
11.
PLoS One ; 17(4): e0266796, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35395061

RESUMO

OBJECTIVE: The study evaluated the socio-demographic characteristics, obstetric variables and foeto-maternal complications associated with low birth weight (LBW) in order to provide better treatment and management options. METHODS: The prospective study conducted from February, 2019 to June, 2020 recruited 312 primigravid pregnant women who reported for antenatal care in three tertiary referral hospitals in northern Ghana. Their socio-demographic, obstetric and adverse foeto-maternal outcome information were obtained with a well-structured questionnaire according to the World Health Organisation (WHO) guidelines. Participants' blood samples were collected for haematological tests. Odds ratio [OR, 95% confidence interval (CI)] for the association between socio-demographic, obstetric characteristics, foeto-maternal complications and haematological tests in relation to LBW were assessed using logistic regression model. RESULTS: This study reported a LBW prevalence of 13.5%. Increasing maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 1st visit, before and after delivery significantly increased the odds of LBW. Preterm delivery (PTD<37 weeks) (COR = 9.92, 95% CI (4.87-2020), p<0.001), preeclampsia (PE) (COR = 5.94, 95% CI (2.96-11.94), p<0.001), blood transfusion (COR = 14.11, 95% CI (2.50-79.65), p = 0.003), caesarian delivery (COR = 3.86, 95% CI (1.96-7.58), p<0.001) and male sex neonates (COR = 2.25, 95%CI (1.14-4.47), P = 0.020) presented with increased odds of LBW. Increasing gestational age at delivery presented with 28% reduced odds of LBW (COR = 0.72, 95% CI (1.12-4.40), P = 0.023). Upon controlling for potential confounders in multivariate logistic regression, only gestational age at delivery (AOR = 0.67, 95% CI (0.47-0.96), P = 0.030) remained significantly associated with reduced odds of LBW. CONCLUSION: This study found that high blood pressure at 1st visit, before and after delivery results in increased chances of delivering a baby with LBW. Furthermore, PTD<37 weeks, having PE in current pregnancy, and male sex potentiate the risk of LBW. On the other hand, increasing gestational age reduces the risk of LBW. Thus, we recommend that midwives should intensify education to pregnant women on the benefits of regular ANC visits to aid in the early detection of adverse foeto-maternal complications. We also recommend proper clinical management of pregnancies associated with an elevated blood pressure at registration. Also, maternal intrapartum blood pressure measurement could be used to predict LBW in low resourced settings.


Assuntos
Hipertensão , Pré-Eclâmpsia , Nascimento Prematuro , Peso ao Nascer , Feminino , Gana/epidemiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Gravidez , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal , Estudos Prospectivos , Fatores de Risco
13.
BMC Pediatr ; 22(1): 174, 2022 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-35366829

RESUMO

BACKGROUND: Although many studies have described an increased risk of necrotizing enterocolitis in duct dependent congenital heart diseases, very few have investigated its occurrence in full-term infants with duct dependent congenital heart diseases. METHODS: To evaluate the characteristics and risk factors of necrotizing enterocolitis, we performed a retrospective review of 355 full-term infants with duct dependent congenital heart diseases who received prostaglandin E1 therapy from April 2000 to May 2020. RESULTS: Necrotizing enterocolitis was observed in 10 patients (3.0%). Their average gestational age and birth weight were 38.2 weeks and 2783.5 g, respectively. The median age at diagnosis was 8.0 days (2-70 days). One patient was diagnosed with necrotizing enterocolitis stage IIA, five with stage IIB, two with stage IIIA, and two with stage IIIB; two (20%) received surgical treatment. The duct dependent pulmonary circulation group had higher frequencies of necrotizing enterocolitis (4.4%) than the duct dependent systemic circulation (2.0%) and parallel circulation (1.3%) groups. The necrotizing enterocolitis and the other groups had significantly different birth weight (2783.5 g vs 3170.9 g, respectively) and gestational age (38.2 weeks vs 39.1 weeks, respectively). Gestational age under 38 weeks (OR 8.87, p = 0.002), birth weight of < 2500 g (OR 5.1, p = 0.042), need for mechanical ventilation (OR 4.6, p = 0.021), parenteral nutrition (OR 107.7, p < 0.001), and functional single ventricle (OR 5.8, p = 0.009) were significant risk factors. The case-fatality rate was higher in the necrotizing enterocolitis (40.0%) than in the other group (8.3%, p = 0.009). CONCLUSIONS: Three percent of full-term infants with duct dependent congenital heart diseases developed necrotizing enterocolitis. Neonates with low birth weight, gestational age less than 38 weeks, functional single ventricle, or receiving assisted mechanical ventilation or parenteral nutrition are at increased risk.


Assuntos
Enterocolite Necrosante , Cardiopatias Congênitas , Doenças do Recém-Nascido , Peso ao Nascer , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/etiologia , Enterocolite Necrosante/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido
14.
Artigo em Inglês | MEDLINE | ID: mdl-35409434

RESUMO

BACKGROUND: The prevalence of low birth weight (LBW) is a major public health issue in India; however, the optimal growth pattern for such infants is not clear. The purpose of this study is to understand the causal association between LBW and stunting of preschool children in India. METHODS: The National Family Health Survey-4 is a large cross-sectional survey based on a nationally representative sample of 699,686 women in the age group of 15-49 years and was conducted during 2015-2016 in India. The study used the children's file with a sample of 259,002 of 0-59 months for investigation. RESULTS: The data revealed that 38.7% of the children in India were stunted. The bivariate analysis revealed that, of the women who did not attend any antenatal care (ANC) meetings, 46.8% had stunted children compared to the women who attended more than three ANC meetings, which 30.7% had stunted children. The low birth weight children experienced a much higher chance of stunting compared to children with a normal birth weight (44.3% vs. 33.8%). The multivariable odds ratios of logistic regression, after adjusting for the confounding characteristics, showed that pregnant women attending more than three ANC meetings compared to not attending any ANC meetings experienced a 19% lower adjusted odds ratio (AOR) of having stunted children (AOR = 0.81; CI 0.78, 0.85; p < 0.001). Another important variable, such as women with underweight body mass index (BMI) compared with normal BMI, had 6% higher odds of having stunted children (AOR = 1.06; CI 1.03, 1.10; p < 0.001). Similarly, women who belong to the Scheduled Caste compared to the General Caste had 36% higher odds of having stunted children (AOR = 1.36; CI 1.30, 1.42; p < 0.001); and children aged 13-23 months compared to children up to one-year-old or younger had 141% higher odds of being stunted (AOR = 2.41; CI 2.32, 2.51; p < 0.001). The conspicuous finding is that LBW babies, after adjusting for other important confounding factors, such as BMI and ANC, experienced 19% higher odds of stunted children (AOR = 1.19; CI 1.14, 1.24; p < 0.001) compared to normal birth weight babies. CONCLUSIONS: The results revealed LBW is associated with stunting of preschool children in India.


Assuntos
Transtornos do Crescimento , Recém-Nascido de Baixo Peso , Adolescente , Adulto , Peso ao Nascer , Pré-Escolar , Estudos Transversais , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Adulto Jovem
15.
BMJ Open ; 12(4): e055467, 2022 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-35473727

RESUMO

OBJECTIVES: To examine whether the risk of cardiovascular disease (CVD) in women with pre-eclampsia is modified by very low or very high offspring birth weight. Further, we studied whether diabetes in pregnancy modified this risk. DESIGN: Nationwide cohort study. SETTING: Norwegian population registries. PARTICIPANTS: 618 644 women who gave birth to their first child during 1980-2009. METHODS: The women were followed from delivery until the development of CVD or censoring, by linkage of the Medical Birth Registry of Norway to the Cardiovascular Disease in Norway project, and the Norwegian Cause of Death Registry. PRIMARY OUTCOME MEASURE: CVD. RESULTS: Compared with normotensive women with normal offspring birth weight, women with pre-eclampsia had increased risk of CVD (HR 2.16; 95% CI 2.05 to 2.26). The CVD risk was even higher when pre-eclampsia was accompanied with a large for gestational age offspring (LGA, z-score >2.0) (HR 2.57; 95% CI 2.08 to 3.18). Women with pre-eclampsia and a small for gestational age offspring (SGA, z-score <-2.0) had an HR of 1.54 (95% CI 1.23 to 1.93) compared with normotensive women with normal offspring birth weight.Also, women with diabetes had increased CVD risk, but no additional risk associated with an LGA or SGA offspring. CONCLUSIONS: Women with pre-eclampsia and an LGA offspring had higher risk of CVD than pre-eclamptic women with a normal weight (z-score -2.0 to 2.0) or SGA offspring. These findings suggest that factors causing pre-eclampsia and an LGA offspring are also linked to development of CVD.


Assuntos
Doenças Cardiovasculares , Recém-Nascido de Baixo Peso , Recém-Nascido de muito Baixo Peso , Pré-Eclâmpsia , Complicações Cardiovasculares na Gravidez , Peso ao Nascer , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Fatores de Risco
16.
Occup Environ Med ; 79(5): 333-338, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35228261

RESUMO

OBJECTIVES: We aimed to investigate the association between type of cooking biomass fuels (crop residues vs fuelwood) and newborn birth outcomes in Bangladeshi children. METHODS: In this birth cohort study, pregnant women who were 18 years or older with ultrasound confirmed singleton pregnancy of ≤16 weeks of gestation were enrolled from two Bangladesh clinics between January 2008 and June 2011. Exposure to cooking biomass fuels during pregnancy was assessed by an administered questionnaire. The newborn size metrics were measured at the time of delivery. We used multiple linear regression and logistic regression to assess the associations between the type of cooking biomass fuels and birth outcomes after adjusting for covariates. RESULTS: A total of 1137 participants were using biomass fuels, including crop residues (30.3%) and fuelwood (69.7%), respectively, for cooking. After adjusting for covariates, the use of crop residues for cooking was associated with a 0.13 SD decrease in birth length (95% CI 0.25 to -0.01), a 0.14 SD decrease in head circumference (95% CI -0.27 to -0.02), and increased risk of low birth weight (LBW, OR 1.52, 95% CI 1.07 to 2.15) compared with the use of fuelwood. CONCLUSION: The use of crop residues for cooking was associated with reduced birth size and increased risk for LBW in Bangladeshi children, implying that the use of crop residues during pregnancy may have a detrimental effect on fetal growth.


Assuntos
Poluição do Ar em Ambientes Fechados , Poluição do Ar em Ambientes Fechados/análise , Bangladesh/epidemiologia , Criança , Estudos de Coortes , Culinária , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez
17.
Wei Sheng Yan Jiu ; 51(1): 68-79, 2022 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-35341504

RESUMO

OBJECTIVE: To explore the associations between birth outcomes and blood pressure, and study the sex dimorphism of these associations. METHODS: With a multistage cluster random sampling method, 62 168 children were recruited in seven provinces of China in September of 2013, with 32 064 boys and 30 104 girls, median age of 10.74 years and mean birth weight of 3.3 kg, 49 843 single birth(97%), 1339 twin(2.6%), 180 triplet or more(0.4%). Questionnaire investigation and physical examination were conducted in the present study. Weight, height and blood pressure were measured in the physical examination. Demographic characteristics, birth outcomes(including birth weight and number of births), dietary behavior, physical activities were measured by questionnaire. The widely used age-, gender-and height-specific high blood pressure standard developed by American CDC was used for the present study. Multivariate linear and logistic regression analysis were conducted to study the associations between birth outcomes and blood pressure level or high blood pressure(HBP), and also sex dimorphism of these associations was explored. RESULTS: A total of 5933 children were categorized as having high blood pressure in the 62 168 participants(9.5%). With stratified analyses by birth weight category, only in the low-birth-weight strata birth weight was significantly inversely associated with systolic blood pressure(SBP) and diastolic blood pressure(DBP) with potential covariates adjusted(SBP: b=-1.628, 95%CI-2.571--0.685, P=0.001; DBP: b=-1.463, 95%CI-2.186--0.740, P<0.001). While compared with the non-low birth weight children, low birth weight was not associated with higher risk of HBP(P>0.05). Compared with those boys born as singleton, boys born as one of the twins have a 36.4% higher risk of HBP(OR=1.364, 95%CI 1.049-1.774), while in girls no such significant association was found. Additionally, compared with a term birth, overdue birth and preterm birth was not associated with higher risk of HBP(P>0.05). CONCLUSION: Birth weight and singleton or not were associated with childhood blood pressure levels and higher risk of high blood pressure, and some associations were sex specific. Gender differences should be paid attention to in the prevention and control of high blood pressure in children and adolescents in the future, and the prevention and control should be focused on low-birth weight children or twin boys.


Assuntos
Hipertensão , Adolescente , Peso ao Nascer/fisiologia , Pressão Sanguínea/fisiologia , Estatura , Criança , Feminino , Humanos , Hipertensão/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Estados Unidos
18.
JAMA Ophthalmol ; 140(4): 401-409, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35297945

RESUMO

Importance: Artificial intelligence (AI)-based retinopathy of prematurity (ROP) screening may improve ROP care, but its cost-effectiveness is unknown. Objective: To evaluate the relative cost-effectiveness of autonomous and assistive AI-based ROP screening compared with telemedicine and ophthalmoscopic screening over a range of estimated probabilities, costs, and outcomes. Design, Setting, and Participants: A cost-effectiveness analysis of AI ROP screening compared with ophthalmoscopy and telemedicine via economic modeling was conducted. Decision trees created and analyzed modeled outcomes and costs of 4 possible ROP screening strategies: ophthalmoscopy, telemedicine, assistive AI with telemedicine review, and autonomous AI with only positive screen results reviewed. A theoretical cohort of infants requiring ROP screening in the United States each year was analyzed. Main Outcomes and Measures: Screening and treatment costs were based on Current Procedural Terminology codes and included estimated opportunity costs for physicians. Outcomes were based on the Early Treatment of ROP study, defined as timely treatment, late treatment, or correctly untreated. Incremental cost-effectiveness ratios were calculated at a willingness-to-pay threshold of $100 000. One-way and probabilistic sensitivity analyses were performed comparing AI strategies to telemedicine and ophthalmoscopy to evaluate the cost-effectiveness across a range of assumptions. In a secondary analysis, the modeling was repeated and assumed a higher sensitivity for detection of severe ROP using AI compared with ophthalmoscopy. Results: This theoretical cohort included 52 000 infants born 30 weeks' gestation or earlier or weighed 1500 g or less at birth. Autonomous AI was as effective and less costly than any other screening strategy. AI-based ROP screening was cost-effective up to $7 for assistive and $34 for autonomous screening compared with telemedicine and $64 and $91 compared with ophthalmoscopy in the primary analysis. In the probabilistic sensitivity analysis, autonomous AI screening was more than 60% likely to be cost-effective at all willingness-to-pay levels vs other modalities. In a second simulated cohort with 99% sensitivity for AI, the number of late treatments for ROP decreased from 265 when ROP screening was performed with ophthalmoscopy to 40 using autonomous AI. Conclusions and Relevance: AI-based screening for ROP may be more cost-effective than telemedicine and ophthalmoscopy, depending on the added cost of AI and the relative performance of AI vs human examiners detecting severe ROP. As AI-based screening for ROP is commercialized, care must be given to appropriately price the technology to ensure its benefits are fully realized.


Assuntos
Retinopatia da Prematuridade , Telemedicina , Inteligência Artificial , Análise Custo-Benefício , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Triagem Neonatal/métodos , Oftalmoscopia/métodos , Retinopatia da Prematuridade/diagnóstico , Telemedicina/métodos
20.
PLoS One ; 17(3): e0264816, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35245309

RESUMO

INTRODUCTION: Birth asphyxia is a prominent and avoidable cause of infant illness and death worldwide, particularly in underdeveloped countries such as Ethiopia. Early identification and control of the underlying contributory factors would help to alleviate the situation. As a result, the goal of this study was to assess the magnitude and determinants of neonatal asphyxia among live newborns at the northern Gondar public Hospitals in northwest Ethiopia. MATERIALS AND METHODS: From April 1 to May 2, 2020, 357 newborns were studied in an institution-based cross-sectional study. The sample size was proportionally distributed among three public hospitals, namely Gondar referral teaching hospital, Debark general hospital, and Kola-Diba District Hospital, which was chosen at random. The number of deliveries given at each hospital six months prior to the data collecting period was used to allocate the hospitals. To get all participants, a systematic random sampling approach was adopted based on hospital delivery registration. The physicians' evaluation of an APGAR score of 7 in the first and fifth minutes of birth was used as the confirmation of birth asphyxia. Data was collected using a standardized and pretested questionnaire. Variables having p-values less than 0.25 were entered into a multivariable logistic regression analysis in the bivariable analysis. At a p-value of 0.05, a statistically significant level was reported. RESULTS: As per the study, the total prevalence of neonatal asphyxia was found to be 27.1 (95% CI: 21.4, 32.7). In a multivariable logistic regression analysis, neonates born to rural mothers (AOR = 2.441, 95% CI: 1.137, 5.241), primiparity (AOR = 5.521 95%CI: 1.691, 8.026), premature rupture of membrane, (AOR = 3.202, 95% CI: 1.484, 6.909) and low birth weight (< 2.5kg) (AOR = 3.706, 95%CI: 3.307, 4.152) were all found to be independent predictors of birth asphyxia. CONCLUSION: This study identified that rural residence, primiparity, premature rupture of membrane, and birth weight were found to be the independent predictors of birth asphyxia. The majority of variables that cause birth asphyxia can be controlled.


Assuntos
Asfixia Neonatal , Asfixia , Asfixia Neonatal/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Públicos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Gravidez
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