BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
Preterm birth(PTB),defined as delivery before 37 weeks of gestation,is the most common adverse pregnancy outcome[1].PTB is a global health concern,with an estimated 13.4 million cases in 2020[1],accounting for more th...Preterm birth(PTB),defined as delivery before 37 weeks of gestation,is the most common adverse pregnancy outcome[1].PTB is a global health concern,with an estimated 13.4 million cases in 2020[1],accounting for more than one in 10 births worldwide.Compared to full-term births,PTBs are associated with a higher risk of short-and long-term complications,including bronchopulmonary dysplasia,necrotizing enterocolitis,visual impairment,and cerebral injuries[2].Despite substantial research efforts to prevent PTB,the global PTB rate has shown little improvement over the past decade[1].Therefore,identifying additional risk factors remains a critical goal in preventing PTB.展开更多
Objective:To investigate the dynamic trajectory,predictors,and underlying adaptation mechanisms of family resilience(FR)among Chinese families with preterm infants(PIs)from birth to six months.Methods:Guided by Ecolog...Objective:To investigate the dynamic trajectory,predictors,and underlying adaptation mechanisms of family resilience(FR)among Chinese families with preterm infants(PIs)from birth to six months.Methods:Guided by Ecological Systems Theory,a convergent parallel mixed-methods study was conducted in the Neonatal Intensive Care Unit(NICU)of a tertiary hospital in Fujian Province,China,from June 2023 to June 2024.Quantitative data were collected from 202 caregivers selected by convenience sampling at four time points:at birth(T0),42 days postpartum(T1),3 months postpartum(T2),and 6 months postpartum(T3).Generalized Estimating Equations(GEE)was used to analyze scale score differences across time points and explore factors influencing FR.Qualitative data were collected through semi-structured interviews with 14 caregivers recruited by maximum variation purposive sampling and analyzed using Colaizzi’s phenomenological approach.After conducting separate data analyses,the findings were integrated through side-by-side comparison and joint display.Results:Quantitative results revealed a non-linear,“V”-shaped trajectory of FR,significantly influenced by educational level,conception via assisted reproduction,farming occupation,coping style,psychological resilience,family functioning,and social support.Qualitative findings identified four themes:initial uncertainty and emotional distress,post-discharge anxiety,gradual adaptation,and eventual stabilization.Integrated mixed-methods findings revealed that the initial confusion phase demands a comprehensive response to family needs(T0);the post-discharge bottleneck requires addressing the care capability-needs gap(T1);the role adaptation phase is pivotal for enhancing internal family resources(T2);and the family-work transition necessitates enhanced work-family facilitation(T3).Conclusions:This study systematically identifies the unique“V”-shaped trajectory of FR in Chinese families with PIs and its key influencing factors,and accurately analyzes their dynamic experiences and adaptation across four stages.These findings provide an empirical basis for stage-specific targeted interventions,strongly support the practical advancement of the family-centered care model,and deliver critical guidance for enhancing FR.展开更多
The association of copper(Cu)with preterm birth(PTB)and its subtypes,spontaneous preterm birth(SPB)and iatrogenic preterm birth(IPB),are still unclear.In addition,previous studies suggested that serum lipid was associ...The association of copper(Cu)with preterm birth(PTB)and its subtypes,spontaneous preterm birth(SPB)and iatrogenic preterm birth(IPB),are still unclear.In addition,previous studies suggested that serum lipid was associated with both Cu and PTB.Therefore,we explored the association of blood Cu in the first trimester with the risk of PTB and its subtypes,as well as the potential mediating effect of serum lipid using a nested case-control study.The concentrations of Cu in the serum and blood cells,and serum lipids in the first trimester were measured.The concentration of Cu in whole blood was calculated based on hematocrit.Compared to the lowest tertile of Cu concentrations in the first trimester,the highest tertile of Cu significantly increased the risk of SPB with adjusted odds ratios(AORs)of 2.75(95% confidence interval(CI):1.41-5.34)for serum and 3.75(95% CI:1.21-11.60)for whole blood,and significantly increased the risk of IPB with AORs of 3.25(95%CI:1.06-9.94)for blood cells.According to the mediation analysis,the indirect effect of triglyceride(β=0.016,95%CI:0.0002-0.042)was the only significant effect in the association between Cu and SPB,with the mediating proportion of 9.8%(95%CI:0.2%-33.4%).It suggested that a high level of serum Cu may be associated with an increased risk of SPB with a possible mediator of serum triglyceride,and a high level of blood cell Cu may be associated with an increased risk of IPB.展开更多
Preterm birth remains a leading cause of neonatal complications and highlights the need for early and accurate prediction techniques to improve both fetal and maternal health outcomes.This study introduces a hybrid ap...Preterm birth remains a leading cause of neonatal complications and highlights the need for early and accurate prediction techniques to improve both fetal and maternal health outcomes.This study introduces a hybrid approach integrating Long Short-Term Memory(LSTM)networks with the Hybrid Greylag Goose and Particle Swarm Optimization(GGPSO)algorithm to optimize preterm birth classification using Electrohysterogram signals.The dataset consists of 58 samples of 1000-second-long Electrohysterogram recordings,capturing key physiological features such as contraction patterns,entropy,and statistical variations.Statistical analysis and feature selection methods are applied to identify the most relevant predictors and enhance model interpretability.LSTM networks effectively capture temporal patterns in uterine activity,while the GGPSO algorithm finetunes hyperparameters,mitigating overfitting and improving classification accuracy.The proposed GGPSO-optimized LSTM model achieved superior performance with 97.34%accuracy,96.91%sensitivity,97.74%specificity,and 97.23%F-score,significantly outperforming traditional machine learning approaches and demonstrating the effectiveness of hybrid metaheuristic optimization in enhancing deep learning models for clinical applications.By combining deep learning withmetaheuristic optimization,this study contributes to advancing intelligent auto-diagnosis systems,facilitating early detection of pretermbirth risks and timely medical interventions.展开更多
BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preven...BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preventing respiratory distress syndrome.Ongoing research on antenatal corticosteroids(ACS)is continuously refining the evidence regarding their efficacy and potential side effects,which may alter the application of this treatment.Recent findings indicate that in resource-limited settings,the effectiveness of ACS is contingent upon meeting specific conditions,including providing adequate medical support for preterm newborns.Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low-and middle-income countries.AIM To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan,following current World Health Organization guidelines.METHODS This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024.A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed,focusing on the completeness of the ACS received.Quantitative variables are presented as means with standard deviations,while frequency analysis of qualitative indicators was performed using Pearson'sχ^(2) test(χ^(2))and Fisher's exact test.If statistical significance was identified,pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.RESULTS The obtained data indicate that the complete implementation of antenatal steroid prophylaxis(ASP)improves neonatal outcomes,particularly by reducing the frequency of birth asphyxia(P=0.002),the need for primary resuscitation(P=0.002),the use of nasal continuous positive airway pressure(P=0.022),and the need for surfactant replacement therapy(P=0.038)compared to groups with incomplete or no ASP.Furthermore,complete ASP contributed to a decrease in morbidity among preterm newborns(e.g.,respiratory distress syndrome,intrauterine pneumonia,cerebral ischemia,bronchopulmonary dysplasia,etc.),improved Apgar scores,and reduced the need for re-intubation and the frequency of mechanical ventilation.However,it was associated with an increased incidence of uterine atony in postpartum women(P=0.0095).CONCLUSION In a tertiary hospital setting,the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions.This,in turn,contributes to better outcomes for this cohort of children.However,the impact of ACS on maternal outcomes requires further thorough investigation.展开更多
Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in ...Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.展开更多
BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital...BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.展开更多
Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB)...Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.展开更多
BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher ...BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.展开更多
Background: Preterm birth is a primary cause of neonatal morbidity and mortality especially in low-income countries. Although understanding the preventable factors of neonatal deaths in preterm infants is required for...Background: Preterm birth is a primary cause of neonatal morbidity and mortality especially in low-income countries. Although understanding the preventable factors of neonatal deaths in preterm infants is required for timely interventions, data on those factors is lacking in Kenya. We attempted to determine mortality and its associated factors in preterm babies in Kenya. Methods and Materials: A hospital-based, prospective study was implemented from July 2019 to October 2019 involving 163 preterm neonates and their mothers admitted at Kenyatta National Hospital. A systematic random sampling method was used to recruit the study participants. Data on mortality and the associated factors in preterm neonates were collected using a pretested questionnaire for mothers and neonatal medical records. Data was analyzed using descriptive and inferential statistics. Results: The mortality rate was 18.4%. Of the neonates who died, respiratory distress syndrome (63.3%) and neonatal sepsis (20.0%) were documented as the primary causes. Neonates born of single mother (AOR = 8.006, 95% CI 2.267 to 28.272, p = 0.001), unemployed (6.960, 1.059 - 45.757, p = 0.043), self-employed (4.040, 1.067 - 15.302, p = 0.040), anemic (7.465, 2.530 - 22.023, p < 0.001) and with history of bleeding during pregnancy were more likely to have died. The neonates born before 28 weeks of gestation (126.188, 14.554 - 1094.060, p < 0.001), those who did not cry immediately at birth (54.271, 5.970 - 493.395, p < 0.001) and the resuscitated at birth (54.406, 6.807 - 434.851, p < 0.001) were likely to die. Conclusion: High mortality rates of preterm neonates are attributed to both maternal and neonatal factors. Focused antenatal care should aim at early identification of high-risk mothers for early management of bleeding during pregnancy, close monitoring of nutritional status for mothers and health education.展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Prematurity is a public health problem in Brazil, ...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Prematurity is a public health problem in Brazil, with 12% of deliveries occurring before 37 weeks of gestation. The measurement of the cervix in the second trimester is already established as a method of screening for prematurity and some studies point out advantages to start this screening in the first trimester. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To define the correlation between the length of the endocervix by transvaginal ultrasound in the first trimester (11 to 14 weeks) with spontaneous early deliveries. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> A prospective and observational study realized in a suplementar and private ultrasound clinic and hospital of Porto Alegre, Brazil between 2019-2020. Ultrasound screening of cervix was performed in singleton pregnancies in first and second trimester of pregnancy and correlated with age of delivery. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 142 pregnant women were studied, 80% were in the first pregnancy. The average age was 33.8 years. The rate of prematurity was 18% before 37 weeks and 4% before 34 weeks. The average of cervix measured in the first and second trimesters in deliveries before 34 weeks was 32.7 mm and 29.3 mm, respectively. In term deliveries the median cervical length was 38.8 mm and 37.8 mm, respectively. When analyzing the measurements of the cervix in the second trimester, the cervix was smaller (p = 0.008) among deliveries below 34 weeks (29</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: In this study, we did not observe a statistically significant relationship between first trimester cervix measurement and prematurity. More studies are needed to evaluate this finding. However, the measurement of the cervix in the second trimester is different from that found in the literature. This suggest</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.</span></span></span>展开更多
There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of ...There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.展开更多
Objective To investigate the relation between air pollution exposure and preterm birth in Shanghai, China. Methods We examined the effect of ambient air pollution on preterm birth using time-series approach in Shangha...Objective To investigate the relation between air pollution exposure and preterm birth in Shanghai, China. Methods We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model （GAM） with penalized splines to analyze the relation between preterm birth, air pollution, and covariates. Results We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 μg/m^3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% （95%CI 1.60%, 7.25%）, 11.89% （95%CI 6.69%, 17.09%）, 5.43% （95%CI 1.78%, 9.08%）, and 4.63% （95%CI 0.35%, 8.91%） increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth. Conclusion Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.展开更多
Background: The Readiness for Hospital Discharge Scale (RHDS)-Parent Form shows satisfactory reli-ability and validity to assess the readiness of parents to take care of their children discharged from hospitals in Wes...Background: The Readiness for Hospital Discharge Scale (RHDS)-Parent Form shows satisfactory reli-ability and validity to assess the readiness of parents to take care of their children discharged from hospitals in Western countries. However, the reliability and validity of this instrument has not been evaluated in Chinese populations.Objectives: Evaluate the psychometric features of the RHDS-Parent Form among Chinese parents of preterm infants. Methods: The RHDS-Parent Form was translated into a Chinese version following an international in-strument translation guideline. A total of 168 parents with preterm infants were recruited from the neonatal intensive care units of two tertiary-level hospitals in China. The internal consistency of this measure was assessed using the Cronbach's a coefficient;confirmatory factor analysis was conducted to evaluate the construct validity;and Pearson correlation coefficient was used to report the convergent validity. Results: The Chinese version of RHDS (C-RHDS)-Parent Form included 22 items with 4 subscales, ac-counting for 56.71% of the total variance. The C-RHDS-Parent Form and its subscales showed good reliability (Cronbach's a values 0.78-0.92). This measure and its subscales showed positive correlations with the score of Quality of Discharge Teaching Scale. Conclusion: The factor structure of C-RHDS-Parent Form is partially consistent with the original English version. Future studies are needed to explore the factors within this measure before it is widely used in Chinese clinical care settings.展开更多
To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effec...To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.展开更多
Objective Abnormal maternal thyroid function is associated with preterm birth.However,this association stays dubious in relevant individual studies for ethnic difference reasons and lack of direct supporting data.This...Objective Abnormal maternal thyroid function is associated with preterm birth.However,this association stays dubious in relevant individual studies for ethnic difference reasons and lack of direct supporting data.This study aimed to evaluate the relationship between preterm birth and thyroid dysfunction or autoimmunity based on ethnic differences.Methods Relevant studies were identified through searches of MEDLINE,Excerpta Medica,Wan Fang,China Biological Medicine disc,and China National Knowledge Infrastructure from inception to June 15,2016.Original articles in which an incidence or prevalence of thyroid dysfunction or autoimmunity before second trimester of pregnancy could be extracted were included.Results Thirty-two unique studies were included for the final meta-analysis.Patients involved were divided into two groups：Group 1（G1） and Group 2（G2） comprising of Asian and Caucasian populations,respectively.Positive thyroid antibodies were associated with the occurrence of preterm birth in both G1 [odds ratio（OR）：3.62,95% confidence interval（CI）：2.83-4.65] and G2（OR：1.35,95% CI：1.17-1.56）;hypothyroidism,only in G2（OR：1.20,CI：1.09-1.33）;and subclinical hypothyroidism or hypothyroxinemia,in neither group.Conclusion Thyroid autoimmunity may be a more favorable factor leading to preterm birth among pregnant women of different ethnicities,compared with thyroid dysfunction.展开更多
Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanica...Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanically ventilated preterm infants. Evidence for additional short-term benefits on reducing the incidence of bronchopulmonary dysplasia and patent ductus arteriosus has also been suggested. Controversies existamong various neonatal intensive care units in terms of drug efficacy compared to other methylxanthines, dosage regimen, time of initiation, duration of therapy, drug safety and value of therapeutic drug monitoring. In the current review, we will summarize the available evidence for the best practice in using caffeine therapy in preterm infants.展开更多
Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 week...Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. Results A total of 1,463 late preterm infants were enrolled, with a mean gestational age（GA） of 35.6（34.9, 36.1） weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants（46.1%） were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge（21.1% of infants born at 34 weeks＇ GA versus 12.1% of infants born at 35 weeks＇ GA versus 12.3% of infants born at 36 weeks＇ GA, P 〈 0.001）. Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/（kg·d） by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. Conclusion Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.展开更多
Preterm infants are vulnerable to brain injuries,and have a greater chance of experiencing neurodevelopmental disorders throughout development. Early screening for motor and cognitive functions is critical to assessin...Preterm infants are vulnerable to brain injuries,and have a greater chance of experiencing neurodevelopmental disorders throughout development. Early screening for motor and cognitive functions is critical to assessing the developmental trajectory in preterm infants, especially those who may have motor or cognitive deficits. The brain imaging technology functional near-infrared spectroscopy(fNIRS) is a portable and low-cost method of assessing cerebral hemodynamics, making it suitable for large-scale use even in remote and underdeveloped areas. In this article, we review peer-reviewed, scientific f NIRS studies of motor performance, speech perception, and facial recognition in preterm infants. f NIRS provides a link between hemodynamic activity and the development of brain functions in preterm infants. Research using fNIRS has shown different patterns of hemoglobin change during some behavioral tasks in early infancy. fNIRS helps to promote our understanding of the developmental mechanisms of brain function in preterm infants when performing motor or cognitive tasks in a less-restricted environment.展开更多
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
基金supported by the National Natural Science Foundation of China(8200340181972981)+1 种基金the Scientific and Technological Project of Henan Province(222102310150,China)the Open Research Fund of the National Health Commission Key Laboratory of Birth Defects Prevention(NHCKLBDP202504,China).
文摘Preterm birth(PTB),defined as delivery before 37 weeks of gestation,is the most common adverse pregnancy outcome[1].PTB is a global health concern,with an estimated 13.4 million cases in 2020[1],accounting for more than one in 10 births worldwide.Compared to full-term births,PTBs are associated with a higher risk of short-and long-term complications,including bronchopulmonary dysplasia,necrotizing enterocolitis,visual impairment,and cerebral injuries[2].Despite substantial research efforts to prevent PTB,the global PTB rate has shown little improvement over the past decade[1].Therefore,identifying additional risk factors remains a critical goal in preventing PTB.
文摘Objective:To investigate the dynamic trajectory,predictors,and underlying adaptation mechanisms of family resilience(FR)among Chinese families with preterm infants(PIs)from birth to six months.Methods:Guided by Ecological Systems Theory,a convergent parallel mixed-methods study was conducted in the Neonatal Intensive Care Unit(NICU)of a tertiary hospital in Fujian Province,China,from June 2023 to June 2024.Quantitative data were collected from 202 caregivers selected by convenience sampling at four time points:at birth(T0),42 days postpartum(T1),3 months postpartum(T2),and 6 months postpartum(T3).Generalized Estimating Equations(GEE)was used to analyze scale score differences across time points and explore factors influencing FR.Qualitative data were collected through semi-structured interviews with 14 caregivers recruited by maximum variation purposive sampling and analyzed using Colaizzi’s phenomenological approach.After conducting separate data analyses,the findings were integrated through side-by-side comparison and joint display.Results:Quantitative results revealed a non-linear,“V”-shaped trajectory of FR,significantly influenced by educational level,conception via assisted reproduction,farming occupation,coping style,psychological resilience,family functioning,and social support.Qualitative findings identified four themes:initial uncertainty and emotional distress,post-discharge anxiety,gradual adaptation,and eventual stabilization.Integrated mixed-methods findings revealed that the initial confusion phase demands a comprehensive response to family needs(T0);the post-discharge bottleneck requires addressing the care capability-needs gap(T1);the role adaptation phase is pivotal for enhancing internal family resources(T2);and the family-work transition necessitates enhanced work-family facilitation(T3).Conclusions:This study systematically identifies the unique“V”-shaped trajectory of FR in Chinese families with PIs and its key influencing factors,and accurately analyzes their dynamic experiences and adaptation across four stages.These findings provide an empirical basis for stage-specific targeted interventions,strongly support the practical advancement of the family-centered care model,and deliver critical guidance for enhancing FR.
基金supported by Beijing Natural Science Foundation(No.7222248)the National Natural Science Foundation of China(No.81673177).
文摘The association of copper(Cu)with preterm birth(PTB)and its subtypes,spontaneous preterm birth(SPB)and iatrogenic preterm birth(IPB),are still unclear.In addition,previous studies suggested that serum lipid was associated with both Cu and PTB.Therefore,we explored the association of blood Cu in the first trimester with the risk of PTB and its subtypes,as well as the potential mediating effect of serum lipid using a nested case-control study.The concentrations of Cu in the serum and blood cells,and serum lipids in the first trimester were measured.The concentration of Cu in whole blood was calculated based on hematocrit.Compared to the lowest tertile of Cu concentrations in the first trimester,the highest tertile of Cu significantly increased the risk of SPB with adjusted odds ratios(AORs)of 2.75(95% confidence interval(CI):1.41-5.34)for serum and 3.75(95% CI:1.21-11.60)for whole blood,and significantly increased the risk of IPB with AORs of 3.25(95%CI:1.06-9.94)for blood cells.According to the mediation analysis,the indirect effect of triglyceride(β=0.016,95%CI:0.0002-0.042)was the only significant effect in the association between Cu and SPB,with the mediating proportion of 9.8%(95%CI:0.2%-33.4%).It suggested that a high level of serum Cu may be associated with an increased risk of SPB with a possible mediator of serum triglyceride,and a high level of blood cell Cu may be associated with an increased risk of IPB.
基金funded by the National Plan for Science,Technology and Innovation(MAARIFAH)-King Abdulaziz City for Science and Technology-The Kingdom of Saudi Arabia-award number(13-MAT377-08).
文摘Preterm birth remains a leading cause of neonatal complications and highlights the need for early and accurate prediction techniques to improve both fetal and maternal health outcomes.This study introduces a hybrid approach integrating Long Short-Term Memory(LSTM)networks with the Hybrid Greylag Goose and Particle Swarm Optimization(GGPSO)algorithm to optimize preterm birth classification using Electrohysterogram signals.The dataset consists of 58 samples of 1000-second-long Electrohysterogram recordings,capturing key physiological features such as contraction patterns,entropy,and statistical variations.Statistical analysis and feature selection methods are applied to identify the most relevant predictors and enhance model interpretability.LSTM networks effectively capture temporal patterns in uterine activity,while the GGPSO algorithm finetunes hyperparameters,mitigating overfitting and improving classification accuracy.The proposed GGPSO-optimized LSTM model achieved superior performance with 97.34%accuracy,96.91%sensitivity,97.74%specificity,and 97.23%F-score,significantly outperforming traditional machine learning approaches and demonstrating the effectiveness of hybrid metaheuristic optimization in enhancing deep learning models for clinical applications.By combining deep learning withmetaheuristic optimization,this study contributes to advancing intelligent auto-diagnosis systems,facilitating early detection of pretermbirth risks and timely medical interventions.
基金Supported by Non-profit Joint Stock Company“S.D.Asfendiyarov Kazakh National Medical University”,Almaty,Kazakhstan。
文摘BACKGROUND For over half a century,the administration of maternal corticosteroids before anticipated preterm birth has been regarded as a cornerstone intervention for enhancing neonatal outcomes,particularly in preventing respiratory distress syndrome.Ongoing research on antenatal corticosteroids(ACS)is continuously refining the evidence regarding their efficacy and potential side effects,which may alter the application of this treatment.Recent findings indicate that in resource-limited settings,the effectiveness of ACS is contingent upon meeting specific conditions,including providing adequate medical support for preterm newborns.Future studies are expected to concentrate on developing evidence-based strategies to safely enhance ACS utilization in low-and middle-income countries.AIM To analyze the clinical effectiveness of antenatal corticosteroids in improving outcomes for preterm newborns in a tertiary care hospital setting in Kazakhstan,following current World Health Organization guidelines.METHODS This study employs a comparative retrospective cohort design to analyze single-center clinical data collected from January 2022 to February 2024.A total of 152 medical records of preterm newborns with gestational ages between 24 and 34 weeks were reviewed,focusing on the completeness of the ACS received.Quantitative variables are presented as means with standard deviations,while frequency analysis of qualitative indicators was performed using Pearson'sχ^(2) test(χ^(2))and Fisher's exact test.If statistical significance was identified,pairwise comparisons between the three observation groups were conducted using the Bonferroni correction.RESULTS The obtained data indicate that the complete implementation of antenatal steroid prophylaxis(ASP)improves neonatal outcomes,particularly by reducing the frequency of birth asphyxia(P=0.002),the need for primary resuscitation(P=0.002),the use of nasal continuous positive airway pressure(P=0.022),and the need for surfactant replacement therapy(P=0.038)compared to groups with incomplete or no ASP.Furthermore,complete ASP contributed to a decrease in morbidity among preterm newborns(e.g.,respiratory distress syndrome,intrauterine pneumonia,cerebral ischemia,bronchopulmonary dysplasia,etc.),improved Apgar scores,and reduced the need for re-intubation and the frequency of mechanical ventilation.However,it was associated with an increased incidence of uterine atony in postpartum women(P=0.0095).CONCLUSION In a tertiary hospital setting,the implementation of ACS therapy for pregnancies between 24 and 34 weeks of gestation at high risk for preterm birth significantly reduces the incidence of neonatal complications and related interventions.This,in turn,contributes to better outcomes for this cohort of children.However,the impact of ACS on maternal outcomes requires further thorough investigation.
基金funded by Shanghai Municipal Health and Wellness Commission Health Industry Clinical Research Special Project(202140299).
文摘Background There have been numerous intervention studies focusing on the development of preterm infants,but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants.The aspects and extent to which the home environment affects the early(18 months corrected age)neuropsychological development of preterm infants are still unclear.Aims This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit(NICU).It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.Methods In this retrospective cross-sectional study,275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital.The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient(evaluated by the Gesell Developmental Scale)and the rate of developmental delays at 18 months corrected age.Results A total of 41.454%of the infants were extremely preterm.The developmental quotient scores at 18 months corrected age were in the middle of the scale.The language domain had the highest rate of developmental delay(46.182%),followed by the adaptive domain(37.091%).Multiple logistic regression analyses showed that compared with infants in supportive home environments,infants with moderate/unsupportive home environments had significantly elevated risks of development delay:2.162-fold for global(odds ratio(OR)2.162,95% confidence interval(Cl)1.274 to 3.665,p=0.004),2.193-fold for fine motor(OR 2.193,95%CI 1.161 to 4.140,p=0.016),2.249-fold for language(0R 2.249,95%CI 1.336 to 3.786,p=0.002)and 2.042-fold for personal-social(OR 2.042,95%CI 1.149 to 3.628,p=0.015).Conclusions A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants.It is associated with higher developmental quotient scores and protects against neuropsychiatric delays.Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.
文摘BACKGROUND Congenital scoliosis(CS)is a spinal deformity caused by defective segmentation and development of vertebrae during early embryogenesis.It occurs in 0.5%-1%in 1000 births and may rarely occur with congenital defects affecting the heart or genitourinary system.Truncus arteriosus(TA)is a life-threatening cardiac defect in which a single arterial trunk supplies both systemic and pulmonary circulation,leading to complications such as pulmonary hypertension,heart failure,and severe hypoxia.Although rare individually,the co-occurrence of both conditions poses unique diagnostic and therapeutic challenges,with limited documentation in medical literature.CASE SUMMARY We present a 36-week preterm neonate with CS associated with TA type 1,pre-senting with respiratory distress,cyanosis,and altered spinal curvature.This case demonstrates the complexity of managing neonates with multiple congenital de-fects.Here,the patient was managed with oxygen supplementation,heart failure medication,nasogastric feeding,and multidisciplinary care to optimize her for surgical corrections.A coordinated,interdisciplinary approach was employed to optimize outcomes,particularly in a resource-limited setting.Immediate re-spiratory and cardiovascular stabilization and long-term orthopedic and cardiac interventions were central to improving the patient’s quality of life and survival.CONCLUSION Recognizing co-existing congenital anomalies and their embryological interre-lation is critical in holistic patient care,particularly during neonatal and infancy.
文摘Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.
基金support from Southern Health NHS Foundation Trust,University College London and Liverpool Women’s hospital.part of the multifaceted ELEMI project that is sponsored by Southern Health NHS Foundation Trust and in collaboration with the University of Liverpool,Liverpool Women’s Hospital,University College London,University College London NHS Foundation Trust,University of Southampton,Robinson Institute-University of Adelaide,Ramaiah Memorial Hospital(India),University of Geneva and Manchester University NHS Foundation Trust。
文摘BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.
文摘Background: Preterm birth is a primary cause of neonatal morbidity and mortality especially in low-income countries. Although understanding the preventable factors of neonatal deaths in preterm infants is required for timely interventions, data on those factors is lacking in Kenya. We attempted to determine mortality and its associated factors in preterm babies in Kenya. Methods and Materials: A hospital-based, prospective study was implemented from July 2019 to October 2019 involving 163 preterm neonates and their mothers admitted at Kenyatta National Hospital. A systematic random sampling method was used to recruit the study participants. Data on mortality and the associated factors in preterm neonates were collected using a pretested questionnaire for mothers and neonatal medical records. Data was analyzed using descriptive and inferential statistics. Results: The mortality rate was 18.4%. Of the neonates who died, respiratory distress syndrome (63.3%) and neonatal sepsis (20.0%) were documented as the primary causes. Neonates born of single mother (AOR = 8.006, 95% CI 2.267 to 28.272, p = 0.001), unemployed (6.960, 1.059 - 45.757, p = 0.043), self-employed (4.040, 1.067 - 15.302, p = 0.040), anemic (7.465, 2.530 - 22.023, p < 0.001) and with history of bleeding during pregnancy were more likely to have died. The neonates born before 28 weeks of gestation (126.188, 14.554 - 1094.060, p < 0.001), those who did not cry immediately at birth (54.271, 5.970 - 493.395, p < 0.001) and the resuscitated at birth (54.406, 6.807 - 434.851, p < 0.001) were likely to die. Conclusion: High mortality rates of preterm neonates are attributed to both maternal and neonatal factors. Focused antenatal care should aim at early identification of high-risk mothers for early management of bleeding during pregnancy, close monitoring of nutritional status for mothers and health education.
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Prematurity is a public health problem in Brazil, with 12% of deliveries occurring before 37 weeks of gestation. The measurement of the cervix in the second trimester is already established as a method of screening for prematurity and some studies point out advantages to start this screening in the first trimester. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To define the correlation between the length of the endocervix by transvaginal ultrasound in the first trimester (11 to 14 weeks) with spontaneous early deliveries. </span><b><span style="font-family:Verdana;">Method:</span></b><span style="font-family:Verdana;"> A prospective and observational study realized in a suplementar and private ultrasound clinic and hospital of Porto Alegre, Brazil between 2019-2020. Ultrasound screening of cervix was performed in singleton pregnancies in first and second trimester of pregnancy and correlated with age of delivery. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 142 pregnant women were studied, 80% were in the first pregnancy. The average age was 33.8 years. The rate of prematurity was 18% before 37 weeks and 4% before 34 weeks. The average of cervix measured in the first and second trimesters in deliveries before 34 weeks was 32.7 mm and 29.3 mm, respectively. In term deliveries the median cervical length was 38.8 mm and 37.8 mm, respectively. When analyzing the measurements of the cervix in the second trimester, the cervix was smaller (p = 0.008) among deliveries below 34 weeks (29</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm) than deliveries after 37 weeks. No statistically related differences were found between preterm birth and first trimester cervix measurements. </span><b><span style="font-family:Verdana;">Conclusions</span></b><span style="font-family:Verdana;">: In this study, we did not observe a statistically significant relationship between first trimester cervix measurement and prematurity. More studies are needed to evaluate this finding. However, the measurement of the cervix in the second trimester is different from that found in the literature. This suggest</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> a possible new cut-off point that increases the sensitivity of transvaginal ultrasound as a method of preventing prematurity.</span></span></span>
文摘There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.
基金The current work was co-funded by China National Science Foundation through grant 30500397 (PI: Y. Zhang)ShanghaiRising-Star Program for Young Investigators through grant 04QMX1402 (PI: H. Kan).
文摘Objective To investigate the relation between air pollution exposure and preterm birth in Shanghai, China. Methods We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model （GAM） with penalized splines to analyze the relation between preterm birth, air pollution, and covariates. Results We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 μg/m^3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% （95%CI 1.60%, 7.25%）, 11.89% （95%CI 6.69%, 17.09%）, 5.43% （95%CI 1.78%, 9.08%）, and 4.63% （95%CI 0.35%, 8.91%） increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth. Conclusion Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.
文摘Background: The Readiness for Hospital Discharge Scale (RHDS)-Parent Form shows satisfactory reli-ability and validity to assess the readiness of parents to take care of their children discharged from hospitals in Western countries. However, the reliability and validity of this instrument has not been evaluated in Chinese populations.Objectives: Evaluate the psychometric features of the RHDS-Parent Form among Chinese parents of preterm infants. Methods: The RHDS-Parent Form was translated into a Chinese version following an international in-strument translation guideline. A total of 168 parents with preterm infants were recruited from the neonatal intensive care units of two tertiary-level hospitals in China. The internal consistency of this measure was assessed using the Cronbach's a coefficient;confirmatory factor analysis was conducted to evaluate the construct validity;and Pearson correlation coefficient was used to report the convergent validity. Results: The Chinese version of RHDS (C-RHDS)-Parent Form included 22 items with 4 subscales, ac-counting for 56.71% of the total variance. The C-RHDS-Parent Form and its subscales showed good reliability (Cronbach's a values 0.78-0.92). This measure and its subscales showed positive correlations with the score of Quality of Discharge Teaching Scale. Conclusion: The factor structure of C-RHDS-Parent Form is partially consistent with the original English version. Future studies are needed to explore the factors within this measure before it is widely used in Chinese clinical care settings.
基金supported by a grant from the Medical and Health Science and Technology Project of Guangzhou(No.20151A011027)
文摘To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.
基金funded by the National Natural Science Foundation of China(Grant No.81302277)
文摘Objective Abnormal maternal thyroid function is associated with preterm birth.However,this association stays dubious in relevant individual studies for ethnic difference reasons and lack of direct supporting data.This study aimed to evaluate the relationship between preterm birth and thyroid dysfunction or autoimmunity based on ethnic differences.Methods Relevant studies were identified through searches of MEDLINE,Excerpta Medica,Wan Fang,China Biological Medicine disc,and China National Knowledge Infrastructure from inception to June 15,2016.Original articles in which an incidence or prevalence of thyroid dysfunction or autoimmunity before second trimester of pregnancy could be extracted were included.Results Thirty-two unique studies were included for the final meta-analysis.Patients involved were divided into two groups：Group 1（G1） and Group 2（G2） comprising of Asian and Caucasian populations,respectively.Positive thyroid antibodies were associated with the occurrence of preterm birth in both G1 [odds ratio（OR）：3.62,95% confidence interval（CI）：2.83-4.65] and G2（OR：1.35,95% CI：1.17-1.56）;hypothyroidism,only in G2（OR：1.20,CI：1.09-1.33）;and subclinical hypothyroidism or hypothyroxinemia,in neither group.Conclusion Thyroid autoimmunity may be a more favorable factor leading to preterm birth among pregnant women of different ethnicities,compared with thyroid dysfunction.
文摘Caffeine is the most commonly used medication for treatment of apnea of prematurity. Its effect has been well established in reducing the frequency of apnea, intermittent hypoxemia, and extubation failure in mechanically ventilated preterm infants. Evidence for additional short-term benefits on reducing the incidence of bronchopulmonary dysplasia and patent ductus arteriosus has also been suggested. Controversies existamong various neonatal intensive care units in terms of drug efficacy compared to other methylxanthines, dosage regimen, time of initiation, duration of therapy, drug safety and value of therapeutic drug monitoring. In the current review, we will summarize the available evidence for the best practice in using caffeine therapy in preterm infants.
基金supported by Science and Technology Project of Beijing Health and Family Planning Commission[2016001]the CAMS Initiative for Innovative Medicine[2016-12M-1-008]
文摘Objective To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. Methods A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. Results A total of 1,463 late preterm infants were enrolled, with a mean gestational age（GA） of 35.6（34.9, 36.1） weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants（46.1%） were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge（21.1% of infants born at 34 weeks＇ GA versus 12.1% of infants born at 35 weeks＇ GA versus 12.3% of infants born at 36 weeks＇ GA, P 〈 0.001）. Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/（kg·d） by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. Conclusion Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.
基金the Key Laboratory of Biomedical Spectroscopy of Xi’an Municipality,China(Y839S11D0Z)an Autonomous Deployment Project of Xi’an Institute of Optics and Precision Mechanics of the Chinese Academy of Sciences(Y855W31213).
文摘Preterm infants are vulnerable to brain injuries,and have a greater chance of experiencing neurodevelopmental disorders throughout development. Early screening for motor and cognitive functions is critical to assessing the developmental trajectory in preterm infants, especially those who may have motor or cognitive deficits. The brain imaging technology functional near-infrared spectroscopy(fNIRS) is a portable and low-cost method of assessing cerebral hemodynamics, making it suitable for large-scale use even in remote and underdeveloped areas. In this article, we review peer-reviewed, scientific f NIRS studies of motor performance, speech perception, and facial recognition in preterm infants. f NIRS provides a link between hemodynamic activity and the development of brain functions in preterm infants. Research using fNIRS has shown different patterns of hemoglobin change during some behavioral tasks in early infancy. fNIRS helps to promote our understanding of the developmental mechanisms of brain function in preterm infants when performing motor or cognitive tasks in a less-restricted environment.
