Racial and Economic Neighborhood Segregation, Site of Delivery, and Very Preterm Neonatal Morbidity and Mortality

Abstract Background The biologic implications of delayed parenthood have been blamed for a major public health crisis in the United States, that includes high rates of neonatal morbidity and mortality (NMM). The objective of this study was to evaluate the risk of parent age on NMM and to provide results that can serve as a starting point for more specific mediation modeling. Methods Data containing approximately 15,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2018. A Bayesian modeling approach was used to estimate the both the total effect and the risk adjusted for confounding between parent ages and for mediation by chromosomal disorders including Down syndrome. Outcomes included intra-hospital death and nine measures of neonatal morbidity. Results For paternal age, seven NMM (preterm birth, very preterm birth, low Apgar score, treatment with antibiotics, treatment with surfactant, prolonged ventilation, intra-hospital death) had U-shaped risk patterns, two NMM (small for gestational age, admission to neonatal intensive care) had J-shaped risk patterns, one NMM (seizures) was not significantly related to paternal age. For maternal age, three NMM (low Apgar score, treatment with antibiotics and intra-hospital death) had U-shaped risk patterns, four NMM (preterm delivery, very preterm delivery, admission to neonatal intensive care, treatment with surfactant) had J-shaped risk patterns, one NMM (small for gestational age) had a risk declining with age, one NMM (prolonged ventilation) had a risk increasing with age and one NMM (seizures) was not significantly related to maternal age. Conclusions Both advancing maternal and paternal ages had U- or J-shaped risk patterns for neonatal morbidity and mortality.

Download Full-text

Neonatal morbidity and mortality by mode of delivery in very preterm neonates

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.07.013 ◽

2021 ◽

Author(s):

Leilah D. Zahedi-Spung ◽

Nandini Raghuraman ◽

George A. Macones ◽

Alison G. Cahill ◽

Joshua I. Rosenbloom

Keyword(s):

Mode Of Delivery ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Preterm Neonates ◽

Very Preterm

Download Full-text

The Effect of Birth Order on Neonatal Morbidity and Mortality in Very Preterm Twins

American Journal of Perinatology ◽

10.1055/s-0037-1598255 ◽

2017 ◽

Vol 34 (09) ◽

pp. 845-850 ◽

Cited By ~ 4

Author(s):

Elad Mei-Dan ◽

Jyotsna Shah ◽

Shoo Lee ◽

Prakesh Shah ◽

Kellie Murphy ◽

...

Keyword(s):

Birth Order ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Matched Pair ◽

Very Preterm ◽

Matched Pair Analysis ◽

Grade 3

Objective This retrospective cohort study examined the effect of birth order on neonatal morbidity and mortality in very preterm twins. Study Design Using 2005 to 2012 data from the Canadian Neonatal Network, very preterm twins born between 24 0/7 and 32 6/7 weeks of gestation were included. Odds of morbidity and mortality of second-born cotwins compared with first-born cotwins were examined by matched-pair analysis. Outcomes were neonatal death, severe brain injury (intraventricular hemorrhage grade 3 or 4 or persistent periventricular echogenicity), bronchopulmonary dysplasia, severe retinopathy of prematurity (ROP) (> stage 2), necrotizing enterocolitis (≥ stage 2), and respiratory distress syndrome (RDS). Multivariable analysis was performed adjusting for confounders. Result There were 6,636 twins (3,318 pairs) included with a mean gestational age (GA) of 28.9 weeks. A higher rate of small for GA occurred in second-born twins (10 vs. 6%). Mortality was significantly lower for second-born twins (4.3 vs. 5.3%; adjusted odds ratio: 0.75; 95% confidence interval [CI]: 0.59–0.95). RDS (66 vs. 60%; adjusted odds ratio: 1.40; 95% CI: 1.29–1.52) and severe retinopathy (9 vs. 7%; adjusted odds ratio: 1.46; 95% CI: 1.07–2.01) were significantly higher in second-born twins. Conclusion Thus, while second-born twins had reduced odds of mortality, they also had increased odds of RDS and ROP.

Download Full-text

The Risks of Advancing Parental Age on Neonatal Morbidity and Mortality are U- or J-Shaped for Both Maternal and Paternal Ages.

10.21203/rs.3.rs-38033/v1 ◽

2020 ◽

Author(s):

James Thompson

Keyword(s):

United States ◽

Neonatal Mortality ◽

Maternal Age ◽

Neonatal Intensive Care ◽

Neonatal Morbidity ◽

The United States ◽

Paternal Age ◽

Morbidity And Mortality ◽

Very Preterm ◽

Prolonged Ventilation

Abstract Background: The biologic implications of delayed parenthood have been blamed for a major public health crisis in the United States, that includes high rates of neonatal morbidity and mortality (NMM). The objective of this study was to evaluate the risk of parent age on NMM and to provide results that can serve as a starting point for more specific mediation modeling. Methods: Data containing approximately 15,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2017. A Bayesian modeling approach was used to estimate the both the total effect and the risk adjusted for confounding between parent ages and for mediation by chromosomal disorders including Down syndrome. Outcomes included neonatal mortality and nine measures of neonatal morbidity.Results: For paternal age, seven NMM (preterm birth, very preterm birth, low Apgar score, treatment with antibiotics, treatment with surfactant, prolonged ventilation, neonatal mortality) had U-shaped risk patterns, two NMM (small for gestational age, admission to neonatal intensive care) had J-shaped risk patterns, one NMM (seizures) was not significantly related to paternal age. For maternal age, three NMM (low Apgar score, treatment with antibiotics and neonatal mortality) had U-shaped risk patterns, four NMM (preterm delivery, very preterm delivery, admission to neonatal intensive care, treatment with surfactant) had J-shaped risk patterns, one NMM (small for gestational age) had a risk declining with age, one NMM (prolonged ventilation) had a risk increasing with age and one NMM (seizures) was not significantly related to maternal age. Conclusions. Under the assumptions of a specific causal model, both advancing maternal and paternal ages had U- or J-shaped risk patterns for neonatal morbidity and mortality.

Download Full-text

Faculty Opinions recommendation of Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727188470.793534026 ◽

2017 ◽

Author(s):

Jeff Keelan

Keyword(s):

Preterm Birth ◽

Individual Patient Data ◽

Meta Analysis ◽

Neonatal Morbidity ◽

Patient Data ◽

Morbidity And Mortality ◽

Short Cervix ◽

Vaginal Progesterone

Download Full-text

Can prophylactic nasal continuous positive airway pressure help to prevent morbidity and mortality in very preterm infants?

Cochrane Clinical Answers ◽

10.1002/cca.1374 ◽

2016 ◽

Keyword(s):

Continuous Positive Airway Pressure ◽

Preterm Infants ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Morbidity And Mortality ◽

Very Preterm Infants ◽

Very Preterm

Download Full-text

Quality of Antenatal, Labour and Delivery Services in Selected Districts in Malawi, Zambia and Zimbabwe: A Descriptive Cross-Sectional Study

10.52916/jogs214011 ◽

2021 ◽

pp. 1-9

Author(s):

Clara Opha Haruzivishe

Keyword(s):

Perinatal Care ◽

Neonatal Morbidity ◽

Health Facilities ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

World Health ◽

Performance Standard ◽

Cross Sectional ◽

Care Services

Background: High Maternal and Neonatal Mortality Ratios persist in Sub-Saharan Africa despite increasing perinatal care coverage. This suggests that coverage alone is not adequate to reduce maternal and neonatal morbidity and mortality. Quality of care should be the emphasis of maternal and child care services. Materials and Methods: A descriptive cross-sectional multicentre study was conducted in selected health facilities in Zambia, Malawi and Zimbabwe using purposive sampling. A World Health Organization-WHO 2016 Quality of Maternal and New-born assessment Framework and the WHO (2015) Service Availability and Readiness Assessment tool were used for data collection. Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0. Results: Less than 43% of the health facilities satisfied at least three of the five Performance Standards of availability and adequacy of Antenatal infrastructure and supplies. Regarding Antenatal processes/care, an observation was the most common performance standard satisfied by 70.6% of all health facilities assessed while less than 30% fulfilled all other standards. Only 57.1% of the health facilities satisfied 5 of the 11 standards for labour and delivery infrastructure, while only 55.6% of the Health facilities satisfied only two of the 13 standards of Labour and delivery care. Conclusion: To achieve a significant and sustainable reduction in maternal and neonatal morbidity and mortality, there is a need for investment and improvement in maternity care services infrastructure and processes as opposed to focusing on mere attendance of Antenatal, and deliveries by trained birth attendants.

Download Full-text