scholarly journals Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

2020 ◽  
Author(s):  
Ngugi Mwenda ◽  
Ruth Nduati ◽  
Mathew Kosgey ◽  
Gregory Kerich
Keyword(s):  
Bacterial Vaginosis ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Estimating Equation ◽  
Morbidity And Mortality ◽  
Bloody Stool ◽  
Maternal Condition ◽  
Cumulative Hazard ◽  
Hazard Curve

Abstract Background: This study aimed to assess the effects of maternal bacterial vaginosis (BV) on the morbidity and mortality of HIV-exposed infants of women enrolled in a randomized controlled trial (pre-dating antiretroviral therapy) at birth, 6 months, and 12 months. Methods: Four hundred and twenty-five HIV-positive pregnant women were enrolled in this trial and were categorized as exposed if they had a laboratory-based diagnosis of BV (Nugent method). We compared the morbidity and mortality of infants of the mothers at birth, 6 months, and 12 months. We assessed morbidities from the mother’s history and clinical examination during scheduled and non-scheduled visits. The data that were collected longitudinally were then analyzed via multiple logistic regression with the generalized estimating equation. An independent correlation structure was assumed to evaluate the specific morbidity risks to infants associated with exposure to BV. We used the Kaplan–Meier method to generate the cumulative hazard curve, to determine mortalities at different stages between the two groups. Overall, only data for 328 infants were complete and used in the analysis.Results: Data were available for 159 and 171 BV exposed and non-exposed mothers, respectively. Exposure to BV was not associated with any neonatal morbidity at birth, but was associated with adverse maternal condition (unadjusted odds ratio [OR], 2.93; 95% confidence interval [CI], 1.19–7.20, P=0.02) and maternal hospital admissions (unadjusted OR, 1.95; 95% CI, 1.08–3.51, P=0.02). At 6 months, infants of BV exposed mothers had higher odds of bloody stool (adjusted OR, 3.08; 95% CI, 1.11–10.00, P=0.04), dehydration (adjusted OR, 2.94; 95% CI, 1.44–6.37, P=0.01), vomiting (adjusted OR, 1.64; 95% CI, 1.06–2.56, P=0.03), and mouth ulcers (adjusted OR, 12.8; 95% CI, 2.27–241.21, P=0.02). At 12 months, exposure to BV was associated with dehydration (adjusted OR, 1.81; 95% CI, 1.05–3.19, P=0.03) and vomiting (adjusted OR, 1.39; 95% CI, 1.01–1.92, P=0.04). Kaplan­–Meier survival analysis showed no association of BV with infant mortality (P=0.65); however, the cumulative hazard curve showed a higher trend toward deaths among BV exposed infants.Conclusion: Our findings demonstrate that BV is a good predictor of maternal and infant morbidities. Infants of both HIV and BV exposed mothers can manifest these symptoms at any stage within a year of growth. Adverse maternal condition and hospitalization of mothers after birth could indicate exposure to BV. Bloody stool, dehydration, vomiting, and mouth ulcers could indicate exposure to BV among infants.

scholarly journals Effect of Bacterial Vaginosis (BV)-HIV-1 Co-existence on Maternal and Infant Health: A Secondary Data Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Ngugi Mwenda ◽  
Ruth Nduati ◽  
Mathew Kosgey ◽  
Gregory Kerich
Keyword(s):  
Bacterial Vaginosis ◽  
Secondary Data ◽  
Neonatal Morbidity ◽  
Original Data ◽  
Morbidity And Mortality ◽  
Bloody Stool ◽  
Maternal Condition ◽  
Data Set ◽  
Infant Morbidity ◽  
Hiv 1

Background: The lactobacillus-rich microbiome forms a defense system against infections. Babies are born sterile and acquire their microbiome from exposure to the mothers' vaginal and rectal microbiota. Bacterial vaginosis (BV), which is characterized by a deficit of the Lactobacilli genera, may predispose women and their babies to an increased frequency of illness.Objective: To determine the effect of BV on HIV-infected women's post-delivery health as well as the morbidity and mortality of the exposed infant at birth, 6 months, and at 12 months of life.Study Design: A retrospective cohort study was conducted using previously collected data to investigate whether there was an association between BV-HIV-1 infected mothers and subsequent infant morbidity and mortality over a 12-month period.Methods: Data for this analysis were extracted from the original data set. Women were categorized into two groups according to whether they had a positive or negative laboratory-based diagnosis of BV using the Nugent method. The two groups were compared for socio-demographic characteristics, prior to the pregnancy experience in their current pregnancy outcome and at post-delivery morbidity, and for the duration of hospital stay. BV-exposed and unexposed infants were compared in terms of morbidity and mortality at birth, and in the periods between birth and 6 months, and between 6 and 12 months, respectively, based on prospectively collected data of the mother's past and present illness, and clinical examination at scheduled and unscheduled visits during the follow-up period of the original study. The generalized estimating equation (GEE) was used to analyze the longitudinally collected data. We used the Kaplan-Meier (KM) method to generate the cumulative hazard curve and compared the mortality in the first year of life between the two groups.Results: In total, 365 patients were included in the study. Exposure to BV was associated with an adverse maternal condition (Relative Risk [RR], 2.45; 95% confidence interval [CI], 1.04–5.81, P = 0.04) and maternal hospital admission (RR, 1.99; 95% CI, 1.14–3.48, P = 0.02) but was not linked to any neonatal morbidity at birth. There was a higher frequency of gastro-intestinal morbidity among BV-exposed infants. At 6 months, infants of BV-exposed mothers had higher odds of bloody stool (Odds Ratio [OR], 3.08; 95% CI, 1.11–10.00, P = 0.04), dehydration (OR, 2.94; 95% CI, 1.44–6.37, P = 0.01), vomiting (OR, 1.64; 95% CI, 1.06–2.56, P = 0.03), and mouth ulcers (OR, 12.8; 95% CI, 2.27–241.21, P = 0.02). At 12 months, exposure to BV was associated with dehydration (OR, 1.81; 95% CI, 1.05–3.19, P = 0.03) and vomiting (OR, 1.39; 95% CI, 1.01–1.92, P = 0.04). KM survival analysis showed non-significant higher trends of deaths among BV-exposed infants (P = 0.65).Conclusion: This study demonstrates differences in maternal and infant morbidity outcomes associated with exposure to BV. Further research is required to determine whether treatment for maternal BV mitigates maternal and infant morbidity.

scholarly journals Clinical Profile and Outcome of Neonates Admitted to the Neonatal Care Unit in a Rural Teaching Hospital

2018 ◽  
Vol 1 (2) ◽  
pp. 23-27 ◽  
Author(s):  
Sandeep Shrestha ◽  
N. Sindan ◽  
N. Kayastha ◽  
D.B. Karki ◽  
K. Jha ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Neonatal Morbidity ◽  
Meconium Aspiration Syndrome ◽  
Clinical Profile ◽  
Morbidity And Mortality ◽  
Mortality And Morbidity ◽  
Period 2 ◽  
Neonatal Care Unit ◽  
One Year ◽  
Rural Teaching

Introduction: Neonatal morbidity and mortality rates reflect efficiency of health services of a country. This study was conducted to identify the clinical profile, pattern of diseases and common causes of mortality and morbidity in neonates admitted to neonatology unit. Methods: The study was conducted in Neonatal Unit of Karnali Academy of Health Sciences, Jumla for a period of one year from 1st May 2017 to 30th April 2018. Data of all admitted patients were reviewed and analyzed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Diagnosis was made on clinical examination, radiological findings and laboratory investigations. Data were analyzed using SPSS version 20. Results: Out of 153 neonates admitted during the study period, 2 were excluded because of deficient record. Full-term neonates were 122(80.7%) while preterm were 29 (19.3%). Low birth weight (LBW) babies were 32 (21.18%). Neonatal sepsis 91 (60.26%) was the most common cause of hospital admissions followed by meconium aspiration syndrome 21(13.9%) and prematurity 10(6.62%). Out of 151 newborns, 112 babies (74.1%) were discharged after improvement, 15(9.93%) left against medical advice, 13(8.6%) babies were referred to higher centers for intensive care and there were 9 (5.9%) mortalities and 2(1.3%) got absconded. Conclusions: The majority of neonatal morbidity is due to sepsis, prematurity and respiratory causes. All these causes are preventable to some extent and, can be effectively treated in order to reduce morbidity and mortality.

scholarly journals A phase 3, randomized, controlled trial of Astodrimer 1% Gel for preventing recurrent bacterial vaginosis

2021 ◽  
Vol 10 ◽  
pp. 100121
Author(s):  
Jane R. Schwebke ◽  
Belvia A. Carter ◽  
Arthur S. Waldbaum ◽  
Kathy J. Agnew ◽  
Jeremy R.A. Paull ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Bacterial Vaginosis ◽  
Controlled Trial ◽  
Phase 3 ◽  
Randomized Controlled

scholarly journals Exercise and education for community-dwelling older participants with knee osteoarthritis: a video-linked programme protocol based on a randomised controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lin Wang ◽  
Suhang Xie ◽  
Tianjie Bao ◽  
Siyi Zhu ◽  
Qiu Liang ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Knee Osteoarthritis ◽  
Rating Scale ◽  
Controlled Trial ◽  
Pressure Pain Threshold ◽  
Estimating Equation ◽  
Community Dwelling ◽  
Self Report ◽  
Exercise Programmes ◽  
Randomised Controlled

Abstract Background Neuromuscular and quadriceps exercises have been shown to be effective approaches to relieve pain and to improve function for patients with knee osteoarthritis. In this study, we aim to provide an informative feasible model in which therapeutic exercise and education will be undertaken with physiotherapy supervision and instruction via video link. We also aim to explore the relationship between program-induced pain alleviation/functional improvements and reduction in irritability, which might be mediated through program-induced psychosocial benefits. Methods In this proposed two-parallel group (neuromuscular exercise versus quadriceps exercise), single-blinded, randomised controlled trial, participants aged ≥50 years with osteoarthritic knee pain will undergo a 12-week intervention, comprising video-linked education, supervised exercises, and a 12-week follow-up. Seven measurements will be taken to collect longitudinal data. A generalised estimating equation will be used to establish the adjusted difference in effectiveness on pain, function, irritability, and psychosocial outcomes between participants undertaking neuromuscular exercises and those undertaking quadriceps exercises. The primary outcomes are overall average pain in the knee joint during walking, as assessed through the 11-point Numerical Pain Rating Scale, and the Western Ontario and McMaster Universities osteoarthritis index physical function subscale. Furthermore, pressure pain threshold and changes in self-report pain scores pre-, during, and post-exercise were also measured as an indication of irritability. In addition, both the 6-min walk test and a timed up & go test were used to assess walking function performance. Finally, patients’ emotions (e.g., fear and catastrophising), self-trust, needs in terms of disease knowledge, mental resilience, social support and health-related quality of life were investigated. Two four-wave cross-lagged models will be used to investigate directional relationships, aiming to investigate the complex mechanisms concerning the effects of exercise programmes. Discussion Through summarising the study’s strengths and limitations, this study may provide promising insights in terms of exercise therapy optimisation for people with knee osteoarthritis and/or other chronic pain within a psychosocial framework. Trial registration ChiCTR2100041978 (chictr.org.cn), January 10, 2021.

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

2021 ◽  
Author(s):  
Teresa Janevic ◽  
Jennifer Zeitlin ◽  
Natalia N. Egorova ◽  
Paul Hebert ◽  
Amy Balbierz ◽  
...  
Keyword(s):  
Neonatal Morbidity ◽  
Morbidity And Mortality ◽  
Very Preterm ◽  
Neighborhood Segregation

Neonatal Outcomes at Extreme Prematurity by Gestational Age Versus Birth Weight in a Contemporary Cohort

2021 ◽  
Author(s):  
Elizabeth B. Ausbeck ◽  
Phillip Hunter Allman ◽  
Jeff M. Szychowski ◽  
Akila Subramaniam ◽  
Anup Katheria
Keyword(s):  
Birth Weight ◽  
Umbilical Cord ◽  
Gestational Age ◽  
Predictive Value ◽  
Neonatal Death ◽  
Controlled Trial ◽  
Neonatal Morbidity ◽  
Mortality And Morbidity ◽  
Severe Morbidity ◽  
Multicenter Randomized Controlled Trial

Objective The aim of the study is to describe the rates of neonatal death and severe neonatal morbidity in a contemporary cohort, as well as to evaluate the predictive value of birth gestational age (GA) and birth weight, independently and combined, for neonatal mortality and morbidity in the same contemporary cohort. Study Design We performed a secondary analysis of an international, multicenter randomized controlled trial of delayed umbilical cord clamping versus umbilical cord milking in preterm infants born at 23 0/7 to 31 6/7 weeks of gestation. The current analysis was restricted to infants delivered <28 weeks. The primary outcomes of this analysis were neonatal death and a composite of severe neonatal morbidity. Incidence of outcomes was compared by weeks of GA, with planned subanalysis comparing small for gestational age (SGA) versus non-SGA neonates. Multivariable logistic regression was then used to model these outcomes based on birth GA, birth weight, or a combination of both as primary independent predictors to determine which had superior ability to predict outcomes. Results Of 474 neonates in the original trial, 180 (38%) were included in this analysis. Overall, death occurred in 27 (15%) and severe morbidity in 139 (77%) neonates. Rates of mortality and morbidity declined with increasing GA (mortality 54% at 23 vs. 9% at 27 weeks). SGA infants (n = 25) had significantly higher mortality compared with non-SGA infants across all GAs (p < 0.01). There was no difference in the predictive value for neonatal death or severe morbidity between the three prediction options (GA, birth weight, or GA and birth weight). Conclusion Death and severe neonatal morbidity declined with advancing GA, with higher rates of death in SGA infants. Birth GA and birth weight were both good predictors of outcomes; however, combining the two was not more predictive, even in SGA infants. Key Points

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

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.

Physical Development and Medical History of Children Who Were Treated Antenatally With Corticosteroids to Prevent Respiratory Distress Syndrome: A 10- to 12-Year Follow-up

PEDIATRICS ◽  
1990 ◽  
Vol 86 (1) ◽  
pp. 65-70 ◽  
Author(s):  
H. Smolders-de Haas ◽  
J. Neuvel ◽  
B. Schmand ◽  
p. E. Treffers ◽  
J. G. Koppe ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Medical History ◽  
Distress Syndrome ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Ophthalmological Examination ◽  
Double Blind ◽  
History Of

Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a randomized, double-blind, placebo-controlled trial of betamethasone. The children had a general physical examination; parents were interviewed about the medical history of their child with special attention to infectious diseases; growth data were collected; and a developmental neurological examination, an ophthalmological examination, and a lung function test were conducted. In the corticosteroid group significantly more hospital admissions because of infectious diseases during the first years of life were reported. On the other variables no differences between the corticoid and the placebo groups were found.

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