Causes and age of neonatal death and associations with maternal and newborn care characteristics in Nepal: a verbal autopsy study

Background In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal’s success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population.

Birth Control: A Review of Pharmacological and Non-pharmacological Modalities, Associated Pros and Cons, and Their Effectiveness

Introduction: Family planning importance is increasing progressively and is regarded as an essential part in every couple’s life. Family planning has a lot of benefits for the whole family as it provides a better control over the period between each pregnancy leading to a better balance over the personal, financial, and societal life. There are multiple birth control methods, from which couples can choose from with the assistance of their physicians since each method has its own advantages and disadvantages. Furthermore, some contraceptive methods may be more suited for a certain couple or situation than another one. This review of current methods aims to shed the lights on the various contraception options along with their advantages and disadvantages to aid providers in taking care of their patients. Methodology: A thorough search was carried out on PubMed using the most suitable keywords representing the aim of the present study. A total of 120 were found and based on whether they are suited to achieve the aim of the study, 28 were selected. Discussion: There is a great variety of birth control methods, and each has its associated advantages and disadvantages. Barrier contraceptive methods, most common of which are male condoms, are extremely popular in Western countries. Combined hormonal contraception methods which are available in the form of pills, patches, and rings. Progestin only contraception either in the form of a pill, injection or an implant is the most commonly used type among breastfeeding women. Furthermore, intrauterine devices are another effective contraceptive method which may be copper-based or hormonal-based. Conclusion: Contraception is an integral part of family planning, which can be achieved through a variety of methods. Each birth control method has its own pros and cons that should be explained to the couple clearly, so they can choose the method that is most suited for them.

The Consistency of White Advantage and the Heterogeneity of Nonwhite Disadvantage: Neighborhood Trajectories over Two Decades in the Lives of Multiple Birth Cohorts

Sociological research has established the greater exposure of African Americans from all income groups to disadvantaged environments compared to whites, but the traditional focus in studies of neighborhood stratification obscures heterogeneity within racial/ethnic groups in residential attainment over time. Also obscured are the moderating influences of broader social changes on the life-course and the experiences of Latinos, a large and growing presence in American cities. We address these issues by examining group-based trajectory models of residential neighborhood disadvantage among whites, Blacks, and Latinos in a multi-cohort longitudinal research design of over 1,000 children from Chicago as they transitioned to adulthood over the last quarter century. We find dynamic consistency among whites and dynamic heterogeneity among nonwhites in exposure to residential disadvantage, especially Blacks and those born in the 1980s compared to the 1990s. Racial and cohort differences are not accounted for by early-life characteristics that predict long-term attainment. Inequalities by race in trajectories of neighborhood disadvantage are thus at once more stable and more dynamic than previous research suggests, and they are modified by broader social changes. These findings offer insights on the changing pathways by which neighborhood racial inequality is produced.

Gene-teratogen interactions influence the penetrance of birth defects by altering Hedgehog signaling strength

ABSTRACT Birth defects result from interactions between genetic and environmental factors, but the mechanisms remain poorly understood. We find that mutations and teratogens interact in predictable ways to cause birth defects by changing target cell sensitivity to Hedgehog (Hh) ligands. These interactions converge on a membrane protein complex, the MMM complex, that promotes degradation of the Hh transducer Smoothened (SMO). Deficiency of the MMM component MOSMO results in elevated SMO and increased Hh signaling, causing multiple birth defects. In utero exposure to a teratogen that directly inhibits SMO reduces the penetrance and expressivity of birth defects in Mosmo−/− embryos. Additionally, tissues that develop normally in Mosmo−/− embryos are refractory to the teratogen. Thus, changes in the abundance of the protein target of a teratogen can change birth defect outcomes by quantitative shifts in Hh signaling. Consequently, small molecules that re-calibrate signaling strength could be harnessed to rescue structural birth defects.

Association between intracytoplasmic sperm injection and neurodevelopmental outcomes among offspring

Purpose To compare the risk of neurodevelopmental disorders in children conceived via intracytoplasmic sperm injection (ICSI) and those conceived naturally. Materials and methods A population-based cohort study using data retrieved from the Taipei Medical University Research Database (TMURD) from January, 2004 to August, 2016. The data included maternal pregnancy history, perinatal history and developmental follow up of their babies up to 5 years of age. The study included 23885 children, of whom 23148 were naturally conceived and 737 were conceived via ICSI. Neurodevelopmental disorders defined by 21 ICD-9-CM codes. Results Of the 23885 children enrolled for analysis, 2778 children were included for further subgrouping analysis after propensity matching to reduce bias from maternal factors. The single-birth group included 1752 naturally conceived (NC) children and 438 ICSI children. The multiple-birth group included 294 NC and 294 ICSI children. The risk of neurodevelopmental disorders was not increased for ICSI children in both groups (single birth: adjusted hazard ratio aHR = 0.70, 95% CI = 0.39–1.27, p = 0.243; multiple-birth group aHR = 0.77, 95% CI = 0.43–1.35, p = 0.853). In the single-birth group, multivariate analyses showed that male sex (aHR = 1.81, 95% CI = 1.29–2.54, p < 0.001), and intensive care unit (ICU) admission (aHR = 3.10, 95% CI = 1.64–5.86, p < 0.001) were risk factors for neurodevelopmental disorders. In the multiple-birth group, multivariate analyses demonstrated that ICU admission (aHR = 3.58, 95% CI = 1.82–7.04, p < 0.001), was risk factor for neurodevelopmental disorders. Conclusion Our study indicated that the use of ICSI does not associated with higher risk of neurodevelopmental disorders in the offspring. But male sex, and ICU admission do have increased risk of neurodevelopmental disorders. However, long term follow up of this cohort on health outcomes in adolescence and adulthood will strengthen the conclusions that ICSI is safe regarding offspring long term outcome.

Evaluation the Effect of Co-Bedding Premature Twin or Multiple Birth Infants on their Growth, Physiological Stability, and Short-Term Prognosis in Nicus

The aim of this study was to investigate the effect of co-bedding among premature twin or multiple birth infants on their growth and physiological stability. In this randomized clinical trial, a total number of 80 pairs of premature twin or multiple birth infants hospitalized in the neonatal intensive care unit (NICU) of Shahid Akbar-Abadi Hospital in Tehran, Iran, were randomly allocated into two groups; co-bedded and routine care. The required data were collected through a demographic characteristics information questionnaire and a co-bedding checklist and compared between groups. In the following, data analysis showed that the weight gain and mean of NICU hospitalization days in the co-bedded group were significantly different from those in the standard care infants (P<0.001). However; there was no significant difference in terms of increase in height (P=0.1), head circumference (P=0.4), heart rate (P=0.3), arterial oxygen saturation (P=0.12), and respiratory rate (P=0.68) between groups. It was concluded that co-bedding twin or multiple birth infants could lead to weight gain among them and consequently accelerate their recovery and discharge. Keywords: co-bedding, premature multiple births, neonatal intensive care unit

Evaluation of the effectiveness of an incentive strategy on the questionnaire response rate in parents of premature babies: a randomised controlled Study Within A Trial (SWAT) nested within SIFT

Background Loss to follow-up resulting in missing outcomes compromises the validity of trial results by reducing statistical power, negatively affecting generalisability and undermining assumptions made at analysis, leading to potentially biased and misleading results. Evidence that incentives are effective at improving response rates exists, but there is little evidence regarding the best approach, especially in the field of perinatal medicine. The NIHR-funded SIFT trial follow-up of infants at 2 years of age provided an ideal opportunity to address this remaining uncertainty. Methods Participants: parents of infants from participating neonatal units in the UK and Ireland followed up for SIFT (multicentre RCT investigating two speeds of feeding in babies with gestational age at birth < 32 weeks and/or birthweight < 1500 g). Interventions: parents were randomly allocated to receive incentives (£15 gift voucher) before or after questionnaire return. The objective was to establish whether offering an unconditional incentive in advance or promising an incentive on completion of a questionnaire (conditional) improved the response rate in parents of premature babies. The primary outcome was questionnaire response rate. Permuted block randomisation was performed (variable size blocks), stratified by SIFT allocation (slower/faster feeds) and single/multiple birth. Multiple births were given the same incentives allocation. Parents were unaware that they were in an incentives SWAT; SIFT office staff were not blinded to allocation. Results Parents of 923 infants were randomised: 459 infants allocated to receive incentive before, 464 infants allocated to receive incentive after; analysis was by intention to treat. Allocation to the incentive before completion led to a significantly higher response rate, 83.0% (381/459) compared to the after-completion group, 76.1% (353/464); adjusted absolute difference of 6.8% (95% confidence interval 1.6% to 12.0%). Giving an incentive in advance is the more costly approach, but the mean difference of ~£3 per infant is small given the higher return. Conclusions An unconditional incentive in advance led to a significantly higher response rate compared to the promise of an incentive on completion. Against a backdrop of falling response rates to questionnaires, incentives can be an effective way to increase returns. Trial registration SIFT (ISRCTN76463425). Registered on March 5, 2013.; SWAT registration (SWAT 69 available from http://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,864297,en.pdf). Registered on June 27, 2016.