Search Results (11,254)

Cyanotic congenital heart disease (CCHD) remains a major contributor to infant morbidity and mortality in the United States, yet the influence of maternal social determinants of health on risk is not fully understood. This study examined associations of maternal age, education, and race/ethnicity with the live birth prevalence of CCHD using recent national birth data from the Centers for Disease Control and Prevention (CDC) National Vital Statistics System (2022–2023). CCHD was identified from birth certificate records and analyzed as a binary outcome. Regression analyses were performed to evaluate relationships between maternal characteristics and CCHD occurrence. Overall, CCHD was a rare outcome with a modest decline in prevalence between the two years examined. Increasing maternal age was associated with higher odds of CCHD, while Latina ethnicity was associated with lower odds compared to the reference group. Other racial/ethnic categories and maternal education level were not significantly associated with CCHD risk in adjusted analyses. These findings suggest that certain maternal factors, particularly age and ethnicity, are associated with variation in the live birth prevalence of CCHD and underscore the need for further research into underlying environmental and structural contributors not captured in standard birth records. Full article

Background/Objectives: Early detection of postnatal growth failure (PGF) is essential for optimizing nutritional management in preterm infants, as PGF is associated with adverse neurodevelopmental outcomes. Early prediction remains difficult because postnatal growth is influenced by multiple clinical factors including gestation age, birth weight, nutritional status, and comorbidities. Machine-learning approaches have been proposed to predict complex neonatal outcomes. This study compared the predictive performance of neonatologists with that of a machine-learning model for predicting PGF. Methods: PGF was defined as a decrease in weight z-score greater than 1.28 at discharge compared with birth. A machine-learning model based on extreme gradient boosting (XGBoost) was trained using a dataset of 7954 very low birth weight (VLBW) infants. Nine neonatologists independently assessed 100 clinical cases through a questionnaire-based evaluation, including 50 patients with PGF. Predictive performance was evaluated using seven metrics: area under the receiver operating characteristic curve (AUROC), accuracy, error rate, positive predictive value (PPV), sensitivity, specificity, and F1 score. Results: The neonatologists had a median of 5 years (range: 4–10 years) of clinical experience. The median prediction score among the neonatologists was 52/100 (range, 44–60), whereas the XGBoost model achieved 79/100. The XGBoost model achieved an AUROC of 0.79, accuracy of 0.79, error rate of 0.21, sensitivity of 0.82, and an F1 score of 0.80, demonstrating superior overall performance compared to the neonatologists. In addition, the XGBoost model had a lower error rate than the neonatologists (0.21 vs. 0.49), whereas specificity (0.76 vs. 0.86) and PPV (0.77 vs. 0.53) did not differ significantly. Conclusions: The machine-learning model demonstrated superior or comparable predictive performance to that of neonatologists in detecting PGF. Machine-learning-based prediction models may support early risk stratification and targeted nutritional management in VLBW infants. Full article

Objective: This study aimed to evaluate maternal serum afamin levels in women with intrahepatic cholestasis of pregnancy (ICP), examine their relationship with fasting bile acid concentrations, and assess their association with perinatal outcomes. Methods: This prospective case-–control study included 80 singleton pregnancies followed at a tertiary perinatology center between October 2025 and March 2026. Forty women with ICP, defined by pruritus and fasting bile acids > 10 μmol/L, were compared with 40 healthy pregnant controls. Women with ICP were further stratified according to fasting bile acid levels as <40 and ≥40 μmol/L. Maternal serum afamin concentrations were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Maternal characteristics, liver biochemistry, fetal biometric and Doppler parameters as well as obstetric and neonatal outcomes were compared. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of afamin for ICP, and logistic regression analysis was used to assess its association with ICP. Results: Baseline maternal characteristics were comparable between groups. Maternal serum afamin levels were significantly higher in the ICP group than in controls (6.18 ± 4.24 vs. 3.98 ± 1.95 ng/mL, p = 0.004). Afamin correlated positively with fasting bile acids (r = 0.372, p = 0.018), but not with transaminases, gestational age at delivery, birth weight, or neonatal outcomes. In logistic regression, afamin was independently associated with ICP (adjusted odds ratio [aOR] 1.260; 95% confidence interval [CI] 1.059–1.500; p = 0.009). ROC analysis showed poor discrimination for ICP (area under the curve [AUC] 0.634, 95% CI 0.51–0.76, p = 0.039), whereas afamin did not discriminate between subgroups defined by fasting bile acid levels (<40 vs. ≥40 μmol/L). The optimal cut-off value of 4.93 ng/mL predicted ICP with 55% sensitivity, 67.5% specificity, a positive likelihood ratio of 1.69, and a negative likelihood ratio of 0.67. Conclusions: Maternal serum afamin levels are elevated in ICP and show a modest association with fasting bile acid burden. Its discriminatory performance is limited, and it does not reliably distinguish patients defined by a ≥40 μmol/L threshold. These findings suggest that afamin reflects the maternal response to cholestasis rather than disease severity and may serve as a complementary biomarker. Full article

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease. Full article

Neonatal puppies and kittens face a critical period after birth, during which their health depends heavily on the microorganisms they acquire from their mothers and environment. These microorganisms, known as the gut microbiota, help newborns develop their immune systems, digest nutrients, and protect against disease. This review explores how these microorganisms are transferred from the mother to her offspring before, during, and after birth, including the process of delivery, nursing, and maternal care. It also examines how factors such as birth type, hygiene, feeding, and maternal health can influence the development of these microbial communities. When this process is disrupted, it may lead to health problems such as infections, diarrhea, and immune disorders. Understanding how and when these microbes are passed to newborns, and how to support this process, is essential to improving survival rates and long-term health in puppies and kittens. Full article

Background: Measles remains a significant occupational hazard in healthcare settings. In the context of the 2017–2018 measles outbreak in Greece and amid an outbreak at the study hospital, this seroprevalence study aimed to identify gaps in measles serologic status among healthcare workers in a tertiary hospital in central Greece. Methods: We conducted a seroprevalence study among hospital employees between February and December 2017. Blood samples and data on sociodemographic and work-related characteristics were collected from a convenience sample of participants. Measles IgG and IgM antibodies were measured using the ELISA method to determine seropositivity. The 95% CIs for measles IgG seronegativity proportions were calculated using the Clopper–Pearson exact method. Associations between participant characteristics and measles antibody status were assessed using Firth’s penalized logistic regression models. Results: A total of 336 healthcare workers participated in the study (response rate: 24.9%). Overall, 5.4% (95% CI: 3.2–8.3) tested negative for measles IgG antibodies. No significant associations were observed between participants’ characteristics and measles IgG antibody status. Male participants had 15.8 times higher adjusted odds of testing positive for measles IgM antibodies compared with female participants (aOR: 15.8; 95% CI: 2.33–107.54; p = 0.005). Conclusions: Our results indicate a low—but not negligible—proportion of IgG measles seronegativity among participants. The detection of seronegative individuals born prior to 1970 challenges the assumption of universal natural immunity based solely on year of birth. Given the recent rise in measles outbreaks and the limited seroprevalence data among healthcare workers in Greece, these findings provide valuable data to support ongoing efforts to achieve full vaccination coverage in this group. Further research is warranted to investigate the observed sex differences in susceptibility to measles infection. Full article

Introduction: Placental malaria increases the risk of adverse birth outcomes. Current preventive measures are undermined by poor coverage, growing resistance to chemo-preventive and therapeutic drugs, and vector eliminating insecticides. Candidate placental malaria (PM) vaccines (PAMVAC and PRIMVAC) have shown safety and immunogenicity in Phase I trials, but empirical evidence on their potential population-level value is lacking. This study modelled the expected cost-effectiveness of a PM vaccine administered before pregnancy. Methods: A decision-analytic model compared two strategies from the provider’s perspective: vaccinating women of childbearing age versus no vaccination. The model incorporated gravidity-specific risks of PM, neonatal mortality and the malaria attributable fractions from the literature. Since the efficacy of a PM vaccine for malaria prevention is unknown, we assumed a 40% efficacy and varied this estimate widely in sensitivity analyses. Primary outcomes were incremental cost-effectiveness ratios (ICERs) per perinatal disability adjusted life years (DALYs) averted. Baseline, best-case, and worst-case scenarios were analysed. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Cost-effectiveness was defined as an ICER below half of sub- Saharan Africa’s 2025 GDP per capita ($1556). Results: The vaccine was most cost-effective among primigravidae. Under baseline assumptions (40% efficacy; 30% uptake; $5 dose price), the ICER was $321 per perinatal DALY averted for primigravidae versus $4444 for multigravidae. Best-case assumptions further improved cost-effectiveness ($225 vs. $3148). Sensitivity analyses showed robust cost-effectiveness for primigravidae across all plausible parameter ranges, while ICERs in multigravidae were highly sensitive to programme costs and vaccine efficacy. Cost-effectiveness acceptability curves demonstrated that vaccination becomes favourable for primigravidae at relatively low willingness-to-pay thresholds. Conclusions: A placental malaria vaccine delivered before pregnancy has high potential to be cost-effective in endemic areas when targeted to protect primigravidae. These findings support prioritised deployment strategies and highlight the value of early economic modelling to inform vaccine development and policy planning. Full article

Background: Adverse pregnancy outcomes such as preeclampsia (PE), preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth are major contributors to maternal and neonatal morbidity and mortality. Elevated maternal homocysteine (Hcy) levels, influenced by genetic, dietary, and lifestyle factors, have been increasingly associated with placental dysfunction and adverse pregnancy outcomes. This review aims to evaluate the link between hyperhomocysteinemia and pregnancy complications to inform clinical practice. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Library was conducted up to December 2024. Observational studies assessing maternal Hcy levels in relation to pregnancy complications were included. Heterogeneity was measured using the I² statistic, and a random-effects model using the DerSimonian–Laird method was applied to account for study variability. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. Elevated maternal Hcy was significantly associated with: PE (OR: 2.49; 95% CI: 1.41–4.40; I² = 96.03%; n = 9), preterm birth (OR: 4.01; 95% CI: 1.84–8.72; I² = 91.08%; n = 6), fetal loss (OR: 1.76; 95% CI: 1.22–2.52; I² = 41.47%; n = 6), SGA (OR: 1.69; 95% CI: 1.35–2.11; I² = 0.00%; n = 3), and LBW (OR: 2.46; 95% CI: 1.37–4.43; I² = 77.71%; n = 3). Conclusions: This review highlights a significant association between elevated maternal Hcy levels and various pregnancy complications. However, given the substantial heterogeneity and reliance on observational evidence, these findings should be interpreted with caution. Future well-designed prospective cohort studies with standardized definitions of hyperhomocysteinemia, consistent timing of exposure assessment across pregnancy trimesters, and adjustment for key confounders are needed to better clarify these associations and underlying mechanisms. Full article

Most demographic studies of fertility use data from surveys of women, not men. These studies have shown that, in the U.S., nonmarital births are more common among women from lower rather than higher socioeconomic (SES) backgrounds and higher among Black than White women. Using panel data, which have been shown to reduce men’s under-reporting of nonmarital births, we show that these generalizations also hold for men. Our analysis of nonmarital births for Black and White men and women distinguishes between nonunion and cohabiting births and shows that nonunion births are predicted by racial and SES disadvantage for both women and men. By contrast, cohabiting births are not higher for Black individuals, and they are higher among women whose mothers had less education only among White, and not Black individuals. The effects of race and mothers’ education on having a nonunion first birth are partly mediated by the income and family structure of one’s family of origin, high school grade point average, and school enrollment. We use NLSY-97 panel data from U.S. men and women born in 1980–1984 and present descriptive statistics, double decrement life tables, and event history models. We conclude that disadvantaged racial and SES backgrounds are strongly predictive of having a nonunion first birth for men as well as women. Full article

Background: Short-term morbidities and mortality decreased significantly in the past decade at preterm born < 25 weeks of gestation. Severe lifelong morbidities affect an important part of these patients. Objective: to investigate the in-hospital morbidity, mortality, and short-term complications of preterm neonates born ≤25 weeks of gestation. Methods: A prospective longitudinal cohort study was conducted in children born 2021–2024, ≤25 weeks of gestation, admitted to a 3rd-level unit, and care till discharge. Pregnancy complications’ effect on neonatal evolution was analyzed, six main in-hospital morbidities specific for preterm birth and other aggravating circumstances, with a possible effect on the evolution were analyzed, as follows: inflammatory syndrome, early pulmonary or digestive hemorrhages, and early inotropic support. The neurological development in the first year of life was analyzed through theparticipation of premature infants in the follow-up program after discharge. Results: Forty-nine premature infants were enrolled, with a mean gestational age of 24.37 ± 0.76 weeks and an average weight of 665 ± 143 g. Most newborns required intubation at birth (42/49), and 33/49 received 2-dose surfactant therapy postnatally. NEC was present in 26.5% of the group, being more common in patients with inflammatory syndrome—increase in procalcitonin (PCT), and those who received a higher number of blood transfusions. The BPD and ROP, as well as the severity of the latter, correlated with the oxygen requirement on the 28th day of life. BPD was more common in infants associated with PDA requiring combination treatment. ROP increased with the number of transfusions required by patients. At the follow-up at the first timepoint evaluation, were 51% of the study group, and 30.6% of them had normal neurological development. At 12 months of age, however, the neurological examination was normal in only three patients (23.08%) but only 36.5% of the study group attended the follow-up. Neurodevelopmental disorders were present in 10 of the patients, one with spastic diplegia. Conclusions: In the hospital, the morbidity and survival rate of the group was like other studies. The small number of follow-up participants does not allow the generalization of the data, but as far as neurological development is concerned, it is like that of other studies. Full article

Perinatal mood disorders (PMDs) affect approximately 15% of birthing persons during the pregnancy or postpartum (up to one year after birth) time period. People who recently gave birth and are of diverse backgrounds and identities, especially those who are oppressed, are disproportionately affected by PMDs and may experience these conditions differently. One such group is low-income birthing persons living in urban areas. This article will summarize PMDs, including their prevalence rates and how they are disproportionately experienced among low-income birthing persons living in urban areas. The factors to be reviewed include racism, cultural stigma, community stressors, issues with access to services, lack of resources, socioeconomic concerns, and healthcare system problems. Additionally, how PMDs among low-income birthing persons living in urban areas can be prevented, identified, and treated will be discussed. Strategies include practicing cultural humility and promoting anti-oppressive practice, building positive relationships with birthing persons, utilizing formal and informal social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing barriers to care, and advocating for effective policies. Full article

Background: Despite the introduction in 2017 of mandatory vaccination for the hexavalent and the measles–mumps–rubella–varicella vaccines, childhood vaccination coverage in Sicily (Italy) remains below the recommended and safety threshold of 95%. A catch-up vaccination intervention was implemented for the pediatric population of the 2022–2023 birth cohorts residing in a health district of Palermo (Bagheria) where in 2024, 24-month coverage for polio and measles was 77.29% and 77.62%, respectively. Methods: A cross-sectional study with a before–after component was conducted between June 2025 and December 2025, with the aim of evaluating the increase in vaccination coverage. A questionnaire was administered to the parents of non-compliant children to investigate the determinants of infant vaccine hesitancy. Results: Collaboration with primary care pediatricians and the organization of active call sessions and extra vaccination sessions resulted in an increase in vaccination coverage of approximately 10–12 percentage points in both birth cohorts. The investigation of the determinants of vaccination adherence showed some significant associations: “perception of infectious disease risk” (OR: 7.91; p = 0.009) and “expectations of a positive outcome from vaccination” (OR: 8.62; p = 0.003). Vaccine information sources such as the internet and media were associated with refusal of catch-up vaccination (OR: 0.47, p < 0.001; and OR: 0.13, p = 0.026, respectively). Conclusions: Despite methodological limitations, such as the self-reported nature of the survey data, the study demonstrated the usefulness of local strategies aimed at vaccination catch-up, representing a valuable example of local public health practice and effectively contributing to improved vaccination coverage in the pediatric population. Full article

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth. Full article

Background: The COVID-19 pandemic increased stress experienced by children through individual-, family-, and community-level factors, with potential sex-specific impacts on behavioural outcomes. Children’s resilience may buffer these effects. This exploratory study investigated associations between COVID-19 stress and children’s internalising, externalising, and overall behavioural symptoms, and whether child resilience and sex assigned at birth moderated these associations. Methods: Data (N = 68) came from the longitudinal COVID-19 Impact Study of the Canadian APrON pregnancy cohort of mothers and their children followed for more than 9 years. COVID-19 stress, combining individual-, family-, and community-level stressors, was reported by mothers (mean age = 42.37, SD = 3.72) and their children (53% female; mean age = 10.21 years, SD = 0.43) across three timepoints (October–December 2020; February–May 2021; June–August 2021). Children’s behavioural problems and self-reported resilience were assessed between April and September 2022. Results: COVID-19 stress was not significantly associated with children’s behavioural problems. Moderated-moderation suggested that the association between COVID-19 stress and children’s internalising (T-score estimate = −2.38, 95% CI [−4.08, −0.68]), externalising (T-score estimate = −3.21, 95% CI [−5.09, −1.33]), and overall (T-score estimate = −2.79, 95% CI [−4.45, −1.12]) symptoms may vary by child resilience and child sex assigned at birth. Among females, COVID-19 stress appeared to be associated with more behavioural problems at lower levels of resilience and fewer problems at higher levels of resilience. Significance: The association between COVID-19 stress and children’s behavioural symptoms across children’s resilience levels may vary based on sex assigned at birth, with effects suggested among females. Null findings may reflect the modest sample size and limited statistical power. Full article

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure distances to the nearest vessels via digital image analysis. In situ topography of the liver, stomach, and umbilical vessels was also documented. Results: A midline corridor of reduced vascular density was identified; minimum circumferential distances to deep vessels above the umbilicus averaged 6.84–6.88 mm. Conversely, lateral regions were highly vascular, particularly at or below the transumbilical plane, with distances to deep vessels as short as 1.08 ± 0.83 mm. The liver and stomach extended significantly below the costal margin (averaging 20.61 ± 8.29 mm and 34.18 ± 14.44 mm, respectively). Conclusions: The results establish an anatomical foundation for using the reduced vascular midline for port placement and highlight the importance of inserting secondary lateral ports under direct visualisation. Full article