Search Results (679)

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article

Congenital hypothyroidism (CH) is a leading preventable cause of neurocognitive impairment. Its incidence appears to be rising in several countries. We analysed 27 years of newborn-screening data (1997–2023) from the largest Chilean screening centre, covering 3,225,216 newborns (51.1% of national births), to characterise temporal trends and potential drivers of CH incidence. Annual CH incidence was modelled with Prais–Winsten regression to correct for first-order autocorrelation; additional models assessed trends in gestational age, sex, biochemical markers, and aetiological subtypes. We identified 1550 CH cases, giving a mean incidence of 4.9 per 10,000 live births and a significant yearly increase of 0.067 per 10,000 (95 % CI 0.037–0.098; p < 0.001). Mild cases (confirmation TSH < 20 mU/L) rose (+0.89 percentage points per year; p = 0.002). The program’s recall was low (0.05%). Over time, screening and diagnostic TSH values declined, total and free T4 concentrations rose, gestational age at diagnosis fell, and a shift from thyroid ectopy toward hypoplasia emerged; no regional differences were detected. The sustained increase in CH incidence, alongside falling TSH thresholds and growing detection of in situ glands, suggests enhanced recognition of milder disease. Ongoing surveillance should integrate environmental, iodine-nutrition, and genetic factors to clarify the causes of this trend. Full article

Iron deficiency (ID) is the most prevalent micronutrient deficiency globally, affecting approximately one in four individuals, with a particularly high burden among children, women of reproductive age, and populations in low- and middle-income countries. It contributes significantly to the global burden of disease, with consequences ranging from impaired cognitive and motor development in children to increased risks during pregnancy, including low birth weight, preterm delivery, and maternal mortality, as well as reduced physical performance and quality of life in adults. ID often precedes iron deficiency anemia (IDA), though clinical and functional impairments—such as cognitive deficits, immune dysfunction, and fatigue—can occur even in the absence of anemia. Despite its widespread nature, challenges remain in precisely defining, diagnosing, and treating ID effectively. Advances in diagnostic tools allow for earlier detection, while novel therapeutic strategies, including updated oral dosing regimens and modern intravenous iron formulations, offer improved efficacy and tolerability. These approaches are particularly valuable in minimizing gastrointestinal side effects and enhancing patient adherence. This review is based on a comprehensive literature search conducted primarily through PubMed and Scopus, emphasizing studies published within the past 10–15 years. It is thematically structured to explore the epidemiology, health consequences, diagnostic complexities, and therapeutic developments related to ID. It highlights the multifactorial nature of ID and underscores the urgent need for early identification, targeted interventions, and updated clinical guidelines to reduce the long-term health and societal impacts of this preventable and treatable condition. Full article

Background: Despite the widespread implementation of childhood vaccination programmes, hepatitis B virus (HBV) infection remains an ongoing occupational risk for healthcare students. In multi-ethnic and international university settings, differences in vaccination programmes and immune responses must be considered. This retrospective study aimed to assess the prevalence of protective levels of anti-HBs among medical students at an international university in Rome, exploring associations with demographic and vaccination-related factors. Methods: Data were collected from routine occupational health surveillance conducted in 2023. Anti-HB titres were measured in 507 students, and information on age, sex, country of birth, age at vaccination, and time since the last dose was analysed. Results: Overall, 55.0% of students had antibody levels of at least 10 mIU/mL, indicating serological protection. Higher seroprotection rates were observed among students vaccinated in the first year of life compared to those vaccinated later. A significant decline in antibody titres was also associated with longer intervals since vaccination. Students born outside Europe tended to show lower levels of protection. Conclusions: These results emphasise the importance of screening future healthcare professionals and continuously monitoring antibody titres to help reduce HBV infections. Full article

Background/Objectives: Childhood stunting remains a critical public health issue in low- and middle-income countries. Despite Malaysia’s economic growth, there is limited large-scale evidence on the determinants of stunting among children from infancy to primary school age. This cross-sectional study, part of South East Asian Nutrition Surveys II (SEANUTS II), aimed to determine sociodemographic and environmental risk factors for stunting among 2989 children aged 0.5–12 years. Methods: Children were recruited from four regions in Peninsular Malaysia (Central, East Coast, 2022–2030Northern, Southern). Standing height or recumbent length was measured, and stunting was classified based on WHO criteria (height-for-age Z-score below −2 standard deviations). Parents reported information on socioeconomic status, sanitation facilities, and hygiene practices. Multivariate binary logistic regression was used to determine the determinants of stunting. Results: Stunting prevalence was 8.9%, with infants (aOR = 2.92, 95%CI:1.14–7.52) and young children (aOR = 2.92, 95%CI:1.80–4.76) having higher odds than school-aged children. Key biological predictors included low birth weight (aOR = 2.41; 95%CI:1.40–4.13) and maternal height <150 cm (aOR = 2.24; 95%CI:1.36–3.70). Chinese (aOR = 0.56; 95%CI:0.35–0.88) and Indian children (aOR = 0.16; 95%CI:0.05–0.52) had a lower risk of stunting compared to Malays. Conclusions: This study highlights the ongoing challenge of childhood stunting in Malaysia, with age, birth weight, ethnicity, and maternal height identified as key determinants. These findings call for early identification of at-risk households and targeted support, especially through education and financial aid to foster healthy child growth. Full article

Multiple studies, starting with Preston’s work in 1975, have suggested that gross domestic product per capita (GDPPC) is an important explanatory factor for understanding differentials in life expectancy at birth (LEB) in countries around the world. This proposition was tested in the present study using two-period cross-sectional regression across a large number of both advanced and developing countries and 16 socioeconomic factors, including GDPPC. The best-performing regression equations in the periods around 2000 and 2015 included four to six of these factors (government effectiveness, safe sanitation, poverty and contraception, plus, in the circa-2000 period, the Gini index and CO₂ emissions); perhaps surprisingly, these equations did not include GDPPC. The results were examined in greater detail for the world’s 15 most populous countries, helping to identify key drivers of LEB growth for each of these countries from circa 2000 to 2015. The fact that GDPPC drops out of the best equations calls into question the view that economic growth is the correct primary target for nations seeking to increase their average life expectancy. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

Consanguinity is the marriage of two related persons. This type of marriage is one of the main pillars when it comes to recessive hereditary diseases, birth defects, infertility, miscarriages, abortion, and infant deaths. Intermarriage continues to be a common practice in various communities in North Africa, the Middle East, and West and South Asia, as well as among migrants from Europe and North America, even though in more and more countries it has become illegal. Even if security and stability are some of the motivations for consanguineous marriage, studies show that women often suffer physical and verbal abuse from their husbands. However, because of the blood bond, tolerance for these habits is much higher. In addition, it seems that the divorce rate is much lower because separation would affect the entire state of the family. The choice of partner is significantly influenced by variables such as limited access to education and financial resources. Illiterate people coming from poor rural areas are much more likely to choose consanguineous marriage to maintain wealth in the family. The lack of medical knowledge about the negative effects of consanguinity leads to an increased rate of abortions, infant deaths, and births of children with congenital birth defects. Today, because of the process of urbanization and increased levels of knowledge, the younger generation is becoming increasingly less receptive to this particular form of marriage. In addition, as education has become more accessible to women, they have become more independent and eager to fulfill their own goals and not the wishes of the family. In conclusion, contrary to the many apparent advantages of consanguineous marriage, partners should put genetic risks first, as medical problems bring with them increased costs in the medical system and also within the family, leading to even lower economic status and consequently perpetuation of this type of marriage. Full article

Background: Parental burnout is one of today’s significant challenges, increasingly manifesting as a problem in our fast-paced world. The aim of this review is to create an exploratory, descriptive summary of parental burnout through the analysis of available international publications, providing a clearer and more accurate understanding of the psychological condition, severity, manifestations, and treatment options. Methods: Our narrative literature review includes publications from 2010 onwards, focusing on those that directly address the topic of parental burnout syndrome and contain epidemiological data, risk factors, symptoms, diagnostic possibilities, and treatment strategies. We excluded publications that examined the condition within narrow societal groups, such as parents caring for children with somatic mental disorders. Results: Based on our review, it appears that parental burnout may potentially affect both women and men. Factors such as low emotional intelligence, workplace stress, and lack of supportive family background render parents vulnerable to this condition. Significant differences in the prevalence of parental burnout can be measured between countries, due to cultural differences. Parental burnout has extremely detrimental effects on family dynamics and the emotional development of children, and it can negatively impact the willingness to have more children at the family level, which has dire consequences considering the low birth rates characteristic of European countries. Full article

Background: Respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract infections and hospitalizations in infants and young children globally. Recently, RSV prevention has advanced with the introduction of nirsevimab, a long-acting monoclonal antibody, and the RSV preF vaccine for maternal immunization. While these interventions have improved early protection, several limitations hinder their broader impact and long-term effectiveness. Methods: This narrative review synthesizes evidence from clinical trials, observational studies, and regulatory reports to evaluate the main limitations of nirsevimab and maternal RSV vaccination. Literature searches were conducted in major databases, focusing on efficacy, safety, immunogenicity, implementation, and population-specific challenges. Results: Both nirsevimab and maternal vaccination provide strong protection during the first six months of life, but their effectiveness wanes thereafter. This is concerning as nearly half of RSV-related deaths occur in children over six months old. Maternal vaccine efficacy is uncertain in very-preterm infants, and safety concerns persist, including potential associations with preterm birth, Guillain–Barré syndrome, and hypertensive disorders. Real-world data from low-income countries are lacking, limiting generalizability. Additionally, the risk of vaccine-associated enhanced disease (VAED), although unconfirmed, has delayed pediatric vaccine development. Emerging monoclonal antibodies and live-attenuated vaccines are under investigation to extend protection beyond infancy. Conclusions: Despite substantial progress, current RSV prevention strategies leave critical gaps, particularly for older infants and underserved populations. There is a pressing need for next-generation vaccines, enhanced pharmacovigilance, and equitable global implementation to ensure sustained and inclusive RSV protection. Full article

Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes. Full article

Accurate population counts and the identification of granularity within aggregated groups are essential for informing funding formulas and health policies, an issue of global significance. Relying solely on aggregated ethnicity-based population counts has limited utility for ethnic minority groups. Accurate and relevant population counts are critical for monitoring and improving outcomes related to health, social welfare, and education. This paper examines additional dimensions of identity to provide a revised estimate of the total population count for Peoples of Fiji (PF) living in Aotearoa. Customised data tables from the Census of Population and Dwellings, provided by Statistics New Zealand, were analysed using ethnicity and additional recorded characteristics, such as country of birth, and parents’ ethnicity, to obtain more accurate counts for the major ethnic groups from Fiji living in Aotearoa. Our analysis revealed that almost 50,000 Fijian Indians were misclassified. Utilizing additional variables, we estimate the revised count for the Fijian Indian ethnic group alone exceeds 70,000 and the PF total count exceeds 2% of Aotearoa’s current population. We highlight significant variations in ethnicity coding for PF and their implications for health monitoring and risk assessment, data quality, and interpretation. We make key recommendations to improve granular reporting for minority migrant groups in Aotearoa. Full article

Invasive neonatal GBS infections constitute a major cause of sepsis and meningitis in Western countries. Vaginal/rectal GBS colonization during pregnancy is the main risk factor for the development of early-onset infections (GBS-EOD) in newborn by vertical transmission at birth, in addition to prematurity and stillbirth. In Italy, intrapartum antibiotic prophylaxis (IAP) to prevent GBS-EOD is offered to pregnant women who tested as GBS-positive in late pregnancy. Passive surveillance in Italy showed that a non-negligible number of GBS-EOD cases (about 50%) occurred from GBS-negative pregnant women. This finding prompted the launch of a national online survey from 15 December 2022 to 12 February 2023 to investigate the microbiological procedures followed for GBS identification in Italian public and private microbiology laboratories, the prevalence of maternal GBS colonization, and the incidence of GBS-EOD cases. The survey results demonstrated that national guidelines for the prevention of EOD-GBS cases as well as harmonization of microbiological methodologies for GBS identification in the antenatal screening are needed. Full article

Background: Adherence to iron supplementation is influenced by systemic barriers, including poor healthcare infrastructure, shortage of healthcare providers, and limited access to antenatal care (ANC) services. These challenges are more pronounced in rural areas. However, evidence on urban–rural disparities in non-adherence to iron supplementation remains limited, particularly in sub-Saharan Africa. This study examined these regional differences, stratified by income levels and national contexts. Method: This analysis utilised Demographic Health Survey (DHS) data conducted between 2015 and 2023 from 26 sub-Saharan African countries, including 287,642 women from urban (n = 91,566) and rural areas (n = 196,076). The outcome of this study was non-adherence to iron supplementation, defined as taking iron supplementation for less than 90 days during pregnancy. This study examines urban–rural differences in non-adherence stratified by country income levels based on World Bank 2022 income classifications and national context. A chi-square test was used to assess urban–rural differences, with a p-value of <0.05 considered statistically significant. Results: Non-adherence was significantly higher in rural areas (68.42%) than in urban areas (51.32%) (p < 0.001), with the disparity more pronounced in low-income countries (LICs). Ethiopia, Madagascar, Uganda, and Burundi were among the countries with the highest rural non-adherence, reflecting severe poverty and limited access to ANC. In contrast, Zimbabwe showed an inverse trend, where rural adherence was higher than urban. Conclusions: Rural sub-Saharan Africa has significantly higher non-adherence to iron supplementation, particularly in LICs, likely driven by systemic barriers such as poor infrastructure and limited access to healthcare. This non-adherence in rural areas undermines efforts to improve pregnancy and birth outcomes across the region. Targeted interventions, like those in Zimbabwe, can help address these inequities and improve maternal health outcomes. Full article

Background and Clinical Significance: The incidence of persistent ductus arteriosus (PDA) in preterm infants is the highest and depends on their birth weight (BW) and respiratory condition after birth. Previously, after the unsuccessful drug treatment, surgical ligation was the primary treatment option. However, according to clinical studies, the Amplatzer Piccolo Occluder was approved for PDA closure for patients ≥700 g. In our country, percutaneous PDA embolization has not been performed yet. Case Presentation: We present three premature infants with hemodynamically significant patent ductus arteriosus (hsPDA) in whom percutaneous occlusion was performed using the Amplatzer Piccolo Occluder (APO). The average gestational week (GW) was 27 ± 1, while body weight was 1030 ± 60 g. All patients had respiratory deterioration, with dilatation of the left heart chambers, and renal failure. The second developed a severe form of broncho-pulmonary dysplasia. Transthoracic echocardiography (TTE) examinations revealed a hemodynamically significant PDA (LA/Ao 1.8–2.2) and medical closure was unsuccessfully carried out. Due to the hemodynamically significant PDA maintenance in all neonates, transvenous PDA closure was performed using the APO (APO 9-PDAP-04-02-L, 9-PDAP-04-04-L, 9-PDAP-05-054L, respectively). The entire devices, with both retention discs, are implanted within the duct. TTE pointed out adequate device position without descending aorta, left pulmonary artery obstruction, residual shunt, and reverse remodelling of the left ventricle and left atrium. The first newborn was weaned from mechanical ventilation three days after the procedure and discharged three weeks after. The second patient was extubated 2 weeks after the procedure, and even the severe BPD, X-ray showed improvement. The third patient’s renal failure completely resolved, weaned from inotropic drug support and mechanical ventilation. Conclusions: Due to a significantly lower complication rate than surgical ligation, we will strive to make percutaneous PDA occlusion a new standard for treatment in newborns, especially preterm newborns, in our country. Full article