Search Results (54)

Neonatal jaundice (NNJ) is a leading cause of death in the early neonatal period, disproportionately affecting newborns in sub-Saharan Africa. In a setting without access to rapid assessment via transcutaneous bilirubin meter, we sought to determine how closely the diagnosis and treatment of neonatal jaundice at an urban district hospital aligned with retrospective assessment and treatment recommendations using the BiliApp (based on the UK NICE Guideline CG98). This retrospective chart review study aimed to identify: (1) What percent of admissions within 8 days of birth to the Mother and Baby Unit (MBU) at our study site were admitted for a primary diagnosis of neonatal jaundice, and what characterized those admissions? (2) How did treatment provided compare to the recommendations of the United Kingdom NICE Guideline CG98 via the “BiliApp”? and (3) Among those with jaundice, what factors were associated with an increased likelihood of severity indicative of the need for blood exchange therapy? The charts of all neonates admitted to the MBU at Suntreso Government Hospital (SGH), in Kumasi, Ghana, in 2020 were reviewed by trained research assistants. Data were collected regarding demographics, reason for admission, diagnostic markers (e.g., serum bilirubin level), treatments performed in the hospital, and outcome. Data were analyzed using Stata 18.0. There were 1059 newborns admitted to the MBU in 2020 at less than 8 days of age. A total of 179 (16.9%) were admitted with a primary diagnosis of neonatal jaundice. According to the BiliApp, 29.4% (n = 50) of newborns admitted for jaundice had bilirubin levels that were normal or below the phototherapy threshold for their gestational age on admission; 25.3% (n = 43) were at or near the threshold for phototherapy; 21.2% (n = 36) were above the phototherapy threshold; and 24.1% (n = 41) were above the blood exchange therapy threshold. The BiliApp recommended no treatment for 21.2% (n = 36) of newborns, repeated assessment for 33.6% (n = 57), phototherapy for 21.2% (n = 36), and exchange therapy for 24.1% (n = 41). By comparison, 8.2% (n = 14) of neonates admitted for jaundice received no treatment, 77.8% (n = 133) received phototherapy only, and 14.0% (n = 24) received both phototherapy and exchange therapy. Without sufficient data on G6PD status and parent/newborn blood type to include in the analysis, the biggest risk factors for a BiliApp recommendation of exchange therapy included serum bilirubin level (OR 1.01, p < 0.001) and gestational age (OR 0.51, p < 0.001), even after controlling for breastfeeding and male sex of the newborn. Without access to rapid assessment tools, many providers in low-resource settings are put in a position to presumptively treat newborns suspected of having jaundice, rather than waiting for serum lab tests to return. Given the cost of transcutaneous bilirubin meters, additional options for rapid diagnostic testing are warranted. Full article

A Neonatal Intensive Care Unit (NICU) stay complicates the transition to parenthood for new mothers. Women respond differently to perinatal stressors, which can impact their mental health and relationship with their new baby. Mothers’ own histories of adverse and benevolent childhood experiences can also shape their early parenting experiences. This study investigated the relationship between mothers’ adverse and benevolent childhood experiences and the observed and reported quality of interactions with their infant at 1 year following a NICU stay. Somewhat unexpectedly, we found that more maternal childhood adversity predicted less intrusive behavior and more responsiveness during a free play interaction at 12 months, while more benevolent childhood experiences predicted higher levels of observed intrusive mothering. Childhood experiences were not related to maternal perceptions of parent–child interaction quality. The length of the NICU stay was positively associated with maternal responsiveness. Findings highlight that childhood risk and protective factors may interact uniquely with a stay in the NICU, with greater adversity and a longer stay predicting more maternal responsiveness and sensitivity. Our study offers evidence that mothers can overcome their own early life challenges, and that overcoming childhood adversity may build resilience that uniquely prepares mothers for the challenge of a NICU stay. Full article

The aim of this study was to assess some variables of women in the 27th week of pregnancy and after childbirth, in addition to determining which of these variables were associated with low birth weight during the coronavirus disease (COVID-19) pandemic. The patients were divided into two groups: mothers with normal-weight babies (G1 = 60) and mothers with below-normal-weight babies (G2 = 16). The variables assessed were education, monthly family income, anthropometric parameters, systemic health, periodontal condition, oral hygiene habits, Oral Health Impact Profile–14 results, data from the babies at birth, and a COVID-19 diagnosis during pregnancy. The mothers in G1 showed greater weight gain during pregnancy. There was an increase in tooth plaque percentage, probing pocket depth, and clinical attachment level during the study period for both groups and an increase in periodontitis cases in the patients from G1. The mothers from G1 had longer pregnancy periods and delivered taller babies with a higher body mass index. A one-unit increase in weight during pregnancy decreases the likelihood of having a below-normal-weight baby by 11.3% [confidence interval = 2.4–20.4%]. Weight gain during pregnancy is a protective factor that decreases the likelihood of babies being born with below-normal weights. Full article

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF > 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF > 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling. Full article

This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient-centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community? This demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Data for maternity units show extreme and unexplained variation in turn-away. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay ‘saves’ money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase ‘efficiency’. Indeed, up to 60% of calculated maternity ‘costs’ are apportioned from (shared) hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, known as ‘the fixed costs dilemma’, are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as ‘boomerang babies’, and then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems. Full article

Background: The first year of life is the period of greatest brain plasticity. Postpartum depression can adversely affect the first interactions with the child and, consequently, their emotional, social, and cognitive development. Objectives: First, to describe the developmental profile of six-month-old infants of mothers suffering from severe postpartum depression, and, second, to compare the development of infants whose mothers suffer from depression with or without bipolar disorder. Methods: This is a retrospective descriptive study on 6-month-old babies hospitalized with their mothers at the Marseille Mother–Baby Unit (MBU) for maternal postpartum depression with or without bipolar disorder. Mothers were clinically diagnosed by a psychiatrist specialized in postpartum depression using the DSM-5; infant development was assessed at 6 months by an independent health professional using the revised Brunet–Lézine Scale, which allowed the calculation of global and partial developmental quotients (DQ). Results: We followed 40 mother–infant dyads. None of the 40 infants had a global developmental delay. However, maternal depression was significantly associated with poorer sociability (mean sociability DQ score of 94 ± 9.6, p < 0.001) and lower postural development (mean postural DQ score of 96.2 ± 8.9 *, p < 0.001) in the infants at 6 months of age. Postural development was significantly lower in children of bipolar mothers than in children of non-bipolar mothers (p = 0.03). Conclusions: Postpartum depression was associated with a weakness in sociability and posture at the age of 6 months, without relevant developmental delay. Screening infants at an early age with specific tools allows for earlier intervention, which would positively influence their developmental trajectory. Full article

Maternal vaccination during pregnancy, in general and against COVID-19 infection, offers protection to both mother and baby, but uptake remains suboptimal. This study aimed to explore the perceptions regarding COVID-19 vaccination in pregnancy, particularly for marginalised populations and those living with social or medical complexity. A total of 96 semi-structured in-depth interviews were conducted with 40 women, 15 partners, 21 HCPs, and 20 policy makers, across all four nations of the United Kingdom (UK), discussing their lived experience of utilising, delivering, or developing policy for COVID-19 vaccination in pregnancy during the pandemic. Three themes were derived: (1) historical and social context, (2) communication of information and guidance, and (3) appraisal and action. Together these captured the participants’ legacy of mistrust in drugs during pregnancy; prior positive experiences; concerns about missing information, conflicting information, or false information about COVID-19 vaccines; and confusing guidance for pregnant women. The final theme describes the participants’ behaviour and actions undertaken consequent to their experiences and the available information. The findings suggest efforts to improve COVID-19 vaccination in pregnancy may be best focused on personalised communication of information. A trusting relationship and prior positive experiences with other vaccines, both in and outside of pregnancy, positively influenced perceptions of COVID-19 vaccination. Full article

A neonatal intensive care unit (NICU) hospitalization can add significant stress to the postpartum period. Parents experience isolation and uncertainty, which can affect their capacity to bond with their new baby. Understanding how stress is shaped by and changes following a NICU experience will help in developing supports for these families. We examined patterns of parenting stress over the first year of life following a NICU stay to better understand changes in stress, differences in maternal and paternal stress, and how medical and developmental variables impact parent stress. Parents of infants (n = 51) who had experienced a NICU hospitalization and met criteria for California’s High-Risk Infant Follow-Up program completed assessments at 6, 9, and 12 months. A comparison group (n = 38) from a historic dataset included parents of infants born full term without medical complications. NICU parents reported higher levels of parenting stress at 6 months, but not 12 months, with mothers and fathers reporting similar stress levels. Parenting-related stress was found to be relatively stable and consistent over this period. Among NICU parents, lower developmental level at 12 months was associated with more distress in interacting with their child. These findings highlight the importance of monitoring parenting stress following discharge from the NICU and developing interventions for supporting parents of NICU graduates showing developmental delays. Full article

Growing evidence indicates that human milk oligosaccharides (HMOs) are important bioactive compounds that enhance health and developmental outcomes in breastfed babies. Maternal dietary intake likely contributes to variation in HMO composition, but studies identifying diet–HMO relationships are few and inconsistent. This study aimed to investigate how the maternal intake of macronutrients and micronutrients—specifically proteins, fats, vitamins, and minerals—associated with HMOs at 1 month (n = 210), 6 months (n = 131), and 12 months postpartum (n = 84). Several associations between maternal dietary factors and HMO profiles were identified utilizing partial correlation analysis. For example, maternal free sugar (rho = −0.02, p < 0.01), added sugar (rho = −0.22, p < 0.01), and sugary sweetened beverage (rho = −0.22, p < 0.01) intake were negatively correlated with the most abundant HMO, 2′-fucosyllactose (2′-FL), at 1 month, suggesting that higher sugar consumption was associated with reduced levels of 2′-FL. Further, vitamins D, C, K, and the minerals zinc and potassium were positively correlated with 2′-FL at 1 month (p_All < 0.05). For the longitudinal analysis, a mixed-effects linear regression model revealed significant associations between maternal vitamin intake and HMO profiles over time. For example, for each unit increase in niacin intake, there was a 31.355 nmol/mL increase in 2′-FL concentration (p = 0.03). Overall, the results provide additional evidence supporting a role for maternal nutrition in shaping HMO profiles, which may inform future intervention strategies with the potential of improving infant growth and development through optimal HMO levels in mothers’ milk. Full article

Human milk is a biofluid with a unique composition among mammalian milks. Besides this milk’s major components, its bioactive compounds, like hormones, immune factors, and oligosaccharides, are unique and important for infant growth and development. The best form of nutrition for term and preterm infants is the mother’s own milk. However, in the absence of the mother’s own milk, donor milk should be made available. Milk banks support neonatal intensive care units by providing preterm infants with human milk that generally has reasonable nutritive value for this sensitive population. However, neither mother’s own milk nor donor milk has sufficient energy content for the growth of preterm babies, so adequate human milk supplementation is crucial for their progress. Due to the different characteristics of human breast milk, as well as ubiquitous environmental pollutants, such as microplastics, new methods are required for monitoring the quality and characteristics of human milk, which will lay a solid foundation for the further development and progress of human milk research. Full article

Pertussis is an important cause of mortality and morbidity in infancy. It is recommended that close contacts of the baby be vaccinated with Tdap, and this practice is called the cocoon strategy. This study aimed to investigate the applicability of the cocoon strategy and to determine the factors affecting the process. Mothers of babies who were hospitalized in the neonatal intensive care unit were included in the study. In the first stage, a face-to-face questionnaire was given to the mothers to measure their level of knowledge about whooping cough and its vaccine. In the second stage, written and verbal information about the cocoon strategy was given, and then vaccination intentions for Tdap were learned. In the third stage, all mothers were contacted 3 weeks after and asked whether they had received a Tdap vaccination and why. Of these mothers, 68% could not answer any questions about pertussis disease and vaccines correctly. After the information, 35% (n = 78) of the mothers stated that they were considering getting vaccinated, while only 2% (n = 5) of the mothers were able to get the Tdap vaccine. The most important reasons for not getting vaccinated were a lack of time (24%) and the cost of vaccination (23%). It is predicted that Tdap vaccination rates may increase if the cost of vaccine, availability of vaccine, and the access of mothers to the vaccine application are facilitated. Full article

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother’s age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62–7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46–0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67–8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24–8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32–0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions. Full article

The objective evaluation of an infant’s activity and sleep pattern is critical in improving the comfort of the babies and ensuring the proper amount of quality sleep. The predefined behavioral states of an infant describe their consciousness and arousal level. The different states are characterized by different movements, body tone, eye movements and breath patterns. To recognize and adapt to these states is an essential part of development-friendly caring. It affects the neonate’s sleep, influencing their brain development, while improving the bonding between mother and baby, and feeding is more successful during the state of quiet awakened. It can be a more difficult task to determine the level of arousal in premature neonates. In preterm clinics, the general practice is continuous observation, requiring the attention of the hospital staff. To create an automated, more objective system, helping the hospital staff and the parents, we developed a multi-RNN (multi-recurrent neural network) network-based solution to solve this classification problem, which works on a time-series-like feature set, extracted from cameras’ video feeds. The set is composed of video actigraphy features, video-based respiration signal and additional descriptors. We separate infant caring from undisturbed presence based on our previous ensemble network solution. The network was trained and evaluated using our database of 402 h of footage, collected at the Neonatal Intensive Care Unit, Dept. of Neonatology of Pediatrics, Dept. of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary, with all-day recordings of 10 babies. Full article

This paper is part two of a series of papers written by the mothers of Neonatal Intensive Care Unit (NICU) graduates. The companion paper, “Parent Perspectives: Part 1—Considerations for Changing the NICU Culture”, considers all aspects of the NICU experience and provides recommendations for interventions and improvements from a life-course perspective while families are in the NICU. In part two, the focus is the transition home post-NICU stay. The time after NICU discharge is a critical and sensitive developmental period for NICU babies and their families, and an important life course transition. This paper provides a parent’s perspective of how to improve the transition home post-NICU stay. Our perspectives draw on the Life Course Health Development approach, which regards health as an active process that is developed over time based on a person’s internal biologic and physiologic systems, their external environment and circumstances, and the interactions or relationships between them. This paper describes a collaborative care model where parents and their healthcare teams work together to develop shared care plans. It also describes how we can build trust and family capacity to support long-term care, ensure family well-being, and link families to needed resources and support that can ease the transition from the NICU back to the home and optimize family health trajectories. Full article

Introduction: We aimed to explore the lived experiences of caesarean birth complicated by impaction of the foetal head, for mothers and midwives. Methods: A pragmatic, qualitative, focus group study of mixed-participants was conducted, face-to-face. They were postpartum women (n = 4), midwives (n = 4), and a postpartum midwife (n = 1) who had experience of either providing care for impacted foetal head, and/or had experienced it during their own labour, in Fife, United Kingdom. Data were transcribed and were analysed using template analysis. Results: Three main themes emerged through analysis: (i) current knowledge of impacted foetal head; (ii) current management of impacted foetal head; and (iii) experiences and outcomes of impacted foetal head. Each theme was made up of various initial codes when data were analysed inductively. Finally, each theme could be overlaid onto the three core principles of the Tydeman Tube: (1) to improve outcomes for mother and baby in the second stage of labour; (2) to reduce the risk of trauma to mother and baby in complicated births; and (3) to increase respectful care for women in labour; thus allowing for a neat analytic template. Conclusion: A lack of consensus regarding definition, management, and training were highlighted by the midwives. Women anticipated caesarean birth in late labour as straightforward and were therefore unaware of this potential complication. Women and midwives would welcome any new device to facilitate delivery of the impacted foetal head (IFH) as long as it is fully evaluated prior to widespread introduction. Women were not averse to being part of this evaluation process. Full article