Search Results (191)

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Background: Prematurely born newborns with low birth weight constitute a group of patients who require special care from the first days of life. Prematurity and low birth weight affect about 13.4 million infants. Risk factors include placental disorders but also factors related to the mother, such as smoking, alcohol drinking, drug use, malnutrition, or certain diseases. It is imperative to educate women of reproductive age (15–49) about the basic factors influencing embryonic development, such as oral health, diet, medicine intake, and harmful habits. Even though most women are aware of the negative impact of harmful habits on the fetus, still too little attention is paid to oral health in pregnant women. Poor oral health may influence the well-being of the future mother, as well as of the child. Therefore, women of reproductive age and those who are pregnant must have adequate knowledge on this subject. The aim of this study was to assess the knowledge of Polish women of reproductive age (15–49) regarding oral health during pregnancy, including the impact of dental treatment, oral hygiene, and maternal oral conditions on pregnancy outcomes and the health of the newborn. Materials and Methods: This was a cross-sectional study of 508 women, in the reproductive age, whose age ranged from 18 to 49 years old. The surveys were conducted from April 2020 to November 2020. The questionnaire was originally developed based on the available literature and consisted of seven sections: basic information, general health and habits, pregnancy status and dental care, knowledge of treatment options during pregnancy, oral health status and its association with the risk of preterm birth, prematurity and the child’s oral health, and breastfeeding and oral development. Results: After excluding incomplete questionnaires, a total of 499 questionnaires were included in the analysis. Women participating in the study had a fairly good understanding of the impact of oral health on the fetus and the role of breastfeeding in the development of the stomatognathic system (from 50% to 70% correct answers). However, even though most respondents had completed higher education (344/68.94%), their knowledge of oral health, preterm birth, and low birth weight was very limited (including the impact of inflammation on the intrauterine development of the child or bacteria and transfer across the placenta). In these sections, the percentage of correct answers ranged from less than 20% to 50%. When analyzing knowledge by age, education, number of births, and place of residence, the highest levels of knowledge were observed among respondents with higher education, particularly those aged 27–32. Conclusions: Respondents had a fairly good understanding of the general impact of oral health during pregnancy and recognition of the importance of breastfeeding for infants. However, their knowledge about the impact of bacteria and inflammation in the mother’s oral cavity on prematurity and low birth weight was limited. Therefore, educating women of reproductive age and pregnant women on this topic is essential, as it may help reduce the adverse consequences of prematurity. Full article

In recent years, advances in organ transplantation medicine have led to an increase in pregnancies and births following transplantation. Pregnancy after organ transplantation is considered high-risk, and its impact on both the recipient and the child must be carefully evaluated. In this review, we summarize the current landscape of pregnancy and childbirth after organ transplantation, with a particular focus on uterus transplantation (UTx). Traditionally, organ transplants have involved vital organs; however, UTx, developed for women with absolute uterine factor infertility, represents a novel approach. Although the number of births following UTx remains limited, it is expected to grow due to the international expansion of this procedure. Importantly, the concept of pregnancy and delivery following UTx is fundamentally different from that of other organ transplants. UTx is a life-enhancing, non-vital, and temporary transplant uniquely intended to enable the creation of new life. Pregnancy after UTx carries specific risks such as a higher incidence of miscarriage, preterm birth, hypertensive disorders of pregnancy, and gestational diabetes. All deliveries are performed via cesarean section, and conception is typically allowed after a relatively short period following transplantation, given the temporary nature of the graft and the goal to minimize recipient burden, with generally good neonatal outcomes. As pregnancies after both solid organ transplantation and UTx continue to rise worldwide, the development of standardized, organ-specific perinatal management strategies, particularly for UTx, is essential. Multidisciplinary collaboration will be critical to supporting these high-risk pregnancies and ensuring the best possible maternal and neonatal outcomes. Full article

Background: Adolescents with a chronological age of less than 15 years or a gynecological age of less than 2 years may have a higher probability of complications because they are more likely to conceive within 1 to 2 years of menarche and, therefore, are still growing and maturing. This could impair their ability to adapt to the physiological demands of pregnancy. Objective: To evaluate the relationship between chronological age and gynecological age with low birth weight and small for gestational age among adolescent mothers in Mexico City. Methods: A retrospective cohort design of adolescent mother–child dyads was conducted. The study followed 1242 adolescents under 19 years of age and their children, collecting data on physical, socioeconomic, and clinical characteristics, including hemoglobin levels. Low birth weight was assessed using the Intergrowth-21st project standards and categorized as above or below 2500 g. The mothers were grouped by chronological age (<15 years and ≥15 years) and gynecological age (<3 years and ≥3 years). Adjusted odds ratios were calculated using binary logistic regression models. The outcome variables were low birth weight and small for gestational age. The independent variables included gynecological age, chronological age, age at menarche, hemoglobin concentration, and gestational weight gain, among others. All independent variables were converted to dummy variables for analysis. Calculations were adjusted for the following variables: marital status, maternal education, occupation, educational lag, family structure, socioeconomic level, pre-pregnancy body mass index, and initiation of prenatal care. Results: The average age of the participants was 15.7 ± 1 years. The frequency of small for gestational age and low birth weight was 20% and 15.3%, respectively. Factors associated with small for gestational age included gynecological age < 3 years [aOR = 2.462, CI 95%; 1.081–5.605 (p = 0.032)], hemoglobin < 11.5 g/dL [aOR = 2.164, CI 95%; 1.08–605 (p = 0.019)], insufficient gestational weight gain [aOR = 1.858, CI 95%; 1.059–3.260 (p = 0.031)], preterm birth [aOR = 1.689, CI 95%; 1.133–2.519 p = 0.01], and living more than 50 km from the care center [aOR = 2.256, CI 95%; 1.263–4.031 (p = 0.006)]. An early age of menarche [aOR = 0.367, CI 95%; 0.182–0.744 (p = 0.005)] showed a protective effect against small for gestational age. Factors associated with low birth weight included gynecological age < 3 years [aOR = 3.799, CI 95%; 1.458–9.725 (p = 0.006)], maternal age < 15 years [aOR = 5.740, CI 95%; 1.343–26.369 (p = 0.019)], preterm birth [aOR = 54.401, CI 95%; 33.887–87.335, p = 0.001], living more than 50 km from the care center [aOR = 1.930, CI 95%; 1.053–3.536 (p = 0.033)], and early age of menarche [aOR = 0.382, CI 95%; 0.173–0.841 (p = 0.017), which demonstrated a protective effect, respectively. Conclusions: The study concludes that biological immaturity, particularly early gynecological age, significantly contributes to adverse birth outcomes during adolescent pregnancies. Interestingly, early menarche appeared to have a protective effect, whereas chronological age was not a significant predictor of small for gestational age. Chronological age has an even greater impact: women younger than 15 years are 5.7 times more likely to have low birth weight infants. However, chronological age did not increase the likelihood of having an SGA newborn. Full article

Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article

Background/Objectives: Research shows that mothers of premature infants can experience increased symptoms of anxiety, depression, and even a post-traumatic stress in comparison to mothers of healthy, full-term infants. The aim of this study was to analyze and compare anxiety, coping, and self-efficacy in mothers who have and have not experienced a preterm birth, providing a basis for developing a targeted, mother-oriented support program that supports their adjustment to difficult situations. Methods: The study included 251 women, 112 of whom delivered infants prematurely (PTB group) and 139 who delivered infants at term (T-B group). Data were collected by using (1) The State-Trait Anxiety Inventory (STAI) Questionnaire, (2) the Generalized Self-Efficacy Scale (GSES), and (3) the Coping Inventory for Stressful Situations Questionnaire (CISS). Results: PTB women had higher results in anxiety in comparison to T-B women. Also, they were characterized by statistically significantly lower generalized self-efficacy and ability to cope with stress. PTB women more often presented the emotion-oriented coping style. Conclusions: A mother-oriented support program based on personal resources is a solution which could help mothers better adjust to difficult situations related to preterm birth child treatment and care. Full article

Background: Children’s interstitial and diffuse lung diseases, commonly referred to as “chILDs”, include around 200 rare conditions that disrupt normal lung function. They are classified, based on etiopathogenesis, into several subgroups, having a varied and multifaceted clinical presentation depending on the type of genetic mutation present. Methods and Results: We describe the case of a late preterm newborn presenting soon after birth with respiratory distress syndrome poorly responsive to surfactant administration, in whom a targeted gene panel analysis for pulmonary congenital diseases, performed using next-generation sequencing (NGS), revealed a novel compound heterozygous variant of the ATP-Binding-Cassette-Subfamily-A-Member-3 (ABCA3) gene. A review of the literature on the subject completes our work. Conclusions: Molecular genetic analysis has become crucial for a more targeted therapeutic treatment, along with the only current curative treatment option that is lung transplantation. Full article

Pediatric chronic kidney disease (CKD) is a growing concern that often originates early in life, yet significant challenges remain in translating clinical guidelines into real-world practice. World Kidney Day 2025 highlights the importance of early detection, but the three levels of preventive strategies commonly recommended for adults may not be directly applicable to children. Unlike adult CKD, primary prevention in pediatrics should focus on prenatal, neonatal, and early-life factors such as congenital anomalies of the kidney and urinary tract (CAKUT), preterm birth, maternal health, and environmental exposures. Secondary prevention, involving early detection through screening, is crucial, yet the effectiveness of mass urinary screening in children remains a subject of global debate. Several key challenges persist, including the accurate estimation of glomerular filtration rate (eGFR), consistent definition and diagnosis of pediatric hypertension, identification of reliable biomarkers, and targeted screening in specific pediatric populations. Although clear guidelines exist to manage CKD progression and enhance quality of life, a critical gap remains between what is known and what is practiced. Closing this gap requires robust evidence to inform best practices, improve health-related quality of life, and advance pediatric kidney replacement therapies. To protect and improve kidney health for every child worldwide, these challenges must be acknowledged, and sustainable, evidence-based solutions must be developed and implemented without further delay. Full article

Air pollution exposure has been increasingly linked to adverse pregnancy outcomes. This study aimed to investigate the effects of PM_2.5 exposure throughout pregnancy on preterm birth, low birth weight (LBW), and small for gestational age (SGA). We analyzed a cohort of 16,965 pregnant women living in northern Thailand between 2016 and 2022. PM_2.5 concentration data were collected from two air quality monitoring stations operated by the Pollution Control Department (PCD) of Thailand. Logistic regression models were used to assess the association between daily PM_2.5 exposure and pregnancy outcomes. PM_2.5 exposure at levels exceeding 37.5 μg/m³ throughout pregnancy significantly increased the risk of preterm birth (aOR = 2.19, p < 0.001) and LBW (aOR = 1.99, p < 0.001) compared to the reference group (15.1–37.5 μg/m³). However, exposure at levels ≤15.0 μg/m³ also increased the risk for both outcomes compared to the same reference group. Subgroup analysis of high-risk pregnant women, including women aged > 35 years, with pre-pregnancy BMI (<18.5), pregnancy-induced hypertension, and nulliparous women, showed that the range of the critical PM_2.5 exposure threshold was 32.3–38.4 μg/m³ for preterm birth and 31.2–38.2 μg/m³ for LBW. This study highlights the significant association between PM_2.5 exposure and adverse pregnancy outcomes and suggests the need for targeted interventions to mitigate its effects on maternal and child health. Full article

Breastfeeding after kidney transplantation remains a complex and underexplored topic, primarily due to concerns regarding the safety of immunosuppressive therapies during lactation. Individuals who have received kidney transplants face a higher likelihood of delivering preterm infants and giving birth to babies with a low birth weight when compared with the general population. In this context, breastfeeding is increasingly important because of its advantages for preterm infants. Despite the well-established benefits of breastfeeding for both the mother and infant, the traditional recommendation has been to avoid nursing due to potential drug transmission through breast milk. However, emerging evidence suggests that certain immunosuppressants may be compatible with breastfeeding, challenging long-standing clinical guidelines. In this review, we examine the current literature on the pharmacokinetics, safety profiles, and clinical outcomes associated with key immunosuppressive agents, including cyclosporine, tacrolimus, everolimus, azathioprine, corticosteroids, and belatacept. Our work highlights that all published reports to date on the studied treatments indicate that the amount of the drug reaching breast milk is considered safe for the child’s health. These conclusions, however, are derived from very short-term measurements and small numbers of patients. Therefore, we emphasize the need to design structured prospective studies to assess safety in the medium and long term. Our review aims to equip clinicians with the most up-to-date evidence on this topic, enabling them to make informed decisions regarding the compatibility of post-kidney transplant treatments with breastfeeding. Full article

The literature has identified several common acute and chronic complications associated with periodontal health during pregnancy, such as gingivitis, recession, periodontitis, and changes in systemic health, such as gestational diabetes, which may act as additional risk factors for chronic periodontal disease. Are the general public and health care providers aware of the potential risks of systemic and intrauterine inflammation caused by bacteria from the oral microbiota entering the bloodstream through inflamed gingival tissue and affecting the fetoplacental unit, leading to complications, such as preterm birth and reduced prenatal growth? A questionnaire-based survey, conducted between January 2023 and June 2023, aimed to assess patients’ personal oral hygiene practices and their understanding of the link between pregnancy and periodontal health. A total of 826 people completed a questionnaire for this study. The majority of women surveyed (86.9%) were not pregnant, but 77.7% had at least one child. The majority of women believed in good oral hygiene during pregnancy but lacked knowledge about how oral care can affect pregnancy outcomes. Full article

In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the rapid changes after birth with adaptation to the extrauterine environment is a unique situation in which absolute serum creatinine is not a reliable indicator of renal function. A rise in serum creatinine from the previous value during the neonatal period can be a result of worsening renal function in neonates but is dependent on many other factors. In addition, urine output can be difficult to measure in sick neonates during their intensive care stay. Despite a high prevalence of acute kidney injury (AKI) in preterm and/or unwell infants, the current definitions are not straightforward and do not take postnatal adaptation processes into account. The management of AKI is challenging in very young and small patients because the assessment of fluid status as well as balancing nutritional needs with fluid restriction can be problematic. The Australian Neonatal Medicines Formulary provides advice on drug dosing in the face of reduced renal function in neonates. Predictors (or long-term outcome, or recovery) after AKI diagnosis are still poorly described. Therefore, the diagnosis of neonatal AKI needs to be documented and transferred to the paediatrician responsible for the follow-up of the child. This educational review aims to give a perspective on neonatal kidney function and AKI, the relation of fluid balance and creatinine, the management of neonatal AKI and the consequences for drug dosing and long-term outcomes. Full article

Background: In recent years, there has been an increase in the incidence of gestational diabetes (GDM) with serious risks for both mother and child. Pre-pregnancy BMI and physical activity significantly influence GDM development. Promoting a healthy lifestyle is essential to prevent GDM and improve health outcomes for mother and baby. Objective: The aim of this study was to evaluate the relationship between pre-pregnancy physical activity and pre-pregnancy BMI and the occurrence of gestational diabetes, as well as to assess their impact on the development of complications associated with gestational diabetes. Methods: A retrospective-prospective study was conducted from October 2024 to December 2024 at a tertiary referral hospital in Poland. The study included 205 pregnant women (42 with gestational diabetes, 163 without gestational diabetes) who met the inclusion criteria. Data were collected using a self-administered questionnaire and the Polish version of the Get Active Questionnaire for Pregnancy (GAQ-P). The impact of pre-pregnancy physical activity and pre-pregnancy BMI on the occurrence of gestational diabetes was assessed based on data collected from both surveys and medical records analysis. Statistical analyses included Pearson’s chi-square tests, logistic regression, and Cramér’s V coefficient to determine the relationship between pre-pregnancy physical activity and ppBMI and the occurrence of gestational diabetes. Results: The study revealed that pre-pregnancy BMI and gestational weight gain were significant predictors, with a higher BMI increasing the risk of gestational diabetes. In contrast, physical activity before pregnancy—including its frequency, intensity, and duration—was not a significant predictor. Additionally, no significant associations were found between physical activity and birth weight, mode of delivery, or preterm birth. These findings highlight the role of pre-pregnancy BMI in gestational diabetes risk while suggesting that physical activity before conception may have a limited impact. Conclusions: These results highlight the significant role of pre-pregnancy body mass index (BMI) in the development of gestational diabetes, emphasizing the need for targeted interventions aimed at maintaining a healthy weight before conception. They suggest that weight management strategies should be an important component of gestational diabetes prevention. Future research should further investigate the complex interaction between lifestyle factors and metabolic health to refine preventive recommendations and improve health outcomes for mothers and newborns. Full article

Early-onset sepsis (EOS) remains a major cause of neonatal morbidity and mortality worldwide, with significant differences in the incidence and outcome of the disease in Europe. Eastern European countries face particular challenges due to differences in access to healthcare, diagnostic facilities, and prevention strategies. This review summarizes the results of recent research to provide insights into maternal risk factors, regional inequalities in access to healthcare, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. This review also examines how healthcare infrastructure and socioeconomic factors influence EOS outcomes in Eastern Europe. Introduction: Early-onset sepsis (EOS) presents a significant health challenge for newborns, characterized by sepsis occurring within the first 72 h of life, primarily caused by the vertical transmission of pathogens from mother to child. Despite advancements in medical care, EOS remains particularly burdensome in resource-poor settings, especially in Eastern Europe, where disparities in healthcare access and maternal health are pronounced. This systematic review aims to provide insights into maternal risk factors, regional inequalities in healthcare access, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. Background/Objectives: EOS is increasingly recognized as a public health issue, with outcomes significantly influenced by maternal health, socioeconomic status, and healthcare infrastructure. The review seeks to summarize the existing literature on EOS, particularly focusing on differences between high-income Western and low-resource Eastern European countries. The influence of maternal access to antenatal care, pathogen prevalence, and antibiotic resistance on EOS outcomes across regions will also be examined. Methods: To achieve the review’s objectives, a comprehensive search was conducted across multiple databases including PubMed, Google Scholar, ScienceDirect, and Scopus, adhering to PRISMA guidelines for systematic reviews. The inclusion criteria encompassed studies published within the last 20 years (January 2004–August 2024) that addressed EOS in late preterm or term infants, emphasizing maternal health, risk factors, diagnostic approaches, and treatment protocols pertinent to European populations. Exclusion criteria included non-English publications and studies lacking a focus on maternal and neonatal health. A total of 29 peer-reviewed articles meeting the specified criteria were ultimately included in the analysis. Results: The findings highlight significant regional disparities in EOS management between Western and Eastern Europe. Key issues include maternal risk factors, socioeconomic barriers to healthcare, diagnostic biomarkers, and pathogen resistance trends. Limited access to prenatal screenings and healthcare infrastructure in Eastern European countries, especially in rural regions in Romania, exacerbate the challenges faced by expectant mothers. Financial burdens, such as high out-of-pocket expenses, were shown to further restrict access to necessary maternal care. Conclusions: This systematic review emphasizes the urgent need for targeted investments in maternal healthcare infrastructure in Eastern Europe to mitigate the impacts of EOS. Enhanced screening programs, standardized surveillance systems, and ensuring equitable health policies are essential to improving neonatal outcomes. Additionally, tailored education and awareness campaigns for disadvantaged groups and comprehensive health policy reforms, including universal antenatal care and Group B Streptococcus (GBS), are essential to bridging healthcare gaps. Full article

Background: Fetal growth restriction (FGR) refers to a condition in which a fetus does not reach its genetically predetermined growth potential due to various pathological factors of maternal or fetal origin, with potential long-life consequences, such as elevated blood pressure, type 2 diabetes mellitus, obesity, dyslipidemia, atherosclerosis. Aim: The purpose of our research is to delve into the intricate relationship between economic and social factors and the occurrence of FGR. Methods: We analyzed risk factors previously associated with FGR and aimed to compare them between two cohorts of infants with FGR: a historical cohort of infants born from 2010 to 2012 and a contemporary cohort of infants born from 2020 to 2022. Results: The global incidence of FGR in our study was 5.13%, with non-significant differences between the two time periods: 5.03% in the historical cohort and 5.25% in the contemporary cohort. More mothers of FGR infants receive formal education and are employed in the contemporary group and thus have a more stable income. There was a major decrease in the number of preterm infants with FGR, from 23.9% in the historical cohort to 5.9% in the contemporary cohort (p < 0.001). Compared to the historical cohort, we found significant increases in the incidence of pregnancy-induced hypertension, Cesarean sections, and prenatal follow-up in the contemporary cohort (8.3% vs. 3.8%, p < 0.001; 59.2% vs. 49.9%, p < 0.001; 67.7% vs. 49.6%, p < 0.001, respectively) and we also found significant correlations between prenatal care on one side and maternal smoking, urban residence, higher maternal education, and prematurity on the other. Conclusions: Certain socioeconomic factors show definite improvements over the ten-year timespan, which results in an increase in prenatal care and a decrease in the rate of prematurity. However, the incidence of FGR remains constant over the considered period, meaning that other factors, apart from socioeconomic factors, play a substantial role. Recognizing these risk factors is crucial for developing effective public health strategies aimed at reducing the incidence of FGR and improving maternal and child outcomes. Full article