Risk Factors for the Occurrence of Scalp Hematoma in Term Neonates in King Chulalongkorn Memorial Hospital

Objectives: To determine the incidence and associated factors of neonatal scalp hematoma.Materials and Methods: This prospective case-control study included all term singleton live newborns that delivered in King Chulalongkorn Memorial Hospital during July 2016 to October 2016. All neonates were prospectively evaluated and divided into two groups: cases with scalp hematoma and controls. Diagnoses of neonatal scalp hematoma either cephalhematoma or subgaleal hemorrhage were confirmed by the experienced neonatologist. Medical records of these neonates and their mothers were reviewed to collect demographic data and information regarding their processes of labor and delivery. Logistic regression analysis was used to identify the risk factors associated with presence of neonatal scalp hematoma.Results: A total of 938 term neonates were included in this study. The incidence of neonatal scalp hematoma was 3.19% (30/938). Operative obstetrics (vacuum and forceps extraction) were found to have the highest rate (15.38%) of scalp hematoma when compare with other routes of delivery. Factors associated with neonatal scalp hematoma were primiparity (adjusted OR 4.86, 95% CI 1.61-14.58) and prolonged second stage of labor (adjusted OR 4.31, 95% CI 1.08-17.25). When analysis was done in only vaginally delivered neonates, the significant factors were primiparity (adjusted OR 3.84, 95% CI 1.26-11.71) and artificial rupture of membranes (adjusted OR 2.93, 95% CI 1.24-6.97).Conclusion: Neonatal scalp hematoma was common. Primiparous women significantly increased risk of neonatal scalp hematoma regardless of route of delivery

Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel\u27s and Nugent\u27s criteria. Results: A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration\u27s tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole. Conclusion: The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use

A synbiotic intervention modulates meta-omics signatures of gut redox potential and acidity in elective caesarean born infants.

Background The compromised gut microbiome that results from C-section birth has been hypothesized as a risk factor for the development of non-communicable diseases (NCD). In a double-blind randomized controlled study, 153 infants born by elective C-section received an infant formula supplemented with either synbiotic, prebiotics, or unsupplemented from birth until 4 months old. Vaginally born infants were included as a reference group. Stool samples were collected from day 3 till week 22. Multi-omics were deployed to investigate the impact of mode of delivery and nutrition on the development of the infant gut microbiome, and uncover putative biological mechanisms underlying the role of a compromised microbiome as a risk factor for NCD. Results As early as day 3, infants born vaginally presented a hypoxic and acidic gut environment characterized by an enrichment of strict anaerobes (Bifidobacteriaceae). Infants born by C-section presented the hallmark of a compromised microbiome driven by an enrichment of Enterobacteriaceae. This was associated with meta-omics signatures characteristic of a microbiome adapted to a more oxygen-rich gut environment, enriched with genes associated with reactive oxygen species metabolism and lipopolysaccharide biosynthesis, and depleted in genes involved in the metabolism of milk carbohydrates. The synbiotic formula modulated expression of microbial genes involved in (oligo)saccharide metabolism, which emulates the eco-physiological gut environment observed in vaginally born infants. The resulting hypoxic and acidic milieu prevented the establishment of a compromised microbiome. Conclusions This study deciphers the putative functional hallmarks of a compromised microbiome acquired during C-section birth, and the impact of nutrition that may counteract disturbed microbiome development. Trial registration The study was registered in the Dutch Trial Register (Number: 2838 ) on 4th April 2011

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Acceptance of Influenza Vaccination among Pregnant Women attending the Antenatal Care Clinic, King Chulalongkorn Memorial Hospital

Objectives: To determine the acceptance rate and associated factors of influenza vaccination among Thai pregnant women.Materials and Methods:A cross-sectional descriptive study was conducted at King Chulalongkorn Memorial Hospital from November 2014 to March 2015. Pregnant women were asked to complete self-administered questionnaires that collected data on acceptance of vaccination, knowledge, attitude and practice regarding to influenza vaccination during pregnancy. The associated factors were determined by logistic regression analysis.Results: A total of 412 women completed the questionnaires. Acceptance rate of influenza vaccination among the participants was 40.5% (95% CI 35.9-45.3). Most participants (320 women, 77.7%) had good knowledge about influenza and the vaccine. Factors positively associated with the acceptance were ‘advice from physicians’ (adjusted OR 2.61, 95% CI 1.55-4.39), ‘notification about vaccination in current pregnancy’ (adjusted OR 1.84, 95% CI 1.17-2.89), ‘protection of newborn’ (adjusted OR 2.83, 95% CI 1.74-4.62) and ‘cost of vaccination’ (adjusted OR 2.36, 95% CI 1.46-3.82). Negatively associated factors included ‘experience of side effects following past vaccination’ (adjusted OR 0.19, 95% CI 0.05-0.74), ‘belief that vaccination is unnecessary’ (adjusted OR 0.42, 95% CI 0.21-0.86), and ‘unsafe during the first trimester’ (adjusted OR 0.55, 95% CI 0.34-0.90).Conclusion: Acceptance rate of influenza vaccination during pregnancy among women in King Chulalongkorn Memorial Hospital was 40.5%. To increase vaccination rate, health care providers should advise or mention on influenza vaccination and provide information to support that the immunization can protect their newborns and is safe at any trimeste

Nadir CD4 count and monthly income predict cervical squamous cell abnormalities in HIV-positive women in a resource-limited setting

We conducted a cross-sectional study with 385 HIV-positive women in Bangkok to assess the prevalence and predictors of cervical abnormalities on Papanicolaou (Pap) smear. Low-grade squamous intraepithelial lesions (LSIL), high-grade SIL (HSIL) and invasive cervical cell cancer (ICC) were assessed by cytological examination after Pap smear and logistic regression models were used to assess associations with patient characteristics. Overall prevalence of LSIL, HSIL and ICC were 11.2% (95% confidence interval [CI] 8.2-14.7%), 4.7% (95%CI 2.8-7.3%) and 0.5% (95%CI 0.06-1.9%), respectively. In multivariate models, only the nadir CD4 count and income remained significantly associated with cytological abnormalities, whereas smoking, hormonal contraceptive or antiretroviral use, condom use, parity and number of lifetime sexual partners were not associated. The odds ratio for having cytological abnormalities was 2.6 (95% CI 1.24-5.34) in those with a nadir CD4 count <200 cells/mm3 compared with those with a higher nadir CD4 count, and 1.99 (1.11-3.57) in those with an income of <125 US dollars/month compared with those with higher incomes. In settings where access to affordable treatment is improving, this study reinforces the importance of regular Pap smear screening in HIV-positive women, particularly those with low nadir CD4 counts and lower incomes