Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Funding Information: M.B.A. holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease at the University of Manitoba and is a Fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. Her effort on this project was partly supported by HDR UK and ICODA. K.K.C.M. declares support from The Innovation and Technology Commission of the Hong Kong Special Administrative Region Government, and Hong Kong Research Grants Council Collaborative Research Fund Coronavirus Disease (COVID-19) and Novel Infectious Disease Research Exercise (Ref: C7154-20G) and grants from C W Maplethorpe Fellowship, National Institute of Health Research UK, European Commission Framework Horizon 2020 and has consulted for IQVIA Ltd. A.S. is supported by ICODA and HDR UK, and has received a research grant from HDR UK to the BREATHE Hub. He participates on the Scottish and UK Government COVID-19 Advisory Committees, unremunerated. S.J.S. is supported by a Wellcome Trust Clinical Career Development Fellowship (209560/Z/17/Z) and HDR UK, and has received personal fees from Hologic and Natera outside the submitted work. D.B. is supported by a National Health and Medical Research Council (Australia) Investigator Grant (GTN1175744). I.C.K.W. declares support from The Innovation and Technology Commission of the Hong Kong Special Administrative Region Government, and Hong Kong Research Grants Council Collaborative Research Fund Coronavirus Disease (COVID-19) and Novel Infectious Disease Research Exercise (Ref: C7154-20G), and grants from Hong Kong Research Grant Council, National Institute of Health Research UK, and European Commission Framework Horizon 2020. H.Z. is supported by a UNSW Scientia Program Award and reports grants from European Commission Framework Horizon 2020, Icelandic Centre for Research, and Australia’s National Health and Medical Research Council. H.Z. was an employee of the UNSW Centre for Big Data Research in Health, which received funding from AbbVie Australia to conduct research, unrelated to the current study. I.I.A.A., C.D.A., K.A., A.I.A., L.C., S.S., G.E.-G., O.W.G., L. Huicho, S.H., A.K., K.L., V.N., I.P., N.R.R., T.R., T.A.H.R., V.L.S., E.M.S., L.T., R.W. and H.Z. received funding from HDRUK (grant #2020.106) to support data collection for the iPOP study. K.H., R.B., S.O.E., A.R.-P. and J.H. receive salary from ICODA. M.B. received trainee funding from HDRUK (grant #2020.106). J.E.M. received trainee funding from HDRUK (grant #2020.109). Other relevant funding awarded to authors to conduct research for iPOP include: M.G. received funding from THL, Finnish Institute for Health and Welfare to support data collection. K.D. received funding from EDCTP RIA2019 and HDRUK (grant #2020.106) to support data collection. R.B. received funding from Alzheimer’s Disease Data Initiative and ICODA for the development of federated analysis. A.D.M. received funding from HDR UK who receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK, which is funded by the Economic and Social Research Council (grant ES/S007393/1). N.A. received funding from the National Institutes of Health (R35GM138353). O.S received funding from NordForsk (grant #105545). The remaining authors declare no competing interests. Funding Information: Funding and in-kind support: This work was supported by the International COVID-19 Data Alliance (ICODA), an initiative funded by the Bill and Melinda Gates Foundation and Minderoo as part of the COVID-19 Therapeutics Accelerator and convened by Health Data Research (HDR) UK, in addition to support from the HDR UK BREATHE Hub. Several ICODA partners contributed to the study, including: Cytel (statistical support), the Odd Group (data visualization) and Aridhia Informatics (development of federated analysis using a standardized protocol ([Common API] https://github.com/federated-data-sharing/ ) to be used in future work). Additional contributors: We acknowledge the important contributions from the following individuals: A. C. Hennemann and D. Suguitani (patient partners from Prematuridade: Brazilian Parents of Preemies’ Association, Porto Alegre, Brazil); N. Postlethwaite (implementation of processes supporting the trustworthy collection, governance and analysis of data from ICODA, HDR UK, London, UK); A. S. Babatunde (led data acquisition from University of Uyo Teaching Hospital, Uyo, Nigeria); N. Silva (data quality, revision and visualization assessment from Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Brazil); J. Söderling (data management from the Karolinska Institutet, Stockholm, Sweden). We also acknowledge the following individuals who assisted with data collection efforts: R. Goemaes (Study Centre for Perinatal Epidemiology (SPE), Brussels, Belgium); C. Leroy (Le Centre d'Épidémiologie Périnatale (CEpiP), Brussels, Belgium); J. Gamba and K. Ronald (St. Francis Nsambya Hospital, Kampala, Uganda); M. Heidarzadeh (Tabriz Medical University, Tabriz, Iran); M. J. Ojeda (Pontificia Universidad Católica de Chile, Santiago, Chile); S. Nangia (Lady Hardinge Medical College, New Delhi, India); C. Nelson, S. Metcalfe and W. Luo (Maternal Infant Health Section of the Public Health Agency of Canada, Ottawa, Canada); K. Sitcov (Foundation for Health Care Quality, Seattle, United States); A. Valek (Semmelweis University, Budapest, Hungary); M. R. Yanlin Liu (Mater Data and Analytics, Brisbane, Australia). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Funding Information: Funding and in-kind support: This work was supported by the International COVID-19 Data Alliance (ICODA), an initiative funded by the Bill and Melinda Gates Foundation and Minderoo as part of the COVID-19 Therapeutics Accelerator and convened by Health Data Research (HDR) UK, in addition to support from the HDR UK BREATHE Hub. Several ICODA partners contributed to the study, including: Cytel (statistical support), the Odd Group (data visualization) and Aridhia Informatics (development of federated analysis using a standardized protocol ([Common API] https://github.com/federated-data-sharing/) to be used in future work). Additional contributors: We acknowledge the important contributions from the following individuals: A. C. Hennemann and D. Suguitani (patient partners from Prematuridade: Brazilian Parents of Preemies’ Association, Porto Alegre, Brazil); N. Postlethwaite (implementation of processes supporting the trustworthy collection, governance and analysis of data from ICODA, HDR UK, London, UK); A. S. Babatunde (led data acquisition from University of Uyo Teaching Hospital, Uyo, Nigeria); N. Silva (data quality, revision and visualization assessment from Methods, Analytics and Technology for Health (M.A.T.H) Consortium, Belo Horizonte, Brazil); J. Söderling (data management from the Karolinska Institutet, Stockholm, Sweden). We also acknowledge the following individuals who assisted with data collection efforts: R. Goemaes (Study Centre for Perinatal Epidemiology (SPE), Brussels, Belgium); C. Leroy (Le Centre d'Épidémiologie Périnatale (CEpiP), Brussels, Belgium); J. Gamba and K. Ronald (St. Francis Nsambya Hospital, Kampala, Uganda); M. Heidarzadeh (Tabriz Medical University, Tabriz, Iran); M. J. Ojeda (Pontificia Universidad Católica de Chile, Santiago, Chile); S. Nangia (Lady Hardinge Medical College, New Delhi, India); C. Nelson, S. Metcalfe and W. Luo (Maternal Infant Health Section of the Public Health Agency of Canada, Ottawa, Canada); K. Sitcov (Foundation for Health Care Quality, Seattle, United States); A. Valek (Semmelweis University, Budapest, Hungary); M. R. Yanlin Liu (Mater Data and Analytics, Brisbane, Australia). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Publisher Copyright: © 2023, The Author(s).Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.Peer reviewe

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Conséquences à l’adolescence de la grande prématurité sur le bien-être (la confiance en soi, la sociabilité, la qualité de vie)

Objectifs : Ces dernières années, de plus en plus d’études se sont penchées sur le devenir psychologique des anciens grands prématurés (<33 semaines de gestation) et ont démontré qu’il existe un risque accru de développer des troubles de l’anxiété, des dépressions, des difficultés dans l’acceptation de soi ainsi qu’un risque d’être plus introverti. Le but de cet article est de comparer, grâce aux résultats de l’étude que nous avons initiée aux Cliniques universitaires Saint-Luc, des anciens grands prématurés à des enfants contrôles nés à terme du point de vue de leur bien-être afin de relever d’éventuelles différences entre les deux échantillons. Par ce biais, nous désirons appuyer les différents résultats déjà obtenus dans la littérature pour ainsi tenter de mettre en exergue une tendance commune. Matériels et méthodes : Nous avons recensé au hasard cinquante enfants nés avant 33 semaines de gestation dans les années 1996 à 1998 aux Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Bruxelles. Vingttrois sur cinquante ont effectivement participé à l’étude et seize enfants contrôles nés à terme y ont été enrôlés. Des questionnaires homologués ont été utilisés afin d’évaluer les différents paramètres étudiés : R-CMAS (The revised childrens manifest of anxiety) pour l’anxiété ; MDI-C (The multiscore depression inventory for children) pour la dépression.; l’inventaire de Coopersmith pour l’estime de soi ; CPI-R (California psychological inventory, revised) pour la sociabilité ; QOLscale (Quality of life scale) pour la qualité de vie. Résultats : Nous n’obtenons pas de résultats statistiquement significatifs lorsque l’on compare les anciens grands prématurés aux contrôles dans les scores d’anxiété, dépression, estime de soi et sociabilité. Néanmoins des résultats significatifs sont objectivés lorsque l’on considère les enfants nés à moins de 29 semaines de gestation. De plus, nous notons que l’anxiété est encore plus importante chez les anciens prématurés (<33 semaines) s’ils sont originaires d’une famille appartenant à une classe socio-économique plus basse. Aucune différence n’est cependant relevée en ce qui concerne la qualité de vie globale des sujets. Seule une différence du point de vue de la qualité de vie par rapport à leur santé se dessine significativement. Conclusions : Les extrêmes prématurés (<29 semaines de gestation) présentent plus de troubles de l’anxiété et de dépression. Ils ont tendance à avoir une moins bonne estime d’eux-mêmes et ont des personnalités plus introverties que l’échantillion contrôle. Cependant, ils ne semblent pas avoir une moins bonne qualité de vie que leur pairs nés à terme.[Consequences of very preterm birth on well-being in adolescence (self-confidence, sociability, and quality of life)] Objectives In the past few years, numerous studies having investigated the psychological development of very preterm babies (less than 33 weeks of pregnancy) have concluded that these babies exhibit a higher risk of developing anxiety disorders, depression, self-esteem issues, and introversion than their term-born counterparts. Our research sought to compare the well-being of very preterm babies to that of a control group comprising term-born subjects in an effort to confirm the results of the published studies. Materials and Methods Fifty preterm babies, born before 33 weeks of gestation between 1996 and 1998 at the Saint Luc University Hospital, Brussels, were randomly recruited. Of these, 23 have effectively participated in the study, and 16 term-born babies represented the control group. Standard questionnaires were used in order to evaluate the impact of prematurity on the parameters used in our study: R-CMAS (revised children’s manifest of anxiety) for anxiety; MDI-C (multiscore depression inventory for children) for depression; Coopersmith inventory for self-esteem; CPI-R (California psychological inventory, revised) for sociability; QOL-scale (Quality of life scale) for life quality. Results While analyzing the scores for anxiety, depression, self-esteem issues, and sociability, we did not find a statistically significant difference between the group of very preterm babies and the control group. However, significant differences were found in our subgroup analysis for the children born prior to 29 weeks gestation. Furthermore, we noted that the anxiety level in preterm subjects from lower-class families was higher. However, there was no between-group difference in terms of global quality of life, whereas the quality of life of preterm born children was clearly influenced by health-related issues. Conclusions Very preterm-born children (less than 29 weeks gestation) are more likely to suffer from depression and anxiety, tend to have self–esteem issues, and are generally more introverted than their full-term counterparts, although there does not appear to be a difference in global quality of life between the two groups, as illustrated by our study

Cathéters pour instillation moins invasive de SURFACTANT : une étude de simulation

peer reviewedIntroduction et objectifs : l’instillation trachéale de surfactant par un cathéter fin (Less invasive surfactant therapy- LIST) chez le prématuré sous CPAP permet de diminuer la morbidité respiratoire. Plusieurs cathéters sont décrits à cette fin : une sonde oro-gastrique insérée avec (LISA-Köln, K) ou sans pince de Maggil (Take Care- Ankara, A), un cathéter veineux de 13 cm (MIST- Hobart, H), un cathéter d’angiographie de 30 cm (Stockholm, S) ou un cathéter ombilical fixé à un stylet d’intubation utilisé localement (Liège, L). L’objectif de l’étude est d’évaluer l’efficacité de ces techniques en prenant l’INSURE (Intubation-Surfactant-Extubation) comme référence. Intervention : 20 néonatologues travaillant dans 4 services ayant des stratégies d’administration du surfactant différentes ont participé. Ils ont simulé ces 6 techniques sur deux têtes d’intubation de difficulté croissante. L’efficacité de l’intervention est évaluée par le taux d’échec et la durée de procédure mesurée sur vidéo. Chaque intervenant apprécie la facilité d’utilisation sur une échelle de 1 à 9 (Difficile> facile). Résultats : Pour le premier modèle, les durées médianes de procédure pour Köln et Ankara sont allongées [K: 21s (IQR 17-24); A: 23s (15-42); H: 10s (8-16); S: 12s (10-22); L (10-20); INSURE: 14s (11-21); p<.0001]. Pour le second modèle, seul Liège permet une durée de procédure similaire à l’INSURE [K: 32s (25-44); A: 39s (27-95); H: 34s (27-46); S: 37s (29-42); L: 24s (15-35); INSURE: 24s (17-32); p<.002]. Les taux d’échec des méthodes LIST sont similaires entre eux (de 3 à 8/ 40 essais), mais supérieurs à celui de l’INSURE (0/40). Köln et Ankara sont considérés comme plus difficiles [scores de facilité : K: 5 (4-6); A: 3 (2-4); H: 6,5 (6-7); S: 7 (4-8); L: 8 (6,5-8); INSURE: 7 (6-8); p<.001]. Conclusions : les cathéters plus rigides sont plus efficaces et perçus comme plus simples d’utilisation. L’insertion d’un cathéter guidé et incurvé pourrait être plus rapide dans les cas difficiles

Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios.

BACKGROUND: Prolonged oligohydramnios following early preterm prelabour rupture of membranes (PPROM) is traditionally associated with high neonatal mortality and significant risk of pulmonary hypoplasia. However, recent evidence points to an apparent improvement in outcome. AIMS: To document current neonatal outcomes following rupture of membranes prior to 25 weeks with severe persistent oligohydramnios and a latency to delivery of at least 14 days. METHODS: A retrospective case note analysis over a 28-month period at Saint Luc University Hospital, Brussels. RESULTS: From 23 pregnancies that were complicated by PPROM prior to 25 weeks, 15 infants were born after 24 weeks with a latency of more than 14 days and persistent oligohydramnios. Nine infants (60%) had severe respiratory failure and clinical signs compatible with pulmonary hypoplasia. Seven of these infants (78%) responded to high frequency ventilation and inhaled nitric oxide therapy with good clinical outcome but two died from severe respiratory failure. Five infants showed no clinical signs of pulmonary hypoplasia and responded to conventional neonatal management. One of these infants died at 77 days of age of necrotising enterocolitis. One infant was not resuscitated and died within minutes of birth, following prior discussion with the perinatal team and the parents. Survivors in this high-risk group (73%) had low morbidity at the time of discharge. SUMMARY: The favourable neonatal survival and morbidity figures are in keeping with recent published evidence. This study confirms improved outcome even amongst the highest risk infants with documented persistent oligohydramnios

Imaging of primary unilateral pulmonary hypoplasia: a case report

Pulmonary hypoplasia is a rare cause of neonatal dyspnea almost always secondary to other conditions. We report an exceedingly rare case of primary unilateral pulmonary hypoplasia. This case illustrates the role of prenatal magnetic resonance imaging when this condition is suspected during the fetal life. Combined with ultrasounds, this imaging modality offers a three-dimensional evaluation of the lungs that can be critical for postnatal medical management