Point-of-admission neonatal hypoglycaemia in a Nigerian tertiary hospital: incidence, risk factors and outcome.

Background: Neonatal hypoglycaemia is a major metabolic problem. It may result in mortality or severe handicap among survivors. Many babies admitted for neonatal care are at high risk for hypoglycaemia. The present study set out to determine its point-of-admission prevalence, clinical presentation and outcome. Methods: Consecutive neonates who met the study criteria had plasma glucose determined at admission into the special care baby unit of Wesley Guild Hospital. Hypoglycaemia was defined as plasma glucose of ≤ 2.5mmol/L. Babies with and without hypoglycaemia were compared for risk factors, clinical features and outcome. Results: A total of 150 neonates were studied out of which 49 (32.7%) had hypoglycaemia. The mean age, 38.3 ± 71.6 in hours was significant ly lower among neonates with hypoglycaemia than those without hypoglycaemia [p = 0.006].Lowsocioeconomic class (p = 0.034), admission weight less t h a n 2500g ( p = 0.009 ) , hypothermia (p = 0.001) and preterm birth (p = 0.020) were significantly more common in babies with hypoglycaemia. Poor suck (p = 0.010), cyanosis (p = 0.020), convulsion (p = 0.040) and pallor (p = 0.048) were also more common among babies with hypoglycaemia. The mortality rate in babies with hypoglycaemia was 32.7%, higher than 18.8% in babies without hypoglycaemia but the difference was not statistically significant (p = 0.060). Conclusion: Hypoglycaemia is common among high-risk neonates and is often associated with morbidity and mortality. Routine monitoring of blood glucose is therefore recommended for this class of babiesKeyWords: Prevalence, Point-of-admission , Neonatal Hypoglycaemia, Morbidity and Mortality, Nigeria

Diagnostic value of procalcitonin in neonatal sepsis

Introduction: Neonatal sepsis is a major cause of mortality in developing countries. Accurate and quick diagnosis are difficult because clinical presentation are non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalcitonin (PCT) has been proposed as an early marker of infections in neonates.Objectives: This study investigated the value of PCT in the diagnosis of Neonatal Sepsis.Methods: Neonates undergoing sepsis evaluation at the Special Baby Care Unit, Federal Medical Centre, Abeokuta, Nigeria between January and April 2013 were included. Blood samples were obtained for white cell count, blood cultures, serum CRP and PCT analysis. Neonates were categorised into Proven Sepsis, Suspected Sepsis and Clinical Sepsis groups on the basis of laboratory findings and risk factors. A control group with no clinical and biological data of infection was also included. Predictive values and area under the receiver operating characteristic curve (AUC) of PCT were evaluated.Result: Of the 85 neonates, 19 (22.4%) had positive blood culture. PCT level was significantly higher in neonates in all sepsis groups in comparison with those in the control group (P< 0.05). At a cut-off of 0.5 ng/ml, the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. There were no significant statistical difference between the AUC values of PCT in Early onset and Late onset sepsis, as well between AUC in Preterm and term cases. A higher percentage of neonates who died (96%) had elevated PCT levels compared to those who survived (46%).Conclusion: These findings support the usefulness of the PCT in diagnosis of Neonatal sepsis.Keywords: Neonatal Sepsis, Diagnosis, Procalcitonin, Receiver Operating Characteristic Curv

Recommendations for The Conduct of Economic Evaluations in Osteoporosis: Outcomes of An Experts’ Consensus Meeting Organized by The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) And the US Branch of The International Osteoporosis Foundation

Summary Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards. Introduction This paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards. Methods A working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted. Results Recommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed. Conclusion While the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers

Analytical performance specifications for the measurement uncertainty of 24,25-dihydroxyvitamin D examinations

Objectives: The exploration of the metabolites in the degradation pathways of vitamin D (VTD) has gained importance in recent years and simultaneous quantitation of twenty-five-hydroxy vitamin D (25(OH)D) mass concentration together with 24,25-dihydroxyvitamin D (24,25(OH)2D) has been proposed as a newer approach to define VTD deficiency. Yet, no data are available on 24,25(OH)2D biological variation (BV). In this study, we evaluated 24,25(OH)2D's BV on the European Biological Variation Study (EuBIVAS) cohort samples to determine if analytical performance specifications (APS) for 24,25(OH)2D could be generated. Methods: Six European laboratories recruited 91 healthy participants. 25(OH)D and 24,25(OH)2D concentrations in K3-EDTA plasma were examined weekly for up to 10 weeks in duplicate with a validated LC-MS/MS method. The Vitamin D Metabolite Ratio (24,25(OH)2D divided by 25(OH)D × 100) was also calculated at each time point. Results: Linear regression of the mean 24,25(OH)2D concentrations at each blood collection showed participants were not in steady state. Variations of 24,25(OH)2D over time were significantly positively associated with the slopes of 25(OH)D concentrations over time and the concentration of 25(OH)D of the participant at inclusion, and negatively associated with body mass index (BMI), but not with age, gender, or location of the participant. The variation of the 24,25(OH)2D concentration in participants over a 10 weeks period was 34.6%. Methods that would detect a significant change linked to the natural production of 24,25(OH)2D over this period at p&lt;0.05 would need a relative measurement uncertainty (u%)&lt;14.9% while at p&lt;0.01, relative measurement uncertainty should be &lt;10.5%. Conclusions: We have defined for the first time APS for 24,25(OH)2D examinations. According to the growing interest in this metabolite, several laboratories and manufacturers might aim to develop specific methods for its determination. The results presented in this paper are thus necessary prerequisites for the validation of such methods.</p

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