Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000-2021.

OBJECTIVE: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION: Liveborn infants. METHODS: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs

Vulnerable newborn types: analysis of subnational, population-based birth cohorts for 541 285 live births in 23 countries, 2000–2021

Objective: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. Design: Descriptive multi-country secondary data analysis. Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000–2021. Population: Liveborn infants. Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. Results: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.The Children's Investment Fund Foundation, grant 2004-04670. The funders had no role in the study design, data collection, analysis or interpretation of the paper

Management of Posterior Urethral Valves at Kilimanjaro Christian Medical Centre: A 10 Years Experience

Background: Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. This study was aimed at reviewing the management and outcome of treatment of PUV at KCMC among children presented for treatment during the period from January 1998 to December 2007.Methods: This was retrospective hospital based review of 56 patients treated for posterior urethral valves. The study was conducted in the Institute of Urology at Kilimanjaro Christian Medical Center, which is a tertiary referral hospital located in northern part of Tanzania. The study population was consisted of all children diagnosed to have posterior urethral valves in the study period. All the children clinically suspected to have posterior urethra valves had the diagnosis confirmed by micturating cystourethrogram and depending on their age, underwent initial vesicostomy and finally posterior urethral valve fulguration as the definitive treatment. Data regarding age at presentation, types of valves seen, clinical presentation, initial treatment given, definitive treatment and complications of definitive treatment of PUV was extracted. Information on outcome of definitive treatment of PUV was also extracted. The information was transferred to a data sheet for analysis.Results: At presentation 57.1% of patients were aged below two years while 16.1% were above six years of age. Hydronephrosis occurred in 94.6% of patients. A dribbling urinary stream was found in 82.1% of patients. Urinary tract infection was also common, being present in 58.9% of patients. Fifty percent of patients presented with urine retention while vesicoureteral reflux was found in 23.2%. Of the valves seen 96.9% were type I. Initial treatment comprised of vesicostomy (42.9%), initial valve ablation (51.8%) and urethral catheterization 5.3%. Electrofulguration was the mainstay of definitive treatment of PUV and was instituted in all of the definitively treated patients. Urethral stricture as a complication was seen in 8.9% of the patients. Residual valves were seen in 20% of patients. A treatment success rate of 86.7% was observed. A mortality rate of 5.4% was found.Conclusion: The clinical presentation of PUV and the age at presentation is similar to that seen in Europe and America. Type I valves form the majority of posterior urethral valves. Electrofulguration is the mainstay definitive treatment of PUV at KCMC. The success rate of treatment of PUV is good and compares with that seen in Europe and America

Management of Posterior Urethral Valves at Kilimanjaro Christian Medical Centre: A 10 Years Experience.

Background: Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns. A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development. This study was aimed at reviewing the management and outcome of treatment of PUV at KCMC among children presented for treatment during the period from January 1998 to December 2007. Methods: This was retrospective hospital based review of 56 patients treated for posterior urethral valves. The study was conducted in the Institute of Urology at Kilimanjaro Christian Medical Center, which is a tertiary referral hospital located in northern part of Tanzania. The study population was consisted of all children diagnosed to have posterior urethral valves in the study period. All the children clinically suspected to have posterior urethra valves had the diagnosis confirmed by micturating cystourethrogram and depending on their age, underwent initial vesicostomy and finally posterior urethral valve fulguration as the definitive treatment. Data regarding age at presentation, types of valves seen, clinical presentation, initial treatment given, definitive treatment and complications of definitive treatment of PUV was extracted. Information on outcome of definitive treatment of PUV was also extracted. The information was transferred to a data sheet for analysis. Results: At presentation 57.1% of patients were aged below two years while 16.1% were above six years of age. Hydronephrosis occurred in 94.6% of patients. A dribbling urinary stream was found in 82.1% of patients. Urinary tract infection was also common, being present in 58.9% of patients. Fifty percent of patients presented with urine retention while vesicoureteral reflux was found in 23.2%. Of the valves seen 96.9% were type I. Initial treatment comprised of vesicostomy (42.9%), initial valve ablation (51.8%) and urethral catheterization 5.3%. Electrofulguration was the mainstay of definitive treatment of PUV and was instituted in all of the definitively treated patients. Urethral stricture as a complication was seen in 8.9% of the patients. Residual valves were seen in 20% of patients. A treatment success rate of 86.7% was observed. A mortality rate of 5.4% was found. Conclusion:The clinical presentation of PUV and the age at presentation is similar to that seen in Europe and America. Type I valves form the majority of posterior urethral valves. Electrofulguration is the mainstay definitive treatment of PUV at KCMC. The success rate of treatment of PUV is good and compares with that seen in Europe and America

Hat sich die Überlebensprognose beim Verbrennungstrauma des alten Menschen in den letzten 15 Jahren verbessert? Ein Vergleich zweier Patientenkollektive 1997-2003 und 2004-2010

This study aims to investigate the limitations and applicability of different ion exchanged zeolites as antimicrobial additive in thermoplastic polyether type polyurethanes. These composites were designed to improve the health quality of hospitalized patients by expressing both biocompatibility and relevant antimicrobial activity. The zeolites were exchanged with silver, copper and zinc ions and single, binary and ternary ion-exchanged zeolite-polyurethane composites were prepared. The antimicrobial activity and the resistance of the composites against the human environment play vital role in the applicability of the materials as a medical device therefore these properties were investigated. The antimicrobial test were performed on Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Candida tropicalis. The tests showed that the efficiency of the silver ions is superior to the other single ionic systems. Besides, the binary and ternary ion-exchanged samples had similar antimicrobial efficiency regardless the type of the ions in the zeolite. The biocompatibility tests were carried out in-vitro in artificial body fluids for a period of 12 weeks. As a result of the invitro test, degradation of the composites were observed and the structural changes of the materials were detected and described by Scanning Electron Microscopy, Contact Angle measurements and Attenuated Total Reflection Fourier Transform Infrared Spectroscopy

Prenatal maternal stress and birth outcomes in rural Ghana: sex-specific associations

Background In developed countries, prenatal maternal stress has been associated with poor fetal growth, however this has not been evaluated in rural sub-Saharan Africa. We evaluated the effect of prenatal maternal stress on fetal growth and birth outcomes in rural Ghana. Methods Leveraging a prospective, rural Ghanaian birth cohort, we ascertained prenatal maternal negative life events, categorized scores as 0-2 (low stress; referent), 3-5 (moderate), and > 5 (high) among 353 pregnant women in the Kintampo North Municipality and Kintampo South District located within the middle belt of Ghana. We employed linear regression to determine associations between prenatal maternal stress and infant birth weight, head circumference, and length. We additionally examined associations between prenatal maternal stress and adverse birth outcome, including low birth weight, small for gestational age, or stillbirth. Effect modification by infant sex was examined. Results In all children, high prenatal maternal stress was associated with reduced birth length (β = − 0.91, p = 0.04; p-value for trend = 0.04). Among girls, moderate and high prenatal maternal stress was associated with reduced birth weight (β = − 0.16, p = 0.02; β = − 0.18, p = 0.04 respectively; p-value for trend = 0.04) and head circumference (β = − 0.66, p = 0.05; β = − 1.02, p = 0.01 respectively; p-value for trend = 0.01). In girls, high prenatal stress increased odds of any adverse birth outcome (OR 2.41, 95% CI 1.01-5.75; p for interaction = 0.04). Sex-specific analyses did not demonstrate significant effects in boys. Conclusions All infants, but especially girls, were vulnerable to effects of prenatal maternal stress on birth outcomes. Understanding risk factors for impaired fetal growth may help develop preventative public health strategies. Trial registration NCT01335490 (prospective registration). Date of Registration: April 14, 2011. Status of Registration: Completed