Neighborhood deprivation and association with neonatal intensive care unit mortality and morbidity for extremely premature infants

IMPORTANCE: Socioeconomic status affects pregnancy and neurodevelopment, but its association with hospital outcomes among premature infants is unknown. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses US Census Bureau data on income, educational level, employment, and housing quality. OBJECTIVE: To determine whether ADI is associated with neonatal intensive care unit (NICU) mortality and morbidity in extremely premature infants. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was performed at 4 level IV NICUs in the US Northeast, Mid-Atlantic, Midwest, and South regions. Non-Hispanic White and Black infants with gestational age of less than 29 weeks and born between January 1, 2012, and December 31, 2020, were included in the analysis. Addresses were converted to census blocks, identified by Federal Information Processing Series codes, to link residences to national ADI percentiles. EXPOSURES: ADI, race, birth weight, sex, and outborn status. MAIN OUTCOMES AND MEASURES: In the primary outcome, the association between ADI and NICU mortality was analyzed using bayesian logistic regression adjusted for race, birth weight, outborn status, and sex. Risk factors were considered significant if the 95% credible intervals excluded zero. In the secondary outcome, the association between ADI and NICU morbidities, including late-onset sepsis, necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH), were also analyzed. RESULTS: A total of 2765 infants with a mean (SD) gestational age of 25.6 (1.7) weeks and mean (SD) birth weight of 805 (241) g were included in the analysis. Of these, 1391 (50.3%) were boys, 1325 (47.9%) reported Black maternal race, 498 (18.0%) died before NICU discharge, 692 (25.0%) developed sepsis or NEC, and 353 (12.8%) had severe IVH. In univariate analysis, higher median ADI was found among Black compared with White infants (77 [IQR, 45-93] vs 57 [IQR, 32-77]; P \u3c .001), those who died before NICU discharge vs survived (71 [IQR, 45-89] vs 64 [IQR, 36-86]), those with late-onset sepsis or NEC vs those without (68 [IQR, 41-88] vs 64 [IQR, 35-86]), and those with severe IVH vs those without (69 [IQR, 44-90] vs 64 [IQR, 36-86]). In a multivariable bayesian logistic regression model, lower birth weight, higher ADI, and male sex were risk factors for mortality (95% credible intervals excluded zero), while Black race and outborn status were not. The ADI was also identified as a risk factor for sepsis or NEC and severe IVH. CONCLUSIONS AND RELEVANCE: The findings of this cohort study of extremely preterm infants admitted to 4 NICUs in different US geographic regions suggest that ADI was a risk factor for mortality and morbidity after adjusting for multiple covariates

Japanese Encephalitis Outbreak, India, 2005

An outbreak of viral encephalitis occurred in Gorakhpur, India, from July through November 2005. The etiologic agent was confirmed to be Japanese encephalitis virus by analyzing 326 acute-phase clinical specimens for virus-specific antibodies and viral RNA and by virus isolation. Phylogenetic analysis showed that these isolates belonged to genogroup 3

Linear and Non-Linear analysis of Heart rate variability in Premature Infants

Heart rate variability signal (HRV) was extracted from ECG recordings in a group of 26 premature babies (average gestational age 28.7 weeks). Data were collected at Columbia University Medical Center, NY. The aim was to identify possible risk conditions arising after premature birth. In order to analyze these signals methods based on Linear and Non-linear analysis were applied. Parameters from Time Domain, Frequency Domain, complexity Entropy measures and Phase Rectified Signal averaging (PRSA) technique presented a significant separation between Active and Quiet sleep. Moreover, we applied parameters from fetal HR analysis, since prematurity is a transitory phase between fetal and mature baby condition. This novel multi-parametric approach will be the basis toward a classification tool based on autonomic system parameters during sleep to identify possible risks connected with prematurity

Prevalence and Risk Factors of Anemia among Antenatal Mothers Registered at a District Hospital in North India: A Cross-sectional Record Based Study

Background Anemia is the most common disorder which contributes significantly to high maternal mortality. Despite the availability of low-cost effective interventions for prevention and treatment of anemia among pregnant women its prevalence is still high.Objective This study aimed to check the prevalence of anemia and its associated risk factors among pregnant women attending a secondary level health care center in North India.Method A cross-sectional record-based study was carried out at a District Hospital in North India to study the prevalence and risk factors of anemia among the registered antenatal females.Results Mean age of antenatal females was 27.68plusmn4.59 years Range 18 ndash 45 years. Around 89.38 females were fully immunized with tetanus toxoid TT 8.94 had taken only one dose and 1.68 were unimmunized. About 96.08 of pregnant women had taken iron folic acid IFA supplementation. 78.77 delivered normally while one-fifth delivered through lower segment Caesarean section LSCS. 20 of registered females delivered neonates with low birth weight. 97.21 pregnant mothers were found to be anemic. 19.55 59.22 and 18.44 pregnant women had mild moderate and severe anemia respectively. Moderate anemia was highest in second order pregnancies while severe anemia was highest in third order pregnancies. Severe anemia was higher among caesarean deliveries 28.95 in comparison to normal deliveries 15.60. There was statistically significant difference between hemoglobin levels of women who delivered low birth weight and those who delivered normal weight babies p0.017 and also between females who had received TT and those who were unimmunized p0.002.Conclusion Anemia in pregnancy continues to be a major public health challenge. Rigorous efforts for implementation of various maternal health schemes at grass root level are imperative to reduce its catastrophic consequences

Reservoir Units Optimization in Pneumatic Spray Delivery-Based Fixed Spray System for Large-Scale Commercial Adaptation

A pneumatic spray delivery (PSD)-based solid set canopy delivery system (SSCDS) consists of in-line reservoirs and micro-emitter assemblies distributed throughout perennial crop canopies. The existing PSD-based SSCDS uses a large number of reservoirs, i.e., one unit per 3 m of linear spacing, which resulted in high installation and maintenance costs. These reservoirs also produces up to 25% post-spray chemical losses. Therefore, this study aimed to optimize the volumetric capacity and functionality of the existing reservoir for an efficient spray performance and the large-scale commercial adaptation of PSD-based SSCDS. Three reservoirs with volumetric capacities of 370 (1×), 740 (2×), and 1110 mL (3×) were developed to cover a spray span of 3.0, 6.1, and 9.1 m, respectively. Five system configurations with modified reservoirs and spray outlets were evaluated in the laboratory for pressure drop and spray uniformity. The three best system configurations were then field evaluated in a high-density apple orchard. These configurations had reservoirs with 1×, 2×, and 3× volumetric capacity and micro-emitters installed in a three-tier arrangement. Each replicate configuration was installed as a 77 m loop length encompassing 50 apple trees trained in a tall spindle architecture. A pair of water-sensitive paper (WSPs) samplers (25.4 × 25.4 mm) were placed on the abaxial and adaxial leaf surfaces in the bottom, middle, and top third of the canopy to evaluate the spray coverage (%). The PSD-based SSCDS showed no significant difference at the 5% level in terms of coverage among the three reservoir treatments. Coverage was more evenly distributed among the top, middle, and bottom zones for the 2× and 3× as compared to the 1× reservoir treatment. Overall, compared to the 1× reservoirs, the 2× and 3× reservoirs could potentially reduce the system costs by USD 20,000 and USD 23,410 ha−1, respectively, for tall spindle apple orchards and potentially reduce maintenance needs as well