Reexamining the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality

BACKGROUND: Low birth weight (<2,500 g) is a strong predictor of infant mortality. Yet low birth weight, in isolation, is uninformative since it is comprised of two intertwined components: preterm delivery and reduced fetal growth. Through nonparametric logistic regression models, we examine the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality. METHODS: We derived data on over 10 million singleton live births delivered at ≥ 24 weeks from the 1998–2000 U.S. natality data files. Nonparametric multivariable logistic regression based on generalized additive models was used to examine neonatal mortality (deaths within the first 28 days) in relation to fetal growth (gestational age-specific standardized birth weight), gestational age, and number of cigarettes smoked per day. All analyses were further adjusted for the confounding effects due to maternal age and gravidity. RESULTS: The relationship between standardized birth weight and neonatal mortality is nonlinear; mortality is high at low z-score birth weights, drops precipitously with increasing z-score birth weight, and begins to flatten for heavier infants. Gestational age is also strongly associated with mortality, with patterns similar to those of z-score birth weight. Although the direct effect of smoking on neonatal mortality is weak, its effects (on mortality) appear to be largely mediated through reduced fetal growth and, to a lesser extent, through shortened gestation. In fact, the association between smoking and reduced fetal growth gets stronger as pregnancies approach term. CONCLUSIONS: Our study provides important insights regarding the combined effects of fetal growth, gestational age, and smoking on neonatal mortality. The findings suggest that the effect of maternal smoking on neonatal mortality is largely mediated through reduced fetal growth

Uteroplacental bleeding disorders during pregnancy: do missing paternal characteristics influence risk?

BACKGROUND: Several studies have assessed the risks of uteroplacental bleeding disorders in relation to maternal characteristics. The association between uteroplacental bleeding disorders and paternal characteristics, however, has received considerably less attention. Data on paternal demographics, notably race and age, from birth certificate data are becoming increasingly incomplete in recent years. This pattern of increasingly underreporting of paternal demographic data led us to speculate that pregnancies for which paternal characteristics are partially or completely missing may be associated with increased risk for uteroplacental bleeding disorders. The objective of this study is to examine the association between placenta previa and placental abruption and missing paternal age and race. METHODS: A retrospective cohort study using U.S. linked birth/infant death data from 1995 through 2001 (n = 26,336,549) was performed. Risks of placenta previa and placental abruption among: (i) pregnancies with complete paternal age and race data; (ii) paternal age only missing; (iii) paternal race only missing; and (iv) both paternal age and race missing, were evaluated. Relative risk (RR) with 95% confidence interval (CI) for placenta previa and placental abruption by missing paternal characteristics were derived after adjusting for confounders. RESULTS: Adjusted RR for placental abruption were 1.30 (95% CI 1.24, 1.37), 1.00 (95% CI 0.95, 1.05), and 1.08 (95% CI 1.06, 1.10) among pregnancies with "paternal age only", "paternal race only", and "both paternal age and race" missing, respectively. The increased risk of placental abruption among the "paternal age only missing" category is partly explained by increased risks among whites aged 20–29 years, and among blacks aged ≥30 years. However, no clear patterns in the associations between missing paternal characteristics and placenta previa were evident. CONCLUSION: Missing paternal characteristics are associated with increased risk of placental abruption, likely mediated through low socio-economic conditions

Is Perioperative Hypothermia a Risk Factor for Post-Cesarean Infection?

Objective: To determine whether hypothermia during Cesarean delivery is a risk factor for postoperative infection. Methods: An historical cohort investigation was conducted on all women delivered by Cesarean at our center during 2001. Initial recovery-room temperature, taken via the oral or axillary route, was used as a surrogate for intraoperative temperature. Adding 0.5(°)C to axillary temperatures generated oral temperature equivalents. Women with chorioamnionitis were excluded, as were those with an initial recovery-room temperature that exceeded 37.9(°)C or was recorded more than 20 minutes after the end of surgery. Prophylactic antibiotics (cefazolin, 1 g) were given during Cesarean delivery. Results: A total of 42 women (7.6%) were diagnosed with postoperative infections. Infections included endometritis (n= 25), wound abscess (n = 7), wound cellulitis (n = 7) and urinary tract infection (UTI) (n = 4). No cases of septic pelvic thrombophlebitis or pelvic abscess occurred. One woman had both endometritis and a UTI. Mean temperatures were higher, rather than lower, for women who subsequently had postoperative infections compared with those who did not (36.4 ± 0.8(°)Cvs. 35.9 ± 0.7(°)C; p < 0.001). Mean temperatures for the various postoperative infections were as follows: endometritis, 36.5 ± 0.8(°)C (p < 0.001 vs. uninfected group); wound abscess 36.0 ± 0.8(°)C (p = 0.63); wound cellulitis, 36.3 ± 0.6(°)C (p = 0.14); UTI, 36.7 ± 0.9(°)C (p = 0.04). Conclusions: Women who develop post-Cesarean infections have higher initial recovery-room temperatures than those who do not develop such infections. This suggests the presence of subclinical infection at the time of Cesarean. Evaluating whether intraoperative warming has any role during Cesarean delivery requires a randomized clinical trial

Between the Post and the Com-Post:Examining the Postdigital ‘Work’ of a Prefix

In examining the work of the prefix ‘post’, we aim to contribute to the current postdigital dialogue. Our paper does not provide a rationale for the use of ‘postdigital’ in the title of this journal: that has been thoroughly explored elsewhere. We want instead to consider the work the prefix might do. We look at ‘post’, as it appears to ‘act’ in the terms of ‘postmodernism’ and ‘posthumanism’, suggesting that modernism and humanism are in need of questioning and reworking. We also examine what gets ‘post-ed’, or sometimes ‘com-posted’. (Com- is another interesting prefix, meaning ‘with’.) We then consider how these inquiries inform our understanding of a ‘postdigital reality’ that humans now inhabit. We understand this as a space of learning, struggle, and hope, where ‘old’ and ‘new’ media are now ‘cohabiting artefacts’ that enmesh with the economy, politics and culture. In entering this postdigital age, there really is no turning back from a convergence of the traditional and the digital. However, this is not simply a debate about technological and non-technological media. The postdigital throws up new challenges and possibilities across all aspects of social life. We believe this opens up new avenues too, for considering ways that discourse (language-in-use) shapes how we experience the postdigital

Brain data:Scanning, scraping and sculpting the plastic learning brain through neurotechnology

Neurotechnology is an advancing field of research and development with significant implications for education. As 'postdigital' hybrids of biological and informational codes, novel neurotechnologies combine neuroscience insights into the human brain with advanced technical development in brain imaging, brain-computer interfaces, neurofeedback platforms, brain stimulation and other neuroenhancement applications. Merging neurobiological knowledge about human life with computational technologies, neurotechnology exemplifies how postdigital science will play a significant role in societies and education in decades to come. As neurotechnology developments are being extended to education, they present potential for businesses and governments to enact new techniques of 'neurogovernance' by 'scanning' the brain, 'scraping' it for data and then 'sculpting' the brain toward particular capacities. The aim of this article is to critically review neurotechnology developments and implications for education. It examines the purposes to which neurotechnology development is being put in education, interrogating the commercial and governmental objectives associated with it and the neuroscientific concepts and expertise that underpin it. Finally, the article raises significant ethical and governance issues related to neurotechnology development and postdigital science that require concerted attention from education researchers

Customized birth weight for gestational age standards: Perinatal mortality patterns are consistent with separate standards for males and females but not for blacks and whites

BACKGROUND: Some currently available birth weight for gestational age standards are customized but others are not. We carried out a study to provide empirical justification for customizing such standards by sex and for whites and blacks in the United States. METHODS: We studied all male and female singleton live births and stillbirths (22 or more weeks of gestation; 500 g birth weight or over) in the United States in 1997 and 1998. White and black singleton live births and stillbirths were also examined. Qualitative congruence between gestational age-specific growth restriction and perinatal mortality rates was used as the criterion for identifying the preferred standard. RESULTS: The fetuses at risk approach showed that males had higher perinatal mortality rates at all gestational ages compared with females. Gestational age-specific growth restriction rates based on a sex-specific standard were qualitatively consistent with gestational age-specific perinatal mortality rates among males and females. However, growth restriction patterns among males and females based on a unisex standard could not be reconciled with perinatal mortality patterns. Use of a single standard for whites and blacks resulted in gestational age-specific growth restriction rates that were qualitatively congruent with patterns of perinatal mortality, while use of separate race-specific standards led to growth restriction patterns that were incompatible with patterns of perinatal mortality. CONCLUSION: Qualitative congruence between growth restriction and perinatal mortality patterns provides an outcome-based justification for sex-specific birth weight for gestational age standards but not for the available race-specific standards for blacks and whites in the United States