Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals

The causal relationship between gut microbiota and preterm birth: a two-sample Mendelian randomization study

BACKGROUND

Preterm birth, a significant global health concern, has been associated with alterations in the gut microbiota. However, the causal nature of this relationship remains uncertain due to the limitations inherent in observational studies.

PURPOSE

To investigate the potential causal relationship between gut microbiota imbalances and preterm birth.

METHODS

We conducted a two-sample Mendelian randomization (MR) study using genome-wide association study (GWAS) data from the MiBioGen consortium focusing on microbiota and preterm birth. Single nucleotide polymorphisms (SNPs) associated with the microbiota were selected as instrumental variables. The inverse variance weighting (IVW) method was used to estimate causality. We confirmed pleiotropy and identified and excluded outlier SNPs using MR-PRESSO and MR-Egger regression. Cochran's Q test was applied to assess heterogeneity among SNPs, and a leave-one-out analysis was performed to evaluate the influence of individual SNPs on overall estimates.

RESULTS

Our findings provide evidence for a causal link between specific components of the gut microbiota and preterm birth, with the identification of relevant metabolites.

CONCLUSION

This study highlights the causal role of gut microbiota imbalances in preterm birth, offering novel insights into the development of preterm birth and potential targets for prevention strategies.

Identification of differentially expressed non-coding RNAs in the plasma of women with preterm birth

This study aimed to identify differentially expressed non-coding RNAs (ncRNAs) associated with preterm birth (PTB) and determine biological pathways being influenced in the context of PTB. We processed cell-free RNA sequencing data and identified seventeen differentially expressed (DE) ncRNAs that could be involved in the onset of PTB. Per the validation via customized RT-qPCR, the recorded variations in expressions of eleven ncRNAs were concordant with the in-silico analyses. The results of this study provide insights into the role of DE ncRNAs and their impact on pregnancy-related biological pathways that could lead to PTB. Further studies are required to elucidate the precise mechanisms by which these DE ncRNAs contribute to adverse pregnancy outcomes (APOs) and their potential as diagnostic biomarkers.

The Association Between Longer Maternal Leukocyte Telomere Length in the Immediate Postpartum Period and Preterm Birth in a Predominately Latina Cohort of Mothers

OBJECTIVES

We investigated the association between maternal leukocyte telomere length (LTL) in the immediate postpartum period and moderate to late preterm birth (32- < 37 weeks) among Latinas, a population at high risk for preterm birth.

METHODS

Maternal LTL was measured using quantitative polymerase chain reaction at delivery in a prospective San Francisco primarily Latina birth cohort. Logistic regression models were used to investigate the association between postpartum maternal LTL and preterm birth. Maternal LTL was analyzed as a continuous predictor.

RESULTS

Out of 194 participants, 23 (11.9%) had preterm delivery. Longer postnatal maternal LTL was associated with preterm birth (crude OR 4.68; 95% confidence interval (CI) 1.07, 20.6, p = 0.039; adjusted OR 12.8, 95% CI 1.83, 99.9, p = 0.010). Age-stratified analysis showed that being under 35 years increased the effect size of the association between maternal LTL and preterm birth (adjusted OR 32.5, 95% CI 2.58, 597, p < 0.01).

CONCLUSIONS FOR PRACTICE

Latina mothers with moderate to late preterm infants had longer LTL in the immediate postpartum period compared to those with term infants. This association was stronger for mothers under the age of 35 years. LTL may serve as a biomarker to better understand the pathophysiology and risk of preterm birth and could inform targeted interventions for prevention and early detection. Future studies are needed to understand physiological changes in maternal LTL from the prenatal to postnatal period in relation to birth outcomes.

Unveiling parents' lived experience with preterm infant care and support in neonatal care units of public hospitals in Nepal: A phenomenological inquiry

BACKGROUND

Preterm infants (PTIs) require hospitalization in different levels of neonatal care units (NCUs) for their survival and developmental needs. The quality of care provided at NCUs significantly influences infant outcomes and parents' experiences. Parents' experience of received support and care of PTIs is one of the indicators for determining the quality of care at NCUs. The study aims to investigate parents' perspectives on the PTIs care and support received from nurses in NCUs of Nepal.

METHODS

A descriptive phenomenological study was conducted within the NCUs of three public tertiary hospitals in Kathmandu, Nepal. In-depth interviews were conducted among 25 purposively selected parents, (both mothers and fathers) of low-birthweight PTIs admitted to the NCUs. Data was collected from November 2019 to February 2020. The data were meticulously analyzed using the Colaizzi method.

FINDINGS

The exploration of parents' experiences identified three main theme areas: (1) Care and support, (2) Initial involvement in PTI care, and (3) Outcome of care involvement. Parents appreciated competent and affectionate PTI care as well as informational support. However, they had varied experiences with communication, emotional support, and opportunities for infant-parent attachment. Guidance and support for PTI care from nurses and peer-parents proved instrumental in mitigating uncertainties related to initial care learning and involvement in PTI care. Parents' involvement in hands on care of their PTIs boosted infant-parent attachment, empowered for care giving, and provided emotional solace.

CONCLUSION

Findings indicate that parents have positive experience with PTI care provided by nurses and their involvement in hands-on care of their PTIs. However, there are gaps in support expectations of parents including communication, emotional support, and care guidance. Findings have important implications for nurses, pediatricians, and policymakers for the enhancement of neonatal care practice by incorporating parental support and parents' involvement in hands on care of PTI across NCUs in Nepal.

Live births and deaths of neonates born to adolescent mothers: analysis of trends and associations from a population study in a region of a middle-income country

BACKGROUND

Adolescent pregnancy is associated with adverse outcomes, and although there has been a global decline in the incidence of teenage pregnancies and neonatal deaths, the absolute number remains significant. This study aimed to evaluate temporal trends in live births and neonatal deaths from adolescent mothers, as well as to identify the effect of adolescent pregnancy on neonatal death.

METHODS

This is a population-based study of all live births from mothers residing in Sao Paulo state, Brazil, between 2004 and 2020. The Prais-Winsten model was used to analyze annual trends for live births from adolescent mothers, neonatal mortality rates, and the percentage of neonatal deaths within specific demographic groups. The Kaplan-Meier survival curve evaluated the time to neonatal death. A Poisson regression model was utilized to identify maternal and neonatal characteristics associated with the risk of neonatal death.

RESULTS

The present study encompassed a total of 9,870,181 live births, with 14.4% occurring to adolescent mothers. There were 75,504 neonatal deaths, with 14,159 (18.8%) of those occurring in the neonates born to adolescent mothers. The annual percentage change in live births to adolescent mothers decreased by -3.03% (95%CI: -4.12% to -1.93%). The neonatal mortality rates showed a declining trend within both adolescent and non-adolescent mothers. Infants born to adolescent mothers had a higher probability of neonatal death and an earlier age of death when compared to non-adolescent mothers' infants. Poisson multiple regression analysis indicated an elevated risk of neonatal death for seven tested variables (adolescent mothers, inadequate prenatal care, multiple gestation, non-hospital delivery, low birth weight, male sex and congenital anomalies) and a reduction on risk of death for neonates born from cesarean section.

CONCLUSIONS

The study showed a reduction in live births to adolescent mothers and neonatal deaths among adolescent mothers from 2004 to 2020 in the state of Sao Paulo. Was also shown a risk association between been born to adolescent mothers and neonatal death.

Worldwide prevalence and disability from preterm-associated developmental intellectual disability during childhood and adolescence

OBJECTIVE

To comprehensively assess the prevalence and years lived with disability (YLDs) of preterm-associated developmental intellectual disability (PDID) in children and adolescents born preterm (CABP) from 1990 to 2021.

METHOD

Using data from the Global Burden of Disease 2021, the burden of PDID in CABP (0-19 years) at global, regional and national levels was assessed by joinpoint regression, age-period-cohort (A-P-C) analysis, and cross-country health inequality analysis.

RESULTS

Globally, there were 12,114,153 prevalent cases and 915,937 YLDs of PDID in CABP in 2021, with much higher values in males than in females. Moreover, the prevalent cases and YLDs demonstrated significant increasing trends, whereas only the age-standardized rate of prevalence showed a slight decline from 1990 to 2021 worldwide, with a slight increase in the proportion of severe cases. The age subgroup analysis showed a significant reduction in the burden of PDID in children aged <5 years. The A-P-C analysis found that, in contrast to middle to high-sociodemographic index (SDI) regions, the risk of PDID was highest in children aged <5 years, and that period and cohort effects were unfavourable in low-SDI regions. The results of cross-country health inequality analysis showed that the burden of PDID in CABP was concentrated in low-SDI countries, while SDI-related inequalities generally decreased between 1990 and 2021.

CONCLUSION

Overall, the global burden of PDID in CABP has increased from 1990 to 2021, while the burden in children under 5 years of age has decreased globally. Despite reduced health inequalities, low-SDI regions still bear a significant burden.

Placental Proteomics Reveals an Elevated Level of Aldo-Keto Reductase 1-B1, Highlighting Its Potential Role in Spontaneous Preterm Birth

Preterm birth (PTB) refers to the delivery of a baby before the completion of 37 weeks of gestation. It is a significant global health issue with implications for both mothers and neonates. The placenta is a transient organ crucial in the sustenance of pregnancy until parturition; its dysfunction is associated with different adverse pregnancy outcomes, including PTB. We conducted a nested case-control study of 40 placental tissue samples from preterm and term deliveries to study their comparative protein profiles. Label-free quantitation (LFQ) revealed 23 differentially expressed proteins (DEPs). Aldo-keto reductase-B1 (AKR1B1) protein expression profile exhibited a declining trajectory with an increasing period of gestation (POG). Immunoblotting and immunohistochemistry analyses of placental samples also revealed elevated protein levels in extreme preterm samples. AKR1B1 is a functional Prostaglandin F synthase responsible for the synthesis of Prostaglandin-F2α, a prostanoid that is elevated during parturition and involved in cervical ripening, membrane rupture, myometrial contraction, and inflammation. Hence, our finding supports the idea that elevated AKR1B1 levels play a significant role in the pathology of preterm birth by amplifying Prostaglandin-F2α synthesis in the placental milieu and can be further explored as a potential predictor of this condition. Data are available via ProteomeXchange with the identifier PXD043480.

Azithromycin to prevent acute lower respiratory infections among Australian and New Zealand First Nations and Timorese children (PETAL trial): study protocol for a multicentre, international, double-blind, randomised controlled trial

INTRODUCTION

Acute lower respiratory infections (ALRIs) remain the leading causes of repeated hospitalisations among young disadvantaged Australian and New Zealand First Nations and Timorese children. Severe (hospitalised) and recurrent ALRIs in the first years of life are associated with future chronic lung diseases (eg, bronchiectasis) and impaired lung function. Despite the high burden and long-term consequences of severe ALRIs, clinical, evidence-based and feasible interventions (other than vaccine programmes) that reduce ALRI hospitalisations in children are limited. This randomised controlled trial (RCT) will address this unmet need by trialling a commonly prescribed macrolide antibiotic (azithromycin) for 6-12 months. Long-term azithromycin was chosen as it reduces ALRI rates by 50% in Australian and New Zealand First Nations children with chronic suppurative lung disease or bronchiectasis. The aim of this multicentre, international, double-blind, placebo-containing RCT is to determine whether 6-12 months of weekly azithromycin administered to Australian and New Zealand First Nations and Timorese children after their hospitalisation with an ALRI reduces subsequent ALRIs compared with placebo. Our primary hypothesis is that children receiving long-term azithromycin will have fewer medically attended ALRIs over the intervention period than those receiving placebo.

METHODS AND ANALYSIS

We will recruit 160 Australian and New Zealand First Nations and Timorese children aged <2 years to a parallel, superiority RCT across four hospitals from three countries (Australia, New Zealand and Timor-Leste). The primary outcome is the rate of medically attended ALRIs during the intervention period. The secondary outcomes are the rates and proportions of children with ALRI-related hospitalisation, chronic symptoms/signs suggestive of underlying chronic suppurative lung disease or bronchiectasis, serious adverse events, and antimicrobial resistance in the upper airways, and cost-effectiveness analyses.

ETHICS AND DISSEMINATION

The Human Research Ethics Committees of the Northern Territory Department of Health and Menzies School of Health Research (Australia), Health and Disability Ethics Committee (New Zealand) and the Institute National of Health-Research Technical Committee (Timor-Leste) approved this study. The study outcomes will be disseminated to academic and medical communities via international peer-reviewed journals and conference presentations, and findings reported to health departments and consumer-based health organisations.

CLINICAL TRIAL REGISTRATION

Australia New Zealand Clinical Trial Registry ACTRN12619000456156.

Fluid Management in ELGANs: Striking the Perfect Balance!

Managing fluid and electrolytes in extremely low gestational age neonates (ELGANs) is often challenging because of their distinctive fluid physiology. Most of the fluid loss in the first week of life is trans-epidermal due to the immature barrier function of the skin. ELGANs also have a developmental tendency for exaggerated diuresis and natriuresis. Allowing an initial weight loss of 6-12% promotes physiological extracellular contraction. Also, restricted fluid intake in the first week of life may decrease the incidence of bronchopulmonary dysplasia, patent ductus arteriosus, and necrotizing enterocolitis. A protocol-based approach for fluid management in ELGANs, developed based on physiology and available evidence, is the best strategy. Based on the estimated dermal and renal losses and desired weight change, the authors recommend initiating total fluids on the first day of life at 100 mL/kg/d in neonates at 26-27 wk gestation and 110 mL/kg/d at 24-25 wk gestation. The subsequent fluid rate is determined based on rigorous monitoring of weight, urine output, and serum sodium, with a typical daily increment in fluids of 10-20 mL/kg and a maximum fluid rate of 150-160 mL/kg/d in 26-27 wk and 160-180 mL/kg/d in 24-25 wk gestation neonates by day 7 of life. Fluid strategy should ideally be revised every 12 h in the first few days of life. A humidified incubator is the ideal care environment to minimize trans-epidermal losses. Since most of these recommendations are not based on concrete evidence from trials, it is advisable to periodically audit the outcomes and devise a unit-specific fluid strategy.

A population-level impact assessment of the National Health Mission on maternal and child health outcomes in India

India launched the National Health Mission (NHM) in 2005 to reduce maternal and child mortality by providing equitable, affordable, and quality healthcare services. Studies evaluating the impact of NHM primarily focused on the uptake of maternal and child health (MCH) services, revealing a dearth of evidence on related health outcomes. Using annual time-series data, we estimated the population-level (intention-to-treat effect) impact of the NHM on MCH outcomes such as infant mortality rate (IMR), stillbirth rate, neonatal mortality rate (NMR), and maternal mortality ratio (MMR). Our results exhibit strong consensus on the positive impact on IMR in the post-NHM period, with a significant reduction in its rate and regional inequity. Conversely, our estimates show a moderate impact on stillbirth rate and an insignificant impact on NMR and MMR. Our findings inform policy decisions for strengthening the public health system to amplify the positive gains in MCH outcomes.

Appraisal of CRISPR Technology as an Innovative Screening to Therapeutic Toolkit for Genetic Disorders

The high frequency of genetic diseases compels the development of refined diagnostic and therapeutic systems. CRISPR is a precise genome editing tool that offers detection of genetic mutation with high sensitivity, specificity and flexibility for point-of-care testing in low resource environment. Advancements in CRISPR ushered new hope for the detection of genetic diseases. This review aims to explore the recent advances in CRISPR for the detection and treatment of genetic disorders. It delves into the advances like next-generation CRISPR diagnostics like nano-biosensors, digitalized CRISPR, and omics-integrated CRISPR technologies to enhance the detection limits and to facilitate the "lab-on-chip" technologies. Additionally, therapeutic potential of CRISPR technologies is reviewed to evaluate the implementation potential of CRISPR technologies for the treatment of hematological diseases, (sickle cell anemia and β-thalassemia), HIV, cancer, cardiovascular diseases, and neurological disorders, etc. Emerging CRISPR therapeutic approaches such as base/epigenetic editing and stem cells for the development of foreseen CRIPSR drugs are explored for the development of point-of-care testing. A combination of predictive models of artificial intelligence and machine learning with growing knowledge of genetic disorders has also been discussed to understand their role in acceleration of genetic detection. Ethical consideration are briefly discussed towards to end of review. This review provides the comprehensive insights into advances in the CRISPR diagnostics/therapeutics which are believed to pave the way for reliable, effective, and low-cost genetic testing.

Renal Regional Oxygen Saturation and Acute Kidney Injury in Neonates with Perinatal Asphyxia

OBJECTIVE

 Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during TH and AKI in neonates with moderate and severe perinatal asphyxia.

STUDY DESIGN

 This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO2 was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the receiver operating characteristic curve.

RESULTS

 Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO2 levels during TH. Specifically, rSrO2 levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01-1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78-0.92) were significantly associated with AKI.

CONCLUSION

 An increase in rSrO2 during the first 12 hours of TH and lower rSrO2 levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH.

KEY POINTS

· Neonates with asphyxia often develop AKI.. · Renal saturations are affected by hypothermia and asphyxia. · Patients with AKI initially show higher rSrO2, then lower rSrO2.. · Monitoring rSrO2 identifies early AKI..

Automated oxygen control for preterm infants receiving continuous positive airway pressure in southwest Nigeria: an open-label, randomised, crossover trial

BACKGROUND

Titration of oxygen therapy to target safe oxygen saturation (SpO2) values is a vital part of care for preterm infants, but is difficult to achieve, particularly in settings in which oxygen, monitoring technology, and human resources are scarce. We aimed to evaluate the safety and efficacy of automated titration of oxygen therapy partnered with a low-cost continuous positive airway pressure (CPAP) device versus manual oxygen control in preterm infants requiring CPAP in a high-mortality, low-resource setting.

METHODS

In this open-label, randomised, crossover trial, preterm infants with a gestational age younger than 34 weeks (or a birthweight <2 kg if gestation was unknown) who were aged 12 h or older and required CPAP and oxygen were recruited at two hospitals in southwest Nigeria. Participants were randomly assigned (1:1) to one of two intervention sequences (ie, to commence the study on automated oxygen control or manual oxygen control) with block randomisation (blocks of 4 and 6) and stratification by health facility. The study statistician was masked to treatment group assignment, but the participants' parents or caregivers and clinical staff were not. Participants received automated or manual oxygen control for two 24-h periods in random sequence. Automated oxygen titration was done with a control algorithm with proven efficacy in high-resource settings. During periods of manual control, oxygen therapy was adjusted by clinicians. The primary outcome was the adjusted mean difference in the proportion of time participants spent in the SpO2 target range (ie, SpO2 91-95% when receiving oxygen or SpO2 91-100% when not receiving oxygen) between automated and manual oxygen control, analysed by intention to treat with weighted repeated measures mixed model linear regression. This trial is registered with ClinicalTrials.gov, NCT05508308, and is completed.

FINDINGS

Between Sept 13, 2022, and Sept 11, 2023, 72 infants were screened, and 49 (22 female, 27 male; median gestation 29 weeks [IQR 28-31]; median birthweight 1·2 kg [1·1-1·5]) were enrolled in the study and randomly assigned. A total of 80 study periods for 46 infants contributed data to the analysis of the primary outcome as three (6%) of the 49 participants had no oxygenation data from either study period. The mean proportion of time spent in the SpO2 target range was higher during automated control periods than during periods of manual control (adjusted mean 88·1% [95% CI 84·0-92·2] vs 30·1% [20·9-39·3]; adjusted mean difference 58·0% [95% CI 48·0-67·9]; p<0·0001). There were no device-related adverse patient outcomes and short-term safety outcomes favoured automated control.

INTERPRETATION

Automated titration of oxygen partnered with a low-cost CPAP device improved time spent in the safe SpO2 range compared with manual control. There is high potential for this technology to mitigate the risk of oxygen-mediated complications in preterm infants in low-resource settings.

FUNDING

National Health and Medical Research Council Australia and University of Tasmania.

Seasonal variation in the incidence of preterm births

OBJECTIVES

To examine the influence of the season of conception, and the season of birth on the incidence of preterm birth (PTB) and neonatal outcomes.

STUDY DESIGN

This is a single center, retrospective cohort study of singleton births that took place in The Coombe Hospital in Dublin, Ireland, between January 2013 and December 2022. A comprehensive database was analyzed to determine the incidence of PTB per season of conception and season of birth. Overall neonatal outcomes were reported and stratified per the occurrence of PTB or term birth.

RESULTS

Following exclusions, 76,988 births were analyzed. Women who conceived in winter between December-February had significantly lower rates of PTBs when compared to other seasons (5.4 % vs 6.5 % (spring) vs 5.6 % (summer) and 5.4 % (autumn), p < 0.001). When considering only spontaneous preterm labor, this trend persists, with most women experiencing spontaneous PTBs conceiving during spring (6.7 % vs 5.5 % (winter) vs 5.7 % (summer) vs 5.5 % (autumn), p = 0.001). Conversely, women who gave birth in December-February had significantly higher rates of premature births when compared to other seasons (6.2 vs 5.8, 5.5 %. and 5.5 %, p < 0,01). PTBs of spontaneous onset were highest between December and February, however no statistical significance was found (6.2 % vs 6.1 % (spring), 5.7 % (summer) and 5.4 % (autumn), p = 0.13). No significant variation in maternal risk factors or neonatal outcomes were identified between the seasons.

CONCLUSIONS

This study has shown that there is a seasonal variation in the incidence of preterm births in this Irish-based cohort. A low prevalence of PTB was demonstrated when conceptions occurred in the winter months. However, there was a greater incidence of preterm births between December and February. This is suggestive that there are potential risk factors associated with seasonal patterns that may be modifiable. Further research to identify these specific risks is warranted.

Dynamic analysis of the epidemiology and pathogen distribution of bronchoalveolar lavage fluid in children with severe pulmonary infection: a retrospective study

BACKGROUND

Severe pulmonary infection is the primary cause of death in children aged < 5 years. The early identification of pathogenic bacteria and targeted anti-infective therapies can significantly improve the prognosis of children with severe infections. This study aims to provide a reference for the rational use of antibiotics at an early stage in children with severe pulmonary infections.

METHODS

A retrospective, single-center longitudinal study included children with severe pulmonary infections between January 2017 and December 2022 by obtaining their bacterial culture results of bronchoalveolar lavage fluid.

RESULTS

This study included 4080 samples. The age of onset for severe pulmonary infection increased annually. The proportion of severe pulmonary infections across the different age groups and years was statistically significant (p < 0.001). Among children with severe pulmonary infections, bacilli were the most prevalent, followed by cocci and fungi. The predominant bacilli were Acinetobacter baumannii and Klebsiella pneumoniae. The predominant cocci identified in this study were Streptococcus pneumoniae and Staphylococcus aureus. The primary fungi included Candida albicans and Aspergillus fumigatus, which showed significant differences (p < 0.05). The incidence of drug-resistant bacteria has gradually declined, with infection rates of multidrug-resistant bacteria and extended-spectrum beta-lactamases consistently decreasing annually. For carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, the infection rates peaked in 2018, with statistical significance (p < 0.001).

CONCLUSIONS

Severe pulmonary infections in children are significantly associated with age and types of infectious pathogens. Gram-negative bacteria are the primary cause of severe pulmonary infections in children. Clinicians should rationally use antibiotics according to the local distribution and drug resistance of pathogens, thereby enhancing therapeutic outcomes.

Parametric modeling of under-5 children survival among 30 African countries: Lognormal accelerated failure time gamma shared frailty model

BACKGROUND

Under-five mortality continues to be a serious public health concern in low-and middle-income countries, particularly in Africa. This study investigates the probability of under-five survival and its predictors of mortality in the African continent using a recent demographic health survey from 2014-2022.

METHODS

This study utilized recent Demographic and Health Survey data from 30 African countries, encompassing 226,862 live births. This study employed a multivariable lognormal accelerated failure time gamma shared frailty parametric survival regression analysis to identify the predictors of time-to-death among under-five children in these African nations.

RESULT

The overall under-five child mortality rate in Africa was 37.55 per 1,000 live births (95% CI: 37.35, 37.74. In this study, children born in Western Africa; children born in Eastern Africa; children born to mothers aged 15-19 years; maternal educational status; maternal decision autonomy; being female; place of delivery; number of ANC visits; children born among mothers who delivered by Cesarean section; mothers who have multiple birth outcome; children who were second birth order; and third birth order and third birth order; children who were small in size at birth; children who were born from a community with a low women education; having poor wealth index; respondents working; mothers delivered at the age between 20-35 were significant predictors of survival time to event of under-five children in Africa.

CONCLUSION

This study found that the overall under-five mortality rates remain high across Africa. In this study country region, maternal age, maternal education status, maternal age at first birth, respondent's employment status, birth outcome, wealth index, birth order, place of delivery, mode of delivery, women's autonomy in healthcare decision-making, number of antenatal care visits, child's size at birth, sex of the neonate, and community-level women's education were found to be significant predictors of survival time to death of under-five children. Addressing these multilevel factors is crucial for developing targeted interventions to reduce under-five mortality further and improve child survival in African countries.

Antibiotics for Paediatric Community-Acquired Pneumonia: What is the Optimal Course Duration?

Despite significant global reductions in cases of pneumonia during the last 3 decades, pneumonia remains the leading cause of post-neonatal mortality in children aged <5 years. Beyond the immediate disease burden it imposes, pneumonia contributes to long-term morbidity, including lung function deficits and bronchiectasis. Viruses are the most common cause of childhood pneumonia, but bacteria also play a crucial role. However, the optimal duration of antibiotic therapy for bacterial pneumonia remains uncertain in both low- and middle-income countries and in high-income countries. Knowing the optimal duration of antibiotic therapy for pneumonia is crucial for effective antimicrobial stewardship. This is especially important as concerns mount over rising antibiotic resistance in respiratory bacterial pathogens, which increases the risk of treatment failure. Numerous studies have focused on the duration of oral antibiotics and short-term outcomes, such as clinical cure and mortality. In contrast, only one study has examined both intravenous and oral antibiotics and their impact on long-term respiratory outcomes following pneumonia hospitalisation. However, study findings may be influenced by their inclusion criteria when children unlikely to have bacterial pneumonia are included. Efforts to differentiate between bacterial and non-bacterial pneumonia continue, but a validated, accurate, and simple point-of-care diagnostic test remains elusive. Without certainty that a child has bacterial pneumonia, determining the optimal duration of antibiotic treatment is challenging. This review examines the evidence for the recommended duration of antibiotics for treating uncomplicated pneumonia in otherwise healthy children and concludes that the question of duration is unresolved.

Preterm births attributable to criteria air pollutant exposure in Bangladesh during 2015-2019

Criteria air pollutant exposure impacts human health through various pathways. Preterm birth (PTB) is one of the major adverse birth outcomes (ABO) associated with such exposure. Although numerous global and regional studies have been conducted on this issue, few have recently investigated the impact of major criteria air pollutant exposure on PTBs in Bangladesh, one of the world's most polluted countries with the highest relative PTB rate. In this study, we retrieved high-resolution criteria air pollution data from recent studies and regionally scaled it to 10 km × 10 km resolution. We incorporated the MERRA-2 model, satellite measurements, and exposure-response modeling to quantify the impacts of CO, O3, PM2.5, SO2, and NO2 exposure on PTBs in Bangladesh from 2015 to 2019. We observed the highest all-source CO, O3, PM2.5, SO2, and NO2 exposure in 2018 at 272.8 μg/m3, 88.2 ppbv, 62.9 μg/m3, 20.5 μg/m3, and 11.6 ppbv, respectively. These exposures were associated with 0.18 million [95% confidence interval (95%CI): 0.08-0.29 million] to 0.20 million [95%CI: 0.08-0.32 million] annual total PTBs among 4.3 million annual total live births, indicating an alarming 4.4-4.9% PTB rate exclusively attributable to the exposure to these five criteria air pollutants. Within these PTB estimates, our study found that combined CO, O3, and PM2.5 exposure caused the majority (94.7-95.8%) of the total PTBs, with hotspots in the central and southern regions of Bangladesh. This study provides quantitative evidence of the PTB incidence caused by major criteria air pollutant exposure and discusses the urgency of the targeted reduction of pollutants as well as source control to reduce the risks of PTBs, which is critical for the overall well-being of the overpopulated and underrepresented women and children of Bangladesh.

Randomised feasibility study of an intestinal adsorbent in acute diarrhoea in The Gambia

BACKGROUND

Diarrhoea remains a leading cause of death in children. An intestinal adsorbent may reduce diarrhoea duration and severity.

METHODS

Randomised controlled feasibility trial with two phases: phase 1 (0-4 hours and double-blind) and phase 2 (up to 5 days and open-label). 50 children aged 6-59 months with acute diarrhoea presenting with no or some dehydration to the emergency paediatric unit and outpatient clinic at Edward Francis Small Teaching Hospital, Banjul, The Gambia were randomised to either standard treatment (oral rehydration fluid and zinc) or standard treatment with polymethylsiloxane polyhydrate for up to 5 days.

RESULTS

Recruitment was completed in 7 months. All but one child completed the study. There were no major protocol deviations although patient-held diaries did not collect reliable information. Time from randomisation to the last watery stool (primary outcome) was shorter in the intervention than control arm (mean difference -19.3 hours, 95% CI -30.9 to -7.8). Stool frequency was lower in the intervention arm on days 2 (95% CI -0.8 to -1.3 to -0.3) and 3 (95% CI -0.8; -1.3 to -0.3). One serious event (death) occurred in the control arm.

CONCLUSIONS

A randomised, controlled trial is feasible. Further clinical trials are warranted to confirm the efficacy of polymethylsiloxane polyhydrate in acute diarrhoea and inform management guidelines.

TRIAL REGISTRATION NUMBER

PACTR202302683128875.

Association of nucleoside reverse transcriptase inhibitors with adverse perinatal outcomes in pregnant women living with HIV: systematic review and meta-analysis

BACKGROUND

The World Health Organization (WHO) recommends antiretroviral therapy (ART) containing two nucleoside reverse transcriptase inhibitors (NRTIs) as backbone. WHO recommends tenofovir disoproxil fumarate combined with lamivudine or emtricitabine as first line in pregnancy, and zidovudine, abacavir or tenofovir alafenamide, combined with lamivudine or emtricitabine, as alternatives.

OBJECTIVES

Evaluate risk of adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving different NRTIs.

DATA SOURCES

Medline, CINAHL, Global Health, EMBASE.

STUDY ELIGIBILITY CRITERIA

Cohort studies.

PARTICIPANTS

Pregnant WLHIV.

INTERVENTIONS

ART regimes containing different NRTI drugs.

ASSESSMENT OF RISK OF BIAS

Newcastle-Ottawa Scale and GRADE.

METHODS OF DATA SYNTHESIS

Random-effects meta-analysis.

RESULTS

22 cohort studies including 124,478 WLHIV met the eligibility criteria. ART containing tenofovir disoproxil fumarate was associated with lower risk of preterm birth (Risk Ratio 0.89; 95% confidence interval 0.81-0.97), very preterm birth (0.58; 0.40-0.86), small for gestational age (0.76; 0.59-0.98), very small for gestational age (0.60; 0.48-0.73), stillbirth (0.49; 0.31-0.78), and neonatal death (0.61; 0.40-0.93), compared to ART not containing tenofovir disoproxil fumarate. ART containing zidovudine was associated with increased risk of very preterm birth (1.59; 1.01-2.49), small for gestational age (1.33; 1.03-1.70), very small for gestational age (1.63; 1.25-2.13), stillbirth (2.23; 1.10-4.55), and neonatal death (1.65; 1.08-2.52), compared to ART not containing zidovudine. For ART regimens also containing either lamivudine or emtricitabine, zidovudine was associated with increased risk of very preterm birth (1.62; 1.04-2.52), small for gestational age (1.52; 1.28-1.82), very small for gestational age (1.68; 1.36-2.06), stillbirth (2.19; 1.03-4.67), and neonatal death (1.65; 1.08-2.52), compared to ART containing tenofovir disoproxil fumarate. Abacavir was not associated with adverse perinatal outcomes. Tenofovir alafenamide was not associated with low birth weight compared to tenofovir disoproxil fumarate.

CONCLUSION

Tenofovir disoproxil fumarate is associated with a lower risk of adverse perinatal outcomes, whereas zidovudine is associated with an increased risk of perinatal outcomes. Abacavir is not associated with adverse perinatal outcomes. Our findings support current WHO guidelines.

Role of the very low frequencies of the renal oxygen saturation signal in acute kidney injury in newborns with perinatal asphyxia

Objective

Renal autoregulation, hemodynamic response, and endothelial dysfunction play significant roles in acute kidney injury (AKI) during perinatal asphyxia. A third mechanism of autoregulation, involving very low-frequency oscillations, has been described. This study aimed to evaluate the relationship between the power of the very low-frequency component of the Fast Fourier Transform (FFT) and AKI during therapeutic hypothermia (TH) treatment in neonates with perinatal asphyxia.

Study design

A retrospective longitudinal study was conducted on neonates with moderate and severe perinatal asphyxia. AKI was defined as a decrease of less than 33% in the serum creatinine level by day 3. The power of the very low-frequency component in the FFT was assessed by analyzing renal oxygen saturation using near-infrared spectroscopy (NIRS), focusing on a frequency band of approximately 0.01 Hz. Bivariate analyses were performed to explore the association between the power of the very-low-frequency component and AKI. The predictive ability of this component for AKI was evaluated using a receiver operating characteristic (ROC) curve. Additionally, a generalized estimating equation (GEE) was developed to investigate whether changes in the power of the very-low-frequency component during treatment differed according to the presence of AKI.

Results

A total of 91 patients were included in the study, of whom 15 (16.5%) developed AKI. Neonates with AKI exhibited a significantly lower power of the very low-frequency component on the second day of treatment (p = 0.001). This component demonstrated good predictive ability for AKI (ROC curve 0.77, 95% CI 0.63-0.90).

Conclusion

Among neonates with perinatal asphyxia who developed AKI, a lower power of the very-low-frequency component in FFT (approximately 0.01 Hz) was observed on the second day of therapeutic hypothermia. This finding suggests that alterations in very-low-frequency oscillations may reflect endothelial dysfunction and contribute to the development of AKI, warranting further investigation in larger cohorts.

The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy

BACKGROUND

Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.

METHODS

From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother-infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.

RESULTS

Among 187 mother-infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).

CONCLUSIONS

CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.

Development of CPAP Overlay Interfaces for Efficient Administration of Aerosol Surfactant Therapy to Preterm Infants

The administration of surfactant aerosol therapy to preterm infants receiving continuous positive airway pressure (CPAP) respiratory support is highly challenging due to small flow passages, relatively high ventilation flow rates, rapid breathing and small inhalation volumes. To overcome these challenges, the objective of this study was to implement a validated computational fluid dynamics (CFD) model and develop an overlay nasal prong interface design for use with CPAP respiratory support that enables high efficiency powder aerosol delivery to the lungs of preterm infants when needed (i.e., on-demand) and can remain in place without increasing the work of breathing compared with a baseline CPAP interface. Realistic in vitro experiments were first conducted to generate baseline validation data, and then the CFD model, once validated, was used to explore key design parameters across a range of preterm infant nose-throat geometries and aerosol delivery conditions. The most important factors for efficient aerosol delivery were shown to be (i) maintaining the aerosol delivery flow rate below the tracheal flow rate (to minimize CPAP line loss) and (ii) concentrating the aerosol within the first portion of the inhalation waveform. An optimized design was shown to deliver approximately 37-60% of the nominal dose through the system and to the lungs with low intersubject variability (1050-2200 g infants) across two modes of device actuation (automated and manual) with room for further improvement. Ergonomic curvatures and streamlining of the prong geometries were also found to reduce work of breathing and flow resistance compared with a commercial alternative.

Effect of Family-Centered Care Interventions on Motor and Neurobehavior Development of Very Preterm Infants: A Systematic Review and Meta-Analysis

AIM

To assess the effectiveness of family-centered care (FCC) interventions on motor and neurobehavior development of very preterm infants.

METHOD

Randomized and quasi-randomized trials assessing the effect of FCC on motor and neurobehavioral outcomes in very preterm infants (28-32 wk gestation) were included. Five electronic databases and grey literature were searched from January 2010 to August 2022. Two reviewers independently screened the titles/abstracts and full texts, assessed the risk of bias, and extracted data. The Cochrane Risk of Bias 2.0 Tool and GRADE were used for risk and evidence certainty assessments. Meta-analysis or narrative synthesis was performed based on data availability and heterogeneity.

RESULTS

Seventeen trials with 21 publications were included. GRADE showed low to moderate evidence. At 24 months, FCC interventions improved motor development (Mean Difference (MD):5.00, 95% CI: 2.58-7.42), cognitive development (MD: 3.64, 95% CI: 1.15-6.12), and behavior development (MD: -2.40, 95% CI: -4.32, -0.48) compared to control groups. Further, the FCC showed minimal or inconclusive effects on language, communication, and personal social development measured anytime between newborn and 24 months of age.

CONCLUSIONS

Early initiated FCC interventions can be a promising approach to improve motor, cognition, and behavioral development in very preterm infants.

[Disease burden of communicable diseases among children and adolescents aged under 20 years in China from 1990 to 2021]

OBJECTIVES

To investigate the epidemiological characteristics and changing trends of communicable diseases among children and adolescents in China from 1990 to 2021.

METHODS

Based on the Global Burden of Disease Database, epidemiological indicators for communicable diseases among the population aged under 20 years in China from 1990 to 2021 were selected to analyze the burden of communicable diseases in this population, and a comparative analysis was performed with global data as well as data from Western Europe and North America.

RESULTS

In 1990-2021, the overall burden of communicable diseases tended to decrease among children and adolescents in China. In 2021, the prevalence rate of communicable diseases in China was lower than the global prevalence rate and was higher than that in Western Europe and North America. There was a significant reduction in the mortality rate of communicable diseases, and the gap with Western Europe and North America gradually narrowed year by year. The overall incidence rate, mortality rate, and disability-adjusted life year rate of communicable diseases in males were higher than those in females, and respiratory infections and intestinal infections were more common in children aged <5 years, while the incidence rate of sexually transmitted diseases was higher in adolescents.

CONCLUSIONS

From 1990 to 2021, the disease burden of communicable diseases among the population under 20 years old in China has significantly decreased. However, there is still a certain gap compared to developed regions. Strengthening the prevention and control of diseases such as respiratory infections and acquired immunodeficiency syndrome, as well as enhancing health interventions for children under 5 years old, will help improve the overall health level of children and adolescents in China.

A cross-sectional study on posttraumatic growth and influencing factors among parents of premature infants

OBJECTIVE

Preterm birth is a significant public health concern that negatively affects parents' mental health. Posttraumatic growth (PTG) is a positive response to trauma that can effectively help parents cope with the stress of preterm birth. However, few studies have investigated PTG among parents with preterm infants. This study aimed to examine the level and influencing factors of PTG among parents with preterm infants and to explore its relationship with social support coping styles.

METHODS

A cross-sectional study was conducted among 160 parents of premature infants in a hospital in Shenzhen, China, from May 2022 to August 2022. Parents' demographic information and birth-related characteristics were collected through a self-designed general information questionnaire. PTG was assessed using the Chinese version of the Posttraumatic Growth Inventory (PTGI). Social support and coping style were measured using the Social Support Scale(SSS) and the Ways of Coping Questionnaire(WCQ). Pearson correlation analysis was used to investigate the relationship between PTGI and WCQ and SSS .A stepwise multiple linear regression analysis was performed to explore independent influencing factors of PTG.

RESULTS

The parents had an average PTG score of 66.41 ± 10.37, with 81.11% having a low and medium level of PTG. The total score of coping style of parents of premature infants was (34.28 ± 4.97) points, which was in the middle and upper level; the total score of social support of parents of premature infants was (14.28 ± 4.97) points, which was in the middle level. In addition, older gestational age at birth (B = 2.396, P < 0.001) ,higher Apgar score at 5 min at birth (B = 2.117, P = 0.023), positive coping style (B = 0.850, P < 0.001), and higher social support score (B = 1.978, P < 0.001) were associated with higher PTG scores.

CONCLUSION

Parents of preterm infants have low to medium levels of PTG, indicating much room for improvement. Older gestational age, higher Apgar score at five minutes at birth, positive coping styles, and high levels of social support were associated with higher PTG levels. Our findings provide helpful guidance for the development of effective and targeted intervention programs to improve parents' PTG and well-being.

Pain management in hospitalized infants: recommendations for achieving the Sustainable Development Goals

OBJECTIVE

to assess pain management in infants in a Neonatal Intensive Care Unit (NICU) and discuss its articulation with the Sustainable Development Goals, with a focus on promoting neonatal well-being.

METHOD

a documentary study, retrospective in nature and quantitative approach, conducted in a NICU of a public hospital in Paraná, Brazil, between January and July 2022, with 386 medical records of infants, hospitalized for more than 24 hours, between 2019 and 2021. Data were subjected to descriptive and inferential analysis, considering p-value<0.05 as a statistical difference. National ethical guidelines were respected.

RESULTS

all infants underwent at least one painful procedure, but only 13.7% had documented pain. Pharmacological interventions, such as fentanyl (25.9%), and non-pharmacological interventions, such as breastfeeding encouragement (86%) were used. Only 2.8% were reassessed.

CONCLUSION

there was a devaluation of neonatal pain management that may perpetuate neonatal well-being and sustainable development.

Early Optimal Parenteral Nutrition During NICU Stay and Neurodevelopmental Outcomes in Very Preterm Infants: State of the Art

BACKGROUND

Preterm infants (PIs) are more susceptible to neurodevelopmental impairment compared with term newborns. Adequate postnatal growth has been associated with improved neurocognitive outcomes; therefore, optimization of nutrition may positively impact the neurodevelopment of PIs.

OBJECTIVE

This study focused on macronutrient parenteral nutrition (PN) intake during the Neonatal Intensive Care Unit stay and their associations with neurodevelopmental outcomes in PIs in the first two years of life.

METHODS

The Embase, MEDLINE, and Cochrane Library databases were searched using the following subject headings and terms (MeSH): "premature infants", "parenteral nutrition", "growth", "brain", "neurodevelopment", and "central nervous system diseases". All relevant papers' reference lists were manually searched. PN and neurodevelopment studies concerning the first two years of life were collected and analyzed.

RESULTS

275 potential studies were retrieved, 64 were selected for full-text reading, and 22 were included (12 randomized controlled trials). While glucose intakes should be immediately provided and strictly monitored avoiding hyperglycemia, the long-term outcomes of aggressive PN caloric intakes are uncertain. Early amino acid (AA) supplementation is mandatory and improves short-term growth, though it is questionable whether increased AA and better neurodevelopment are directly related. Lipid infusion should be initiated right after birth, and further investigation will enable us to ascertain the potential impacts of lipid emulsions, particularly fish oil, on PI neurodevelopment.

CONCLUSIONS

An aggressive PN and its possible metabolic complication could not favor neurodevelopment; the way forward could be a customized approach, depending on the patient's clinical state and tolerance. Long-term follow-up studies and the search for specific markers of tolerance are warranted.

Development of a core outcome set and core measurement set for kangaroo mother care: a study protocol

BACKGROUND

Kangaroo mother care (KMC) is a care of preterm and low birthweight infants carried skin-to-skin contact with the mother's chest and breastfeeding when possible. KMC has been proven to reduce mortality and morbidity in these infants. However, research on KMC has been limited by significant variability and inconsistency in reported outcomes across studies. These discrepancies hinder the inclusion of KMC clinical research in systematic reviews or meta-analyses, reducing its research value, leading to resource wastage and raising concerns about selective reporting biases. A core outcome set (COS), which defines a list of critical outcomes, can help harmonise the outcomes reported across studies in the same healthcare field. Further, how these outcomes should be measured and/or reported is defined in a core measurement set (CMS). This study aims to develop both a COS and a CMS for KMC to standardise outcome reporting, improve the quality assessments in clinical trials and facilitate data integration. This protocol outlines the methodology for developing a COS and CMS for KMC.

METHODS AND ANALYSIS

The development of the COS and CMS for KMC will follow six phases: (1) a systematic review, (2) semistructured interviews, (3) merging outcomes, (4) two/three rounds of international Delphi survey, (5) a consensus meeting and (6) development of the CMS. In phases 1 and 2, we will conduct a systematic review and semistructured interviews to identify potential core outcomes and measurements, which will form an initial outcome pool. In phase 3, these outcomes will be categorised into domains based on the core outcome measures for effectiveness (COMET) classification, creating a long list of outcomes for the Delphi survey. In phase 4, the Delphi survey will involve two/three rounds with key stakeholders, including neonatal clinical experts (including doctors and nurses), users of COS (including editors, public health experts, experts in evidence-based medicine and researchers), parents of neonates and policymakers, to refine the candidate core outcomes and measurements. In phase 5, an online consensus meeting with representatives of all stakeholders will finalise the COS. In phase 6, the CMS will be following Consensus-based Standards for the selection of health Measurement Instruments guidelines, which involve conceptual considerations, finding existing outcome measurement instruments, assessing their quality and selecting appropriate instruments for the COS. Parents of neonates will participate in phases 2, 4 and 5.

ETHICS AND DISSEMINATION

Ethical approval of this study has been granted by the Medical Ethics Committee of West China Second University Hospital (Medical Research 2024 ethics approval no. 167). The finalised COS and CMS will be disseminated through publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

We have registered the COS in the COMET database (http://www.comet-initiative.org/Studies/Details/2940).

Single-nucleus RNA sequencing reveals distinct pathophysiological trophoblast signatures in spontaneous preterm birth subtypes

Spontaneous preterm birth (sPTB) poses significant challenges, affecting neonatal health and neurodevelopmental outcomes worldwide. The specific effects of placental trophoblasts on the pathological development of sPTB subtypes-preterm premature rupture of fetal membranes (pPROM) and spontaneous preterm labor (sPTL)-are not fully understood, making it crucial to uncover these impacts for the development of effective therapeutic strategies. Using single-nucleus RNA sequencing, we investigated transcriptomic and cellular differences at the maternal-fetal interface in pPROM and sPTL placentas. Our findings revealed distinct trophoblast compositions with pPROM characterized predominantly by extravillous trophoblasts (EVTs), while sPTL showed an abundance of syncytiotrophoblasts (STBs). Through cell differentiation and cell-to-cell communication analyses, other distinguishing factors were also found. In pPROM, heightened inflammation, oxidative stress, and vascular dysregulation with key pathways including tumor necrosis factor signaling, matrix metalloproteinase activation, and integrin-mediated cell adhesion, highlighted an invasive EVT profile potentially driven by hypoxic conditions and immune cell recruitment. In contrast, sPTL was marked by increased smooth muscle contraction, vascular remodeling, and altered signaling dynamics involving fibroblasts, including TGF-β and WNT pathways. Our study highlights the critical need to distinguish sPTB subtypes to improve diagnostic precision and therapeutic targeting. The molecular insights gained provide a foundation for future investigations aimed at functional validation of key pathways and exploration of trophoblasts on the development of sPTB. Ultimately, these findings pave the way for more personalized and effective interventions to mitigate adverse outcomes associated with preterm birth.

Long non-coding RNA C1RL-AS1 aggravates influenza A virus pneumonia through miR-16-5p/LAMP3

Influenza A viruses continue to pose a serious threat to public health and economic stability. To investigate the role of C1RL-AS1 in influenza A virus (IAV) pneumonia. Using RT-qPCR analysis, we determined C1RL-AS1 expression levels in children with IAV-infected pneumonia and A549 cells. C1RL-AS1 expression levels in children were subjected to ROC analysis. C1RL-AS1 was knocked down to investigate its role in IAV-infected A549 cells, including effects on viral nucleoprotein (NP) production, cell survival, and apoptosis. Downstream miRNAs of C1RL-AS1 were predicted and validated. MiR-16-5p target genes were predicted and validated. C1RL-AS1 was up-regulated in IAV-infected children and A549 cells. C1RL-AS1 expression levels distinguished children with IAV pneumonia from healthy children. Knockdown of C1RL-AS1 attenuated viral NP production, promoted A549 cell survival, and inhibited apoptosis. MiR-16-5p was a downstream C1RL-AS1 miRNA. miR-16-5p counteracted the anti-IAV infection effect brought about by C1RL-AS1 knockdown. LAMP3 was a miR-16-5p target gene associated with pneumonia. LAMP3 restored the cellular effects brought about by C1RL-AS1/miR-16-5p co-knockdown. C1RL-AS1 is a possible diagnostic factor for IAV pneumonia in children. C1RL-AS1 may participate in IAV pneumonia by sponging miR-16-5p and then moderating LAMP3.

Early childhood respiratory morbidity according to gestational age at birth: A nationwide cohort study

BACKGROUND

Preterm birth survivors are at risk for short- and long-term respiratory morbidity. This includes increased rates of chronic obstructive pulmonary disease and infectious morbidity. Previous studies showed increased utilization of healthcare services throughout early childhood. However, only a few large-scale studies showed the effect on respiratory morbidity throughout the full spectrum of gestational age at birth. The aim of this study was to show the healthcare burden associated with prematurity, in a large nationwide cohort.

STUDY DESIGN

Data regarding gestational age at birth, month and year of birth, and infant sex were gathered for all 1,762,149 infants born in Israel between January 1, 2010, and December 31, 2019. Rates of hospitalization, length of hospitalization, and emergency department visits were calculated per 1000 live births and stratified by gestational age. Poisson regression was constructed to adjust for infant sex, year and month of birth.

RESULTS

Preterm birth occurred in 6.43 % of deliveries (n = 109,405). A negative association was found between gestational age at birth and respiratory morbidity. As gestational age at birth advances, rates of respiratory hospitalization decrease, and length of hospitalization shortens. This association continues even after full term is reached.

CONCLUSION

The short- and long-term effect of preterm birth poses a significant burden on healthcare systems globally, not only at birth or in infancy, but well into early childhood. These results are a call for action to stakeholders and professional organizations to increase efforts in preventing and treating preterm and early term labor.

Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebocontrolled randomized trial

BACKGROUND

The oropharyngeal administration of colostrum (OAC) in neonates has several benefits.

PURPOSE

To investigate the short-term outcomes of OAC in preterm neonates.

METHODS

We performed this 2-arm, double-blind, placebo-controlled randomized trial at a tertiary neonatal center in Iran in 2021-2023. The intervention and control arms received 0.2 mL of their mother's colostrum or distilled water via oropharyngeal administration every 6 hours for 3 days starting from birth until 72 hours of age. The main study outcomes were neonatal death, the incidence of necrotizing enterocolitis, sepsis, retinopathy of prematurity (ROP), length of hospital stay, and period to full enteral feeding. A regression analysis was used to adjust for possible confounders.

RESULTS

A total of 126 neonates (mean gestational age, 30.05 weeks) were randomized to the intervention and placebo groups (n=63 each) and had a mean±standard deviation weight of 1,247±193 g versus 1,156±215 g (P=0.013) and 1- and 5-min Apgar scores of 6.35 versus 5.38 (P=0.003) and 7.84 versus 7.13 (P=0.001), respectively. The mortality rate was 12.7% in the intervention group versus 14.3% in the placebo group (P=0.794). The necrotizing enterocolitis rate was significantly lower in the intervention versus placebo arm (11.1% vs. 28.6%, respectively, P=0.010), as was the clinically suspected sepsis rate (15.9% vs. 39.7%, respectively, P=0.004). The ROP and bronchopulmonary dysplasia rates did not differ significantly between groups after the adjustment for confounders. The mean length of hospital stay was shorter in the intervention group (26.1 days vs. 37.32 days, P=0.023). Moreover, the mean duration of antibiotic therapy and period to full feeding were significantly shorter in the intervention group.

CONCLUSION

OAC could effectively decrease the incidence of complications in preterm infants and facilitate earlier patient discharge.

Associations between term cesarean delivery in the first pregnancy and second-pregnancy preterm delivery

INTRODUCTION

Cesarean delivery has been shown to increase the risk of preterm delivery in future pregnancies. The association could be a direct result of the procedure, or because the indications that led to the cesarean delivery also increase the risk of preterm delivery in later pregnancies.

MATERIAL AND METHODS

298 901 mothers with first and second singleton deliveries from 1999 to 2020 were investigated using data from the Medical Birth Registry of Norway linked with Statistics Norway. The mothers were categorized by mode of cesarean delivery (total, emergency and planned) and vaginal delivery at term in the first pregnancy. We used log-binomial regression models to estimate relative risks with 95% confidence intervals (CI) of iatrogenic and spontaneous preterm delivery <37 gestational weeks in the second pregnancy. Second, we explored the role of recurrent placental disease in preterm delivery by comparing estimates in mothers with placental disease in neither or both pregnancies.

RESULTS

8243 mothers (2.8%) had a preterm delivery in the second pregnancy. The adjusted relative risk (aRR) of preterm delivery was 1.24 (95% CI 1.17-1.32) after cesarean compared with vaginal delivery in the first pregnancy. The association was stronger in previous planned compared with emergency cesarean delivery (aRR 1.52, 95% CI 1.30-1.77 and aRR 1.21, 95% CI 1.14-1.29, respectively). Spontaneous preterm delivery was not associated with the previous mode of delivery; the risk was confined to iatrogenic preterm delivery after both emergency and planned cesarean delivery (aRR 1.69, 95% CI 1.52-1.87 and aRR 2.65, 95% CI 2.12-3.30, respectively). Mothers with placental disease in both pregnancies had a sixfold increased risk of preterm delivery in the second pregnancy compared with mothers with no placental disease, however, the association between mode of delivery and subsequent preterm delivery was similar in mothers with and without placental disease in the pregnancies.

CONCLUSIONS

Compared with vaginal term delivery in the first pregnancy, cesarean delivery increases the risk of iatrogenic, but not spontaneous preterm delivery in the next pregnancy. Although strongly associated with preterm delivery, placental disease had limited influence on the estimates.

Health Outcomes 50 Years After Preterm Birth in Participants of a Trial of Antenatal Betamethasone

BACKGROUND AND OBJECTIVES

Preterm birth results in neonatal and childhood morbidity and mortality. Additionally, population-based studies show poorer cardiovascular health in adult survivors, but a full range of health outcomes has not been investigated into midlife. We aimed to assess the health outcomes after preterm vs term birth at 50 years in survivors of a randomized trial of antenatal betamethasone.

METHODS

Participants were asked to complete a health questionnaire and for consent to access administrative data. Participants deceased prior to follow-up were assessed with administrative data alone. The primary outcome was a composite: any of diabetes mellitus, prediabetes, treated hypertension, treated dyslipidemia, or a previous major adverse cardiovascular event. Secondary outcomes included respiratory, mental health, educational, and other health outcomes.

RESULTS

We included 470 participants: 424 assessed at mean age 49.3 years and 46 who died after infancy. The primary outcome occurred in 34.5% (112/325) of those born preterm and 29.9% (43/144) of those born at term; adjusted relative risk (aRR) 1.14 (95% CI, 0.85-1.54; P = .37). Cardiovascular events were less common in those born preterm (9/326 [2.8%] vs 10/144 [6.9%]; aRR 0.33, 95% CI, 0.14-0.79), while self-reported hypertension was more common (101/291 [34.7%] vs 23/116 [19.8%]; aRR 1.74, 95% CI, 1.16-2.61), although treated hypertension was not statistically significantly different (66/323 [20.4%] vs 22/143 [15.4%]; aRR 1.32, 95% CI, 0.84-2.06). Other components of the composite endpoint were similar between those born preterm and at term.

CONCLUSIONS

Those aged 50 years born preterm were more likely to have hypertension but had similar risk of diabetes, prediabetes, and dyslipidemia than those born at term, and their risk of cardiovascular events was lower.

Global burden of tuberculous meningitis in children aged 0-14 years in 2019: a mathematical modelling study

BACKGROUND

Tuberculous meningitis is fatal if untreated and can lead to lifelong neurological sequelae. However, to our knowledge, there are no data on the number of children affected by this disease. We aimed to estimate the global disease burden and attributable mortality of childhood tuberculous meningitis by WHO regions, age groups, treatment status, and HIV status in 2019.

METHODS

We developed a Bayesian mathematical model to estimate the number of children aged 0-14 years who developed tuberculous meningitis, died from tuberculous meningitis, and did not die from tuberculous meningitis but had neurological sequelae in 2019. We reviewed the literature and used meta-analyses to quantify key parameters used as model inputs: risk of tuberculous meningitis after Mycobacterium tuberculosis infection, tuberculous meningitis as a proportion of tuberculosis notification data (ie, routine surveillance data that countries report to WHO), and risk ratios for tuberculous-meningitis mortality by age group. We identified routine tuberculosis surveillance data from countries and literature that reported the proportion of notified childhood tuberculosis that was due to tuberculous meningitis. Country-level data were from Brazil; the USA; Ukraine; South Africa; and the European Centre for Disease Prevention and Control, which included 29 countries but was aggregated and considered as one site. We assumed tuberculosis notification was synonymous with detection and treatment, combined age-disaggregated risk ratios and published meta-analytic estimates of the case-fatality rate in children who received treatment to produce estimates of tuberculous-meningitis mortality by age group and HIV status, and assumed that untreated tuberculous meningitis was always fatal. We assumed similar age-disaggregated risk ratios for neurological sequelae among children who had treatment for tuberculous meningitis and lived as for children who died.

FINDINGS

An estimated 24 000 (95% credible interval 22 300-25 700) children younger than 15 years developed tuberculous meningitis in 2019. Of these children, 13 000 (12 100-13 900) were estimated to have been diagnosed and treated for tuberculous meningitis. Most untreated children were younger than 5 years. Among the 24 000 children with tuberculous meningitis, 16 100 (14 900-17 300) were estimated to have died in 2019, of whom 1101 (6·8%) had HIV. 13 380 (83·1%) of 16 100 deaths were estimated to be in children younger than 5 years and 11 000 (68·3%) were estimated to be in children who did not receive tuberculous-meningitis treatment. Of the 7900 (5800-10 000) children who did not die, 5550 (5110-5980) were estimated to have neurological sequelae.

INTERPRETATION

Our estimates of tuberculous meningitis in children younger than 15 years showed substantial mortality and morbidity. Improved diagnostics and strong health-care systems to facilitate early diagnosis are crucial to improve outcomes, and tuberculosis prevention should be a public health priority.

FUNDING

Fogarty International Center of the US National Institutes of Health.

Multiple introductions of NRCS-A Staphylococcus capitis to the neonatal intensive care unit drive neonatal bloodstream infections: a case-control and environmental genomic survey

Background. The Staphylococcus capitis NRCS-A strain has emerged as a global cause of late-onset sepsis associated with outbreaks in neonatal intensive care units (NICUs) whose transmission is incompletely understood.Methods. Demographic and clinical data for 45 neonates with S. capitis and 90 with other coagulase-negative staphylococci (CoNS) isolated from sterile sites were reviewed, and clinical significance was determined. S. capitis isolated from 27 neonates at 2 hospitals between 2017 and 2022 underwent long-read (ONT) (n=27) and short-read (Illumina) sequencing (n=18). These sequences were compared with S. capitis sequenced from blood culture isolates from other adult and paediatric patients in the same hospitals (n=6), S. capitis isolated from surface swabs (found in 5/150 samples), rectal swabs (in 2/69 samples) in NICU patients and NICU environmental samples (in 5/114 samples). Reads from all samples were mapped to a hybrid assembly of a local sterile site strain, forming a complete UK NRCS-A reference genome, for outbreak analysis and comparison with 826 other S. capitis from the UK and Germany.Results. S. capitis bacteraemia was associated with increased length of NICU stay at sampling (median day 22 vs day 12 for other CoNS isolated; P=0.05). A phylogeny of sequenced S. capitis revealed a cluster comprised of 25/27 neonatal sterile site isolates and 3/5 superficial, 2/2 rectal and 1/5 environmental isolates. No isolates from other wards belonged to this cluster. Phylogenetic comparison with published sequences confirmed that the cluster was NRCS-A outbreak strain but found a relatively high genomic diversity (mean pairwise distance of 84.9 SNPs) and an estimated NRCS-A S. capitis molecular clock of 5.1 SNPs/genome/year (95% credibility interval 4.3-5.9). The presence of S. capitis in superficial cultures did not correlate with neonatal bacteraemia, but both neonates with rectal NRCS-A S. capitis carriage identified also experienced S. capitis bacteraemia.Conclusions. S. capitis bacteraemia occurred in patients with longer NICU admission than other CoNS. Genomic analysis confirms clinically significant infections with the NRCS-A S. capitis strain, distinct from non-NICU clinical samples. Multiple introductions of S. capitis, rather than prolonged environmental persistence, were seen over 5 years of infections.

Pulmonary Function Testing in Healthy Infants in Rural Bangladesh: Feasibility Study

BACKGROUND

Infant pulmonary function testing (iPFT) in low- and middle-income countries is limited. We evaluated the early feasibility of iPFT in rural Bangladesh.

METHODS

Experts established an iPFT laboratory at Zakiganj Upazila Health Complex in Sylhet, Bangladesh and trained staff. Infants ≤ 6 months old participating in a cohort study between 2021 and 2022 were eligible for respiratory oscillometry (Osc), tidal breath flow-volume loops (TBFVL), and sulphur hexaflouride multiple breath washout (MBW) during natural sleep. Participants with a respiratory infection within 4 weeks were not tested. Among the first 25 infants with attempted Osc, TBFVL, or MBW measurements, we report the test proportions meeting international quality standards, measurement averages, and the mean measurement differences between laboratory staff and experts.

RESULTS

Among the first 25 eligible infants with attempted measurements, acceptable Osc measurements were achieved in 88% (22/25), TBFVL in 96% (24/25), and MBW in 88% (22/25). Infants tested by Osc at 2 months were a median (IQR) of 81 days old (73, 85) and tested at 6 months were a median of 194 days old (193, 202); TBFVL/MBW tested infants were a mean 83 days (79, 87). Mean (SD) Osc resistance at 7 Hz was 66.3 (25.2) and 64.0 (22.4) hPa.s.L-1 at 2 and 6 months. At 2 months, TBFVL mean tidal volume/body weight was 7.4 (1.4) mL/kg and MBW mean (SD) lung clearance index was 7.2 (1.0) turnovers. iPFT staff and expert interpretation differences were minimal.

CONCLUSIONS

Establishing an iPFT laboratory and performing quality measurements and expert-level interpretations in rural Bangladesh is feasible.

Antibiotics and indomethacin as perioperative management for cerclage: A systematic review and meta-analysis

OBJECTIVE

Prematurity complications remain the leading cause of perinatal morbidity and mortality. Although cerclage shows promise in preventing preterm birth, it remains unclear whether perioperative management, such as the use of antibiotics or indomethacin, offers any additional benefit.

STUDY DESING

We conducted a systematic review and random-effects meta-analysis comparing the use of indomethacin, antibiotics, and their combination as perioperative management for cerclage versus cerclage alone. Our research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on June 9, 2024 (ID CRD42024552516).

RESULTS

Our systematic review encompassed ten studies, and 838 pregnant women submitted to cerclage for prevention of preterm birth. We found no association between perioperative management and preterm birth before 28 weeks (RR 1.03; 95 % CI 0.76-1.39; p = 0.86), or perinatal mortality (RR 0.81; 95 % CI 0.54-1.22; p = 0.32).

CONCLUSION

Antibiotics, indomethacin, and their combination may have no additional benefit to cerclage in risk reduction of preterm birth or perinatal mortality.

Epidemiological and pathological characterization of acute respiratory infections

This research comprehensively investigates the epidemiological features and pathogen profile of acute respiratory infections (ARI) in Shihezi City, Xinjiang. A pivotal aspect of this study is the construction of a Bayes discriminant function for principal pathogen infections. This innovative methodology aims to furnish a robust scientific basis for the prevention and clinical management of ARI, potentially guiding more effective strategies in both public health and clinical settings. We compiled and examined data from January 2020 to June 2023, pertaining to patients admitted with acute respiratory infections at the First Affiliated Hospital of Shihezi University. This investigation focused on discerning patterns in epidemiology and pathogen etiology. Among 2110 cases of acute respiratory infections (ARI), 1736 underwent pathogenetic testing. Of these, 595 cases tested positive for at least one pathogen, marking a positivity rate of 34.27%. Viral detections, at a rate of 27.47%, were notably higher than bacterial detections, which stood at 6.51%. The most prevalent viruses identified were Human respiratory syncytial virus (hRSV), Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and Human adenovirus (HAdV), while the dominant bacterial pathogens included Klebsiella pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Co-infections were observed in 76 cases, accounting for 12.77% of positive diagnoses, predominantly involving hRSV in conjunction with other pathogens. In cases of acute bronchiolitis, hRSV was the most frequent pathogen, contributing to 23.10% of such cases. Similarly, in severe pneumonia cases, SARS-CoV-2 was predominant, accounting for 25.4% of these infections. The group with bacterial positivity exhibited elevated levels of C-reactive protein (CRP, 19.17 mg/L) and neutrophilic granulocyte percentage (NE%, 54.7%). The Bayes discriminant function demonstrated an initial validation accuracy of 74.9% and a cross-validation accuracy of 63.7%. The study underscores that hRSV, SARS-CoV-2, and HAdV are the primary pathogens in acute respiratory infections in the Shihezi region. Pathogen susceptibility exhibits variation across different age groups, with a higher pathogen detection rate in children compared to adults. The Bayes discriminant function shows significant promise in the classification and diagnosis of major pathogenic infections.

Gathering information on maternal immunization readiness in Bangladesh, Ghana, Kenya, Mozambique, and Nepal: Applying a WHO checklist

New respiratory syncytial virus (RSV) maternal vaccines have begun roll out in some countries, with efforts in progress to broaden access worldwide and shorten the timeline to access for low- and middle-income countries (LMICs). Prior to new maternal immunization (MI) introductions, countries will need to evaluate their capacity and readiness for successful introduction. The World Health Organization's Maternal Immunization and Antenatal Care Situation Analysis (MIACSA) project (2016-2019) developed a checklist for countries to self-evaluate their capacity to introduce new maternal vaccines. Here, we report on our use of the MIACSA checklist in Bangladesh, Ghana, Kenya, Mozambique, and Nepal to gather country stakeholders' perceptions of MI readiness and provide additional considerations for implementers when using the checklist to optimize its usefulness.

Facility capacity and provider knowledge for cholera surveillance and diarrhoea case management in cholera hotspots in the Democratic Republic of Congo - a mixed-methods study

BACKGROUND

Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera.

OBJECTIVE

Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners.

METHODS

We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0-100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation.

RESULTS

Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an -11.6 (95% CI, -16.7 to -6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41-58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%).

CONCLUSIONS

Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.

Efficacy and safety of nasal high-frequency oscillation in preventing intubation in very-low-birth-weight infants with respiratory distress syndrome

BACKGROUND

Invasive mechanical ventilation in very-low-birth-weight infants (VLBWI) was associated with immediate and long-term complications. Nasal high-frequency oscillation (nHFO) has recently become a new non-invasive ventilation (NIV) mode for treating respiratory failure in VLBWI. This study aimed to investigate the safety and efficacy of nHFO as an alternative respiratory support to prevent intubation in VLBWI.

METHODS

A retrospective analysis was conducted using the clinical data of 42 VLBWIs with respiratory distress syndrome (RDS) who were treated in our department from August 2018 to August 2020 and met the selection criteria.

RESULTS

nHFO was used as a rescue strategy in 32 infants and a prophylactic strategy in 10 infants. It was observed that out of 42 cases, 30 cases (71.4%) were able to avoid intubation within 72 h, while 23 cases (54.8%) were successfully switched to another NIV mode from nHFO. There was a significant decrease in pCO2 and an increase in pH 1 h after using nHFO in the success group. Two cases (4.8%) of feeding intolerance associated with nHFO were noted.

CONCLUSION

This study showed that nHFO as alternative respiratory support for preterm infants with RDS might be safe and effective in reducing the need for intubation.

Childhood Vaccinations and Associated Factors in 35 Sub-Saharan African Countries: Secondary Analysis of Demographic and Health Surveys Data from 358 949 Under-5 Children

Objective. We examined childhood vaccinations coverage and its associated factors in sub-Saharan Africa (SSA) countries. Methods. We used demographic and health surveys (DHSs) data collected between 2008 and 2022 from 35 SSA countries. A sample of 358 949 under-5 children was analyzed. Percentage and multivariable binary logistic regression analyses were conducted. A 5% significance level was set. Results. Rwanda (7461/8092; 92.2%), Burundi (10 792/13 192; 81.8%), Gambia (6548/8362; 78.3%), Kenya (14 570/19 530; 74.6%), and Burkina Faso (8739/12 343; 70.8%) had the leading coverage of under-5 children who received all basic vaccinations in the first year of life. For every unit increase in the age of a child, there was 72% increase in the odds of vaccination. Children from older mothers had higher odds of vaccination, when compared with children with mothers aged 15 to 19 years. There was a 6% reduction in the odds of vaccination among children from rural residence, when compared with their urban counterparts. Children with educated mothers had over two times higher odds of vaccination, when compared with those from mothers with no formal education. Children from rich households had higher odds of vaccination, when compared with children from poorest household. There was a 13% increase in the odds of vaccination among children covered by health insurance, when compared with those not covered by health insurance. Conclusion. Vaccination uptake for children under-5 in SSA was found to be sub-optimal and associated with several factors. A health educational intervention for pregnant women could potentially increase the uptake of vaccines among children.

High Detection Rate of Rotavirus Infection Among Children Admitted with Acute Gastroenteritis to Six Public Hospitals in Luanda Province After the Introduction of Rotarix® Vaccine: A Cross-Sectional Study

Rotavirus group A (RVA) is a major cause of pediatric acute gastroenteritis (AGE). Vaccination is an effective public health strategy and Angola implemented it in 2014. This hospital-based study aimed to estimate the prevalence of RVA infection and the severity of AGE in children under five years of age treated at six hospitals in Luanda Province. Between April 2021 and May 2022, 1251 fecal samples were screened by an immunochromatographic rapid test (SD Bioline). Data on socio-demographic profile, nutritional status, and clinical assessment were obtained. The association of RVA infection and AGE severity with possible risk factors was evaluated with a binary logistic regression model. Overall, the detection rate was 57.8% and girls tend to be more often infected than boys (55.2%). Infection was more common in the youngest group (1 to 6 months, 60.3%). Important sources of RVA infection were drinking water kept in tanks (57.9%) and private sanitary facilities with piped water (61%). Surprisingly, according to the Vesikari Scale score, the most severe symptoms were observed in children vaccinated with two doses (80.7%). RVA prevalence remains high despite vaccination, and further studies should address the association between infection sources and disease severity, as well as the causes underlying vaccine (un)effectiveness.

Comparative genomic study of non-typeable Haemophilus influenzae in children with pneumonia and healthy controls

Non-typeable Haemophilus influenzae (NTHi) is a common pathogen causing respiratory infections, including pneumonia in children, and can also be found in the upper respiratory tracts of asymptomatic individuals. This study examines genomic variations between NTHi strains from healthy children and those from children with acute or chronic community-acquired pneumonia (CAP). Using bacterial genome-wide association studies (bGWAS), we compared these strains to identify key differences. Our analysis revealed that approximately 32% of genes exhibit variations between commensal and pathogenic states. Notably, we identified changes in peptidoglycan biosynthesis pathways and significant virulence factors associated with pneumonia. Furthermore, we observed a significant difference in β-lactam resistance due to PBP3 mutations between the healthy and pneumonia groups, confirmed by the ampicillin susceptibility test and characterized by the mutation pattern D350N, S357N, S385T, L389F. These findings contribute valuable insights into the genomic basis of NTHi pathogenicity and may inform more targeted clinical diagnostics and treatments.

Comparison of INTERGROWTH- 21st and Fenton growth standards to assess size at birth and at discharge in preterm infants in the United Arab Emirates

BACKGROUND

Accurate growth assessment of preterm infants is essential in guiding medical care and suitable nutritional interventions. Currently, different growth references are used across hospitals in the United Arab Emirates (UAE). This study aims to compare the INTERGROWTH-21st standards with Fenton growth references regarding birth size classification and at the time of discharge in a sample of preterm infants in the UAE.

METHODS

A retrospective single-center evaluation of medical records of infants born < 37 weeks of gestation was conducted using data from 2018 to 2020. Anthropometric measurements (weight, length, and head circumference) were obtained at birth and at the time of discharge, and then converted to percentiles according to the two reference standards.

RESULTS

A total of 1537 infants with a median birth gestation of 35.3 weeks, and a median birthweight of 2320 g were included. The rates of SGA, AGA, and LGA at birth were 11.5%, 80.42%, and 9.08% using INTERGROWTH-21st growth charts compared to 9.5%, 83.2%, and 7.3% respectively according to Fenton charts. The findings indicated statistically significant differences between the two growth charts classifying of preterm infants based on weight, length, and head circumference (p < 0.05). For every 5 cases assessed as SGA at discharge according to Fenton charts, only 3 were classified as SGA by INTERGROWTH-21st curves.

CONCLUSIONS

Differences exist between the two growth charts with only moderate agreement. Thus, there is a need for harmonizing growth assessment standards. Misclassification of these vulnerable infants would affect their in-hospital and post-discharge nutrition and medical care plan.

Spatial variation in housing construction material in low- and middle-income countries: A Bayesian spatial prediction model of a key infectious diseases risk factor and social determinant of health

Housing infrastructure and quality is a major determinant of infectious disease risk and other health outcomes in regions where vector borne, waterborne and neglected tropical diseases are endemic. It is important to quantify the geographical distribution of improvements to dwelling components to identify and target resources towards populations at risk. This study aimed to model the sub-national spatial variation in housing materials using covariates with quasi-global coverage and use the resulting estimates to map predicted coverage across the world's low- and middle-income countries. Data on materials used in dwelling construction were sourced from nationally representative household surveys conducted since 2005. Materials used for construction of flooring, walls, and roofs were reclassified as improved or unimproved. Households lacking location information were georeferenced using a novel methodology. Environmental and demographic spatial covariates were extracted at those locations for use as model predictors. Integrated nested Laplace approximation models were fitted to obtain, and map predicted probabilities for each dwelling component. The dataset compiled included information from households in 283,000 clusters from 350 surveys. Low coverage of improved housing was predicted across the Sahel and southern Sahara regions of Africa, much of inland Amazonia, and areas of the Tibetan plateau. Coverage of improved roofs and walls was high in the Central Asia, East Asia and Pacific and Latin America and the Caribbean regions. Improvements in all three components, but most notably floors, was low in Sub-Saharan Africa. The strongest determinants of dwelling component quality related to urbanization and economic development, suggesting that programs should focus on supply-side interventions, providing resources for housing improvements directly to the populations that need them. These findings are made available to researchers as files that can be imported into a GIS for integration into relevant analyses to derive improved estimates of preventable health burdens attributed to housing.

Clustering of care activities for promoting development and preventing morbidity in hospitalized preterm infants

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of clustering of care activities for promoting development and preventing morbidity in preterm infants.