Influences on the degree of preterm birth in New South Wales

NICUs in the US: levels of acuity, number of beds, and relationships to population factors

OBJECTIVE

To 1) define the number and characteristics of NICUs in the United States (US) and 2) identify hospital and population characteristics related to US NICUs.

STUDY DESIGN

Cohort study of US NICUs.

RESULTS

There were 1424 NICUs identified in the US. Higher number of NICU beds was positively associated with higher NICU level (p < 0.0001). Higher acuity level and number of NICU beds related to being in a children's hospital (p < 0.0001;p < 0.0001), part of an academic center (p = 0.006;p = 0.001), and in a state with Certificate of Need legislation (p = 0.023;p = 0.046). Higher acuity level related to higher population density (p < 0.0001), and higher number of beds related to increasing proportions of minorities in the population up until 50% minorities. There was also significant variation in NICU level by region.

CONCLUSIONS

This study contributes new knowledge by describing an updated registry of NICUs in the US in 2021 that can be used for comparisons and benchmarking.

Negative affectivity moderated by preterm birth predicted toddlers' behavior problems

OBJECTIVE

The present study aimed to examine the predictive effect of temperament moderated by preterm childbirth on behavioral problems in toddlerhood.

METHOD

The sample comprised 100 toddlers of 18-36 months of chronological age and their mothers. They were divided into two groups: 50 toddlers born preterm and admitted to the Neonatal Intensive Care Unit (PT group), and 50 toddlers born full-term (FT group) and recruited from day-care centers. Mothers completed questionnaires about toddlers' temperament and behavior. The Early Childhood Behavior Questionnaire was used to assess temperament, and the Child Behavior Checklist (CBCL 1¹/²-5) to evaluate the total, internalizing, and externalizing behavior problems. Multiple regression analysis was performed to examine the moderation effects of preterm childbirth and temperament factors after controlling for toddlers' age and socioeconomic level.

RESULTS

There was a moderation effect between preterm childbirth and temperament. Temperament with more Negative Affectivity, moderated by preterm birth, and less Effortful Control explained the total, internalizing, and externalizing behavior problems.

CONCLUSION

The findings contribute to a better understanding of the impact of preterm childbirth and the dispositional traits of temperament on behavioral problems of toddlers born preterm.

Modeling Differential Effects of Maternal Dietary Patterns across Severity Levels of Preterm Birth Using a Partial Proportional Odds Model

Preterm birth is a common cause of death worldwide of children under the age of five years. This condition is linked with short and long term neonatal morbidity and mortality. Maternal nutrition during pregnancy has a profound effect on fetal growth and development and subsequently also on the incidence of preterm birth. The aim of this study was to assess the differential effect of dietary patterns of pregnant women across ordered levels of preterm birth. Dietary assessments were performed using a food frequency questionnaire, presented to 687 pregnant women, in the "Mother and Child in the Environment" birth cohort during the period of 2013 to 2017. Each pregnancy resulted in a live birth. Eight dietary patterns were extracted, using exploratory factor analysis. The partial proportional odds model was employed to model severity levels of preterm birth. The partial proportional odds model has been recognized to be a flexible approach since it allows the effect of predictor variables to vary across categories of the ordinal response variable of interest. Women with increased consumption of vegetable-rich foods showed a reduced risk of very to moderately preterm birth incidence (AOR = 0.73, 95% CI = (0.531, 0.981), p = 0.036). Lower odds of very/moderately preterm birth compared to late preterm or term birth were observed for women following "nuts and rice foods" dietary pattern (AOR = 0.25, 95% CI = (0.099, 0.621), p = 0.003). High dietary consumption of starch foods dietary pattern (AOR = 2.09, 95% CI = (1.158, 3.769), p = 0.014) was associated with the most severe level of preterm birth outcome incidence, i.e. very/moderately preterm birth. The partial proportional odds modeling allowed the description of the effect of maternal dietary patterns across the different severity levels of preterm birth.

Pregnancy risk factors associated with birthweight of infants born to Australian Aboriginal women in an urban setting - a retrospective cohort study

Background

A key focus of the Closing the Gap campaign is to reduce low birthweight in Aboriginal babies. Limited research exists on factors affecting Aboriginal birthweight in urban areas.

Methods

Retrospective cohort analysis of 38,382 births (38,167 non-Aboriginal, 215 Aboriginal) at the Royal Women’s Hospital in Melbourne from January 2010 to December 2015. Aboriginal status was defined by mothers who identified themselves and their baby as Aboriginal or Torres Strait Islander. The aim was to examine the association of maternal health risk behaviours and obstetric complications with birthweight of infants born to Australian Aboriginal women birthing in an urban setting.

Results

Aboriginal babies had a lower mean birthweight than non-Aboriginal babies (mean difference -290 g; 95% confidence interval [CI] -413, − 166 g), but when accounting for gestational age and sex there was little difference (mean difference 5 g; 95% CI -53, 6 g). Aboriginal babies were significantly more likely to be delivered preterm < 37 weeks (23.3% vs 7.9%, odds ratio [OR] 3.58; 95% CI 2.58, 4.95) and be of low birthweight < 2500 g (22.3% vs 6.7%, OR 4.03; 95% CI 2.90, 5.60) or very low birthweight < 1500 g (9.8% vs 1.8%, OR 5.81; 95% CI 3.67, 9.16).

Aboriginal mothers were significantly more likely to be teenage mothers (9.8% vs 1.6%, OR 5.72; 95% CI 3.54, 9.24), smoke cigarettes throughout the pregnancy (53.8% vs 5.6%, OR 17.2; 95% CI 12.8, 23.0), and use drugs (26.5% vs 2.4%, OR 14.3; 95% CI 10.4, 19.6) during pregnancy, all of which were associated with lower birthweight. Aboriginal mothers were also more likely to have a mental health diagnosis (49.5% vs 18.8%, OR 3.77; 95% CI 2.86, 4.97), be overweight (59.9% vs 42.6%, OR 1.88; 95% CI 1.39, 2.56) and have diabetes (15.3% vs 7.3%, OR 2.31; 95% CI 1.59, 3.35) which were all associated with higher birthweight.

Conclusions

Aboriginal babies born in metropolitan Melbourne are more likely to be of low birthweight compared with non-Aboriginal babies, which in turn was related to higher rates of prematurity and not to being small for gestational age.

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

OBJECTIVE

To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women.

METHODS

The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported.

RESULTS

The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby.

CONCLUSIONS

Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.

The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013)

Objective:

To explore the incidence of preterm delivery, maternal risk factors for having a preterm neonate, and preterm neonates’ mortality in Jordan.

Materials and Methods:

A cross-sectional population-based design was applied. Socio-demographic, perinatal, delivery risk factors, and survival information were gathered in pre- and post-hospital discharge interviews with 21075 women who gave birth to live neonates at ≥20 weeks of gestation in 18 hospitals in Jordan. Women were interviewed between 2012 and 2013. The sample was limited to singleton women who gave birth to live neonates. Women who gave birth to stillborn babies were excluded.

Results:

Preterm delivery incidence was 5.8%, of which 85% were in 32-36 gestational weeks. Male sex, primigravidity, hypertension, preeclampsia, and diabetes were significantly associated with an increased risk of preterm delivery. Women aged 20-35 years had the lowest risk of preterm delivery. Mother’s weight <50 kg, hospitalization at 24-34 gestational weeks, lack of antenatal care visits or <8 visits during pregnancy, a history of preterm delivery, and a history of stillbirth/neonatal death were associated with increased risks of preterm delivery. The neonatal mortality rate was 4/1000 live births among full-term and 123/1000 live births among preterm babies. Prematurity, congenital anomalies, and maternal diseases were the causes of 84% of preterm neonatal deaths.

Conclusion:

The mortality rate was considerably higher among preterm neonates than among term neonates; discrepancies between Jordan and other countries existed. Systematic prenatal risk assessment and quality postnatal health care improvements are required to improve the survival rates of preterm neonates.

The distribution of maternity services across rural and remote Australia: does it reflect population need?

Background

Australia has a universal health care system and a comprehensive safety net. Despite this, outcomes for Australians living in rural and remote areas are worse than those living in cities. This study will examine the current state of equity of access to birthing services for women living in small communities in rural and remote Australia from a population perspective and investigates whether services are distributed according to need.

Methods

Health facilities in Australia were identified and a service catchment was determined around each using a one-hour road travel time from that facility. Catchment exclusions: metropolitan areas, populations above 25,000 or below 1,000, and a non-birthing facility within the catchment of one with birthing. Catchments were attributed with population-based characteristics representing need: population size, births, demographic factors, socio-economic status, and a proxy for isolation - the time to the nearest facility providing a caesarean section (C-section). Facilities were dichotomised by service level – those providing birthing services (birthing) or not (no birthing). Birthing services were then divided by C-section provision (C-section vs no C-section birthing). Analysis used two-stage univariable and multivariable logistic regression.

Results

There were 259 health facilities identified after exclusions. Comparing services with birthing to no birthing, a population is more likely to have a birthing service if they have more births, (adjusted Odds Ratio (aOR): 1.50 for every 10 births, 95% Confidence Interval (CI) [1.33-1.69]), and a service offering C-sections 1 to 2 h drive away (aOR: 28.7, 95% CI [5.59-148]). Comparing the birthing services categorised by C-section vs no C-section, the likelihood of a facility having a C-section was again positively associated with increasing catchment births and with travel time to another service offering C-sections. Both models demonstrated significant associations with jurisdiction but not socio-economic status.

Conclusions

Our investigation of current birthing services in rural and remote Australia identified disparities in their distribution. Population factors relating to vulnerability and isolation did not increase the likelihood of a local birthing facility, and very remote communities were less likely to have any service. In addition, services are influenced by jurisdictions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2084-8) contains supplementary material, which is available to authorized users.

What contributes to disparities in the preterm birth rate in European countries?

PURPOSE OF REVIEW

In countries with comparable levels of development and healthcare systems, preterm birth rates vary markedly--a range from 5 to 10% among live births in Europe. This review seeks to identify the most likely sources of heterogeneity in preterm birth rates, which could explain differences between European countries.

RECENT FINDINGS

Multiple risk factors impact on preterm birth. Recent studies reported on measurement issues, population characteristics, reproductive health policies as well as medical practices, including those related to subfertility treatments and indicated deliveries, which affect preterm birth rates and trends in high-income countries. We showed wide variation in population characteristics, including multiple pregnancies, maternal age, BMI, smoking, and percentage of migrants in European countries.

SUMMARY

Many potentially modifiable population factors (BMI, smoking, and environmental exposures) as well as health system factors (practices related to indicated preterm deliveries) play a role in determining preterm birth risk. More knowledge about how these factors contribute to low and stable preterm birth rates in some countries is needed for shaping future policy. It is also important to clarify the potential contribution of artifactual differences owing to measurement.

Cognitive abilities in preterm and term-born adolescents

OBJECTIVE

To investigate the influence of a range of prenatal and postnatal factors on cognitive development in preterm and term-born adolescents.

STUDY DESIGN

Woodcock-Johnson III Tests of Cognitive Abilities were used to assess general intellectual ability and 6 broad cognitive abilities in 145 young adolescents aged approximately 12.5 years and born 25-41 weeks gestational age (GA). To study potential links between neurophysiologic and cognitive outcomes, corticomotor excitability was measured using transcranial magnetic stimulation and surface electromyography. The influence of various prenatal and postnatal factors on cognitive development was investigated using relative importance regression modeling.

RESULTS

Adolescents with greater GA tended to have better cognitive abilities (particularly general intellectual ability, working memory, and cognitive efficiency) and higher corticomotor excitability. Corticomotor excitability explained a higher proportion of the variance in cognitive outcome than GA. But the strongest predictors of cognitive outcome were combinations of prenatal and postnatal factors, particularly degree of social disadvantage at the time of birth, birthweight percentile, and height at assessment.

CONCLUSIONS

In otherwise neurologically healthy adolescents, GA accounts for little interindividual variability in cognitive abilities. The association between corticomotor excitability and cognitive performance suggests that reduced connectivity, potentially associated with brain microstructural abnormalities, may contribute to cognitive deficits in preterm children. It remains to be determined if the effects of low GA on cognitive outcomes attenuate over childhood in favor of a concomitant increase in the relative importance of heritability, or alternatively, if cognitive development is more heavily influenced by the quality of the postnatal environment.