Prevalence of adolescent deliveries and its complications in Cameroon: a systematic review and meta-analysis

Global, Regional and National Trends in the Burden of Neonatal Respiratory Failure and essentials of its diagnosis and management from 1992 to 2022: a scoping review

Neonatal respiratory failure (NRF) is an emergency which has not been examined extensively. We critically synthesized the contemporary in-hospital prevalence, mortality rate, predictors, aetiologies, diagnosis and management of NRF to better formulate measures to curb its burden. We searched MEDLINE and Google Scholar from 01/01/1992 to 31/12/2022 for relevant publications. We identified 237 papers from 58 high-income and low-and middle-income countries (LMICs). NRF prevalence ranged from 0.64 to 88.4% with some heterogeneity. The prevalence was highest in Africa, the Middle East and Asia. Globally as well as in Asia and the Americas, respiratory distress syndrome (RDS) was the leading aetiology of NRF. Neonatal sepsis was first aetiology in Africa, whereas in both Europe and the Middle East it was transient tachypnoea of the newborn. Independent predictors of NRF were prematurity, male gender, ethnicity, low/high birth weight, young/advanced maternal age, primiparity/multiparity, maternal smoking, pregestational/gestational diabetes mellitus, infectious anamneses, antepartum haemorrhage, gestational hypertensive disorders, multiple pregnancy, caesarean delivery, antenatal drugs, foetal distress, APGAR score, meconium-stained amniotic fluid and poor pregnancy follow-up. The NRF-related in-hospital mortality rate was 0.21-57.3%, highest in Africa, Asia and the Middle East. This death toll was primarily due to RDS globally and in all regions. Clinical evaluation using the Silverman-Anderson score was widely used and reliable. Initial resuscitation followed by specific management was the common clinical practice.

CONCLUSION

NRF has a high burden globally, driven by RDS, especially in LIMCs where more aggressive treatment and innovations, preferably subsidized, are warranted to curb its alarming burden.

WHAT IS KNOWN

• Neonatal respiratory failure is a frequent emergency associated with a significant morbidity and mortality, yet there is no comprehensive research paper summarizing its global burden. • Neonatal respiratory failure needs prompt diagnosis and treatment geared at improving neonatal survival.

WHAT IS NEW

• Neonatal respiratory failure has an alarmingly high global burden largely attributed to Respiratory distress syndrome. Low resource settings are disproportionately affected by the burden of neonatal respiratory failure. • Independent preditors of neonatal respiratory failure are several but can be classified into foetal, maternal and obstetrical factors. An illustrative pedagogical algorithm is provided to facilitate diagnosis and management of neonatal respiratory failure by healthcare providers.

Adolescent pregnancies in Turkey: a single center experience

BACKGROUND

Adolescent pregnancies are more likely to be complicated with adverse perinatal outcomes.

OBJECTIVE

Assess the sociodemographic and clinical characteristics of adolescents who have delivered singleton newborns.

DESIGN

Retrospective cohort.

SETTINGS

A tertiary training and research hospital in Turkey.

PATIENTS AND METHODS

This was a review of adolescents and adults who delivered singleton newborns at a tertiary health center between January 2018 and June 2022. Pregnant adolescents were aged <20 years.

MAIN OUTCOME MEASURES

Adverse maternal and perinatal outcomes.

SAMPLE SIZE

2233 pregnant women (754 adolescents and 1479 adults).

RESULTS

Turkish nationality was significantly less prevalent in pregnant adolescents than pregnant adults (P=.001). Oligohydramnios, fetal growth restriction, perineal injury and postpartum intravenous iron treatment were significantly more prevalent in pregnant adolescents than pregnant adults (P<.05 for all). The neonates born to adolescent mothers had significantly lower birth weight and first minute Apgar score than the neonates born to adult mothers (P=.001 for both). Small for gestational age, need for intensive care and death were significantly more prevalent in neonates born to adolescent mothers than those born to adult mothers (P=.001 for all). Compared with pregnant adults, pregnant adolescents had a significantly higher risk of oligohydramnios (P=.001), preterm delivery (P=.024), intravenous iron treatment (P=.001), and small for gestational age (P=.001).

CONCLUSION

Due to the refugee population received by Turkey, it would be prudent to expect more frequent adolescent pregnancies. Adolescent pregnancies are more likely to be complicated with low birth weight, oligohydramnios, preterm delivery, postpartum iron treatment, lower Apgar scores, need for neonatal intensive care and neonatal death.

LIMITATION

Retrospective.

Prevalence and factors associated with adolescent pregnancy among sexually active adolescent girls in Peru: Evidence from Demographic and Family Health Survey, 2015-2019

Background

The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem.

Methods

A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model.

Results

The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4-32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI:1.33-1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48-4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07-1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76-0.86), being currently studying (aPR: 0.43; 95%CI: 0.38-0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85-0.97), third (aPR: 0.81; 95%CI: 0.74-0.89), fourth (aPR: 0.79; 95%CI: 0.69-0.91) and fifth (aPR: 0.59; 95%CI: 0.47-0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69-0.83) or late adolescence (aPR: 0.40; 95%CI: 0.35-0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72-0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77-0.92).

Conclusions

Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnancy. To decrease the prevalence of teenage pregnancy in Peru, it is imperative to enhance national policies concerning family planning and provide comprehensive sex education targeted at adolescents.

Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey

BACKGROUND

A minimum length of stay following facility birth is a prerequisite for women and newborns to receive the recommended monitoring and package of postnatal care. The first postnatal care guidelines in Cameroon were issued in 1998 but adherence to minimum length of stay has not been assessed thus far. The objective of this study was to estimate the average length of stay and identify determinants of early discharge after facility birth.

METHODS

We analyzed the Cameroon 2018 Demographic and Health Survey. We included 4,567 women who had a live birth in a heath facility between 2013 and 2018. We calculated their median length of stay in hours by mode of birth and the proportion discharged early (length of stay < 24 h after vaginal birth or < 5 days after caesarean section). We assessed the association between sociodemographic, context-related, facility-related, obstetric and need-related factors and early discharge using bivariate and multivariable logistic regression.

RESULTS

The median length of stay (inter quartile range) was 36 (9-84) hours after vaginal birth (n = 4,290) and 252 (132-300) hours after caesarean section (n = 277). We found that 28.8% of all women who gave birth in health facilities were discharged too early (29.7% of women with vaginal birth and 15.1% after a caesarean section). Factors which significantly predicted early discharge in multivariable regression were: maternal age < 20 years (compared to 20-29 years, aOR: 1.44; 95%CI 1.13-1.82), unemployment (aOR: 0.78; 95%CI: 0.63-0.96), non-Christian religions (aOR: 1.65; 95CI: 1.21-2.24), and region of residence-Northern zone aOR:9.95 (95%CI:6.53-15.17) and Forest zone aOR:2.51 (95%CI:1.79-3.53) compared to the country's capital cities (Douala or Yaounde). None of the obstetric characteristics was associated with early discharge.

CONCLUSIONS

More than 1 in 4 women who gave birth in facilities in Cameroon were discharged too early; this mostly affected women following vaginal birth. The reasons leading to lack of adherence to postnatal care guidelines should be better understood and addressed to reduce preventable complications and provide better support to women and newborns during this critical period.

Mirroring Perinatal Outcomes in a Romanian Adolescent Cohort of Pregnant Women from 2015 to 2021

Although the rates of adolescent pregnancies appear to have dropped according to the World Health Organization (WHO), the decrease in the age of the first menarche and better nutrition seems to contribute to the otherwise high rate of adolescent pregnancy worldwide, despite the efforts of different organizations to improve upon this trend. We conducted a population-based retrospective cohort study from January 2015 to December 2021 using our hospitals' database. We totaled 2.954 adolescent and 6.802 adult pregnancies. First, we compared younger adolescents' outcomes with those of older adolescents, as well as with adolescents aged between 18 and 19 years old; secondly, we compared adolescent pregnancies with adult ones. We detected higher percentages of cephalo-pelvic disproportion (43.2%), cervical dystocia (20.7%), and twin pregnancy (2.7%) in underage adolescents compared with 32%, 14.1%, and 1% in older underage adolescents, respectively, and 15.3%, 3.1%, and 0.6% in older ones. As teens became older, the likelihood of malpresentations and previous C-sections rose, whereas the likelihood of vaginal lacerations declined. When comparing adolescents with adult women, we found more cases that required episiotomy (48.1% compared with 34.6%), instrumental delivery (2.1% compared with 1%), and cervical laceration (10.7% compared with 8.4%) in the adolescent group, but the rates of malpresentation (11.4% compared with 13.5%), previous C-section (13.9% compared with 17.7%), and placenta and vasa praevia (4.5.6% compared with 14%) were higher in the adult women group. Adolescent pregnancy is prone to being associated with higher risks and complications and continues to represent a challenge for our medical system.

Adolescent Pregnancy: A Case-Series Study of 112 Adolescent Mothers and Their Newborns

Background

Although declining, adolescent pregnancy remains an important health concern and is associated with adverse maternal and fetal outcomes. We aimed to characterize adolescent pregnancy in a level II hospital and the observed maternal, fetal, and perinatal complications.

Methods

We conducted a case-series study of five-years duration with adolescent mothers and their newborns. We collected sociodemographic, obstetric, and neonatal data through chart review and conducted a comparison analysis between newborns who needed hospitalization and those who did not.

Results

We identified 112 newborns with adolescent mothers. Most pregnancies were unplanned (89.3%) and the start of pregnancy surveillance was late. The most frequent complications were intrauterine growth restriction, oligohydramnios, and threatened preterm labor. Prematurity was found in 9.8% of the newborns and 0.9% had less than 32 weeks at the time of birth. Thirteen newborns (11.6%) needed hospitalization in the neonatal intensive care unit, with three (23%) needing invasive ventilation. The main diagnoses of admission were prematurity, social risk, low birth weight, feeding difficulties, and newborn respiratory distress syndrome. Hospitalization seemed associated with less frequent breastfeeding. Among the hospitalized newborns, there was a high rate of discharge at the care of a relative or an institution (30.8%). Surprisingly, surveillance during pregnancy did not seem to differ between newborns that needed hospitalization and those that did not.

Discussion

Adolescent pregnancy is associated with poor surveillance as well as obstetric and neonatal complications. Newborns of adolescent mothers have a high hospitalization rate, but further investigations are needed to fully understand the contributing factors. The creation of multidisciplinary teams is fundamental for reducing complications, and appropriate reproductive health programs should focus on reducing adolescent pregnancy through better access to education and contraception.