Thermoregulation,incubator humidity,and skincare practices in appropriate for gestational age ultra-low birth weight infants:need for more evidence

Background Although not universal,active care is being offered to infants weighing<500 g at birth,referred to as ultra-low birth weight(ULBW)infants appropriate for gestational age.These infants have the greatest risk of dying or developing major morbidities.ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin.Although there is an emerging literature on the outcomes of ULBW infants,there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants.Data sources A comprehensive review of the literature was performed using the PubMed and Embase databases.Searched keywords included“thermoregulation or body temperature regulation”,“incubator humidity”,“skin care”,“infant,extremely low birth weight”and“ultra-low birth weight infants”.Results Evidences for thermoregulation,incubator humidity,and skincare practices are available for preterm infants weighing<1500 g at birth but not specifically for ULBW infants.Studies on thermoregulation,incubator humidity,or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants.Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants.Conclusions This narrative review focuses on challenges in thermoregulation,incubator humidity,and skincare practices in ULBW infants,highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants.

Low Birth Weight in Cameroon: Research and Analysis of Factors Associated with Their Occurrence in Douala Maternity Wards

Introduction: Low birth weight (LBW) is defined by the World Health Organization (WHO) as a birth weight strictly below 2500 g, whatever the term of pregnancy. It constitutes a major public health problem, both in developed and developing countries, due to its magnitude and its strong association with infant morbidity and mortality. Main objective was to study the factors associated with the occurrence of small-for-gestational-age newborns in Douala. Methodology: We carried out a cross-sectional analytical study with prospective data collection using a technical pretested sheet in the maternity wards of the Douala General Hospital, the Laquintinie Hospital, and the District hospitals of Deido, Nylon and Bonassama over a period of 4 months (January to April 2020). We were interested in any newborn, born alive, vaginally or by cesarean section, of low weight, seen in the first 24 hours from a full-term single-fetal pregnancy whose mother had given her consent. Our sampling was consecutive and non-exhaustive. We excluded newborns whose term was unclear and those with congenital malformations or signs of embryo-foetopathy. Data collection was done using survey sheets. Statistical analyzes were carried out with CS Pro 7.3 and SPSS version 25.0 software. The Student, Chi-square and Fischer tests were used to compare the means of the variables, the percentages with a significance threshold P value Results: During the study period, 305 full-term newborns were included, divided into 172 boys and 133 girls. The percentage of small-for-gestational-age newborns was 9.8%;after multivariate analysis by logistic regression to eliminate confounding factors, we found maternal factors associated with small for gestational age newborns;maternal age less than 20 years, primiparity, gestational age (37 - 38), a delay in prenatal visits greater than 14 weeks, anemia in pregnancy, positive toxoplasmosis serology in pregnancy, a body mass index of Conclusion: Our study revealed the potential determinants of low birth weight at term in the Cameroonian urban context and specifically in Douala.

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lomé (Togo) in 2021: A Cross-Sectional Study

Background: Since 2012, the World Health Organization has recommended intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) to prevent malaria-related complications in pregnant women. Ten years following these recommendations, we conducted this study to estimate the coverage for three doses of IPT-SP (IPT3) as well as the prevalence of low birth weight (LBW), and its associated factors in Lomé (Togo) in 2021. Methods: A cross-sectional study was conducted between January and March 2021. An exhaustive recruitment of women and their newborns was carried out in the maternity wards of the Sylvanus Olympio University Hospital Center. Data from antenatal consultations and clinical data of the newborns were collected. Multivariate logistic regression was carried out to determine factors associated with LBW. Results: A total of 252 mother-child pairs were included in this study. Median age of the mothers was 27 years, IQR [24-31]. More than a third (35.3%) of the mothers were primigravida. IPT3 coverage was 66.7% and 14.7% of newborns had a LBW. The prevalence of LBW was 33.3% [23.3-43.4] in women who had received fewer than 3 doses of IPT-SP and 5.4% [2.0-8.8] in those who had received at least 3 doses of IPT-SP (p Conclusion: Ten years following recommendations of the WHO on IPT-SP, malaria prevention based on IPT-SP is not optimal among pregnant women in Lomé, and the proportion of LBW children remains high. Actions to strengthen the three-dose IPT-SP policy are needed to prevent malaria and its consequences among newborns in Togo.

Impact of Delivery Mode on Morbidity in Preterm Infants with Very Low Birth Weights (<1500 Grams)

The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.

Acceptability of Kangaroo Mother Care (KMC) by Mothers with Low-Birth-Weight Babies at Arthur Davison Children’s Hospital, in Ndola, Zambia

Background: Kangaroo Mother Care is a simple safe method used to care for low-birth-weight babies. Low-birth-weight is a global public health issue that pose significant challenge to perinatal care systems. Globally, complications due to low-birth-weight are the leading cause of neonatal mortality, resulting in an estimated 1 million deaths annually. Kangaroo Mother Care (KMC) is a low-cost method of care for low-birth-weight infants in areas with inadequate incubators and power outages with positive outcomes. Objectives: To assess factors influencing acceptability of Kangaroo Mother Care (KMC) in NICU at Arthur Davison Children’s Hospital in Ndola, Zambia. Methodology: A cross sectional quantitative analytical study design was used. The study was conducted at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia. The purposive sampling method was used to select the study participants and a total of 129 mothers with Low Weight Babies A were selected to participate structured closed ended questionnaire was used to collect data from the participants using an interview. Data was analyzed using a Statistical Package for Social Scientists (SPSS) software version 26. Cross tabulations were done to determine association of variables using a Chi square (x2) test at 95% confidence interval and were assumptions where not met, fishers exact test was used. Multivariate binary logistic regression analysis was used to quantify the relationship between the dependent and independent variables. Results: Most of the respondents had male babies 77%, 69% of the babies weighed 1000 g - 1400 g, majority 79% had normal delivery, 71% of the respondents were multigravida and most of the respondents 79% were married. The study reviewed that 85% of those who attained secondary education accepted KMC, 74% of the respondents without monthly income accepted KMC, 80% of the respondents had positive attitude and accepted KMC. 82% of the respondents who had positive perception accepted KMC. Conclusion: Acceptance of Kangaroo Mother Care (KMC) among 75% of the mothers underscores its widespread favourability as a beneficial method for infant care.

Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Consequences of gestational and pregestational diabetes on placental function and birth weight

Maternal diabetes constitutes an unfavorable environment for embryonic and fetoplacental development. Despite current treatments, pregnant women with pregestational diabetes are at increased risk for congenital malformations, materno-fetal complications, placental abnormalities and intrauterine malprogramming. The complications during pregnancy concern the mother (gravidic hypertension and/or preeclampsia, cesarean section) and the fetus (macrosomia or intrauterine growth restriction, shoulder dystocia, hypoglycemia and respiratory distress). The fetoplacental impairment and intrauterine programming of diseases in the offspring's later life induced by gestational diabetes are similar to those induced by type 1 and type 2 diabetes mellitus. Despite the existence of several developmental and morphological differences in the placenta from rodents and women, there are similarities in the alterations induced by maternal diabetes in the placenta from diabetic patients and diabetic experimental models. From both human and rodent diabetic experimentalmodels, it has been suggested that the placenta is a compromised target that largely suffers the impact of maternal diabetes. Depending on the maternal metabolic and proin ammatory derangements, macrosomia is explained by an excessive availability of nutrients and an increase in fetal insulin release, a phenotype related to the programming of glucose intolerance. The degree of fetal damage and placental dysfunction and the availability and utilisation of fetal substrates can lead to the induction of macrosomia or intrauterine growth restriction. In maternal diabetes, both the maternal environment and the genetic background are important in the complex and multifactorial processes that induce damage to the embryo, the placenta, the fetus and the offspring. Nevertheless, further research is needed to better understand the mechanisms that govern the early embryo development, the induction of congenital anomalies and fetal overgrowth in maternal diabetes.

Maternal risk factors for low birth weight for term births in a developed region in China:a hospital-based study of 55,633 pregnancies

Low birth weight （LBW） is an important risk factor for neonatal and infant mortality and morbidity in adults.. How- ever, no large scale study on the prevalence of LBW and related maternal risk factors in China has been published. To explore the effects of maternal factors on LBW for term birth in China, we conducted a hospital-based retrospective study of 55, 633 Chinese pregnancy cases between 2001 and 2008. Maternal sociodemographic data, history of infer- tility and contraceptive use were obtained. Their medical status and diseases during pre-pregnancy were examined by physical examination at the first antenatal care visit. Maternal medical status before childbirth and pregnancy outcomes, including body weight, infant gender, multiple pregnancy and congenital anomalies, were recorded. Univariate and multivariate logistic regression, and linear regression were used to investigate the relationship be- tween maternal factors and term LBW. The general incidence of term LBW was 1.70% in the developed area of China. After preliminary analysis using the univariate model, low primary education, anemia, hypertensive disor- ders, placental previa, oligohydramnios and premature rupture of membrane were predicted as independent factors of term LBW in the multivariate model. Furthermore, the decrease in annual frquencies of these risk factors were major causes of gradual decline in the incidence of LBW （from 2.43% in 2001 to 1.21% in 2008）. The study dem- onstrated that among maternal factors, primary education, anemia and hypertensive disorders could contribute to LBW for term birth even in the most developed area of China.

Enhanced Efficiency of Milk Utilization for Growth in Surviving Low-Birth-Weight Piglets

This study determined effects of birth weights （0.70 to 1.09, 1.10 to 1.49, 1.50 to 1.89, and ≥ 1.90 kg） on the efficiency of milk utilization for growth in sow-reared piglets. One-hundred-sixty piglets from 18 multiparous sows （ Landrace × Large White） were individually weighed immediately after birth （ day 0） and at 7-day intervals for 35 days. Milk consumption of piglets was determined weekly using the weigh-suckle-weigh method. Deaths of piglets were recorded daily. Piglets with the lightest birth weight had the highest incidence of mortality. Birth weights between 0.70 and 1.89 kg were positively as- sociated with average dally gains （ADG, g/day ） during the suckling period （ P 〈 0.01 ）. Compared with piglets having birth weights of 1.50 to 1.89 kg, birth weights ≥ 1.90 kg did not confer any additional benefit on preweaning survival or ADG. Colostrum or milk consumption per kilogram of body weight among low-, normal-, and large-birth-weight piglets did not differ in the first week. At days 14 to 35, milk consumption of piglets （ g/kg BW/day ） increased （e 〈 0. 01 ） but the ratio of gain to milk consumption decreased （ P 〈 0.01 ） progressively, as their birth weights increased from 0.70 to ≥1.90 kg. Additionally, surviving low-birth-weight piglets had a higher relative growth rate （%/day ） than normal-and large-birth- weight piglets. Based on these novel findings, it is imperative that great efforts be made to improve the survival of low-birth-weight piglets so as to increase the efficiency of nutrient utilization by both lactating sows and suckling piglets.

Culture Media Influenced Laboratory Outcomes But Not Neonatal Birth Weight in Assisted Reproductive Technology

Summary： Whether the type of culture media utilized in assisted reproductive technology has impacts on laboratory outcomes and birth weight of newborns in in-vitro fertilization （IVF）/intracytoplasmic sperm injection （ICSI） was investigated. A total of 673 patients undergoing IVF/ICSI and giving birth to live singletons after fresh embryo transfer on day 3 from Jan. 1, 2010 to Dec. 31, 2012 were included. Three types of culture media were used during this period： Quinn＇s Advantage （QA）, Single Step Medium （SSM）, and Continuous Single Culture medium （CSC）. Fertilization rate （FR）, normal fertilization rate （NFR）, cleavage rate （CR）, normal cleavage rate （NCR）, good-quality embryo rate （GQER） and neonatal birth weight were compared using one-way ANOVA and Z2 tests. Multiple linear regression analysis was performed to determine the impact of culture media on laboratory outcomes and birth weight. In IVF cycles, GQER was significantly decreased in SSM medium group as compared with QA or CSC media groups （63.6% vs. 69.0% in QA; vs. 71.3% in CSC, P=0.011）. In ICSI cycles, FR, NFR and CR were significantly lower in CSC medium group than in other two media groups. No significant difference was observed in neonatal birthweight among the three groups （P=0.759）. Multiple linear regression analyses confirmed that the type of culture medium was correlated with FR, NFR, CR and GQER, but not with neonatal birth weight. The type of culture media had potential influences on laboratory outcomes but did not exhibit an impact on the birth weight of singletons in ART.

A review of the amino acid metabolism in placental function response to fetal loss and low birth weight in pigs

The fertility of sows mainly depends on the embryo losses during gestation and the survival rate of the postfarrowing piglets.The selection of highly-prolific sows has been mainly focused on the selection of genotypes with high ovulatory quota.However,in the early-and post-implantation stages,the rate of embryo losses was increased with the increase of zygotes.Among the various factors,placental growth and development is the vital determinant for fetal survival,growth,and development.Despite the potential survival of fetuses with deficient placental development,their life-conditions and growth can be damaged by a process termed intrauterine growth retardation(IUGR).The newborn piglets affected by IUGR are prone to increased morbidity and mortality rates;meanwhile,the growth,health and welfare of the surviving piglets will remain hampered by these conditions,with a tendency to exacerbate with age.Functional amino acids such as glycine,proline,and arginine continue to increase with the development of placenta,which are not only essential to placental growth(including vascular growth)and development,but can also be used as substrates for the production of glutathione,polyamines and nitric oxide to benefit placental function in many ways.However,the exact regulation mechanism of these amino acids in placental function has not yet been clarified.In this review,we provide evidence from literature and our own work for the role and mechanism of dietary functional amino acids during pregnancy in regulating the placental functional response to fetal loss and birth weight of piglets.This review will provide novel insights into the response of nutritionally nonessential amino acids(glycine and proline)to placental development as well as feasible strategies to enhance the fertility of sows.

Influence of birth order, birth weight, colostrum and serum immunoglobulin G on neonatal piglet survival

Background： Intake of colostrum after birth is essential to stimulate intestinal growth and function, and to provide systemic immunological protection via absorption of Immunoglobulin G （IgG）. The birth order and weight of 745 piglets （from 75 litters） were recorded during a one-week period of farrowing. Only pigs weighing greater than 0.68 kg birth weight were chosen for the trial. Sow colostrum was collected during parturition, and piglets were bled between 48 and 72 hours post-birth. Piglet serum IgG and colostral IgG concentrations were determined by radial immunodiffusion. Results： Sow parity had a significant （P 〈 0.001） effect on sow colostral IgG concentration, being 5% higher in multiparous females. Sow colostral IgG concentration explained 6% and piglet birth order accounted for another 4% of the variation observed in piglet serum IgG concentration （P 〈 0.05）; however, birth weight had no detectable effect. Piglet serum IgG concentration had both a linear （P 〈 0.05） and quadratic effect （P 〈 0.05） on % survival. Piglets with 1,000 mg/dl serum IgG or less （n=24） had a 67% survival; whereas, piglets with IgG concentrations between 2250 to 2500 mg/dl （n=247） had a 91% survival. Birth order had no detectable effect on survival, but birth weight had a positive linear effect （P 〈 0.05）. Piglets weighing 0.9 kg （n = 107） at birth had a 68% survival rate, and those weighing 1.6 kg （n = 158） had an 89% survival. Conclusion： We found that the combination of sow colostrum IgG concentration and birth order can account for 10% of the variation of piglet serum IgG concentration and that piglets with less than 1,000 mg/dl IgG serum concentration and weight of 0.9 kg at birth had low survival rate when compared to their larger siblings. The effective management of colostrum uptake in neonatal piglets in the first 24 hrs post-birth may potentially improve survival from birth to weaning.

Association of hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIM To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODS All deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way ANOVA.RESULTS Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSION A low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM.Women of ethnic backgrounds(Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.

Rescue case of low birth weight infant with acute hepatic failure

We report a case involving a rescued low birth weight infant(LBWI) with acute liver failure. Case: The patient was 1594 g and 32^(3/7) gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation(LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.

Determinant of Low Birth Weight Infants: A Matched Case Control Study

Background: Low birth weight (LBW) is a well-known factor associated with neonatal mortality and has contributed to a range of poor health outcomes. Thus, the objective of this study was to determine factors associated with LBW infants. Methods: A matched case control study was conducted in Universiti Kebangsaan Malaysia. Data of deliveries were obtained from Total Hospital Information System and medical records. All registered deliveries from January to June 2012 were used as sample populations. There were 180 pairs of cases and controls matched on babies’ gender. Fourteen variables were analyzed: maternal age, ethnicity, gravida, parity, gestational age, maternal booking weight, height and body mass index (BMI), history of low birth weight infants, birth interval, booking hemoglobin levels, hypertension, diabetes mellitus and mode of delivery. Results: Younger mother (t = 6.947, p < 0.001), lower booking BMI (t = 3.067, p = 0.002), prematurity (t = 12.324, p < 0.001), history of LBW infants (OR = 3.0, p = 0.001), LSCS (OR = 0.06, p = 0.001) and current hypertension (OR = 3.1, p = 0.008) were found significant in bivariate analysis. Multivariable conditional logistic regression identified younger maternal age (AOR = 2.9, 95% CI = 1.86 -4.51, p 13.58, p = 0.045), prematurity (AOR = 2.4, 95% CI = 1.79 -3.26, p < 0.001), and current hypertension (AOR = 4.5, 95% CI = 1.06 -19.22, p = 0.041) as significant factors associated with LBW infants. Conclusion: Younger maternal age, history of LBW infants, prematurity and hypertension have been recognized as predictors of LBW infants. The importance of pre-pregnancy screening, early antenatal booking and proper identification of high risk-mother needs to be strengthened and enforced in effort to reduce incidence of LBW infants.

Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis

AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.RESULTS This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

Neurally adjusted ventilator assist in very low birth weight infants:Current status

Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not include longterm patient oriented outcomes.Multicenter,randomized,outcome trials are needed to determine whether NAVA is effective in avoiding intubation,facilitating extubation,decreasing time of ventilation,reducing the incidence ofCLD,decreasing length of stay,and improving long-term outcomes such as the duration of ventilation,length of hospital stay,rate of pneumothorax,CLD and other major complications of prematurity.In order to prevent barotrauma,next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA.They should also include an upper limit to the inspiratory time as in conventional ventilation.The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants.Newly developed ventilators should also include leak compensation and high frequency ventilation.A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA.

Study on the Relationship between Nursing Staffing and Nosocomial Infection in Very Low Birth Weight Infants

Background: At present, there is no domestic research on the relationship between nurse staffing and hospital infection in very low birth weight infants. In this paper, we will explore the relationship between nurses of very low birth weight (VLBW) infants in neonatal intensive care unit (NICU) and nosocomial infections. Methods: The clinical data of 280 very low birth weight infants born in our hospital from January 2010 to January 2020 were collected, and the chi-square test and multiple logistic regression analysis were used to study the nursing staff of each very low birth weight infant who was admitted to the NICU The relationship between the number of infections and hospital infections. Results: On average, each nurse needs to care for 4.3 very low birth weight infants (lowest to highest: 2.50 - 8.42). In the univariate analysis, the higher the incidence of urinary tract infection (P < 0.05), the multivariate logistic regression analysis of neonatal nosocomial infection showed that nurse staffing was significantly related to the incidence of urinary tract infection (OR = 1.78;95% confidence interval, 1.17 - 2.35, P < 0.05). However, there was no significant correlation between nurse staffing and bloodstream infection (OR = 0.91;95% confidence interval, 0.74 - 1.06, P > 0.05) or Ventilator associated pneumonia (VAP) infection (OR = 1.17;95% confidence interval, 0.94 - 1.47, P > 0.05). Conclusion: Our research shows that in the neonatal intensive care unit, the reasonable deployment of nursing staff is an important factor in preventing urinary tract infections in very low birth weight infants. It is important for improving the survival rate of very low birth weight infants and reducing the occurrence of sequelae.

Racial and Ethnic Analysis of Birth Weight Trends among Full-Term Singleton Newborns Delivered in a Prosperous Multicultural Society

Objectives: This study aims to describe birth weight and its variations concerning maternal characteristics as well as to standardize birth weight curves for Qatari and expatriate’s newborn population born in the state of Qatar. Methods: PEARL-Peristat registry is a National maternal-neonatal observation epidemiologic database project where both maternal and neonatal cohort data are collected to evaluate specified outcomes for a population defined by a disease, conditions, or exposures. Results: Out of 50,535 singleton deliveries, only 44,178 live-born infants were included in this study. The LBW rate has remained constant since 2011 and was reported as 2.4% in males and 3.5% in females. The average total LBW was 3%. The lowest incidence of LBW was seen in maternal age between 30 - 45 years. There was a marginal increase in the incidence of LBW among mothers less than 20 years of age. The incidence of LBW among Qatari mothers was reported as 2.6%, 2.2%, and 2.4% in years 2011, 2012, 2017 respectively with a significant difference when compared to expatriates’ newborns particularly in the year 2017 (p-value < 0.001). Moreover, among Qatari newborns, there is a significant rise in the rate of LBW from 2011 to 2017, 2.9% to 4.1% (p-value ≥ 0.007). The expatriate’s population received 69 % of all maternal hospital services offered in government hospitals. Conclusion: The birth weight of newborns delivered in the state of Qatar is to a large extent consistent with the international birth weight figures for both Qatari and expatriate newborns delivered in Qatar. Low birth weight is increasing particularly among young mothers. The lowest rate of LBW was reported among mothers aged above 29 years old. Large for the date was observed among mothers older than 29 years of age.