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Household air pollution (HAP) from cooking with solid fuels used during pregnancy has been associated with adverse pregnancy outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial that assessed the impact of a liquefied petroleum gas (LPG) stove and fuel intervention on health in Guatemala, India, Peru, and Rwanda. Here we investigated the effects of the LPG stove and fuel intervention on stillbirth, congenital anomalies and neonatal mortality and characterized exposure-response relationships between personal exposures to fine particulate matter (PM2.5), black carbon (BC) and carbon monoxide (CO) and these outcomes. Pregnant women (18 to

Sepsis is the overwhelming immunological response to infection, which if not treated can lead to multi-organ failure, shock and death. Specifically, neonatal sepsis results in 225,000 neonatal deaths globally per annum. Moreover, Uganda experiences one of the highest materno-fetal death rates (62,000 p.a.), with neonatal sepsis deaths at approximately 6,500 p.a.. The difficulty in diagnosing neonatal sepsis lies in the non-specific signs and symptoms associated with sepsis and an absence of definitive sepsis-specific biomarkers. However, serum amyloid A (SAA) detection has potential as a superior biomarker for the diagnosis of probable neonatal sepsis. Herein, in ethically-approved studies we have deployed a competitive lateral flow test (NeoSep-SAA (research-use only)) to detect SAA in whole blood at patient bedside in a resource-limited environment. Results are available within 10 minutes and test format is compatible with small blood volumes available from neonates (5 μl). NeoSep-SAA exhibited a high sensitivity and specificity for diagnosis of adult sepsis, and in neonates showed a sensitivity and specificity of 92% (89%, 95%) and 73% (68%, 77%) with PPV and NPV of 78% (75%, 81%) and 90% (86%, 93%), respectively (n = 714 individuals; 95% CI). NeoSep-SAA showed superior sensitivity for neonatal sepsis over C-Reactive Protein detection (sensitivity: 37%), albeit with some sacrifice of specificity. NeoSep-SAA enabled rapid diagnosis, which combined with minimally-invasive blood withdrawal, was less stressful for neonates. Overall, NeoSep-SAA can readily identify infection/inflammation and has the potential to enable rapid and informed clinical decisions to combat sepsis. This approach has potential to improve neonatal sepsis detection and reduce neonatal mortality in line with United Nations Sustainable Development Goal (SDG) 3.2 objectives. [ABSTRACT FROM AUTHOR]

Background: The magnitude of maternal and neonatal death and morbidity during the postnatal period remains too high. In contrast to the decline in global mortality rates, maternal and neonatal deaths continue to occur at the highest rate in sub-Saharan Africa. Appropriate care during the postpartum period is vital to prevent neonatal and maternal deaths. This study is aimed at delivering evidence on the pooled prevalence and associated factors of adequate postnatal care using the recent demographic and health surveys from 20 sub-Saharan African countries. Methods: Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 90,251 women aged 15–49 years with live births in the 2 years preceding the survey was included in the study. Multilevel logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 were declared statistically significant. Results: The overall pooled prevalence of adequate postnatal care among women aged 15–49 years in SSA countries was 27.42% (95% CI: 27.13%, 27.71%). Factors like age [AOR = 1.10; 95% CI (1.05, 1.16)], educational status [AOR = 1.52; 95% CI (1.39, 1.67)], marital status [AOR = 0.83; 95% CI (0.79, 0.88)], working status [AOR = 0.81; 95% CI (0.78, 0.84)], media exposure [AOR = 1.05; 95% CI (1.01, 1.09)], sex of the household head [AOR = 1.13; 95% CI (1.08, 1.18)], household size [AOR = 1.07; 95% CI (1.03, 1.12)], number of ANC visits [AOR = 3.38; 95% CI (3.04, 3.75)], place of delivery [AOR = 3.77; 95% CI (3.57, 3.99)], prenatal community health workers visit [AOR = 1.45; 95% CI (1.39, 1.51)], and residence [AOR = 1.26; 95% CI (1.21, 1.32)] were significantly associated with adequate postnatal care. Conclusion: Only nearly three out of ten women received adequate postnatal care in sub-Saharan African countries. Adequacy of postnatal care was determined by the age of respondents, educational status, current marital status, working status, media exposure, sex of the household head, household size, number of ANC visits, place of delivery, prenatal community health workers visit, and residence. Therefore, women's empowerment through education, employment, and decision-making involvement; strengthening ANC service utilization and health facility delivery; information dissemination through media; promoting prenatal care through community health workers home-to-home visits; and giving special attention to unmarried, young, and non-working women are strongly recommended. [ABSTRACT FROM AUTHOR]

Background: Improving the quality of intrapartum and immediate postnatal care is critical for reducing maternal and neonatal mortality in low- and middle-income countries (LMICs). This review aimed to assess the extent of Person-Centred Maternity Care (PCMC) practices during childbirth in LMICs. Methods: We retrieved studies from four databases, including PubMed/Medline, Embase, CINAHL, and Maternal and Infant Care, up to 30 May 2023 and updated 26 April 2024. Additionally, manual searching was performed to identify additional studies. Our study included studies that examined PCMC using PCMC scale. The included studies were assessed using the Joanna Briggs Institute (JBI) checklist for quality appraisal. Findings: Twelve articles out of 888 were retained in the review. Among these, nine studies specifically examined various elements of PCMC, such as dignity and respect, communication and autonomy, and supportive care. The lowest and highest levels of the mean (± SD-standard deviation) PCMC were 46.5 (6.9) and 60.2 (12.3) out of 90 total scores in Ghana and urban Kenya, respectively. The lowest score was reported in the communication and autonomy subscale domain of PCMC at a mean (± SD) score of 8.3 (3.3). Women who were wealthier and educated, and those who received ANC and birthing care by the same health care providers were found to have a higher level of PCMC during childbirth. Whereas those women who did not have ANC follow-up, visited health facilities for ANC in the second or third trimester, stayed at health facilities after birth for 2–7 days, had complications, and received care from auxiliary midwives, nurses, or assisted by unskillled attendants were associated with a lower level of PCMC during childbirth. Conclusions: Our findings indicated that the communication and autonomy components of PCMC are notably low, affecting the rapport between healthcare providers and women, as well as decision-making and the execution of procedures. To enhance PCMC, continuity of care through antenatal and intrapartum care provided by the same healthcare providers, along with fostering a supportive environment for both women and healthcare providers during childbirth is imperative. PROSPERO ID: CRD42023426638. [ABSTRACT FROM AUTHOR]

Background: Since 2019, Jiangsu province has implemented newborn screening for congenital heart disease (CHD). As of 2023, 591 hospitals (584 public or private midwifery institutions, 7 specialized hospitals for children) in Jiangsu province conduct CHD screening, including 132 with diagnostic capabilities and 21 with treatment facilities, ensuring comprehensive coverage of 13 prefecture-level cities, 95 counties (19 counties, 21 county-level cities, 55 districts) in Jiangsu Province. This study aims to examine the implementation of the newborn CHD screening program within Jiangsu Province's healthcare systems using real-world clinical data and to assess its effectiveness in patient care systematically. Additionally, we seek to offer data-driven recommendations for advancing the development of patient risk screening tools. Methods: Our study analyzed dataset from live births at midwifery institutions across Jiangsu province from 2019 to 2023. All newborns aged 6–72 h were screened by trained medical staff using the dual-index method. Newborns diagnosed without CHD or screened negative were tracked through the Child Health Management program, a basic public health service for children under 7 years of age in China. Newborns testing positive were referred to a diagnostic institution for echocardiographic assessment, and those with confirmed CHDs were directed to a treatment facility for further evaluation and treatment. Results: During the study period, 2,512,635 out of 2,648,298 infants (94.88%) were screened within 72 h of birth. Of these, 71,041 (2.83%) tested positive for screening, and 23,150 (32.59%) of those positive were diagnosed with CHD. From 2018 to 2023, there was approximately a twofold decrease in the infant mortality rate (IMR) due to CHD, from 0.37‰ to 0.14‰ (APC= -17.33, P < 0.001), and a reduction in the under-five mortality rate (U5MR) due to CHD, from 0.45‰ to 0.17‰ (APC= -16.79, P < 0.001). Conclusions and relevance: The current study provides encouraging evidence that the screening program has effectively advanced the diagnosis of CHD in children and reduced infant mortality, thereby supporting health rights and benefiting children with CHD throughout the province. Furthermore, our analysis demonstrates that the newborn CHD screening program has been effectively implemented across Jiangsu province's healthcare systems. [ABSTRACT FROM AUTHOR]

Background: Ninety‐eight percent of neonatal deaths worldwide occur in low‐ and middle‐income countries (LMICs), yet there is little bereavement care guidance available for these settings. Objectives: To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs. Search Strategy and Selection Criteria: Four databases were searched for peer‐reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting. Data Collection and Analysis: Data were collected by two independent reviewers, collated through line‐by‐line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven‐step meta‐ethnography approach to create first‐, second‐ and third‐order themes. Main Results: Seven first‐order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third‐order themes arose: The individual, the healthcare setting and the community/context. Conclusions: Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high‐quality, bereavement care guidelines suitable for use in LMIC settings. [ABSTRACT FROM AUTHOR]

Background: As extreme events such as drought and flood are projected to increase in frequency and intensity under climate change, there is still large missing evidence on how drought exposure potentially impacts mortality among young children. This study aimed to investigate the association between drought and risk of infant mortality in Africa, a region highly vulnerable to climate change that bears the heaviest share of the global burden. Methods and findings: In this cross-sectional study, we obtained data on infant mortality in 34 African countries during 1992–2019 from the Demographic and Health Surveys program. We measured drought by the standardized precipitation evapotranspiration index at a timescale of 24 months and a spatial resolution of 10 × 10 km, which was further dichotomized into mild and severe drought. The association between drought exposure and infant mortality risk was estimated using Cox regression models allowing time-dependent covariates. We further examined whether the association varied for neonatal and post-neonatal mortality and whether there was a delayed association with drought exposure during pregnancy or infancy. The mean (standard deviation) number of months in which children experienced any drought during pregnancy and survival period (from birth through death before 1 year of age) was 4.6 (5.2) and 7.3 (7.4) among cases and non-cases, respectively. Compared to children who did not experience drought, we did not find evidence that any drought exposure was associated with an increased risk of infant mortality (hazard ratio [HR]: 1.02, 95% confidence interval [CI] [1.00, 1.04], p = 0.072). When stratified by drought severity, we found a statistically significant association with severe drought (HR: 1.04; 95% CI [1.01, 1.07], p = 0.015), but no significant association with mild drought (HR: 1.01; 95% CI [0.99, 1.03], p = 0.353), compared to non-exposure to any drought. However, when excluding drought exposure during pregnancy, the association with severe drought was found to be non-significant. In addition, an increased risk of neonatal mortality was associated with severe drought (HR: 1.05; 95% CI [1.01, 1.10], p = 0.019), but not with mild drought (HR: 0.99; 95% CI [0.96, 1.02], p = 0.657). Conclusions: Exposure to long-term severe drought was associated with increased infant mortality risk in Africa. Our findings urge more effective adaptation measures and alleviation strategies against the adverse impact of drought on child health. Author summary: Why was this done?: Climate change is projected to result in a higher frequency and intensity of drought events. Previous studies have found rainfall anomaly to be associated with increased infant mortality. The risk of drought exposure for infant health outcomes is not well understood. What did the researchers do and find?: Employing an advanced measure of drought incorporating multiple climatic variables, we found no evidence that any drought exposure was associated with an increased risk of infant mortality in Africa. When stratifying the analysis by drought severity, exposure to long-term severe drought was observed to be associated with higher infant mortality risk. There is a delayed association between exposure to drought during pregnancy and risk of infant mortality. What do these findings mean?: The protection of pregnant women and young children from drought could potentially help reduce the heavy toll of infant mortality in Africa. Our study urges the prioritization of neonatal and pediatric care as well as the development of water, sanitation, and hygiene infrastructure and adaptation strategies in rural Africa. This study may underestimate the potential impact of drought on mortality in early life given it could have already contributed to miscarriage or stillbirth. [ABSTRACT FROM AUTHOR]

Background: We synthesised the current evidence in coverage and quality of delivery care, change in neonatal mortality (NMR), and causes of neonatal death in the private sector deliveries in the Indian state of Bihar from 2011 to 2021. Methods: Women aged 15–49 years with livebirths were interviewed in three household surveys involving state-representative samples in 2011, 2016 and 2020–2021 designed to document the coverage of maternal and newborn health services and change in NMR over time. Verbal autopsy interviews were used to assign the cause of neonatal death. The coverage of private sector facilities for livebirths in each survey and the percent change over time by 38 districts in the state and select socio-demographic characteristics, along with trends in NMR and causes of neonatal death across years are reported. Results: Private sector delivery coverage was 17.3% (95% CI = 16.6–17.9), 16.7% (95% CI = 16.2–17.2) and 26.1 (95% CI = 25.6–26.6) in 2011, 2016 and 2020–2021, respectively. A significant increase of 56.3% (95% CI = 49.3 to 63.3) in this coverage was documented between 2016 and 2020–2021 with the highest increase in the lowest wealth index quartile in urban areas. The district-wise coverage of private sector delivery ranged from 4.6% to 34.9%, 5.5% to 40.7%, and 5.9% to 62.0% in 2011, 2016 and 2020–2021, respectively. NMR was estimated at 41.3 (95% CI = 31.4–51.2), 36.6 (95% CI = 29.4–43.8), 38.6 (95% CI = 34.4–43.3) per 1000 livebirths in 2011, 2016 and 2020–2021, with no significant change over the years. Birth asphyxia was the leading cause of death in 2016 (37.8%) and 2020–2021 (33.9%) followed by preterm delivery and neonatal pneumonia; a statistically significant reduction was seen in meningitis/sepsis between 2016 and 2020–2021 (77.8%; 95% CI = − 145.4 to − 10.1). Conclusions: This analysis contributes to a nuanced understanding of the changes in the private sector delivery in a given population over time to facilitate appropriate actions and interventions to improve newborn survival and maternal services. [ABSTRACT FROM AUTHOR]

Introduction: For years, the placenta was believed to be sterile, but recent studies reveal it hosts a unique microbiome. Despite these findings, significant questions remain about the origins of the placental microbiome and its effects on pregnancy and fetal health. Some studies suggest it may originate from the vaginal tract, while others indicate that oral bacteria can enter the maternal bloodstream and seed the placenta. However, research analyzing the vaginal, oral, and placental microbiomes within the same cohort is lacking. Additionally, it's unclear whether the placental microbiome differs between healthy pregnancies and those with complications like preterm birth (PTB), which remains a leading cause of neonatal morbidity and mortality worldwide. Methods: In this study, we performed 16S rRNA gene sequencing to investigate the composition of the oral and placental microbiome in samples collected from 18 women who experienced PTB and 36 matched controls who delivered at term (TB), all of whom were part of the Molecular Signature in Pregnancy (MSP) study. We leveraged on the multisite microbiome sampling from the MSP participants and on our previously published vaginal microbiome data to investigate the potential origins of the placental microbiome and assess whether its composition varies between healthy and complicated pregnancies. Results and Discussion: Our analysis revealed distinct profiles in the oral microbiome of PTB subjects compared to those who delivered at term. Specifically, we observed an increased abundance of Treponema maltophilum, Bacteroides sp, Mollicutes, Prevotella buccae, Leptotrichia, PrevotellaAlloprevotella, in the PTB group. Importantly, Treponema maltophilum species showed higher abundance in the PTB group during the second trimester, suggesting its potential use as biomarkers. When we assessed the placenta microbiome composition, we found that Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria were the most dominant phyla. Interestingly, microorganisms such as Ureaplasma urealyticum were more abundant in PTB placenta samples. Our findings suggest that the placenta microbiome could originate from the oral or vaginal cavities, with a notable increase in the crosstalk between the vaginal and placental sites in cases of PTB. Specifically, our data revealed that in PTB cases, the placental microbiome exhibited a closer resemblance to the vaginal microbiome, whereas in term pregnancies, the placental microbiome was similar to the oral microbiome. [ABSTRACT FROM AUTHOR]

Background: Timely initiation of and exclusive breastfeeding have been recommended as key interventions to enable countries to attain the sustainable development target of reducing neonatal mortality to no more than 12 deaths per 1000 live births and to reduce mortality of children under 5 years to no more than 25 deaths per 1000 live births. Methods: We conducted a cluster randomized controlled trial with the main objective to assess the effect of an integrated package consisting of: peer counseling, mobile phone messages, and mama kits on promoting health facility births between January 2018 and February 2019, in Lira district, Northern Uganda. In this article, we assessed the effect of the intervention on our two secondary objectives: timely initiation of and exclusivity of breastfeeding. We used a generalized estimation equation of the Poisson family, with a log or identity link, taking clustering into account to estimate prevalence ratios and prevalence differences. Results: A total of 64% (594/926) of participants in the intervention arm initiated breastfeeding within the first hour after birth compared to 60% (493/829) in the control arm. The proportion of participants in the intervention arm that initiated breastfeeding within the first hour of life did not significantly differ from that in the control arm [Prevalence Ratio (PR) 1.08 (0.97 to 1.21)] and [Prevalence Difference (PD) 0.05 (-0.02 to 0.12)]. When we restricted the analysis to only mothers who decided on when to breastfeed, there was some evidence of intervention effectiveness [PR 1.20, 95% CI (0.99–1.5)]. In the intervention arm, 89% (804/904) of participants exclusively breastfed their infants in the first month of life compared to 81% (656/813) in the control arm. Participants in the intervention arm were 10% more likely to have exclusively breastfed in the preceding 24 hours compared to mothers in the control arm [PR 1.10 (1.04 to 1.17)] and [PD 0.08 (0.04 to 0.13)], and 16% more likely to have exclusively breastfed since birth compared to mothers in the control arm [PR 1.16 (1.03 to 1.30)] and [PD 0.12 (0.03 to 0.20]. Conclusion: The intervention improved the proportion of mothers who practiced exclusive breastfeeding in the first month of life, but did not increase the proportion of mothers who initiated breastfeeding in the first hour of life. Future breastfeeding promotion interventions should consider including a health facility component and improving maternal autonomy to promote timely initiation of breastfeeding. [ABSTRACT FROM AUTHOR]

Background: The Every Newborn Action Plan (ENAP) indicators are essential in monitoring neonatal healthcare coverage and quality. The District Health Information System (DHIS2), an open-source platform in over 80 countries, supports health data collection and analysis, enabling progress tracking at national and subnational levels. This study evaluates the availability and quality of maternal and newborn health indicators, explicitly focusing on ENAP indicators within Tanzania's DHIS2. Methods: Using the EN-MINI tool, we assessed data availability for 20 ENAP indicators by analysing their numerators and denominators in Tanzania's DHIS2 (2015–2022) across all healthcare levels. World Health Organization's (WHO) data quality framework was adapted to examine four dimensions: (a) availability of indicators, (b) completeness of indicator reporting, (c) internal consistency of related indicators, and (d) indicator plausibility by comparing DHIS2 data with population-based Demographic and Health Survey (DHS) data. Results: Of the 20 ENAP indicators, 14 were available in Tanzania's DHIS2, with definitions, numerators and denominators aligned with WHO standards. Between 2015 and 2022, the number of facilities reporting at least one delivery annually increased by 19% from 5,898 to 7,016. During this period, 75% to 97% of facilities consistently reported data on skilled attendance at birth and early breastfeeding initiation. In contrast, 4% to 54% of facilities reported on maternal and newborn outcomes, including complications such as stillbirths and maternal mortality. Internal consistency was high (> 94%). However, neonatal mortality rates reported in DHIS2 were lower than those reported in Tanzania DHS for similar periods, even after a 20% adjustment to account for home births. Conclusion: Tanzania's DHIS2 captures many ENAP indicators; however, notable variability in data quality persists, with substantial data gaps related to maternal and newborn outcomes and complications. To address these challenges, it is crucial to strengthen routine data review, implement robust quality checks, enhance validation processes, provide targeted training, deliver constructive feedback, and conduct supportive supervision. Placing greater emphasis on using DHIS2 data to monitor progress will help identify gaps and drive improvements in data quality, ultimately supporting better maternal and newborn health outcomes. [ABSTRACT FROM AUTHOR]

Background: Maternal tetanus toxoid (MTT) vaccination during pregnancy remains an important factor for reducing infant mortality globally, especially in developing nations, including Bangladesh. Despite commendable progress in reducing child mortality through widespread MTT vaccination during pregnancy, the issue still exists. This analysis explores the impact of MTT vaccination on neonatal mortality in Bangladesh and identifies associated factors. Methods: This research utilizes data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS). The dataset consists of 23,402 cases; among them, 587 cases resulted in infant death. The outcome variable was infant mortality, which was binary. The independent variables identified as potential contributors to the cause of death included tetanus toxoid vaccination status, mode of delivery (cesarean section or not), and mother's education level, among others. The Poisson model was employed to analyze the data. Results: The analyses showed that the neonatal mortality rate was 2.51%. Notably, 45.90% of mothers received the MTT vaccination during pregnancy. Among them, 23.07% received a single dose, and 22.82% took adequate doses (receiving more than two doses) and adhered to WHO guidelines. The adjusted incidence rate ratio (IRR) was 1.36, which indicates that there was a 36% higher risk of neonatal mortality for those children whose mothers did not take TT (IRR = 1.36, p = 0.081). We also found that women from middle-class households (IRR = 1.58, 95% CI = 0.98, 2.54) and women with higher parity (IRR = 1.96, 95% CI = 0.95, 4.03) also had a higher risk of newborn fatalities. A comparable trend has been observed regarding the correlation between the number of tetanus doses administered and neonatal mortality, where it also emphasizes the importance of receiving adequate doses (a minimum of 2 doses of tetanus vaccine) to mitigate neonatal mortality (adjusted IRR = 0.54, 95% CI = 0.29, 1.01) in comparison to no doses received. Conclusion: Administering a minimum of one maternal tetanus dose significantly lowers the risk of neonatal mortality. Other than Maternal Tetanus Toxoid vaccination, the analyses underscore various contributors to neonatal mortality, encompassing maternal healthcare, delivery procedures, socio-economic status, and education. Targeted interventions addressing these factors have the potential to efficiently decrease neonatal mortality rates and improve overall maternal and child health. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hypoxic-ischemic encephalopathy (HIE) in late preterm and term neonates accounts for neonatal mortality and unfavorable neurodevelopmental outcomes in survivors despite therapeutic hypothermia (TH) for neuroprotection. The circumstances of death in neonates with HIE, including involvement of neonatal palliative care (NPC) specialists and neurodevelopmental follow-up at 18–24 months in survivors, warrant further evaluation. Methods: A retrospective multicenter cohort study including neonates ≥ 35 weeks gestational age with moderate to severe HIE receiving TH, registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2021. Neurodevelopmental follow-up at 18–24 months in survivors was assessed. The groups of survivors and deaths were compared regarding perinatal demographic and HIE data. Prognostic factors leading to redirection of care (ROC) were depicted. Results: A total of 137 neonates were included, with 23 (16.8%) deaths and 114 (83.2%) survivors. All but one death (95.7%) occurred after ROC, with death on a median of 3.5 (2–6) days of life. Severe encephalopathy was indicated by a Sarnat score of 3 on admission, seizures were more frequent, and blood lactate values were higher on postnatal days 1 to 4 in neonates who died. Lactate in worst blood gas analysis (unit-adjusted odds ratio 1.25, 95% CI 1.02–1.54, p = 0.0352) was the only variable independently associated with ROC. NPC specialists were involved in one case. Of 114 survivors, 88 (77.2%) had neurodevelopmental assessments, and 21 (23.9%) of those had unfavorable outcomes (moderate to severe disability). Conclusions: Death in neonates with moderate to severe HIE receiving TH almost exclusively occurred after ROC. Parents thus had to make critical decisions and accompany their neonate at end-of-life within the first week of life. Involvement of NPC specialists is encouraged in ROC so that there is continuity of care for the families whether the neonate survives or not. [ABSTRACT FROM AUTHOR]

Simple Summary: Porcine epidemic diarrhea virus (PEDV), a member of the Coronaviridae family, is responsible for severe watery diarrhea, vomiting, and dehydration, leading to significant mortality in neonatal piglets. A rapid detection system for PEDV, based on reverse transcription-recombinase-aided amplification (RT-RAA) technology, was successfully developed in this study. The developed detection system is characterized by its simplicity in operation, high sensitivity, and stability. Additionally, when integrated with a compact blue-light detection device, it facilitates on-site visual detection, making it suitable for field applications. Porcine epidemic diarrhea virus (PEDV) continues to spread globally, causing clinical symptoms in piglets, including watery diarrhea, vomiting, and dehydration. Its exceptionally high morbidity and mortality rate contributes significantly to the economic losses of the swine industry. The continuous genetic mutations of PEDV have compromised the effectiveness of classical strain vaccines. Early detection and accurate diagnosis are therefore crucial for controlling its further spread. Developing a detection method that is user-friendly, highly sensitive, and efficient is crucial for disease control. In this study, a point-of-care rapid detection method for PEDV was successfully established using reverse transcription-recombinase-aided amplification (RT-RAA) technology. This method enables results to be obtained within 20 min of amplification at a constant temperature of 42 °C. It demonstrates high sensitivity, with a detection limit as low as 1 copy/μL, and shows strong specificity, with no cross-reactivity observed with seven other common swine pathogens. When applied to clinical samples, the results were 100% consistent with those obtained by RT-qPCR. This method is distinguished by its portable instrumentation and simple operation, making it particularly suitable for resource-constrained settings. [ABSTRACT FROM AUTHOR]

Background: Sepsis is one of the leading causes of mortality and morbidity among neonates. An estimated 5.29–8.73 million Disability-adjusted life years (DALYs) are lost annually in SSA due to neonatal sepsis (NS). Uganda registered stagnated neonatal mortality of 27 deaths per 1000 live births in 2020 of which 12% was attributed to NS. Early risk factor identification and improved obstetric care are proven to reduce deaths due to NS, yet there is scanty literature on the LRRH. We, therefore, determined the prevalence of NS and identified its associated factors within the LRRH of northern Uganda. Methods: A hospital-based, cross-sectional study with a retrospective chart review was conducted in the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH), in northern Uganda. 194 records of neonates admitted to the NICU from September 2022 to February 2023 were reviewed. The participant records were selected by systematic sampling technique and a structured data extraction tool was used to collect data. Using SPSS version 25 data entry and analysis were done. The univariable analysis gave a general description of the data. Logistic regression analysis was used to show associations and the statistical significance was declared at a P value of 0.05 after multivariable analysis. Results: Among a total of 194 neonates whose charts were reviewed, 80 neonates had neonatal sepsis, giving a proportion of 0.412 and then prevalence of 41.2%. Age in days of the neonate (AOR = 4.212, 95% CI: [1.627-10.903]) for neonates of 1-3days of age, sex where males (AOR = 2.09, 95% CI: [1.123-3.887]), an APGAR score of 1-4 at birth (AOR = 0.309, 95% CI: [0.115-0.831]) and weight at birth <2500g (AOR = 2.543, 95% CI: [1.381-4.683]) were significantly related to it. Conclusions and recommendations: The results found the prevalence of NS among neonates admitted to the NICU of LRRH high at 41.2%. Factors 1-3 days of age, male sex, a birth weight of <2500g, and an Apgar score of 1-4 at birth among all neonates were significant. Therefore, it was suggested that caregivers ensure safe newborn care, detect infections early, and use prophylactic antibiotics for high-risk babies after birth, to reduce NS. Further research will be conducted on the major causative agents and outcomes of NS in the NICU of LRRH. [ABSTRACT FROM AUTHOR]

Neonatal mortality remains a critical global challenge, particularly in resource-limited settings with restricted access to advanced diagnostic tools. Early detection of life-threatening conditions like Sepsis and Respiratory Distress Syndrome (RDS), which significantly contribute to neonatal deaths, is crucial for timely interventions and improved survival rates. This study investigates the use of newborn cry sounds, specifically the expiratory segments (the most informative parts of cry signals) as non-invasive biomarkers for early disease diagnosis. We utilized an expanded and balanced cry dataset, applying Self-Supervised Learning (SSL) models—wav2vec 2.0, WavLM, and HuBERT—to extract feature representations directly from raw cry audio signals. This eliminates the need for manual feature extraction while effectively capturing complex patterns associated with sepsis and RDS. A classifier consisting of a single fully connected layer was placed on top of the SSL models to classify newborns into Healthy, Sepsis, or RDS groups. We fine-tuned the SSL models and classifiers by optimizing hyperparameters using two learning rate strategies: linear and annealing. Results demonstrate that the annealing strategy consistently outperformed the linear strategy, with wav2vec 2.0 achieving the highest accuracy of approximately 90% (89.76%). These findings highlight the potential of integrating this method into Newborn Cry Diagnosis Systems (NCDSs). Such systems could assist medical staff in identifying critically ill newborns, prioritizing care, and improving neonatal outcomes through timely interventions. [ABSTRACT FROM AUTHOR]

Background: A preterm neonate is defined by the World Health Organization as a child delivered before 37 weeks of gestation. In low- and middle-income countries, including Ethiopia, preterm-related complications are serious health problems due to increases in the mortality and morbidity of newborns and children under 5 years of age. The aim of this study was to assess the time to neonatal mortality and its predictors among preterm neonates admitted to the neonatal intensive care unit in northern Ethiopia, 2023/2024. Methods: An institution-based retrospective cohort study was conducted among 495 randomly selected preterm neonates in six out of the fourteen general hospitals of Tigray, Ethiopia from October 2023 to June 2024. Epi Data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Descriptive statistics were carried out to determine the distribution. Kaplan-Meier analysis, life table, and log rank were computed. Cox proportional hazards models were fitted to identify independent predictors of preterm mortality. Results: The proportion of preterm neonatal mortality was 109 (22.7%). The overall median survival time was 21 (95% CI: 20, 28) days. Initiation of breast milk (AHR = 0.38 (95% CI: 0.24, 0.61)), respiratory distress syndrome (AHR = 1.9 (95% CI: 1.07,3.63)), perinatal asphyxia (AHR = 2.05 (95% CI: 1.05, 4.00)), receiving kangaroo mother care practice (AHR = 0.5 (95% CI: 0.34, 0.83)), and gestational age (AHR = 1.6 (95% CI 1.07, 2.59) were the predictors of time to death. Conclusion: Respiratory distress syndrome, gestational age less than 32 weeks, and perinatal asphyxia at admission were found to be independent risk factors for preterm neonatal mortality. Breastfeeding and receiving kangaroo-mother care were independent preventive predictors of preterm neonatal mortality. It is better to give full emphasis and close follow-up to preterm neonates, especially during the early neonatal period. [ABSTRACT FROM AUTHOR]

Background: Malaria is a disease deeply rooted in poverty. Malaria in pregnant women leads to severe complications, including low birth weight and neonatal mortality, which can adversely affect both mother and child. This study aimed to identify the factors associated with malaria in pregnancy among women attending antenatal care (ANC) clinics in three districts of the Ashanti Region, Ghana. Methods: A cross-sectional study was conducted among 1215 pregnant women selected through multi-stage sampling. Data were collected using structured questionnaires and analysed using descriptive and inferential statistics, including regression analysis. Results: The self-reported prevalence of at least one episode of malaria was 76.7% (95% CI [74.1–79.3%]). Age, education, marital status, income, and religion were significantly associated with the prevalence of malaria among pregnant women, with a p-value < 0.001. Pregnant women aged 17–25 years were 10.26 times more likely to have malaria compared to other age groups (aOR = 10.26, 95% CI [4.52–11.05], p = 0.000). Women with no formal education had higher odds of malaria, being 15.10 times more likely to have malaria compared to those with tertiary education (aOR = 15.10, 95% CI [7.32–16.78], p = 0.002). Women not using insecticide-treated bed nets (ITNs) were 20 times more likely to have malaria compared to those who used ITNs (aOR = 20.0, 95% CI [7.04–21.03], p = 0.000). Conclusion: Age, education, marital status, income, religion and insecticide-treated bed net (ITN) use significantly influence malaria prevalence in pregnancy. To achieve SDG 3 (Good Health and Well-being), particularly Target 3.1 (reducing maternal mortality) and Target 3.3 (ending malaria), the Ghana Health Service and Ministry of Health should prioritize expanding ITN distribution, educational campaigns, and targeted support for vulnerable groups to reduce malaria prevalence during pregnancy and improve maternal health outcomes. [ABSTRACT FROM AUTHOR]

Pre-eclampsia is a leading cause of maternal and neonatal mortality; 30,000 pre-eclampsia-related maternal deaths occur annually, with 70% in Sub-Saharan Africa (SSA) and 16% in South Asia. We have shown that early, accurate detection of hypertension combined with planned early delivery in women with late preterm pre-eclampsia significantly reduces stillbirth and severe maternal hypertension. We describe co-development and delivery of policy labs, working with The Policy Institute (King's College London), and local stakeholders in Sierra Leone and Zambia, to expedite integration of new knowledge into pre-eclampsia care pathways, to improve care for women and babies with the worst outcomes. Policy labs are a unique, user-centric engagement approach, bringing diverse stakeholders together in co-designing strategies for translation of evidence into policy and impact. Both labs were facilitated by local, well-respected female team members, and addressed co-developed questions: 'How can we improve timely detection and appropriate action in women with pre-eclampsia?' (Sierra Leone); 'What are enablers and barriers to offering planned early delivery between 34 and 37 weeks?'(Zambia). Participants at both labs identified lack of pre-eclampsia awareness as a key barrier, and recommended local co-design of community-based strategies to increase access to timely pre-eclampsia management. We demonstrated policy labs as an effective approach in two low-and middle income settings to facilitate transfer of new knowledge into policy and action. [ABSTRACT FROM AUTHOR]

Introduction: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking. Methods: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5). Results: Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6–9.5) with 1, 118.1 (108.4–128.4) with 3, and 395.3 (367.2–425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6–6.7), 11.2 (10.9–11.3), and 11.9 (11.6–12.2), and RR for extended hospital stay were 6.6 (6.4–6.7), 12.2 (11.7–12.7), and 26.4 (25.2–27.5). International comparison suggested that Canada had a higher prevalence of NAOI. Conclusion: The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years. Introduction: In Canada, newborn morbidity far surpasses mortality. The neonatal adverse outcome indicator (NAOI) summarizes neonatal morbidity, but Canadian trend data are lacking. Methods: This Canada-wide retrospective cross-sectional study included hospital livebirths between 24 and 42 weeks' gestation, from 2013 to 2022. Data were obtained from the Canadian Institute of Health Information's Discharge Abstract Database, excluding Quebec. The NAOI included 15 newborn complications (e.g., birth trauma, intraventricular hemorrhage, or respiratory failure) and seven interventions (e.g., resuscitation by intubation and/or chest compressions), adapted from Australia's NAOI. Rates of NAOI were calculated by gestational age. Unadjusted rate ratios (RR) and 95% confidence interval (CI) were calculated for neonatal mortality, neonatal intensive care unit (NICU) admission, and extended hospital stay, each in relation to the number of NAOI components present (0, 1, 2, 3, 4, or ≥5). Results: Among 2,821,671 newborns, the NAOI rate was 7.6%. NAOI increased from 7.3% in 2013 to 8.0% in 2022 (p < 0.01). NAOI prevalence was highest in the most preterm infants. Compared to no NAOI, RRs (95% CI) for mortality were 8.5 (7.6–9.5) with 1, 118.1 (108.4–128.4) with 3, and 395.3 (367.2–425.0) with ≥5 NAOI components. Respective RRs for NICU admission were 6.7 (6.6–6.7), 11.2 (10.9–11.3), and 11.9 (11.6–12.2), and RR for extended hospital stay were 6.6 (6.4–6.7), 12.2 (11.7–12.7), and 26.4 (25.2–27.5). International comparison suggested that Canada had a higher prevalence of NAOI. Conclusion: The Canadian NAOI captures neonatal morbidity using hospitalization data and is associated with neonatal mortality, NICU admission, and extended hospital stay. Newborn morbidity may be on the rise in recent years. [ABSTRACT FROM AUTHOR]

Introduction: The USA has the poorest health statistics of any high-income country. Political polarization has risen dramatically; newer safety net programs (the Affordable Care Act [ACA]) are unevenly provided because many Republican-leaning states refused expanded Federal coverage. Democratic programs have reduced physician leadership of medicine. Both have been deleterious. Here, we investigated associations among four key health measures two of which directly impact pregnancy outcomes and two that affect all patients by percentage of each state that voted for the Republican versus Democratic candidate in the 2020 presidential election. Methods: For each state, we used public, non-partisan databases to assess the incidence of COVID, maternal, and infant mortality per 100,000 population and average life expectancy. Correlations among these four outcome variables and percentage Republican vote were calculated (r), contextualized by measuring associations with related variables including COVID vaccination rates, access to medical care, and incidences of heart disease, obesity, diabetes, gunshot deaths, and automotive fatalities. Results: COVID mortality, maternal and infant mortality, and life expectancy were highly correlated with percentage Republican ("red") vote per state. If "red" states had vaccination rates equivalent to Democratic-leaning ("blue") states, 72,000 deaths could have been avoided. Overall, "red" states have lower health metrics, reduced access to care, and higher comorbidities. Conclusion: The percent Republican vote was strongly associated, but not the whole answer, with worse health outcomes for multiple key measures of public health including mortality, access to care, and various comorbidities. Overall, the ACA has improved patient access to care but has also led to "maternity care deserts" disproportionately in rural areas in "red" states. Translating insurance coverage into improved care and outcomes requires further analysis and will require multi-pronged approaches including expanding coverage and incentivizing quality care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bronchopulmonary dysplasia (BPD) ranks among preterm infants' most common and severe respiratory diseases. Lung ultrasound scores (LUS) play a vital role in predicting early BPD and guiding treatment and intervention strategies for affected patients. OBJECTIVE: Performed a meta-analysis to assess the diagnostic LUS for newborns with BPD. METHODS: Online electronic databases such as MEDLINE, CINAHL, the Cochrane Library, and Web of Science were used to retrieve relevant research until May 2023. A total of 117 literatures were collected, and ten eligible articles were selected for meta-analysis. RESULTS: Meta-analysis was performed on 10 studies (1274 neonates). LUS at 7 days after birth (7 days of life, DOL 7) showed good diagnostic accuracy for any type of BPD, moderate and severe BPD. DOL 7 was more accurate in predicting all types of BPD (AUC = 0.87, sensitivity = 0.75, specificity = 0.83) than moderate and severe BPD (AUC = 0.80, sensitivity = 0.69, specificity = 0.79). There was no statistical significance between DOL 7 and DOL 14 in their accuracy for predicting all types of BPD (difference in AUC = 0.04, p = 0.068). There was no notable distinction between DOL 7 and DOL 14 in their accuracy for predicting moderate and severe BPD (difference in AUC = - 0.04, p = 0.104). CONCLUSIONS: The diagnostic efficacy of LUS on DOL 7 in predicting the occurrence of all types of BDP and moderate-severe BPD is determined. This will facilitate rapid and accurate detection and timely treatment, thereby reducing the risk of neonatal mortality and sequelae. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of severe neonatal brain injury (SNBI) on gestational age‐related trends in neurodevelopmental impairment (NDI) outcome in infants born very preterm. Method: A population‐based cohort study recruited 1091 infants born at a gestational age of less than 31 weeks between 2011 and 2020. The trends in neonatal morbidities, mortality, and 24‐month NDI severity (no/mild, moderate, severe) by epoch (2011–2015, 2016–2020) and gestational age (22–25 weeks, 26–28 weeks, 29–30 weeks) were determined in infants with and without SNBI inclusion. Results: There was increased antenatal steroid use and higher maternal education and socioeconomic status over time. The rates of neonatal morbidities and mortality had no temporal changes. Among 825 infants with follow‐up, those in the 22 to 25 weeks gestational age group had declining trends in cerebral palsy and severe cognitive impairment, with decreased rates of severe NDI from 19% to 8% across epochs, particularly in those without SNBI (from 16% to 2%). Relative to its occurrence in epoch 2011 to 2015, risk of severe NDI was significantly reduced in epoch 2016 to 2020 (adjusted relative risk 0.39, 95% confidence interval 0.16–0.96) for infants born at 22 to 25 weeks gestational age, and the risk dropped even lower in these infants without SNBI (0.12, 0.02–0.84). Interpretation: Infants born at 22 to 25 weeks gestational age had decreased rates of severe NDI in the decade between 2011 and 2020, particularly those without SNBI. The improvement might be attributed to better perinatal/neonatal and after‐discharge care. [ABSTRACT FROM AUTHOR]

Aim: To analyse the rising prevalence of cerebral palsy (CP) in children born preterm in Denmark. Method: We included all live‐born children born preterm in Denmark from 1997 to 2013. The prevalence of CP in children born preterm was categorized by gestational age and correlated with neonatal mortality and changes in clinical factors. Results: Among 70 876 children, 824 (1.2%) had CP. The overall CP prevalence in children born preterm decreased substantially until 2001, from when it increased annually by 2.8% (95% confidence interval 0.6–5.0). When categorized, the prevalence only increased significantly in children born very preterm (gestational weeks 28–31). Neonatal mortality rates decreased steadily at all gestational ages during the entire study period. Clinical factors that changed during the study period were increasing numbers of high‐risk pregnancies, maternal obesity, emergency caesarean sections, neonatal admissions, and usage of assisted ventilation. Interpretation: The increasing prevalence of CP in children born preterm was driven by the subgroup born very preterm and matched their decrease in neonatal mortality. In similar population studies, decreased mortality was not followed by increased CP prevalence. An increase in clinical risk factors was unlikely to explain our findings, but more active neonatal life support may have played a role. Plain language summary: https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16141 This original article is commented by Morgan on pages 8–9 of this issue. [ABSTRACT FROM AUTHOR]

The 2030 Sustainable Development Goal (SDG) envisions eliminating preventable newborn deaths and reducing neonatal mortality to 12 per 1000 live births. There is a paucity of data on outborn newborns. By doing this study, areas for further reductions in neonatal mortality rate (NMR) can be identified and interventions can target these areas for reduction of NMR. The objectives of this study were to determine the causes of admission of outborn newborns, identify the timing and causes of mortality, distinguish between possibly preventable or probably unpreventable deaths, and identify areas for further reductions in NMR. A cross-sectional, retrospective, and descriptive study was conducted on outborn newborns at a Special Newborn Care Unit (SNCU) of a medical college hospital in eastern India from January 1, 2021 to December 31, 2021. Admission and mortality data were collected after ethics committee approval and analyzed. Sick outborn newborns admitted to the SNCU were 1671. Deaths occurred in 281. Males were 62.28%. The highest number of deaths occurred in birth weight ≤999 g, (91.84%), gestational age <28 weeks (100%). The causes of death were sepsis in 35.23%, perinatal asphyxia in 22.78%, and prematurity (<28 weeks) and ELBW (≤999 grams) in 16.73%. First-day deaths were 55.87%, deaths in the first 2 days were 69.85%, and deaths in the first 7 days were 86.83%. To reduce NMR, interventions should target male gender, scheduled tribe social category, <28 weeks gestation, birth weight ≤999 g, cases of sepsis, perinatal asphyxia, and prematurity. [ABSTRACT FROM AUTHOR]

Background: Chorioamnionitis is recognized as a major consequence of preterm premature rupture of membranes (PPROM), and a frequent cause of neonatal morbidity and mortality. The association between fetal heart rate (FHR) and chorioamnionitis remains unclear. Objectives: The aim of this study was to evaluate the dynamics of FHR in a PPROM population at the approach of delivery according to the presence or absence of chorioamnionitis. Materials & methods: 120 pregnant women with PPROM between 26 and 34 weeks' gestation were enrolled in this multicenter prospective unblinded study. All participants were fully informed of the study's objectives. 39 of the 120 patients were included in the analysis of FHR recordings. The analysis consisted of extracting features from computerized FHR analysis (cFHR) and fetal heart rate variability analysis (FHRV) in the temporal, frequency and nonlinear domains. Then, each set of features was analyzed separately using the multiple factor analysis, where three groups were defined as the feature set for days 0, -1 and -2 prior to birth. The distances between the global projection and the projections for each day were computed and used in the ROC analysis to distinguish chorioamnionitis from non-chorioamnionitis group. Results: The results showed that there were significant differences in certain features between populations with and without chorioamnionitis. The distinction between the two populations reached an area under the curve (AUC) of only 37% [34–40] for cFHR features and 63% [59–66] for time-domain FHRV features when comparing all stages of chorioamnionitis to non-chorioamnionitis subjects. When only stage 3 chorioamnionitis was compared to non-chorioamnionitis patients, the AUC reached 90% [88–93] for nonlinear-domain and 84% [82–87] for time-domain FHRV features, whereas it was limited to 71% [68–74] using cFHR features. Conclusion: The present study suggests that the HRV features are more reliable for diagnosing chorioamnionitis than cFHR, and that the assessment of features dynamics over several days is an interesting tool for detecting chorioamnionitis. Further study should be carried out on a larger sample to confirm these findings, improve the diagnostic performance of chorioamnionitis and help clinicians decide on delivery criteria. [ABSTRACT FROM AUTHOR]

Background: Health literacy, influenced by sociodemographic characteristics such as ethnicity, economic means and societal factors, affects the ways in which pregnant women maintain their health; this in turn may increase risk of adverse pregnancy outcomes. Objective: To explore what is known about the impact of personal health literacy on prevention of stillbirth and related adverse outcomes in pregnant women of low socioeconomic status or from ethnic minority backgrounds. Search Strategy: MEDLINE, CINAHL, PsychINFO, and CENTRAL were searched as well as reference lists of included studies and gray literature. Selection Criteria: Included studies focused on personal health literacy and stillbirth prevention in women from low socioeconomic or ethnic minority backgrounds in the perinatal period. Data Collection and Analysis: A meta‐summary approach was adopted for qualitative, observational, descriptive, and audit studies. Findings of intervention studies were extracted, and meta‐analyses were conducted where possible. The primary outcome was stillbirth; maternal mortality and neonatal mortality were secondary outcomes. Main Results: Forty‐one studies were included from diverse geographical settings. The meta‐summary synthesized five abstracted statements. These recognized lower personal health literacy and greater difficulty interacting with healthcare services in the studied populations, primarily as the result of limited health knowledge, lack of positive perception towards health services, language barriers, illiteracy, and relying on friends or family members for health information. Meta‐analysis of intervention studies revealed no association between current interventions that aimed to increase personal health literacy and the risk of stillbirth (relative risk [RR] 1.04, 95% confidence interval [CI] 0.96–1.12), neonatal mortality (RR 0.88, 95% CI 0.75–1.03), and maternal mortality (RR 0.87, 95% CI 0.63–1.22). Conclusions: Various factors suggest lower personal health literacy in women of low socioeconomic status or ethnic minority, which can increase the risk of stillbirth. However, this review identified no significant impact of current health education interventions on the risk of stillbirth, or neonatal or maternal mortality. Although not directly measured, the health education interventions were anticipated to increase personal health literacy. Further research on the topic of this scoping review is warranted, particularly in lower‐resource settings and regarding the potential role of e‐literacy and organizational health literacy to improve pregnancy outcomes. To address deficits in health literacy, efforts must be made to provide pregnant women with health information in novel, accessible ways. Synopsis: Current health educational interventions, improving low health literacy in socioeconomically deprived and ethnic minority women, do not significantly reduce stillbirth, or maternal and neonatal mortality. [ABSTRACT FROM AUTHOR]

Despite efforts to reduce stillbirths and neonatal deaths, inconsistent definitions and reporting practices continue to hamper global progress. Existing data frequently being limited in terms of quality and comparability across countries. This paper addresses this critical issue by outlining the new International Classification of Disease (ICD‐11) recommendations for standardized recording and reporting of perinatal deaths to improve data accuracy and international comparison. Key advancements in ICD‐11 include using gestational age as the primary threshold to for reporting, clearer guidance on measurement and recording of gestational age, and reporting mortality rates by gestational age subgroups to enable country comparisons to include similar populations (e.g., all births from 154 days [22+0 weeks] or from 196 days [28+0 weeks]). Furthermore, the revised ICD‐11 guidance provides further clarification around the exclusion of terminations of pregnancy (induced abortions) from perinatal mortality statistics. Implementing standardized recording and reporting methods laid out in ICD‐11 will be crucial for accurate global data on stillbirths and perinatal deaths. Such high‐quality data would both allow appropriate regional and international comparisons to be made and serve as a resource to improve clinical practice and epidemiological and health surveillance, enabling focusing of limited programmatic and research funds towards ending preventable deaths and improving outcomes for every woman and every baby, everywhere. Synopsis: This paper summarizes new ICD‐11 guidance for standardized stillbirth and perinatal death reporting. [ABSTRACT FROM AUTHOR]

Four indicators of severe neonatal morbidity (SNM) (intraventricular hemorrhage stages 3–4, retinopathy of prematurity (ROP) stage 3, severe bronchopulmonary dysplasia (BPD), and/or necrotizing enterocolitis) are well-known to be associated with poor infancy outcome after very preterm birth. Practice changes according to recent guidelines were implemented after medical team restructuration. We hypothesized that these changes may have improved overall survival and SNM-free survival in extremely preterm infants (EPI). We conducted a monocentric, retrospective, uncontrolled before-after study at our neonatal intensive care unit including all inborn alive neonates with gestational age less than 28 weeks during two periods (period 1 2016–2017, period 2 2019–2020). We compared the global and SNM-free survival rates before and after changes were implemented. Clinical, ventilatory, and nutritional data were also collected for comparison. We included 163 EPI (76 for period 1, 87 for period 2). Twenty-five patients deceased before home discharge in each group. The median duration of invasive ventilation was shorter during period 2 (4 vs 17 days, p < 0.01). Patients of period 2 had an earlier exclusive enteral nutrition (20 vs 34 days, p < 0.01). The composite endpoint of “death or SNM” was lower during period 2 (40.2% vs 55.3%, p = 0.06). Neonates of period 2 were more frequently free of any SNM indicators (83.9% vs 66.7%, p = 0.03). ROP and nosocomial infections were less frequent during period 2 (3.2% vs 21.7%, p < 0.005 and 37.1% vs 62.7%, p = 0.006; respectively). We also observed lower rates of moderate and severe BPD during period 2. Conclusion: The evolution of our clinical practices appears to have positive effects on global and SNM-free survival and seems to have reduced the incidence of nosocomial infections. What is Known: • Using global survival and severe neonatal morbidity-free survival rates allows to compare inter- and intra-team critical care practices in neonatal intensive care units. • Major changes in clinical procedures, in accordance to recent guidelines, were implemented after the restructuration of the medical team in 2018, with the expected objective of improving morbidity and mortality of extremely premature infants (EPI) in our unit. What is New: • After the changes, EPI exhibit a lower composite endpoint of “death or severe neonatal morbidity (SNM)” and were more frequently free of any SNM indicators concomitantly with a shorter median duration of invasive ventilation and parenteral nutrition. • The evolution of local clinical practices may positively impact mortality and morbidity within a few years. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: India contributes to the highest number of neonatal deaths in the world, a fourth of the world's total. Targeted interventions can be planned after a specific analysis of region-specific causes if India is to achieve the sustainable development goal (SDG 3.2) of neonatal mortality of 12 per 1000 live births. Material and Methods: A retrospective study of medical records of all neonates admitted in the special care neonatal unit (SCNU) over the 6-year period of 2018–23 at a teaching medical college. Results: A total of 9462 neonates were admitted over the 6-year period. The trends in mortality were encouraging, declining from 19.40% in 2018 to 12.34% in 2023. The reduction was more in outborn (24.32% to 11.68%) than inborn (14.86% to 12.89%) neonates. The low birth rate also declined from 40.77% in 2018 to 25% in 2023. The rate of discharges went up. The trends in etiology of death were uniform over the years with respiratory distress syndrome (RDS) (37.24%), hypoxic-ischemic encephalopathy (HIE) (29.5%), sepsis (16.12%), prematurity (11.45%), and congenital malformations (2.47%) being the chief contributors to death among newborns admitted in SNCU. Conclusion: The trends are encouraging but may be insufficient to meet the target of SDG 3.2. Further targeted intervention to tackle preventable cause, such as perinatal asphyxia, sepsis, better antenatal care, and better management of preterm neonates on mission mode, is need of the hour as they continue to contribute significantly to neonatal mortality. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in sub-Saharan Africa where 40% of global neonatal deaths occur. We identified and combined demographic, clinical, and psychosocial correlates of PTB among Kenyan women to develop a risk score. Methods: We used data from a prospective study enrolling HIV-negative women from 20 antenatal clinics in Western Kenya (NCT03070600). Depressive symptoms were assessed by study nurses using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale (HITS), and social support using the Medical Outcomes Survey scale (MOS-SSS). Predictors of PTB (birth < 37 weeks gestation) were identified using multivariable Cox proportional hazards models, clustered by facility. We used stratified k-fold cross-validation methods for risk score derivation and validation. Area under the receiver operating characteristic curve (AUROC) was used to evaluate discrimination of the risk score and Brier score for calibration. Results: Among 4084 women, 19% had PTB (incidence rate: 70.9 PTB per 100 fetus-years (f-yrs)). Predictors of PTB included being unmarried (HR:1.29, 95% CI:1.08–1.54), lower education (years) (HR:0.97, 95% CI:0.94–0.99), IPV (HITS score ≥ 5, HR:1.28, 95% CI:0.98–1.68), higher CESD-10 score (HR:1.02, 95% CI:0.99–1.04), lower social support score (HR:0.99, 95% CI:0.97–1.01), and mild-to-severe depressive symptoms (CESD-10 score ≥ 5, HR:1.46, 95% CI:1.07–1.99). The final risk score included being unmarried, social support score, IPV, and MSD. The risk score had modest discrimination between PTB and term deliveries (AUROC:0.56, 95% CI:0.54–0.58), and Brier Score was 0.4672. Women considered "high risk" for PTB (optimal risk score cut-point) had 40% higher risk of PTB (83.6 cases per 100 f-yrs) than "low risk" women (59.6 cases per 100 f-ys; HR:1.6, 95% CI:1.2–1.7, p < 0.001). Conclusion: A fifth of pregnancies were PTB in this large multi-site cohort; PTB was associated with several social factors amenable to intervention. Combining these factors in a risk score did not predict PTB, reflecting the multifactorial nature of PTB and need to include other unmeasured factors. However, our findings suggest PTB risk could be better understood by integrating mental health and support services into routine antenatal care. [ABSTRACT FROM AUTHOR]

There is a need for reliable diagnostic tests for early identification of sepsis to prevent neonatal mortality and antibiotic misuse. During sepsis, many immature neutrophils came into the bloodstream, altering the mean neutrophil volume (MNV) shown in the previous studies. To summarize the diagnostic performance of mean neutrophil volume (MNV) in neonatal sepsis from the published literature. Databases such as PubMed, Scopus, and Web of Science were searched from January 1990 to April 2023 for studies reporting MNV as a diagnostic test in neonatal sepsis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve of MNV were estimated with reference blood culture-positive sepsis and clinical sepsis for meta-analysis. The diagnostic performance of MNV was analyzed in 1685 neonates, including 829 septic and 856 non-septic neonates, from six prospective studies. The pooled sensitivity and specificity of MNV were 0.87 and 0.75, respectively, for neonatal sepsis; the DOR was 20.01 (95% CI: 5.90–67.82); and the AUC of the SROC for MNV was 0.81 (95% CI: 0.69–0.88). Higgins I2 was 92.1% (95% CI: 85.5%–95.7%). The diagnostic performance of MNV was better during sub-group analysis of studies reporting culture-positive sepsis (DOR 85.61). The diagnostic performance of MNV is moderate for neonatal sepsis. As the evidence originated from a small number of studies with marked heterogeneity, further large-scale diagnostic accuracy studies are recommended to resolve heterogeneity in the future. [ABSTRACT FROM AUTHOR]

Infancy, the critical phase from birth to early childhood, holds immense importance, with each day contributing significantly to a child's development. Globally, approximately four million neonatal deaths occur annually, with 98% of these taking place in developing countries. In these regions, many newborns succumb to mortality at home, often under the care of mothers, family members, and traditional birth attendants. In Unani Medicine, this stage is associated with the temperament known as Mizāj 'ārr Ra'b (hot and moist), highlighting a period of rapid growth and developmental milestones. Comprehensive neonatal and child care guidelines, referred to as Tadābīr-i-Navmawlūd, encompass various aspects, including newborn care, infant feeding, management of dentition, and therapeutic principles and treatments for children. Renowned Unani scholars such as Ibn Sī na, Zakariyya Ra zī, Ali Ibn Abbas Maju sī, Ibn Rushd, and Ibn Hubal Baghda dī have extensively discussed these topics in classical Unani texts like Al-Qānūn fi'l 'ibb, Kitāb al-Man'ūrī, Kāmil al-'anā'a, Kitāb al-Kulliyat, and Kitāb al-Mukhtārāt fi'l 'ibb. Their writings outline regimens and medicinal practices aimed at promoting the health and well-being of newborns, infants, and children. [ABSTRACT FROM AUTHOR]

Neonatal sepsis remains a significant cause of neonatal morbidity and mortality globally. At present, no clear consensus definition for sepsis in neonates exists, even though a positive blood culture is considered as the gold standard for definitive diagnosis. The accurate and timely diagnosis of sepsis in neonates presents significant difficulties, since "culture negative" or "suspected" sepsis varies widely worldwide. Antibiotic overuse and resistance are emerging problems, but on the other hand, under-recognition of sepsis and delayed antibiotic treatment could have serious or even fatal adverse outcomes in this vulnerable population. In the context of rapid recognition of sepsis and timely initiation of appropriate antibiotic therapy, various sepsis risk assessment tools have been developed, a variety of biomarkers are in clinical use or under research for future use, and new diagnostic techniques are under evaluation. In this review, we summarize the most recent data on neonatal sepsis, the utility of sepsis risk assessment tools for term and preterm infants with sepsis, and current diagnostic and preventive tools. [ABSTRACT FROM AUTHOR]

Objective: Predicting neonatal survival is essential for targeting interventions to reduce neonatal mortality. Pacific Islanders have been underrepresented in existing prediction tools and have unique, maternal obesity-related risk factors for both preterm birth and neonatal mortality. Using neonatal sex, birth weight, and gestational age, we developed a graphical tool for neonatal survival among Pacific Islander singletons in the United States. Methods: Birth-infant death data files from the United States National Center for Health Statistics were used (2014–2018). Pacific Islander mothers and singletons without congenital anomalies born between 22–36 gestational weeks were included. Poisson regression models were used to predict neonatal mortality (<28 days of life) rate including neonatal sex, birth weight, and gestational age in weeks as predictors. Predicted survival rates in the graphical tool were calculated as "1 minus mortality rate". Results: Of the 5192 included neonates, the neonatal mortality rate was 2.0%; 43.5% of mothers had pre-pregnancy obesity, and 16.5% of neonates were born large-for-gestational age. Birth weight and gestational age had a non-linear association with neonatal death, and their interaction was included in the model. Retaining neonatal sex, models with gestational age at birth or both birth weight and gestational age at birth performed better than the model with birth weight only. Conclusion: This is the first graphical tool for neonatal survival prediction among preterm-born Pacific Islander singletons in the United States. Using only neonatal sex, birth weight, and gestational age, this graphical tool is a straightforward reference for survival among groups of neonates with similar characteristics. [ABSTRACT FROM AUTHOR]

Background: Despite recent improvements in the overall health status of Nepal's population, newborn morbidities and mortalities have remained a challenge. This study explores the situation and care strategies for newborn health problems in the Gandaki Province of Nepal. Methods: This is a retrospective hospital records analysis. A structured questionnaire was employed to collect data on socio-demographic, clinical, and outcome variables in 1,355 newborns admitted to the Special Newborn Care Unit (SNCU) between May 1, 2021, and April 30, 2022, in five hospitals within the Gandaki Province. Results: Among all newborns, 60% were male, and 40% belonged to Janajati indigenous families. The mean age of mothers at the time of delivery was 24.4 years; the average birth weight of babies was 2.8 kg; and the gestational week was 38 weeks. Around 96% of births occurred in healthcare facilities. The average inpatient hospital stay was 4.7 days. The reasons for SNCU admission were newborn sepsis (51%), neonatal hyperbilirubinemia (23%), respiratory distress syndrome (18%), and low birth weight (11%). Approximately 7% of the newborns were found to have died due to various causes, including sepsis, asphyxia, and indirect medical reasons. Female newborns had a 0.45-times (CI: 0.23–0.84) lower risk of mortality compared to male newborns. Underweight newborns had 8.8 times (CI: 4.5–17.2) higher risk of death than newborns with a normal birth weight, even after adjusting for other factors like sex, delivery site, mode of delivery, mother's age, respiratory distress syndrome, neonatal hyperbilirubinemia, neonatal sepsis, and age at admission to SNCU. The most common treatments included injectable antibiotics (73%), intravenous fluids (53%), oxygen delivery (39%), and phototherapy (36%), while 3% received "Kangaroo Mother Care (KMC)". Conclusions: The study showed that newborns suffered from multiple health complications such as sepsis, hyperbilirubinemia, or asphyxia, and many newborns received essential medical services from hospitals. Birth weight, sex of the newborn, and respiratory distress syndrome were significantly associated with neonatal mortality. Hospitals should focus on reinforcing KMC, neonatal resuscitation, and early infection control measures. [ABSTRACT FROM AUTHOR]

Background: Almost everywhere, neonatal mortality can be decreased with ease if competent obstetricians give the necessary treatment. Unfortunately, observational techniques were not used to examine basic essential newborn care practice among obstetric care providers in Ethiopia. Thus, the purpose of this study was to evaluate factors related to essential newborn care practice using observational techniques among obstetric care providers in public hospitals in the Gamo, Gofa, and Wolayta zones, southern Ethiopia. Methods: An institutional-based cross-sectional study carried out from May 15 to June 30, 2022. A simple random sampling method was used. Structured self-administered questionnaires with a clinical observational checklist were used to collect data. Data imported into Epidata version 4.6 and analyzed using the SPSS Version 25. Bivariable and multivariable analyses were used to identify factors associated with essential newborn care practices. An odds ratio with a 95% confidence interval was used to assess the direction and strength of the association. Results: The overall magnitude of good essential newborn care practice among obstetric care providers was 53.5% (95% CI = 49, 58). Factors positively associated with the practice of essential newborn care were having interest on working in delivery room (AOR = 3.16, 95% CI = 1.71,5.83), having no work load (AOR = 2.96, 95% CI = 1.78,4.49), received in-service training (AOR = 3.09, 95% CI = 1.75,5.45), having supportive supervision (AOR = 3.41, 95% CI = 1.25, 9.24), and having good knowledge on essential newborn care (AOR = 3.04, 95% CI = 1.89,4.90). Conclusion: The observed level of essential newborn care practices among obstetric care providers underscores the necessity for targeted interventions that stimulate interest in delivery room work, effectively manage workloads, and offer comprehensive training along with supportive supervision. By concentrating on these aspects and enhancing providers' knowledge, we can significantly improve essential newborn care practices. [ABSTRACT FROM AUTHOR]

Neonatal hypothermia is a significant global problem of neonates with huge contribution of neonatal morbidity and mortality. Recognizing major contributors of neonatal hypothermia is very important in designing preventing methods which was the objective of our study. This was an institution-based cross-sectional study conducted on 339 neonates admitted to Neonatal Intensive Care Unit of University of Gondar Comprehensive Specialized Hospital over 6months. Study participants were selected using systematic random sampling techniques and both bivariate and multivariate logistic regression analyses were used to identify contributors and p-value of < 0.05 was considered statistically significant. In our study, the prevalence of neonatal hypothermia was 70.05%. Low birth weight (AOR = 8.35, 95%CI: 2.34, 29.80), bathing within 24 h (AOR = 3.96, 95%CI: 1.06, 14.78), absence of head cover (AOR = 3.11, 95%CI: 1.16, 8.38), C/S delivery (AOR = 8.54, 95%CI: 2.01, 36.39), night time delivery (AOR = 2.92, 95%CI: 1.29, 6.61) and being out born (AOR = 6.84, 95%CI: 2.12, 22.13) were having significant association with neonatal hypothermia. In this study, the prevalence of neonatal hypothermia was significantly high. Factors having significant association with neonatal hypothermia were low birth weight, bathing within 24 h, absence of head cover, C/S delivery, delivery at night and being out born were having. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance Hypoxic–ischemic brain damage (HIBD) is a leading cause of neonatal mortality, resulting in brain injury and persistent seizures that can last into the late neonatal period and beyond. Effective treatments and interventions for infants affected by hypoxia–ischemia remain lacking. Clinical investigations have indicated an elevation of nuclear factor of activated T cells 5 (NFAT5) in whole blood from umbilical cords of severely affected HIBD infants with epilepsy. Experimental research has demonstrated that NFAT5 has ambivalent effects on neuroprotection and neurologic damage. However, the mechanistic role of NFAT5 in HIBD remains unclear. This investigation aims to further clarify the role of NFAT5 in epilepsy following HIBD insult.We created a neonatal HIBD mouse model through left common carotid artery occlusion. By specifically knocking down astrocytic NFAT5 and its downstream molecule, Nedd4‐2, using hippocampal delivery of adeno‐associated virus 5‐driven targeted shRNA, we investigated the role of astrocytic NFAT5 in epilepsy susceptibility in HIBD mice. This was assessed through electroencephalographic recordings, behavioral observations in vivo, and whole‐cell recordings of hippocampal neuronal activity. In vitro, we evaluated the effects of astrocytic NFAT5 alteration on Kir4.1 expression and IKir4.1 in both brain slices from HIBD mice and cultured astrocytes treated with oxygen–glucose deprivation/reoxygenation.Hypoxia–ischemia‐induced upregulation of hippocampal NFAT5 occurs in astrocytes rather than in neurons. This upregulation leads to increased expression of the ubiquitin ligase Nedd4‐2, resulting in excessive degradation of Kir4.1 in astrocytes. Consequently, astrocytic function in buffering extracellular K+ is impaired, causing depolarization of the resting potential and enhanced neuronal discharge. This disruption ultimately affects local neural network balance and increases susceptibility to epilepsy. In contrast, inhibiting or knocking down astrocytic NFAT5 almost completely reverses these effects.Our findings suggest that manipulating the NFAT5–Nedd4‐2–Kir4.1 axis in astrocytes could provide a potential therapeutic strategy for the epileptic complications of HIBD. [ABSTRACT FROM AUTHOR]

Background: Despite progress made towards SDG 3, sub-Saharan Africa lags behind the rest of the world, accounting for over 50% of global neonatal deaths. The increased number of hospital births in the region has not reciprocated the reduction in neonatal mortality rates. Sick newborns face uncertain journeys from peripheral facilities to specialized centres arriving in suboptimal conditions, which impacts their outcomes, due partly to the scarcity of dedicated neonatal transport services. Methods: This was a 2-arm nonrandomized controlled cluster study of preterm and low-birth-weight neonates transferred from eight peripheral sites to a tertiary neonatal unit via conventional methods or the KMC (August 2022–April 2023). Results: A total of 77 (mother-baby pairs) were recruited, 34 in the KMC group and 43 in the conventional arm. Most (60%) were transported by taxis/private cars. Overall mortality was 20.8%. No untoward event was recorded for neonates transported by KMC, with marginally better temperatures on arrival. Although the observed differences were not statistically significant given that this was not the primary aim, the findings add to evidence that KMC transport may not be more life-threatening than the current practice of transporting newborns in the caregiver's arms. KMC transport has the added advantage of ensuring non-separation of the small and sick child from its mother from birth and improved temperatures upon arrival. Conclusion: KMC transport for preterm and Low birth weight infants using available transport in Sub-Saharan Africa is feasible. Local large-scale randomized trials are needed to gather more evidence for policy direction needed to inform a scale-up of this low-cost intervention. Trial registration: ISRCTN98748162. Retrospectively registered 02.09.2024. [ABSTRACT FROM AUTHOR]