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Carbapenems are antimicrobial drugs of last resort for infections caused by multidrug-resistant gram-negative bacteria. Therefore, the global spread of carbapenemase-producing Enterobacteriaceae, which are resistant to carbapenems, is troubling (1,2). Because [...]

IL-17-producing [ROR[gamma]t.sup.+] [gamma][delta] T cells ([gamma][delta]T17 cells) are innate lymphocytes that participate in type 3 immune responses during infection and inflammation. Herein, we show that [gamma][delta]T17 cells rapidly proliferate within neonatal lymph nodes and gut, where, upon entry, they upregulate T-bet and coexpress IL-17, IL-22, and IFN-[gamma] in a STAT3- and retinoic acid-dependent manner. Neonatal expansion was halted in mice conditionally deficient in STAT5, and its loss resulted in [gamma][delta]T17 cell depletion from all adult organs. Hyperactive STAT5 mutant mice showed that the STAT5A homolog had a dominant role over STAT5B in promoting [gamma][delta]T17 cell expansion and downregulating gut-associated T- bet. In contrast, STAT5B preferentially expanded IFN-[gamma]producing yd populations, implying a previously unknown differential role of STAT5 gene products in lymphocyte lineage regulation. Importantly, mice lacking [gamma][delta]T17 cells as a result of STAT5 deficiency displayed a profound resistance to experimental autoimmune encephalomyelitis. Our data identify that the neonatal microenvironment in combination with STAT5 is critical for post-thymic [gamma][delta]T17 development and tissue-specific imprinting, which is essential for infection and autoimmunity., Introduction IL-17-producing [gamma][delta] T cells ([gamma][delta]T17 cells) are one of the major type 3 innate lymphocytes in the mouse, occupying the skin and most mucosal surfaces as well as secondary [...]

During the past decade, outbreaks of bloodstream infections (BSIs) caused by rare and challenging to identify fungi have increased (1). Many rare infections occurred among patients admitted to neonatal intensive [...]

Spiroplasma is a genus of Mollicutes, a class of bacteria without cell wall. Spiroplasma are intracellular organisms with helical morphology and a small genome (0.78-2.2 Mb) comprising 38 species isolated [...]

* Context.--Infections are the leading cause of perinatal and infant mortality in low-income and low-resource countries, which have a higher prevalence of infections. Definitive diagnosis of congenital and perinatal infections is largely dependent upon the results of laboratory tests. Objective.--To develop a multiplex nested polymerase chain reaction (PCR) technique for the simultaneous detection of 7 pathogens containing DNA in their genomes in suspected cases of congenital infection. Design.--Eligible participants were pregnant women with positive immunoglobulin M antibodies raised to one of the pathogens in the prenatal serologic screening, associated or not with fetal ultrasound abnormalities or positive fetal serology. Neonates whose mothers did not attend prenatal care were included when they presented with symptomatology and laboratory parameters suggestive of infection. The detection rate of the multiplex nested PCR was compared with maternal, fetal, and neonatal serology, as well as placental immunohistochemistry and noncommercial amplifications. Results.--Of 161 suspected cases, the multiplex nested PCR detected 60 (37.3%), whereas the tests available in hospital laboratories detected 13 of 60 (21.7%) of the cases detected by the multiplex nested PCR, demonstrating a 4.6 times higher detection rate for the multiplex nested PCR (Fisher exact test, P < .001). Positive amplifications were to Toxoplasma gondii (32 cases), cytomegalovirus (14 cases), parvovirus B19 (5 cases), and adenovirus (5 cases). In 4 cases, 2 pathogens were simultaneously detected. All types of biological matrices were suitable for amplification. Sequencing of multiplex nested PCR products confirmed the molecular findings. Conclusions.--The multiplex nested PCR significantly increased the number of diagnosed congenital infections. Given the scarcity of DNA recovered from amniotic fluid and some neonatal samples, this multiplex nested PCR allows the simultaneous detection of 7 pathogens associated with congenital infections in a reliable, faster, cost-effective, and more sensitive way. (Arch Pathol Lab Med. 2020;144:99-106; doi: 10.5858/arpa.2018-0544-OA), Infections are the leading cause of perinatal mortality in low- and middle-income countries, which have a higher prevalence of infections, and are responsible for 50% of infant deaths in the [...]

All circulating immunoglobulin G (IgG) antibodies in human newborns are of maternal origin.sup.1 and transferred across the placenta to provide passive immunity until newborn IgG production takes over 15 weeks after birth.sup.2. However, maternal IgG can also negatively interfere with newborn vaccine responses.sup.3. The concentration of IgG increases sharply during the third trimester of gestation and children delivered extremely preterm are believed to largely lack this passive immunity.sup.1,2,4. Antibodies to individual viruses have been reported.sup.5-12, but the global repertoire of maternal IgG, its variation in children, and the epitopes targeted are poorly understood. Here, we assess antibodies against 93,904 epitopes from 206 viruses in 32 preterm and 46 term mother-child dyads. We find that extremely preterm children receive comparable repertoires of IgG as term children, albeit at lower absolute concentrations and consequent shorter half-life. Neutralization of the clinically important respiratory syncytial virus (RS-virus) was also comparable until three months of age. These findings have implications for understanding infectious disease susceptibility, vaccine development, and vaccine scheduling in newborn children. A longitudinal survey of maternal antiviral antibodies in newborns provides a blueprint for understanding infectious disease susceptibility and vaccine development, and inform vaccine scheduling in newborn children., Author(s): Christian Pou [sup.1] , Dieudonné Nkulikiyimfura [sup.1] , Ewa Henckel [sup.2] [sup.3] , Axel Olin [sup.1] , Tadepally Lakshmikanth [sup.1] , Jaromir Mikes [sup.1] , Jun Wang [sup.1] , [...]

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups., Author(s): Galya Bigman [sup.1] , Anna V. Wilkinson [sup.1] , Adriana Pérez [sup.2] , Nuria Homedes [sup.3] Author Affiliations: (Aff1) 0000 0000 9206 2401, grid.267308.8, Epidemiology, Human Genetics and Environmental [...]

Introduction Natural disasters in resource-poor countries have differential effects on socially disadvantaged groups such as women. In addition to the acute reproductive health needs of women during the immediate response phase of a disaster, research suggests that maternal, newborn, and child health (MNCH) may continue to be seriously impacted for numerous months, even years, after the event. Methods This ethnographic field research investigates the impacts of the 2015 Nepal earthquakes on mothers and children under five on the 6-month anniversary of the earthquakes. Results Though families were not channeling household funds away from health care expenses for pregnant and lactating women and children under five, the findings suggest that a delayed response by the Nepali government in administering funds for rebuilding combined with an ongoing fuel crisis were negatively impacting families' abilities to provide adequate shelter, warmth, cooking gas, and transportation for mothers and young children. This study highlights the importance of understanding the impacts of specific social and political contexts on intra-household family finances as they relate to MNCH, not just variables related to the disaster itself. Discussion Future research and policies on MNCH during the long-term recovery period after a natural disaster such as the 2015 Nepal earthquakes therefore should take into account the social and political context as well as institute multiple periodic assessments of MNCH in the first few years following the disaster., Author(s): Jan Brunson [sup.1] Author Affiliations: (1) Department of Anthropology, University of Hawaii at Manoa, 0000 0001 2188 0957, grid.410445.0, , 2424 Maile Way, Saunders Hall 346, 96822, Honolulu, HI, [...]

Author(s): Aliza Mittal [sup.1] [sup.2] , Daisy Khera [sup.1] , Varuna Vyas [sup.1] , Bharat Choudhary [sup.1] , Kuldeep Singh [sup.1] Author Affiliations: (Aff1) 0000 0004 1767 6103, grid.413618.9, Department [...]

Abstract Introduction: HIV-1 polymerase chain reaction (PCR) testing at birth aims to facilitate earlier initiation of antiretroviral therapy (ART) for HIV-infected neonates. Data from two years of universal birth testing [...]

Objective To investigate the effect of birth weight on infant mortality, illness and care seeking in rural Ghana. Methods Using randomized controlled trial data, we compared infants weighing 2.00-2.49,1.50-1.99 and Findings Among 22 906 infants, compared with non-low-birth-weight infants: (i) Infants weighing 2.00-2.49,1.50-1.99 and < 1.50 kg were about two (aHR: 2.13; 95% confidence interval, CI: 1.76-2.59), eight (aHR: 8.21; 95% CI: 6.26-10.76) and 25 (aHR: 25.38; 95% CI: 18.36-35.10) times more likely to die in infancy, respectively; (ii) those born weighing Conclusion For low-birth-weight infants in Ghana, strategies to minimize mortality and improve care seeking are needed. Objectif Etudier l'effet du poids a la naissance sur la mortalita, la maladie et le recours a des soins de sante, pendant la periode infantile, dans des regions rurales du Ghana. Methodes En utilisant les donnees d'un essai controle randomise, nous avons compare les nourrissons nes avec un poids compris entre 2,00 et 2,49 kg, entre 1,50 et 1,99 kg et inferleur a 1,50 kg avec les nourrissons qui ne presentaient pas un faible poids a la naissance. Nous avons genere des ratios de risque de mortalite ajustes (RRa), des ratios de taux de maladies ajustes (RTa) et des rapports des cotes ajustes (RCa) pour ' les admissions dans des centres de sante et l'absence de recours a des soins, sur quatre periodes de vie: entre 0 et 364 jours, entre 0 et 27 jours, entre 28 et 182 jours et entre 183 et 364 jours. Resultats Dans l'echantlllon etudie de 22 906 nourrissons, comparatlvement a ceux qui ne presentaient pas un faible poids a la naissance: (i) les nourrissons nes avec un poids compris entre 2,00 et 2,49 kg, entre 1,50 et 1,99 kg et inferieur a 1,50 kg ont ete associes, respectivement, a un risque deuxfois superieur (RRa: 2,13; intervalle de confiance (IC) de 95%: 1,76-2,59), huitfois superieur (RRa: 8,21; IC 95%: 6,26-10,76) et 25 fois superieur (RRa:25,38; IC 95%: 18,36-35,10) de deces durant la premiere annee de vie; (li) ceux pesant molns d'1,50 kg a la naissance ont ete associes a un risque environ 48 fois superieur (RRa:48,45; IC 95%: 32,81-71,55) et huit fois superieur (RRa: 8,42; IC 95%: 3,09-22,92) de deces entre 0 et 27 jours et entre 183 et 364 jours respectivement; (Hi) ceux nes avec un poids compris entre 1,50 et 1,99 kg (RTa: 1,57; IC 95%: 1,27-1,95) ou inferieur a 1,50 kg (RTa: 1,58; IC 95%: 1,13-2,21) ont ete associes a des taux superieurs de maladies durant les 27 premiers jours de vie; et (lv) pour les nourrissons nes avec un poids compris entre 1,50 et 1,99 kg, le recours a des soins de sante a ete molns frequent durant les 27 premiers jours de vie (RCa: 3,30; IC 95%: 1,98-5,48) et sur la periode allant du 28eme au 182emejour de vie (RCa: 1,74; IC 95%: 1,26-2,39). Conclusion Au Ghana, pour les nourrissons nes avec un faible poids, des strategles doivent etre adoptees afin de reduire la mortalite et d'ameliorer le recours aux soins. Objetivo Investigar el efecto del peso al nacer en la mortalidad infantil, las enfermedades y la atencion medica en la Ghana rural. Metodos Utilizando datos de ensayos controlados aleatorios, se comparo a los recien nacidos con un peso de 2,00-2,49,1,50-1,99 y Resultados Entre 22 906 recien nacidos, comparados con recien nacidos sin insuficiencia ponderal: (i) los recien nacidos con un peso de 2,00-2,49, 1,50-1,99 y Conclusion Se necesitan estrategias para minimizar la mortalidad y mejorar la atencion medica de los recien nacidos con insuficiencia ponderal en Ghana., Introduction Approximately 14% of infants in low-income countries weigh less than 2.5 kg at birth--many are born preterm. (1) Most research on mortality and illness among low-birth-weight infants has focused [...]

Background Low birthweight infants have a reduced number of nephrons and are at high risk of chronic kidney disease. Preterm birth and/or intrauterine growth restriction (IUGR) may also affect peritubular capillary development, as has been shown in other organs. Case-Diagnosis/Treatment We report two patients with a history of preterm birth and extremely low birthweight who showed polycythemia and renal capillary rarefaction. Patient 1 and 2, born at 25 weeks of gestation with a birthweight of 728 and 466 g, showed mild proteinuria at age 8 and 6 years, respectively. In addition to increasing proteinuria, hemoglobin levels became elevated towards adolescence and their serum erythropoietin (EPO) was high despite polycythemia. Light microscopic examination of renal biopsy specimens showed glomerular hypertrophy, focal segmental glomerulosclerosis, and only mild tubulointerstitial fibrosis. A decrease in the immunohistochemical staining of CD31 and CD34 endothelial cells in renal biopsy specimens was consistent with peritubular capillary rarefaction. Conclusions Since kidney function was almost normal and fibrosis was not severe, we consider that the capillary rarefaction and polycythemia associated with elevated EPO levels were largely attributable to preterm birth and/or IUGR., Author(s): Nariaki Asada [sup.1] , Takanori Tsukahara [sup.2] , Megumi Furuhata [sup.3] , Daisuke Matsuoka [sup.2] , Shunsuke Noda [sup.2] , Kuniaki Naganuma [sup.4] , Akinori Hashiguchi [sup.5] , Midori [...]

Background Tetanus is an acute, potentially fatal, disease caused by a neurotoxin produced by the bacterium Clostridium tetani (C. tetani). Maternal and neonatal tetanus (MNT) are forms of generalized tetanus [...]

Objective to assess the feasibility of applying the World Health Organization's proposed 15 indicators of quality of care for maternal and newborn health at health-facility level in low- and middle-income settings. Methods Six of the indicators are about maternal health, five are for newborn health and four are general cross-cutting indicators. We used data collected routinely in facility registers and obtained as part of facility assessments from 963 health-care facilities specializing in maternity services in 10 countries in Africa and Asia. We made a feasibility assessment of the availability of data and the clarity of indicator definitions and identified additional information and data collection processes needed to apply the proposed indicators in real-life settings. Findings Of the indicators evaluated, 10 were clearly defined, of which four could be applied directly in the field and six would require revisions to operationallze them. The other five Indicators require further development, with one of them being ready for implementation by using Information readily available in registers and four requiring further information before deployment. For Indicators that measure coverage of care or availability of services or products, there is a need to further strengthen measurement. Information on emergency obstetric complications was not recorded in a standard manner, thus limiting the reliability of the Information. Conclusion While some of the proposed indicators can already be applied, other Indicators need to be refined or will need additional sources and methods of data collection to be applied in real-world settings. Objectif Evaluer s'il est faisable d'appliquer les 15 indicateurs proposes par l'Organisation mondiale de la Sante relatifs a la qualite des soins de sante maternelle et neonatale dans des centres de sante de regions a revenu faible et intermediaire. Methodes Six indicateurs portent sur la sante maternelle, cinq sur la sante neonatale et quatre sur des facteurs transversaux d'ordre general. Nous avons utilise les donnees consignees habituellement dans les registres des centres de sante et obtenues dans le cadre d'evaluations de ces centres; des donnees couvrant au total 963 centres de sante, specialises dans les services de maternite, dans 10 pays d'Afrique et d'Asie. Nous avons realise une etude de faisabilite portant sur la disponibilite des donnees et la clarte des definitions des indicateurs, et nous avons identifie les processus de collecte des donnees et informations complementaires necessaires pour pouvoir appliquer ces indicateurs en conditions reelles. Resultats Parmi tous les indicateurs evalues, 10 sont clairement definis, parmi lesquels quatre pourraient etre directement appliques sur le terrain, tandis que les six autres necessiteraient des ajustements avant de pouvoir etre mis en oeuvre. Les cinq indicateurs restants necessitent d'autres developpements; meme si l'un d'eux pourrait etre exploite en utilisant les Informations consignees dans les registres deja disponibles, pour les quatre autres indicateurs, des informations complementaires sont necessaires. Pour les indicateurs relatifs a la couverture des soins ou a la disponibilite des services ou des produits, des evaluations plus detaillees seraient necessaires. Les Informations sur les complications obstetricales d'urgence n'ont pas ete enregistrees de facon standardisee, ce qui limite la fiabilite de ces Informations. Conclusion Alors que certains des Indicateurs proposes sont d'ores et deja applicables, d'autres indicateurs doivent etre affines ou necessitent des sources d'information supplementaires et des methodes complementaires de collecte de donnees avant de pouvoir etre appliques en conditions reelles. Objetivo Evaluar la viabilidad de aplicar los 15 indicadores de calidad de atencion sanitaria materna y obstetrica propuestos por la Organizacion Mundial de la Salud en centros sanitarios de entornos con ingresos bajos y medios. Metodos Seis de los indicadores tratan sobre salud materna, cinco sobre salud obstetrica y cuatro son indicadores transversales generales. Se utilizaron datos recopilados de forma rutinaria en los registros de los centros y se obtuvieron como parte de las evaluaciones de las instalaciones de 963 centros sanitarios especializados en servicios de maternidad de 10 paises de Africa y Asia. Se realizo una evaluacion de viabilidad sobre la disponibilidad de datos y la claridad de las definiciones de los indicadores, y se identifico informacion adicional y los procesos de recopilacion de datos necesarios para implementar los indicadores propuestos en centros reales. Resultados De los indicadores evaluados, 10 se definieron con claridad, de los cuales cuatro podian aplicarse directamente en el campo y seis necesitarian revisiones para hacerlos operativos. Los otros cinco indicadores requieren un mayor desarrollo: uno de ellos esta listo para ser implementado utilizando Informacion inmediatamente disponible en los registros y cuatro necesitan mas informacion antes de su puesta en practica. Para los indicadores que miden la cobertura de la atencion o la disponibilidad de productos o servicios, se necesita fortalecer mas la medicion. No se ha registrado informacion sobre complicaciones obstetricas de emergencia de forma estandar, por lo que la fiabilldad de la informacion es limitada. Conclusion Mientras que algunos de los Indicadores propuestos ya pueden aplicarse, otros necesitan perfeccionarse o requeriran fuentes y metodos de recopilacion de datos adicionales para poderse aplicar en entornos reales., Introduction Improving the quality of care for maternal and newborn health is important if health outcomes for mothers and babies are to continue to improve. This will require a renewed [...]

Objectives To study the independent effect of pre-pregnancy weight, gestational weight gain (GWG), and other important risk factors on newborn birth weight. Methods Baseline data of 435 adult women and their singletons born between January and February 2012 at a public hospital in Brazil were used. Logistic regression was applied to determine the independent importance of pre-pregnancy weight and GWG for large for gestational age (LGA) newborns. Results Among all mothers, 37.9 % were overweight and obese before pregnancy and 45.3 % experienced excessive GWG. Among the newborns, 24.4 % were classified as LGA. Univariate analysis showed an association of family income, GWG, pre-pregnancy BMI and excessive GWG with LGA newborns. Smoking before and during pregnancy was associated with a decreased likelihood of giving birth to an LGA newborn compared to mothers who did not smoke. After adjustment for confounding variables, age at birth of first child, GWG, HbA1c and pre-pregnancy weight-GWG were significant and independent determinants of giving birth to an LGA newborn. Mothers with pre-pregnancy overweight and excessive GWG were more likely to deliver an LGA newborn (OR 2.54, P < 0.05) compared to mothers who were normal weight and experienced adequate GWG. Conclusions for Practice Age at first birth of child, GWG, HbA1c and pre-pregnancy overweight combined with excessive GWG are independent determinants of LGA newborns. The results of this study suggest that both primary prevention of overweight in women of childbearing age and management of GWG may be important strategies to reduce the number of LGA newborns and, consequently, the long-term public health burden of obesity., Author(s): Marco F. Mastroeni [sup.1] [sup.2] [sup.4] , Sandra A. Czarnobay [sup.1] , Caroline Kroll [sup.2] , Katherinne B. W. Figueirêdo [sup.1] , Silmara S. B. S. Mastroeni [sup.3] [sup.4] [...]

Objectives The magnitude, characteristics, and morbidity of term ([greater than or equal to]37 weeks gestation) newborns that are small-for-gestational-age (SGA) in the U.S. are underexplored. We sought to examine characteristics and trends for SGA-coded term newborns in the U.S. Methods Data were obtained from the Nationwide Inpatient Sample, a nationally representative database of hospital stays in the U.S. from 2002 to 2011. Term, singleton newborns with SGA codes were identified and examined over the study period. Demographic characteristics were compared for term newborns according to presence of SGA codes using [chi].sup.2 tests. Odds ratios (OR) were calculated to compare morbidities between the two groups, adjusting for relevant demographic and clinical variables. Results In 2011, 15 per 1000 term newborns in the U.S. were coded as SGA, a 29.9 % increase since 2002. Compared with other term newborns, SGA term newborns were significantly (p < 0.05) more likely to be female, receive public insurance, and reside in lower income zip codes. Comorbidities, including perinatal complications, metabolic disorders, central nervous system diseases, infection, and neonatal abstinence syndrome were more common among SGA-coded term newborns. These newborns also had higher odds of in-hospital death (OR = 3.0 95 % confidence interval: 2.0, 4.4), longer mean length of stay (3.7 vs. 2.3 days, p < 0.001), and higher mean hospital charges ($12,621 vs. $5012, p < 0.001). Conclusions for practice Term newborns coded as SGA have higher morbidity, mortality, and incur higher hospital charges than other term newborns. More research is needed to understand causes of SGA so its incidence and effects can be reduced., Author(s): Alexander C. Ewing [sup.1] , Sascha R. Ellington [sup.1] , Carrie K. Shapiro-Mendoza [sup.1] , Wanda D. Barfield [sup.1] , Athena P. Kourtis [sup.1] Author Affiliations: (1) grid.416738.fDivision of [...]

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation., Author(s): Ifeyinwa V. Asiodu [sup.1] , Catherine M. Waters [sup.2] , Dawn E. Dailey [sup.3] , Audrey Lyndon [sup.3] Author Affiliations: (1) grid.185648.6Department of Women, Children, and Family Health Science, [...]

Introduction: Timely diagnosis is necessary to avert early death in HIV-infected neonates. Birth PCR testing may improve early identification and facilitate access to care. We implemented a birth HIV diagnosis programme in Johannesburg, South Africa and present successes and challenges of the first two and a half years of operation. Methods: Between June 2014 and December 2016, we sought to identify all HIV-exposed births and offer newborn HIV PCR testing before discharge after delivery. The programme identified newly delivered women who had tested positive during pregnancy and provided post-partum HIV antibody testing for women without recent negative results. HIV-positive women were required to consent for neonatal birth testing and asked to return a week later to obtain their results. Neonatal venous blood was sampled and tested at the national laboratory using Roche COBAS[R] TaqMan[R] HIV-1 Qualitative Test (Version 2.0). Non-negative results triggered active follow-up for confirmatory testing and appropriate treatment. Results: Of 30,591 women with live births, 6864 (22.4%) were known to be HIV positive and an additional 221 women (1.4% of those tested) were identified during maternal postnatal testing. Of 7085 HIV-positive women, 6372 (89.9%) were interviewed and agreed to data collection, 6358 (99.8%) consented to birth testing for 6467 neonates and a blood sample was collected for 6377 (98.6%). If tested, 6210 (97.4%) tested negative, 91 (1.4%) positive, 57 (0.9%) revealed errors and 19 (0.3%) were indeterminate. Seven of the 19 neonates with indeterminate results and one with initial error result were found to be infected on subsequent testing yielding an intrauterine transmission rate of 1.6% (95% CI: 1.3-1.9). Sixteen (16%) of 99 infected infants were born to women (n = 221) identified during postnatal testing. With active outreach, 95/99 (96%) infected infants were initiated on antiretroviral therapy. Of 6261 neonates with negative results, 3251 (52%) returned to receive their test results. Conclusion: Our programme successfully achieved high coverage and uptake of birth PCR testing and was able, with active tracking, to start almost all identified HIV-infected neonates on antiretroviral therapy. Implementation required additional staff for counselling, quality control and outreach. Return for negative results was low and neonates with indeterminate results required multiple repeat tests. Keywords: HIV; diagnosis; neonate; polymerase chain reaction; birth; in-utero, Introduction Timely diagnosis is necessary to avert early death in HIV-infected infants as these infants progress rapidly and almost half will die in the first two years of life without [...]

Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as [less than or equal to] or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p < 0.001). After initial program implementation, we observed a 3 % monthly increase (RR 1.03, p < 0.001 for test of slope change from pre-exposure to post-exposure), such that likelihood of recommended follow-up increased by roughly 72 % after discharge coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p < 0.001). Conclusions for Practice Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization., Author(s): Neera K. Goyal[sup.1] [sup.2] [sup.3] [sup.6] , Eric S. Hall[sup.3] [sup.4] , Robert S. Kahn[sup.3] [sup.5] , Scott L. Wexelblatt[sup.1] [sup.3] , James M. Greenberg[sup.1] [sup.3] , Zeina M. [...]

Objectives To determine the relation of paternal lifelong socioeconomic position (SEP) to the racial disparity in low birth weight (, Author(s): James W. Collins[sup.1] , Kristin M. Rankin[sup.2] , Richard J. David[sup.3] Author Affiliations: (1) Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, #45 225 E. [...]

The induction-delivery time during Cesarean section is traditionally conducted under light anesthesia because of the possibility of anesthesia-induced neonatal respiratory depression. The serious consequences of such an approach could be the increased risk of maternal intraoperative awareness and exaggerated neuroendocrine and cardiovascular stress response to laryngoscopy, endotracheal intubation, and surgical stimuli. Here, we briefly discuss the various pharmacological options for attenuation of stress response to endotracheal intubation during Cesarean delivery and then focus on remifentanil, its pharmacokinetic properties, and its use in anesthesia, both in clinical studies and case reports. Remifentanil intravenous bolus doses of 0.5-1 [mu]g/kg before the induction to anesthesia provide the best compromise between attenuating maternal stress response and minimizing the possibility of neonatal respiratory depression. Although neonatal respiratory depression, if present, usually resolves in a few minutes without the need for prolonged resuscitation measures, health care workers skilled at neonatal resuscitation should be present in the operating room whenever remifentanil is used., Author(s): Marija S. Kutlesic[sup.1] [sup.2] , Ranko M. Kutlesic[sup.2] [sup.3] , Tatjana Mostic-Ilic[sup.4] [sup.5] Author Affiliations: (1) Center for Anesthesia, University Clinical Centre Nis, Nis, Serbia (2) Clinic of Gynecology [...]

Background Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. Methods and findings We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score ( Conclusion These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care. Trial registration ISRCTN30829654., Author(s): Ashish KC 1,2,*, Uwe Ewald 1, Omkar Basnet 3, Abhishek Gurung 3, Sushil Nath Pyakuryal 4, Bijay Kumar Jha 5, Anna Bergström 1,6, Leif Eriksson 7, Prajwal Paudel 4, [...]

Background In Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0-6 days). Only 50% of newborns in Bangladesh initiated breastfeeding within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing severe illnesses leading to sepsis. This study explores the effect of breastfeeding initiation time on early newborn danger signs and severe illness. Methods and findings We used data from a community-based trial in Bangladesh in which we enrolled pregnant women from 2013 through 2015 covering 30,646 newborns. Severe illness was defined using newborn danger signs reported by The Young Infants Clinical Science Study Group. We categorized the timing of initiation as within 1 hour, 1 to 24 hours, 24 to 48 hours, [greater than or equal to]48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and multivariable mixed-effects logistic regression while adjusting for the clustering effects of the trial design, and maternal/infant characteristics. In total, 29,873 live births had information on breastfeeding among whom 19,914 (66.7%) initiated within 1 hour of birth, and 4,437 (14.8%) neonates had a severe illness by the seventh day after birth. The mean time to initiation was 3.8 hours (SD 16.6 hours). The proportion of children with severe illness increased as the delay in initiation increased from 1 hour (12.0%), 24 hours (15.7%), 48 hours (27.7%), and more than 48 hours (36.7%) after birth. These observations would correspond to a possible reduction by 15.9% (95% CI 13.2-25.9, p < 0.001) of severe illness in a real world population in which all newborns had breastfeeding initiated within 1 hour of birth. Children who initiated after 48 hours (odds ratio [OR] 4.13, 95% CI 3.48-4.89, p < 0.001) and children who never initiated (OR 4.77, 95% CI 3.52-6.47, p < 0.001) had the highest odds of having severe illness. The main limitation of this study is the potential for misclassification because of using mothers' report of newborn danger signs. There could be a potential for recall bias for mothers of newborns who died after being born alive. Conclusions Breastfeeding initiation within the first hour of birth is significantly associated with severe illness in the early newborn period. Interventions to promote early breastfeeding initiation should be tailored for populations in which newborns are delivered at home by unskilled attendants, the rate of low birth weight (LBW) is high, and postnatal care is limited. Trial registration Trial Registration number: anzctr.org.au ID ACTRN12612000588897., Author(s): Shahreen Raihana 1,2,*, Michael J. Dibley 1, Mohammad Masudur Rahman 2,3, Tazeen Tahsina 2, Md. Abu Bakkar Siddique 2, Qazi Sadequr Rahman 2, Sajia Islam 2, Ashraful Alam 1, [...]