Prevalence of hypospadias and other genital anomalies among singleton births, 1988-1997, in Scotland

BACKGROUND: Considerable debate exists on the epidemiology of genital anomalies. METHODS: All genital anomalies, excluding undescended testes, were identified from neonatal returns, stillbirth and infant death survey records, and returns relating to hospital admissions and linked to form infant profiles on a cohort of singleton births between 1988 and 1997 with follow up for a minimum of three years. FINDINGS: The mean genital anomaly prevalence rate in Scotland was calculated at 4.6 per 1000 births varying from 4.0 per 1000 births in 1988 to 5.9 per 1000 births in 1996. However, there was no evidence of a clear trend to an increasing prevalence of hypospadias, which constituted 73% of the anomalies studied. Logistic regression analysis of the data also showed this rate to be independently associated with being relatively small for gestational age (odds ratio (OR) 1.43, p < 0.001) and increasing maternal age (OR 1.2, p < 0.05). Infants born in deprived areas, as judged by the Carstairs deprivation score, were least likely to have a genital anomaly (OR 0.73, p < 0.01). INTERPRETATION: A new linked register of congenital genital anomalies in Scotland suggests that over a decade, the birth prevalence of genital anomalies has changed little. The associations between genital anomalies, maternal age, and socioeconomic deprivation require further study.     

The choice of place of delivery. Effect of hospital level on mortality in all singleton births in New York City

In an analysis of all singleton births and neonatal deaths with known birth weights and gestational ages in New York City maternity services during a three-year period (1976 to 1978), intensive care services at the hospital of birth were found to influence mortality only in preterm (less than 37 weeks' gestation) or low-birth-weight infants (less than 2251 g). By contrast, for infants who were born at term and of normal birth weight, mortality rates did not differ by level of perinatal care available at the hospital of birth. On the average, preterm and low-birth-weight infants were at a 24% higher risk of death if birth occurred outside of a level 3 center, regardless of whether birth occurred at a level 1 or level 2 hospital. Preterm and low-birth-weight infants, though constituting only 12% of births, accounted for 70% of neonatal deaths in New York City. The remaining infants, ie, those born at term and of normal birth weight, who experienced no measurable mortality advantage when born in a level 3 hospital, accounted for 88% of all births.     

Social trends in singleton births and birth weight in Wirral residents, 1990-2001

OBJECTIVE: To examine social trends in the number of singleton births and birth weight in an English health district between 1990 and 2001, using an area based deprivation index. DESIGN: Analysis of routinely collected hospital data. SETTING: Wirral Health District in north west England. PARTICIPANTS: All 48 452 live births to Wirral residents from 1990 to 2001. MAIN OUTCOME MEASURES: Birth numbers, birth weight, and standard deviation score for birth weights for singleton births. Townsend material deprivation scores derived from postcodes. RESULTS: The number of singleton births fell by 28% over the 12 years. The fall in the least deprived Townsend quartile (45%) was more than triple that in the most deprived quartile (gamma = 0.045; 95% confidence interval (CI) = 0.036 to 0.054; p < 0.001). Over the study period, the mean birth weight in the least deprived Townsend quartile was 141 g higher than in the most deprived quartile. There was a highly significant association between the standard deviation score for birth weight and Townsend quartile (tau-b = -0.062; 95% CI = -0.068 to -0.055; p < 0.001). Numbers of low birth weight babies in the least deprived quartile fell disproportionately compared with those from the most deprived quartile (gamma = 0.17; 95% CI = 0.09 to 0.25; p < 0.001). CONCLUSION: The reduction in birth rate in the Wirral was significantly less in the most deprived districts. This was accompanied by related differences in mean birth weight and the number of low birth weight babies, indicating increasing social inequality in birth trends. Previously described social inequity in birth weight and the number of low birth weight babies continues in the north west of England.     

The association between childhood maltreatment subtypes and current suicide risk among homeless men and women

This study explored self-reports of five childhood maltreatment (CM) subtypes and their associations with current suicide risk in a sample of 500 homeless persons. Participants completed the Childhood Trauma Questionnaire and the Mini-International Neuropsychiatric Interview. Individual, unique, and cumulative associations of CM subtypes and subtype combinations with suicide risk (no vs. low vs. moderate/high) were examined. In multivariate analyses, four of the five CM subtypes were associated with suicide risk in individual models, but not in a model that included all CM subtypes. The strongest associations were found for reports of multitype CM involving all five subtypes. Mental disorders and female sex were independently associated with suicide risk. Clinicians working with CM victims should be aware that homeless clients are likely to report multitype maltreatment and should assess a variety of CM experiences. Future studies need to further examine multitype maltreatment and suicidal behaviors in homeless populations with complex conditions.     

Population-based trends in mortality and neonatal morbidities among singleton,very preterm,very low birth weight infants over 16 years

BackgroundImproved survival of singleton very preterm, very low birth weight (VPTVLBW) infants has been associated with increasing rates of severe neonatal morbidities.AimTo assess changes in mortality and neonatal morbidities among singleton VPT-VLBW infants.Study designPopulation-based observational study of data collected by the Israel Neonatal Network.Subjects10,705 singleton VPT-VLBW infants born at 24–32 gestational weeks in 1995–2010.Outcome measuresMortality and major neonatal morbidities over 3 time periods: 1995–2000, 2001–2005, and 2006–2010. Major neurological morbidities comprised intraventricular hemorrhage grades 3–4, periventricular leukomalacia and retinopathy of prematurity grades 3–4.ResultsThe mortality rate decreased over time from 20.2% to 13.8% for all birth weight and gestational age groups. Compared to the 1995–2000 period, the adjusted odds ratios (aORs) (95% confidence intervals,) for mortality in 2001–2005 and 2006–2010 were 0.78 (0.67–0.90) and 0.72 (0.62–0.84), respectively. The combined outcomes of death or major neurological morbidities, aOR 0.74 (0.65–0.84) and death or major neurological morbidities and/or bronchopulmonary dysplasia aOR 0.85 (0.75–0.96) decreased significantly between the first and last periods. A significant improvement in mortality rates and survival without one or more major neonatal morbidity was observed for all birth weight and gestational age groups.Among 8,886 surviving infants the rates of major neurological morbidities decreased from 16.4% to 12.8%, aOR 0.80 (0.68–0.95).ConclusionThe improving survival of singleton VTP-VLBW infants was not associated with a concomitant increase in the risk for major neonatal neurological morbidities among surviving infants. Bronchopulmonary dysplasia, however, remained a significant burden. This analysis emphasizes the need to direct efforts towards the prevention and treatment of adverse respiratory sequelae.     

Triplets and higher-order multiple births. Time trends and infant mortality.

OBJECTIVES--To describe changes in rates of higher-order multiple births (triplets and higher) between 1972 and 1989, to compare infant mortality rates in infants of higher-order multiple births and singletons born from 1983 through 1985, and to compare infant mortality rates among higher-order multiples born from 1983 through 1985 with rates among those born in 1960. RESEARCH DESIGN--Population-based analysis of live births (1972 through 1989) and infant deaths (1960 and 1983 through 1985) in the United States. The rate of higher-order multiple births was calculated per 100,000 live births. DATA SOURCE--Computerized national natality files for 1972 through 1989 and national linked birth/infant death data sets for 1960 and 1983 through 1985 from the National Center for Health Statistics, Centers for Disease Control. POPULATION--Live births to white and black women in the United States. INTERVENTIONS--None. MAIN RESULTS--Between 1972 through 1974 and 1985 through 1989 the rate of higher-order multiple births increased by 113% among infants of white mothers and by 22% among infants of black mothers. In whites the increase was mostly age specific and was not due to the upward shift in the maternal age distribution. The increase was particularly large in white women aged 30 through 34 years (152%) and 35 through 39 years (165%) and in more highly educated mothers. In blacks the modest increase in the rate of higher-order multiple births was mostly due to an upward shift in the maternal age distribution. From 1983 through 1985, mortality of infants of higher-order multiple births was about 15 times that of singletons. This was due almost entirely to the lower birth weight distribution of infants of higher-order multiple births. Their weight-specific mortality compared favorably with that of singletons. At 500 through 999 g, mortality was about the same. In weight categories between 1000 and 1999 g, mortality rates in higher-order multiple births were much lower: weight-specific relative risks ranged from 0.30 to 0.73. Between 1960 and 1983 through 1985 infant mortality in higher-order multiple births declined by about 50%. CONCLUSIONS--It is likely that much of the increase in the incidence of higher-order multiple births is due to the rise in the use of ovulation-inducing drugs for the treatment of infertility. This increase and the decline in mortality risk have created a much greater need for medical and social services for infants of higher-order multiple births and their families.     

Short-term outcome among term singleton infants with intrapartum oligohydramnios

Aim:  To evaluate rates of early short‐term neonatal complications among term singleton newborn infants with oligohydramnios. Methods:  Retrospective data were collected on 456 term infants with prenatal diagnosis of oligohydramnios and on matched controls, including information on maternal condition and on infant perinatal complications. Results:  Infants in the study group were born with lower birthweight and were SGA compared with those in the control group. Rates of renal malformations were significantly higher in the study group compared with the controls (15–3.3% and 3–0.7%, respectively; p = 0.007). Among the severe oligohydramnios subgroup (Amniotic Fluid Index <2), renal anomalies were even more prevalent compared to other infants with oligohydramnios and to the controls (6–9.8%, 9–2.3% and 3–0.7%, respectively; p < 0.001). The incidence of skeletal deformities (developmental dislocation of hip and torticollis) was higher among the study group. Conclusion:  Term infants with oligohydramnios that was detected near birth are associated with a greater prevalence of renal malformations (mostly mild hydronephrosis) as well as congenital torticollis and developmental dislocated hips compared with controls. Postnatal renal evaluation should be considered in infants with severe oligohydramnios.     

Recent trends in the incidence of multiple births and associated mortality.

The overall incidence of multiple births in England and Wales, which had been declining since the early 1950s, started to increase in the early 1980s in all age groups except for women under 20. This followed a rise in the incidence of triplet and higher order multiple births which had started in the late 1970s. Analyses of data for births between 1978 and 1983 showed that while stillbirth, perinatal, neonatal, and post-neonatal mortalities among multiple births fell considerably, they remained consistently higher than those for singleton births. Differences in the distribution of birth weight do not wholly explain these differences. Analyses of certified causes of stillbirth and death are difficult to interpret because a considerable proportion were attributed to ''multiple pregnancy''.     

早产儿和小于胎龄儿发生的危险因素的比较分析

目的 比较早产儿和小于胎龄儿发生的危险因素.方法 选择1 270例排除明确孕母疾病和产科危险因素的新生儿,自制调查问卷调查母亲身高、体重、被动吸烟和不良孕产史等因素,将研究对象分类为早产儿和足月儿、小于胎龄儿和适于胎龄儿,采用多因素logistic 回归分析比较早产儿和小于胎龄儿发生的危险因素.结果 孕期增重<9 kg使早产(OR=1.63,95%CI:1.12~2.07)和小于胎龄儿(OR=1.92,95%CI:1.56~2.58)发生的危险性均增高;母亲既往流产史(OR=1.46,95%CI:1.09~1.93)和早产史(OR=2.63,95%CI:1.81~3.92)是早产儿发生的的独立危险因素;孕母身高<1.55 m(OR=2.46,95%CI:1.78~3.48)、孕前BMI<18.5(OR=2.16,95%CI:1.53~3.16)、被动吸烟(OR=2.24,95%CI:1.65~2.98)是小于胎龄儿发生的的独立危险因素.结论 早产儿和小于胎龄儿的危险因素不同,针对两类特征孕妇应采取不同的预防措施,有针对性地减少两类不良妊娠结局的发生.     

单胎濒死儿发生的围生期危险因素分析（英文翻译）

目的 研究早产儿校正18~24月龄时的体格生长和神经发育水平。 方法 利用早产儿出院后随访系统,前瞻性收集2018年4月—2021年12月在暨南大学附属深圳市宝安区妇幼保健院定期随访的484例早产儿校正18~24月龄的体格生长数据和神经发育评估数据。219例足月儿作为对照。采用儿童神经心理行为检查量表2016版评估神经发育水平。根据胎龄分组（超早产儿组、极早产儿组、中期早产儿组、晚期早产儿组和足月儿组）,比较各组体格生长和神经发育水平。 结果 除中期早产儿组年龄别身长Z值高于足月儿组（P=0.038）,其余各早产儿组的体格生长指标与足月儿组比较差异均无统计学意义（均P>0.05）。各早产儿组总发育商（developmental quotient,DQ）均低于足月儿组（均P<0.05）;除社会行为能区外,超、极早产儿组其他各能区DQ均低于足月儿组（均P<0.05）;胎龄<32周早产儿全面发育迟缓发生率（16.7%）显著高于足月儿组（6.4%）（P=0.012）,全面发育迟缓发生率有随着胎龄减小而升高的趋势（P=0.026）。 结论 早产儿校正18~24月龄时体格生长可完成追赶,但神经发育水平落后于足月儿,应特别重视胎龄<32周早产儿的神经发育监测及早期干预。     

Infant mortality in Pondicherry--an analysis of a cohort of 8185 births.

Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.     

单胎濒死儿发生的围生期危险因素分析

目的 探讨单胎濒死儿发生的围生期危险因素,为濒死儿综合诊治提供依据。 方法 该研究为病例对照研究。选取2006年1月—2015年12月在复旦大学附属妇产科医院出生的154例胎龄≥28周、1 min Apgar评分为0~1分的单胎新生儿为病例组（濒死组）,按1∶4比例随机选取616例同期出生的单胎非濒死儿（1 min Apgar评分>1分）为对照组,采用单因素分析和多因素logistic回归分析评估濒死儿发生的围生期危险因素。 结果 濒死组胎龄和出生体重均显著低于对照组（P<0.05）。濒死组胎儿水肿、脐带脱垂、羊水Ⅲ度污染、胎盘早剥、臀位、重度子痫前期、母亲产时全麻、产前胎心监护异常、产前胎动减少发生比例显著高于对照组（P<0.05）。多因素logistic回归分析显示母亲产时全麻（OR=34.520）、产前胎动减少（OR=28.168）、胎盘早剥（OR=15.641）、羊水Ⅲ度污染（OR=6.365）、产前胎心监护异常（OR=5.739）、臀位（OR=2.614）是濒死儿发生的危险因素（P<0.05）,胎龄较大（OR=0.686）是濒死儿发生的保护因素（P<0.05）。 结论 临床需对产前胎心监护异常、胎动减少、早产、胎盘早剥、臀位、羊水Ⅲ度污染、全麻手术的产妇引起重视,做好新生儿复苏准备,防范濒死儿的发生。     

Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000–2006

Aim: The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates. Methods: The computed delivery room data of 11.741 liveborn singleton term neonates was used to compare malnourished and nourished newborns. Results: Of the total subjects, 577 (4.9%) were malnourished. There were no differences between the groups with regard to gender distribution, Apgar scores, maternal parity, smoking during pregnancy and type of delivery. Maternal age and neonatal gestational age (GA) were significantly lower in malnourished newborns (P < 0.001). Birthweight (BW), birth length (BL) and head circumference (HC) were significantly lower in the malnourished group compared with well‐nourished group (P < 0.001). Mean BW (g) was 2724.7 ± 17.0 in the malnourished group versus 3234.3 ± 3.8 in the well‐nourished group; BL (cm) was 47.8 ± 0.1 in malnourished versus 49.5 ± 0.0 in well‐nourished neonates; HC (cm) was 33.25 ± 0.1 in the malnourished versus 34.3 ± 0.0 in the well‐nourished group. Between the groups, there were significant differences in the ratio of small, appropriate and large for GA (P < 0.001). Of the malnourished newborns, 35.5% were small for GA, 63.3% were appropriate for GA and 1.2% were large for GA. Conclusion: Fetal malnutrition (FM) still exists despite the advances in current obstetric care. Neonates of adolescent mothers and of low GA are particularly at risk for FM. The BW, BL and HC of fetally malnourished neonates are lower than that of well‐nourished neonates. Like term singleton appropriate and small for GA neonates, term singleton large for GA neonates could also have been fetally malnourished.     

A comparison of three scoring systems for mortality risk among retrieved intensive care patients

Aims: To assess the impact of two paediatric intensive care unit retrieval teams on the performance of three mortality risk scoring systems: pre-ICU PRISM, PIM, and PRISM II. Methods: A total of 928 critically ill children retrieved for intensive care from district general hospitals in the south east of England (crude mortality 7.8%) were studied. Results: Risk stratification was similar between the two retrieval teams for scores utilising data primarily prior to ICU admission (pre-ICU PRISM, PIM), despite differences in case mix. The fewer variables required for calculation of PIM resulted in complete data collection in 88% of patients, compared to pre-ICU PRISM (24%) and PRISM II (60%). Overall, all scoring systems discriminated well between survival and non-survival (area under receiver operating characteristic curve 0.83–0.87), with no differences between the two hospitals. There was a tendency towards better discrimination in all scores for children compared to infants and neonates, and a poor discrimination for respiratory disease using pre-ICU PRISM and PRISM II but not PIM. All showed suboptimal calibration, primarily as a consequence of mortality over prediction among the medium (10–30%) mortality risk bands. Conclusions: PIM appears to offer advantages over the other two scores in terms of being less affected by the retrieval process and easier to collect. Recalibration of all scoring systems is needed.