Experience in the screening of Streptococcus group B infection during pregnancy: can severe neonatal infection be prevented?

INTRODUCTION, OBJECT: GBS has been responsible for most cases of severe perinatal infection in the last few decades. 10-30% of women is colonised; the vertical transmission is approximately 50% with pregnant carriers. Since the bacterium is responsible for approximately 50% of perinatal sepsis's, and the same time patients may recover with severe residual symptoms, prevention is of great importance. METHOD: The authors screened 1762 out of 2214 women before giving birth at the Obst. and Gyn. Ward of the St. Jones Hosp. and the Obst. and Gyn. Ward of Semmelweis University Kútv?lgyi Clinic between May. 1998 and Dec. 1999 following the recommendations issued in 1992 and modified in 1997 by the Committee on Infectious Diseases and the Committee on Fetus and Newborn. RESULTS: The rate of positive cultures was approximately 10%, and the rate of colonised newborn was 1.36%. No severe diseases with residual symptoms were recorded during the period of examination. CONCLUSIONS: On the bases of the international literature and their own experiences the authors recommend the GBS screening and prophylaxis by antibiotics based on positive cultures and risk factors.     

Optimizing treatment for the prevention of pre-eclampsia/eclampsia in Nepal: is calcium supplementation during pregnancy cost-effective?

Background

In Nepal, pre-eclampsia/eclampsia (PE/E) causes an estimated 21% of maternal deaths annually and contributes to adverse neonatal birth outcomes. Calcium supplementation has been shown to reduce the risk of PE/E for pregnant women and preterm birth. This study presents findings from a cost-effectiveness analysis of a pilot project, which provided calcium supplementation through the public sector to pregnant women during antenatal care for PE/E prevention as compared to existing PE/E management in Nepal.

Methods

Economic costs were assessed from program and societal perspectives for the May 2012 to August 2013 analytic time horizon, drawing from implementing partner financial records and the literature. Effects were calculated as disability-adjusted life years (DALYs) averted for mothers and newborns. A decision tree was used to model the cost-effectiveness of three strategies delivered through the public sector: (i) calcium supplementation in addition to the existing standard of care (MgSO₄); (ii) standard of care, and (iii) no treatment. Uncertainty was assessed using one-way and probabilistic sensitivity analyses in TreeAge Pro.

Results

The costs to start-up calcium introduction in addition to MgSO₄ were $44,804, while the costs to support ongoing program implementation were $72,852. Collectively, these values correspond to a program cost per person per year of $0.44. The calcium program corresponded to a societal cost per DALY averted of $25.33 ($25.22–29.50) when compared against MgSO₄ treatment. Primary cost drivers included rate for facility delivery, costs associated with hospitalization, and the probability of developing PE/E. The addition of calcium to the standard of care corresponds to slight increases in effect and cost, and has a 84% probability of cost-effectiveness above a WTP threshold of $40 USD when compared to the standard of care alone.

Conclusions

Calcium supplementation for pregnant mothers for prevention of PE/E provided with MgSO₄ for treatment holds promise for the cost-effective reduction of maternal and neonatal morbidity and mortality associated with PE/E. The findings of this study compare favorably with other low-cost, high priority interventions recommended for South Asia. Additional research is recommended to improve the rigor of evidence available on the treatment strategies and health outcomes.

     

Asthma-like symptoms in the first year of life and health-related quality of life at age 12 months: the Generation R study

Purpose  

This study compares HRQOL among subgroups of infants with asthma-like symptoms to a subgroup without such symptoms and examines independent associations between asthma-like symptoms during the first year of life and HRQOL at age 12 months.     

Does low maternal blood pressure during pregnancy increase the risk of perinatal death?

BACKGROUND: A recent report described an association between low maximum diastolic blood pressure (DBP) during pregnancy and perinatal death (stillbirth and death in the first week combined). The authors did not account for gestational length, a strong predictor of perinatal death. METHODS: We studied 41,089 singleton pregnancies from the U.S. Collaborative Perinatal Project (1959-1966). RESULTS: We observed an association between low maximum DBP and elevated risk of perinatal death. However, this association disappeared after accounting for reverse causation related to gestational length. At any given gestational week, women whose offspring ultimately experienced perinatal death did not have significantly lower maximum DBP than women whose offspring survived the perinatal period. When accounting for the trend of increasing DBP during late pregnancy through gestational-age-specific DBP standardized score, we saw no association between low diastolic blood pressure and perinatal death. CONCLUSIONS: Low maximum maternal DBP during pregnancy is a post hoc correlate of perinatal death, not a true risk factor.     

Assessing the operational costs of routine immunization activities at the sub-center level in Myanmar: What matters for increasing national immunization coverage?

BackgroundMyanmar’s national immunization program was launched in 1978. Routine immunization is mainly provided at sub-center level with midwives assigned as main vaccinators. The vaccinators at the sub-centers have to obtain vaccines from their designated township health department’s cold room for immunization services. This study aimed to calculate the operational costs of routine immunization at sub-centers in Myanmar.MethodsA cross-sectional study was conducted among 160 sub-centers throughout the country. Face-to-face interviews were conducted with the main vaccinator at each sub-center using a pre-tested questionnaire. The study analyzed the operational costs per facility and the associations between sub-center characteristics and operational costs.ResultsIn Myanmar, the average operational costs of routine immunization per sub-center ranged from 434,700–990,125 MMK for rural areas and 235,875–674,250 MMK for urban areas. The operational costs increased by 8,749.50 MMK (95% CI: 6,805.79–10,693.21; p < 0.001) per mile and 5,752.50 MMK (95% CI: 914.22–10,590.79; p < 0.05) per working day.ConclusionThis study indicated that the operational costs at sub-centers were high and varied significantly among the different geographical areas. The operational costs could be reduced by additional support for the resources, for example, installing cold chain facilities at sub-centers and opening new sub-centers throughout the country.     

Does maternal nutrition in pregnancy and birth weight influence levels of CHD risk factors in adult life?

The fetal-origins hypothesis suggests that maternal and fetal nutrition can have a profound and sustained impact on the health of the offspring in adult life. Although there is abundant literature reporting on the associations between birth weight and disease risk factors, only a handful of studies have been able to examine the relationship between maternal nutrition in pregnancy with the health of offspring in adult life directly. Between 1942 and 1944, nearly 400 pregnant women were recruited into a dietary study to determine whether the wartime dietary rations were sufficient to prevent nutritional deficiencies. Detailed biochemical and clinical assessments were conducted for each of the women, who were followed-up until after delivery. More than 50 years later, approximately one-quarter of the adult offspring were recruited into a study to explore the possible impact of maternal nutrition in pregnancy on CHD risk factors, including glucose tolerance, blood pressure and components of the lipid profile. Results from the present study provide no evidence to support the hypothesis that birth weight or maternal nutrition in pregnancy are associated with CHD risk factors in adult life.     

Vaccinations in the first year of life and risk of atopic disease – Results from the KiGGS study

BackgroundThe study focused on the question of whether and – if so – to what direction and extent immunisations in the 1st year may be associated with the risk of being diagnosed with atopic diseases after the 1st year of life.MethodsData from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003–2006) were analysed. For analyses of potential associations between vaccination status and risk of hay fever, atopic dermatitis or asthma, sample sizes of 15254, 14297, and 15262, respectively, were available.ResultsChildren with a sufficient TDPHiHeP vaccination at the end of the 1st year of life had a lower risk of being diagnosed with hay fever after the 1st year of life (adjusted prevalence ratio 0.85, 95% confidence interval 0.76–0.96). Analyses for associations between TDPHiHeP vaccination and risk of atopic dermatitis or asthma, or between age at onset of vaccination or of the number of antigens vaccinated in the 1st year of life and risk of atopic disease failed to yield statistical significance.ConclusionsOur results provide no evidence that immunisations in the 1st year of life may increase the risk of atopic disease. If any association exists at all, our results may be interpreted as weakly supportive of the hypothesis that immunisations may slightly decrease the risk of atopy in later life.     

Why infants miss vaccination during routine immunization sessions? Study in a rural area of Anand District, Gujarat

A cross-sectional study was conducted in a rural area of Anand District, Gujarat to measure the efficiency of immunization sessions and to identify the reasons for missing a vaccine in a session. Caregivers of infants aged less than one year and in need of any vaccine as per routine immunization schedule were interviewed by a house-to-house survey after immunization session was completed. Efficiency of immunization session was 66.7%. Reasons for 'missed' vaccination were prior reminder not given (32.9%, P<0.01); mother's forgetfulness (26.6%); unavailability of vaccine (15%). Higher birth order (OR=2.86; 3.16-2.56), mother's current residence at father's home (OR=3.17; 3.53-2.81) were associated with 'missed' vaccination. There are barriers in health care system such as lack of prior reminder and unavailability of vaccines which should be assessed and eliminated.     

Does salt intake in the first two years of life affect the development of cardiovascular disorders in adulthood?

Excess salt intake impacts on blood pressure (BP) and the pathogenetic mechanisms of atherosclerosis predisposing to stroke and other cardiovascular disorders. The influence of salt starts early in life. Two randomized controlled trials in newborn infants suggest a direct association between dietary sodium intake and BP since the first few months of life. Newborn infants display aversion to the salt taste to develop a "preference" for salt only at age 2-3 years, in part in relation to post-natal events: this preference might be associated with later development of hypertension. The amount of sodium to be retained by an infant for proper physiological growth is largely covered by breast feeding (or low sodium formula milk) in the first six months, and later on by the gradual implementation of complementary feeding, without the need for any added salt upon food preparation. Given the lack of dose-dependence data, reference nutrient intakes (RNI) or adequate intakes (AI) for sodium have been established by national health institutions in various countries. The U.K. RNI was set at 242?mg a day for infants 0-6 months with gradual increase to?0.5?g up until age 3. The U.S. AI is somewhat lower for age 0-6 months but larger for age 1-3 years. According to a recent report, the average sodium intake in U.S. children is close to the AI up to age 2 years, to become progressively greater exceeding the Institute of Medicine recommendation later on.     

Vaccination with the CHAT strain of attenuated poliomyelitis virus in L��opoldville, Congo: 3. Safety and efficacy during the first 21 months of study

Between August 1958 and April 1960 nearly all children less than five years old in Léopoldville were orally vaccinated with the CHAT, type 1, attenuated poliovirus strain of Koprowski. In a previous report, the first nine months of the campaign were reviewed and tentative conclusions were drawn concerning the safety and efficacy of the vaccine. The present paper is a report on a further twelve-month period of observation. Additional epidemiological data and virological studies, including the use of virus markers for assessing the safety of the attenuated strain, lend added support to the earlier conclusions. Of particular interest were the results of virus isolations from patients with paralytic poliomyelitis, there being an apparent shift in the predominant causative agent from type 1 to type 3 poliovirus concomitant with the completion of the type 1 vaccination campaign.     

Does maternal diet during pregnancy and lactation affect outcomes in offspring? A systematic review of food-based approaches

ObjectivesThe aim of this study was to investigate the relationship between maternal diet during pregnancy and lactation and development of atopic disorders in childhood.MethodsWe included studies published up to August 2011 that assessed food-based maternal dietary interventions or that examined associations between maternal dietary intake during pregnancy and/or lactation and allergic outcomes (eczema, asthma, hay fever, and sensitization) in their children.ResultsWe included 42 studies (>40 000 children): 11 intervention studies (including 7 randomized control trials), 26 prospective cohort studies, 4 retrospective cohort studies, and 1 case–control study. In the randomized control trials, no significant difference was noted overall in the prevalence of eczema and asthma in the offspring of women on diets free from common food allergens during pregnancy. The prospective cohorts investigated a large number of potential associations, but reported few significant associations between maternal dietary intake and development of allergy. Maternal diets rich in fruits and vegetables, fish, and foods containing vitamin D and Mediterranean dietary patterns were among the few consistent associations with lower risk for allergic disease in their children. Foods associated with higher risk included vegetable oils and margarine, nuts, and fast food.ConclusionThis review did not find widespread or consistent links between mothers' dietary intake and atopic outcomes in their children. However, maternal consumption of Mediterranean dietary patterns, diets rich in fruits and vegetables, fish, and vitamin D-containing foods were suggestive of benefit, requiring further evaluation.     

Mothers of infants with congenital heart defects: well-being from pregnancy through the child’s first six months

Purpose  

This study compared the well-being among mothers of children with congenital heart defects (CHD) with mothers of children without CHD (controls), at pregnancy and at 6 months postpartum.     

Is carbohydrate intake in the first years of life related to future risk of NCDs?

Studies on children's carbohydrate intake, especially fibre intake, and its associations with later health are rare. The current recommendations for fibre intake in children are based on average assumptions and data extrapolated from intakes in adults. Generally, increase in whole-grain consumption and decrease in sucrose intake are considered healthy. Due to fibre's high bulk volume however, excessive dietary fibre has been feared to decrease energy density have effects on growth, at least in developing countries and in children consuming very restricted diets. Furthermore, it has been speculated that if fats are reduced from the diet, it may become high in sucrose. In STRIP study, which is a long-term, randomized controlled trial designed to decrease the exposure of children to known risk factors of atherosclerosis, carbohydrate intakes have been investigated in detail in children aged 13 months to 9 years. The intervention was successful in decreasing saturated fat intake and cholesterol concentrations throughout childhood and adolescence. The study results also show that a higher than average fibre intake does not displace energy or disturb growth in children and that children with high fibre intake have better dietary quality than those with low fibre intake. Dietary fibre intake associated with lower serum total cholesterol concentrations whereas increases in total carbohydrate, sucrose and fructose intakes associated with increases in serum triglyceride concentrations. In conclusion, from the point of view of CHD risk factor prevention, efforts aiming at increasing the fibre intake while restricting that of refined sugar seem justified in the child population in developed countries. Clinical Trial Registration Information: NCT00223600.     

Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring?

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring’s obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3–17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.     

Finke's 1792 map of human diseases: the first world disease map?

Documentary evidence reveals that a German physician L.L. Finke produced a world map of diseases in 1792. This is much earlier than any world disease map previously known. Contrary to the contemporary literature in medical cartography this data proves that: (1) It was neither yellow fever nor cholera epidemics but indigenous diseases that were the catalyst for this earlier world disease map. (2) It predates Humboldt's influence on thematic mapping.     

Vaccination coverage in the first year of life in 4 cities of the state of S?o Paulo, Brazil]

Immunization is an important disease prevention measure, and evaluating the effectiveness of immunization programs is crucial to ensuring their success. This study describes the results of a household survey in four cities in the state of S?o Paulo, Brazil: Francisco Morato, Guarulhos, Osasco, and S?o Paulo. The survey was done in order to estimate immunization coverage for the cohort of children born in 1996. The city of S?o Paulo was divided into five strata, according to socioeconomic and living conditions. The survey followed the methodology that the Pan American Health Organization recommends for immunization coverage surveys. The proportion of children who had received a complete set of the recommended vaccinations at the time of the interview, taking into account both oral reports and information recorded on the children's immunization cards, was above 90% for all the cities except Francisco Morato, which had the worst living conditions. In the city of S?o Paulo, the worst coverage was found in the lowest and highest strata. When only the doses received during the first year of life were considered, the coverage was not adequate to produce herd immunity. The use of private vaccination services was higher in the areas with better living conditions. The difference between the coverage calculated based on data from health services and the coverage calculated based on the survey was inversely proportional to living conditions. Our results suggest that surveys similar to the one described here should be carried out in other cities. Employees who provide vaccination services should be trained to correctly record vaccination data. In addition, it is important to make health professionals aware of the official immunization calendar, and to facilitate the public's access to health services.     

Hormone levels in children during the first week of ICU-admission: is there an effect of adequate feeding?

BACKGROUND & AIMS: To evaluate the course of hormonal parameters in relation to clinical parameters, illness severity and nutritional intake in children admitted to the pediatric ICU during the first week of admission. METHODS: Prospective, observational study. Levels of triiodothyronine (T3), reverse T3 (rT3), ratio T3/rT3 and insulin-like growth factor I (IGF-1) were evaluated in 84 critically ill children (50 term neonates and 34 children aged 32 d-15 yr) admitted to our multidisciplinary tertiary pediatric intensive care unit within 24 h after admission, on days 4 and 6 after admission. Changes in hormones levels over time were related to illness severity, C-reactive protein-levels and the adequacy of feeding. RESULTS: For both age groups IGF-1 levels remained low until day 4, but at day 6 IGF-1 levels were significantly higher than admission level. In 88% and 89% of the older children, T3 levels remained below normal at days 4 and 6, respectively. In both age groups, rT3 levels declined significantly over time, whereas the ratio T3/rT3 increased. The increases in IGF-1, T3 and ratio T3/rT3 and decrease in rT3 were significantly associated with decreases in CRP-levels. No significant relations were found between changes in IGF-1 and thyroid hormone levels during admission and the adequacy of energy and protein intake. CONCLUSIONS: During the first week of ICU-admission, abnormalities in levels of IGF-1, T3 and rT3 were frequently observed in critically ill children, especially in the children aged >1 month. The adequacy of feeding did not seem to affect the normalization of IGF-1 and thyroid hormone levels.