A review of issues surrounding medically elective cesarean delivery

The rate of cesarean delivery has increased dramatically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth.     

Sex selective feticide in India

Regarding sex selective abortion in India, all are aware of exclusive female disadvantage. And yet few study reported sizeable selective male feticide as such. This exercise reveals that: (1) the age-old son-preference has slightly declined on the end of the twentieth century, and (2) a substantial selective male feticide are also being committed annually, of course, along with larger selective female feticide.     

利用信息技术提高河南省出生缺陷防治管理水平

目的 总结通过信息平台,提高出生缺陷防控水平的经验和挑战.方法 回顾性总结系统中出生缺陷三级预防措施落实,沿胎儿生命周期获取功能和代谢障碍缺陷个案的数据并进行总结分析.结果 平台促进了出生缺陷三级预防措施落实.系统包括11 912例有遗传病或缺陷儿家族史的孕妇信息,433例染色体和基因异常胎儿产前诊断记录,7977例结...     

Vitamin D Metabolite Ratio in Pregnant Women with Low Blood Vitamin D Concentrations Is Associated with Neonatal Anthropometric Data

Existing evidence on the correlation between maternal vitamin D concentrations and birth outcomes is conflicting. Investigation of these associations requires accurate assessment of vitamin D status, especially in individuals with low 25-hydroxyvitamin D (25(OH)D) concentrations. This study examined the correlations between birth outcomes and the maternal vitamin D metabolite ratio (VMR) 1 (defined as the ratio of 24,25(OH)₂D₃ to 25(OH)D) and VMR2 (defined as the ratio of 3-epi-25(OH)D₃ to 25(OH)D) using data from the Japan Environment and Children’s Study at Chiba Regional Center. A total of 297 mother–neonate pairs were analyzed. Using liquid chromatography–tandem mass spectrometry, we measured 25(OH)D₂, 25(OH)D₃, 24,25(OH)₂D₃, and 3-epi-25(OH)D₃ concentrations in maternal serum samples. These data were analyzed in relation to birth anthropometric data using multivariable linear regression. Of the study participants, 85.2% showed insufficient vitamin D concentrations. VMR1 was strongly correlated with 25(OH)D concentrations, whereas VMR2 showed a weak correlation. Only VMR2 was associated with all anthropometric data. VMR2 in pregnant women with low vitamin D blood concentrations is a useful marker for neonatal anthropometric data and is independent of 25(OH)D. Accurate measurement of vitamin D metabolites could help better understand the effects of vitamin D on birth outcomes.     

Application of Machine Learning Approaches to Predict Postnatal Growth Failure in Very Low Birth Weight Infants

PurposeThe aims of the study were to develop and evaluate a machine learning model with which to predict postnatal growth failure (PGF) among very low birth weight (VLBW) infants.Materials and MethodsOf 10425 VLBW infants registered in the Korean Neonatal Network between 2013 and 2017, 7954 infants were included. PGF was defined as a decrease in Z score >1.28 at discharge, compared to that at birth. Six metrics [area under the receiver operating characteristic curve (AUROC), accuracy, precision, sensitivity, specificity, and F1 score] were obtained at five time points (at birth, 7 days, 14 days, 28 days after birth, and at discharge). Machine learning models were built using four different techniques [extreme gradient boosting (XGB), random forest, support vector machine, and convolutional neural network] to compare against the conventional multiple logistic regression (MLR) model.ResultsThe XGB algorithm showed the best performance with all six metrics across the board. When compared with MLR, XGB showed a significantly higher AUROC (p=0.03) for Day 7, which was the primary performance metric. Using optimal cut-off points, for Day 7, XGB still showed better performances in terms of AUROC (0.74), accuracy (0.68), and F1 score (0.67). AUROC values seemed to increase slightly from birth to 7 days after birth with significance, almost reaching a plateau after 7 days after birth.ConclusionWe have shown the possibility of predicting PGF through machine learning algorithms, especially XGB. Such models may help neonatologists in the early diagnosis of high-risk infants for PGF for early intervention.     

Advanced parental age is an independent risk factor for term low birth weight and macrosomia

We aimed to investigate association between parental age and the risks of term low birth weight and macrosomia.This was a retrospective cohort study using a national database including 2,245,785 term singleton live births with complete parental age data. Old parental age was defined as 35 years or older. Odd ratios (OR) for term low birth weight and macrosomia were analyzed using univariate and multivariate logistic regression analysis.Neonatal sex, maternal occupation, parity, nationality, age, and paternal age were significant factors of term low birth weight and macrosomia, in univariate analysis. In multivariate analysis, old maternal age (≥35 years old) showed increased odds of term low birth weight and macrosomia (aOR = 1.122, 95% CI: 1.083 –1.162; and aOR = 1.166, 95% CI: 1.143 – 1.189, respectively). Similarly, old paternal age (≥35 years old) showed increased odds of term low birth weight and macrosomia (aOR = 1.090, 95% CI: 1.058 –1.122; and aOR = 1.101, 95% CI: 1.083 – 1.119, respectively). Maternal education that lasted more than 12 years had reduced odds of term low birth weight and macrosomia (OR = 0.817, 95% CI: 0.792 –0.842; and OR = 0.894, 95% CI: 0.879 – 0.91, respectively). Paternal education that lasted more than 12 years also had reduced odds of term low birth weight and macrosomia (OR = 0.865, 95% CI: 0.84 –0.892; and OR = 0.897, 95% CI: 0.881 – 0.913, respectively).This study suggests that not only maternal age but also paternal age are significantly associated with term low birth weight and macrosomia. In addition, parental education levels are also associated with term low birth weight and macrosomia.     

完全性房室隔缺损的手术治疗(附36例报告)

目的探讨完全性房室隔缺损的治疗方法。方法在中度低温体外循环下采用双补片法修复36例完全性房室隔缺损。结果手术死亡2例,余患者术后均恢复为窦性心律,无完全性房室传导阻滞。复查心脏彩超二尖瓣轻度反流8例,中度反流2例。结论完全性房室隔缺损应尽早手术。双补片法效果较好。术中应注意预防左室流出道狭窄和矫治二尖瓣关闭不全。     

深圳市龙岗区2009-2014年围产儿出生缺陷监测资料分析

目的 了解深圳市龙岗地区围产儿出生缺陷的发生情况及影响因素,为制定针对性干预措施、降低出生缺陷提供依据.方法 依照《中国出生缺陷监测方案》,将深圳市龙岗区妇幼保健信息系统中监测的2009至2014年围产儿出生缺陷资料导出后进行回顾性分析.结果 深圳市2009-2014年围产儿出生缺陷总的发生率为15.12‰,发生率呈逐年上升趋势(趋势x2=114.23,P＜0.001),其中产前确诊占10.39％,产后确诊占89.02％.6年间出生缺陷发生率前5位依次为:先天性心脏病、多指(趾)、马蹄内翻足、外耳其他畸形、唇裂合并腭裂.男婴和女婴出生缺陷发生率有显著性差异(x2=57.914,P＜0.001),不同户籍类型的产妇出生缺陷发生率也有显著性差异(x2=8.518,P=0.014).开展免费筛查和诊断前后引产孕周的差异有统计学意义(t=4.127,P＜0.001).结论 龙岗区近几年出生缺陷发生率逐年增多,尤其以先天性心脏病增长比例最高,因此应制定一、二级预防措施,加强宣传教育,加强婚前、孕前保健,重视产前筛查和产前诊断,降低出生缺陷率.     

Gut Microbiome Changes Occurring with Norovirus Infection and Recovery in Infants Enrolled in a Longitudinal Birth Cohort in Leon,Nicaragua

Noroviruses are associated with one fifth of diarrheal illnesses globally and are not yet preventable with vaccines. Little is known about the effects of norovirus infection on infant gut microbiome health, which has a demonstrated role in protecting hosts from pathogens and a possible role in oral vaccine performance. In this study, we characterized infant gut microbiome changes occurring with norovirus-associated acute gastroenteritis (AGE) and the extent of recovery. Metagenomic sequencing was performed on the stools of five infants participating in a longitudinal birth cohort study conducted in León, Nicaragua. Taxonomic and functional diversities of gut microbiomes were profiled at time points before, during, and after norovirus infection. Initially, the gut microbiomes resembled those of breastfeeding infants, rich in probiotic species. When disturbed by AGE, Gammaproteobacteria dominated, particularly Pseudomonas species. Alpha diversity increased but the genes involved in carbohydrate metabolism and glycan biosynthesis decreased. After the symptoms subsided, the gut microbiomes rebounded with their taxonomic and functional communities resembling those of the pre-infection microbiomes. In this study, during disruptive norovirus-associated AGE, the gut microbiome was temporarily altered, returning to a pre-infection composition a median of 58 days later. Our study provides new insights for developing probiotic treatments and furthering our understanding of the role that episodes of AGE have in shaping the infant gut microbiome, their long-term outcomes, and implications for oral vaccine effectiveness.