Addressing perinatal health inequities in Dutch municipalities: Protocol for the Healthy Pregnancy 4 All-3 programme

BackgroundHealth inequities are already present at birth and affect individuals’ health and socioeconomic outcomes across the life course. Addressing these inequities requires a cross-sectoral approach, covering the first 1,000 days of life. We believe that - in the Dutch context - municipal governments can be the main responsible actor to drive such an approach, since they are primarily responsible for organising adequate public health. Therefore, we aim to identify and develop transformative change towards the implementation of perinatal health into municipal approaches and policies concerning health inequities.MethodsA transition analysis will be combined with action research in six Dutch municipalities. Interviews and interactive group sessions with professionals and organisations that are relevant for the institutional embedding of perinatal health into approaches and policies regarding health inequities, will be organised in each municipality. As a follow-up, a questionnaire will be administered among all participants one year after completion of the group sessions.DiscussionWe expect to gain insights into the role of municipalities in addressing perinatal health inequities, learn more about the interaction between different key stakeholders, and identify barriers and facilitators for a cross-sectoral approach to perinatal health. This knowledge will serve to inform the development of approaches to perinatal health inequities in areas with relatively poor perinatal health outcomes, both in the Netherlands and abroad.     

2014-2018济南市522437例围产儿出生缺陷发生情况分析

目的 了解近5年济南市出生缺陷发生情况,为政府部门制定针对性的防控措施提供依据。方法 利用济南市妇幼信息平台收集出生缺陷相关信息,分析出生缺陷发生率、发生顺位变化趋势。结果 2014-2018年济南市出生缺陷平均发生率为136.02/万,发生率最高的年份为2017年（183.87/万）,发生率最低的年份为2014年（99.63/万）总体呈上升趋势（Z=185.153,P<0.05）。男性围产儿缺陷发生率为152.79/万,女性围产儿缺陷发生率为117.34/万。出生缺陷围产儿的母亲发生年龄分布呈“U”型,20岁以下低年龄段和35岁以上高年龄段发生率较高,其中2014年、2015年20岁以下年龄段发生率最高,2016、2017、2018年35岁以上年龄段发生率最高;主要出生缺陷病种为先天性心脏病、多指/趾、总唇裂、并指/趾、尿道下裂,其中先天性心脏病发病率逐年上升（Z=223.604,P<0.05）。结论 济南市出生缺陷发生率呈逐年上升趋势,应特别关注低年龄段人群,重点关注先天性心脏病的防控工作。     

Immune non-interference and safety study of Vi-DT typhoid conjugate vaccine with a measles,mumps and rubella containing vaccine in 9–15 months old Nepalese infants

BackgroundTyphoid fever is a common disease in developing countries especially in the Indian subcontinent and Africa. The available typhoid conjugate vaccines (TCV) have been found to be highly immunogenic in infants and children less than 2 years of age. Many countries are planning to adopt TCV in their routine EPI programs around 9 months of age when measles containing vaccines are given. Therefore, Vi-DT TCV was tested in 9–15 months aged healthy infants in Nepal to demonstrate non-interference with a measles containing vaccine.MethodsThis was a randomized, open label, phase III study to assess the immune non-interference, safety, and reactogenicity of Vi-DT typhoid conjugate vaccine when given concomitantly with measles, mumps and rubella (MMR) vaccine. A total of 360 participants aged 9–15 months were enrolled and randomized equally into Vi-DT + MMR (180 participants) or MMR alone (180 participants) group and were evaluated for immunogenicity and safety 28 days post vaccination.ResultsUsing the immunogenicity set, difference between proportions (95% CI) of the Vi-DT + MMR group vs MMR alone group were ?2.73% (-8.85, 3.38), ?3.19% (-11.25, 4.88) and 2.91% (-3.36, 9.18) for sero-positivity rate of anti-measles, anti-mumps and anti- rubella, respectively. Only the lower bound of the range in difference of the proportions for sero-positivity rate of anti-mumps did not satisfy the non-inferiority criteria as it was above the ?10% limit, which may not be of clinical significance. These results were confirmed in the per protocol set. There were no safety concerns reported from the study and both Vi-DT + MMR and MMR alone groups were comparable in terms of solicited and unsolicited adverse events .ConclusionsResults indicated that there is non-interference of MMR vaccine with Vi-DT and Vi-DT conjugate vaccine could be considered as an addition to the EPI schedule among children at risk of contracting typhoid.     

Urinary endothelin excretion in the neonate: influence of maturity and perinatal pathology

The present study was undertaken to establish the developmental pattern of urinary endothelin-1 (ET-1) excretion and to define its possible role in mediating pathophysiological changes related to perinatal asphyxia/infection and dopamine treatment. Urinary ET-1 levels were measured by radioimmunoassay in 7 full-term neonates (mean gestational age 39.3 weeks) on days 1, 3 and 5, and in 9 pre-term neonates (mean gestational age 30.8 weeks) on days 1, 3, 5, 7 and weekly thereafter for 5 consecutive, weeks. The results were compared with those of three age-groups of 30 normal children (4–8 years, 9–12 years and 13–18 years); each group, consisted of 10 children. The influence of severe cardiopulmonary distress (n=16, mean gestational age 33.9 weeks, post-natal age 3.3 days) and dopamine administration in a dose of 2 g/min per kg (n=10, mean gestational and post-natal ages 32.1 weeks and 5.6 days, respectively) were also studied. In full-term infants, ET-1 concentration fell from 34.3±1.8 pmol/l on day 1 to 21.5±1.5 pmol/l on day 5 (P<0.01). In premature infants its absolute value and its post-natal fall were similar in the 1st week and no further change occurred in weeks 2–5; it stabilized at levels between 17.1±2.2 and 16.7±1.7 pmol/l. These concentrations tended to be lower than those of 25.5±1.3, 23.0±1.0 and 26.2±0.7 pmol/l measured in three groups of older children. During the 1st week, daily ET-1 excretion remained unchanged in term infants (3.1±1.0 vs. 3.7±1.5 pmol/m² per day), but there was a significant increase from 6.5±1.0 to 12.4±0.7 pmol/m² per day (P<0.01) in premature infants. During weeks 2–5, preterm infants excreted more ET-1 than older children (P<0.01). In response to perinatal ashphyxia/infection and dopamine therapy, urinary ET-1 excretion markedly rose and there was a significant positive correlation between urine flow rate and ET-1 excretion (P<0.001). We conclude that ET-1 concentration rather than excretion rate may have a role in mediating the changes in renal functions that occur soon after birth. The pathophysiological significance of the flow-dependent increase in urinary ET-1 excretion needs to be further studied.     

Factors influencing birth weight in newborns of diabetic and non-diabetic women a population based study

Maternal diabetes is known to be related to an increase in birth weight of the offspring. However, the mechanism of the association is not entirely clear. In addition, the contribution of the demographic, obstetric and metabolic factors to birth weight in diabetic mothers is not well defined. All the diabetic women (68 requiring insulin-treatment and 403 on diet alone) and a random sample of 1 in 12 of all non-diabetic women (893 women) who delivered in one regional hospital between March 1987 and June 1988 inclusive, were included in the study. Tests for gestational diabetes are routinely performed in our pregnant women population, thus, the study is a population based one. The mean birth weight of infants of diabetic mothers adjusted for gestational age was higher than in those of non-diabetic mothers. However, no relationship was found between maternal glycosylated hemoglobin measured at delivery and the infants birth weight. Furthermore, at each week of gestation, infants born to diabetic mothers were heavier than the infants of non-diabetic mothers (for weeks 37 to 40, p < 0.05), while no differences were found in glycosylated hemoglobin levels between the two groups at any time. In a multivariate model we showed that after controlling for gestational age, the only factors which independently and significantly affected birth weight in our population were diabetes, ethnic origin, and the parity of the mother. Our findings support the possibility that substances which induce hyperinsulinemia, other than glucose, may be related to the higher birth weight of infants of diabetic mothers.     

围产期缺氧对新生儿脐血氧自由基的影响及意义

目的:探讨围产期缺氧而Apgar评分≥8分的新生儿脐血中氧自由基的变化情况。方法:以同期正常新生儿作对照,搜集围产期缺氧而生后Apgar评分≥8分的新生儿脐血,测定脐血中的超氧化物歧化酶(SOD)、过氧化物酶(GPX)及丙二醛(MDA)的含量。结果:围产期缺氧能引起新生儿脐血中SOD及MDA显著意义的改变;GPX有一定程度的降低,与对照组比较无差异。结论:围产期缺氧能够造成氧自由基的生成增多和抗氧化酶的消耗,即使生后Apgar评分≥8分的新生儿,亦应加强监护,及时补充外源性抗氧化剂以预防缺氧后的多器官系统损伤。     

10年早产儿及新生儿结果分析

目的 探讨早产儿的发生因素和对母儿的影响及防治。方法 收集１９８９年１月至１９９８年１２月,１０年中我院住院分娩的全部早产病例８１６例,按产５年和后５年分为两组进行回顾性分析。结果 前组早产数为５３４例,早产发生率为３．２０％;后组早产数为２８２例,发生率为３．０５％,两组发生率对比无统计学差异（Ｐ〉０．０５）。其流行病学调查显示在职业、流动人口数和产前检查方面两组对比有极其显著性差异（Ｐ〈０．０     

Chronic dialysis in the infant less than 1 year of age

Dialysis in the infant carries a mortality rate of 16%. Institution of dialysis may be the result of adequate nutritional intake, but avoidance of nutritional intake should never be seen as a way to prevent dialysis. Increased caloric intake, usually via enteral feeding tubes, is needed for optimal growth in the infant with end-stage renal disease (ESRD) in order to attain adequate nutrition with resulting good growth. Renal formulae may be constituted as dilute (as in thepolyuric infant) or concentrated (as in theanuric infant) to fit the infants needs. Peritoneal dialysis (PD) is the usual mode of renal replacement therapy (97%), with access via a surgically placed cuffed catheter with attention to the placement of the exit site in order to avoid fecal or urinary contamination. PD volumes of 30–40 ml/kg per pass or 800–1,200 ml/m² per pass usually result in dialysis adequacy. Additional dietary sodium (3–5 mEq/kg per day) and protein (3–4 g/kg per day) are needed, due to sodium and protein losses in the dialysate. Protein losses are associated with significant infectious morbidity and nonresponsiveness to routine immunizations. Hemodialysis (HD) can be performed either as single- or dual-needle access that have minimal dead space (less then 2 ml) and recirculation rate (less then 5%). Attnetion to extracorporeal blood volume (<10% of=" intravascular=" volume),=" blood=" flow=" rates=" (3–5=" ml/kg=" per=" min),=" heparinization=" (activated=" clotting=" times),=" ultrafiltration=" (ultrafiltration=" monitor),=" and=" temperature=" control=" is=" imperative=" during=" each=" treatment.=" because=" infants'=" nutrition=" is=" mostly=" fluid,=" hd=" may=" be=" needed=" 4–6=" days/week=" (especially=" in=" the=" oligoanuric=" infant)=" to=" avoid=" excessive=" volume=" overload=" between=" treatments.=" at=" the=" end=" of=" the=" treatment=" a=" slow=" blood=" return=" with=" minimal=" saline=" rinse=" is=" needed=" to=" avoid=" hemodynamic=" compromise.=" infant=" dialysis,=" although=" technically=" challenging=" with=" a=" significant=" morbidity=" and=" mortality=" rate,=" can=" be=" safely=" carried=" out=" in=" the=" infant=" with=" esrd=" but=" requires=" infant-specific=" equipment=" and=" trained=">     

Intracerebral haemorrhages in surfactant treated neonates with severe respiratory distress syndrome: age at diagnosis,severity and risk factors

Within a randomized European multicentre trial the time of onset, severity and progression of intracerebral haemorrhages (ICH) were investigated prospectively by serial cranial ultrasonography in 343 ventilated infants with severe respiratory distress syndrome (RDS) following instillation of single or multiple doses of a natural porcine surfactant (Curosurf). In 148/343 infants (43%) ICH was diagnosed (grade I or II: 22%, grade III or IV: 21%). In 26 cases (8%) ICH was present on the ultrasound scan prior to surfactant instillation at a median age of 6h. Incidence and severity of ICH was similar after single- or multiple-dose surfactant treatment. Using a logistic regression model the following risk factors predictive of ICH were defined: low birth weight, allocation to certain hospitals, vaginal delivery, Apgar score6, rectal temperature on admission 36°C, primary anaemia, acidosis prior to treatment, RDS grade IV in pre-treatment chest films and poor response to surfactant treatmentOur study provides supportive evidence that multiple doses of Curosurf do not increase the risk for ICH as compared to single-dose administration.A preliminary report of this work was presented at 8th International Workshop on Surfactant Replacement, Oslo, Norway, May 21 1993. The study was supported by grants of the German government (BMFT 93 607 27) and the German Research Council (Deutsche Forschungsgemeinschaft He 2072: 1–2). The surfactant used in the trial was prepared ang tested in Stockholm with the skilful technical assistance of Elin Arvesen, Bim Linderholm. Eva Lundberg, Gunhild Nilsson and Petru Popa (supported by the Swedish Medical Research Council (Project No. 3351) and Oscar II:s Jubileumsfond)Dedicated to the memory of Edgar (Eddi) Laufkötter, one of the most active trial collaborators, who died under tragic circumstances on April 10, 1994.     

过期妊娠104例临床分析

本文对104例过期妊娠与同期2571例足月妊娠的并发症及分娩方式进行了比较分析,结果表明:过期妊娠中头盆不称、胎位异常、胎儿宫内窘迫、巨大儿等发生率明显高于足月妊娠,且剖宫产率也较高,故认为适时终止妊娠对减少过期妊娠的发生至关重要。