Academic literature on the topic 'Newborn infants Victoria Mortality'

Introduction: Out of 130 million births, about four million infants die in the first fourweeks of their life. Birth asphyxia is a major cause of neonatal deaths in developing countries.Birth asphyxia is estimated to account for approximately 25% of neonatal mortality worldwide.Allopurinol is a cheap and freely available medicine whereas other management options arenot widely used. Objectives: To analyze the short-term outcome between allopurinol-treatedand non-allopurinol-treated asphyxiated neonates. Study Design: A randomized controlledstudy. Setting: Pediatric unit 2, Bahawal Victoria Hospital, Bahawalpur. Duration of Study: Thisstudy was conducted from March 2015 to September 2015. Materials and Methods: A totalof 62 (31 in allopurinol and 31 in non allopurinon treated group) infants having admitted within6 hours after birth with gestational age > 36 weeks. All were suffering from stage-2 hypoxicischemic encephalopathy, lethargy, hypotonia, flexion posture. All were having hyperactivetendon reflexes and poor moro reflex. All the admitted neonates were managed and followedup to to 7 days of admission to note the need of anti-convulsants, conscious level and lengthof admission in intensive care unit (< 7 days or > 7 days). Neonates who died during the staywere noted and compared between both the groups. Results: Out of 62 infants, there were 34(54.8%) males and 28 (45.2%) females. Mean gestational age was 37.90 weeks while meanweight of newborn infants was 2.75 kg. Overall Mortality was noted in 6 (9.68%) infants. Whenboth groups were compared, no statistically significant difference was found between the twogroups in terms of sex, gestational age, birth weight or mortality (p value > 0.05). Conclusion:Short-term outcome in terms of mortality between allopurinol-treated and conventional treatmentasphyxiated neonates was found to be 6.5 vs 12.9%.

Objectives Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes. Methods Retrospective cohort study including all infants born in Victoria, Australia, from 2005–2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only). Results Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30–2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26–2.57), NICU admissions (RR 1.38, 95%CI 1.12–1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25–1.56) and emergency CS (RR 1.12, 95%CI 1.06–1.18). Conclusions Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.

Objective. To investigate the effect of hospital discharge time on neonatal mortality of term newborns. Design. Infants who were discharged home at 5 days of age or younger and who subsequently died were compared with control infants using a retrospective casecontrol design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented. Methods. We reviewed death certificates for all infacts with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109 256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants. Results. The mean age of hospital discharge was 43 ± 21 hours for the 17 case infants and 47 ± 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours. Conclusions. Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.

Neonatal encephalopathy has been defined as “a clinically defined syndrome of disturbed neurological function in the earliest days of life in the term infant, manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, sub normal level of consciousness and often seizures”. It occurs in about 2–3 per 1000 births in developed countries. In developing countries, neonatal encephalopathy accounts for the largest number of deaths in infancy and childhood – approximately 1 million per year worldwide. Neonatal encephalopathy is associated with significant morbidity and mortality and is an important predictor of long term neurodevelopmental disability in near- and full-term newborn infants. Fifteen to 20 percent of infants with neonatal encephalopathy die in the neonatal period, and a further 25 percent have permanent neurologic deficits.

Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.

Meconium aspiration syndrome (MAS) is still one of the common causes of morbidity and mortality in neonatal period. A retrospective study was conducted from January 1993 to December 1999, to identify factors associated with mortality in MAS. Univariate analysis disclosed that preeclampsia/eclampsia, sex, Apgar scores, consistency of meconium, and use of mechanical ventilation were significantly associated with mortality in MAS, while gestational age, mode of delivery, hypertension, birth weight, tracheal suctioning, blood cultures, and complications were not. Logistic regression analysis showed that mode of delivery, preeclampsia/eclampsia, Apgar scores, consistency of meconium, and use of mechanical ventilation were associated with mortality in MAS, while other variables were not.

Newborn care refers to the care that is provided to the baby from birth to one-month-old by a caregiver or by the mothers including thermal care, hygienic care, cord care, eye care, breastfeeding, immunization, and identification of newborn danger signs. According to Ethiopian Demographic and Health Survey (EDHS) 2016, the neonatal mortality rate was 29 deaths per 1000 live births, and the postneonatal mortality rate was 19 deaths per 1000 live births with neonates contributing 48 deaths per 1000 of the infant mortality. Neonatal mortality accounts for approximately two-thirds of all infant mortality worldwide. Objective. The objective of this study was to assess newborn care practice and associated factors among mothers with babies of one-month-old in Hossana town, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, 2018. Methods. A community-based cross-sectional study was conducted among randomly selected 422 mothers with babies of one-month-old in Hossana town, southwest Ethiopia. The data were entered to EpiData 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 22. Bivariate and multivariate analyses were applied, and frequencies and odds ratios were calculated to determine the prevalence and associated factors, respectively. Results. In this study, 31% of participants had good newborn care practice based on three composite variables such as 84% who have done early breastfeeding initiation, 32.9% who have done safe cord care, and 30.6% who have done thermal care. Educational status of the mother’s, primary ( AOR = 2.80 , 95% CI: 1.027-7.637), secondary ( AOR = 2.596 , 95% CI: 0.921-7.316), and college and above ( AOR = 3.63 , 95% CI: 1.056-12.492); mothers who practiced handwashing (hygiene) before touching a newborn ( AOR = 2.552 , 95% CI: 1.092-5.963); and mothers who had good knowledge on newborn care practice ( AOR = 15.638 , 95% CI: 3.599-67.943) were significantly associated with newborn care practice. Conclusion and Recommendation. The present study indicated that the level of comprehensive newborn care practice was unsatisfactory; all responsible bodies were giving attention and intervene on the predictors to improve newborn care practice and provide health education regarding newborn care practice. Education level, health education (counseling) on hygiene, and knowledge of mother on newborn care practice were independent predictors of newborn care practice.

Kangaroo care maintains thermoregulation between infants and their mothers. This technique can also be called the human incubator method, reducing newborn morbidity and mortality at considerably lower costs of infrastructure or safe and reliable practicality for both health professionals and mothers. It has recently been revealed that kangaroo care helps to reduce mortality rates in preterm infants, stabilises heart rate, maintains body temperature, reduces the need for oxygen, positively affects weight gain and sleep duration, and assures early discharge. Kangaroo care also guarantees mother–infant commitment in the postnatal period. Despite the evidence for its reliability and efficiency, its practice still remains limited due to lack of qualified medical personnel and an inadequate care environment. Consequently, it can be suggested that primary care providers in newborn intensive care units promote kangaroo care practices by establishing an efficient care environment in order to improve medical results and enhance the care quality. Keywords: Kangaroo care, premature newborn, neonatal intensive care unit, primary care, providers.

Multivariate statistical methods, including recent computing-intensive techniques, are explained and applied in a medical sociology context to study infant death in relation to socioeconomic risk factors of households in Sri Lankan villages. The data analyzed were collected by a team of social scientists who interviewed households in Sri Lanka during 1980-81. Researchers would like to identify characteristics (risk factors) distinguishing those households at relatively high or low risk of experiencing an infant death. Furthermore, they would like to model temporal and structural relationships among important risk factors. Similar statistical issues and analyses are relevant to many sociological and epidemiological studies. Results from such studies may be useful to health promotion or preventive medicine program planning. With respect to an outcome such as infant death, risk groups and discriminating factors or variables can be identified using a variety of statistical discriminant methods, including Fisher's parametric (normal) linear discriminant, logistic linear discrimination, and recursive partitioning (CART). The usefulness of a particular discriminant methodology may depend on distributional properties of the data (whether the variables are dichotomous, ordinal, normal, etc.,) and also on the context and objectives of the analysis. There are at least three conceptual approaches to statistical studies of risk factors. An epidemiological perspective uses the notion of relative risk. A second approach, generally referred to as classification or discriminant analysis, is to predict a dichotomous outcome, or class membership. A third approach is to estimate the probability of each outcome, or of belonging to each class. These three approaches are discussed and compared; and appropriate methods are applied to the Sri Lankan household data. Path analysis is a standard method used to investigate causal relationships among variables in the social sciences. However, the normal multiple regression assumptions under which this method is developed are very restrictive. In this thesis, limitations of path analysis are explored, and alternative loglinear techniques are considered.
Science, Faculty of
Statistics, Department of
Graduate

The issue of child mortality is currently under international spotlight, as the rates of neonatal and under five mortality are sobering. „About 29,000 children under the age of five [approximately] 21 each minute die every day, mainly from preventable causes‟. Although there has been a decline in global child mortality rates since 1990, sub-Saharan Africa still has the highest rates, where one child in eight dies before age five. As contained in the Millennium Development Goals (MDGs) 2010 report, in 2008, sub-Saharan Africa bore half of the 8.8 million deaths in children under five.
Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2012.
http://www.chr.up.ac.za/
nf2012
Centre for Human Rights
LLM

Undernutrition in prevalent in Aboriginal communities, in utero, infancy and childhood. It influences childhood morbidity and mortality and growth patterns. Undernutrition and poor socio-economic status also contribute to endemic and epidemic infectious disease, including scabies and streptococcal infection. It has been suggested that early undernutrition, and streptococcal and scabies infection are risk factors for renal disease, which is at epidemic levels and increasing. This thesis examines the prevalence of undernutrition in newborns and infants in an Aboriginal community over time, and its impact on childhood growth and child and adult renal markers. The association between skin lesions, streptococcal serology, post-streptococcal glomerulonephritis (PSGN) and renal markers as evaluated through a community wide screening program in 1992-1995 is also examined. Birthweights have increased since the 1960s, but they are still much lower than the non-Aboriginal values. Weights in infancy have decreased since the 1960s. At screening in childhood stunting was common, reflecting the presence of long-term poor nutrition in infancy. In both adults and children, birth weight and infant weights were negatively associated with albuminuria measured by the albumin to creatine ratio (ACR).

Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: When estimating the covariance matrices of two or more populations, the covariance matrices are often assumed to be either equal or completely unrelated. The common principal components (CPC) model provides an alternative which is situated between these two extreme assumptions: The assumption is made that the population covariance matrices share the same set of eigenvectors, but have di erent sets of eigenvalues. An important question in the application of the CPC model is to determine whether it is appropriate for the data under consideration. Flury (1988) proposed two methods, based on likelihood estimation, to address this question. However, the assumption of multivariate normality is untenable for many real data sets, making the application of these parametric methods questionable. A number of non-parametric methods, based on bootstrap replications of eigenvectors, is proposed to select an appropriate common eigenvector model for two population covariance matrices. Using simulation experiments, it is shown that the proposed selection methods outperform the existing parametric selection methods. If appropriate, the CPC model can provide covariance matrix estimators that are less biased than when assuming equality of the covariance matrices, and of which the elements have smaller standard errors than the elements of the ordinary unbiased covariance matrix estimators. A regularised covariance matrix estimator under the CPC model is proposed, and Monte Carlo simulation results show that it provides more accurate estimates of the population covariance matrices than the competing covariance matrix estimators. Covariance matrix estimation forms an integral part of many multivariate statistical methods. Applications of the CPC model in discriminant analysis, biplots and regression analysis are investigated. It is shown that, in cases where the CPC model is appropriate, CPC discriminant analysis provides signi cantly smaller misclassi cation error rates than both ordinary quadratic discriminant analysis and linear discriminant analysis. A framework for the comparison of di erent types of biplots for data with distinct groups is developed, and CPC biplots constructed from common eigenvectors are compared to other types of principal component biplots using this framework. A subset of data from the Vermont Oxford Network (VON), of infants admitted to participating neonatal intensive care units in South Africa and Namibia during 2009, is analysed using the CPC model. It is shown that the proposed non-parametric methodology o ers an improvement over the known parametric methods in the analysis of this data set which originated from a non-normally distributed multivariate population. CPC regression is compared to principal component regression and partial least squares regression in the tting of models to predict neonatal mortality and length of stay for infants in the VON data set. The tted regression models, using readily available day-of-admission data, can be used by medical sta and hospital administrators to counsel parents and improve the allocation of medical care resources. Predicted values from these models can also be used in benchmarking exercises to assess the performance of neonatal intensive care units in the Southern African context, as part of larger quality improvement programmes.
AFRIKAANSE OPSOMMING: Wanneer die kovariansiematrikse van twee of meer populasies beraam word, word dikwels aanvaar dat die kovariansiematrikse of gelyk, of heeltemal onverwant is. Die gemeenskaplike hoofkomponente (GHK) model verskaf 'n alternatief wat tussen hierdie twee ekstreme aannames gele e is: Die aanname word gemaak dat die populasie kovariansiematrikse dieselfde versameling eievektore deel, maar verskillende versamelings eiewaardes het. 'n Belangrike vraag in die toepassing van die GHK model is om te bepaal of dit geskik is vir die data wat beskou word. Flury (1988) het twee metodes, gebaseer op aanneemlikheidsberaming, voorgestel om hierdie vraag aan te spreek. Die aanname van meerveranderlike normaliteit is egter ongeldig vir baie werklike datastelle, wat die toepassing van hierdie metodes bevraagteken. 'n Aantal nie-parametriese metodes, gebaseer op skoenlus-herhalings van eievektore, word voorgestel om 'n geskikte gemeenskaplike eievektor model te kies vir twee populasie kovariansiematrikse. Met die gebruik van simulasie eksperimente word aangetoon dat die voorgestelde seleksiemetodes beter vaar as die bestaande parametriese seleksiemetodes. Indien toepaslik, kan die GHK model kovariansiematriks beramers verskaf wat minder sydig is as wanneer aanvaar word dat die kovariansiematrikse gelyk is, en waarvan die elemente kleiner standaardfoute het as die elemente van die gewone onsydige kovariansiematriks beramers. 'n Geregulariseerde kovariansiematriks beramer onder die GHK model word voorgestel, en Monte Carlo simulasie resultate toon dat dit meer akkurate beramings van die populasie kovariansiematrikse verskaf as ander mededingende kovariansiematriks beramers. Kovariansiematriks beraming vorm 'n integrale deel van baie meerveranderlike statistiese metodes. Toepassings van die GHK model in diskriminantanalise, bi-stippings en regressie-analise word ondersoek. Daar word aangetoon dat, in gevalle waar die GHK model toepaslik is, GHK diskriminantanalise betekenisvol kleiner misklassi kasie foutkoerse lewer as beide gewone kwadratiese diskriminantanalise en line^ere diskriminantanalise. 'n Raamwerk vir die vergelyking van verskillende tipes bi-stippings vir data met verskeie groepe word ontwikkel, en word gebruik om GHK bi-stippings gekonstrueer vanaf gemeenskaplike eievektore met ander tipe hoofkomponent bi-stippings te vergelyk. 'n Deelversameling van data vanaf die Vermont Oxford Network (VON), van babas opgeneem in deelnemende neonatale intensiewe sorg eenhede in Suid-Afrika en Namibi e gedurende 2009, word met behulp van die GHK model ontleed. Daar word getoon dat die voorgestelde nie-parametriese metodiek 'n verbetering op die bekende parametriese metodes bied in die ontleding van hierdie datastel wat afkomstig is uit 'n nie-normaal verdeelde meerveranderlike populasie. GHK regressie word vergelyk met hoofkomponent regressie en parsi ele kleinste kwadrate regressie in die passing van modelle om neonatale mortaliteit en lengte van verblyf te voorspel vir babas in die VON datastel. Die gepasde regressiemodelle, wat maklik bekombare dag-van-toelating data gebruik, kan deur mediese personeel en hospitaaladministrateurs gebruik word om ouers te adviseer en die toewysing van mediese sorg hulpbronne te verbeter. Voorspelde waardes vanaf hierdie modelle kan ook gebruik word in normwaarde oefeninge om die prestasie van neonatale intensiewe sorg eenhede in die Suider-Afrikaanse konteks, as deel van groter gehalteverbeteringprogramme, te evalueer.

Thesis (MScMedSc)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined.
AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly.
Harry Crossley Foundation
Poliomyelitis Research Foundation (PRF)
National Health Laboratory Services Research Trust

Du fait de son impact sur la morbidité et la mortalité infantile, ainsi que de ses implications sur la santé à l’âge adulte, le petit poids de naissance constitue un problème majeur de santé publique. Le Burkina Faso, pays sahélien enclavé au cœur de l’Afrique occidentale est classé dans le groupe des pays pauvres très endettés et présente une forte prévalence de petit poids de naissance, imputable dans la majorité des cas au retard de croissance intra-utérine. Le contexte de ce travail, réalisé en milieu rural, se caractérise par une situation socioéconomique précaire se traduisant par un faible niveau des indicateurs de l’état de santé et une faible accessibilité aux services sociaux de base.

Objectifs, hypothèses

Ce travail repose sur les hypothèses que les facteurs socioéconomiques influencent la survenue du petit poids de naissance et que le petit poids de naissance a un impact négatif sur la croissance et la survie au cours de la première année de vie.

Ce travail s’est fixé pour objectifs de :

•connaître l’importance du petit poids de naissance à terme ;

•analyser les déterminants du petit poids de naissance ;

•proposer un score pour l’identification des femmes enceintes à risque de mise au monde d’un enfant de petit poids ;

•identifier les facteurs influençant la croissance des enfants nés de petit poids ;

•étudier l'impact du déficit pondéral à la naissance sur la morbidité et la mortalité infantile ;

•formuler des recommandations pour la prévention et la prise en charge du petit poids de naissance en milieu défavorisé dans le but d’orienter les stratégies de réduction de la mortalité infantile.

Méthodologie

Trois types d’études ont été réalisés:

•une étude de cohorte rétrospective portant sur 435 enfants dans le but d’explorer les facteurs de risque, la croissance, le statut nutritionnel et la mortalité des enfants nés de petit poids de naissance à terme.

•Une étude transversale portant sur 1013 naissances vivantes à terme qui a permis de déterminer la fréquence du petit poids de naissance et d’analyser les facteurs associés qui lui étaient associés.

•Une étude de cohorte prospective au cours de laquelle les 1013 enfants enrôlés dans l’étude transversale ont été suivis afin d’analyser leur croissance et leur survie au cours des 12 premiers mois de vie.

Principaux résultats

•Le petit poids de naissance représente 15,8% des naissances à terme.

•Le sexe féminin est prédominant chez les enfants de petit poids.

•Les facteurs sociodémographiques associés au petit poids de naissance sont essentiellement des caractéristiques sociodémographiques maternelles :le jeune âge de la mère (moins de 20 ans), le faible niveau d’instruction, le mauvais état nutritionnel et la faible accessibilité géographique aux structures de santé.

•Les facteurs obstétricaux associés au petit poids sont :la primiparité, la survenue de vomissements gravidiques, l’exécution de travaux champêtres et une charge de travail plus importante en cours de grossesse.

•Le score proposé pour l’identification des femmes à risque a un pouvoir de discrimination acceptable et présente une bonne stabilité et une faible marge d’erreur de prédiction.

•Indépendamment de la catégorie de poids à la naissance, tous les enfants demeurent en dessous des médianes des courbes de référence internationales pour l’ensemble des indices nutritionnels entre 0 et 12 mois.

•Malgré des gains plus importants mais de façon non significative, les enfants de PPN montrent une incapacité à combler leur retard en taille et en poids.

•Le PPN est associé à un risque significativement plus élevé de retard de croissance et d’insuffisance pondérale au cours de la première année de vie.

•Le petit poids de naissance et la non-complétude de la consultation prénatale étaient associés à un risque deux fois plus important de décès.

•L’état nutritionnel à l’âge de 3 mois ainsi qu’à l’âge de 6 mois joue un rôle plus important dans la survie chez les enfants de PPN que chez les enfants nés de poids normal.

Conclusions

Les solutions au problème du petit poids de naissance impliquent un paquet d’interventions intégrant des stratégies avant, pendant et après la grossesse et des programmes de prise en charge ciblant les enfants de petit poids après leur naissance. Il s’agit prioritairement de :

•l’information et de la sensibilisation des populations pour un meilleur suivi de la grossesse et une complétude de la consultation prénatale ;

•l’adoption de pratiques et d’habitudes en faveur d’une alimentation équilibrée des femmes enceintes ;

•un plaidoyer pour un allègement de la charge de travail des femmes enceintes ;

•l’utilisation de méthodes opérationnelles pour l’identification des femmes à risque ;

•l’amélioration de la qualité des prestations de surveillance de la grossesse ;

•la redéfinition du contenu et des protocoles des programmes de suivi et de promotion de la croissance des jeunes enfants avec une attention particulière pour les enfants nés de petit poids ;

•la lutte contre certaines pratiques sociales comme les mariages précoces et les grossesses chez les adolescentes et les femmes de moins de 20 ans ;

•la promotion de la scolarisation des jeunes filles et l’alphabétisation des mères ;

•l’amélioration de l’état nutritionnel de la population ;

•la réalisation d’études pour évaluer l’impact de certains déterminants et interventions sur l’incidence du petit poids et le devenir des enfants nés avec un handicap pondéral :rôle de l’infection palustre, interventions nutritionnelles ciblant les enfants de petit poids, apports nutritionnels pendant la grossesse.

Summary

Due to its impact on infant morbidity and mortality, and its effects on adult’s health, low birth weight (LBW) is a major issue in the public health sector. Burkina Faso, a Sahelian country land-locked in the heart of West Africa is listed among the heavily indebted poor countries, with a high prevalence of Low Birth Weight, caused in most cases by intra uterine growth retardation. The context of the current study, conducted in urban area, is characterised by a poor socio-economic situation resulting in weak health indicators and difficult access to the basic social services.

Objectives, assumptions

The study is based o the assumptions that socio-economic factors have an influence on the occurrence of Low Birth Weight and that Low Birth Weight has a negative impact on growth and survival during the first year of the infant.

The study has the following objectives:

•To assess the importance of low birth weight a term;

•To analyse the determinant factors of low birth weight;

•To suggest a classification for the identification of pregnant women at risk of giving birth to low birth weight infants ;

•To identify factors which have an impact on the growth of low birth weight children ;

•To look at the impact of body weight deficiency at birth on infant morbidity and mortality ;

•To give recommendations on the prevention and treatment of low birth weight children from underprivileged background with the aim to orientate strategies for infant mortality reduction.

Methodology

Three types of studies were conducted:

•A retrospective cohort study of 435 children aiming at exploring risk factors, growth, nutritional status, and mortality of low birth weight infants in the long run.

•A cross-sectional study of 1013 live full-term births, which led to determining the frequency of low birth weight and at analysing associated factors which are linked to low birth weight.

•A prospective cohort study during which the 1013 children taken into consideration for the cross-sectional study were followed up so as to analyse their growth and survival all along the first 12 months of their life.

Main results

•Low birth weight represents 15.8% of full-term births.

•Female babies are predominant among low birth weight babies.

•Socio-demographic factors linked to low birth weight are mainly maternal socio-demographic characteristics: young mother (below 20 years old), low educational level, poor nutritional status and limited geographical access to health infrastructures.

•Obstetrical factors linked to low birth weight are the following: primiparity, occurrence of vomiting during pregnancy, field work and a heavier workload during pregnancy.

•The suggested classification for the identification of women at risk proves to have an acceptable power of discrimination and shows good stability and limited margin of error for prediction.

•Regardless of weight categories at birth, all children remain below medians of international reference curves for all nutritional indicators between 0 and 12 months.

•In spite of more important but not significant weight gains, LBW children prove not to be able to catch up on height and weight.

•LBW is linked to a significantly higher risk in growth retardation and weight deficiency during the newborn’s first year of life.

•LBW and non-complete antenatal visits are linked to a death risk multiplied by two.

•The nutritional status at the age of 3 months and 6 months old plays a more important role in the survival in LBW children than in children born with normal weight.

Conclusions

Solutions to LBW imply a package of interventions which should integrate strategies before, during and after pregnancy, together with treatment programmes targeting LBW children after their birth. In priority, these are:

•Information and awareness given to population for a better follow-up of pregnancies and complete cycles antenatal visits ;

•New practices and habits to be taken on favouring a balanced diet of pregnant women ;

•Advocacy actions aiming at reducing the workload of pregnant women ;

•The use of operational methods to identify women at risk ;

•Improving the quality of monitoring of pregnancy;

•Redefined content and procedures of monitoring programs and promoting young children growth, with particular focus on LBW children ;

•The fight against some social practices such as early marriages and pregnancies of teenagers and women below 20 years;

•The promotion of school education for young girls and literacy for mothers ;

•Improving the nutritional status of the population;

•The realisation of studies to assess the impact of some determinant factors and interventions on the occurrence of low birth weight and on the future of children born with weight deficiency: role of malaria, nutritional interventions targeting LBW children, nutritional intakes during pregnancy

Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

Background: Neonatal mortality is a major burden in developing countries. Most neonatal deaths in Bangladesh can be prevented by simple interventions or by preventive measures before birth, better delivery practices or basic treatments after birth. Researchers over the years have focused on upgrading health care options to combat particular causes of disease but simple preventive measures before birth are often ignored. The outcome of neonatal illnesses depends on how it is managed and when. An illness that is addressed before the actual occurrence will have a better outcome especially when it involves newly-born neonates who have limited immunity. Thus, understanding the neonatal causes of deaths is an effective way to improve neonatal outcomes at low cost. Study Design: This study used primary data from two ICDDR,B surveillance sites, Abhoynagar and Mirsarai from the period 1997-2006 and analysed the major 'preventable causes' that can be prevented before the birth of the baby. It also identified the 'treatable causes' that are not amenable to prevention before the birth of the baby. This categorization is based on context of a developing country as Bangladesh where advanced techniques to treat severe conditions is unavailable or expensive. A particular cause of death can potentially be prevented or treated but consideration needs to be given to what is feasible in terms of available resources. The study compares deaths between the two surveillance sites and observes some of the biological, social and health care variables associated with preventable and treatable causes of deaths. Result of Neonatal death causes: Preventable causes of neonatal deaths comprised 75 percent of all neonatal deaths signifying the importance of targeted interventions before birth .Major identified preventable causes were prematurity (48.9%), birth asphyxia(30.2%), maternal and pregnancy-related complications (16.5%)),and neonatal tetanus (4.4%). Pneumonia (66.4%) and sepsis (33.6%) were the two treatable causes identified. Preventable deaths comprised 79.5% (163/205) of deaths in Abhoynagar and 69.2% (144/208) of deaths in Mirsarai. Result of Post-neonatal causes of death: The study grouped preventable (Diarrhoea and malnutrition, composed 30%) and treatable (Pneumonia, sepsis and SIDS, comprise 70%) causes of post-neonatal deaths. Except for sepsis, all causes of deaths were found in greater proportion in Mirsarai. Conclusion: The study found that preventable causes constitute the majority of neonatal deaths in Bangladesh. To address the majority of causes of neonatal deaths, interventions are needed to focus on the period before birth of the baby.

Poppy extract accompanied the human infant for more than three millennia. Motives for its use included excessive crying, suspected pain, and diarrhoea. In antiquity, infantile sleeplessness was regarded as a disease. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. Opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were sold at the doorstep or in grocery stores. Opium’s toxicity for infants was common knowledge, but the willingness to use it in infants persisted and physicians continued to prescribe it for babies. Intoxication became a significant factor in infant mortality. As late as 1912, the International Opium Convention signed at The Hague forced governments to implement legislation which effectively curtailed the access to opium and broke the dangerous habit of sedating infants.

Nearly 2% of all pregnancies nowadays are complicated by maternal pregestational or gestational diabetes. Long before diabetic fetopathy was acknowledged, macrosomia was dreaded by obstetricians because of the trauma risk and the need for mutilating operations. Diabetic fetopathy was described and maternal glucosuria quantified by Henrich Bennewitz in 1824. However, most authors ignored his findings and well into the 20th century, series of ‘giant babies’ were published without even mentioning diabetes mellitus. When insulin became available in 1923, maternal but not fetal mortality decreased. In 1952, Priscilla White classified six forms of maternal diabetes during pregnancy and reported an overall intrauterine, intrapartum, and neonatal death rate of 45%. But not all those infants died from macrosomia-associated traumatism and birth asphyxia: the main finding in the deceased infants was pulmonary hyaline membranes, demonstrated by Louis Gluck in 1973 to result from retarded surfactant maturation in diabetic fetuses.

COVID 19 has already affected more than 191 million people worldwide and has claimed more than 4 million lives to date (22nd July 2021). Yet, we still do not completely understand this disease. Data on children are even more sparse, making it difficult to lay down a comprehensive guideline for the same. However, thanks to a handful of studies, we now understand that children are less affected, are less infectious, have lesser mortality and risk of complications. Children with underlying chronic diseases and infants under 1 year are especially at risk and are advised selective shielding. Diagnosis is done by RT-PCR or serology, just like in adults. Most affected children are asymptomatic, and even the symptomatic children have a good outcome and usually need supportive management and monitoring only. Up to 7% of children were found to require PICU support, and mortality was less than 2%. Most deaths were attributed to underlying conditions and immunological complications, especially MIS-C. Treatment is predominantly supportive, with little consensus on specific treatments, including corticosteroids, remdesivir, and IVIg. Management is best individualized by a multidisciplinary team involving pediatricians, hematologists, immunologists, and intensivists. Prevention of COVID 19 can be achieved by proper hygiene, face masks, and social distancing. The upcoming vaccines are expected to bring down the cases and hopefully bring this pandemic to a halt.

There is paucity of knowledge on the causes, diagnosis, management and prevention of fetal congenital anomalies in Africa. The chapter will highlight on the general causes and specific factors concerning congenital anomalies in Africa. The problems of diagnosis and management of congenital anomalies will be extensively discussed. There is also going to be a discussion on how fetal anomalies contribute to maternal and perinatal mortality and morbidity. Screening of congenital anomalies is another black point and will be discussed emphasizing on simple strategies applicable in resource constrained environment. A section will be dedicated on prevention of fetal congenital anomalies, particularly prevention of specific factors that increase the risk of fetal anomalies in Africa. Finally, there will also be discussion on collaborative care as a panacea in the management of fetal congenital fetal anomalies, including my experience in this area. Specific examples will be given to illustrate the utility of collaborative in resource limited countries.

The Wiskott-Aldrich syndrome (WAS) could be a rare X-linked primary immunodeficiency disorder characterized by recurrent infections, eczema, and bleeding following thrombocytopenia. Despite the rarity of this syndrome, today our understanding of the cellular and molecular basis of the pathogenesis of this disease has increased and it’s well established that this disorder encompasses a wide range of clinical disorders including immunodeficiency, atopy, autoimmunity, and cancer. Wiskott–Aldrich Syndrome protein (WASP) mutations are located throughout the gene and inhibit or regulate the conventional function of WASP. Thus classic WAS occurs when WASP is absent, X-linked thrombocytopenia when mutated WASP is expressed, and X-linked neutropenia when missense mutations occur within the Cdc42-binding site. Developments within the use of diagnostic tools, supportive care, and advances in allogeneic hematopoietic cell transplantation have remarkably reduced the mortality related to this disorder. Besides, gene therapy has provided optimistic perspectives on the treatment approaches of those patients.

Congenital diaphragmatic hernia (CDH) is a major congenital anomaly of the neonates, characterized by the herniation of abdominal contents into the thoracic cavity during fetal life. This results in significant pulmonary hypertension and hypoxemia after birth, which responds poorly to therapeutic interventions. CDH is associated with high morbidity and mortality. The exact pathogenesis is not well understood, and genetic factors have been proposed. The management starts in utero, with antenatal diagnosis and identification of prenatal predictors for the outcomes, which help in the selection of cases suitable for fetal therapy. The postnatal management is complicated by the need for variable cardio-respiratory support and even extra corporeal membrane oxygenation (ECMO), before corrective surgery is undertaken. Improvement in the understanding of the pathophysiology of the underdeveloped lungs and pulmonary vessels has contributed to substantial progress in the management of CDH, which has translated into improved outcomes and survival. Still, many questions regarding CDH remain unanswered and the management is largely based on weak evidence.

Globally, the neonatal mortality rate is the highest contributor to all deaths in children under five years of age. Children, particularly newborn infants, continue to face widespread regional disparities in their chances of survival. The year 2015 marked the official end of the period set by the United Nations to achieve the Millennium Development Goals (MDGs). New targets, the Sustainable Development Goals (SDGs), aim to end preventable deaths of newborns and children and to reduce the neonatal mortality rate in all countries. There is a sense of urgency to implement large-scale, high-impact interventions to improve maternal and newborn care before, during, and in the immediate period following birth. Two of the highly successful and widely available interventions to improve neonatal outcome are kangaroo mother care (KMC) and breast-feeding. However, the threat of COVID-19 to ongoing efforts may further compromise the chances of success in improving neonatal mortality, particularly in low- and medium-income countries (LMICs).

The survival of preterm newborn patients (PNB) depends in a great extent on the anesthetic technique used. Spinal anesthesia (SA) is considered the best-tolerated regional anesthetic method for highly unstable newborn infants (NB) with high risk of complications during the perioperative period. SA has been recommended for children at high risk for postoperative apnea due to general anesthetics or prematurity. Bronchopulmonary dysplasia (BPD) in the newborn is a disease that accompanies the patient to the operating room with a high incidence of mortality. SA in emergency surgery is a well-tolerated anesthetic procedure with proven effectiveness, with less hemodynamic and respiratory repercussions. At the same time, it produces greater protection against surgical stress in the NB weakened by the premature condition. Hemodynamic stability remains constant even in the newborn with heart disease.

TGA is the commonest complex congenital cyanotic cardiac anomaly occurring during the first week of life. It is characterized by the unusual anomaly of ventriculoarterial discordance, with the aorta (A) originating from the right ventricle (RV) and the pulmonary artery (PA) from the left ventricle (LV). In the common Dextro form (DTGA), A is abnormally located to the right, anterior, and inferior of PA. The anatomic configuration results in the lethal hemodynamic pattern of 2 independent and parallel running circulatory circuits, which mandates creating a conduit to ensure the mixing of oxygenated and deoxygenated blood for survival. In the rare Levo form (LTGA), the aorta is placed anterior and to the left of PA with ventricular inversion. TGA is well tolerated in the fetus and is challenging to diagnose by fetal echocardiography unless the outflow tracts are specifically visualized. Postnatally the typical findings of murmur and cyanosis vary according to the associated cardiac defects and the degree of intercirculatory mixing. The arterial switch operation (ASO), which involves establishing ventriculoarterial concordance, is the standard surgical repair of D-TGA and has replaced the atrial switch procedures due to its superior long-term outcomes. The Rastelli procedure is used for complex DTGA cases. DTGA has a 90% mortality rate in the first year of life if untreated, while over 95% survive for 5 to 25 years after surgery. Post-surgical course may be complicated and require surgical revisions. The long-term outcome is associated with normal or mild to moderate neurodevelopmental disabilities, depending upon the type, complexity, and course of the disease. Expert follow-up of the patients into adulthood is an integral part of the management of TGA for best outcomes.

Recent advances in the clinical management of at-risk pregnancy and care of the newborn have reduced morbidity and mortality among sick neonates, and improved our knowledge of factors that influence the risks of brain injury. In parallel, the refinement of imaging techniques has added to the ability of clinicians to define the etiology, timing and location of pathologic changes with diagnostic and prognostic relevance to the developing fetus and newborn infant. Abnormalities of brain growth, or injury to the developing brain can occur during pregnancy; during labor and delivery, hypoxia, acidosis and ischemia pose major risks to the fetus. Defined practices for the management of pregnancy and delivery, and evidence-based strategies for care in the newborn period are influencing outcome. However, newborn infants, especially those born prematurely, remain at risk from situations that can cause or worsen brain injury. The literature reviewed here explains the mechanisms and timing of injury, and the importance of hypoxia, ischemia, hypotension and infection; describes current diagnostic strategies, neuroimaging technologies and care entities available; and outlines approaches that can be used to prevent or mitigate brain injury. Some show particular promise, and all are relevant to lowering the incidence and severity of brain damage.

Approximately 904,000 newborns die of breathing complications, or birth asphyxia, each year[1]. It is estimated that 30% of these deaths could be prevented[2]; however, healthcare workers in developing nations often lack the training, skills, or equipment necessary to properly resuscitate these infants. For this reason, child mortality is disproportionally clustered in low-resource locations in which the current standard of care is ineffective. The bag-valve mask resuscitator (or BVM) is the recommended treatment for a newborn who is not breathing properly.

Improvement in a woman’s quality of life is a prerequisite for development of human resources, because the quality of children’s physical and mental development is inextricably tied to the health and welfare of women as future mothers. If a mother is well protected during the pregnancy, birth, and postpartum period, the risk of illness and other problems in fetuses and newborn babies will be reduced. On the other hand, if a woman does not survive the pregnancy, birth, and postpartum period, her fetus or newborn will also be threatened. This paper provides a situation analysis of pregnant women, women in labor, and postpartum mothers, presenting also the level of morbidity and mortality of fetuses in the perinatal period (pregnancy from 28 weeks until the newborn is 7 days old), and, in more depth, the level of morbidity or mortality of infants in the neonatal period (age 0–28 days). Also presented are the risks and needs of reproductive-age couples or women of reproductive age (15–49 years), which require intervention at the individual, family, community, environmental, and national levels.