D espite advancements in medicine, preterm infants continue to experience high neonatal mortality and morbidity, with many having lifelong neurodevelopmental deficits, such as cerebral palsy (CP) and impaired cognitive abilities. The risk of impairment increases with decreasing gestational age at birth and many studies of short-term and long-term outcomes have focused on infants born at <33-week gestation. There are few data, however, on neonates born at 33 or 34 weeks. Issues include optimal places for delivery of preterm infants and the optimal gestational age for delivery in women with such pregnancy complications as gestational hypertension, intrauterine growth restriction (IUGR), and preterm premature rupture of membranes. In this population-based study of infants born at 30 to 34 weeks, neonatal mortality and morbidity and 5-year neurodevelopmental outcomes were assessed.All live and stillbirths occurring between 30 and 32 weeks in 1997 (n = 2020) and all between 33 and 34 weeks in April and October of 1997 (n = 457) in all maternity units in 9 French regions were included in the EPIPAGE study. Data on the mother, pregnancy, and neonate were recorded on standardized forms and included maternal complications, gestational age at birth, adverse neonatal outcomes, and treatments used in the neonatal unit. Survivors had a medical and neuropsychological assessment at 5 years of age.Of the 2467 infants enrolled in the study, 2018 were eligible for follow-up and 1461 were evaluated at 5 years. The distribution of pregnancy complications varied with gestational age in that the proportion of pregnancies with singletons and IUGR or hypertension decreased from 26% at 30 weeks to 18% at 34 weeks. On the other hand, the proportion with preterm premature rupture of membranes increased from 19% at 30 weeks to 26% at 34 weeks. The rate of cesarean births, antenatal corticosteroid therapy, and birth in tertiary-care facilities decreased as gestational age increased. So did the rate of adverse neonatal outcomes, although such morbidities as respiratory distress syndrome and bronchopulmonary dysplasia continued through all birth ages. Hospital length of stay also decreased with increasing gestational age; however, 27% of infants born at 34 weeks required admission to the neonatal intensive care unit; 7% needed endotracheal ventilation; 16% received antibiotics for >7 d and 5%, parenteral nutrition for >10 d; 9% received caffeine for apneas; and 47% had phototherapy for jaundice. The CP rate was 6.3% in the 30-week group, 8.7% at 31 weeks, 4.1% at 32 weeks, 3.7% at 33weeks, and 0.7% at 34 weeks (P<0.01). The proportion of children with Mental Processing Composite scores below 70 ranged from 10% in the 30-week and 31-week groups to 5% in the 34-week group, with the mean Mental Processing Composite score increasing significantly from 94 at 30 weeks to 98 at 34weeks. There was little difference among age groups as to visual and hearing deficiencies. In multivariate analysis, only gestational age at birth and pregnancy complication...

Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.

Results confirmed the etiologic heterogeneity of spina bifida and the more pronounced effect of folic acid in decreasing the risk of the more severe clinical presentations.

BackgroundSeasonal malaria chemoprevention (SMC) using sulfadoxine–pyrimethamine plus amodiaquine has been introduced in 12 African countries. Additional strategies for safety monitoring are needed to supplement national systems of spontaneous reporting that are known to under represent the incidence of adverse reactions.ObjectivesThis study aimed to determine if adverse event (AE) reporting could be improved using a smartphone application provided to village health workers, or by active follow-up using a symptom card provided to caregivers.MethodsTwo strategies to improve reporting of AEs during SMC campaigns were evaluated, in comparison with the national system of spontaneous reporting, in 11 health post areas in Senegal. In each health post, an average of approximately 4000 children under 10 years of age received SMC treatment each month for 3 months during the 2015 malaria transmission season—a total of 134,000 treatments. In three health posts (serving approximately 14,000 children), caregivers were encouraged to report any adverse reactions to the nurse at the health post or to a community health worker (CHW) in their village, who had been trained to use a smartphone application to report the event (enhanced spontaneous reporting). In two health posts (approximately 10,000 children), active follow-up of children at home was organized after each SMC campaign to ask about AEs that caregivers had been asked to record on a symptom card (active surveillance). Six health posts (approximately 23,000 children) followed the national system of spontaneous reporting using the national reporting (yellow) form. Each AE report was assessed by a panel to determine likely association with SMC drugs.ResultsThe incidence of reported AEs was 2.4, 30.6, and 21.6 per 1000 children treated per month, using the national system, enhanced spontaneous reporting, and active surveillance, respectively. The most commonly reported symptoms were vomiting, fever, and abdominal pain. The incidence of vomiting, known to be caused by amodiaquine, was similar using both innovative methods (10/1000 in the first month, decreasing to 2.5/1000 in the third month). Despite increased surveillance, no serious adverse drug reactions were detected.ConclusionTraining CHWs in each village and health facility staff to report AEs using a mobile phone application led to much higher reporting rates than through the national system. This approach is feasible and acceptable, and could be further improved by strengthening laboratory investigation and the collection of control data immediately prior to SMC campaigns.Electronic supplementary materialThe online version of this article (10.1007/s40290-018-0232-z) contains supplementary material, which is available to authorized users.

LMMC seems to be pathogenically distinct from myelomeningocele and more studies are needed to understand the embryologic mechanisms leading to this condition, and the environmental and genetic factors involved in its etiology.