Background Although preterm birth less than 37 weeks gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design Secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008–2011. All live born non-anomalous singleton preterm (23.0–36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade 1/2, necrotizing enterocolitis stage 1, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome they met criteria for. Results 8,334 deliveries met inclusion criteria. There were 119 neonatal deaths (1.4%). 657 (7.9%) neonates had major morbidity, 3,136 (37.6%) had minor morbidity, and 4,422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death, and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell beyond 32 weeks. Neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26 to 32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median post-menstrual age at discharge nadired at 35.7 weeks post-menstrual age for babies born at 32–33 weeks of gestation. Conclusions Our data show that there is a continuum of outcomes, with each additional week for gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

OBJECTIVE To describe the prevalence of serious maternal complications following early preterm birth by gestational age (GA), delivery route and type of cesarean incision. STUDY DESIGN Trained personnel abstracted data from maternal and neonatal charts for all deliveries on randomly selected days representing 1/3 of deliveries across 25 US hospitals over 3 years (n=115,502). All women delivering non-anomalous singletons between 23 and 33 weeks’ gestation were included. Women were excluded for antepartum stillbirth and highly morbid conditions for which route of delivery would not likely impact morbidity including non-reassuring fetal status, cord prolapse, placenta previa, placenta accreta, placental abruption, and severe, unstable maternal conditions (cardiopulmonary collapse, acute respiratory distress syndrome, seizures). Serious maternal complications were defined as: hemorrhage (blood loss ≥1500 mL, blood transfusion, or hysterectomy for hemorrhage); infection (endometritis, wound dehiscence, or wound infection requiring antibiotics, reopening or unexpected procedure); ICU admission; or death. Delivery route was categorized as classical cesarean delivery (CCD), low transverse cesarean delivery (LTCD), low vertical cesarean delivery (LVCD), and vaginal delivery (VD). Association of delivery route with complications was estimated using multivariable regression models yielding adjusted relative risks (aRR) controlling for maternal age, race, body mass index, hypertension, diabetes, preterm premature rupture of membranes, preterm labor, GA, and hospital of delivery. RESULTS Of 2659 women who met criteria for inclusion in this analysis, 8.6% of women experienced serious maternal complications. Complications were associated with GA and were highest between 23–27 weeks of gestation. The frequency of complications was associated with delivery route; compared with 3.5% of SVD, 23.0% of CCD (aRR 3.54, 95%CI 2.29–5.48), 12.1% of LTCD (aRR 2.59, 95%CI 1.77–3.77), and 10.3% of LVCD (aRR 2.27, 95%CI 0.68–7.55) experienced complications. There was no significant difference in complication rates between CCD and LTCD (aRR 1.37, 95%CI 0.95–1.97) or between CCD and LVCD (aRR 1.56, 95%CI 0.48–5.07). CONCLUSION The risk of maternal complications after early preterm delivery is substantial, particularly in women who undergo cesarean delivery. Obstetricians need to be prepared to manage potential hemorrhage, infection and ICU admission for early preterm births requiring cesarean delivery.

Background Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery in the second stage versus cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean versus operative vaginal delivery. Objective Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps versus cesarean delivery) in patients needing second stage assistance at a fetal station of +2 or below. Study Design Secondary analysis of an observational obstetric cohort in 25 academically-affiliated U.S. hospitals over a three-year period. A subset of ≥37 weeks, non-anomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, non-reassuring fetal status, labor dystocia or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother’s, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third and fourth degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the three attempted modes of delivery. Odds ratios were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. Results 2531 women met inclusion criteria. Vacuum attempt was associated with the lowest frequency of the neonatal composite (4.2% vs. 6.1% vaginal forceps vs. 6.9% cesarean) and maternal complications (Postpartum infection 0.2% vs. 0.9% forceps vs. 5.3% cesarean, Postpartum hemmorhage 1.4% vs. 2.8% forceps vs. 3.8% cesarean), except for severe lacerations (19.1% vs. 33.8% forceps vs. 0% cesarean). When confounders were taken into account, both forceps (odds ratio 0.16, 95%CI 0.05-0.49) and vacuum (odds ratio 0.04, 95%CI 0.01-0.17) were associated with a significantly lower odds of Post partuminfection. The neonatal composite and Postpartum hemmorhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P=.04). Conclusion In patients needing second stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of Postpartum infection, but higher frequency of severe lacerations.

BackgroundAs the elderly population and prevalence of dementia is increasing, it is necessary to have a better comprehension of the influence of specific factors on cognitive function. Dementia is not an inevitable consequence of ageing. Lifestyle factors might either increase or decrease the risk. Even though different studies have focused on individual factors, only a few studies are available which assess all these factors as a whole. Available evidence on these factors is mainly from high income countries and much less evidence is available from low and middle income countries. As cognition is critical for elderly people to engage in a physically independent life, we aimed to identify the associated factors of cognition.MethodsThis was a descriptive cross sectional study performed with 421 elderly people dwelling in residential care facilities for the aged in two selected districts in the Southern Province of Sri Lanka. Cognition was assessed using the Mini Mental State Examination (MMSE). Independent sample t test, ANOVA and regression analyses were used to explore associated factors for cognition. The statistical significance was kept at bonferroni adjusted p < 0.004.ResultsThe study included elderly people with a mean age of 71.9 ± 6.7 years and of them 65.8% were females. Factors affecting higher level of cognition were, having upper secondary, advanced and higher education; being married; arriving at the facility on one’s own accord; being visited by family members; higher physical activity levels and engaging in social and leisure activities (p < 0.004). The factors, namely physical activity level, educational status, visits by family members and engaging in leisure activities were the predictors of cognition in the regression model.ConclusionThough there were several factors that associated with the level of cognition such as educational status, marital status, reason for attending the facility, visits by family members, physical activity levels and participation in social and leisure activities, only the factors, such as physical activity levels, visits by family members, educational status and engaging in leisure activities were the predictors of cognition.

BackgroundAlthough cognitive functions affect the health related quality of life (QoL), the relationship between perceived QoL and cognition including executive functions has not been studied adequately. Available studies show moderate to weak correlations. We evaluated the association of cognition and executive functions, namely working memory (WM) and inhibitory control (IC) with the perceived QoL of a sample of elderly people dwelling in residential aged care facilities (RACFs) in Southern Province of Sri Lanka.MethodsCognition was assessed using Mini-Mental State Examination (MMSE), while verbal WM (VWM), visuo-spatial WM (VSWM) and IC (interference control, inhibition of pre potent and ongoing responses) were assessed using VWM, VSWM tasks, colour word Stroop (CWS), go/no-go (GNG) and stop signal (SS) tasks respectively. WHOQoL-Bref (Total score and domain scores) were used to assess QoL. The relationship was analysed using Pearson correlation and hierarchical multiple regression analysis.ResultsStudy included 237 elderly people with a mean age of 71.11 ± 6.44 years. Participants scored the highest in the domain of environment (63.48 ± 10.63) and lowest in the domain of social relationships (55.43 ± 21.84) of QoL. Psychological health domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS, SS and GNG task errors. Both physical health domain and total QoL demonstrated positive correlations with MMSE, VSWM and VWM scores, while negative correlations were observed with CWS task errors. Social relationships domain demonstrated a significant positive correlation with VSWM score. Environment domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS and SS task errors. All were significant but weak correlations. When controlled for covariates, such as educational status, physical activity and marital status, cognition was a predictor of the domain of environment of QoL, while executive functions were not predictors of total QoL and domains of QoL.ConclusionCognition and executive functions weakly but significantly correlated with different domains of QoL. Only the level of cognition measured by MMSE was a predictor of the domain of environment of QoL and executive functions were not predictors of total QoL and domains of QoL in elderly people with normal cognitive functions dwelling in RACFs.

Introduction: Fever is a common health problem in childhood. Parents often administer paracetamol to children without consulting a doctor since it is a widely available over the counter drug. The aim of this study was to find out knowledge and practices of administration of paracetamol for children below the age of five years. Methods: Community based descriptive cross-sectional study was carried out using a pre-tested interviewer administered questioner in Bope-Poddla Medical Officer of Health area. Results: One hundred and six parents participated (89.6% female). Mean age (SD) of participants was 32 (5.9) years. All parents were aware of the availability of tablets and syrup. Only 55.7% was aware of suppositories. Majority (95.3%) of the participants did not know the recommended dose. More than half of the parents (62.3%) administered paracetamol without a medical advice. The association between use of package label instruction with correct dosing was statistically significant (p = 0.04). The commonly used measuring device was a measuring cup (83%). Among the seven teaspoon users, two knew its capacity correctly. Fifty-nine percent of the parents gave weight appropriate dose; 15.1% had given subtherapeutic dose and 25.5% given supratherapeutic dose. Level of education was not associated with correct dosing (p = 0.1). There were statistically significant associations between the age group of the participants with correct dosing (p = 0.04). The recommended dosing frequency was exceeded by 50.9%. Conclusions: Administration of supratherapeutic and subtherapeutic doses of paracetamol to children under five years old is not uncommon. Further, parents are not adhering to the recommended frequency of administration.

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Background The COVID-19 pandemic is a serious global health concern, posing a greater risk of psychological vulnerabilities for frontline healthcare workers (HCWs), military professionals and the general public around the globe. These psychological issues appear to be long lasting and heighten the risk of mental health disorders. Therefore, this study aimed to identify psychological problems encountered by HCWs, military professionals, and the general public in Sri Lanka during the COVID-19 pandemic. Methods A descriptive cross-sectional study was undertaken with 367 participants, including frontline HCWs (n = 128), military professionals (n = 102), and the general public (n = 137). Depression and anxiety were assessed using the Peradeniya Depression Scale (PDS) and the Generalized Anxiety Disorder scale (GAD-7), respectively. Results Mean (± SD) age of the participants was 35.0 (± 10.6) years. A reasonable proportion of participants experienced depressive symptoms (39.25%, n = 144) and severe anxiety (12.8%, n = 47). Military professionals showed depressive symptoms (73.50%, n = 75) and severe anxiety (32.4%, n = 33) predominantly. Multivariate binary logistic regression revealed that only the level of education and professional engagement affected depressive symptoms and severe anxiety (p < 0.01). Having a high level of education was a protective factor for depressive symptoms (Adjusted OR = 0.34) compared to lower-level education, while being a HCW (Adjusted OR = 4.40) and military professional (Adjusted OR = 5.43) were identified as risk factors for depressive symptoms compared to the general public. Similarly, having a high level of education was a protective factor for severe anxiety (Adjusted OR = 0.29) compared to lower-level education, while being a HCW (Adjusted OR = 3.90) and military professional (Adjusted OR = 4.52) were identified as risk factors for severe anxiety compared to the general public. Conclusion The current study revealed a greater level of anxiety and depressive symptoms among frontline HCWs and military professionals in Sri Lanka during the pandemic of COVID-19 compared to the general public. Therefore, providing psychological first aid for them to better deal with mental problems and an emergency preparedness plan to deal with sudden outbreaks of infectious situations are important.