No abstract

Summary Background Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1–59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India. Methods Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1.3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001–13 with annual UN estimates of national births and deaths (partitioned across India’s states and rural or urban areas) for 2000–15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1–59-month-old children. Findings The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1–59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11.9 per 1000 livebirths in 2000 to 4.0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9.0 per 1000 livebirths in 2000 to 2.2 per 1000 livebirths in 2015. At 1–59 months, the mortality rate from pneumonia fell by 63% from 11.2 per 1000 livebirths in 2000 to 4.2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9.4 per 1000 livebirths in 2000 to 3.2 per 1000 livebirths in 2015 (with narrowing girl–boy gaps). The neonatal tetanus mortality rate fell from 1.6 per 1000 livebirths in 2000 to less than 0.1 per 1000 livebirths in 2015 and the 1–59-month measles mortality rate fell from 3.3 per 1000 livebirths in 2000 to 0.3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12.3 per 1000 livebirths in 2000 to 14.3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3.3% for neonates and 5.4% for children aged 1–59 months. Annual declines from 2005 to 2015 (3.4% decline for neonatal mortality and 5.9% decline in 1–59-month mortality) were faster than were annual declines from 2000 to 2005 (3.2% decline for neonatal mortality and 4.5% decline in 1–59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000–05 declines. Interpretation To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1–59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwar...

A single measurement of attained weight at 5 or 7 lunar months (16-20 or 24-28 weeks) is the most practical screening instrument for LBW and IUGR in most primary health care settings and provides warning of the need for intervention. The operational value of these findings should be demonstrated through their successful large-scale application in service settings.

Several studies have evaluated outcomes of singleton pregnancies after blastocyst versus cleavage stage embryo transfer. Higher incidences of preterm birth (PTB), very preterm birth (VPTB), low birthweight (LBW) and congenital malformations were identified in a few of them. The objective of our study was to systematically review and meta-analyze pregnancy and neonatal outcomes among singleton births following blastocyst versus cleavage stage embryo transfer. METHODS EMBASE, MEDLINE, EBM Reviews and bibliographies of included studies were searched from their inception until March 2013. Observational studies or clinical trials comparing blastocyst with cleavage stage embryo transfer and reporting on outcomes of PTB (<37 weeks), VPTB (<32 weeks), LBW (<2500 g), very low birthweight (VLBW) (<1500 g) and/or congenital anomalies in singleton neonates were included. Data on the outcomes were extracted by two reviewers. Statistical heterogeneity among studies was evaluated by calculating I(2) values and χ(2) statistics. Meta-analyses were conducted to estimate the pooled unadjusted odds ratio (OR) and the adjusted OR (AOR) with a 95% confidence interval (CI) using the random effect model. RESULTS Six observational studies, of low to moderate risk of bias, were included in this review. There were significantly higher odds of PTB (four studies, 54 792 cleavage stage and 20 724 blastocyst stage births; AOR 1.32, 95% CI 1.19-1.46) and congenital anomalies (two studies, 22 068 cleavage stage and 4517 blastocyst stage births; AOR 1.29, 95% CI 1.03-1.62) among births after blastocyst transfer compared with cleavage stage transfer. There was no difference in the adjusted odds of VPTB (four studies, 54 792 cleavage stage and 20 724 blastocyst stage births; AOR 1.18, 95% CI 0.93-1.49), LBW (four studies, 54 109 cleavage stage and 20 392 blastocyst stage births; AOR 1.06, 95% CI 0.99-1.15) or VLBW (three studies, 22 088 cleavage stage and 5772 blastocyst stage births; AOR 1.01, 95% CI 0.73-1.38). CONCLUSIONS Risk of PTB in IVF singleton pregnancies is significantly higher following blastocyst transfer compared with cleavage stage transfer. Risk of congenital anomalies may also be higher but further studies are needed to confirm this finding and to identify reasons for such outcomes.

Background  History of induced termination of pregnancy (I‐TOP) is suggested as a precursor for infant being born low birthweight (LBW), preterm (PT) or small for gestational age (SGA). Infection, mechanical trauma to the cervix leading to cervical incompetence and scarred tissue following curettage are suspected mechanisms. Objective  To systematically review the risk of an infant being born LBW/PT/SGA among women with history of I‐TOP. Search strategy  Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria  Studies reporting birth outcomes to mothers with or without history of induced abortion were included. Data collection and analyses  Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder adjustment, analytical, outcome assessments and attrition. Meta‐analyses were performed using random effect model and odds ratio (OR), weighted mean difference and 95% confidence interval (CI) were calculated. Main results  Thirty‐seven studies of low–moderate risk of bias were included. A history of one I‐TOP was associated with increased unadjusted odds of LBW (OR 1.35, 95% CI 1.20–1.52) and PT (OR 1.36, 95% CI 1.24–1.50), but not SGA (OR 0.87, 95% CI 0.69–1.09). A history of more than one I‐TOP was associated with LBW (OR 1.72, 95% CI 1.45–2.04) and PT (OR 1.93, 95% CI 1.28–2.71). Meta‐analyses of adjusted risk estimates confirmed these findings. Conclusions  A previous I‐TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I‐TOP increased.

Objective: Organisms causing early-onset neonatal sepsis (EONS) have consistently changed over time. The distribution of organisms in EONS helps to influence the appropriate type of antibiotic prophylaxis strategy during labor and the antibiotics used in neonates with suspected sepsis. Result: A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n ¼ 24969) in the earlier cohort compared with 6.2/1000 admissions (n ¼ 37484) in the later cohort (P ¼ 0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P ¼ 0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms. Conclusion:Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted. (2011) Introduction Early-onset neonatal sepsis (EONS) occurs within the first 3 to 7 days of life, and is thought to be mainly caused by vertical transmission of organisms from the mother. 1,2 The incidence of EONS has been reported to vary from 1 to 4.6 cases per 1000 live births. [2][3][4] Traditionally, prevention of EONS has focused on prevention of vertical transmission of group B Streptococcus (GBS or Streptococcus agalactiae) through administration of maternal intrapartum antibiotic prophylaxis. 5 No effective strategies are currently available to prevent EONS caused by other organisms, 6 such as Escherichia coli. 7 Several recent studies of patient populations in the US have reported a change in neonatal infection patterns, with a reduction in EONS caused by GBS but an increase in EONS caused by ampicillin-resistant E. coli. 8,9 The growing problem of antibiotic resistance may be a contributing factor in increasing mortality rates of infants with EONS. 2,10 These studies have identified an urgent need to better understand the changing epidemiology of EONS, to enable delivery of appropriate intrapartum care to mothers 8,11 and postnatal care of the newborns. We have therefore analyzed data from a large population of infants admitted to Canadian neonatal intensive care units (NICUs) between 2003 and 2008, to identify trends in EONS, and determine the distribution of organisms in infants with EONS. The objective of this study was to add to our understanding of changing patterns of organisms associated with EONS, thereby helping to strategize future interventions. Journal of Perinatology Methods Study populationThe Canadian Neonatal Network (CNN) maintains and updates an established neonata...

No abstract

This systematic review and meta-analysis compared the efficacy and toxicity of dexamethasone (DEX) versus prednisone (PRED) for induction therapy in childhood acute lymphoblastic leukemia (ALL). We searched biomedical literature databases and conference proceedings for randomized controlled trials comparing DEX and PRED during induction therapy for childhood ALL. A total of eight studies were eligible for inclusion in this meta-analysis. DEX, in comparison with PRED, reduced events (that is, death from any cause, refractory or relapsed leukemia, or second malignancy; risk ratio (RR) 0.80; 95% confidence interval (CI), 0.68-0.94) and central nervous system relapse (RR 0.53; 95% CI, 0.44-0.65), but did not alter bone marrow relapse (RR 0.90; 95% CI, 0.69-1.18) or overall mortality (RR 0.91; 95% CI, 0.76-1.09). Patients receiving DEX had a higher risk of mortality during induction (RR 2.31; 95% CI, 1.46-3.66), neuro-psychiatric adverse events (RR 4.55; 95% CI, 2.45-8.46) and myopathy (RR 7.05; 95% CI, 3.00-16.58). There was no statistically significant difference in the risk of osteonecrosis, sepsis, fungal infection, diabetes or pancreatitis. DEX in induction therapy for children with ALL is more efficacious than PRED. However, DEX is also associated with more toxicity, and currently it remains unclear whether shortterm superiority of DEX will also result in better overall survival.