Gender disparities in preterm neonatal outcomes

O'Driscoll, David N; McGovern, Matthew; Greene, Catherine M.; Molloy, Eleanor J.

doi:10.1111/apa.14390

Cited by 119 publications

(114 citation statements)

References 61 publications

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“…Sex is known to have a significant bearing on neonatal outcomes with male preterm infants experiencing more adverse outcomes than females 33 , and yet we saw very few significant differences in immune parameters between male and female infants. The few immune differences that were identified may, therefore, be functionally relevant.…”

Section: Discussionmentioning

confidence: 86%

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies

et al. 2020

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Infection and infection-related complications are important causes of death and morbidity following preterm birth. Despite this risk, there is limited understanding of the development of the immune system in those born prematurely, and of how this development is influenced by perinatal factors. Here we prospectively and longitudinally follow a cohort of babies born before 32 weeks of gestation. We demonstrate that preterm babies, including those born extremely prematurely (<28 weeks), are capable of rapidly acquiring some adult levels of immune functionality, in which immune maturation occurs independently of the developing heterogeneous microbiome. By contrast, we observe a reduced percentage of CXCL8producing T cells, but comparable levels of TNF-producing T cells, from babies exposed to in utero or postnatal infection, which precedes an unstable post-natal clinical course. These data show that rapid immune development is possible in preterm babies, but distinct identifiable differences in functionality may predict subsequent infection mediated outcomes.

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Section: Discussionmentioning

confidence: 86%

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies

et al. 2020

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“…This nding is in agreement with nding of a study in Australia. It reported that risk of neonatal sepsis was found increase three times more in male neonates as compared to female neonates (30). Male sex is associated with a higher risk of neurological, pulmonary, cardiovascular and infectious morbidities as well as overall mortality when compared to female infants of similar preterm gestation (29).…”

Section: Discussionmentioning

confidence: 99%

“…Important differences in the immune response between male and female preterm neonates have also been noted (31). However, the etiology of sex-speci c differences in disease remains relatively undetermined and is likely multifactorial, with genetic, immunological and hormonal in uences playing key roles (30).…”

Section: Discussionmentioning

confidence: 99%

Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.

Agnche¹,

Yeshita

Gonete

2020

Preprint

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Background: Neonatal sepsis contributes substantially to neonatal morbidity and mortality and is an ongoing major global public health challenge particularly in developing countries. Studies conducted on proportion and risk factors of neonatal sepsis in Ethiopia are from referral hospital which may not be generalized to primary health care units where a significant proportion of mothers give birth in these health facilities. This study sought to determine the proportion of clinical neonatal sepsis and associated factors in the study areas.Methods: Institutional based cross-sectional study was conducted from March to April 2019, in Amhara regional state, central Gondar zone public primary hospitals in Ethiopia. A total of 352 subjects (mother-neonate pairs ) were selected using systematic random sampling technique and pre-tested and structured questionnaires were used to collect data. Multivariable logistic regression analysis was fitted to identify factors associated with neonatal sepsis. Adjusted Odds Ratio (AOR) with the corresponding 95% confidence Interval (CI) was used to show the strength of associations and variables with p-values of <0.05 were considered as statistically significant.Results: The overall proportion of neonatal sepsis was 64.8 %( 95% CI (59.2, 69.2). Being male neonate(AOR=3.7; 95% CI(1.76,7.89)), history of urinary tract infections during the index pregnancy(AOR =6,26; 95% CI (1.16,33.62)), frequency of per-vaginal examination greater than three during labor and delivery(AOR=6.06; 95% CI((2.45,14.99)), neonatal resuscitation at birth (AOR=6.1; 95% CI (1.71,21.84)), place of delivery at the health center(AOR=3.05; 95% CI(1.19,7.79)), lack of training of health workers on neonatal resuscitation and infection prevention practices (AOR=2.14; 95% CI (1.04,4.44)), late age of neonate at onset of illness(AOR=0.05; 95% CI(0.01, 0.21)) and maternal age of 30-34 years (AOR=0.19; 95% CI(.047, 0.81)) were significantly associated with neonatal sepsis.Conclusion: The proportion of neonatal sepsis is high. Maternal, neonatal and health service related factors were identified for neonatal sepsis. Therefore; training of health workers, provision of health care services as per standards and monitoring and evaluation of obstetrical/neonatal cares during labor and delivery are mandatory.

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“…Increased rates of respiratory disorders among boys are partly due to their delayed lung maturation. 27 Sex hormones have been shown to impact fetal lung development with androgens negatively and estrogens positively, influencing surfactant production. 27 -29 However, to our knowledge, there have been no studies in which the authors examined whether changes in morbidities, as reported in recent studies, 1, 2, 4 have affected male and female infants differently.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation

et al. 2018

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OBJECTIVE:To examine whether changes in mortality and morbidities have benefited male more than female infants. METHODS: Infants of gestational ages 22 to 29 weeks born between January 2006 and December 2016 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals by sex and birth year. We tested temporal differences in mortality and morbidity rates between boys and girls by means of a likelihood ratio test (LRT) on nested binomial regression models with log links. RESULTS:A total of 205 750 infants were studied; 97 048 (47.2%) infants were girls. The rate for mortality and chronic lung disease decreased over time faster for boys than for girls (LRT P < .001 for mortality; P = .006 for lung disease). Restricting to centers that remained throughout the entire study period did not change all the above but additionally revealed a significant year-sex interaction for respiratory distress syndrome, with a faster decline among boys (LRT P = .04). Morbidities, including patent ductus arteriosus, necrotizing enterocolitis, early-onset sepsis, late-onset sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and pneumothorax, revealed a constant rate difference between boys and girls over time.CONCLUSIONS: Compared with girls, male infants born at <30 weeks' gestation experienced faster declines in mortality, respiratory distress syndrome, and chronic lung disease over an 11-year period. Future research should investigate which causes of death declined among boys and whether their improved survival has been accompanied by a change in their neurodevelopmental impairment rate. abstract

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Gender disparities in preterm neonatal outcomes

Abstract: The male disadvantage in preterm outcomes is likely multifactorial with hormonal, genetic and immunological differences likely playing key roles. Gender is an important variable in preterm outcome and should be considered when designing clinical and experimental research.

Cited by 119 publications

References 61 publications

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies

Institutional Delivery Predisposes to Neonatal Sepsis and Its Associated Factors Among Neonates Admitted to Neonatal Intensive Care Units in Central Gondar Zone Primary Hospitals, Northwest Ethiopia, 2019.

Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation

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