A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Masters of Science Degree in Occupational Therapy, by course work. Johannesburg, 1992. / The incidence of learning problems in a group of Normal and At-Risk preterm children was deterlined in this study. The children were allocated to Normal and At- Risk groups using the Neurodevelopmental Assessment Scale (NDS). The NOS was designed by Muriel Goodman for her thesis, "Evaluation of Physiotherapy on Preterm Infants", submitted to the Faculty of Medicine, University of he Witwatersrand, Johannesburg, in fulfilment of the requirements for the Degree of Doctor of Philosophy, 1987. [Abbreviated Abstract. Open document to view full version]

Introdução - O baixo peso ao nascer (BPN) é considerado um dos mais importantes problemas de saúde pública em todo o mundo, contribuindo, substancialmente, para a morbi-mortalidade infantil. Objetivos Estimar a proporção de baixo peso ao nascer e identificar a presença de associações entre o baixo peso ao nascer e fatores relacionados à gestação, ao parto, ao recém-nascido e a características sócio-demográficas maternas. Métodos Estudo transversal onde se analisaram 3220 declarações de nascidos vivos referentes aos partos ocorridos no município de Cruzeiro do Sul, Estado do Acre, no período de 2006 e 2007, de mães residentes nesta localidade. Na análise, utilizou-se regressão linear generalizada família Poisson ligação logarítmica com variância robusta, simples e múltipla. Adotou-se nível de significância de 0,10. Resultados - A proporção de baixo peso ao nascer foi 9,13%. Os fatores associados ao baixo peso ao nascer foram: prematuridade; nascimento no domicílio; sexo feminino; idades maternas entre 12 e 13 anos, 16 e 17 anos, 18 e 19 anos, 35 e mais anos; realização de 1 a 3 consultas de pré-natal, crianças não brancas, mães sem ocupação fora do lar e mães solteiras. Conclusão São poucos (ou nenhum) os fatores suscetíveis de mudança ou controle com ações isoladas de saúde. Estratégias de ampla abrangência são necessárias para a redução da proporção de BPN em Cruzeiro do Sul, Acre e, uma vez ocorrido baixo peso ao nascer, atenção especial deve ser proporcionada à criança. / Introduction - The low birth weight (LBW) is considered one of the most important public health problems around the world, contributing substantially to infantile morbidity and mortality. Objectives - To estimate the proportion of low birth weight and identify the presence of associations between low birth weight and factors related to pregnancy, chilbirth, newborn baby and maternal socio-demographic characteristics. Methods - Cross-sectional study which examined 3220 statements of births relating to births occurring in the city of Cruzeiro do Sul, Acre, in the period 2006 to 2007, of resident mothers in this locality. In the analysis, was used linear regression generalized with Poisson family logarithmic linking robust variance, simple and multiple. It was used a significance level of 0,10. Results - The proportion of low birth weight was 9,13%. Factors associated with low birth weight were: prematurity, birth at home, female, maternal age between 12 and 13 years, 16 and 17 years, 18 and 19 years, more than 34 years, achieving 1-3 pre-natal consultations, non-white children, mothers with no occupation outside home and single mothers. Conclusion- Few (or none) the factors susceptible to change or control with isolated actions health. Wide variety of strategies are needed to reduce the proportion of LBW in the city of Cruzeiro do Sul, Acre, and once occurred low birth weight, attention should be given to the child.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2019-03-12T21:48:07Z No. of bitstreams: 2 Carla_Massaro_2018.pdf: 2100131 bytes, checksum: 49b8d75049eba84cd9747560262c9888 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2019-03-12T21:48:07Z (GMT). No. of bitstreams: 2 Carla_Massaro_2018.pdf: 2100131 bytes, checksum: 49b8d75049eba84cd9747560262c9888 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-04-03 / Introduction: Periodontitis is considered a public health problem because of its high prevalence in the world and has been associated with preterm birth and low birth weight. Prematurity is one of the most serious perinatal problems, persisting as one of the major causes of perinatal mortality and morbidity. Objective: To evaluate the effect of periodontal disease on preterm birth and the birth of low birth weight babies. Materials and Methods: This is a study involving 45 mothers of newborn infants, assessed periodontally 48 hours postpartum, who presented mild to moderate / severe, localized or generalized chronic periodontitis with probing bleeding and gingival inflammation. Divided into DPL (mild periodontal disease) (n = 15) and DPMS group (moderate / severe periodontal disease) (n = 30). Data were collected from the current gestation and baby data. The variables were tested for normality and homogeneity (Shapiro-Wilk test) and submitted to the Student's T-test (p <0.05). The correlation between variables was analyzed using the Pearson Correlation Test. Results: The results showed that there was a moderate (-0.5388) and significant (p = 0.014) negative correlation between gingival crevicular fluid and gestational age, a moderate (-0.5026) and significant (p = 0.0046) negative correlation between the index of plaque and gestational age and a moderate (-0.4562) and significant (p = 0.0112) negative correlation between gingival index and gestational age in the DPMS group alone. Conclusion: From the results obtained, it was possible to conclude that the presence of inflammation due to moderate / severe periodontitis may represent a risk factor for the occurrence of preterm birth. / Introdução: A periodontite é considerada um problema de saúde pública pela elevada prevalência no mundo, e tem sido associada ao parto prematuro e baixo peso ao nascer. A prematuridade constitui um dos problemas perinatais mais graves, persistindo como uma das maiores causas de mortalidade e morbidade perinatal. Objetivo: Avaliar o efeito da doença periodontal no parto prematuro e nascimento de bebês com baixo peso. Materiais e Métodos: Trata-se de um estudo envolvendo 45 mães de crianças recém-nascidas, avaliadas periodontalmente 48 horas pós-parto, que apresentaram periodontite crônica leve a moderada/severa, localizada ou generalizada, com sangramento à sondagem e inflamação gengival. Divididas em Grupo DPL (doença periodontal leve) (n=15) e Grupo DPMS (doença periodontal moderada/severa) (n=30). Foram coletados dados da gestação atual e dados do bebê. As variáveis passaram pelo teste de normalidade e homogeneidade (Teste de Shapiro-Wilk) e submetidas ao teste T-Student (p< 0.05). A correlação entre as variáveis foi analisada através do Teste de Correlação de Pearson. Resultados: Os resultados mostraram que houve uma correlação negativa moderada (-0.5388) e significativa (p=0.014) entre o fluido crevicular gengival e a idade gestacional, uma correlação negativa moderada (-0.5026) e significativa (p=0.0046) entre o índice de placa e a idade gestacional e uma correlação negativa moderada (-0.4562) e significativa (p=0.0112) entre o índice gengival e a idade gestacional somente no Grupo DPMS. Conclusão: A partir dos resultados obtidos, foi possível concluir que a presença de inflamação decorrente de uma periodontite moderada/severa pode representar um fator de risco para a ocorrência de parto prematuro.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivos: Verificar a existÃncia de associaÃÃo entre a idade materna e o internamento de recÃm-nascidos (RN) na Unidade de Terapia Intensiva (UTI) em maternidades de nÃvel terciÃrio no estado do CearÃ. Aferir os indicadores peso ao nascimento e idade gestacional, comparando grupos divididos pela idade materna em adolescente precoce, adolescente tardia e nÃo adolescente. Metodologia: estudo observacional, descritivo, do tipo transversal, onde se avaliou o nÃmero de partos simples de nascidos vivos realizados no Hospital Geral Dr. CÃsar Cals (HGCC) e na Maternidade Escola Assis Chateaubriand (MEAC) no perÃodo de 01 de janeiro a 31 de dezembro de 2003 e os 1351 recÃm-nascidos de partos simples internados na UTI destes hospitais foram estudados quanto as variÃveis, idade materna, idade gestacional e peso ao nascer, atravÃs de pesquisa em livros de registro, prontuÃrios e arquivo eletrÃnico. Na anÃlise dos dados foram utilizados os testes de Qui-quadrado de Pearson, da relaÃÃo Linear, e o Exato de Fisher. Foram considerados estatisticamente significantes todos os achados com valor de p< 0,005. Como medida de risco foi calculada a odds ratio, com intervalo de confianÃa de 95%. Resultados: do total de partos (11.429), 24,8% eram de mÃes adolescentes e 11,8% dos recÃm-nascidos (RN) foram internados na UTI. Embora exista indicativo de relaÃÃo linear, p= 0, 097 (<0,100), onde à medida que aumenta a faixa etÃria da mÃe, diminui a incidÃncia de RN em UTI, nÃo se obteve estatisticamente, associaÃÃo significativa entre idade materna e internamento em UTI (p= 0,207). Observou-se maior percentual de prematuridade nos RN de adolescentes precoces (86,1%), quando comparadas com adolescentes tardias (85,2%) e nÃo adolescentes (74,8%), mostrando que estatisticamente existe associaÃÃo entre idade gestacional e idade materna (p< 0,001). Entretanto estatisticamente nÃo se nota diferenÃa entre os dois grupos de adolescentes quanto à prematuridade (OR 1,08; IC 95% 0,51 â 2,27). Embora exista diferenÃa estatÃstica, quando comparamos adolescentes precoces e tardias com nÃo adolescentes (OR 2.08; IC 1.05 - 4.13 e OR 1.93; IC 1.35 - 2.76 respectivamente). Quanto a variÃvel peso ao nascer, observou-se maior percentual de baixo peso ao nascer (BPN) nos filhos de mÃes adolescentes precoces (87,5%) quando comparado com adolescentes tardias (83,0%) e nÃo adolescentes (73,3%), mostrando que existe associaÃÃo estatisticamente significante entre peso ao nascer e idade materna (p< 0,001). Estatisticamente nÃo se nota diferenÃa de BPN entre adolescentes precoces e tardias (OR 1.42; IC 0.66 - 3.66). Quando comparamos adolescentes precoces e tardias com nÃo adolescentes encontramos diferenÃa estatisticamente significante (OR 3.07; IC 1.50 â 6.25 e OR 2.15; IC 1.53 â 3.01 respectivamente). Observou-se tambÃm maior percentual de RN de muito baixo peso ao nascer entre as adolescentes precoces, mas estatisticamente nÃo se nota diferenÃa quando comparadas com as adolescentes tardias, (OR 1.17; IC95% 0.69 â 1.97). Quando comparamos adolescentes precoces e tardias com nÃo adolescentes encontramos diferenÃa estatisticamente significante (OR 1.65; IC95% 1.02 â 2.69 e OR 1.41; IC95% 1.07 â 1.86) respectivamente. ConclusÃes: Estatisticamente, nÃo foi encontrada associaÃÃo significativa entre a idade materna e o fato do RN ir ou nÃo para a UTI. Existe associaÃÃo estatisticamente significante entre idade gestacional e idade materna e entre peso ao nascer e idade materna. Existe diferenÃa estatisticamente significante entre adolescentes e nÃo adolescentes, quanto ao percentual de prematuridade, baixo peso e muito baixo peso ao nascer. O percentual de prematuridade, baixo peso e muito baixo peso ao nascer foi maior nas adolescentes precoces do que nas tardias, entretanto, a odds ratio nÃo alcanÃou significÃncia estatÃstica. / Study Objective: To check existence of association between motherâs age and newbornâs hospitalizing at Intensive Therapy Unit at tertiary level maternity on 2003 on Cearà â Brasil. To measure the variables birth weight and pregnancy age comparing groups by the motherâs age of precocious teenagers, late teenagers and adults. Method: transversal and descriptive study where it was rated the number of simple deliveries of alive newborns on Hospital Geral CÃsar Cals (HGCC) and Maternidade Escola Assis Chateaubriand (MEAC) since January 1s until December 31 on the year of 2003 and the 1351 simple deliveries newbornâs hospitalizing at Intensive Therapy Unit (ITU) of those hospitals were studied about motherâs age, pregnancy age and birth weight, through searches on books of maternity hospital, medical register and registers on electronics archives. Pearsonâs chi-square, linear relation and Exact of Fisher tests were used on analysis of data. Chi-square test and odds ration (OR) with 95% confidence intervals (95%CI) were used to compare quantitative variables. Results: Eleven thousand four hundred twenty nine (11.429) women delivered at maternities hospitals studied, 24,8% were teenagers mothers , 11,8% newborns were hospitalized at ITU. Although there was indicative of linear relation, p= 0, 097 (<0,100), there wasnât significant statically association between mother age and hospitalizing at ITU (p= 0,207). Was observe highest percentages of prematurely on newborns of precocious teenagers, (86,1%), when compared with late teenagers (85,2%) and adults. (74,8%), evidence that there was statically association between pregnancy age and mothers age (p< 0,001). However there wasnât statically difference between precocious teenagers and late teenagers when prematurely was studied (OR 1,08; IC 95% 0,51 â 2,27). Although, there was statically difference when precocious and late teenagers were compared with adults. (OR 2.08; IC 1.05 - 4.13 e OR 1.93; IC 1.35 - 2.76). When birth weight was measured, there was highest percentages of low weight on children of precocious teenagers (87,5%) than late teenagers (83,0%) and adult (73,3%), evidence that there was significant statically association between birth weight and mothers age (p< 0,001). Statically there wasnât difference of low weight between precocious and late teenagers (OR 1.42; IC 0.66 - 3.66). When precocious and late teenagers were compared with adults there was significant statically difference (OR 3.07; IC 1.50 â 6.25 e OR 2.15; IC 1.53 â 3.01 respectively). It was observed highest percentages of newborns with very low birth weight on precocious teenagers, but there wasnât statically difference when they were compared with late teenagers, (OR 1.17; IC95% 0.69 â 1.97). When precocious and late teenagers were compared with adults there was significant statically difference (OR 1.65; IC95% 1.02 â 2.69 e OR 1.41; IC95% 1.07 â 1.86 respectively). Conclusions: It wasnât found significant statically association between mother age and hospitalizing at ITU. There was significant statically association between pregnancy age and mother age and birth weight and mother age. There was significant statically difference between teenagers and adults about prematurely, low birth weight and very low birth weight percentages. The percentages of prematurely, low birth weight and very low birth weight were more frequent on precocious teenagers than late teenagers. However the odds ratio wasnât significant statically.

Introdução - O baixo peso ao nascer (BPN) é considerado um dos mais importantes problemas de saúde pública em todo o mundo, contribuindo, substancialmente, para a morbi-mortalidade infantil. Objetivos Estimar a proporção de baixo peso ao nascer e identificar a presença de associações entre o baixo peso ao nascer e fatores relacionados à gestação, ao parto, ao recém-nascido e a características sócio-demográficas maternas. Métodos Estudo transversal onde se analisaram 3220 declarações de nascidos vivos referentes aos partos ocorridos no município de Cruzeiro do Sul, Estado do Acre, no período de 2006 e 2007, de mães residentes nesta localidade. Na análise, utilizou-se regressão linear generalizada família Poisson ligação logarítmica com variância robusta, simples e múltipla. Adotou-se nível de significância de 0,10. Resultados - A proporção de baixo peso ao nascer foi 9,13%. Os fatores associados ao baixo peso ao nascer foram: prematuridade; nascimento no domicílio; sexo feminino; idades maternas entre 12 e 13 anos, 16 e 17 anos, 18 e 19 anos, 35 e mais anos; realização de 1 a 3 consultas de pré-natal, crianças não brancas, mães sem ocupação fora do lar e mães solteiras. Conclusão São poucos (ou nenhum) os fatores suscetíveis de mudança ou controle com ações isoladas de saúde. Estratégias de ampla abrangência são necessárias para a redução da proporção de BPN em Cruzeiro do Sul, Acre e, uma vez ocorrido baixo peso ao nascer, atenção especial deve ser proporcionada à criança. / Introduction - The low birth weight (LBW) is considered one of the most important public health problems around the world, contributing substantially to infantile morbidity and mortality. Objectives - To estimate the proportion of low birth weight and identify the presence of associations between low birth weight and factors related to pregnancy, chilbirth, newborn baby and maternal socio-demographic characteristics. Methods - Cross-sectional study which examined 3220 statements of births relating to births occurring in the city of Cruzeiro do Sul, Acre, in the period 2006 to 2007, of resident mothers in this locality. In the analysis, was used linear regression generalized with Poisson family logarithmic linking robust variance, simple and multiple. It was used a significance level of 0,10. Results - The proportion of low birth weight was 9,13%. Factors associated with low birth weight were: prematurity, birth at home, female, maternal age between 12 and 13 years, 16 and 17 years, 18 and 19 years, more than 34 years, achieving 1-3 pre-natal consultations, non-white children, mothers with no occupation outside home and single mothers. Conclusion- Few (or none) the factors susceptible to change or control with isolated actions health. Wide variety of strategies are needed to reduce the proportion of LBW in the city of Cruzeiro do Sul, Acre, and once occurred low birth weight, attention should be given to the child.

Made available in DSpace on 2017-07-10T14:17:11Z (GMT). No. of bitstreams: 1 DISSERTAcaoO MILENE ROVER.pdf: 5749062 bytes, checksum: 18f8d6f313597b7afe33896aa5a3c610 (MD5) Previous issue date: 2015-03-13 / The increasing survival of preterm infants with birth weight below 1500 grams (VLBW) determines the need for a focus on care and follow-up of this group after discharge from the Neonatal Intensive Care Unit (NICU). Based on the high morbidity rate and changes in the growth of these children, the growth follow-up of the VLBW preterm is turned into an essential tool for monitoring its health. Thus, this study aims to: evaluate the growth of the VLBW preterm from birth to 12 months of Corrected Age (CA) after the NICU s discharge; describe the Z score profile of the anthropometric variables from birth to 12 months of CA; identify events that have influenced the Extra Uterine Growth Restriction (EUGR) during hospitalization and in the 12 month period of follow-up; identify the morbidities that have influenced the growth of the VLBW preterm. It is a quantitative, observational, longitudinal, retrospective and cross sectional study, which was realized in High Risk Follow up Ambulatory. The study enrolled 71 children who were attended between 2006-2013, with birth weight below 1500 g; admitted to the NICU at birth and had at least three outpatient visits in the following periods: period I up to 3 months of CA; period II between 4-6 months of CA and period III between 7-12 months of CA. In order to classify the relation Weight/Gestational Age (GA) the Fenton and Kim s curve was used. Besides, to calculate the Z score, the Research Bulk Calculator and the Anthro calculators were used. The variables were analyzed by logistic regression with XLSTAT program. The GA average was 29.4 weeks; 36 (51%) PT male, 50 (70%) PT babies the weight was Appropriate for GA (AGA). During hospitalization, 43 (61%) babies used Parenteral Nutrition. The weight score Z average at birth was -0.95; at the hospital discharge -3.05; in period I -2.4; period II -1.8; period III -1.2. The height at birth was -1.21, at discharge -2.23; -2.5, -1.8 and -1.1 for the periods I, II and III, respectively. Regarding the Head Circumference (HC): Z score at birth was -0.71; at discharge -1.5; and monitoring -1.1, -0.8 and -0.5, respectively in the periods I, II and III. Presenting AGA birth weight, shorter hospitalization and percentage of lost weight during the hospitalization, reduce the chance for EUGR. In the follow up period, the occurrence of metabolic bone disease, retinopathy of prematurity, gastro esophageal reflux and hospitalization, increase the EUGR chance. Despite of the substantial reduction in the Z score during hospitalization, there was a progressive improvement during follow up in this score in the three anthropometric variables, especially in the HC. At 12 months of CA 86% of infants were with Z score above -2 in relation to HC. Thus, it was possible to verify the importance of nutrition in the neonatal period, as well as, the proper and systematic follow-up in order to minimize the consequences and changes in the growth caused by prematurity, focusing on the full potential of preterm. / A crescente sobrevida de Prematuros (PT) com peso ao nascimento abaixo de 1.500 gramas (PTMBP) determina a necessidade do enfoque no atendimento e acompanhamento desse grupo após alta da Unidade de Terapia Intensiva Neonatal (UTIN). Frente ao elevado índice de morbidades e alterações no crescimento dessas crianças, o acompanhamento do crescimento infantil do PTMBP se traduz em ferramenta essencial à vigilância à sua saúde. Nesse contexto, têm-se como objetivos: avaliar o crescimento do PTMBP do nascimento aos doze meses de Idade Corrigida (IC) após a alta da UTIN; descrever o perfil do escore Z das variáveis antropométricas do nascimento até aos 12 meses de IC; identificar intercorrências que influenciaram o Retardo de Crescimento Extrauterino (RCEU) durante a internação e no período de 12 meses de seguimento ambulatorial; identificar as morbidades que influenciaram o crescimento dos PTMBP. Estudo quantitativo, observacional, longitudinal, retrospectivo e de corte transversal, realizado em Ambulatório de Seguimento de Alto Risco. Participaram do estudo 71 crianças atendidas entre 2006 a 2013, nascidas com peso menor de 1.500 g; que ficaram internadas na UTIN ao nascimento e realizaram pelo menos três consultas ambulatoriais, nos seguintes períodos: período I - até 3 meses de IC; período II - entre 4 a 6 meses de IC e período III - entre 7 a 12 meses de IC. Para relação Peso/Idade Gestacional (IG) foi utilizada a curva de Fenton e Kim. O escore Z obteve-se na Calculadora de Pesquisa em Massa disponível em: http://www.ucalgary.ca/fenton/ e calculadora Anthro. As variáveis foram analisadas por meio da regressão logística com o programa XLStat 2014. A IG média foi de 29,4 semanas, 36 (51%) masculinos, 50 (70%) PT eram Adequados para a IG (AIG). Na internação, 43 (61%) PT fizeram uso de Nutrição Parenteral (NP). Média do escore Z do peso ao nascimento: -0,95; na alta hospitalar: -3,05; no período I: -2,4; no período II: -1,8; no período III: -1,2. A média da estatura foi: -1,21 ao nascimento; -2,23 na alta; -2,5, -1,8 e -1,1 nos períodos I, II e III, respectivamente. Em relação ao Perímetro Cefálico (PC): escore Z ao nascimento foi -0,71; na alta: -1,5; e seguimento: -1,1, -0,8 e -0,5, respectivamente nos períodos I, II e III. Apresentar o peso AIG, menor tempo de internação na UTIN e porcentagem de peso perdido na hospitalização, reduz a chance de RCEU. No seguimento ambulatorial, a ocorrência de doença metabólica óssea, retinopatia da prematuridade, refluxo gastroesofágico e reinternação, aumentam a chance de RCEU. Apesar da importante queda do escore Z durante a internação, houve melhora progressiva durante o seguimento ambulatorial nos índices de escore Z das três variáveis antropométricas, principalmente do PC. Sendo que com 12 meses de IC, 86% das crianças acompanhadas estavam com escore Z acima de -2 em relação ao PC. Verifica-se a importância da nutrição no período neonatal, assim como, do seguimento ambulatorial adequado e sistematizado, visando minimizar as sequelas e alterações no crescimento advindas da prematuridade, na busca de alcançar todo o potencial do RNPT.

Thesis (Ph.D. (Clinical Psychology)) --University of Limpopo, 2008 / Refer to document

Adverse birth outcomes and adverse childhood experiences (ACE) are concerns in the United States, with potential to impact health indices now and in the future. The purpose of this study was to quantitatively examine the association between maternal exposure to ACE, low birth weight, and county of residence in the Appalachian population using the Life Course Approach as the theoretical framework. A cross-sectional study design and clustering strategy was used to randomly select potential respondents from a data set that was provided by Ohio Department of Health. Self-administered questionnaires were sent to potential respondents to collect information about ACE in the maternal population of Appalachia, Ohio with an overall response rate of 29.5% and 212 total participants. A chi-square analysis was completed and no significant association was found between county of residence and risk of low birth weight. However, statistically significant associations were found between the different types of ACE exposure and low birth weight delivery as well as Appalachian county of residence and exposure to ACE. As the sample of low birth weight deliveries was small, it is recommended that the relationship between ACE exposure and low birth weight be further studied to develop more purposeful health interventions to improve maternal health in Appalachia, Ohio specifically, as well as other rural communities. Reducing rates of adverse birth outcomes and chronic disease burden in Appalachia have potential to reduce health disparities between urban and Appalachian communities, allowing for positive social change for many socioeconomically disadvantaged communities and improving population health.

Low birth weight (LBW) is a major public health concern globally. Despite its negative social and economic impact on the family and community at large, it has remained relatively unexplored at population level in Zimbabwe. The purpose of the study was to establish determinants of LBW using data from the 2015 Zimbabwe Demographic and Health Survey. The socioecological model was the conceptual framework for the study. A secondary analysis was conducted on 4,227 mother-infant dyads. Independent variables were duration of pregnancy, number of births within the past 5-year period, exposure to mass media, type of fuel used for cooking in the household, and intimate partner violence. Covariates were maternal age at delivery, place of residence, anemia, marital status, education, wealth index, ever terminated pregnancy, infant sex, and alcohol consumption. For parsimony, statistical significance was set at p < 0.05 at the 95% confidence interval (CI). Multivariable logistic regression analysis showed that mild maternal anemia (adjusted odds ratio [aOR] 1.83 CI 1.17-2.87 p = 0.01), moderate to severe anemia (aOR 1.80 CI 1.01-3.19 p = 0.05), and being a female neonate (aOR 1.48 CI 1.17-2.87 p = 0.008) had higher odds for LBW. Pregnancy duration of 8 months (aOR 0.01 CI 0.003-0.039 p < 0.001) and of 9 months (aOR 0.12 CI 0.04-0.33 p = 0.001) had lower odds for LBW. Birth of 2 infants within a 5-year period (aOR 2.40 CI 1.24-4.66 p = 0.01) was associated with LBW. Implications for positive social change include coming up with a health policy on the management of anemia during pregnancy and health promotion messages to promote optimal birth spacing, including strategies that reduce chances for preterm deliveries.

Trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13) represent the most common autosomal trisomies detected in live-born infants. Previous studies have addressed interventions, morbidities and survival in term or near-term infants with T21, T18 or T13, or were limited by a small number of patients. However, the combination of one of these chromosomal anomalies and very low birth weight (VLBW) presents greater challenges. Data from the NICHD Neonatal Research Network (NRN) and from the Vermont Oxford Network (VON) databases were used to examine the frequency, interventions, risk of mortality and neonatal morbidities, including patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD), among VLBW infants with T21, T18 or T13 compared to VLBW infants without major birth defects (BD) and VLBW infants with non-chromosomal BD. Anthropometric VON charts for the assessment of birth weight for gestational age among 22 week to term infants with T21, T18 or T13 were also developed. In the VON database (n=539,509), the frequency of VLBW infants diagnosed with T21 was 1681 (0.31%), with T18 was 1416 (0.27%), and with T13 was 435 (0.08%). Major surgery was reported for 30.4% of infants with T21, 9.2% with T18, and 6.8% with T13. In-hospital mortality occurred for 33.1% of infants with T21, 89.0% with T18, and 92.4% with T13. Median survival time was 4 days (95% CI: 3-4) among infants with T18 and 3 days (95% CI: 2-4) among infants with T13. Birth weight for gestational age charts were created using VON data with a total of 5147 infants with T21 aged 22-41 weeks, 1053 infants with T18 aged 22-41 weeks, and 613 infants with T13 aged 22-40 weeks. Among the three groups, infants with T18 were the most likely to be growth restricted while infants with T21 were the least likely to be growth restricted. The new anthropometric VON charts for infants with T21 were also compared to the Lubchenco and Fenton charts and both showed frequent misclassification of infants with T21 as small or large for gestational age. In the NICHD NRN database (n=52,259), 133 (0.26%) VLBW infants were diagnosed with T21, 132 (0.25%) with T18 and 40 (0.08%) with T13. The adjusted relative risk, estimated using Poisson regression models with robust variance estimators, showed an increased risk of death, PDA, NEC, LOS, and BPD among infants with T21 relative to infants with no BD. Relative to infants with non-chromosomal BD, infants with T21 were at increased risk of PDA and NEC. A trend toward a lower risk of ROP was observed among infants with T21 compared to infants with non-chromosomal BD and infants without major BD. Infants with T13, but not infants with T18, were less likely to be mechanically ventilated than infants with T21 and infants without BD. Infants with T18 had increased risk of PDA compared to infants with T13, infants with T21 and infants without BD and increased risk of BPD compared to infants with T21 and infants without BD. The current studies evaluated the largest cohorts of VLBW infants with T21, T18 or T13. These data are important to help families and care providers make informed decisions involving the care of their VLBW infants with these chromosomal anomalies.