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 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.
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PMID:Reducing infant mortality. 1228 45

187 babies born elsewhere and referred to the Pediatric Department of the Christian Medical College and Hospital, Ludhiana, for management of prematurity over a period of 6 years were studied. Babies with hypothermia and those below 1200 g were given iv fluids. Preterm babies delivered in the institution and managed in the neonatal special care nursery over 1 year were also studied for comparison. The preterm babies were evenly distributed in the different gestation age groups between 28 and 36 weeks. About half the babies were appropriate for gestational age, while 47% were small for gestational age. The weight ranged from 760 to 2260 g. Males (166) outnumbered females (21) by a ratio of 8:1. There was a high incidence of hypothermia (54%) at the time of admission, more so in babies with gross prematurity. In babies less than 30 weeks old, 80% had become hypothermic during transit to the hospital. A fatal outcome was seen in 69% of babies with hypothermia as compared to 38% of babies admitted without hypothermia. 85% of babies were born in circumstances of potential infection in the form of prolonged rupture of membranes, multiple unsterile vaginal examinations, foul smelling liquor, fever of the mother, or a combination of these. Septicemia, purulent meningitis, bronchopneumonia, and diarrhea were the common infections. Other common morbidities were hyaline membrane disease, necrotizing enterocolitis, and metabolic disturbances. The overall mortality was 54% and it was inversely proportional to the gestational age, increasing from 36% at 35-36 weeks to 82% at 28-30 weeks. On the other hand, there was only a 21% mortality rate among preterm babies delivered at the hospital and managed in the neonatal nursery. Mortality was 9% in babies at 35-36 weeks. Intracranial hemorrhage was the most common cause of death in the study group, accounting for 42% of total deaths (59% of deaths at 28-30 weeks gestation, decreasing to only 4% at 35-36 weeks), followed by septicemia in 31%. On the other hand, septicemia caused about one-third of deaths at 35-36 weeks.
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PMID:Outcome of hospitalised out-born preterm babies. 1228 86

A prospective study on infant mortality was conducted in the field practice area of Rural Health Training Center (RHTC), Jawan, Aligarh. A sample of 1792 registered families in 9 villages under RHTC with a population of 12,118 were selected. The household survey was done in March 1989 by a questionnaire on type and composition of family, socioeconomic status, family environment, age, parity, and interval between the births. All live births and infant deaths in these villages during the period of April 1989 to March 1990 were considered. There were 416 births in the study year, giving a birth rate of 34.02/1000 mid-year population. Male and female births were 52.8% and 47.12%, respectively. 33 infants died during the period, giving an infant mortality rate of 79.32/1000 live births. Infant deaths equalled 39.4% for males and 60.6% for females. Neonatal and postneonatal deaths made up 63.6% and 36.4%, respectively. 33.3% of the neonatal deaths occurred in the first 24 hours, 23.8% in the next 6 days, and 42.9% beyond this period. The mortality risk was high in 5th and higher parity births and lowest in 2nd to 4th parity births. Diarrhea (21.2%), pneumonia (18.18%), tetanus (15.15%), prematurity (9.1%), and unqualified fever (9.1%) constituted main causes of infant death. Pneumonia and prematurity were responsible for more than 70% of infant deaths. In the 2nd to 4th parity groups, diarrhea and tetanus were the main causes. Deaths during the first 24 hours were mainly caused by birth injury, while, during the next 6 days, pneumonia and tetanus were the leading causes. Beyond this period, in addition to the above causes, diarrhea played a major role. In the postnatal period, diarrhea, pneumonia, and malnutrition were the main causes. To reduce infant mortality further, training of health workers, strengthening of delivery systems, maximum utilization of existing health infrastructure, environmental hygiene and health education regarding oral rehydration, and control of respiratory infection are needed.
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PMID:Certain aspects of infant mortality -- a prospective study in a rural community. 1228 17

The present review examines the role of dietary nucleotides in infants, and the scientific rationale and benefits of nucleotide supplementation of infant formula. The immunoprotective benefits of human milk, the biology of human milk nucleotides, and the immunological and gastrointestinal effects of dietary nucleotides in animal studies and in vitro experiments are examined. Clinical studies are reviewed, especially those examining the efficacy of nucleotide-supplemented infant formula in enhancing immunity and reducing the risk of sepsis. The presence of human milk cells, and a variety of immunoactive and trophic components of human milk, can explain the reduced incidence of sepsis in breastfed term and preterm infants. Nucleotides, believed to play an immunomodulatory role, are found in lower concentrations in infant formula. Animal studies have shown that dietary nucleotides enhance a number of immune responses and the growth, differentiation and repair of the gut. Several clinical studies have reported beneficial effects of nucleotide supplementation on gut microflora, diarrhoea and immune function, and one study has reported better catch-up growth in term infants with severe intrauterine growth retardation. More basic research studying the metabolism of nucleotides in neonates is encouraged. Additional randomized controlled trials are necessary to demonstrate the clinical benefits of nucleotide supplementation of infant formula, as it cannot be presumed that nucleotides produce the same benefits for the infant as human milk. Studies are especially necessary in high-risk neonatal situations, such as extreme prematurity, significant suboptimal nutrient intake before and after birth, and recovery from gut injury.
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PMID:Scientific rationale and benefits of nucleotide supplementation of infant formula. 1241 Aug 63

Congenital chloride diarrhea (CLD) is an autosomal recessive disorder of intestinal electrolyte absorption. It is characterized by persistent secretory diarrhea resulting in polyhydramnios and prematurity prenatally, and dehydration, hypoelectrolytemia, hyperbilirubinemia, abdominal distention, and failure to thrive immediately after birth. CLD is caused by mutations in the solute carrier family 26, member 3 gene (SLC26A3, alias CLD or DRA), which encodes a Na+-independent Cl-/HCO3- (or OH-) exchanger. SLC26A3 is a member of the SLC26 sulfate permease/anion transporter family and it is expressed mainly in the apical brush border of intestinal epithelium. The only extraintestinal tissues showing SLC26A3 expression are eccrine sweat glands and seminal vesicles. A wide variety of different mutations in the SLC26A3 gene have been associated with CLD with no apparent evidence of phenotype-genotype correlation. The clinical course of CLD, however, is variable and may rather depend on environmental factors and compensatory mechanisms than mutations. In this report, we present a summary of all published and two novel SLC26A3 mutations and polymorphisms, and review them in the context of their functional consequences and clinical implications.
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PMID:SLC26A3 mutations in congenital chloride diarrhea. 1244 66

The aim of this study was to determine the impact of training of health workers in the management of pediatric morbidity in terms of reduction in infant mortality rate (IMR) a 2-year period in rural Ballabgarh with a present IMR of 37 per 1000 live births. The study was designed as a pre- and post-intervention trial. The intervention was started in November 1999 and the outcome measured for the years 2000 and 2001. A sample size of 4000 was estimated for a power of 80 per cent at 5 per cent significance level. The training of the workers was for 4 days and included didactics, video-films, patient demonstrations, etc. Data on under-fives' deaths and their causes using a verbal autopsy tool was done as a part of the routine data collection system. The workers management of pediatric morbidity was assessed based on the post-training knowledge gain, forms filled by them, and referrals seen at the secondary level. The knowledge of the workers on disease and their management improved after the initial training but reached a plateau at a 50 per cent score. A review of 948 forms showed that the workers' disease classification and management was not satisfactory, especially for pneumonia and sick neonates. It was better for fever, measles, dysentery, and diarrhoea. A review of 11 cases referred by workers confirmed this. There was no impact on IMR. A look at the cause of death revealed that malnutrition, diarrhoea, and pneumonia to be the main causes among post-neonatal deaths and birth-asphyxia and prematurity as the main cause of deaths in the neonates. While implementing Integrated Management of Childhood Illnesses (IMCI) in India through the health workers, increased emphasis needs to be placed on training and supervision. Community level issues, such as healthcare seeking, female neglect, etc., may limit the scope of reduction in IMR due to implementation of IMCI.
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PMID:Management of sick children by health workers in Ballabgarh: lessons for implementation of IMCI in India. 1498 69

Palivizumab (Synagi) is a humanized monoclonal antibody that provides immunoprophylaxis against serious lower respiratory tract infections (LRTIs) caused by respiratory syncytial virus (RSV). RSV is the leading cause of hospitalization for LRTIs in infants, causing winter- or wet-season epidemics. In two double-blind, placebo-controlled trials, intramuscular palivizumab 15 mg/kg every 30 days for 5 months significantly reduced RSV-related hospitalizations by 55% in 1502 infants with prematurity and/or bronchopulmonary dysplasia/chronic lung disease (BPD/CLD) and by 45% in 1287 infants with hemodynamically significant congenital heart disease (HSCHD). Reductions were statistically significant versus placebo in infants with BPD/CLD, with all degrees of prematurity, and with acyanotic/other heart disease. Palivizumab was generally well tolerated, with < or =1.9% of recipients discontinuing treatment for tolerability reasons. In placebo-controlled trials, the most common potentially drug-related adverse events were fever, nervousness, injection-site reactions, and diarrhea. Drug-related events occurred in 7.2-11% of palivizumab recipients in controlled trials (vs 6.9-10% with placebo) and 0-7.9% in open-label trials. Very few serious potentially drug-related adverse events occurred in clinical trials; four occurred in 2 of 285 patients in one open-label trial. No significant anti-palivizumab antibodies developed during palivizumab use. Palivizumab trough serum concentrations were below the recommended 40 microg/mL in about 33% and up to 14% of children prior to their second and third palivizumab injections. In pharmacoeconomic studies, the cost of palivizumab per hospitalization averted was generally lowest in the highest-risk infants. Drug cost was generally the most influential factor in sensitivity analyses. In conclusion, prophylaxis with palivizumab significantly reduces the incidence of RSV-related hospitalization relative to placebo and is generally well tolerated in high-risk infants aged <2 years, including those with prematurity and BPD/CLD or HSCHD, which are risk factors for early or serious RSV infection. Palivizumab is approved for use in these patients. Other high-risk infants in whom palivizumab has not been formally assessed, such as those with immunodeficiency, cystic fibrosis, or location-specific risk factors (including extended hospital stays) might potentially benefit from palivizumab. The use of palivizumab in these other high-risk populations is likely to be determined as much by pharmacoeconomic considerations as by efficacy outcomes.
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PMID:Palivizumab: a review of its use as prophylaxis for serious respiratory syncytial virus infection. 1517 Mar 64

Verbal autopsy (VA) is used to ascertain cause-specific neonatal mortality using parental/familial recall. We sought to compare agreement between causes of death obtained from the VA by physician review vs. computer-based algorithms. Data were drawn from a cluster-randomised trial involving 4130 live-born infants and 167 neonatal deaths in the rural Sarlahi District of Nepal. We examined the agreement between causes ascertained by physician review and algorithm assignment by the kappa (kappa) statistic. We also compared responses to identical questions posed posthumously during neonatal VA interviews with those obtained during maternal interviews and clinical examinations regarding condition of newborns soon after birth. Physician reviewers assigned prematurity or acute lower respiratory infection (ALRI) as causes of 48% of neonatal deaths; 41% were assigned as uncertain. The algorithm approach assigned sepsis (52%), ALRI (31%), birth asphyxia (29%), and prematurity (24%) as the most common causes of neonatal death. Physician review and algorithm assignment of causes of death showed high kappa for prematurity (0.73), diarrhoea (0.81) and ALRI (0.68), but was low for congenital malformation (0.44), birth asphyxia (0.17) and sepsis (0.00). Sensitivity and specificity of VA interview questions varied by symptom, with positive predictive values ranging from 50% to 100%, when compared with maternal interviews and examinations of neonates soon after birth. Analysis of the VA data by physician review and computer-based algorithms yielded disparate results for some causes but not for others. We recommend an analysis technique that combines both methods, and further validation studies to improve performance of the VA for assigning causes of neonatal death.
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PMID:Evaluation of neonatal verbal autopsy using physician review versus algorithm-based cause-of-death assignment in rural Nepal. 1595 55

Congenital chloride diarrhea (CCD) is a rare hereditary disease, with a prenatal onset, secondary to a deficit in the intestinal chloride transport. In the present study, we describe the clinical characteristics of three patients with congenital watery diarrhea, two of them females, aged between 9 and 14 months at the first visit. All patients presented perinatal antecedents of polyhydramnios and prematurity, watery stools since birth and growth failure. Metabolic alkalosis, hypokalemia and hypochloremia were found. Stool ionogram with elevated doses of chloride, exceeding both sodium and potassium, confirmed the diagnosis of CCD. Substitute treatment with sodium and potassium chloride was started with good results. CCD should be considered as a differential diagnosis to congenital watery diarrhea, since early diagnosis and appropriate treatment are mandatory for the normal development of the child, avoiding severe complications such as neurological sequelae and even death.
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PMID:[Congenital chloride diarrhea]. 1612 86

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.
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PMID:[Childhood cholelithiasis in a district hospital]. 1758 24


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