BackgroundIn June of 2010, an antenatal ultrasound program to perform basic screening for high-risk pregnancies was introduced at a community health care center in rural Uganda. Whether the addition of ultrasound scanning to antenatal visits at the health center would encourage or discourage potential patients was unknown. Our study sought to evaluate trends in the numbers of antenatal visits and deliveries at the clinic, pre- and post-introduction of antenatal ultrasound to determine what effect the presence of ultrasound at the clinic had on these metrics.Methods and FindingsRecords at Nawanyago clinic were reviewed to obtain the number of antenatal visits and deliveries for the 42 months preceding the introduction of ultrasound and the 23 months following. The monthly mean deliveries and antenatal visits by category (first visit through fourth return visit) were compared pre- and post- ultrasound using a Kruskal-Wallis one-way ANOVA. Following the introduction of ultrasound, significant increases were seen in the number of mean monthly deliveries and antenatal visits. The mean number of monthly deliveries at the clinic increased by 17.0 (13.3–20.6, 95% CI) from a pre-ultrasound average of 28.4 to a post-ultrasound monthly average of 45.4. The number of deliveries at a comparison clinic remained flat over this same time period. The monthly mean number of antenatal visits increased by 97.4 (83.3–111.5, 95% CI) from a baseline monthly average of 133.5 to a post-ultrasound monthly mean of 231.0, with increases seen in all categories of antenatal visits.ConclusionsThe availability of a low-cost antenatal ultrasound program may assist progress towards Millennium Development Goal 5 by encouraging women in a rural environment to come to a health care facility for skilled antenatal care and delivery assistance instead of utilizing more traditional methods.

Methicillin-resistant Staphylococcus aureus is a frequent source of infections affecting premature and critically ill infants in neonatal intensive care units. Neonates are particularly vulnerable to colonization and infection with Methicillin-resistant Staphylococcus aureus, and many studies have attempted to identify risk factors that predispose certain infants to its acquisition in order to discover potential areas for clinical intervention. In addition, epidemiologic assessment of transmission patterns and molecular analysis of changes in the characteristics of Methicillin-resistant Staphylococcus aureus strains over time have helped clarify additional factors affecting Methicillin-resistant Staphylococcus aureus infections in the neonatal intensive care unit. Numerous strategies for prevention and eradication have been employed with variable rates of success. Despite these interventions, Methicillin-resistant Staphylococcus aureus remains a significant source of morbidity in the neonatal intensive care unit population.

1, 2). The National Nosocomial Infections Surveillance System observed a Ͼ300% increase in the incidence of late-onset MRSA infections in NICUs, from 0.7 to 3.1 infections/10,000 patient days, between 1995 and 2004 (3). Unique host and environmental factors, including immature immune systems, high frequency of contact with health care providers (4), exposure to numerous invasive procedures, NICU overcrowding and understaffing (5, 6), and prolonged hospitalization (7), make NICU patients at especially high risk of becoming colonized and infected with MRSA. Since colonization with MRSA is a risk factor for development of MRSA infection, prevention of MRSA transmission within the NICU is critical (7,8). Many NICUs have implemented active detection and isolation (ADI) programs, which involve surveillance to rapidly identify affected patients, followed by cohorting and isolation with standard contact precautions, in attempts to prevent MRSA transmission and reduce infection rates.Several large NICUs have published reports regarding the clinical epidemiology of neonatal MRSA following implementation of surveillance, transmission prevention, and/or decolonization strategies (7,(9)(10)(11)(12). Some also incorporated molecular analyses in their studies, including antibiotic susceptibility testing (9, 10), strain typing (9, 11, 12), genotyping (9, 12), and/or Panton-Valentine leukocidin gene detection (9,12). No studies have comprehensively examined all of those molecular features of MRSA and additionally assessed the presence or absence of genes encoding proteins for a variety of staphylococcal toxins and potential virulence factors over an extensive time period following implementation of an ADI program in an NICU.In response to the appearance of MRSA in the NICU at YaleNew Haven Children's Hospital (YNHCH)

Haploinsufficiency of FOXF1 causes an autosomal dominant neonatally lethal lung disorder, Alveolar Capillary Dysplasia with Misalignment of Pulmonary Veins (ACDMPV). We identified novel 0.8-kb deletion within the 1.4-kb intron of FOXF1 in a deceased newborn diagnosed with ACDMPV. The deletion arose de novo on the maternal copy of the chromosome 16, and did not affect FOXF1 minigene splicing tested in lung fibroblasts. However, FOXF1 transcript level in the ACDMPV peripheral lung tissue was reduced by almost 40%. We found that, in an in vitro reporter assay, the FOXF1 intron exhibited moderate transcriptional enhancer activity, correlating with the presence of binding sites for expression regulators CTCF and CEBPB, whereas its truncated copy, that lost major CTCF and CEBPB binding sites, inhibited the FOXF1 promoter. Our data further emphasize the importance of testing the non-protein coding regions of the genome currently not covered by diagnostic chromosomal microarray analyses or whole exome sequencing.

No abstract