D espite advancements in medicine, preterm infants continue to experience high neonatal mortality and morbidity, with many having lifelong neurodevelopmental deficits, such as cerebral palsy (CP) and impaired cognitive abilities. The risk of impairment increases with decreasing gestational age at birth and many studies of short-term and long-term outcomes have focused on infants born at <33-week gestation. There are few data, however, on neonates born at 33 or 34 weeks. Issues include optimal places for delivery of preterm infants and the optimal gestational age for delivery in women with such pregnancy complications as gestational hypertension, intrauterine growth restriction (IUGR), and preterm premature rupture of membranes. In this population-based study of infants born at 30 to 34 weeks, neonatal mortality and morbidity and 5-year neurodevelopmental outcomes were assessed.All live and stillbirths occurring between 30 and 32 weeks in 1997 (n = 2020) and all between 33 and 34 weeks in April and October of 1997 (n = 457) in all maternity units in 9 French regions were included in the EPIPAGE study. Data on the mother, pregnancy, and neonate were recorded on standardized forms and included maternal complications, gestational age at birth, adverse neonatal outcomes, and treatments used in the neonatal unit. Survivors had a medical and neuropsychological assessment at 5 years of age.Of the 2467 infants enrolled in the study, 2018 were eligible for follow-up and 1461 were evaluated at 5 years. The distribution of pregnancy complications varied with gestational age in that the proportion of pregnancies with singletons and IUGR or hypertension decreased from 26% at 30 weeks to 18% at 34 weeks. On the other hand, the proportion with preterm premature rupture of membranes increased from 19% at 30 weeks to 26% at 34 weeks. The rate of cesarean births, antenatal corticosteroid therapy, and birth in tertiary-care facilities decreased as gestational age increased. So did the rate of adverse neonatal outcomes, although such morbidities as respiratory distress syndrome and bronchopulmonary dysplasia continued through all birth ages. Hospital length of stay also decreased with increasing gestational age; however, 27% of infants born at 34 weeks required admission to the neonatal intensive care unit; 7% needed endotracheal ventilation; 16% received antibiotics for >7 d and 5%, parenteral nutrition for >10 d; 9% received caffeine for apneas; and 47% had phototherapy for jaundice. The CP rate was 6.3% in the 30-week group, 8.7% at 31 weeks, 4.1% at 32 weeks, 3.7% at 33weeks, and 0.7% at 34 weeks (P<0.01). The proportion of children with Mental Processing Composite scores below 70 ranged from 10% in the 30-week and 31-week groups to 5% in the 34-week group, with the mean Mental Processing Composite score increasing significantly from 94 at 30 weeks to 98 at 34weeks. There was little difference among age groups as to visual and hearing deficiencies. In multivariate analysis, only gestational age at birth and pregnancy complication...

Introduction: The 2015 Global Meningococcal Initiative (GMI) meeting discussed the global importance of meningococcal disease (MD) and its continually changing epidemiology. Areas covered: Although recent vaccination programs have been successful in reducing incidence in many countries (e.g. Neisseria meningitidis serogroup [Men]C in Brazil, MenA in the African meningitis belt), new clones have emerged, causing outbreaks (e.g. MenW in South America, MenC in Nigeria and Niger). The importance of herd protection was highlighted, emphasizing the need for high vaccination uptake among those with the highest carriage rates, as was the need for boosters to maintain individual and herd protection following decline of immune response after primary immunization. Expert commentary: The GMI Global Recommendations for Meningococcal Disease were updated to include a recommendation to enable access to whole-genome sequencing as for surveillance, guidance on strain typing to guide use of subcapsular vaccines, and recognition of the importance of advocacy and awareness campaigns. ARTICLE HISTORY

Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.

2019) The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and highrisk populations, Expert Review of Vaccines, 18:1, 15-30, ABSTRACT Introduction: The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents. Areas covered: Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide. Expert commentary: The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention. ARTICLE HISTORY

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