Maternal-Fetal Disproportion and Birth Asphyxia in Rural Sarlahi, Nepal

Lee, Anne C C; Darmstadt, Gary L.; Khatry, Subarna K.; LeClerq, Steven C.; Shrestha, S. R.; Christian, Parul

doi:10.1001/archpediatrics.2009.75

Cited by 31 publications

(25 citation statements)

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“…Although our data collectors were highly trained and used standardized questionnaires to elicit morbidity histories every 24 hours, our data may suffer from reporting bias and misclassification. Yet, we used previously validated algorithms for defining sepsis and birth asphyxia [21,23,27]. The other consideration is that hospital-based, physician diagnosed conditions may be very likely to identify severe morbidity, and emergency interventions may have resulted in improved survival, whereas our self-reported morbidity symptoms among surviving neonates were likely less severe.…”

Section: Discussionmentioning

confidence: 99%

“…Sepsis was defined as at least 2 consecutive days of 2 of the following symptoms: 1) inability or difficulty suckling, 2) lethargy, 3) difficulty breathing, 4) convulsions or stiffness of back, 5) hot to touch or temp > 100°F, 6) cold to touch or temp < 96.6°F, 7) red purulent umbilicus [21]. Birth asphyxia was defined as inability to cry at birth and one of the following symptoms: 1) inability to breathe at birth, 2) convulsions or spasms, or 3) inability to suckle normally after birth [23]. Data were analyzed with all maternal and child intervention groups combined for two reasons - one, combinations of micronutrients in the maternal supplementation trial was shown to impact some of the exposure variables in this analysis and was deemed as being in the causal pathway [11,21] and two, child supplementation with iron-folic acid and/or zinc had no impact on the outcomes [9].…”

Section: Methodsmentioning

confidence: 99%

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Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal

et al. 2014

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BackgroundThe long term consequences of low birth weight (LBW), preterm birth, small-for-gestational age (SGA, defined as birth weight for given gestational age less than the 10th percentile of the reference), and early newborn morbidity on functional outcomes are not well described in low income settings.MethodsIn rural Nepal, we conducted neurocognitive assessment of children (n = 1927) at 7–9 y of age, for whom birth condition exposures were available. At follow-up they were tested on aspects of intellectual, executive, and motor function.ResultsThe prevalence of LBW (39.6%), preterm birth (21.2%), and SGA (55.4%) was high, whereas symptoms of birth asphyxia and sepsis were reported in 6.7% and 9.1% of children. In multivariable regression analyses, adjusted for confounders, LBW was strongly associated with scores on the Universal Nonverbal Intelligence Test (UNIT), tests of executive function, and the Movement Assessment Battery for Children (MABC). Preterm was not associated with any of the test scores. Conversely, SGA was significantly (all p < 0.005) associated with lower UNIT scores (−2.04 SE = 0.39); higher proportion failure on Stroop test (0.06, SE = 0.02); and lower scores on the backward digit span test (−0.16, SE = 0.04), MABC (0.98, SE = 0.25), and finger tapping test (−0.66, SE = 0.22) after adjusting for confounders. Head circumference at birth was strongly and significantly associated with all test scores. Neither birth asphyxia nor sepsis symptoms were significantly associated with scores on cognitive or motor tests.ConclusionIn this rural South Asian setting, intrauterine growth restriction is high and, may have a negative impact on long term cognitive, executive and motor function.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal

et al. 2014

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“…These results are generally consistent with a UNIMAPP trials analysis [43] with a notable, though non-significant increase in early neonatal mortality (OR = 1.23; 95% CI: 0.96 – 1.59), while there was a 6% non-significant reduction in late neonatal mortality (OR = 0.94; 95% CI: 0.73 – 1.23). These findings suggest that the use of multiple micronutrient supplements in populations to address maternal anemia and reduce the incidence of SGA, must be accompanied by the provision of skilled care at delivery and facility births to offset any potential increase in the risk of obstructed labour and birth asphyxia [44,45]. It must be noted that in most studies evaluated, despite reduction in rates of SGA, there was no reduction in neonatal mortality.…”

Section: Discussionmentioning

confidence: 99%

Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

2011

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Objectives/backgroundGiven the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA) births, low birth weight, stillbirths, perinatal and neonatal mortality. This review evaluates the evidence of the impact of multiple micronutrient supplements during pregnancy, in comparison with standard iron-folate supplements, on specific maternal and pregnancy outcomes of relevance to the Lives Saved Tool (LiST).Data sources/review methodsA systematic review of randomized controlled trials was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction and Child Health Epidemiology Reference (CHERG) adaptation of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) technique were used for data abstraction and overall quality of evidence. Meta-analyses were performed to calculate summary estimates of utility to the LiST model for the specified outcome of incidence of SGA births. We also evaluated the potential impact of multiple micronutrients on neonatal mortality according to the proportion of deliveries occurring in facilities (using a threshold of 60% to indicate functionality of health systems for skilled births).ResultsWe included 17 studies for detailed data abstraction. There was no significant benefit of multiple micronutrients as compared to iron folate on maternal anemia in third trimester [Relative risk (RR) = 1.03; 95% confidence interval (CI): 0.87 – 1.22 (random model)]. Our analysis, however, showed a significant reduction in SGA by 9% [RR = 0.91; 95% CI: 0.86 – 0.96 (fixed model)]. In the fixed model, the SGA outcome remained significant only in women with mean body mass index (BMI) ≥ 22 kg/m2. There was an increased risk of neonatal mortality in studies with majority of births at home [RR = 1.47, 95% CI: 1.13-1.92]; such an effect was not evident where ≥ 60% of births occurred in facility settings [RR = 0.94, 95% CI: 0.81-1.09]. Overall there was no increase in the risk of neonatal mortality [RR = 1.05, 95% CI: 0.92 – 1.19 (fixed model)].ConclusionThis review provides evidence of a significant benefit of MMN supplementation during pregnancy on reducing SGA births as compared to iron-folate, with no significant increase in the risk of neonatal mortality in populations where skilled birth care is available and majority of births take place in facilities. Given comparability of impacts on maternal anemia, the decision to replace iron-folate with multiple micronutrients during pregnancy may be taken in the context of available services in health systems and birth outcomes monitored.

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“…Programs to reduce intrapartumrelated injury must address risk factors across the entire continuum of the life cycle from adolescence through pregnancy and childbirth. For example, ensuring adequate child nutrition may reduce rates of maternal stunting, and delayed age of first birth may decrease the risk of obstructed labor [80]. Interventions for the primary prevention of intrapartum-related injury are required during the time of pregnancy and childbirth, while secondary and tertiary prevention measures are needed in the immediate postnatal and neonatal periods.…”

Section: Addressing Deadly Delays: the Need For Linkagesmentioning

confidence: 99%

Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?

Lawn

Lee

Kinney

et al. 2009

International Journal of Gynecology & Obstetrics

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475

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Maternal-Fetal Disproportion and Birth Asphyxia in Rural Sarlahi, Nepal

Abstract: Participants: Mothers and newborns (n = 3189). Outcome Measure: Birth asphyxia, defined as an infant who failed to cry at birth, and who was unable to breathe or suckle normally after birth or had convulsions.

Cited by 31 publications

References 36 publications

Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal

Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal

Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes

Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?

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