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Background: The number of children with medical complexity (CMC) is increasing worldwide. For these children and their families, various forms of support are legislated; among them, short‐stay respite care has a great unmet need. We examined such children's parents' preferences for respite care and their willingness to pay. Methods: We used discrete choice experiments (DCEs) to estimate the parents' preferences and willingness to pay. Parents whose children used overnight short‐stay respite services answered a questionnaire to compare two hypothetical facilities of respite care having seven attributes and three levels. The DCE data was analyzed using the conditional logit model. The willingness to pay was calculated based on DCE estimates. Results: A total of 70 parents participated in this study and mean age of their children was 7.8 years (standard deviation [SD] 4.3). Among those children, 67 (96%) had the severest certification of disability, and 27 (38%) used a ventilator at home. We found that the parents' highest preferences was the best level of medical care level that can manage ventilators (coefficient 1.61, 95% confidence interval [CI]: 1.32–1.90). The better and best level of medical care, daily care, education/nursing, and emergency care were preferred over basic quality services. Willingness to pay for the best level of medical care was approximately 75,367 JPY per night. Conclusion: This study shows a need for respite care that can deliver high‐level medical care, especially for the management of ventilators, to CMC. This finding can serve as a basis for promoting respite care services. [ABSTRACT FROM AUTHOR]

BACKGROUND: Universal prevention approaches that target the general population can be effective for promoting children's health. This overview aims to summarize evidence presented in existing reviews of school‐based interventions. METHODS: We present an overview of evidence sourced from Campbell and Cochrane systematic reviews. These reviews examined randomized controlled trials concerning school‐based health‐promotion programs for children (mostly aged 4‐18 years) in the general population. RESULTS: We identified 56 high‐quality reviews. The reviews focused on emotional and behavioral outcomes, infectious diseases, injury reduction, mental health, nutrition intake, oral health, physical and developmental changes, sense‐organ diseases, sexual‐health outcomes, and substance use/abuse. Positive evidence—such as vision screening plus provision of free spectacles for spectacle wear increase and a combination of social competence and social‐influence approaches for preventing illicit drug use—were considered high certainty. CONCLUSIONS: Of the various interventions implemented in school settings that involved people from various occupations, some positive effects were found. In most cases, evidence certainty was negatively affected by a high risk of bias within studies, inconsistencies within the estimates, and insufficient sample sizes. Further primary studies in these areas would be helpful for accumulating evidence to promote stronger cooperation between health and education stakeholders. [ABSTRACT FROM AUTHOR]

Background: Life expectancy in Japan has increased dramatically and is one of the longest in the world. However, the changes in lifespan in Japanese individuals with congenital diseases remain unknown. We investigated secular changes in the lifespan of people with Down syndrome over the last 20 years. Methods: We observed secular trends in the number of stillbirths, deaths and the mortality rates at ages 20, 40, and 60 among all deaths registered with Down syndrome as the cause of death (ICD10 code: Q90) in the Japan national death registry database between 1995 and 2016. Changes in the median age at death between 1995–2005 and 2006–2016 were investigated based on sex and history of surgery. Results: We identified 240 stillbirths and 1,099 deaths in this period. The annual number of stillbirths and deaths above the age of 1 year increased, whereas the number of deaths below 1 year did not change. The proportional mortality indicator at ages 20, 40, and 60 increased from 21.7%, 11.7%, and 1.7% in 1995 to 69.9%, 66.7%, and 36.6% in 2016, respectively. The median age at death was higher in females, individuals without a surgical history, and deaths occurring in 2006–2016. The median age at death increased over the period in those without a surgical history. Conclusions: The age at death among people with Down syndrome has increased over the last 20 years, with currently 1 in 3 persons living over 60 years, necessitating adequate social welfare services in this aging population. [ABSTRACT FROM AUTHOR]

Objective: To characterise the current clinical practice patterns regarding the use of magnesium sulphate (MgSO4 ) for eclampsia prevention and treatment in a multi-country network of health facilities and compare with international recommendations.Design: Cross-sectional survey.Setting: A total of 147 health facilities in 15 countries across Africa, Latin America and Asia.Population: Heads of obstetric departments or maternity units.Methods: Anonymous online and paper-based survey conducted in 2015.Main Outcome Measures: Availability and use of MgSO4 ; availability of a formal clinical protocol for MgSO4 administration; and MgSO4 dosing regimens for eclampsia prevention and treatment.Results: Magnesium sulphate and a formal protocol for its administration were reported to be always available in 87.4% and 86.4% of all facilities, respectively. MgSO4 was used for the treatment of mild pre-eclampsia, severe pre-eclampsia and eclampsia in 24.3%, 93.5% and 96.4% of all facilities, respectively. Regarding the treatment of severe pre-eclampsia, 26.4% and 7.0% of all facilities reported using dosing regimens that were consistent with Zuspan and Pritchard regimens, respectively. Across regions, intramuscular maintenance regimens were more commonly used in the African region (45.7%) than in the Latin American (3.0%) and Asian (22.9%) regions, whereas intravenous maintenance regimens were more often used in the Latin American (94.0%) and Asian (60.0%) regions than in the African region (21.7%). Similar patterns were found for the treatment of eclampsia across regions.Conclusions: The reported clinical use of MgSO4 for eclampsia prevention and treatment varied widely, and was largely inconsistent with current international recommendations.Tweetable Abstract: MgSO4 regimens for eclampsia prevention and treatment in many hospitals are inconsistent with international recommendations. [ABSTRACT FROM AUTHOR]

Background: Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries.Methods: The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome.Results: A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not.Conclusions: In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not. [ABSTRACT FROM AUTHOR]

Background Child poverty is a growing, serious issue in Japan, where various social disparities are increasing. Numerous reports have focused on the relationship between social inequity and health, but few studies have assessed how the overall magnitude of disparities in child health has changed in the course of drastic social and economic transitions from 1899 to more recent times. In this study, we assessed the trend of the under-5 mortality rate (U5 MR) and its inter-prefecture disparity in Japan. Methods This is a secondary analysis of Japan's vital statistics data from 1899 to 2014 (115 years), which covers a core period of modern Japan. We calculated the U5 MR of each prefecture and its Theil index by year to assess the trend of inter-prefecture disparity in child health from 1899 to 2014. Results The U5 MR monotonically decreased from 238 per 1,000 births in 1899 to 3 in 2014. The Theil index of the U5 MR increased in the post-war period, peaked in 1962 (0.027) and gradually reduced to <0.01 in the 1970s. In the 2000s, however, even though U5 MR continued to decrease, the Theil index started to increase, and in 2014 (0.013) it exceeded that in 1970 and was more similar to that before World War II. Conclusions The disparities in child health appear to be widening, and may serve as a warning to today's society that increasing socioeconomic gradients may lead to rising health inequity among children. Further investigations into the causes, mechanisms, and possible interventions are needed. [ABSTRACT FROM AUTHOR]

Background Since the publication of the Tokyo Guidelines ( TG13) for the management of acute cholecystitis ( AC), multidirectional studies have been published. However, epidemiological research about AC with big data was not projected. The aim of this study was to reveal the actual clinical conditions of AC. Method The study was designed as an international multicenter retrospective study of AC in Japan and Taiwan from 2011 to 2013. The factors investigated comprised data related to demographic, history, physical examinations, laboratory and imaging findings. Based on these data, we investigated the various values of AC, and real situation with respect to severity and treatment. Results A total of 5,459 patients with AC were reviewed. Thirty-day mortality rate was 1.1%. Based on the diagnostic criteria, 4,088 patients had a definite diagnosis and 291 had a suspected diagnosis. According to the severity grading, 939 patients were classified as Grade III, 2,308 as Grade II, and 2,130 as Grade I. Cholecystectomy was performed in total of 4,266 patients and 2,765 patients had laparoscopic cholecystectomy. The main etiologies were gallbladder stones in 4,623 cases. Conclusion This epidemiological study with large population will undoubtedly contribute to establish the best practice for managing AC worldwide. [ABSTRACT FROM AUTHOR]

Background The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. Methods This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. Results A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively ( P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. Conclusions This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies. [ABSTRACT FROM AUTHOR]

Background Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. Results The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index ( CCI) scores below and above 6 ( P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission ( P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+ II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity. [ABSTRACT FROM AUTHOR]

Background The collaborative multicenter retrospective study of acute cholecystitis ( AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. Method The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. Results An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades ( P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate ( P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients ( P < 0.001), and the higher the grade, the more likely open surgery would be selected ( P < 0.001). Conclusion TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed. [ABSTRACT FROM AUTHOR]

Background The Tokyo Guidelines 2007 ( TG07) first presented the diagnostic and severity grading criteria for acute cholangitis. Subsequently updated in 2013, the Tokyo Guidelines ( TG13) have been widely adopted throughout the world as global standard guidelines. We set out to verify the efficacy of these TG13 criteria in an international multicenter study. Methods We reviewed 6,063 patients who were clinically diagnosed with acute cholangitis in Japan and Taiwan over a 2-year period. The TG13 diagnostic and severity grading criteria were retrospectively applied, and 30-day mortality was investigated. Results A diagnosis of acute cholangitis was made in 5,454 (90.0%) patients on the basis of the TG13 criteria, and in 4,815 (79.4%) patients on the basis of the TG07 criteria. The 30-day mortality rates of patients with Grade III, Grade II, and Grade I were 5.1%, 2.6%, and 1.2%, respectively, and increased significantly along with disease severity. The mortality rate in the 1,272 Grade II cases where urgent or early biliary drainage was performed was 2.0% ( n = 25), which was significantly lower than that of 3.7% ( n = 28) in the other 748 cases. Conclusion By using the TG13 diagnostic and severity grading criteria, more patients with possible acute cholangitis can be diagnosed, and patients whose prognosis can potentially be improved by early biliary drainage can be identified. The TG13 criteria are appropriate and useful for clinical practice. [ABSTRACT FROM AUTHOR]

Lactation may protect women with previous gestational diabetes mellitus (GDM) from developing type 2 diabetes mellitus, but the results of existing studies are inconsistent, ranging from null to beneficial. We aimed to conduct a systematic review to gather available evidence. Databases MEDLINE, CINAHL, PubMed, and EMBASE were searched on December 15, 2015, without restriction of language or publication year. A manual search was also conducted. We included observational studies (cross-sectional, case-control, and cohort study) with information on lactation and type 2 diabetes mellitus incidence among women with previous GDM. We excluded case studies without control data. Data synthesis was conducted by random-effect meta-analysis. Fourteen reports of 9 studies were included. Overall risk of bias using RoBANS ranged from low to unclear. Longer lactation for more than 4 to 12 weeks postpartum had risk reduction of type 2 diabetes mellitus compared with shorter lactation (OR 0.77, 95% CI 0.01-55.86; OR 0.56, 95% CI 0.35-0.89; OR 0.22, 95% CI 0.13-0.36; type 2 diabetes mellitus evaluation time < 2 y, 2-5 y, and >5 y, respectively). Exclusive lactation for more than 6 to 9 weeks postpartum also had lower risk of type 2 diabetes mellitus compared with exclusive formula (OR 0.42, 95% CI 0.22-0.81). The findings support the evidence that longer and exclusive lactation may be beneficial for type 2 diabetes mellitus prevention in women with previous GDM. However, the evidence relies only on observational studies. Therefore, further studies are required to address the true causal effect. [ABSTRACT FROM AUTHOR]

The use of different definitions for bronchopulmonary dysplasia (BPD) has been an ongoing challenge. We searched papers published in English from 2010 and 2015 reporting BPD as an outcome, together with studies that compared BPD definitions between 1978 and 2015. We found that the incidence of BPD ranged from 6% to 57%, depending on the definition chosen, and that studies that investigated correlations with long-term pulmonary and/or neurosensory outcomes reported moderate-to-low predictive values regardless of the BPD criteria.Conclusion: A comprehensive and evidence-based definition for BPD needs to be developed for benchmarking and prognostic use. [ABSTRACT FROM AUTHOR]

Background A collaborative network for pediatric research has not been fully established in Japan. To identify the network infrastructure, we conducted a survey on the support and education for clinical research currently available in children's hospitals. Methods In November 2014, a 27-question survey was distributed to 31 hospitals belonging to the Japanese Association of Children's Hospitals and Related Institutions ( JACHRI) to assess clinical research support, research education, research achievements, and their expectations. Results All the hospitals responded to the survey. Overall, 74.2% of hospitals had clinical research support divisions. Although all hospitals had ethics committees, <30% of the hospitals had a data manager, intellectual property management unit, biostatistician, and English-language editor. Seven hospitals had education programs for clinical research. The number of seminars and workshops for clinical research had significant correlations with the number of physicians ( r = 0.927), pediatricians ( r = 0.922), and clinical trial management physicians ( r = 0.962). There was a significant difference in the number of clinical trials initiated by physicians between hospitals with research education programs and those without ( P < 0.01). The number of education programs was significantly correlated with the number of original articles and case reports in English ( r = 0.788), and the number of publications in Japanese ( r = 0.648). All hospitals recognized the need for a leader to establish a collaborative network for clinical research. Conclusions Important factors for creating a collaborative system for pediatric research in Japan were identified. Human resources to support clinical research are a key factor to improve clinical research education and research achievements. [ABSTRACT FROM AUTHOR]

Background: Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates.Methods: Singleton infants (n = 23 788) of 24(0) -28(6) weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated.Results: The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 29.2) vs. 24.6% (95% CI 24.1, 25.2)]. The association of SGA with the composite outcome was similar when using common or country-specific references for the total sample for birthweight [aRRs 1.47 (95% CI 1.43, 1.51) and 1.48 (95% CI 1.44, 1.53) respectively] and for EFW references [aRRs 1.35 (95% CI 1.31, 1.38) and 1.39 (95% CI 1.35, 1.43) respectively].Conclusion: Small for gestational age is associated with higher mortality and morbidity in infants born <29 weeks' gestational age. Although common and country-specific birthweight/EFW references identified slightly different proportions of SGA infants, the risk of the composite outcome was comparable. [ABSTRACT FROM AUTHOR]

Aim In developing countries, around 200 million children with poor development cannot excel academically. Detecting children with developmental delay is fundamental in targeting early interventions. As the lack of a convenient screening tool in Mongolia remains a significant barrier, we aimed to produce an easy-to-administer developmental screening tool in Mongolia and to validate it against an internationally recognised instrument, the Bayley Scales of Infant and Toddler Development Third Edition (Bayley- III). Methods We developed the Mongolian Rapid Baby Scale consisting of 161 items arranged under seven developmental domains for children aged from zero months 16 days to 42 months 15 days. We recruited 150 children in Ulaanbaatar, Mongolia. After conducting face and content validity of the tool, we evaluated concurrent validity. Results Concurrent validity ranged from high correlation (r = 0.86) to very high (r = 0.97) for each of the corresponding domains between the two tests. Summary statistics showed good sensitivity (81.8%) and moderate specificity (52.3%). Conclusion Our newly developed tool takes only 15 min to complete and is easy to administer. It demonstrated good concurrent validity and sensitivity for the screening of developmental status in young children. This innovative tool will be useful to identify children who may benefit from early interventions in Mongolia. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia ( BPD) is one of the most common complications in premature infants. Although several different drugs have been developed for BPD, there is a wide variation in the choice of drug used among facilities. The aim of this study was to carry out a survey of the current drugs used to treat BPD in Japan. Questionnaires regarding the current use of drugs for BPD were sent to tertiary neonatal units. The response rate was 80% (77/96). Most units used antenatal steroids and oral diuretics for the prevention and treatment of BPD, respectively. Only 4% used caffeine for prevention, whereas 88% used systemic corticosteroids for treatment. Few units used inhaled anticholinergics and i.v. vitamins for the prevention and treatment of BPD, respectively. It was found that the drugs used to treat BPD vary greatly among institutions. Further research is required to develop evidence-based clinical guidelines for BPD in premature infants. [ABSTRACT FROM AUTHOR]

Aim: Methods to improve the mental development of extremely low birthweight (ELBW) children are currently lacking. We assessed the effects of long-term supplementation of alpha-tocopherol on the neurological development of 259 school-aged ELBW children. Methods: Extremely low birthweight participants were divided into three groups: group A with no alpha-tocopherol supplementation (n = 121); group B with the supplementation for <6 months (n = 104) and group C with the supplementation for more than 6 months (n = 34). We analysed the participants’ data at birth and between the ages of one-and-a-half to 8 years and evaluated potential factors associated with intellectual disabilities. Results: Children from group C had the best outcome. The groups’ mean gestational weeks and mean ventilator days were as follows: 27.5 weeks, 16.1 days (group A); 25.7 weeks, 41.7 days (group B); and 25.1 weeks, 75.5 days (group C). Multivariate regression analysis revealed that the odds ratios for impaired mental development at 8 years were 1.5 in group B and 0.19 (p = 0.017) in group C, compared with 1.0 in group A. The association between the duration of alpha-tocopherol administration and performance intelligence quotient (IQ) was dose dependent (p = 0.03). Conclusion: Long-term supplementation of alpha-tocopherol appeared to improve mental development, in particular, performance IQ, in school-aged ELBW children. [ABSTRACT FROM AUTHOR]

Background Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. Objectives To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. Selection criteria Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). Data collection and analysis Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. Main results We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge. The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support. For most of our outcomes only one or two studies provided data, and overall results were inconsistent. There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no strong evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. Authors' conclusions Overall, findings were inconsistent. Postnatal home visits may promote infant health and maternal satisfaction. However, the frequency, timing, duration and intensity of such postnatal care visits should be based upon local needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package. Plain Language Summary Home visits in the early period after the birth of a baby Health problems for mothers and babies commonly occur or become apparent in the weeks following the birth. For the mothers these include postpartum haemorrhage, fever and infection, abdominal and back pain, abnormal discharge, thromboembolism, and urinary tract complications, as well as psychological and mental health problems such as postnatal depression. Mothers may also need support to establish breastfeeding. Babies are at risk of death related to infections, asphyxia, and preterm birth. Home visits by health professionals or lay supporters in the early postpartum period may prevent health problems from becoming long-term, with effects on women, their babies, and their families. This review looked at different home-visiting schedules in the weeks following the birth. We included 12 randomised trials with data for more than 11,000 women. Some trials focused on physical checks of the mother and newborn, while others provided support for breastfeeding, and one included the provision of practical support with housework and childcare. They were carried out in both high-resource countries and low-resource settings where women receiving usual care may not have received additional postnatal care after early hospital discharge. The trials focused on three broad types of comparisons: schedules involving more versus less postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies postnatal care at home was delivered by healthcare professionals. For most of our outcomes only one or two studies provided data and overall results were inconsistent. There was no evidence that home visits were associated with reduced newborn deaths or serious health problems for the mothers. Women's physical and psychological health were not improved with more intensive schedules of home visits. Overall, babies were less likely to have emergency medical care if their mothers received more postnatal home visits. More home visits may have encouraged more women to exclusively breastfeed their babies. The different outcomes reported in different studies, how the outcomes were measured, and the considerable variation in the interventions and control conditions across studies were limitations of this review. The studies were of mixed quality as regards risk of bias. More research is needed before any particular schedule of postnatal care can be recommended [ABSTRACT FROM AUTHOR]

Aim The study aims to determine the risk factors associated with mortality and necrotising enterocolitis ( NEC) among very low birthweight infants in 95 neonatal intensive care units in the Asian Network on Maternal and Newborn Health. Methods This is a cross-sectional study using an international collaborative database of 17 595 very low birthweight infants admitted within 28 days of birth between 2003 and 2006 in four Asian countries. Information on the mortality and morbidity of neonates admitted to the neonatal intensive care units was recorded. Factors associated with the death and diseases of infants were estimated using multilevel multivariate logistic regression. Random effects were included to account for the clustering of the observations. Results Overall discharge mortality was 15% and it was significantly different by countries and units. The mortality rate was found to be significantly higher in neonates with pulmonary haemorrhage (odds ratio 1.83, 95% confidence interval 1.63-2.04) and air leak syndrome (odds ratio 1.51, 95% confidence interval 1.30-1.72). The incidence of NEC was 4.3% and was strongly associated with other morbidities. Multivariate logistic regression showed that patent ductus arteriosus was the most significant risk factor associated with NEC. Conclusions Our analysis has highlighted the great potential that multi-country, collaborative datasets have in terms of epidemiologic research when it comes to identifying issues in perinatal health that are common throughout Asia, and in relation to particular issues pertaining to specific countries and neonatal units. Establishing collaborative networks, conducting analyses of common datasets and further epidemiologic research are now essential measures to improve newborn health in Asia. [ABSTRACT FROM AUTHOR]

Aim: To examine the long-term effects of earlier initiated continuous Kangaroo Mother Care (KMC) for relatively stable low-birth-weight (LBW) infants in a resource-limited country. Methods: A randomized controlled trial with long-term follow-up was performed in LBW infants in Madagascar. Earlier continuous KMC (intervention group) was initiated as soon as possible within 24 h postbirth, and later continuous KMC (control group: conventional care) was initiated after complete stabilization. Outcome measures were mortality or readmission, nutritional indicators at 6-12 months postbirth and feeding condition at 6 months postbirth (ClinicalTrials.gov, NCT00531492). Results: A total of 72 infants were followed for mortality or readmission at 6-12 months postbirth. There was no difference between the two groups (7/36 vs. 7/36, Risk ratio (RR), 1.00; 95% CIs, 0.39-2.56; p = 1.00). The proportion of exclusive breast feeding (EBF) at 6 months postbirth was significantly higher with earlier KMC than later KMC (12/29 vs. 4/26; RR 2.69; 95% CIs, 1.00-7.31; p = 0.04). There were no differences in nutritional indicators between the two groups at 6-12 months postbirth. Conclusion: Earlier initiated continuous KMC results in a significantly higher proportion of EBF at 6 months postbirth. Further larger-scale long-term evaluations of earlier initiated continuous KMC for LBW infants are needed. [ABSTRACT FROM AUTHOR]

Tobe RG, Mori R, Shinozuka N, Kubo T, Itabashi K. A nationwide investigation on gestational age specific birthweight and mortality among Japanese twins. Paediatric and Perinatal Epidemiology 2011; : 228-235. Gestational age specific birthweight has been used as an important indicator to identify the health status of neonates and to provide appropriate neonatal care services to those at high risk. To identify the gestational age specific birthweight of twins born in secondary and tertiary hospitals in Japan and to explore factors affecting mortality, we used a nationwide obstetric database in Japan. Liveborn twins from 2001 to 2005 in the database, which was established with the national Perinatal Health Care Project, were enrolled ( n = 22 240). Obstetric data from the medical records were collected and analysed. Approximately 60% of liveborn twins were delivered between weeks 33 and 38, most frequently at 36 and 37 weeks. The mean birthweight of liveborn twins was 2084 g and the mean gestational age was 34.9 weeks. Intrauterine growth differed by parity, mode of delivery, birth order, chorionicity and sex. Using logistic regression, lower gestational age, small for gestational age, monochorionic twins and vaginal delivery tended to have higher risks of mortality. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the effectiveness of earlier continuous Kangaroo Mother Care (KMC) for relatively stable low-birth-weight (LBW) infants in a resource-limited country. Methods: A randomized controlled trial was performed in LBW infants at a referral hospital in Madagascar. Earlier continuous KMC (intervention) was begun as soon as possible, within 24 h postbirth, and later continuous KMC (control: conventional care) was begun after complete stabilization (generally after 24 h postbirth). Main outcome measure was mortality during the first 28 days postbirth. This trial was registered with ClinicalTrials.gov, NCT00531492. Results: A total of 73 infants (intervention 37, control 36) were included. Earlier continuous KMC had higher but no statistically different mortality in the first 28 days postbirth (1 vs. 2; risk ratio, 1.95; 95% CIs, 0.18–20.53; p = 1.00). There were no differences in incidence of morbidities. Body weight loss from birth to 24 h postbirth was significantly less in earlier KMC infants compared with later KMC infants. (−34.81 g vs. −73.97 g; mean difference, 39.16 g; 95% CIs, 10.30–68.03; p = 0.01; adjusted p = 0.02). Adverse events and duration of hospitalization were not different between the two groups. Conclusions: Further evaluations of earlier continuous KMC including measurement of KMC dose, are needed in resource-limited countries. [ABSTRACT FROM AUTHOR]

Background: Skin-to-skin care has been adopted all over the world, although physiological changes during or after it have not been evaluated very well. The purpose of the present study was therefore to investigate whether skin-to-skin contact for newborn babies and their mothers affects body temperature, heart rate and oxygen saturation of the babies. Methods: Studies investigating body temperature, heart rate and oxygen saturation of babies during and/or after skin-to-skin contact were systematically searched and reviewed. Meta-analyses to examine the effects and meta-regression analyses to investigate correlations between the effects and birthweight, duration of the care, environmental temperature, and resources of the setting, were conducted. Results: A total of 23 studies were included. Meta-analyses showed evidence of an increase in body temperature (weighted mean difference [WMD] 0.22°C, P < 0.001) and a decrease in saturation of babies (WMD −0.60%; P= 0.01) during skin-to-skin care, compared with those before skin-to-skin care. Increase in body temperature was more evident in middle–low-income settings (WMD, 0.61°C, P < 0.001) than high-income settings (WMD 0.20°C, P < 0.001). Both the positive effect on body temperature and the negative effect on saturation were more marked in cold environments than where the environmental temperature was higher (WMD 0.18°C, P < 0.001; WMD −0.82%, P= 0.02). Conclusion: Skin-to-skin care is effective in increasing the body temperature of babies, especially where resources are limited and the environment is cold. Decreased oxygen saturation of the babies, however, warrants further prospective studies to confirm the findings. [ABSTRACT FROM AUTHOR]

Background: Antibiotic prophylaxis in children who have had urinary tract infection (UTI) to prevent further infection is a common practice. The aim of this study is to reduce the development of further renal scarring by the prevention of recurrent acute pyelonephritis. Methods: A systematic review of randomized controlled trials assessing effectiveness of antibiotic prophylaxis in children who have recovered from a symptomatic UTI and children in whom vesico-ureteric reflux has been identified independent of a history of acute UTI was carried out by systematic search in Medline, EMBASE, the Cochrane Library and CINAHL using keywords and thesaurus terms. Identified trials were independently appraised by two researchers. Data were extracted and synthesized in meta-analyses. Results: A total of 677 children in eight trials were included in the analyses. There was no evidence of difference on meta-analysis of all the included studies, or any of the four subgroups, between the intervention and control groups in recurrence of symptomatic UTI [four trials, RR 0.96 (95% CI: 0.69–1.32]) and incidence of new or progressive renal scarring [four trials, overall RR 1.15 (95% CI: 0.75–1.78)]. Conclusion: Given the lack of evidence on positive benefit of using prophylactic antibiotics for children at risk of developing UTI, routine use of antibiotics for these children is not recommended. [ABSTRACT FROM AUTHOR]

Background: Accurate prediction of the prognosis of infants with very low birth weight is beneficial both for their parents and for healthcare professionals. Methods: This was a population-based study of all low-birth-weight infants admitted to neonatal units in one region in Japan. The Apgar score at 1 and 5 min and neonatal mortality were retrospectively analyzed to obtain the predictive values of the scores. The results were stratified into two categories by birth weight and three time periods (1980–1986, 1987–1993 and 1994–2000). Results: The predictive values improved in the later years, and therefore only the data obtained in the period 1994–2000 were used. A score of less than 5 at 5 min appears to be a good predictor of neonatal mortality in infants with a birth weight between 1500 g and 2499 g (positive likelihood ratio, 17.59 [95% confidence interval (CI) 12.68–24.40]); however, there is no evidence that the score is a good predictor of neonatal mortality in infants with very low birth weight. Conclusion: In infants with a low birth weight between 1500 g and 2499 g, an Apgar score at 5 min of less than 5 is a good predictor of neonatal mortality. The score is not useful in predicting the short-term prognosis of very low-birth-weight infants. [ABSTRACT FROM AUTHOR]

Background: Regionalization of perinatal health services has been actively discussed, although important determinants such as effect of duration of neonatal transport on neonatal outcomes have not been investigated well as yet. Therefore the purpose of the present paper was to investigate the association between duration of inter-facility transport and perinatal mortality. Methods: For the systematic review, six major databases were searched. Any comparative studies investigating associations between duration of inter-facility neonatal transport and their outcomes, published in the English language were selected. The studies were screened and reviewed by two independent researchers. For the cohort study, study subjects included every neonate transported to neonatal wards in Osaka, Japan between 1980 and 2000 in an existing surveillance called Neonatal Mutual Cooperative System. They are followed up until 28 days of age, or discharge if earlier. Other variables were also considered as effect modifiers or confounders, including calendar year, birthweight (BW), gestational age (GA), sex, maternal/paternal age, Apgar scores at 1 and 5 min, place of birth and personnel accompanying the neonate during transport (transport personnel), body temperature before transport and on admission, severity of illness, and intraventricular hemorrhage (IVH) grade. Cox regression analyses were performed to obtain principal results, and sensitivity analysis to support them. Results: Systematic review: only one cross-sectional study conducted in an urban area in India was identified. That study showed that neonates with a long duration of transport had 79% higher odds of death than those transported for a short duration after adjusting for the confounding effects. For the cohort study, among 16 429 subjects, full data were available for 4966 neonates. There was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (rate ratio [RR] 2.26, 95% confidence interval [CI]: 1.26–4.04), and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death (RR 1.81, 95%CI: 1.07–3.06), both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects. A sensitivity analysis on missing values also supported the results. Conclusion: There is evidence of an association between duration of transport and increased neonatal mortality, which can be applied to organization of perinatal health services. A prospective cohort study is needed for further investigation. [ABSTRACT FROM AUTHOR]

Presents the case study of an infant with fatal neonatal mitochondrial cytopathy and disseminated fatty nodules in the liver. Potential causes of hepatic failure in neonates; Medical history of the patient; Findings from the autopsy conducted on the infant's liver; Common histological features of fatal neonatal liver failure.

The article discusses that prophylactic indomethacin reduces patent ductus arteriosus (PDA) and intraventricular hemorrhage in very low birth weight infants. Studies suggested that indomethacin should be withheld to avoid worsening of intracranial hemorrhage (ICH) in infants with currently inactive ICH. The article concludes that indomethacin remains a possible option for PDA closure in preterm infants with inactive ICH.

The article presents the study regarding the use of imaging techniques in investigating children having urinary tract infection. It states that the imaging techniques were based on different national protocols which have been developed over the past 50 years aiming to detect the lack of renal parenchyma and vesicoureteric reflux. The investigations also involved an intravenous pyelogram (IVP) and a micturition cystourethrogram (MCUG) and assumed that vesicoureteric reflux (VUR) and lack of renal parenchyma were essentials to protect children from renal damage and from end stage renal failure and dialysis.

The article examines the effectiveness of "Japanese Maternal and Child Health" handbook for child cognitive development in Mongolia. Topics include using cluster randomized controlled trial method for examining the efficiency of handbook; risk factor of child development delays such as poor school performance, poverty, and developmental delays; and using univariate analysis for performing study.