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Objective: The aim of this study was to determine the impact of chorioamnionitis on neonatal outcome. Methods: This cross-section descriptive study was conducted in the neonatal intensive care unit (NICU) of the Department of Pediatrics, Liaquat National Hospital Karachi from June 1st, 2016 to December 31st, 2016. Neonates (infants < 28 days of age) with maternal risk factors indicative of chorioamnionitis (maternal febrile illness in last trimester, high WBC count in maternal blood, lower abdominal pain or tenderness, and foul-smelling discharge) were included in the study. The neonates with an inborn error of metabolism and congenital anomalies were excluded from this study. The neonates were further categorized by gestational age as a term (gestational age >37 weeks) and preterm (gestational age <37 weeks). The neonatal outcome is classified into binary categories; dead or alive. Data were recorded by the data collectors in the predesigned proforma. The data were entered and analyzed using SPSS version 22. Results: During the study period, 1200 women delivered a singleton baby, out of which 400 were admitted at NICU. Of 400 infants, a total of 68 neonates of mothers with the indication of chorioamnionitis were enrolled in the study. The mean age of enrolled neonates was 2.55 ± 1.22 days. Out of 68 neonate babies, 33 (48.5%) were males and 35 (51.5%) were females. Only 43 (63%) were delivered, pre-term babies. The morbidities identified were respiratory distress syndrome (33.8%), sepsis (27.9%), intraventricular hemorrhage (10.3%), persistent pulmonary hypertension of newborns (11.8%) and necrotizing enterocolitis (7.4%). A total of 16 (23.5%) neonates died. Out of 16 newborns who died, 32.6% were preterm and 8% were born at term. It was noted that weight, body mass index, fronto-occipital circumference, and gestational age were significant contributors to the mortality. Conclusion: In conclusion, chorioamnionitis is an important contributor to neonatal mortality and morbidity. The neonates of a mother with indications of chorioamnionitis are at an increased risk of respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Background: Unplanned pregnancy is one of the leading causes of maternal mortality and morbidity in the world. The objective of this systematic review was to synthesize the findings of various studies regarding prevalence and determinates of unintended pregnancy. Data sources: A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2015. English-language publications were searched using relevant keywords, and reference lists were hand searched. Review methods: A systematic review was carried out for all the quantitative studies which met the inclusion criteria. The quality of selected studies was assessed using Newcastle-Ottawa Scale. Results: Twenty-two papers were included in the review. Average prevalence of unintended pregnancy was estimated to be 35% ranging from 13% to 82%. The predictors of unintended pregnancy were found to be, socio-demographic factors include women's age, women's education, parity, birth order and interval, previous pregnancy intention, age at the time of marriage, socioeconomic status, marital status, religion, caste, and ethnicity. Conclusion: Main correlates were found to be age, parity, educational and economic status. This means that undertaking outreach in poor countries might be helpful in fulfilling the needs of Family planning for these women. Furthermore, community-based distribution of family planning methods or counseling should be targeted to the illiterate older aged women of reproductive age with poor socioeconomic status. [ABSTRACT FROM AUTHOR]

We had a number of goals for our study.2,3 The first was to develop and describe a methodology to evaluate stillbirth preventability in hospital settings in low- and middle-income countries (LMICs). We thank Drs Sharma and Aggarwal for their positive comments about our PURPOSe study.1 We are pleased to acknowledge their efforts and those of others to determine which stillbirths might be preventable. [Extracted from the article]

A letter to the editor which discusses the use of vitamin D supplementation in reducing the risk of sepsis in neonates.

Objective: To assess the diagnostic accuracy of postnatal foot length (FL) measurements as a proxy to identify low birth weight (LBW) for frontline healthcare workers in rural Sindh Province, Pakistan., Design: A community-based cross-sectional study., Setting: This study was conducted in the catchment area of Global Network's Maternal and Newborn Health Registry, Thatta, Sindh Province, Pakistan, from January to June 2023., Participants: Singleton live births irrespective of gestational age at birth., Reference Standard: Birth weight was measured using calibrated digital weighing scales in grams based on the average of three readings with minimal clothing., Index Test: FL was measured within 48 hours of birth using a rigid transparent plastic ruler in centimetres based on the average of three measurements., Primary Outcome: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristics curve and area under the curve with 95% CI were calculated. Euclidean distance was used to identify the cutoff of FL to identify LBW. A simple linear equation was created to predict the birth weight., Results: Out of 336 analysed newborns, 179 (53.3%) were male and 157 (46.7%) were female. The median birth weight was 2801 g (IQR: 2465-3057), of whom 88 (26.2%) were LBW. The median foot length was 7.9 cm (IQR: 7.6-8.1). For identifying LBW, the foot length cutoff was ≤7.6 cm with 90.3% sensitivity, 81.8% specificity, 63.8% PPV and 96.0% NPV. A FL of 7.6 cm predicted birth weight of 2459.4 g., Conclusion: Postnatal FL cutoff of ≤7.6 cm has adequate predictive value served as a simple, low-cost and reliable method to identify LBW for frontline healthcare providers in the rural settings of Thatta without calibrated weighing scales to triage LBW newborns in need of higher-level care., Trial Registration Number: NCT05515211., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated., Methods: Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models., Results: A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of ±2.8 to ±3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement ≤7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed., Conclusion: This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results., Prospero Registration Number: CRD42020209455., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan., Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for select variables. Frequency and percentages were reported for categorical variables. For data validation, Kappa statistics (κ) were applied to assess the agreement between categorical observations, and the Bland-Altman test was used to assess agreement for continuous data., Results: Of the 14 clusters sampled, 12 clusters had adequate coverage. Agreement of hemoglobin performance between the women's response and information in birth registry data was good (κ = 0.718) (95% confidence interval [CI]: 0.58-0.82); agreement on birth outcome recorded by the workers in the registry and as mentioned by women was very good (κ = 1.0); and agreement whether birth weight was assessed within 48 h of delivery was good (κ = 0.648) (0.37-0.92)., Conclusion: LQAS is a powerful tool to monitor coverage and data quality of the birth registry maintained by the global network for women's and children's health in Pakistan and potentially for data from other surveillance systems., Competing Interests: There are no conflicts of interest.

This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 neonates (9.3%). All neonates were male.

Objective: To determine the safety of gentamicin when used in a community setting to treat neonatal sepsis., Methods: The study was conducted in peri-urban areas of Karachi from September 2009 to April 2010. The exposed group consisted of children 6 months to 3 years of age who were treated for sepsis during 0-2 months of age in the community, with a regimen that included gentamicin for at least five days.The control group included children from the same area who never received gentamicin. The outcome measure was hearing loss, which was assessed by Brainstem Evoked Response Audiometry., Results: Of the 255 children enrolled, 125 (49%) received gentamicin, while 130 (51%) were not exposed to gentamicin. Children in the gentamicin exposed group were not at increased risk for hearing loss compared to controls (n = 30; 30.9% vs. n = 33; 31.4%, RR 0.98; 95% Cl: 0.60-1.61). Children with history of ear discharge (RR 1.7) and children with family history of deafness (RR 2.0) were more at risk for having hearing loss., Conclusion: No association was found between hearing loss and gentamicin exposure in a community setting for the management of sepsis in the first two months of life.