Low birth weight, intrauterine growth retardation, and prematurity are overwhelming risk factors associated with infant mortality and morbidity. The lack of efficacious prenatal screening tests for these three outcomes illuminates the problems inherent in bivariate estimates of association. A biocultural strategy for research is presented, integrating societal and familial levels of analysis with the metabolic, immune, vascular, and neuroendocrine systems of the body. Policy decisions, it is argued, need to be based on this type of biocultural information in (...) order to impact the difficult-to-change problems of low birth weight, intrauterine growth retardation, and prematurity. (shrink)

The aim of this study is an analysis of the possible adaptive consequences of delivery of low birth weight infants. We attempt to reveal the cost and benefit components of bearing small children, estimate the chance of the infants’ survival, and calculate the mothers’ reproductive success. According to life-history theory, under certain circumstances mothers can enhance their lifetime fitness by lowering the rate of investment in an infant and/or enhancing the rate of subsequent births. We assume that living (...) in a risky environment and giving birth to a small infant may involve a shift from qualitative to quantitative production of offspring. Given high infant mortality rates, parents will have a reproductive interest in producing a relatively large number of children with a smaller amount of prenatal investment. This hypothesis was tested among 650 Gypsy and 717 non-Gypsy Hungarian mothers. Our study has revealed that 23.8% of the Gypsy mothers had low birth weight (<2,500 g) children, whose mortality rate is very high. These mothers also had more spontaneous abortions and stillbirths than those with normal weight children. As a possible response to these reproductive failures, they shortened birth spacing, gaining 2–4 years across their reproductive lifespan for having additional children. Because of the relatively short interbirth intervals, by the end of their fertility period, Gypsy mothers with one or two low birth weight infants have significantly more children than their ethnic Hungarian counterparts. They appear to compensate for handicaps associated with low birth weights by having a larger number of closely spaced children following the birth of one or more infants with a reduced probability of survival. The possible alternative explanations are discussed, and the long-term reproductive benefits are estimated for both ethnic groups. (shrink)

RESUMEN La problemática del muy bajo peso al nacer ha sido abordada desde hace varios años, sin embargo, las investigaciones están enfocadas desde diferentes perspectivas y contextos, no siempre se ha considerado su repercusión a corto y a largo plazo, así como la interacción de los diferentes factores que se relacionan con este riesgo biológico. Por ello en esta revisión bibliográfica se realiza una valoración de estudios ejecutados a nivel internacional y en Cuba dedicados al desarrollo neuropsicológico de niños con (...) muy bajo peso al nacer. Se concluye que el muy bajo peso al nacer repercute en el desarrollo neuropsicológicos desde edades tempranas, hasta la adolescencia; por ello es necesario una visión integradora que tenga en cuenta el riesgo biológico, las particularidades individuales y el contexto social en que se desenvuelve el niño desde los primeros momentos, lo que posibilitará, perfeccionar la atención a corto y largo plazo al grupo de riesgo. ABSTRACT The problems of very low birth weight have been dealt with for many years, however, research on the matter is approached from different perspectives and contexts, not always have its short and long term repercussions being considered as well as the interaction of different factors related to this biological risk. Therefore, this bibliographical review makes an assessment of international and Cuban studies devoted to very low birth weight children’s neuropsychological development. It was reached the conclusion that very low birth weight affects neuropsychological development from early ages to adolescence; for that reason, it is necessary to have an integrated approach of the problem that takes into account the biologicals risk, individual characteristics and the social context in which the child develops from the beginning, which will make the improvement of short and long term care to this risk group possible. (shrink)

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The (...) decrease in IMR was larger in the 25000·63); it increased to 0·57 (95% CI 0·350·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth. (shrink)

The aim of the paper is to prove the consistency of libertarianism. We examine the example of Jane, who deliberates at length over whether to vacation in Colorado (C) or Hawaii (H), weighing the costs and benefits, consulting travel brochures, etc. Underlying phenomenological deliberation is an indeterministic neural process in which nonactual motor neural states n(C) and n(H) corresponding to alternatives C and H remain physically possible up until the moment of decision. The neurophysiological probabilities pr(n(C)) and pr(n(H)) evolve continuously (...) according to the different weights Jane's judgement attaches to C and H at different times during the deliberation. The overall process is indeterministic, since Jane's exact judgemental weighting would vary slightly were the process to be repeated from the same initial conditions. The weighting is however rational, and entirely under Jane's control. This controlled, rational, indeterministic process shows that libertarianism is a consistent philosophical thesis. (shrink)

The aim of the paper is to prove the consistency of libertarianism. We examine the example of Jane, who deliberates at length over whether to vacation in Colorado (C) or Hawaii (H), weighing the costs and benefits, consulting travel brochures, etc. Underlying phenomenological deliberation is an indeterministic neural process in which nonactual motor neural states n(C) and n(H) corresponding to alternatives C and H remain physically possible up until the moment of decision. The neurophysiological probabilities pr(n(C)) and pr(n(H)) evolve continuously (...) according to the different weights Jane's judgement attaches to C and H at different times during the deliberation. The overall process is indeterministic, since Jane's exact judgemental weighting would vary slightly were the process to be repeated from the same initial conditions. The weighting is however rational, and entirely under Jane's control. This controlled, rational, indeterministic process shows that libertarianism is a consistent philosophical thesis. (shrink)

In _The Body in Late-Capitalist USA_, Donald M. Lowe explores the varied social practices that code and construct the body. Arguing that our bodily lives are shaped by a complex of daily and ongoing practices—how we work, what we buy and consume—Lowe contends that as a result of the commodification of these and other social practices in the late-twentieth century, what we often understand to be the needs of the body are in fact means for capital accumulation. Moving beyond studies (...) of representations and images of the body, Lowe focuses on the intersection of body practices, language, and the Social to describe concretely the reality of a lived body. His strongly synthetic work brings together Marxist critique, semiotics, Foucaultian discourse analysis, and systems and communications theory to examine those practices that construct the body under late capitalism: habits of work and consumption, the ways we give birth and raise children, socialization, mental and physical healing, reconstructions and contestations of sexuality and gender. Lowe draws upon a wide range of sources, including government and labor studies and statistics, diagnostic and statistical manuals on mental illness, computer manuals, self-help books, and guides to work-related stress disorders, to illustrate the transformation of the body into a nexus of exchange value in postmodern society. (shrink)

In his paper ‘‘Bad luck once again’’ Neil Levy attacks our proof of the consistency of libertarianism by reiterating a time-worn compatibilist complaint.1 This is, that what is not determined must be due to chance. If A has a choice of X or Y, neither X nor Y being causally determined, then if A chooses X it can only be by chance, never for a reason. The only ‘‘reason’’ that could explain the choice of X over Y would have to (...) be a causally sufficient reason, which would rule out A’s having a genuine choice in the first place. Either X is causally necessitated or X is realized by sheer luck. But that these are the only alternatives is untrue. The exercise of deliberative reason opens the way between the Scylla of causal necessitation and the Charybdis of chance, as we shall try to make clear. The central core of Levy’s argument is that any attempt to give a reasons-based explanation of a contrastive fact must fail. A contrastive fact is a fact of the kind ‘‘Jane decides to vacation in Hawaii rather than Colorado,’’ or ‘‘Jane assigns a greater weight to surfing that to white-water rafting.’’ In the last three paragraphs of his paper Levy argues that Jane’s assigning more weight to surfing than to rafting cannot be a reasons-based assignment, because, as he puts it, ‘‘the reasons that would explain the weighting are the weighted reasons themselves.’’ Similarly, prior to making her Hawaii⁄ Colorado decision, Jane has.. (shrink)

From Santa, elves and Ebenezer Scrooge, to the culture wars and virgin birth, _Christmas - Philosophy for Everyone_ explores a host of philosophical issues raised by the practices and beliefs surrounding Christmas. Offers thoughtful and humorous philosophical insights into the most widely celebrated holiday in the Western world Contributions come from a wide range of disciplines, including philosophy, theology, religious studies, English literature, cognitive science and moral psychology The essays cover a wide range of Christmas themes, from a defence (...) of the miracle of the virgin birth to the relevance of Christmas to atheists and pagans. (shrink)

Let T be a one-based theory. We define a notion of width, in the case of T having the finiteness property, for the lattice of finitely generated algebraically closed sets and prove Theorem. Let T be one-based with the finiteness property. If T is of bounded width, then every type in T is nonorthogonal to a weight one type. If T is countable, the converse is true.

Maternity careproviders often have strong views concerning a woman’s choice of where to give birth. These views may be based on the ethical principle of autonomy, or on the principle of beneficence. The authors propose that an approach utilizing shared decision making allows careproviders and women to move beyond disagreements regarding which evidence on risk should “count,” instead adopting a process of increased knowledge and support for women and their partner while they make choices regarding place of birth.

Preterm birth is defined as delivery occurring before 37 weeks gestation.1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases.2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women.1 The outcomes for these infants (...) are also disparate–preterm birth and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers.3 Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born <28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates.4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast …. (shrink)

BackgroundThe interRAI 0–3 Early Years was recently developed to support intervention efforts based on the needs of young children and their families. One aspect of child development assessed by the Early Years instrument are motor skills, which are integral for the maturity of cognition, language, social-emotional and other developmental outcomes. Gross motor development, however, is negatively impacted by pre-term birth and low birth weight. For the purpose of known-groups validation, an at-risk sample of preterm children using the (...) interRAI 0–3 Early Years was included to examine correlates of preterm risk and the degree of gross motor delay.MethodsParticipant data included children and families from 17 health agencies in Ontario, Canada. Data were collected as part of a pilot study using the full interRAI 0–3 Early Years assessment. Correlational analyses were used to determine relationships between prenatal risk and preterm birth and bivariate analyses examined successful and failed performance of at-risk children on gross motor items. A Kruskal-Wallis test was used to determine the mean difference in gross motor scores for children born at various weeks gestation.ResultsCorrelational analysis indicated that prenatal and perinatal factors such as maternal nicotine use during pregnancy did not have significant influence over gross motor achievement for the full sample, however, gross motor scores were lower for children born pre-term or low birth weight based on bivariate analysis. Gross motor scores decreased from 40 weeks’ gestation, to moderate to late preterm, and to very preterm, however extremely preterm performed comparably to very preterm.InterpretationThe interRAI 0–3 was evaluated to determine its efficacy and report findings which confirm the literature regarding delay in gross motor performance for preterm children. Findings confirm that pre-term and low birth weight children are at greater risk for motor delay via the interRAI 0–3 Early Years gross motor domain. (shrink)

In this research, an Artificial Neural Network (ANN) model was developed and tested to predict Birth Weight. A number of factors were identified that may affect birth weight. Factors such as smoke, race, age, weight (lbs) at last menstrual period, hypertension, uterine irritability, number of physician visits in 1st trimester, among others, as input variables for the ANN model. A model based on multi-layer concept topology was developed and trained using the data from some (...) class='Hi'>birth cases in hospitals. The evaluation of testing the dataset shows that the ANN model is capable of correctly predicting the birth weight with 100% accuracy. (shrink)

Pregnancy is thought to be a metabolically very expensive endeavor, yet investigations have produced inconsistent results concerning the responsiveness of human birth weight to maternal nutritional stress or nutritional intervention. These findings have led some researchers to conclude that fetal growth is strongly buffered against fluctuations in maternal energy balance, making the fetus in effect a “nearly perfect parasite.” This buffering would appear to be a reasonable adaptive response given the high risk of morbidity and mortality associated with (...) low birth weight. However, a life-history approach leads to the prediction that maternal investment strategies in pregnancy should be geared toward maximizing lifetime reproductive success rather than simply the success of the current pregnancy, and by extension that maternal investment strategies should vary with reproductive value. The physiology of human pregnancy in fact appears to include a number of mechanisms that protect maternal energy resources from diversion to the fetus and preserve them for future reproductive events. These mechanisms include adjustment of blood flow to the uterus and perhaps minor adjustments in gestation length, although evidence for the latter is scant. Suggestions are made for ways of investigating these maternal options. (shrink)

Several conceptual and methodological challenges must be solved in order to create knowledge that can be useful to pregnant women, their families, and any clinicians who serve them: (1) going beyond nominal and ordinal hypotheses and presenting estimates of conditional probabilities; (2) focusing on clearly defined outcomes; (3) modeling the relationship of fetal growth and length of gestation; (4) understanding the process of fetal growth even though most of our data is cross-sectional; (5) estimating the independent effects of genetics, race, (...) ethnicity, maternal risk behaviors, medical prenatal care, and socioeconomic status on fetal growth and length of gestation; and (6) estimating the independent effects of maternal pre-pregnancy weight, weight gain during pregnancy, and nutrition on fetal growth and length of gestation. (shrink)

Low‐molecular‐weight (LMW) thiols are extensively involved in the maintenance of cellular redox potentials and the protection of cells from a variety of reactive chemical and electrophilic species. However, we recently found that the metabolic coupling of two LMW thiols – mycothiol (MSH) and ergothioneine (EGT) – programs the biosynthesis of the anti‐infective agent lincomycin A. Remarkably, such a constructive role of the thiols in the biosynthesis of natural products has so far received relatively little attention. We speculate that the (...) unusual thiol EGT might function as a chiral thiolation carrier (for modification) and a novel activator (for glycosylation) of sugar. Additionally, we examine recent evidence for LMW thiols (MSH and others) as sulfur donors of sulfur‐containing natural products. Clearly, the LMW thiols have more diverse activities beyond cell protection, and more attention should be paid to the correlation of their functions with thiol‐dependent enzymes. (shrink)

The mother–adult daughter relationship has been highlighted in both the social sciences and the public health literature as an important facet of social support networks, particularly as they pertain to maternal and child health. Evolutionary anthropologists also have shown positive associations between support from maternal grandmothers and various outcomes related to reproductive success; however, many of these studies rely on proximity as a surrogate measure of support. Here I present data from the Puerto Rican Maternal and Infant Health Survey (PRMIHS) (...) comparing geographic proximity of mother and daughter with a self-reported measure of mother-to-daughter support. These two measures were used to predict infant health outcomes as well as various measures of instrumental and emotional aid provided during pregnancy and after birth. Primary support was shown to have a positive effect across the analyses, whereas geographic proximity was associated with an increased risk of infant mortality and low birth weight as well as reduced odds of receiving support. This paradox was then examined using a combination variable that teased out the interactions of maternal support and proximity. Women who were geographically close to their mothers but who did not consider them a primary source of support had increased odds of infant death and low birth weight, and were less likely to receive either tangible or intangible forms of aid, while women whose mothers were both close and primary showed uniformly positive outcomes. These results place the role of propinquity within the larger context of social support and highlight the need for more detailed studies of social support within evolutionary anthropology. (shrink)

This Essay examines the elegantly simple idea that consent to medical treatment or participation in human research must be “informed” to be valid. It does so by using as a case study the controversial clinical research trial known as the Surfactant, Positive Pressure, and Oxygenation Randomized Trial. The Essay begins by charting, through case law and the adoption of the common rule, the evolution of duties to secure fully informed consent in both research and treatment. The Essay then utilizes the (...) SUPPORT study, which sought to pinpoint the level of saturated oxygen that should be provided to extremely low birth weight infants to demonstrate modern complexities and shortcomings of the duty to secure informed consent. This Essay shows how the duty is measured by foreseeability of risks and benefits in human research and why federal regulators believed the tradeoffs in risk and benefits from differing oxygen levels administered in the support study were foreseeable. It then explores the contours of the duty to secure informed consent when applied to researchers who also serve as treating physicians, highlighting how common law duties differ in jurisdictions that apply the professional standard and those that apply the patient-centered material risk standard. This Essay provides new insight into what the law must do to make real the notion that [e]very human being of adult years and sound mind has a right to determine what shall be done with his body.”. (shrink)

The emergence of new obstetrical and neonatal technologies, as well as more aggressive clinical management, has significantly improved the survival of extremely low birth weight infants. This development has heightened concerns about the limits of viability. ELBW infants, weighing less than 1,000 grams and no larger than the palm of one's hand, are often described as of late twentieth century technology. Improved survivability of ELBW infants has provided opportunities for long-term follow-up. Information on their physical and emotional development (...) contributes to developing standards of practice regarding their care. (shrink)

IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according (...) to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

This article is a thoughtful and well written examination of some of the complex issues that have emerged as a result of recent improvements in the treatment of extremely low birth weight (ELBW) infants, including those who weigh 500 to 600 grams or who are believed to be 23 to 24 weeks gestation. The authors argue that the 23 to 24 week gestation period is filled with ambiguity and flexibility in practice relative to active resuscitation. However, such ambiguity (...) and flexibility is likely to prevail whatever the boundary conditions of viability happen to be. Thus moral guidelines that inform the rescue of an infant believed to be 500 to 600 grams or 23 or 24 weeks gestation are likely to be relevant whatever the boundary conditions are. (shrink)

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, (...) pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women’s subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers. (shrink)

Parents may experience profound stress when their infant is extremely premature or has exceptionally low birth weight. This article presents several approaches that clinicians and ethics consultants can use to reduce this stress when a parent is single and alone, as well as when both parents are present. Offering parents additional options, taking preventative measures, and using approaches based on recent innovations in psychotherapies are emphasized. Since the clinicians who care for these neonates may find it exceptionally stressful (...) and may experience “burn out,” especially over time, this article also addresses what may work best for them. Finally it will discuss clinicians, who, despite their best efforts, find that caring for these infants is simply too painful to bear. (shrink)

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the (...) city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death. (shrink)

Neonatal mortality during the first week of life, corresponding to the years 19750·023 per year. This decline cannot be explained by an increase in the mean birth weight (MBW=23440·835−10·107 g per year). From the most frequent of the causes of death to the least were: congenital anomalies, preterm born or low birth weight, respiratory problems, pregnancy difficulties, hypoxaemia/asphyxia, delivery difficulties and infectious diseases. This sequence changed when the specific age at death was considered. The NMR descended (...) evenly for both sexes for the causes indicated above, except for preterm born or low birth weight, in which the male mortality decrease was greater since its rate was more elevated at the beginning of the period studied. For all the causes listed, NMR was more elevated both in urban areas and for males. Early neonatal mortality (first 24 hours) was higher for pregnancy difficulties, preterm born or low birth weight, congenital anomalies and hypoxaemia/asphyxia. (shrink)

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, (...) plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study. (shrink)

The dramatic increases in the survival rate of prematurely born, very low birth weight infants (<1500 g) have created concern about the possible sequelae experienced by these children, in terms of both severe problems and less severe learning and behavior problems. The methodological difficulties involved in answering questions about the outcomes of these children, including the choice of appropriate outcome measures, the analysis of individual variation, the problems associated with dropouts, the relevant comparison groups, the importance of survival (...) rate, and the question of correcting for the degree of prematurity, are considered. In spite of the difficulties in interpreting the studies, the research indicates that many premature children have learning disabilities, particularly in the perceptual and visual motor functioning and some aspects of language and reading. In addition, ethical issues related to prematurity are discussed, including parents’ rights, decision-making, and cost and treatment. Finally, some solutions are proposed involving the use of risk indices for the early detection of developmental problems. (shrink)

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to (...) these infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called “neonatologist,” seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. What was to be the cost in dollars and in anguish to save the Patrick Kennedys of the world? Triumphs led to grave concerns as we approached the edge. However, no advancement in neonatology has ever changed the ultimate questions. (shrink)

This research explores the causes of early marriage and assesses the consequences of early marriage on maternal and child well-being in a district of Nepal. A two week long field operation was carried out to collect data where 126 respondents were selected through convenience sampling methods on the basis of two criteria, including 1) being a married women only who got married before 19 years of age; and 2) those who have children below three years. The interviews were mainly focused (...) on those who have a neonatal child. A structured interview schedule found that early marriage is still prevalent among the illiterate group. A paradigm shift was found in some aspects, such as the shift in decision-making from parents to children, a shift from arranged to love marriages, and from parental pressure to marry to love and fulfillment of sexual desire as reasons for marrying. Most of the respondents have no idea about the legal marriage age and punishment for underage marriage. Most of the respondents suffered from different physical health-related problem including poor maternal and child well-being, weakness, immaturity, miscarriage, sexual problems, no prenatal check up, and/or low birth weight. To deal with the problem a number of strategies have been suggested, mainly providing economic opportunities to young girls, improving the strictness of legal strategies about marriage age, promoting education of girls, and using mass media to increase the awareness of the whole community about the consequences of early marriage on girls themselves and on her children along with their family. Efforts need to be made in the community and other parts of Nepal where early marriage and child marriage is prevalent. (shrink)

This study reports an ecologic analysis of the relationship between mean birth weight (MBW) and nutritional, medical and social variables, using 1982 data for 47 prefectures in Japan.

Is the assessment of motor milestones valid and scaled equivalently for all infants? It is not only important to understand if the way we use gross and fine motor scores are appropriate for monitoring motor milestones but also to determine if these scores are confounded by specific infant characteristics. Therefore, the aim of the study is to investigate the latent structure underlying motor milestone assessment in infancy and measurement invariance across sex, birth weight, and gestational age. For this (...) study, the birth cohort data from the United Kingdom Millennium Cohort Study was used, which includes the assessment of eight motor milestone tasks from the Denver Developmental Screening Test in 9-month-old infants, depicting early motor development of the first children of generation Z. Confirmatory factor analyses showed a better model fit for a two-factor structure compared to a one-factor structure, and multiple indicators multiple causes modeling revealed no differential item functioning related to sex, birth weight, and gestational age. The study provides support for the use of gross and fine motor scores when assessing motor milestones in infants—both boys and girls with different birth weights and of varying gestational ages. Further investigation into widely adopted assessment tools is recommended to support the use of valid composite scores in early childhood research and practice. (shrink)

Three clinical cases of very ill neonates exemplifying extreme ethical situations for nurses are interpreted through Arendt's concepts of life and natality, and Agamben's critique of bare life. Agamben's notions of form-of-life, as the inseparability of zoe/bios, and testimony are offered as the potential foundation of nursing ethics.