Search Results (305)

Background/Objectives: The structure and adequacy of health financing critically shape population health outcomes. This study examines financing typologies in relation to healthy life expectancy (HALE) and infant mortality across 38 OECD countries and Türkiye (2000–2021), quantifying financing model effectiveness and sex-disaggregated disparities. Methods: Time-weighted averages (exponential weighting, λ = 1.5) emphasized recent policy environments while preserving historical context. Principal component analysis addressed multicollinearity among six financial indicators. Multidimensional scaling (stress = 1.16 × 10⁻¹²) and K-means clustering identified four financing typologies. TOPSIS composite scores measured proximity to ideal outcomes (maximum HALE, minimum infant mortality), with success rates calculated as the percentage achieving top-quartile performance (TOPSIS ≥ 70). Sex-disaggregated analysis examined gender gaps across clusters. Results: High-Public-Spending systems achieved an 81.2% success rate (mean TOPSIS = 76.0), those with Balanced High-Expenditure achieved 77.8%, whereas Moderate/Emerging systems exhibited only 8.3% success. Türkiye ranked 36th of the 38 (TOPSIS = 24.8), 45% below cluster average, with extreme deficits in HALE (percentile = 15.8%) and infant mortality (7.9%). Low-resource systems showed significantly wider gender gaps (HALE: 3.43 vs. 1.66 years; infant mortality male excess: 1.04 vs. 0.53 per 1000; p < 0.01), with Türkiye demonstrating the third-highest male excess mortality globally (1.69 per 1000), indicating critical neonatal care deficiencies. Conclusions: Robust public financing (>USD 3500 per capita, >7% GDP) is necessary and nearly sufficient for superior outcomes, with success rates differing 10-fold between high- and low-resource systems (81% vs. 8%). Türkiye’s extreme underperformance reflects both inadequate public investment (USD 813 per capita, 22% of high-performing averages) and efficiency deficits requiring doubled expenditure alongside targeted maternal–child health interventions. Full article

Background: Respiratory syncytial virus (RSV) is a major contributor to severe Acute Respiratory Infections (ARI) in infants worldwide, leading to significant morbidity and mortality. The seasonal nature of RSV and other respiratory infections presents unique risks, especially for infants in low- and middle-income countries, such as Mexico, where comprehensive RSV surveillance is limited. This study aims to analyze respiratory infant mortality rates by month of birth across Mexico, with a focus on identifying high-risk periods and regional differences. Methods: National birth and mortality data from the Instituto Nacional de Estadística y Geografía were analyzed for all infants born between April 2014 and March 2020. Respiratory mortality rates (based on ICD-10 J and U codes) were calculated by month of birth and examined across eight geographical regions in Mexico. Mortality trends were analyzed using descriptive statistics to assess seasonal and regional variations. A correlation analysis was conducted between respiratory mortality and confirmed RSV hospitalization data to assess the temporal relationship between increased mortality and epidemic activity of this virus. Results: A total of 12,604,902 live births were recorded in Mexico during the study period, with 8805 infant deaths attributed to respiratory causes, resulting in a respiratory infant mortality rate of 0.7 deaths per 1000 births. Mortality rates exhibited strong seasonal patterns, with infants born between September and November at higher risk of respiratory death, peaking in October. The highest mortality rates were observed in the South region, while the lowest rates were in the Northeast. Conclusions: These findings highlight the importance of implementing preventive strategies in Mexico that are aligned with regional RSV seasonality. Timing preventive interventions with regional and seasonal mortality trends should enhance the cost-effectiveness and impact of RSV immunization programs, ultimately reducing infant mortality nationwide. Full article

Methicillin-susceptible Staphylococcus aureus (MSSA) remains a major pathogen in neonatal intensive care units (NICUs), with colonization and infection posing significant risks. MSSA colonization occurs in up to 42.8% of neonates, while 12–41% of healthcare personnel also carry MSSA, contributing to nosocomial transmission. MSSA accounts for approximately 12% of neonatal S. aureus bloodstream infections, with mortality rates up to 20.5%, particularly among very-low-birth-weight infants. This review analyzes the molecular attributes, epidemiology, risk factors, clinical presentations, decontamination methods, and treatment alternatives for MSSA infections in newborns. MSSA strains show considerable genetic heterogeneity, being distinguished by a wide variety of sequence types (STs) and Staphylococcal Protein A types (SpA). They harbor several pathogenicity genes—including hemolysins, superantigens, adhesins, and Panton–Valentine leukocidin (PVL)—which are implicated in severe infections, while biofilm-associated genes enhance environmental persistence. Prematurity, low birth weight, prolonged hospitalization, and exposure to invasive devices are key risk factors. Active surveillance and decolonization programs have achieved reductions of up to 73% in MSSA infections. β-lactam antibiotics remain first-line therapy, with adjunctive aminoglycosides reserved for severe cases. Ongoing genomic surveillance and targeted preventive strategies are essential to reduce MSSA-associated morbidity and mortality in this vulnerable population. Full article

Background/Objectives: The optimal rate of enteral feeding advancement in preterm infants remains uncertain despite decades of clinical research. This uncertainty arises from concerns that rapid feeding progression may increase the risk of feeding intolerance and necrotizing enterocolitis (NEC), two major causes of morbidity and mortality in this population. The feeding rate may also influence intestinal oxygenation due to mesenteric hemodynamic changes during feeding. This study aimed to evaluate whether the rate of enteral feeding advancement (slow vs. rapid) affects intestinal oxygenation and its association with feeding intolerance (FI) or necrotizing enterocolitis in very low birth weight preterm infants. Methods: This prospective, randomized, two-center study included infants born at 28–32 weeks of gestation. Group 1 received slow advancement (20 mL/kg/day) and Group 2 rapid advancement (30 mL/kg/day) of enteral feeds. Splanchnic (srSO₂) and cerebral (crSO₂) oxygenation were monitored daily using the FDA-approved INVOS NIRS device during feeding periods (08:00–16:00). Monitoring was performed during minimal enteral nutrition (Phase 1), advancement phases (Phase 2), and for two days after achieving full enteral feeding (Phase 3). The splanchnic-to-cerebral oxygenation ratio (SCOR) was also calculated. Percentage changes in srSO₂ and SCOR during and after feeding were calculated from baseline (prefeeding) values and analyzed. Results: Sixty infants were enrolled. Mean gestational age and birth weight were 29.76 ± 1.33 weeks and 1375.05 ± 271.19 g, respectively. Group 2 achieved full enteral feeding significantly earlier (p = 0.001), with no other demographic differences between groups. No cases of NEC were observed. Feeding intolerance occurred in 14 infants (23.3%): 8 in Group 1 and 6 in Group 2 (p = 0.192). Both groups exhibited increased srSO₂ and SCOR during feeding; however, the between-group differences were not statistically significant (Phase 2 srSO₂ and SCOR: p = 0.07, 0.08; Phase 3 srSO₂ and SCOR: p = 0.069, 0.071). However, the percentage change from baseline in srSO₂ and SCOR during and after feeding was significantly greater in Group 2 during the advancement and full enteral feeding phases (Phase 2 srSO₂ and SCOR: p = 0.03, 0.022; Phase 3 srSO₂ and SCOR: p = 0.015, 0.048). Infants with feeding intolerance demonstrated significantly lower srSO₂ and SCOR values compared to tolerant infants, and this reduction persisted even after reaching full enteral feeding. ROC analysis suggested gestational age < 30 weeks, birth weight < 1180 g, srSO₂ < 52, and SCOR < 0.6 were associated with feeding intolerance. Conclusions: Intermittent bolus feeding increased intestinal oxygenation, with a more pronounced effect in the rapid advancement group. No difference in gastrointestinal adverse outcomes was observed between groups. Lower intestinal oxygenation was associated with feeding intolerance, and the suggested predictive criteria may help guide individualized feeding strategies. Full article

This retrospective population-based study aimed to update the epidemiology of hepatitis B in Vojvodina, Serbia, and assess the impact of vaccination on acute and chronic forms of the disease. Surveillance data from 1978 to 2024 were analyzed by period, age/sex, and geographic distribution. Joinpoint and Poisson regression analyses were used to evaluate long-term trends in hepatitis B incidence and mortality rates and the vaccine-coverage effects, respectively. A decreasing trend in both acute and chronic hepatitis B incidence and mortality was observed over the study period. The average incidence rate declined from 11.51/100,000 in the pre-immunization period (1978–1987) to 1.68/100,000 during the universal immunization period (2006–2024). For chronic hepatitis B, the average incidence rates were 2.27 and 2.62/100,000 in the periods 1997–2005 and 2006–2024, respectively. Uneven spatial distribution was noted across municipalities. Poisson regression analysis showed that for every 1% increase in infant vaccine coverage in the previous year, the incidence rates of acute and chronic hepatitis B decreased significantly by 2.20% and 1.80%, respectively. These findings support the sustained effectiveness of hepatitis B vaccination, particularly among children and adolescents, and underscore the importance of addressing subnational disparities. Full article

Introduction: Despite the advances in its prevention, invasive meningococcal disease (IMD) remains a serious health problem worldwide due to its high morbidity and mortality, including in Romania, with 22% mortality rate. The objectives were to describe the trends of IMD cases admitted to a tertiary care hospital in Romania, over 24 years, and the case fatality rate (CFR) by age, year of admission, and Neisseria meningitidis serogroups. Materials and Methods: A retrospective study was conducted in IMD patients admitted to the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest, Romania, between 2001 and 2024. Results: A total of 256 IMD patients were admitted, 171 under fourteen years, out of which 75 were infants. Most cases were reported before 2008. The case distribution showed 90 patients (35%) with meningitis, 84 (32%) with meningococcaemia, and 82 (32%) with an association of both. Serogroup B was the most frequently and steadily found (58 cases). The overall CFR was 12%. CFR was highest in infants younger than 6 months (19%) and meningococcaemia cases (29%). Conclusions: In our study, IDM had the highest frequency and CFR in infants and meningococcaemia cases. The trends showed a decline in cases after 2008. Serogroup B was the most prevalent and stable strain over 24 years. Full article

Background/Objectives: Acute leukemias (AL) in children under 1-year-old are combined under the term “infant leukemia” and are a very rare malignancies, accounting for up to 5% of all childhood AL cases. The predominance of unfavorable clinical and laboratory characteristics leads to unsatisfactory treatment results, even with the use of modern treatment protocols. Patients/Methods: A comprehensive search through MEDLINE, PubMed, Scopus, and ScienceDirect using infant leukemia-related keywords was performed and included a final set of 52 academic articles. Our own experience included 11 patients with infant leukemia underwent allo-HSCT (allogeneic hematopoietic stem cell transplantation) at the NN Blokhin National Medical Research Center of Oncology in 2021–2023. Types of leukemia included acute myeloid leukemia, lymphoblastic leukemia, and mixed-phenotype acute leukemia. The most frequent cytogenetic aberration was KMT2A. All patients were in clinical and hematological remission, but four had positive MRD status (minimal residual disease). Donors: haploidentical—5 (45.4%), matched unrelated donor—5 (45.4%), and matched related donor—1 (9.2%). Graft manipulations: post-transplant cyclophosphamide was given to three patients with haplo-HSCT, and TCRαβ/CD19 depletion was performed in two patients. The type of immunosuppressive therapy (IST) varied based on the donor. Conditioning regimens were myeloablative. Results: Median follow-up was 23.5 months. Acute GVHD grade I–II developed in two patients (18%) and grade III–IV in three patients (27%). The overall survival rate was 54.5% (n = 6). The relapse rate after allo-HSCT was 18% (n = 2). The most common cause of treatment failure was infectious complications in the early post-transplant period (70%). Conclusions: Our center’s experience demonstrated acceptable transplant-related mortality and satisfactory relapse rates after allo-HSCT in patients with infant leukemia. The treatment of acute leukemia in infants is challenging, and optimal protocols are being developed around the world specifically for these patients. Taking into account the characteristics of this age group, the choice of chemotherapy drug doses should be carefully considered, and the indications for allo-HSCT should be balanced. Full article

Background: This study compares short- and mid-term morbidity and mortality outcomes in preterm infants treated with the natural surfactants poractant alfa and calfactant, to assess differences in their clinical efficacy and safety profiles. Methods: In this prospective cohort study, preterm infants (25 ^0⁄7–32 ^6⁄7 weeks gestation) admitted to a Level III NICU between January 2023 and March 2024 received either poractant alfa or calfactant according to hospital supply. The primary outcome was moderate-to-severe bronchopulmonary dysplasia (BPD) and/or mortality. Secondary outcomes included extubation success, need for repeat surfactant dosing, and treatment cost per patient. Short- and mid-term morbidity and mortality outcomes were compared between groups. Results: The study included 215 preterm infants (137 in the poractant alfa group; 78 in the calfactant group). Use of less invasive surfactant administration (LISA) and INSURE techniques was significantly higher in the poractant alfa group (32.8% vs. 10.3%; p < 0.01). Poractant alfa was administered earlier, at higher per-kg doses, and at lower median treatment cost. Rates of moderate-to-severe BPD, the composite outcome BPD or mortality, reintubation, duration of respiratory support, and length of hospitalization did not differ significantly between groups. In the poractant alfa group, the need for a second surfactant dose was lower (p = 0.027). Overall mortality was similar (21.2% vs. 24.4%; p = 0.13), with no significant difference in timing of death. Conclusions: Compared with calfactant, poractant alfa offers practical advantages—such as a higher initial dose, lower cost, and reduced need for a second repeat dose—while yielding comparable short- and mid-term morbidity and mortality outcomes. Full article

Background/Objectives: Preterm birth is a leading cause of neonatal mortality, especially in low- and middle-income countries. Despite advances in neonatal care, mortality among preterm infants in intensive care units remains high, and specific risk factors are not fully understood. This study aimed to identify neonatal factors associated with mortality among preterm infants admitted to the neonatal intensive care unit (NICU) of a Peruvian national hospital. Methods: An analytical cross-sectional study was conducted at Guillermo Almenara National Hospital in Lima, Peru, including all preterm neonates (<37 weeks gestational age) admitted to the NICU in 2022. Clinical and demographic data were extracted from medical records. Bivariate and multivariate logistic regression analyses identified independent associations with in-hospital mortality. Results: A total of 300 preterm neonates were included, with an in-hospital mortality rate of 15%. In adjusted analysis, extremely low birth weight (<1000 g) was the strongest predictor of mortality. Mild and severe depression in Apgar score at 1 min were associated with increased risk of death (adjusted OR: 12.08 and 6.18, respectively). Hypoglycemia was also independently associated with higher mortality (adjusted OR: 5.65). Conversely, perinatal asphyxia was linked to a lower risk of death in the multivariate model. Sex, mode of delivery, and other neonatal complications were not significant predictors after adjustment. Conclusions: Extremely low birth weight, abnormal Apgar scores at 1 min, and hypoglycemia are key determinants of mortality in preterm infants in intensive care. Early risk identification and focused management are essential to reducing preventable deaths in similar resource-limited settings. Full article

Background/Objectives: In Brazil, nearly universal access to prenatal care coexists with ongoing negative fetal and infant outcomes. This review explores how the adequacy of prenatal care affects maternal, fetal, and child health, and highlights recurring gaps in service delivery. Methods: A narrative review of Brazilian studies published between 2018 and 2024 was conducted through the Virtual Health Library and PubMed. The initial search (July 2024) was updated in February 2025, and two reviewers independently screened and extracted data, synthesizing clinical outcomes from the findings. Results: A total of thirty-six studies were included in the review. Inadequate prenatal care was consistently linked to higher rates of infant and neonatal mortality, prematurity, low birth weight, congenital syphilis, and neonatal near misses. The studies indicated that counting visits alone does not adequately reflect the quality of care: when evaluated against the Prenatal and Birth Humanization Program (PHPN), most studies met only one of the eight minimum criteria. Common shortcomings included late initiation of care, incomplete diagnostic testing, fragmented follow-up, and insufficient treatment for partners regarding sexually transmitted infections. Conclusions: Adverse outcomes persist in Brazil not due to a lack of access, but rather due to deficiencies in the content and continuity of prenatal care. To improve perinatal outcomes, it is essential to strengthen care through standardized, multidimensional indicators and integrated strategies that combine clinical, educational, and psychosocial support. Full article

Background: Compared to other high-income countries, US women face higher maternal and infant mortality rates. Methods: This study used structural equation modeling (SEM) to examine cross-sectional, county-level associations between structural and intermediary social determinants of health (SDOHs) and maternal and infant mortalities, based on the World Health Organization’s Commission on Social Determinants of Health framework. Results: Our findings suggest maternal mortality may be linked to increased food insecurity, food assistance, distance to obstetric care, and decreased walkability and marriage rates. Our modeling also points toward a connection between infant mortality and increased food insecurity, food assistance, Black race, mental distress, and decreased walkability, education, and income. SEM revealed significant direct and indirect effects of these SDOHs. Notably, food insecurity and walkability had direct associations with both maternal and infant mortality in both SEM models. Conclusions: The findings underscore the need for policy, practice, and research efforts to address key SDOHs and reduce mortality disparities in the US. Full article

Typhoid fever, measles, and rubella continue to contribute significantly to childhood morbidity and mortality in India. In line with WHO recommendations for co-administration of Typhoid Conjugate Vaccine (TCV) and measles–rubella (MR) vaccine at 9 months of age, this phase IV, randomized, open-label, multicenter clinical trial was conducted to assess their immunological compatibility and safety when administered concomitantly. A total of 900 healthy Indian infants aged 9–10 months were randomized into three groups: Group A received TCV and MR vaccine concomitantly; Group B received MR on Day 0 and TCV on Day 28; Group C received TCV on Day 0 and MR on Day 28. Subjects were followed for 6 months after concomitant/last vaccination. Seroconversion rates (SC) in Groups A/B/C at Day 28 were 90.2%/75.3%/89.5% for anti-Vi; 80.4%/75.2%/77.7% for anti-measles, and 87.7%/84.0%/85.2% for anti-rubella antibodies. By study end, SC for anti-Vi was 87.1%/71.6%/83.0%, while SC for anti-measles and anti-rubella reached ~90% and ≥98%, respectively, across all groups. Geometric mean titers increased significantly for all antigens, with no evidence of immunological interference. Safety assessments showed adverse events in 23.9%/32.0%/32.7% participants in Group A/B/C. Most adverse events were mild, and only one serious adverse event was reported. These findings support the co-administration of TCV and MR vaccine as a safe and effective strategy. Full article

Background/Objectives: Meningococcal disease (MD) remains a significant public health concern worldwide. In Serbia, mandatory immunization against MD with the meningococcal polysaccharide vaccine (MenAC) for high-risk groups and international travelers was introduced in 2006. Since 2017, the polysaccharide vaccine has been replaced with the quadrivalent meningococcal conjugate vaccine (MenACWY). The aim of this study was to analyze long-term trends in incidence, age-specific patterns, seasonality, and lethality of invasive meningococcal disease (IMD) in the Autonomous Province of Vojvodina (AP Vojvodina), Serbia, over a 28-year period. Methods: A descriptive study analyzed all reported cases of IMD in AP Vojvodina, from 1997 to 2024. Data were obtained from the regional communicable disease surveillance system, based on mandatory hospital reporting and case classification according to national and WHO guidelines. Temporal, demographic, and clinical characteristics, along with disease outcomes, were analyzed. Results: From 1997 to 2024, 175 IMD cases were reported in AP Vojvodina. The annual incidence peaked in 1997 (1.24/100,000), with smaller surges in 2003 and 2005. Since 2006, coinciding with the introduction of immunization against MD, a sustained decline has been observed, with incidence rarely exceeding 0.30/100,000. A slight resurgence occurred in 2023–2024, with 13 cases reported. From 1997 to 2024, IMD in AP Vojvodina exhibited a clear seasonal pattern, with most cases occurring in winter and early spring, peaking in January (17%), March (12%), and February (11%), and the fewest cases occuring in the summer months. Throughout the study period, the highest IMD incidence rates were consistently observed among infants <1 year of age and children aged 1–4 years, with peaks of up to 22.9/100,000 and 16.0/100,000, respectively. Incidence was much lower in older age groups, especially adults. After a 2006 peak, rates declined across all ages, with a slight resurgence in 2023–2024 among children and adolescents. Children aged 1–4 years made up the largest share of IMD cases, peaking in January–March (45.1%). Half of the infant cases were recorded in October–November, while cases in older children, adolescents, and adults were fewer and showed varied monthly patterns, with small peaks in winter and early spring. During the 28-year study period, the highest IMD mortality rate was observed among infants <1 year of age (0.59 per 100,000 population), followed by children aged 1–4 years (0.32 per 100,000). Mortality rates declined progressively with increasing age, with the lowest rate recorded among individuals aged ≥40 years (0.01 per 100,000). Of the 175 IMD cases reported in AP Vojvodina (1997–2024), 21 were fatal (case fatality rate [CFR] = 12.0%). The CFR of IMD varied across age groups. The highest CFR was observed among individuals aged ≥40 years (21.4%), followed by the 5–9 years (17.4%) and <1 year (16.7%) age groups. None of the patients had been vaccinated against MD. Fatal outcomes were more common in children aged 1–4 years and among rural residents, though differences were not statistically significant (p > 0.05). Most deaths (57.1%) occurred in the first quarter of the year. A strong association was found between clinical form and outcome, with meningococcal sepsis being significantly more frequently associated with fatality than meningitis (p = 0.0002). Deaths were sporadic over time, with most occurring within 1–2 days of notification. All confirmed fatal cases were due to serogroup B. Conclusions: MD remains a rare yet serious public health threat in AP Vojvodina. Mortality rates indicate that the public health impact of this disease is greatest among the youngest age groups; however, the risk of death, i.e., disease severity, does not appear to be age dependent. The recent rise in cases, high fatality among sepsis patients, and absence of prior vaccination among all IMD cases highlight the need for enhanced surveillance, physician education, and consideration of introducing both MenACWY and MenB vaccines for high-risk groups. Full article

Chad, a Sub-Saharan country, has some of the worst child mortality and health indicators. A lack of recent and accurate health records in Béré, rural Chad, due to decades of strife compromises the development of relevant health interventions by Project 21, a community health program. This study investigates child mortality, weight gain ability, and related factors in 0–2-year-olds through a cross-sectional study completed by trained community health workers using a survey questionnaire. Most household heads are Nangtchéré Christian males with secondary-level education. Male infants have the highest mortality rate. Infant mortality is predicted by non-exclusive breastfeeding started within 6 days after birth and by the number of household children who experienced and received treatment for meningitis. Toddlers’ mortality is predicted by the number of household adults who experienced and received treatment for meningitis and the number of household adults and children who were vaccinated. The odds of children having no difficulty gaining weight vary with their gender, age, the food or liquid given to them, the source of breastfeeding advice, handwashing and vaccination practices, and experiences with infectious diseases and their treatments. These findings provide targets for future health interventions towards achieving SDG3 in Sub-Saharan Africa. Full article

Background: Acute kidney injury (AKI) in critically ill neonates is usually of pre-renal origin and, often, pharmacological treatment is not sufficient for resolution, requiring kidney replacement therapy (KRT). Due to the small body size and the unavailability of adequate devices for these patients, peritoneal dialysis (PD) appears to be the most easily achievable procedure. However, guidelines for PD management are lacking in this population. Objective: We aimed to report a single-center experience with preterm infants who underwent PD, describing the technical issues and the outcomes, and to review the existing literature. Methods: This retrospective study included preterm infants undergoing PD because of AKI unresponsive to pharmacological treatment. Data were compared to those available in the current literature. Results: Neonatal outcomes of twelve preterm infants were reported. PD was started before the onset of anuria in two oliguric patients, while it was started within 60 h of anuria in four patients, and between 72 and 144 h of anuria in the remaining six patients. One oliguric patient and one who started PD after 60 h of anuria had a complete recovery of kidney function with normalization of diuresis and renal function parameters. The other infants did not achieve complete resolution of AKI. The mortality rate was 91.7%, and even one of the two infants who had recovered kidney function later died due to an infectious complication. Conclusions: Our experience with a limited sample size did not allow us to obtain definitive conclusions. Our data and the current literature suggested that the prognosis is still negative, with a high mortality rate. Further research is needed to develop guidelines to optimize the management of preterm infants with AKI. Full article