JAMA Pediatrics Online First

Perinatal Infections and Neurodevelopmental Outcome in Very Preterm and Very Low-Birth-Weight Infants A Meta-Analysis Perinatal Infection and Neurodevelopmental Outcome

van Vliet EG, de Kieviet JF, Oosterlaan J, et al. — Mon, 20 May 2013 00:00:00 GMT

Importance

Perinatal infections are commonly present in preterm and very low-birth-weight (VLWB) infants and might contribute to adverse neurodevelopmental outcome.

Objective

To summarize studies evaluating the effect of perinatal infections on neurodevelopmental outcome in very preterm/VLBW infants.

Evidence Review

On December 12, 2011, we searched Medline, PsycINFO, Embase, and Web of Knowledge for studies on infections and neurodevelopmental outcome. All titles and abstracts were assessed for eligibility by 2 independent reviewers. We also screened the reference lists of identified articles to search for additional eligible studies. Preselected criteria justified inclusion in this meta-analysis: (1) the study included infants born very preterm (≤32 weeks) and/or with VLBW (≤1500 g); (2) the study compared infants with and without perinatal infection; (3) there was follow-up using the Bayley Scales of Infant Development 2nd edition; and (4) results were published in an English-language peer-reviewed journal. The quality of each included study was assessed using the Newcastle-Ottawa Scale.

Findings

This meta-analysis includes 18 studies encompassing data on 13.755 very preterm/VLBW infants. Very preterm/VLBW infants with perinatal infections had poorer mental (d = −0.25; P < .001) and motor (d = −0.37; P < .001) development compared with very preterm/VLBW infants without infections. Mental development was most impaired by necrotizing enterocolitis (d = −0.40; P < .001) and meningitis (d = −0.37; P < .001). Motor development was most impaired by necrotizing enterocolitis (d = −0.66; P < .001). Chorioamnionitis did not affect mental (d = −0.05; P = .37) or motor (d = 0.19; P = .08) development.

Conclusions and Relevance

Postnatal infections have detrimental effects on mental and motor development in very preterm/VLBW infants.

Sleep-Deprived Young Drivers and the Risk for Crash The DRIVE Prospective Cohort Study Sleep-Deprived Young Drivers and Crash Risk

Martiniuk AC, Senserrick T, Lo S, et al. — Mon, 20 May 2013 00:00:00 GMT

Importance

Short sleep duration is common in adolescents and young adults, and short sleep duration is a risk factor for motor vehicle crash.

Objectives

To assess the association between hours of sleep and the risk for motor vehicle crash, including the time of day of crash and types of crash (single, multiple vehicle, run off road, and intersection).

Design

Prospective cohort study.

Setting

New South Wales, Australia.

Participants

Questionnaire responses were obtained from 20 822 newly licensed drivers aged 17 to 24 years. Participants held a first-stage provisional license between June 2003 and December 2004 prospectively linked to licensing and police-reported crash data, with an average of 2 years of follow-up. Analyses were conducted on a subsample of 19 327 participants for which there was full information.

Exposure

Sleeping 6 or fewer hours per night.

Main Outcomes and Measures

The main outcome variable was police-reported crash. Multivariable Poisson regression models were used to investigate the role of sleep duration on the risk for crash.

Results

On average, those who reported sleeping 6 or fewer hours per night had an increased risk for crash compared with those who reported sleeping more than 6 hours (relative risk [RR], 1.21; 95% CI, 1.04-1.41). Less weekend sleep was significantly associated with an increased risk for run-off-road crashes (RR, 1.55; 95% CI, 1.21-2.00). Crashes for individuals who had less sleep per night (on average and on weekends) were significantly more likely to occur between 8 PM and 6 AM (RR, 1.86; 95% CI, 1.11-3.13, for midnight to 5:59 AM and RR, 1.66; 95% CI, 1.15-2.39, for 8:00 PM to 11:59PM).

Conclusions and Relevance

Less sleep per night significantly increased the risk for crash for young drivers. Less sleep on weekend nights increased the risk for run-off-road crashes and crashes occurring in the late-night hours. This provides rationale for governments and health care providers to address sleep-related crashes among young drivers.

Stunting the Growth of Child Health Research A Need to Reframe “Children Are Not Small Adults” Stunting the Growth of Child Health Research

Davis MM. — Mon, 20 May 2013 00:00:00 GMT

The notion that “children are not small adults” has deep roots in intellectual thought. Influential scientists (Jean Piaget, PhD), educators (Maria Montessori, MD), and philosophers (Jean-Jacques Rosseau) each described how children are not only shorter in stature than adults, but also fundamentally different in their thoughts, actions, and consciousness.

Young Drivers and the Risk for Drowsy Driving Young Drivers and the Risk For Drowsy Driving

Ebel BE. — Mon, 20 May 2013 00:00:00 GMT

In this issue of JAMA Pediatrics, Martiniuk et al prospectively followed up a large cohort of 19 327 Australian new drivers aged 17 through 24 years. Drivers were asked to describe their hours of sleep overall, as well as their typical hours of sleep on weekends. Participants were also asked about other important injury risk factors including alcohol and drug use. These survey data were linked prospectively to licensing data and police-reported crashes over the following 2 years. Crash risk was adjusted for a number of important confounders: time in the study, prior crashes, age group, sex, average weekly driving hours, remoteness of residence, drinking behavior (Alcohol Use Disorders Identification Test score), risky driving behaviors, self-harm, drug use, sensation seeking, and psychological distress.

The Effect of Increased Coverage of Participatory Women's Groups on Neonatal Mortality in Bangladesh A Cluster Randomized Trial Participatory Women's Groups in Bangladesh

Fottrell E, Azad K, Kuddus A, et al. — Mon, 20 May 2013 00:00:00 GMT

Importance

Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings.

Objective

To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh.

Design

A cluster randomized controlled trial in 9 intervention and 9 control clusters.

Setting

Rural Bangladesh.

Participants

Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention.

Interventions

Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues.

Main Outcomes and Measures

Neonatal mortality rate.

Results

Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices.

Conclusions and Relevance

Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh.

Trial Registration

isrctn.org Identifier: ISRCTN01805825