Latest news with #neonatalmorbidity
Medscape
4 days ago
- Health
- Medscape
Perinatal Substance Use: Ups Risk for Mothers and Babies?
TOPLINE: Among individuals with perinatal substance use disorder, the odds of maternal and neonatal morbidity and infant mortality were increased and were influenced by factors such as location, type of substance used, and demographics. METHODOLOGY: A retrospective cohort study was conducted in British Columbia, Canada, to assess the link between clinical and sociodemographic factors and maternal and neonatal morbidity and mortality among people with perinatal substance use disorder. A total of 22,856 individuals with perinatal substance use disorder (median maternal age, 28 years), linked to 27,637 deliveries and 27,774 live births, were identified using data from nine linked health administrative databases from April 2010 to March 2021. Perinatal substance use disorder was defined by the presence of opioid, alcohol, or other substance use disorders within the period from 12 months before the first pregnancy-related healthcare record to delivery; cannabis use disorder was the most common substance use disorder (60.8%). Maternal and neonatal morbidity were assessed using admissions to hospitals and emergency departments; outcomes were measured up to 42 days postpartum for mothers and 28 days of age for infants, with 1337 and 4129 cases identified, respectively. All-cause maternal and infant mortality were recorded within 1 year postpartum, with infant mortality defined as death within 12 months following birth. TAKEAWAY: Regional factors were associated with increased morbidity; residing in Vancouver Coastal area increased the odds of maternal morbidity by 35% compared with the provincial average (adjusted odds ratio [aOR], 1.35; P < .01), while residing in Interior or Vancouver Island was associated with 16% and 10% higher odds of neonatal morbidity (aOR, 1.16 and aOR, 1.10; P < .01 for both), respectively. Opioid use disorder, stimulant use disorder, multifetal pregnancy, and hypertensive disorder during pregnancy were independently associated with higher odds of maternal and neonatal morbidity. Receiving five or more visits for prenatal care and delivering vaginally were linked to reduced odds of maternal and neonatal morbidity. The odds of maternal mortality increased by 11% annually (P = .04), with over half of maternal deaths being drug-related (52%). Attending five or more visits for prenatal care was associated with reduced odds of both maternal mortality (aOR, 0.48; P = .04) and infant mortality (aOR, 0.23; P < .01). IN PRACTICE: 'During heightened drug toxicity and mortality, enhancing PSU [perinatal substance use] care and health surveillance should be prioritized to inform strategies to remove barriers in access to care related to resources, stigma, and lack of understanding of PSU to address health disparities among birthing people who use substances and their infants,' the authors of the study wrote. SOURCE: This study was led by Micah Piske, MSc, of the Health Economic Research Unit at the Centre for Advancing Health Outcomes, St. Paul's Hospital in Vancouver, British Columbia, Canada. It was published online on July 10, 2025, in Pediatrics. LIMITATIONS: The findings may have been influenced by factors not captured in the analysis. Differences in coding systems for measures of morbidity may have affected the comparability of data. The results may not be generalizable to populations outside of British Columbia. DISCLOSURES: This study was supported by the Health Canada Substance Use and Addictions Program. No relevant conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
18-06-2025
- Health
- Medscape
Severe Neonatal Illness Predicts Mortality Into Adolescence
Severe neonatal morbidity (SNM) significantly increased the risk for death from infancy through late adolescence, particularly for neurologic conditions. Female infants and those born term with SNM faced higher relative mortality risks. METHODOLOGY: Researchers conducted a population-based cohort study using data from the Swedish Medical Birth Register to assess the association between SNM and all-cause and cause-specific mortality from infancy to adolescence. This study included 2,098,752 live-born singleton infants born between 2002 and 2021, of whom 49,225 (2.4%) were diagnosed with SNM (defined as respiratory infections or neurologic or procedural complications within 27 days of birth). Mortality was classified on the basis of age as infancy (28 days to 11 months), early childhood (1-4 years), later childhood (5-9 years), and adolescence (≥ 10 years). Primary outcomes were all-cause and cause-specific mortality from 28 days to a follow-up duration of 21.2 years. TAKEAWAY: The mortality rate was 1.81 vs 0.13 per 1000 person-years among children with SNM vs those without SNM (adjusted hazard ratio [aHR], 5.92; 95% CI, 5.27-6.64). Neurologic morbidity had the strongest association (aHR, 17.67; 95% CI, 15.08-20.71). Female children with SNM had a higher risk for mortality than male children (aHR, 7.28 vs 4.97; P for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. Among children aged 1 year or older, SNM was strongly associated with deaths from neurologic diseases (aHR, 18.64; 95% CI, 12.51-27.79), circulatory diseases (aHR, 5.41; 95% CI, 2.67-10.94), and metabolic disorders (aHR, 3.56; 95% CI, 1.70-7.44). Among children with SNM, those born preterm had higher absolute mortality rates than those born term (2.76 vs 1.30 per 1000 person-years); however, infants born term showed a stronger relative risk than those born preterm (aHR, 7.16 vs 3.51). IN PRACTICE: "Efforts to further prevent severe neonatal morbidity, ensure early identification, and provide long-term follow-up care may help reduce mortality and inform discussions with families regarding prognosis and follow-up needs," the authors wrote. SOURCE: This study was led by Hillary Graham, MS, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. It was published online on June 10, 2025, in JAMA Pediatrics . LIMITATIONS: This study included over 20 years of follow-up; mortality data became limited beyond 15 years. Lower early-life survival in the earliest birth cohort may have led to survivor bias, potentially underestimating the long-term risk for mortality. Although the sibling-controlled analysis helps address familial confounding, it may still be affected by unmeasured differences between siblings. DISCLOSURES: This study was supported by grants from the Swedish Research Council and Stockholm City Council, ALF Medicine. The authors reported having no conflicts of interest.
