ABSTRACT
Background: Reports on the survival of infants born at periviable gestation (GA of ≤24 weeks and birth weight of <500 gm) vary significantly. We aimed to determine hospital factors associated with their survival and to assess the trend for the timing of postnatal mortality in these periviable infants. Methods: We utilized the de-identified National Inpatient Sample (NIS) dataset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). National data were analyzed for the years 2010-2018. Hospitals were categorized according to delivery volume, USA regions, and teaching status. Results: We identified 33,998,014 infants born during the study period; 76,231 infants were ≤24 weeks. Survival at birth and first 2 days of life was greatest in urban teaching hospitals in infants <24 weeks and those who completed 24 weeks, respectively. The Northeast region has the lowest survival rate. There was a significant delay in the postnatal day of mortality in periviable infants. Conclusions: Hospital factors are associated with increased survival rates. Improved survival in large teaching hospitals supports the need for the regionalization of care in infants born at the limits of viability. There was a significant delay in the postnatal mortality day.
ABSTRACT
OBJECTIVE: We aimed to look for the mortality of Black and White Neonates and compare the Black and White neonates' mortalities after stratifying the population by many significant epidemiologic and hospital factors. DESIGN/METHOD: We utilized the National Inpatient Sample (NIS) dataset over seven years from 2012 through 2018 for all neonates ≤ 28 days of age in all hospitals in the USA. Neonatal characteristics used in the analysis included ethnicity, sex, household income, and type of healthcare insurance. Hospital characteristics were urban teaching, urban non-teaching, and rural. Hospital location was classified according to the nine U.S. Census Division regions. RESULTS: Neonatal mortality continues to be higher in Black populations: 21,975 (0.63%) than in White populations: 35,495 (0.28%). Government-supported health insurance was significantly more among Black populations when compared to White (68.8% vs. 35.3% p < 0.001). Household income differed significantly; almost half (49.8%) of the Black population has income ≤ 25th percentile vs. 22.1% in White. There was a significant variation in mortality in different U.S. LOCATIONS: In the Black population, the highest mortality was in the West North Central division (0.72%), and the lower mortality was in the New England division (0.51%), whereas in the White population, the highest mortality was in the East South-Central division (0.36%), and the lowest mortality was in the New England division (0.21%). Trend analysis showed a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by sex, type of insurance, household income, and type of hospital, the mortality was consistently higher in Black groups throughout the study years. CONCLUSIONS: Disparities in neonatal mortality continue to be higher in Black populations; there was a significant variation in mortality in different U.S. LOCATIONS: In the Black population, the highest mortality was in the West North Central division, and the lower mortality was in the New England division, whereas in the White population, the highest mortality was in the East South Central division, and the lowest mortality was in the New England division. There has been a significant decrease in mortality in Black and White populations over the years, but when stratifying the population by many significant epidemiologic and hospital factors, the mortality was consistently higher in Black groups throughout the study years.
ABSTRACT
Vulvar leiomyosarcoma is a rare smooth muscle malignant neoplasm but it is the commonest type of vulvar sarcomas. It may mimic benign tumors and misdiagnosis could delay proper management. We report a case of a 38-year-old pregnant woman with leiomyosarcoma of the vulva. The patient presented to her primary general practitioner with a small vulvar mass that she had first noticed one year prior. The tumor was suspected to be benign Bartholin's cyst and treated with antibiotics. The patient declined improvement and had many consultations to different clinics where she had been diagnosed and treated the same. The tumor size started to grow rapidly after she got pregnant, and the patient was referred to our hospital where she underwent tumor resection. Histopathology revealed leiomyosarcoma. The patient had further assessment and close follow-up and has had no recurrence for 12 months. There is little literature available on vulvar leiomyosarcoma, most of which are case reports, and most gynecologic oncologists will go through their whole careers without seeing a single case.
