Newborn Research Articles

The Newborn Infant Parasympathetic Evaluation Index for Assessment of Procedural Pain and Discomfort in Mechanically Ventilated Pediatric Intensive Care Patients: A Prospective, Exploratory, Observational Study.

The heart rate variability-based Newborn Infant Parasympathetic Evaluation (NIPE) Index is a continuous noninvasive tool for the assessment of pain and discomfort in infants. Little is known about its performance in the pediatric intensive care unit (PICU) setting, where assessment of pain/discomfort is usually based on discontinuous observational scoring systems or personal experience of medical staff. Evaluation of the performance of NIPE as an indicator of procedural pain and/or discomfort in conscious mechanically ventilated PICU patients. Procedural pain/discomfort was simultaneously assessed during pain- or stressful procedures by two validated discontinuous clinical scoring systems (FLACC and COMFORT-B scale) and the NIPE. NIPE values, FLACC- and COMFORT-B scores were recorded in 17 infants with a mean age of 1.2 (range 0.8-5.9) months. NIPE values associated with positive FLACC- (≥ 4; indicative of pain) and/or COMFORT-B (≥ 17, indicative of discomfort) scores were lower (p < 0.001) than when associated with negative FLACC (< 4) and/or COMFORT-B (< 17) scores with 95% CI's of a difference of -14 to -11 (FLACC), -13 to -11 (COMFORT-B) and -14 to -11 (FLACC and COMFORT-B), with significant interindividual variability in NIPE values. Logistic regression analyses revealed odds ratios between 0.84 and 0.85; the adjacent receiver operating curve analyses showed areas under the curve between 0.83 and 0.88. NIPE data recording failure occurred during 49.3% of the periods with a FLACC ≥ 4% and 40.7% with a COMFORT-B ≥ 17. The NIPE detects procedural pain and discomfort in conscious mechanically ventilated infants with an accuracy comparable to established clinical scoring systems. However, because of significant interindividual variability of NIPE values and frequent data recording failure associated with patient movement, we believe it is premature to recommend its use in conscious infants.

Sinkretisme Islam dan Hindu (Studi Terhadap Tradisi Rasol Bu’sobu’ Pelet Betheng di Desa Gunung Sekar Madura)

Tradition and culture give another color to the living conditions of the community. The traditions and cultures adopted provide an explanation of religious practices. Although in essence culture is the result of human creation that has certain norms and rules. Rasol Bu’sobu’ pelet Betheng tradition, for example, is one of the traditions in Java, intended for pregnant women whose pregnancies have entered the seventh month. In this tradition there is a mixture of Islamic and Hindu elements. The ritual begins with reading verses from the Qur'an and from Surah Yusuf, Surah Maryam and prayers to the Prophet with the hope that the newborn baby will make the Qur'an and Hadith the source of his life. These are the elements that exist in Islam. Hindu elements include giving food to gods and goddesses or to spirits known from supernatural whispers. Bathing to purify the body and soul from mistakes or sins, as well as bringing seven flowers, eggs, young coconuts, and a chicken.

Development of an Ointment to Medicate Medicine for Dosage Caused by Mucus in Babies with the Active Compound Sotong (Sepia sp.) and Essential Oils Cymbopogon citratus

Sumbawa society is rich in culture, especially in traditional medicine. People use materials from the surrounding environment, including plants and animals, as active ingredients for medicine. Newborn babies and toddlers are susceptible to blockage of the respiratory tract with mucus. In babies, it is usually caused by an imperfect suction process, while in toddlers, it is caused by bacteria or viruses. The Samawa people use a mixture of cuttlefish (Sepia sp.) and eucalyptus oil as a medicine that effectively removes mucus from the body. The active ingredient in cuttlefish has an unpleasant odour and cannot be stored for long. When they need cuttlefish, people must look for them in markets or traders on the coast. Of course, this takes time to use. The ointment production innovation has many advantages, including practicality, no fishy smell, ease of obtaining, and ease of storage for the long term. Using the natural active ingredient lemongrass, essential oil adds aromatherapy and provides warmth to the chests of babies and toddlers. Natural active and gel-based ingredients are safe to use without side effects. The ointment was tested for active ingredient content using GCMS and organoleptic tests for gel stability, spreadability (homogeneity), pH, and skin irritation. Based on the description above, it can be concluded that the ointment product is made from an anti-skin irritation gel base, pH 7, and gel spreadability of 5.5 cm. The active substance comes from cuttlefish Sepia sp. by inhibiting the COX-2 enzyme and reducing the production of prostaglandin E2 (PGE2), an essential inflammatory mediator in the pathogenesis of asthma and bronchitis. The simple production process means that the price of the ointment is within people's purchasing power.

Sensitivity and Specificity of Pulse Oximetry for Congenital Heart Disease Screening in Newborn: A Meta-Analysis

Background: Early detection for Congenital Heart Disease (CHD) using pulse oximetry is a routine procedure for newborn. Pulse Oximetry Screening (POS) has been shown to be effective in detecting CHD. Aims: To evaluate the accuracy of POS through sensitivity and specificity in detecting CHD. Methods: In this meta-analysis, we conducted a search on Pubmed, Scopus, and ScienceDirect for studies that were published up to June 20, 2024. We selected studies that assessed the sensitivity and specificity of POS for the screening of CHD in newborn babies in a hospital or home setting, regardless of gestational age at birth and excluded newborns with a previous diagnosis of CHD. We used RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2) to assess the quality of the studies included and used Stata/SE 16.0 software to pool the sensitivity and specificity. Results: The results showed that 17 studies, including 413,516 newborns, had pooled sensitivity and specificity of 0.69 (95% CI: 0.57-0.81) and 0.93 (95% CI: 0.85-1.00). Conclusion: This study’s results suggest that POS has moderate sensitivity and high specificity in screening CHD in newborns. It can be concluded that there is a prospective usefulness of POS as a valuable tool in clinical practice for screening and management of CHD, especially in settings where access to higher diagnostic technologies may be limited. Received: 25 September 2024 | Reviewed: 20 October 2024 | Revised: 13 November 2024 | Accepted: 30 November 2024.

Impact of normal vs. caesarean deliveries on child nutritional status and mortality in India: insights from NFHS-5 data

ObjectiveSkilled birth attendance and place of delivery have a significant effect on child growth. The present paper examined the mode of delivery and its impact on child health among children 0–59 months in India.MethodsA total of 200,794 samples were used in the study. Among them, 45,784 births were delivered by C-section, and the remaining 150,010 births were delivered through normal delivery. Life table estimation of mortality, as well as bivariate and multivariate logistic regression, were used to identify the association between child health and mode of delivery using data from the fifth round of the National Family Health Survey conducted in 2019-21.ResultsThe study results indicate that children born through normal delivery had significantly lower rates of stunting, wasting, and underweight compared to those born via C-section. Additionally, the likelihood of a new-born baby dying during the neonatal period was higher for those delivered by C-section compared to those delivered vaginally, which holds true for various background characteristics. Mothers with a 3rd or higher order birth who deliver via C-section face a higher risk of their baby dying during the neonatal and infant periods compared to those with a 2nd order birth.ConclusionThe conclusion of the study found that C-section delivery may adversely affect child undernutrition as compared to normal birth. These findings would help formulate the policies and implement actions that would improve the quality of painless labor and immediate delivery in health facilities particularly public hospitals and shall reduce the C-section birth.

Glycaemic Status Among Neonates in Perinatal Asphyxia with Hypoxic Ischaemic Encephalopathy (Stage II and Stage III) in a Tertiary Level Hospital

Background: Perinatal asphyxia is major cause of neonatal mortality and morbidity. Hypoxic ischaemic brain injury is the most important consequences of perinatal asphyxia which ultimately results in immediate and delayed form of neuronal death. The aim of this study was to find a relationship between glycaemic status and immediate outcomes of perinatal asphyxia. Methods: This prospective study was carried out in Department of Paediatrics, Shaheed Suhrawardy Medical College Hospital, from 16th April 2019 to 15th October 2019. Total 100 term asphyxiated newborn babies with HIE (Stage II and III) admitted within 24 hours were enrolled according to selection criteria, Blood glucose level and other relevant tests were done in all included patients. Results: The mean age of the neonates was 6.31±0.91 hours. Among the patients, 60% were male and 40% were female. Most cases (65%) had normal birth weight, while 35% were low birth weight. Common clinical features included respiratory distress (59%), poor feeding (75%), lethargy (33%), grunting (48%), and petechiae (6%). Moderate encephalopathy (Stage II) was observed in 63% of cases, and severe asphyxia (Stage III) in 37%. Hypoglycaemia was present in 26% of neonates, hyperglycaemia in 3%, and 71% had normal glucose levels. Hypoglycaemia was significantly associated with severe asphyxia, occurring in 45.9% of severe cases compared to 14.2% of moderate cases (p&amp;lt;0.05). Conclusion: There was significant association between glycaemic abnormalities with severity of perinatal asphyxia and immediate outcome of the asphyxiated newborn.

Proportion of Low Birth Weight (LBW) Among Newborn Babies Delivered at Dhaka Medical College Hospital

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Low birth weight (LBW) remains a major public health problem especially in developing countries like Bangladesh. We assessed the proportion of LBW of the newborn babies delivered at DMCH and its associated maternal factors. &amp;lt;i&amp;gt;Methodology: &amp;lt;/i&amp;gt;This cross-sectional descriptive study was conducted among 57 mother and newborn pairs delivered at Postnatal obstetrics wards of Dhaka Medical College Hospital (DMCH), Dhaka. Data was collected from each participants by face to-face interview using a semi-structured pre-tested questionnaire which included socio-demographic information and information about birth weight and its associated maternal factors. &amp;lt;i&amp;gt;Result: &amp;lt;/i&amp;gt;This study involved 257 participants with a mean age of 25 years (±4.26), primarily aged 21 to 30 (64.97%). Approximately 38.13% had a monthly family income below 15,000 taka, and 10.98% of mothers were illiterate. One-third received 2 to 4 antenatal visits, with 8.56% having none. Delivery methods were nearly equal, with 49.02% vaginal and 50.97% cesarean. Common complications included PROM (14.39%), pre-term labor (11.67%), and GDM (10.89%). Term pregnancies accounted for 70%, while among preterm births, 20.23% were low birth weight (LBW) and 4.67% very low birth weight (VLBW), surpassing general population rates. &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;Lack of regular antenatal care (ANC) visits and poor maternal diet significantly impact newborn birth weight. To reduce low birth weight (LBW), it is essential to monitor maternal diets and ensure at least four ANC visits for all mothers. LBW infants are at higher risk of mortality and chronic diseases, making its reduction vital for achieving Sustainable Development Goals (SDGs) on infant mortality. Further multi-center studies are needed to accurately assess LBW prevalence in Bangladesh.

Evaluation of the safety and efficacy of herby angel tummy roll-on in managing infantile colic: a case series

Evaluation of the safety and efficacy of herby angel tummy roll-on in managing infantile colic: a case series

Playing and its relation to psyche-soma. Origins of psychoanalytic apperception.

This essay was inspired by the experience of observing a newborn baby and the mother on a weekly basis for an entire year. I explore the receptive function of the maternal body whose mirroring acts created the intermediate area between her and her baby facilitating for what I call imitative playing. The concept of imitation came to mind because of its physicality. The reason for naming it 'playing' lies in its quality: I am trying to capture something about the perceptual and communicative capacity of the body. Born out of affective mutuality of the dyad, it is a corporeal elaboration of their union, the primary physical aliveness, that could be an observable element of personalization, a precursor in the journey to symbolism. The direct observation of infants is not sufficient to arrive at the ideas that I have suggested without psychoanalytic knowledge, the substance that I have imbued with what I perceived. In Winnicottian language this could be described as psychoanalytic apperception. I think it stems from an analyst's visceral self that gives life to psycho-analytic concepts as well as transforms an analysand's non-verbal expressions into communications.

Assessment of level and source of stress in mothers of newborns admitted to neonatal intensive care unit in tertiary care hospital

Background: The hospitalization of a neonate is stressful for the mother and all family members Severe stress can affect mother–baby relationship and thus affect newborn development subsequently. The parent-infant bonding process during the newborn period establishes the foundation a lifelong relationship. This process is affected when the newborn spends the first several weeks in NICU. Quantifying stress levels of parents and identifying environmental stressor is useful in assisting the health personnel in improving the quality of medical care. To study the level and source of stress in mothers of Newborns admitted in the Neonatal intensive care unit and to quantify the stress levels by parental stressor scale. Methods: In this cross-sectional study included 400 mothers of newborn babies admitted in NICU of Basaveshwar Hospital and Sangameshwar hospital attached to Mahadevappa Rampure Medical College, Kalaburgi with semi structured validated interview-based questionnaire consisting of parenteral stressor scale: NICU (PSS: NICU) comprising three subscales and questions related to maternal and neonatal characteristics will be used. Results: Among the study population the mean stress score was maximum in parental role domain of PSS: NICU stress scale. The maternal stress was higher among preterm and non-breast-fed babies in looks and behaviour and parental role. Maternal stress was statistically significant among rural, illiterate and home maker participants in all 3 domains. Conclusions: NICU mothers are under significant stress and appropriate counselling targeted towards specific stressors is required and before designing remediation programs for parents, local demography and the predominant NICU stressors need to be kept in mind. maternal stress, neonatal intensive care unit environment, baby looks and behaves.

Cardiac Troponin-I Level at 24 hours of Age in Stable Newborn Infants Born at ≥35 Weeks of Gestation.

Cardiac troponin-I is a known biomarker of myocardial injury in adults and children but its diagnostic utility is unclear in newborns.This study aimed to establish normative data for troponin-I in stable newborns and assess any variation due to maternal diabetes status, mode of delivery, and Apgar scores. Prospective, observational study of stable newborn ≥35 weeks gestation admitted to a well-baby nursery at a single institution. Infants with respiratory distress, congenital infections, malformations, or syndromes were excluded. Troponin-I values were obtained by a validated point-of-care capillary blood sample at 24 hours of age. A total of 132 patients were included for analysis. Thirteen infants were born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and analyzed as a subgroup, with the remaining 119 infants comprising the base cohort to establish baseline normative troponin-I levels in stable newborn infants. The mean (standard deviation) troponin-I level of infants in the base cohort group was 0.019 ± 0.018 ng/mL and in infants born with maternal SARS-CoV-2 infection during pregnancy troponin-I level was 0.081 ± 0.1 ng/mL (p < 0.001). In infants of the base cohort, there was no significant difference in troponin-I levels between diabetic versus nondiabetic mothers, vaginal birth versus cesarean section, and 5-minute Apgar score of <7 versus ≥7. Cardiac troponin-I level in healthy term newborns was 0.019 ± 0.018 ng/mL, which conforms to healthy children and adult lab values. There was no statistically significant difference in troponin-I levels in infants of maternal diabetes or normal glucose status, mode of delivery, cesarean versus vaginal, or 5-minute Apgar score of <7 or ≥7. Troponin-I levels in asymptomatic neonates born to mothers with a history of SARS-CoV-2 during pregnancy demonstrated an elevation when compared to the baseline group of infants. · Troponin-I level, biomarker of myocardial injury, in newborns not requiring delivery-room.. · Resuscitation is comparable to normal pediatric & adult population independent of mode of delivery or maternal diabetes status..

Features of the transition of newborn children with pathology from tube feeding to breastfeeding

Features of the transition of newborn children with pathology from tube feeding to breastfeeding

Outcome Assessment of Perinatal Asphyxia in Neonates: Study in a district hospitalMd

Perinatal asphyxia (also known as neonatal asphyxia or Perinatal Asphyxia in children) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the delivery process to cause physical harm, usually to the brain. Perinatal Asphyxia in children is defined by the World Health Organization (WHO) "the failure to initiate and sustain breathing at birth". There were 102 live births asphyxia neonates whose were clinically diagnosed and admitted in several private clinics in Jamalpur, Bangladesh during January 2017 to December 2017 were selected as study subjects. The aim of this study was to assess the outcome of perinatal asphyxia in neonates. Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications. The NICU records provided additional information about new born infant.The outcome of treatment in babies with Perinatal Asphyxia in children showing in (Table 3) Recovery rate in group one (HIE I) was 14(13.78%) , in group two (HIE II) was 75(73.52) and in group three (HIE III) was 05(4.9%) and Death ratio was in group one (HIE I)was 1(0.98%) , in group two (HIE II) was 2(1.96%) and in group three (HIE III) was 05(4.90%). The morbidity and mortality in cases of Perinatal Asphyxia in children the highest causes of death in stage 3(HIE III). Preterm with Hyaline membrane disease was 4(3.92%) and then the higher causes of death in stage II was Neonatal sepsis 3(2.94%). Perinatal Asphyxia in children was one of the commonest causes of admission and mortality in NICU and others beds. Babies with HIE Stage III had a very poor prognosis. Perinatal Asphyxia in children combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of Perinatal Asphyxia in children. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergencycaesarean section, preterm and in addition male sex were the risk factors for Perinatal Asphyxia in neonates.

Metabolic bone disease in premature infants receiving parenteral nutrition: Incidence, clinical, laboratory and nutritional profile

BackgroundMetabolic bone disease (MBD) of newborns (NB) is characterized by tissue reduction and inadequate postnatal bone mineralization with clinical, laboratory, and/or radiologic repercussions between the third and twelfth weeks of postnatal life, which, in its most severe forms, can lead to a growth deficit and fractures. The aim of our study is to evaluate the incidence of MBD in premature patients receiving parenteral nutrition for >15 days in the neonatal intensive care unit (NICU) and assess their clinical and laboratory characteristics. MethodsSingle-center retrospective cohort study. From 2015 to 2020, patients <33 weeks of gestational age or <1500 g birth weight receiving parenteral nutrition for >15 days who met the metabolic bone disease criteria (alkaline phosphatase >800 U/L and phosphorus <3.5 mg/dL and/or compatible radiological alterations) were evaluated. Exclusion criteria: skeletal dysplasia, orthopedic surgeries, intraventricular hemorrhage grades III and IV, periventricular leukomalacia and chronic renal failure or severe liver disease. Clinical, laboratory and radiological data were collected during the first 90 days of life and/or discharge/death. ResultsThe MBD incidence was 17.7 % over a five-year period. The gestational age at birth was 26 ± 1.41 weeks; birth weight was 745 (592–858) grams; maximum alkaline phosphatase level was 1091 ± 243.87 U/L and phosphorus nadir was 2.45 ± 0.48 md/dL. Among the 14 patients with metabolic bone disease, twelve had laboratory diagnosis, six had radiological and four had both; two patients had fractures; 42 % of patients received enteral calcium and phosphorus supplementation, and 50 % received intravenous calcium replacement. ConclusionsMetabolic bone disease incidence was in accordance with international literature. The metabolic bone disease diagnosis was, in most cases, based on surveillance of laboratory tests. However, treatment for metabolic bone disease requires more active and preventive measures in risk groups.

Diagnosis and treatment of infection specific to the perinatal period (Draft clinical recommendations for discussion by neonatologists and pediatricians)

Perinatal infections occupy a leading place among the causes of neonatal morbidity, maternal and perinatal mortality. Infections are among the main causes of termination of pregnancy and premature birth. The practical recommendations presented in the work are intended for doctors of obstetric institutions in order to make a clinical diagnosis of an infection specific to the perinatal period, the tactics of examination and treatment of newborn children. The clinical recommendations correspond to the latest scientific data on the topic, contain information that is applied to the practical activities of a neonatologist, intensive care specialist and pediatrician. These clinical recommendations contain information about infections specific to the perinatal period, including the definition, frequency of occurrence, etiology of infections, pathogenetic mechanisms of disease development Numerous high-risk factors for infection of the fetus and newborn are described in detail. The document discusses and proposes the classification of the disease, the criteria for the adoption of the diagnosis. The features of the clinical picture of the disease are described, it is noted that the inflammatory process in a newborn child can be localized in any organ or acquire a systemic (generalized) character, in some cases, the ingress of an infectious agent into a macroorganism is not necessarily accompanied by clinical manifestations, which indicates an asymptomatic or subclinical course of infection. The recommendations provide advanced laboratory and instrumental diagnostics. The stages of treatment are described, including the choice and correction of antibacterial therapy, taking into account the peculiarities of the mother’s anamnesis, the child’s gestation period and the etiology of the disease. These clinical recommendations have been prepared taking into account the level of credibility of the recommendations and the level of reliability of the evidence.These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation.

Charting the history of premature birth in France from the 17th century to modern state-of-the art care.

To describe the concept of preterm birth in the history of medicine in France, from the 17th century up until the end of the 20th century, on the basis of old medical textbooks. Historical manuscripts and books held in medical libraries and from our personal collection were examined. Digital copies of medical textbooks online were also studied. Premature deliveries were often referred to as spontaneous abortions or miscarriages, irrespective of the infant's condition at birth. The difference between growth restriction and prematurity was not known. At the end of the 18th century, care for newborn infants entered the age of modern medicine, with observations of the newborn infant and its illnesses and experiments concerning nutrition and thermoregulation treatments. The responsibility for newborn infants, long allocated to midwives and obstetricians, was passed to neonatologists and paediatricians in the 1960s, thanks to developments in our knowledge of neonatal physiology in general and respiration, nutrition and thermoregulation in particular. This article delays the history of medicine concerned the care of preterm infants by obstetricians and then neonatologists, from the 17th century to modern period.

Knowledge and attitudes of health care professionals regarding birth preparedness of women in labour at selected Hospitals in KwaZulu-Natal, South Africa: A qualitative study

Introduction Low and middle-income countries account for the largest proportion of women’s deaths as a result of pregnancy or childbirth-related complications. The sub-Saharan region is the most affected with approximately 70% (202 000) of maternal deaths between 2000 and 2020. These deaths could have been prevented if expectant mothers were prepared for childbirth. Birth preparedness is perceived as a better strategy that helps attain a substantial reduction in maternal mortality. This is achieved by attending early antenatal classes, receiving skilled care during childbirth, and care and support right after birth. The latest survey on antenatal class attendance conducted in South Africa provides an estimated 30.8% of expectant mothers in public healthcare facilities. Methods This study employed a qualitative approach to collect data, as a result, one focus group discussion with five (N=5) participants and two others with six (N=6) participants each (n=6X2=12) and twenty individual interviews were conducted. The study sought to explore and describe the knowledge and attitudes of healthcare professionals regarding the birth preparedness of women in labour at selected hospitals in Durban KwaZulu-Natal. Results Expectant mothers were unprepared for both labour and postnatal care. The unprepared expectant mothers were uncooperative and made the task of midwives difficult to the extent of endangering the life of their expected newborn babies and their own. Factors such as finance, heterogeneity, staff shortage, language barrier, lack of family support, lack of interest, cultural beliefs, and confusion caused by various sources of information were responsible for birth unpreparedness. Conclusion The synergy between expectant mothers and midwives appears to be an important factor in achieving better birth preparedness.

Quality of newborn care and associated factors: An analysis of the 2022 Kenya demographic and health survey.

Kenya one of the African countries has pledged to reduce neonatal death as per the 2030 World Health Organization target. Providing high-quality newborn care is critical in minimizing neonatal mortality. This study aimed to determine the factors that influence the quality of newborn care in Kenya. Secondary data from 11,863 participants of the 2022 Kenya Demographic and Health Survey (KDHS) were analyzed. The participants were chosen using two-stage stratified sampling. The quality of newborn care was operationalized as receiving all components of newborn care after childbirth, as reported by the mother. Using SPSS (version 29), univariate and multivariable logistic regression analyses were used to analyse the data. In this study, 32.7% (95% confidence interval [CI]: 31.0%-34.5%) of the mothers reported that their newborns had received all components of quality neonatal care after childbirth. Mothers who spent an average of one hour accessing the health facilities compared with those who spent less than half an hour were 1.33 (95%CI: 1.01-1.75) times more likely to report that their newborns had received quality newborn care. Mothers who gave birth in a non-government organization health facility were 30.37 (95%CI: 2.69-343.20) times more likely to report that their newborns had received quality newborn care compared with those who delivered from a faith-based organization. On the contrary, in terms of regions, mothers who lived in Nyanza, Eastern, and Rift Valley provinces compared with those who lived in the coastal regions were 0.53 (95%CI: 0.34-0.82), 0.61 (95%CI: 0.39-0.94), and 0.62 (95%CI: 0.41-0.93) times less likely to report that their newborns had received quality newborn care, respectively. Mothers who subscribed to other religions or faith (0.28 (95%CI: 0.10-0.76) compared with those from the Christian faith, were less likely to report that their newborns had received quality newborn care. Finally, mothers who gave birth through cesarean section were 0.44 (95%CI: 0.32-0.61) times less likely to report that their newborns had received quality newborn care than mothers who gave birth through spontaneous vaginal delivery. The study indicates that about a third of the neonates received quality newborn care and that facility-related and parental social factors were associated with receiving quality newborn care. Stakeholders need to pay more attention to newborn babies whose mothers come from certain regions of Kenya where the quality of newborn care was found to be low, minority religious faith denominations, and those who delivered by ceasearen section. Stakeholders also should focus on strengthening collaborations with NGO health facilities and achieving universal health coverage to improve the quality of newborn care provided in health facilities.

Inequalities and Differences in Health Status of Pre- and Perinatal Periods in Hungarian Long-Term Series Analysis (1997-2019).

The main goal of this study is to publish findings on the lifestyle factors of pregnant women in Hungary and their impact on early childhood health status by examining changes over time and regional/geographical disparities. The source of the data is the raw indicators reported by health visitors as per mandatory annual report data for the period of 1997-2019. To examine the association, we used indicators of pregnant women's states as explanatory variables (for example, pregnant women in very late care, prenatal smoking habits, and pregnant women without care), and the outcome indicators were prematurity, intrauterine malnutrition, and newborn babies with developmental disorders. A univariate Poisson regression was used to examine the correlations. Our results show a decreasing trend in the proportion of pregnant women who smoke and of pregnant women who apply late for care (after 28 weeks of pregnancy), with an increasing indicator of regional differences. The research results of the prenatal and perinatal indicators show that the counties Borsod-Abaúj-Zemplén and Szabolcs-Szatmár-Bereg are the most critical areas in terms of health status in Hungary. The number of pregnancies attended very late (after 28 weeks) and the number of women who gave birth without health visitor care are associated with the number of preterm births (R2 = 0.7313; p < 0.001; R2 = 0.5519; p < 0.001) and intrauterine growth restrictions (R2 = 0.3306; p < 0.001; R2 = 0.2632; p < 0.001). Interventions to improve early childhood health in some counties of Hungary are urgently needed to reduce regional disparities. Such counties include Borsod-Abaúj-Zemplén, Szabolcs-Szatmár-Bereg, Heves, Somogy, Bács-Kiskun, and Nógrád. Health education for pregnant women and activities to strengthen the compliance of pregnant women are key to improving early childhood health outcomes.

Abstract 4136030: Fatty acids disturb cardiomyocyte proliferation by increasing PDK4 and HMGCS2 via PPARδ activation

Background: Almost all cardiac diseases are difficult to cure entirely because cardiomyocytes rarely proliferate to recover cardiac damage. In fact, most mammals have a capacity to regenerate cardiomyocytes immediately after birth. Newborn infant drastically changes cardiac metabolism from glycolysis to oxidative phosphorylation using fatty acids. Previous research revealed that lipid metabolism had a negative influence on cardiomyocyte cell cycle but the mechanism has not been clarified completely. Objective: This study was performed to elucidate the way fatty acid metabolism affects cardiomyocyte proliferation. Methods and results: Isolated and cultured neonatal rat cardiomyocytes (NRCM) were treated with the mixture of palmitic acid, oleic acid, and L-carnitine (FA mix) for 24 hours. Realtime RT-PCR revealed that FA mix increased the mRNA expressions of pyruvate dehydrogenase kinase 4 (PDK4), a fatty acid metabolism regulator, and HMG-CoA synthase 2 (HMGCS2), a ketogenic factor, as well as β-oxidation-related enzymes in dose dependent manner. Simultaneously, the results of immunofluorescent staining showed that FA mix decreased cardiomyocytes expressing Ki67, a cell cycle marker. GW501516, a peroxisome proliferator-activated receptor δ (PPARδ) agonist, also increased fatty acid metabolism factors with the reduction of Ki67 positive cardiomyocytes, whereas fenofibrate, a PPARα agonist, or pioglitazone, a PPARγ agonist, caused little or no change in these phenotypes. Moreover, NRCM pretreated with GSK3787, a PPARδ antagonist, before FA mix stimulation suppressed the upregulations of fatty acid metabolism factors and the reduction of Ki67 expressing cardiomyocytes. Finally, the lentiviral vectors which expressed PDK4 or HMGCS2 were produced to investigate these proteins suppressed NRCM cell cycle directly. Either overexpressing PDK4 or HMGCS2 decreased Ki67 positive NRCM without the upregulation of each other or β-oxidation-related enzymes. Conclusion: Fatty acids disturbed NRCM proliferation by upregulating PDK4 and HMGCS2 through the activation of PPARδ independently from β-oxidation.