Basic Neonatal Care Research Articles

Evaluating the implementation fidelity of basic emergency obstetrics and neonatal care services in Beyeda District, Northwest Ethiopia: a case study evaluation.

Worldwide, nearly 830 women die from complications of pregnancy and childbirth daily. Ninety-nine per cent of these maternal deaths take place in low and middle-income countries. Basic Emergency Obstetric Care (BEmONC) is one method of reducing maternal mortality related to pregnancy and childbirth complications. However, the status of its implementation fidelity has not been investigated. Therefore, this study sought to evaluate the implementation fidelity of BEmONC services in Beyeda District, Northwest Ethiopia. A single case study design with mixed method was employed from June 01 to July 30, 2022. 415 client exit interviews, 14 key informants' interviews and 423 retrospective document reviews were conducted. Adherence, participant responsiveness and quality of delivery dimensions from Carroll's conceptual framework, with a total of 21 indicators were used in this evaluation. The overall implementation fidelity status of BEmONC service was judged based on the pre-seated judgmental criteria as; low, medium, and high fidelity. The overall degree of implementation fidelity of the BEmONC services was 74.5%. Moreover, the implementation fidelity status of adherence, quality of delivery, and participant responsiveness dimensions were 74.7%, 77.2%, and 71.5% respectively. Uterotonic drugs were not administered as per the recommended protocol. Participants' engagement towards the neonatal resuscitation service delivery was inadequate. Likewise, healthcare providers' respect for the clients was not sufficient. Furthermore, women aged >30 years, being government employed and ANC visits four and above were variables positively associated with the quality of delivery of BEmONC services. The overall implementation fidelity of the BEmONC services was judged as implemented in medium fidelity. Moreover, the adherence, participant responsiveness and quality of delivery dimensions were found to be implemented in medium fidelity. Therefore, public health sectors at all levels should strive to enhance the implementation fidelity of BEmONC services. Moreover, healthcare providers should adhere to the BEmONC implementation protocol guideline during service delivery. Healthcare managers should facilitate a continuous awareness creation for mothers regarding the merit of neonatal resuscitation for neonatal complications. Furthermore, healthcare providers should give due respect to mothers while delivering the services.

Clinico-socio demographic characteristics of neonates at NICU, Mediciti Hospital, Medchal, Telangana, India

Background: Children face the greatest risk of disease and death in their first 28 days. Improvements in basic neonatal care such as thermoregulation and breastfeeding have substantially reduced neonatal mortality and morbidity. There is still a need to strengthen the provision of advanced care for neonates. Identifying factors impacting neonatal mortality and morbidity and addressing them through a package of evidence-based interventions are essential to avoiding preventable deaths. Methods: The current study analyses data from a cross-sectional study in the rural outreach area of a tertiary hospital in Hyderabad, India to assess clinical and socio-demographic factors affecting neonatal morbidity. One hundred and fifty neonates admitted in neonatal intensive care unit and their mothers were included. A semi-structured questionnaire was used to obtain responses through face-to-face interview. Descriptive and inferential analyses were performed using R Statistical Software (version 4.3.2). Results: Among the 150 neonates, 99 (66%) neonates were admitted for respiratory distress. 39 (26%) males were low birth weight and 28 (18.67%) females were low birth weight. There was no significant association between low birth weight, high risk pregnancy and gender of the neonate. A significant association was obtained between low socio-economic status and low birth weight. Conclusions: Neonatal mortality and morbidity can be attributed to several factors including neonatal characteristics, maternal characteristics, health infrastructure and health manpower. However, prevalence of socio-demographic risk factors affecting neonates is disproportionately higher in low- and middle-income countries. A multi-pronged approach is required to address the multimodal causation of low birth weight and morbidity in neonates.

Geographical distribution of emergency obstetric and neonatal care signal functions in Ethiopian health facilities: 2021–2022 Ethiopian service Provision Assessment (SPA)

BackgroundThe maternal mortality ratio in Ethiopia is still high, with an estimate of 412 deaths per 100,000 live births in 2016. Signal functions for emergency obstetric and neonatal care must be accessible and usable in order to successfully prevent maternal deaths. It is an important strategy to reduce maternal and newborn morbidity and mortality in countries with limited resources. Hence, an assessment of the availability of fully functioning EmONC services and their coverage per 500,000 people in Ethiopia is crucial.MethodsThis study is a retrospective analysis of data from the Ethiopian Service Provision Assessment Survey (ESPA), a national-level survey data source. Data collection for the survey took place from August 11, 2021, to February 4, 2022. For this investigation, 905 healthcare facilities in total were evaluated for the availability of emergency obstetric and new-born care (EmONC) services at all hospitals, selected health centers, and private clinics were evaluated. Descriptive data analysis was done by the using statistical package for social science version 26 (SPSS) to run frequency and cross-tabs. Global Positioning System (GPS) (arc map 10.8) Software was used for spatial distribution in order to locate the physical accessibility of EmONC providing health facilities on flat map surfaces. It was projected based on Ethiopia’s geographic coordinate system at Adindan UTM zone 370N.ResultsOf 905 health facilities, only 442 (49%) could provide fully functioning BEmONC, and 250 (27.6%) health facilities have been providing fully functioning CEmONC. The overall coverage of BEmONC ratios in Ethiopia is 1.5–3.77 per 500,000 population and CEmONC (0.83–2.1) per 500,000 populations. Regions such as Amhara, SNNPR and Addis Ababa had found to have high BEmONC ratio. The geographical distribution of the EmONC showed that the central areas of the country, such as southwest Shewa and east Shewa, the Oromia region, the northern areas of the South Nation, nationalities, and peoples regions (SNNPR), including the Gurage zone and the Wolaita-Soddo zone, and the middle areas in the Amhara region (west Gojjam or around Bahir Dar town), and the southern areas, Debra Tabor and Debre Birhane zones, all had greater access to facilities offering complete EmONC services.ConclusionComprehensive emergency obstetrics and neonatal care (CEmONC) in Ethiopia met WHO recommendations, despite basic emergency obstetric and neonatal care (BEmONC) falling below those standards in Ethiopia. There are extremely large disparities in the accessibility of both basic and comprehensive emergency obstetrics and neonatal care in Ethiopia. Thus, Strategic planning is needed to improve infrastructures and inputs for EmONC services, particularly in remote areas of the country. Additionally, private facilities ought to place a priority on the provision of these services.

Simulation and team training to improve preterm birth knowledge, evidence-based practices, and communication skills in midwives in Kenya and Uganda: Findings from a pre- and post-intervention analysis.

Simulation training in basic and emergency obstetric and neonatal care has previously shown success in reducing maternal and neonatal mortality in low-resource settings. Though preterm birth is the leading cause of neonatal deaths, application of this training methodology geared specifically towards reducing preterm birth mortality and morbidity has not yet been implemented and evaluated. The East Africa Preterm Birth Initiative (PTBi-EA) was a multi-country cluster randomized controlled (CRCT) trial that successfully improved outcomes of preterm neonates in Migori County, Kenya and the Busoga region of Uganda through an intrapartum package of interventions. PRONTO simulation and team training (STT) was one component of this package and was introduced to maternity unit providers in 13 facilities. This analysis was nested within the larger CRCT and specifically looked at the impact of the STT portion of the intervention package. The PRONTO STT curriculum was modified to emphasize prematurity-related intrapartum and immediate postnatal care practices, such as assessment of gestational age, identification of preterm labour, and administration of antenatal corticosteroids. Knowledge and communication techniques were assessed at the beginning and end of the intervention through a multiple-choice knowledge test. Clinical skills and communication techniques used in context were assessed through the use of evidence-based practiced (EBPs) as documented in video-recorded simulations through StudioCodeTM video analysis. Pre-and-post scores were compared in both categories using Chi-squared tests. Knowledge assessment scores improved from 51% to 73% with maternal-related questions improving from 61% to 74%, neonatal questions from 55% to 73%, and communication technique questions from 31% to 71%. The portion of indicated preterm birth EBPs performed in simulation increased from 55% to 80% with maternal-related EBPs improving from 48% to 73%, neonatal-related EBPs from 63% to 93%, and communication techniques from 52% to 69%. STT substantially increased preterm birth-specific knowledge and EBPs performed in simulation.

Every breath counts: Lessons learned in developing a training NICU in Northern Tanzania.

IntroductionNeonatal mortality rates in resource-limited hospitals of Sub-Saharan Africa (SSA) remain disproportionately high and are likely underestimated due to misclassification of extremely preterm births as “stillbirths” or “abortions”, incomplete death registries, fear of repercussions from hospital and governmental authorities, unrecorded village deaths, and cultural beliefs surrounding the viability of premature newborns. While neonatology partnerships exist between high income countries and hospitals in SSA, efforts have largely been directed toward improving newborn survival through neonatal resuscitation training and provision of equipment to nascent neonatal intensive care units (NICUs). These measures are incomplete and fail to address the challenges which NICUs routinely face in low-resource settings. We draw on lessons learned in the development of a low-technology referral NICU in Tanzania that achieved an overall 92% survival rate among infants.Lessons learnedAchieving high survival rates among critically ill and preterm neonates in SSA is possible without use of expensive, advanced-skill technologies like mechanical ventilators. Evidence-based protocols adapted to low-resource hospitals, mentorship of nurses and physicians, changes in hierarchal culture, improved nurse-infant staffing ratios, involvement of mothers, improved procurement of consumables and medications, and bedside diagnostics are necessary steps to achieving high survival rates. Our NICU experience indicates that low-technology solutions of thermoregulation, respiratory support via continuous positive airway pressure, feeding protocols and infection control measures can ensure that infants not only survive, but thrive.ConclusionsNeonatal mortality and survival of preterm newborns can be improved through a long-term commitment to training NICU staff, strengthening basic neonatal care practices, contextually appropriate protocols, and limited technology.

Neonatal resuscitation from a global perspective

The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.

Nurse workload, missed nursing care, and the contributing factors in the Neonatal Intensive Care Unit in a limited resource setting: A case from Indonesia

Background: Nurses who are in charge of the Neonatal Intensive Care Units (NICUs) have a different workload and work assignments compared to other units. Evidence suggests that higher nurse workloads will increase the risk of missed nursing care. Missed nursing care in the NICU will eventually worsen the neonatal prognosis. This is a major problem in developing countries, which currently still have a high neonatal mortality rate. Methods: This was a cross sectional study using questionnaires to collect data from 48 nurses who work in Dr. Soetomo Hospital NICU from April 15th 2021 to July 25th 2021. The collected data was then processed with descriptive statistics, meanwhile the correlation between workload with missed nursing care was analyzed with Pearson and Spearman correlation. Results: The total mean of NICU nurse workload score according to the NASA-TLX (National Aeronautics and Space Administration Task Load Index) was 68.36, indicating a moderate overall workload, with effort as the highest component. Overall, 91.67% of the nurses had missed at least 1 out of 21 basic neonatal nursing care components. Labor resource factor was the most frequent missed nursing care factor, in which urgent patient situations were the most frequent problem. There was no significant correlation between the total nurse workload and the frequency of any missed nursing care (P=0.536). Conclusions: Effort was the biggest component of the NICU nurse total workload. The most frequently missed nursing care was giving emotional support for the patient’s parents and/or family. Labor resource factor was the most frequent problem which caused missed nursing care. However, there is no statistically significant correlation between the total workload with the frequency of missed nursing care.

Facility and care provider emergency preparedness for neonatal resuscitation in Kano, Nigeria.

The knowledge, attitude, and practice of emergency neonatal resuscitation are critical requirements in any facility that offers obstetric and neonatal services. This study aims to conduct a needs assessment survey and obtain individual and facility-level data on expertise and readiness for neonatal resuscitation. We hypothesize that neonatal emergency preparedness among healthcare providers in Kano, Nigeria is associated with the level of knowledge, attitudinal disposition, practice and equipment availability at the facility level. A semi-structured, self-administered questionnaire was administered to a cross-section of health providers directly involved with neonatal care (n = 112) and attending a neonatal resuscitation workshop in Kano state. Information regarding knowledge, attitude, practice and facility preparedness for neonatal resuscitation was obtained. Bloom's cut-off score and a validated basic emergency obstetric and neonatal care assessment tool were adopted to categorize outcomes. Multivariable logistic regression was employed to determine independent predictors of knowledge and practice. Almost half (48% and 42% respectively) of the respondents reported average level of self-assessed knowledge and comfort during resuscitation. Only 7% (95% CI:3.2-13.7) and 5% (95% CI:2.0-11.4) of health providers demonstrated good knowledge and practice scores respectively, with an overall facility preparedness of 46%. Respondents' profession as a physician compared to nurses and midwives predicted good knowledge (aOR = 0.08, 95% CI: 0.01-0.69; p = 0.01), but not practice. Healthcare provider's knowledge and practice including facility preparedness for emergency neonatal resuscitation were suboptimal, despite the respondents' relatively high self-assessed attitudinal perception. Physicians demonstrated higher knowledge compared to other health professionals. The low level of respondents' awareness, practice, and facility readiness suggest the current weak state of secondary health systems in Kano.

Scalability of the Basic Care Model for Very Low Birth Weight Infants and Implementation Research Considerations

Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects.
 Study design: Observational
 Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013).
 Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g.
 Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available.
 Main outcome measure: Mortality
 Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system.
 Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically.
 What is already known about this subject?
 
 Implementation research constitutes a relatively new and underdeveloped field,
 One of the facets of health system research is the implementation research.
 Implementation research aims at bridging the gaps between knowledge and action.
 
 What does this study add?
 
 Tertiary care center can help in developing basic newborn care at a rural hospital.
 The rural hospital model can be upscaled vertically as well as horizontally.
 Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality.
 
 How might it impact on clinical practice in the foreseeable future?
 The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.

Survey of neonatal nursing: Staffing, education, and equipment availability in Rwanda

IntroductionResearch studies have repeatedly shown that better educated nurses provide safer and higher quality care. In Rwanda, neonatal nursing is not recognized as a nursing specialty and there is no consistent approach in neonatal education or training of nurses who work with newborn infants. PurposeThe purpose of the study was to describe existing neonatal nursing practices in Rwanda, specifically 1) orientation program content and orientation process; 2) nurses' education, skill levels and comfort with performing neonatal care; and 3) availability and use of medical equipment. MethodsA descriptive cross-sectional survey design was used. Data were collected from October through November 2017. A convenience sample of nurses and midwives was used; nurses and midwifes working in Rwandan neonatal care units (NCUs) were invited to participate and complete a questionnaire specifically designed for this study. ResultsA total of 99 participants representing all 47 Neonatal Care Units (including 2 neonatal Intensive care units-NICUs) in Rwanda completed the questionnaire. Seventy-six (76) were nurses, 19 were midwives, and 4 were nurse-midwives. A lack of consistency in orientation/training to the neonatal unit was evident with approximately 70% who felt that the orientation was not sufficient. Comfort level with skills depended on the type of procedure. Basic neonatal care procedures were reported as comfortable, however this level varied across the geographic regions. Some vital equipment was unavailable. For more than half the respondents there was no 24-h physician coverage available for back up. DiscussionThe findings of this exploratory descriptive study reveal that the majority of Rwandan nurses/midwifes had limited neonatal care experience. Orientation program content and duration varied across the country. Most included basic content but was not always sufficient when there was poor staffing or a lack of physician coverage. Procedures that were rarely performed were uncomfortable because there was no opportunity for practice. Competency demonstration not expected of most of the respondents. ConclusionsThere needs to be consistent education/training for neonatal nurses. Competency based education and practice performance should be developed. Further research needs to focus on staffing patterns, education/competencies of the nursing staff, and the direct impact on neonatal outcomes.

Evidence Based Skin Care in Preterm Neonates- A Short Review

Preterm neonates are the neonates born alive before completion of 37 weeks of gestation. Prematurity is the real threat for survival of these neonates, especially those who are very-preterm (less than 32 weeks). In developing countries due to lack of basic care such as maintenance of warm chain, breast feeding support, infection control and scarcity of resources to tackle respiratory difficulties; the mortality in preterm infants is very high. Good skin care is a critical component of the basic neonatal care, that can directly reduce complications of prematurity as well address issues arising during the handling of these preterm infants such as injuries due to adhesives or devices, skin dryness, the use of skin emollients and disinfectants etc. In contemporary era, evidence-based practices are the need of hour to guide clinical practice. There are limited research articles dealing with skin care in preterm neonates that offer strong recommendations for skin care modalities. In this short review, the authors have compiled the recent evidences to address various issues related to skin care in very preterm neonates. In this article the evidences related to bathing practices in preterm infants, and the use of disinfectants and emollients for premature skin care has been discussed; besides making general recommendation related to skin care in preterm infants. Keywords: Preterm, skin care, emollients, disinfectant, neonate, prematurity, premature skin.

Assessment of knowledge about Essential Obstetric Care among Pregnant Females of Punjab, Pakistan

Purpose: The first step towards achieving the goals of the Child Health and Reproductive Health Program is to raise awareness and educate pregnant women about the essential features of basic and emergency maternity and neonatal care. Aims: To assess the level of knowledge on essential antenatal care among pregnant females. Study Design: A cross-sectional study. Place and Duration: The study was conducted at Gynaecology and Obstetrics department of Sheikh Zayed Hospital, Rahim Yar Khan and Shahida Islam Teaching Hospital, Lodhran for the duration of six months from 16th August 2020 to 15th February 2021. Methods: This study was held among 110 pregnant women who arrived based on information on antenatal care in the literature. Participants were selected by simple random sampling, and data on “essential obstetrics care" information was collected through a structured interview program based on the mother-Child Protection Charter. Results: This study shows that 46.4% of participants have sufficient knowledge of the signs / symptoms of the dangers of pregnancy, 44.5% have sufficient knowledge of antenatal care and only 9.1% have sufficient knowledge of maternity care. It was found that knowledge of obstetric care is significantly related to the education level of pregnant women. Conclusions: The knowledge gap found in this study indicates the need to reassess the effectiveness of health education activities implemented through the health system and improve / renew the content and quality of health education materials in order to raise awareness among pregnant women. Keywords: Antenatal care, MCP card, Obstetrics care, Primary health care.

Performance of health workers on neonatal resuscitation care following scaled-up quality improvement interventions in public hospitals of Nepal - a prospective observational study

BackgroundHigh-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal.MethodsA prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions.ResultsOut of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13–0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03–1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04–1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline.ConclusionQI intervention package improved health workers’ performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.

Facility readiness for basic emergency obstetric and neonatal care at PHC centres in Nigeria

Abstract Background Functionality of essential delivery services at primary health care (PHC) centres is crucial to achieving targeted improvements in maternal and neonatal outcomes in Nigeria. However, evidence suggests that PHC centres are often unable to adequately render basic emergency obstetric and neonatal care (BEmONC) services. This study assessed BEmONC availability and facility readiness at PHC centres in Edo State, Nigeria. Methods This facility-based cross-sectional survey was conducted in Edo State, Nigeria among 36 public primary health care centres selected by multistage sampling. The WHO service availability and readiness assessment tool was adapted to obtain data from PHC centres. BEmONC availability index was derived using 6 indicators (intravenous oxytotics, intravenous anticonvulsants, intravenous antibiotics, assisted deliveries, removal of retained products of conception and neonatal resuscitation). A composite readiness index was developed based on 26 indicators across five domains (trained staff, basic amenities, basic equipment, diagnostic tests and essential medicines). Indices were summarized as mean percentages and 95% confidence intervals. Results Among 36 facilities assessed, the mean BEmONC availability index score was 48.6% (CI = 41.7 - 55.5%) while the mean composite readiness index score was 58.9% (CI = 54.5 - 63.2%). Domain specific readiness indices showed marked variations with low mean scores for basic amenities (45.8%, CI = 38.4 - 55.3%) and trained staff (43.5%, CI = 33.1 - 53.9%), moderate score for basic equipment (53.5%, CI = 48.6 - 58.5%) and high scores for diagnostic tests (71.2%, CI = 60.5 - 82.1%) and essential medicines (80.1%, CI = 72.4 - 87.8%). Conclusions BEmONC availability and readiness at PHC centres in Edo State was suboptimal. Current efforts to improve services at PHC centres should strategically target availability of emergency obstetric functions, enhancing staff capacity and upgrading basic amenities. Key messages There are crucial gaps in the provision of BEmONC at primary health care level in Edo State, Nigeria that may negatively impact the quality of maternal and neonatal care. This study highlights the need for stakeholders to intensify PHC strengthening initiatives geared towards better pregnancy outcomes.

Morbidities & outcomes of a neonatal intensive care unit in a complex humanitarian conflict setting, Hajjah Yemen: 2017-2018

BackgroundThe protracted conflict in Yemen has taken a massive toll on the health system, negatively impacting the health of children, especially the most vulnerable age group; the newborns.MethodsA 2-year retrospective study of admissions into the Neonatal Intensive Care Unit (NICU) in Al-Gomhoury Hospital Hajjah, Northwest Yemen was conducted. Data was analyzed with IBM SPSS® version 25.0 statistical software using descriptive/inferential statistics.ResultsA total of 976 newborns were eligible and included in this study; 506 preterm newborns (51.8%) and 470 term newborns (48.2%). Over half, 549 (56.3%) newborns were admitted within 24 h after birth and 681 (69.8%) newborns travelled for over 60 min to arrive at the NICU. The most common admission diagnoses were complications of prematurity (341; 34.9%), perinatal asphyxia (336; 34.4%), neonatal jaundice (187; 18.8%), and neonatal sepsis (157, 16.1%). The median length of stay in the NICU was 4 days. There were 213 neonatal deaths (Facility neonatal mortality rate was 218 neonatal deaths per 1000 livebirths); 192 (90.1%) were preterm newborns, while 177 (83.1%) were amongst newborns that travelled for more 60 min to reach the NICU. Significant predictors of neonatal deaths are preterm birth (aOR = 3.09, 95% CI: 1.26–7.59, p = 0.014 for moderate preterm neonates; aOR = 6.18, 95% CI: 2.12–18.01, p = 0.001 for very preterm neonates; and aOR = 44.59, 95% CI: 9.18–216.61, p < 0.001 for extreme preterm neonates); low birth weight (aOR = 3.67, 95% CI: 1.16–12.07, p = 0.032 for very low birth weight neonates; and aOR = 17.42, 95% CI: 2.97–102.08, p = 0.002 for extreme low birth weight neonates); and traveling for more than 60 min to arrive at the NICU (aOR = 2.32, 95% CI: 1.07–5.04, p = 0.033). Neonates delivered by Caesarean section had lower odds of death (aOR = 0.38, 95% CI 0.20–0.73, p = 0.004) than those delivered by vaginal birth.ConclusionsPreterm newborns bear disproportionate burden of neonatal morbidity and mortality in this setting which is aggravated by difficulties in accessing early neonatal care. Community-based model of providing basic obstetric and neonatal care could augment existing health system to improve neonatal survival in Yemen.

Low analysis of community interest maintenance in Central Health Center Sukmajaya Kota Depok Provinsi Jawa Barat

According to the recapitulation of the utilization of Community Health Center inpatient services in Depok in 2016-2018, it was very low. The results of an initial survey in October 2018 conducted by Community Heath Center researchers who only served inpatients in only 3 districts, while 1 sub-district had not served general inpatients since one year ago. Of the three sub-districts, only 1 sub-district has inpatients, while others sometimes do not have an in-patient visit within one month. Sukmajaya Community Health Center was appointed to serve general inpatient care, basic neonatal obstetric services and care for malnourished children. Because of the low number of inpatient visits in the city of Depok, the researchers were interested in knowing the strengths and weaknesses as well as the opportunities and threats of the Sukmajaya Community Health Center. This study used a qualitative method conducted in February 2020 with in-depth interviews using interview guidelines and voice recording devices. Interviews were conducted with the Head of the Community Health Center, Head of Administration, Responsible for Inpatients, Doctors and Nurses. As a result, Sukmajaya Community Health Center was unable to compete with Private Hospitals because private hospitals had better health personnel and infrastructure than Sukmajaya Community Health Center. Besides that, the number of private hospitals in the city of Depok is large and the location is easy to reach, so people prefer hospitals with more convenient facilities.

Diagnosis and Management of Critical Congenital Heart Diseases in the Newborn

Congenital heart disease (CHD) has been one of the most important contributors to neonatal mortality in the western world for the past 2 decades. With improvement in basic neonatal medical care in most parts of our country, the traditional contributors to neonatal mortality such as birth asphyxia and infections have reduced in numbers. This has hence thrust greater focus on CHD. Facilities with capability to diagnose and intervene on neonates with critical CHD are available in most states. Refinements in surgical techniques and advances in post-operative care have ensured that most neonates with critical CHD can undergo surgical or interventional procedures with very low mortality and can be expected to survive to adulthood with a reasonable quality of life. Unrecognized critical CHD could however result in death in the neonatal period. Focus has hence shifted towards sensitizing pediatricians about timely recognition of neonates with CHD. In this article, authors discuss the presentation and initial stabilization of neonates with CHD and attempt to provide practical solutions which can aid early diagnosis of CHD in the Indian scenario.

Health Status and Programs Implemented by the Provincial Government of Catanduanes in Bicol Region, Philippines

As the world grapples with various health threats and pandemics, implementation and assessment of the delivery of health services especially in emerging economies is vital to promote health accessibility, coverage, quality and continuity. This study determined the status in the actual service delivery on health implemented in the Rural Health Units (RHU) of Catanduanes, a typhoon-prone area in the Philippines facing the vast Pacific Ocean. The mixed-methods of research were employed in the study primarily using documentary analysis, Key Informant Interview (KII) and focus group discussions (FGD). Results show that there was an increasing trend for the past four years in the incidence of preventable diseases, such as hypertension, trauma, all types of wounds and upper urinary tract infection and increasing rate in pre-natal mortality even when infant deliveries were no longer permitted at home but, rather, done in hospitals or RHU with basic emergency maternal obstetric and neonatal care (Bermonc) facilities; and an increasing rate in the incidence of diseases in infant mortality which can be associated to hygiene, (e.g. diarrhea). The provincial government, in response to identified gaps in health programs of the province, crafted a Province-wide Investment Plan for Health (PIPH) that transformed local plan into multi-sectoral endeavor that involved unified efforts of all the sectors. However, despite all the efforts, there are still cases identified in the health status indicators like pre-natal mortality that remain to be high. Health Programs of the department of health (DOH) being implemented along with to service delivery of the RHU in the 11 towns of the province include intensified disease prevention and control; child health; maternal health; lifestyle and risk prevention; and health promotion and advocacy.

Effect of guideline on positioning of neonates in the neonatal intensive care unit

Background: Developmentally Supportive Care is a broad category of interventions that is designed to minimize the stress of the NICU environment which include care such as control of external stimuli, clustering of nursery care activities, and positioning or swaddling of the preterm infant so as to provide a sense of containment similar to the intrauterine experience. The preterm neonates often lack adequate muscle tone and are at risk for developing abnormal movement pattern as well as skeleton deformation. Positioning is one of the important aspects of Developmentally Supportive Care to keep the baby comfortable. It is a basic neonatal nursing care and includes keeping the baby in supine, prone and side lying. As postural stability is a foundational milestone for motor development and premature infants are unable to exhibit postural stability without support, standardizing the definition of optimal positioning will lead to consistency in practice. A neonatal positioning guideline implemented in NICU will help in the growth and development of preterm neonates.&#x0D; Materials and Methods: A prospective study was conducted in NICU of a tertiary medical College Hospital, Bangalore. It was an experimental study. Neonatal nurses who were involved in preterm infants care were selected by purposive sampling. Sample size was calculated based on the study by Jeansonetal. Pretest and posttest practices were assessed by taking the average of two observations for each nurse using infant positioning Assessment tool (IPAT). The nurses were trained by lecture followed by practical demonstration of neonatal positioning guidelines. After one week post test was repeated. Paired T test was used for comparing the positioning in pre and post intervention.&#x0D; Results: Pre-test practice concludes that100% (25) of the staff nurses were in the category of ‘need for repositioning’ and 100% (25) of the nurses were in the category of ‘acceptable positioning’ in post-test (P &lt;0.001) with respect to all the positioning parameters. The mean Pretest score was 4.14 ±1.02 and post test mean score was 10.17 ± 0.57(P &lt;0.001). There was a significant association in practice score with respect to years of experience in NICU (P&lt;0.05).&#x0D; Conclusion: There was a significant improvement in the infant positioning scores in the post test after introducing the positioning guidelines and training the nurses, compared to the pretest scores.

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)\u2014a stepped wedge cluster randomized controlled trial in public hospitals

BackgroundEach year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal.MethodsWe will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations.DiscussionWith the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings.Trial registration numberISRCTN16741720. Registered on 2 March 2019.