Sick Newborn Care Research Articles

A nationwide survey on neonatal medical resources in mainland China: current status and future challenges

BackgroundWith the rapid development of economy in recent two decades, neonatology has been progressing quickly in China. However, there is little knowledge about the exact developmental status of neonatal departments in China. The aim of this study was to assess resources available for care of sick newborns in mainland China.MethodsQuestionnaires were sent to the membership of the Chinese Neonatologist Association (CNA) and used to survey the scale, facilities, staff, technologies, transport systems and preterm infants’ outcomes of neonatal departments (NDs) in different areas of China from June 2012 to December 2012.ResultsThe result of this survey including a total of 117 questionnaires showed that investigated ND had a mean of 65 (median 47; range 5–450) beds, including 19.59 (median 15, range 0–100) NICU beds. The overall doctor/bed and nurse/bed ratio was 1:3.84 and 1:1.43, respectively. Lack of medical equipment was one of the main problems in most NDs surveyed, and only 26 NDs (22.2%) had more than one neonatal incubator per bed. Only 70.1, 30.6, 30.8 and 4.3% NDs carried out high-frequency ventilation, hypothermia, nitric oxide inhalation, and ECMO respectively. The capacity to provide advanced therapies increased with the size of the NDs (P < .01). A total of 81 NDs (69.2%) carried out neonatal transport, but only 70 NDs (86.4%) were equipped with transport incubators, 36 NDs (44.4%) had the ability of performing intrauterine transport of the preterm infants, and 3 NDs (3.7%) had the ability of performing air transport. The survival rate of extremely preterm infants (Gestational age less than 28w) to discharge home was 47.8% in 2011.ConclusionNDs in mainland China are not well distributed and still face many problems, such as staff shortage, inadequate facilities, and imperfect transport. It is urgent to set up a classification of neonatal care to enhance the utilization rate of medical resources and improve the prognosis of critically ill infants.

Distance from referral hospital as a risk factor for mortality and length of stay of neonates admitted in a tertiary care hospital

Background: Around 66% of infant and over 50% of under-five mortality occurs in newborn period. 99% of neonatal deaths occur in low and middle income countries. Most of these deaths can be prevented by suitable interventions at various levels. The premise of the study is that the neonates who require long transportation (&gt;1 hour) have higher chances of mortality or prolonged stay in the hospital.Methods: A retrospective retrieval of data and prospective interview was conducted in G.B Pant children’s hospital Srinagar, an associated hospital of Govt. Medical College Srinagar in North India.Results: During the period of study 1431 neonates from twelve districts of the state were referred to the hospital for treatment, out of whom, 102 (7.13%) could not be saved. Neonatal death rate was found highest (11.11%) in neonates referred from districts of category-III (&gt;100 kms from the referral hospital), followed by category-II (50-100 kms from the referral hospital) and category-I (&gt;50 kms from the referral hospital). Average length of stay was observed longest for the neonates referred from districts of category-III followed by category-II and category-I.Conclusions: Several other studies found that transfer of sick neonates from another health facility were associated with relatively higher probability of morbidity and mortality after controlling for other predictors. Distance no doubt is a risk factor for neonatal outcome of referred neonates as we have observed in our study. To minimize neonatal deaths it is necessary to strengthen the perinatal services sick newborn care unit {(SNCUs) in district Hospitals)}.

Anthropometric outcome of extremely low birth weight and very low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p&lt;0.001). The mean weight for age (Mean±SD) was 7.615±1.1092 kg with median 7.8 kg. The mean length for age (Mean±SD) was 72.6±3.74 cm with median 73 cm. The mean head circumference for age (Mean±SD) was 42.5±2.12 cm median 43 cm. Adverse neonatal outcome associated with CRIB II score ≥10. Total CRIB II score with parameters of growth (&lt;-2 Z score) like weight for age, length for age, weight for length and head circumference for age shows significant correlation (p&lt;0.001).Conclusions: Perinatal risk factors are important determinant for future anthropometric outcome in very low and extremely low birth weight babies. They should be identified, and appropriate measures should be taken to achieve good outcome.

EFFICACY OF A NOVEL DEVICE TO DETECT, ALERT AND RESOLVE NEONATAL APNEA - PILOT STUDY

Objective: To measure the accuracy of a novel device in detecting Bradycardia andDesaturation (B&amp;D) events and to determine its efficacy in resolving apneas innewborns with comparison to standard monitor (which only detects B&amp;D eventsand alerts).Design: This was a prospective observational study.Setting: Sick Newborn Care Unit of a large tertiary referral hospital in Hyderabad,India.Methods: 31 newborns were provided with a novel device, which monitored oxygensaturation and pulse rate and alarmed when values dropped below a set thresholdwhich is referred as an event, henceforth. The novel device also provided footstimulation in response to above-mentioned events. When the monitor alarmed, anurse attended to the baby to confirm whether the baby was breathing and whetherthe event had been resolved by the device. If the event had not resolved, appropriateaction as per the standard-of-care was performed.Results: The novel device “ApneBootTM” positively detected B&amp;D events 94.03% oftimes as compared to the standard reference monitor. 56 of 67 observed B&amp;D eventswere visually confirmed to be apneas, indicating that 83.6% of B&amp;D eventscoincided with apneas. Of the 56 apneic events, 50 were central apneas, of which 35were resolved by the novel device, making the device’s efficacy of apnea resolution70%.Conclusion: The results of the study indicate that this novel device “ApneBootTM”is very effective in detecting and alarming B&amp;D events, which coincides with theapnea, and resolving it by providing foot stimulation.Keywords: Novel Device, Neonatal Apnea, Low Birth Weight, Body Temperature,Kangaroo Mother Care, Community Health,

Categorising interventions to levels of inpatient care for small and sick newborns: Findings from a global survey.

BackgroundIn 2017, 2.5 million newborns died, mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Defined levels of emergency obstetric care (EmOC) and standardised measurement of “signal functions” has improved tracking of maternal care in low- and middle-income countries (LMICs). Levels of newborn care, particularly for small and sick newborns, and associated signal functions are still not consistently defined or tracked.MethodsBetween November 2016-November 2017, we conducted an online survey of professionals working in maternal and newborn health. We asked respondents to categorise 18 clinical care interventions that could act as potential signal functions for small and sick newborns to 3 levels of care they thought were appropriate for health systems in LMICs to provide: “routine care at birth”, “special care” and “intensive care”. We calculated the percentage of respondents that classified each intervention at each level of care and stratified responses to look at variation by respondent characteristics.ResultsSix interventions were classified to specific levels by more than 50% of respondents as “routine care at birth,” three interventions as “special care” and one as “intensive care”. Eight interventions were borderline between these care levels. Responses were more consistent for interventions with relevant WHO clinical care guidelines while more variation in respondents’ classification was observed in complex interventions that lack standards or guidelines. Respondents with experience in lower-income settings were more likely to assign a higher level of care for more complex interventions.ConclusionsResults were consistent with known challenges of scaling up inpatient care in lower-income settings and underline the importance of comprehensive guidelines and standards for inpatient care. Further work is needed to develop a shortlist of newborn signal functions aligned with emergency obstetric care levels to track universal health coverage for mothers and their newborns.

The evaluation of effectiveness of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital: a before and after study

Background: Kangaroo mother care (KMC) is a standard of care for preterm and low birth weight babies. To implement KMC in institutional care it was often practiced inside intensive care unit and also in separate ward. In present study authors have tried to evaluate effect of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital.Methods: Uncontrolled study before and after establishment of separate kangaroo mother care ward comparing kangaroo mother care in sick new-born care unit versus kangaroo mother care in separate ward.Results: In separate ward, as compared to kangaroo mother care practice in sick newborn care unit, mean (SD) duration of kangaroo mother care increased from 5.3 (1.6) to 11.4 (7.4) hours/day (95%CI 5.0-7.1, p value &lt;0.0001). Mean (SD) weight gain increased from 10.7 (7.0) g/day to 13.7 (11.1) g/day (95% CI 1.0-4.8, p value &lt;0.0024). Incidence of sepsis diminished from 14.0% to 28.9% (95% CI 6.4-23, p value &lt;0.0006). Exclusive breast-feeding rate at discharge (42.3% vs. 57.3%) (95% CI 4.8- 24.9, p value &lt;0.0041) and follow up (49.4% vs. 65.0%) (95% CI 1-29.4, p value &lt;0.0378) increased. Mortality also decreased in this group of patients (8.6% vs.2.3%) (95% CI-1.6-11.4, p value &lt;0.0082).Conclusions: Kangaroo mother care ward is better place than sick new born care unit for providing kangaroo mother care in tertiary care hospital.

Delivery point immunization in tertiary care hospital in Eastern India and challenges

Background: Hepatitis B is a major public health problem. The efficiency of the vaccine decreases as the time period between the birth and first dose increases. “WHO recommends that all infants should receive their first dose of Hep B vaccine as soon as possible after birth, preferably within 24 hrs. In India the birth dose/ 0 dose coverage was 45% on 2015. Prior to initiation of “Delivery Point Immunization” the birth dose Hep B was 35%. During the course of this programme the challenges and problems faced has been addressed in this study.Methods: It is a prospective observational study for a period of 15 months conducted by postpartum programme department in O&amp;G department. It includes all the babies delivered in the department.Results: After the integration of delivery point immunization with JSY (Janani Surakhya Yojana) programme, the 0 dose hep B coverage was 72%.The coverage of BCG and 0dose OPV remained 89.48%.The most modifiable cause due to which babies were not received 0 dose Hep B vaccine was due to ignorance 36.19% and babies not received due to SNCU (Sick Newborn Care Unit) admission was 36.06%.Conclusions: Initiation of delivery point immunization has definitely increased the 0 dose hep B vaccine coverage. Integration with other maternal and child health programme had further increased the coverage. Though significant percentage of people know about the at birth immunization but are ignorant about the timing of 0 dose hep B vaccine.

Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting

Aim: Quality improvement approaches have been integrated into routine health care in high-resource settings, but not in low-resource settings. We aimed to report the achievements in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting.Methods: After a first quality assessment in 2012 at Tosamaganga hospital in Tanzania, main areas of intervention were identified and a quality improvement program was implemented. In 2016, a second quality assessment was conducted by the same assessment team by using the World Health Organization’s maternal and neonatal quality of hospital care assessment tool. Some hospital indicators were also collected during the same period.Results: Access to hospital care, maternity ward and management of maternal complications improved from inadequate to substandard care, alongside with an increment of deliveries from 2145 to 2838 and a substantially stable rate of complicated deliveries (21–26%). The improvements in the maternity ward, maternal complications and emergency care coupled with the reduction of direct obstetric case fatality rate obstetric mortality that dropped from 2.9 to 0.27%. Some neonatal areas (neonatal ward, routine neonatal care, sick newborn care, monitoring, and follow-up) improved from poor to substandard care, while others (infection control and supportive care, emergency care, guidelines protocols, and audit) showed only limited improvements. These changes coupled with a decrease in the perinatal mortality rate from 5.8 to 2.9%.Conclusion: The quality improvement program resulted in substantial progress in most aspects of quality care, which coupled with a decrease in obstetric and perinatal mortality. Nevertheless, the overall quality of care remained substandard with the limited effect of the intervention on some areas, which require further efforts in order to achieve an acceptable level of care.

A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

BackgroundMany newborn infants die from preventable causes in South Africa, often these deaths occur in district hospitals. A multipronged intervention aiming to improve quality of newborn care in district hospitals was implemented comprising training in clinical care for sick and small newborns, skills development for health managers, on-site mentoring, and hospital accreditation. We present the results of the project evaluation.MethodsWe conducted three sequential cross-sectional surveys in 39 participating district hospitals at baseline, midpoint and endpoint of the three-year intervention period. Data were collected by a trained midwife using a series of checklists including: availability of trained staff, drugs and equipment; newborn care practices; perinatal mortality audits; neonatal unit staff skills; quality of record keeping. A scoring system was developed for three domains: resources; care practices; resuscitation equipment, and a composite score that included all variables measured. Health worker (HW) knowledge was assessed at midpoint and endpoint.ResultsThe average score for resources increased from 13.5 at baseline to 22.6 at endpoint (maximum score 34), for care practices from 17.7 to 22.6 (maximum score 29), and for resuscitation equipment from 10.8 to 16.1 (maximum 25). Average composite score improved significantly from 42.0 at baseline to 55.7 at midpoint to 60.7 at endpoint (maximum score 88) (p = 0.0012). Among 39 participating hospitals, 38 achieved higher scores at endpoint compared to baseline. Knowledge was higher among HWs trained during the project at midpoint and endpoint. Gaps that remained included poor infrastructure, lack of resuscitation equipment in some areas, poor postnatal care and lack of a dedicated doctor.ConclusionsThis intervention achieved measurable improvements in many important elements contributing to newborn care. A scoring system was used to track progress, compare facilities’ performance, and identify areas for improvement. Various methods were used to generate the quality of care score, including skills assessment and record reviews. However, measuring quality of clinical care and outcomes was challenging, and we were unable to determine whether the intervention improved clinical care and lead directly to improved outcomes for babies. In developing a future score for quality of care, a stronger focus should be placed on assessing clinical care and outcomes.

Admissions to a sick new born care unit in a secondary care hospital: Profile and outcomes.

To reduce neonatal mortality in North Bihar, evidence is required about the impact of sick newborn care units (SNCUs) in secondary level hospitals on mortality at the end of the neonatal period. The objective of the study is to assess the profile of neonates admitted to an SNCU and the outcome at the completion of neonatal period. A cohort of neonates admitted from March to June 2014 to an SNCU was assessed through family interviews and hospital records. Demographic details (age, sex, and socioeconomic status) and clinical details (antenatal care, birthplace, weight, diagnosis, and family history) were documented. Follow-up was done at discharge or death or referral and the completion of neonatal period. The primary outcome was survival at the completion of neonatal period. Secondary outcomes were case fatality rate at discharge and weight gain. Of 210 neonates assessed, 87.6% (95% confidence interval [CI] 82.4-91.4) survived till the end of the neonatal period. The case fatality rate at the time of discharge was 0.9% (95% CI 0.3-3.4). Majority of the diagnoses were infections, hyperbilirubinemia, and infant of diabetic mother. Mean weight gain at the end of neonatal period (n = 157) was 706 g (P = 0.00). Sex ratio at admission was 567 girls to 1000 boys (95% CI 428/1000-751/1000). No neonate from lower socioeconomic families was admitted. SNCUs in remote areas can bring down neonatal mortality in North Bihar. Unequal access of SNCUs services to girls and lower socioeconomic groups highlighted the existing barriers which require attention.

Nursing knowledge of essential maternal and newborn care in a high-mortality urban African setting: A cross-sectional study.

AimsTo assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya.BackgroundThe vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low‐resource settings.DesignCross‐sectional survey.MethodsQuestionnaires comprised of clinical vignettes and direct questions and were administered in 2015–2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed.ResultsNurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case‐load facilities had lower average knowledge scores compared with better‐resourced and busier facilities.ConclusionOverall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6).Relevance to clinical practiceFocus on periodic training, ensuring retention of knowledge and skills among health workers in low‐case load setting, and bridging the know‐do gap may help to improve the quality of care delivered to mothers and newborns in Kenya.

Improving quality of care for perinatal and newborn care at district and subdistrict hospitals in Haryana, India: Implementation research protocol

This implementation research aims to improve quality of care for mothers and newborns in three districts of Haryana, India at different public health facilities. The decline in key maternal and newborn health indicators in India is relatively slower than expected and missed the millennium development goals. The multifold rise in institutional delivery in last decade has limited impact on neonatal and maternal mortality. Despite investments in infrastructure, equipment, supplies, monitoring tools, and also manpower, suboptimal gains in indicators point towards potential challenge in quality of care. This study adopts pre-post, quasi-experimental study design with repeated observations using mixed research methods to document the impact of the plan-do-study-act implementation cycles. The quality improvement interventions shall be implemented at three district hospitals and six-first referral unit hospitals in three districts of Haryana targeting the antenatal, delivery, newborn care services with nurses as the key partners. Formative research, situational analysis, and root-cause analysis shall inform the contextualization, prioritization of interventions. Incremental plan-do-study-act cycles over 15months shall be implemented. The changes in adherence to protocols, appropriate documentation, reduction in delays, and client satisfaction shall be documented for 16 indicators across delivery, antenatal, and sick newborn care domains. The successful implementation of the quality improvement processes has the potential of improving the pregnancy outcomes in terms of stillbirths, maternal, and newborn mortality and sick newborn outcomes. The feasibility and learning of coimplementation in the public health system shall inform integration into standards and scaling up.

Public health system integration of avoidable blindness screening and management, India

In India, 73 million people have diabetes and 3.5 million infants are born preterm. Without timely screening, there is a risk of visual loss due to diabetic retinopathy and retinopathy of prematurity in these two groups, respectively. Both conditions are emerging causes of visual impairment in India but there is no public health programme for screening or management. Pilot projects were initiated in 2014 to integrate the screening and management of these conditions into existing public health systems, particularly in rural communities and their referral networks. The World Health Organization’s health systems framework was used to develop the projects and strategies were developed with all stakeholders, including the government. Both projects involved hub-and-spoke models of care units around medical schools. For diabetic retinopathy, screening was established at primary health-care facilities and treatment was provided at district hospitals. For retinopathy of prematurity, screening was integrated into sick newborn care units at the district level and treatment facilities were improved at the closest publically funded medical schools. In the first two years, there were substantial improvements in awareness, screening, treatment and partnership between stakeholders, and changes in public health policy. By March 2018, diabetic retinopathy screening was established at 50 facilities in 10 states and treatment had been improved at 10 hospitals, whereas retinopathy of prematurity screening was established at 16 sick newborn care units in district hospital in four states and treatment had been improved at six medical schools. Advocacy within state governments was critical to the success of the initiative.

Mode of gavage feeding: does it really matters

Background: The establishment of safe oral feeding in preterm or low birth weight infants may be delayed because of poor co-ordination of sucking and swallowing, neurological immaturity and respiratory distress. Enteral feeds may be delivered through a catheter (feeding tube) passed via the nose or via the mouth. This study was planned to compare oro-gastric and naso-gastric route for placing feeding tube to see duration to achieve full feeding.Methods: The study was conducted in in-patient of SCNU (Sick Newborn Care Unit) of Department of Paediatrics. All patients (200 newborns) in the study were randomly enrolled in groups as per gestational weeks between 28-34 weeks by using New Ballard Scoring (NBS) chart at the time of admission.Results: The mean duration to achieve full feeding either by direct breast feeding or cup feeding in oro-gastric and naso-gastric tube groups are (6.18±0.61) and (6.47±0.59) days respectively. This study will help in the individualization of the mode of gavage feeding in various institutions across the country.Conclusions: In the present study the episodes of non-intentional removal and displacement are more in OGT group and it is statistically significant (p = 0.012 and p &lt;0.0001 respectively). The episodes of feed intolerance are more.

Service readiness for inpatient care of small and sick newborns: what do we need and what can we measure now?

BackgroundEach year an estimated 2.6 million newborns die, mainly from complications of prematurity, neonatal infections, and intrapartum events. Reducing these deaths requires high coverage of good quality care at birth, and inpatient care for small and sick newborns. In low- and middle-income countries, standardised measurement of the readiness of facilities to provide emergency obstetric care has improved tracking of readiness to provide care at birth in recent years. However, the focus has been mainly on obstetric care; service readiness for providing inpatient care of small and sick newborns is still not consistently measured or tracked.MethodsWe reviewed existing international guidelines and resources to create a matrix of the structural characteristics (infrastructure, equipment, drugs, providers and guidelines) for service readiness to deliver a package of inpatient care interventions for small and sick newborns. To identify gaps in existing measurement systems, we reviewed three multi-country health facility survey tools (the Service Availability and Readiness Assessment, the Service Provision Assessment and the Emergency Obstetric and Newborn Care Assessment) against our service readiness matrix.FindingsFor service readiness to provide inpatient care for small and sick newborns, our matrix detailed over 600 structural characteristics. Our review of the SPA, the SARA and the EmONC assessment tools identified several measurement omissions to capture information on key intervention areas, such as thermoregulation, feeding and respiratory support, treatment of specific complications (seizures, jaundice), and screening and follow up services, as well as specialised staff and service infrastructure.ConclusionsOur review delineates the required inputs to ensure readiness to provide inpatient care for small and sick newborns. Based on these findings, we detail where questions need to be added to existing tools and describe how measurement systems can be adapted to reflect small and sick newborns interventions. Such work can inform investments in health systems to end preventable newborn death and disability as part of the Every Newborn Action Plan.

Effective coverage of essential inpatient care for small and sick newborns in a high mortality urban setting: a cross-sectional study in Nairobi City County, Kenya

BackgroundEffective coverage requires that those in need can access skilled care supported by adequate resources. There are, however, few studies of effective coverage of facility-based neonatal care in low-income settings, despite the recognition that improving newborn survival is a global priority.MethodsWe used a detailed retrospective review of medical records for neonatal admissions to public, private not-for-profit (mission) and private-for-profit (private) sector facilities providing 24×7 inpatient neonatal care in Nairobi City County to estimate the proportion of small and sick newborns receiving nationally recommended care across six process domains. We used our findings to explore the relationship between facility measures of structure and process and estimate effective coverage.ResultsOf 33 eligible facilities, 28 (four public, six mission and 18 private), providing an estimated 98.7% of inpatient neonatal care in the county, agreed to partake. Data from 1184 admission episodes were collected. Overall performance was lowest (weighted mean score 0.35 [95% confidence interval or CI: 0.22–0.48] out of 1) for correct prescription of fluid and feed volumes and best (0.86 [95% CI: 0.80–0.93]) for documentation of demographic characteristics. Doses of gentamicin, when prescribed, were at least 20% higher than recommended in 11.7% cases. Larger (often public) facilities tended to have higher process and structural quality scores compared with smaller, predominantly private, facilities. We estimate effective coverage to be 25% (estimate range: 21–31%). These newborns received high-quality inpatient care, while almost half (44.5%) of newborns needed care but did not receive it and a further 30.4% of newborns received an inadequate service.ConclusionsFailure to receive services and gaps in quality of care both contribute to a shortfall in effective coverage in Nairobi City County. Three-quarters of small and sick newborns do not have access to high-quality facility-based care. Substantial improvements in effective coverage will be required to tackle high neonatal mortality in this urban setting with high levels of poverty.

Neonatal nursing policy and practice in Kenya: Key stakeholders and their views on task-shifting as an intervention to improve care quality.

Background: Improving the quality of facility based neonatal care is central to tackling the burden of neonatal mortality in Low and Middle Income Countries (LMIC). Quality neonatal care is highly dependent on nursing care but a major challenge facing health systems in LMICs is human resource shortage. In Kenya, task-shifting among professional care cadres is being discussed as one potential strategy of addressing the human resource shortage, but little attention is being paid to the potential for task-shifting in the provision of in-patient sick newborn care. This study identified key neonatal policy-making and implementation stakeholders in Kenya and explored their perceptions of task-shifting in newborn units. Methods: The study was exploratory and descriptive, employing qualitative methods including: document review, stakeholder analysis, observation of policy review process meetings and stakeholder feedback. A framework approach was used for analysis. Results: In Kenya, guidelines for the care of sick neonates exist but there are few specialized neonatal nurses and no policy documents outlining the nurse to patient ratio required in neonatal care or other higher dependency areas. The Ministry of Health, Nursing Council of Kenya and international agencies were identified as playing key roles in policy formulation while County governments, the National Nurses Association of Kenya and frontline care providers are central to implementation. Newborns were perceived to be highly vulnerable requiring skilled care but in light of human resources challenges, most expressed some support for shifting ‘unskilled’ tasks. However, a few of the key implementers were concerned about the use of unqualified staff and all stakeholders emphasized the need for training, regulation and supervision. Conclusions: Task-shifting has the potential to help address human recourse challenge in low-income settings. However, any potential task-shifting intervention in neonatal care would require a carefully planned process involving all key stakeholders and clear regulations to steer implementation.

A study on neonatal hyperbilirubinemia due to ABO incompatibility in sick newborn care unit, Telangana

Background: Hyperbilirubinemia is one of the most common clinical signs encountered in neonates which if untreated is potentially neurotoxic. The neonates at higher risk of jaundice should be identified at birth and kept under enhanced surveillance for occurrence and progression of jaundice and promptly intervened. Aim: This study aims to study and analyze the neonatal hyperbilirubinemia in the babies born to O positive mother. Subjects and Methods: A prospective observational cohort study of healthy term neonates born to O positive mothers with clinical jaundice was conducted in a sick newborn care unit (SNCU) attached to a tertiary level government maternity hospital. SPSS version 19 was used for statistical analysis. Descriptive statistics such as mean, median, standard deviation, and Chi-square test were calculated. p&lt;0.05 was taken as statistically significant. Results: A total of 100 babies, born to O positive mothers brought to SNCU with clinical jaundice of &lt;120 h of age, were studied. 72 babies had ABO incompatibility, of which 52 (72%) babies required phototherapy and 1 (1.3%) required exchange transfusion. There was no significant difference in the severity and outcome in both O-A and O-B incompatibility, although O-B incompatibility was more (65%). Conclusion: Blood group of mother should always be noted and babies born to O positive mothers must be followed for early identification and prompt intervention.

Clinical features and drug sensitivity pattern of Klebsiella pneumoniae sepsis: A descriptive study in a level 2 neonatal care unit in India

Objectives: To study the signs and symptoms of neonatal sepsis caused by Klebsiella pneumoniae and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a level 2 neonatal unit in India. Method : This descriptive study was conducted with neonates who were admitted in Sick Newborn Care Unit (level 2 neonatal care unit) and whose blood culture showed growth of Klebsiella pneumoniae in a study period of 1 year. The data was entered into a register and presented by descriptive statistics. Results: Forty eight neonates were included in the study. Predominant presenting symptoms were abdominal distension (75%), petechiae, purpura (62.5%) and sclerema (50%). Klebsiella pneumoniae was highly sensitive to tigecycline and meropenem. Conclusions: Predominant presenting symptoms of neonatal sepsis caused by Klebsiella pneumoniae were abdominal distension, petechiae, purpura and early sclerema. Klebsiella pneumoniae was highly sensitive to tigecycline and meropenem. Sri Lanka Journal of Child Health , 2017; 46 (3): 259-261

Status of neonatal death in sick newborn care unit of a tertiary care hospital

Background: In view of clusters of death in Sick New Born Care Units of tertiary care hospitals in recent past and few studies done so far in this field necessitates a research. The aim of the present study was to assess the factors associated with neonatal mortality and the infrastructure of the SNCU.Methods: All sick neonates admitted in the SNCU during June and July 2017 were followed up till they were discharged or declared dead. Data were collected by facility observation, interview of parents/attendants and from patient case sheet with a predesigned a pretested questionnaire and were analyzed applying appropriate statistical methods.Results: Prevalence neonatal death was 12 per cent among 250 sick neonates studied. Majority of neonatal deaths occurred among mothers having lower SE Status 25 (27.4), antenatal visits less than 4 times (22, 22%), undernourished neonates (24, 37.5%) all of which were significant. Majority of morbidity were of Prematurity, (110, 44%) followed by Birth Asphyxia (96, 38.4%) and Infections (35.2%) and leading cause of death was infection. There was a deficit of resources from 25% to 75% and no monitoring and supervision were done till date.Conclusions: Health care delivery system at block level and below needs to be strengthened in terms of antenatal visits, improvement of nutritional status of mother. The resource constraint of SNCU at tertiary care hospital and surveillance and monitoring mechanism requires prompt action to make SNCU more effective.