Cause Of Neonatal Death Research Articles

Diagnostic Value of PTX-3 Combined with PCT and CRP for Neonatal Sepsis

Aim: Neonatal sepsis is a critical illness among neonates and is the leading cause of neonatal death. In this study, we compared the changes in serum PTX-3 levels in neonates with sepsis and non-septicemia, as well as the diagnostic advantages and value of serum PTX-3 compared to traditional indicators such as WBC, CRP, and PCT. Methods: A total of 109 neonates were included in this study. Neonates were divided into three groups: 35 neonates were assigned to the sepsis group; 36 to the local infection group; and 38 assigned to the control group. Blood was collected to measure complete blood counts, CRP, PCT, liver and kidney function, lactate, and PTX-3 levels. Results: CRP, PCT, and PTX-3 in the sepsis group were significantly higher compared to the local infection group and non-infection group (P<0.01 or P>0.05). PCT and PTX-3 levels in the local infection group were significantly higher compared to the non-infection group (P>0.05). The combination of WBC+CRP+PCT+PTX-3 was more sensitive for the diagnosis of neonatal infection. For the diagnosis of neonatal sepsis, CRP was the most sensitive index, with PTX-3 having the best specificity. The combination of WBC+CRP+PTX-3 was found to significantly improve the sensitivity and specificity of diagnosis. Conclusion: PTX-3 could be used as a new biomarker for neonatal sepsis, while the combination with WBC, CRP, and PCT could significantly improve the sensitivity and specificity for sepsis diagnosis.

The need for neonatal jaundice screening awareness in the Pakistani population: short communication.

Neonatal jaundice is a common illness that affects around 80% of preterm and 50-60% of full-term newborn infants. It is one of the most common causes of neonatal death. Neonatal jaundice may be physiological or pathological. Physiologic jaundice is far more common than pathologic jaundice and accounts for most hyperbilirubinemia. Physiologic jaundice in neonates is due to greater hemoglobin breakdown compared to bilirubin clearance. While pathological jaundice occurs due to various infections, drug toxicity, inborn enzyme deficiencies, Rhesus fetal-maternal incompatibility, hypothyroidism, and congenital biliary duct obstruction diseases. In many parts of the world, midwives, and nurses perform spontaneous vaginal deliveries and they only rely on visual screening for neonatal jaundice. However, this is not reliable, especially for newborns having darker skin. Educating the mothers on screening for early detection of neonatal jaundice and seeking medical treatment in a country like Pakistan, which is considered a high-risk population, is crucial. Also, as most females give birth at home, hence, midwives' knowledge about neonatal jaundice also needs to be improved.

Incidence and predictors of mortality among neonates with respiratory distress syndrome admitted at West Oromia Referral Hospitals, Ethiopia, 2022. Multi-centred institution based retrospective follow-up study.

Respiratory distress syndrome is the major cause of neonatal death. However, data on the mortality and predictors related to respiratory distress syndrome were scarce. Hence, this study aimed to assess the incidence and predictors of death among neonates admitted with respiratory distress syndrome in West Oromia Referral Hospitals, Ethiopia, 2022. A retrospective follow-up study was conducted among 406 neonates admitted with respiratory distress syndrome at five referral hospitals from, 1 January 2019 to, 31 December 2021 in West Oromia, Ethiopia. The data were collected using a structured checklist and participants were selected using simple random sampling technique. The data were entered into Epi data version 4.6.0.2 and exported to STATA version 14 for cleaning, coding and analysis. The Kaplan-Meier curve was used to estimate survival time. The Weibull regression model was fitted to identify the predictors of mortality and variables with a P-value < 0.05 was taken as significant predictors of mortality. Four hundred six neonates with respiratory distress syndrome were included in the analysis. The overall incidence of neonatal mortality was 59.87/1000 neonates-days observations (95%CI: 51.1-70.2) with a proportion of 152 (37.44%) (95% CI: 32.7-42.2). The median time of follow-up was 11 days (95% CI: 10-23). Very low birthweight (AHR = 4.5, 95%CI: 2.0-10.9) and low birth weight (AHR = 3.1, 95%CI: 1.4-6.6), perinatal asphyxia (AHR = 2.7, 95%CI: 1.8-4), Chorioamnionitis (AHR = 2.2, 95%CI: 1.4-3.5) and multiple pregnancies (AHR = 2.2, 95%CI: 1.4-3.4) increased the hazard of death, whereas, antenatal corticosteroid administration (AHR = 0.33, 95%CI: 0.2-0.7) was negatively associated with neonatal mortality. High mortality rate of neonates with respiratory distress syndrome was observed. Chorioamnionitis, perinatal asphyxia, low birth weight and multiple pregnancies increase the, mortality hazard while administering antenatal corticosteroids decreases it. Thus, administering corticosteroids- before giving birth and special emphasis on children with Chorioaminoitis, asphyxia, low birth weight and multiple pregnancies is important for reducing neonatal mortality.

Mortality rate among Iraqi neonates in neonatal intensive care units: Retrospective study

BackgroundNeonatal mortality (NM) is defined as the death of babies within the first 28 days of their lives, and it's considered a key outcome indicator used to assess and evaluate the development of maternal and neonatal health services in the community. ObjectiveTo identify the neonatal mortality rate (NMR) and to find out the essential causes and related factors of mortality among neonates admitted to the neonatal intensive care units (NICU) at all hospitals of Babylon governorate/Iraq. MethodsA retrospective study was used to review the medical records of all the admitted neonates (No = 27379) to the NICU at hospitals of Babylon governorate, throughout 2020 and 2021 years, the study was done from mid-November 2022 to the end of March 2023. Data were obtained from the statistical department in the health directorate of Babylon governorate electronically from the program called (Microsoft Visual FoxPro). ResultsThe neonatal deaths rate was 42.9 for each 1000 live birth in 2020 and September 38, 1000 live birth in 2021 among all admitted neonates in Babylon hospitals, NMR was very high among neonates with respiratory distress syndrome (RDS) (48% in 2020 and 55.2% in 2021), and low-birth-weight preterm neonates (25.8% in 2020 and 10.3% in 2021). The obstetric history such as gestational age, mode and place of delivery, and type of pregnancy, as well as birth weight, age at the time of death, and residency, were significantly associated with high rates of neonates’ mortality. ConclusionThe neonatal mortality rate was high in Babylon governmental hospitals, especially the hospitals in rural areas. RDS and prematurity were the main cause of neonatal deaths. Furthermore, the maternal history and neonatal characteristics data were associated with increased NMR in prematurity, low birth weight, normal delivery, and delivery at home than a hospital, and in single birth than twins in both 2020 and 2021.

Pneumonia, lymphocytes and C-reactive protein are valuable tests for predicting surgical intervention in necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is one of the important causes of neonatal death, and proper timing of operation is of critical significance. This study aimed to explore the high-risk factors for NEC requiring surgical intervention and to provide a reference for its clinical diagnosis and treatment. Clinical and radiological evidence of NEC neonates admitted to Zhujiang Hospital of Southern Medical University and Zhongshan Boai Hospital from January 2010 to October 2022 were retrospectively analyzed. Patients were divided into surgical group and conservative group according to whether they underwent surgery or not. Univariate analysis of the clinical data of the two groups was conducted, and multivariate logistic regression analysis was then performed for statistically significant results in the univariate analysis. 267 infants were included in this study, of which 90 patients underwent surgical intervention for NEC and 177 conservation treatment. The univariate analysis showed that the gestational age, pneumonia, leukocytes, lymphocytes, erythrocytes, platelets, C-reactive protein, and blood glucose were statistically significant in the surgical group compared to the conservative group (All P < 0.05). Furthermore, the results of multivariate logistic regression analysis showed that compared to the conservative group, patients in the surgical group had a higher proportion of pneumonia (OR = 2.098; 95% CI: 1.030-4.272; P = 0.041), lower lymphocyte values (OR = 0.749; 95% CI: 0.588-0.954; P = 0.019), and higher C-reactive protein values (OR = 1.009; 95% CI: 1.003-1.016; P = 0.004). Pneumonia, decreased lymphocytes, and elevated C-reactive protein are potential high-risk factors for neonates with NEC requiring surgical intervention and may have potential clinical implications for predicting surgical risk.

Changes of Functional Brain Network in Neonates with Different Degrees of Hypoxic-Ischemic Encephalopathy.

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is the main cause of neonatal death and disability worldwide. At present, there are few researches on the application of resting-state functional magnetic resonance imaging (rs-fMRI) to explore the brain development of HIE children. This study aimed to explore the changes of brain function in neonates with different degrees of HIE using rs-fMRI. Methods: From February 2018 to May 2020, 44 patients with HIE were recruited, including 21 mild patients and 23 moderate and severe patients. The recruited patients were scanned by conventional and functional magnetic resonance image, and the method of amplitude of low-frequency fluctuation and connecting edge analysis of brain network was used. Results: Compared with the mild group, the connections between the right supplementary motor area and the right precentral gyrus, the right lingual gyrus and the right hippocampus, the left calcarine cortex and the right amygdala, and the right pallidus and the right posterior cingulate cortex in the moderate and severe groups were reduced (t values were 4.04, 4.04, 4.04, 4.07, all p < 0.001, uncorrected). Conclusion: By analyzing the functional connection changes of brain network in infants with different degrees of HIE, the findings of the current study suggested that neonates with moderate to severe HIE lag behind those with mild HIE in emotional processing, sensory movement, cognitive function, and learning and memory. Chinese Clinical Trial Registry registration number: ChiCTR1800016409.

Absolute Neutrophil Count in Diagnosis of Neonatal Sepsis : A Hospital Based Cross Sectional Study

Background : Sepsis is the leading cause of neonatal death in developing countries. Delay in initiating treatment can considerably increase the morbidity and mortality. So early diagnosis is important.Traditional methods such as blood culture do not provide a rapid diagnosis. Absolute neutrophil count is one of the important hematological markers for diagnosis of sepsis. The purpose of the study to see the absolute neutrophil count in diognosis of neonatal sepsis.&#x0D; Materials and methods: This is a hospital based cross sectional study conducted from January to June 2014. A total of 100 sick neonates admitted in the Neonatal ward of Chattagram Maa Shishu O General Hospital (CMSOGH) with suspected neonatal sepsis (Based on history and physical examination) constituted the study population. Investigation sent for Absolute neutrophil count, C-reactive Protein (CRP) and blood culture. The collected data was analyzed by statistical software packages SPSS method version 15.&#x0D; Results: A total of 100 sick neonates of both sexes with suspected sepsis were enrolled in this study, out of which most of the patient showed neutropenia (66%), C-reactive protein positive 65% and blood culture positive 33%. Within the Creactive protein positive patients 78.8% patient had neutropenia (c2 =17.711, p= .001). From blood culture positive patients 85% showed neutropenia (c2 =8.510, p= 0.014).&#x0D; Conclusion: Neutropenia is a common hematological finding in neonatal sepsis along with other screening test and neutropenia is more significant than neutrophilia.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 66-70

Recent research on machine learning in the diagnosis and treatment of necrotizing enterocolitis in neonates

Necrotizing enterocolitis (NEC), with the main manifestations of bloody stool, abdominal distension, and vomiting, is one of the leading causes of death in neonates, and early identification and diagnosis are crucial for the prognosis of NEC. The emergence and development of machine learning has provided the potential for early, rapid, and accurate identification of this disease. This article summarizes the algorithms of machine learning recently used in NEC, analyzes the high-risk predictive factors revealed by these algorithms, evaluates the ability and characteristics of machine learning in the etiology, definition, and diagnosis of NEC, and discusses the challenges and prospects for the future application of machine learning in NEC.

Assessing Essential New-Born Care Knowledge, Skills and Associated Factors among Nurses/Midwives in Zanzibar: A Cross-Sectional Study.

Essential newborn care (ENC) is one of the significant strategies for neonatal survival, especially immediately after delivery. Nurses and midwives are the key healthcare providers who care for neonates immediately after birth, their knowledge and skills on ENC are very important for the preventable causes of neonatal deaths. Therefore, this study aimed to assess essential newborn care knowledge and skills among nurses/midwives in Zanzibar. A hospital-based analytical cross-sectional study that included 246 nurses-midwives was conducted in Zanzibar from January to February 2021. The purposive sampling method was used to select district and regional hospitals. Simple random sampling was used to select primary health facilities. A systematic random sampling technique was used to select study participants. A standard structured self-administered questionnaire was used. Predictors of knowledge and skills of ENC were determined using Binary Logistic regression under multivariate analysis using SPSS version 23.0. P<.05 was considered to be significant. Among the total (246) participants, 89 (36.2%) and 66 (26.8%) had adequate knowledge and appropriate skills of ENC, respectively. Having a BSc in Nursing (AOR = 8.83, 95%CI = 2.00-38.96) and the presence of guidelines (AOR = 3.52, 95%CI = 1.59 -7.80) were significantly associated with knowledge of ENC. Residing in Pemba (AOR = 0.30, 95%CI = 0.11-0.80), availability of staff (AOR = 0.80, 95%CI = 0.02-0.32), adequate knowledge (AOR = 2.80, 95%CI = 1.15-6.84) were factors significantly associated with ENC skills. Generally, nurses-midwives had suboptimal knowledge and skills on essential newborn care. Nurses-midwives are in urgent need of positive supportive supervision and low-dose- high-frequency skills training in ENC for the prevention of neonatal morbidity and mortality. Also, policymakers should be aware of this gap and should plan necessary interventions to close the gap to resecure newborns' survival.

Multidrug-Resistant Bacterial Infections Among Very Low Birthweight Infants With Late-Onset Sepsis in Johannesburg, South Africa.

An estimated 2.4 million babies died within the first 28 days of life in 2020. The third leading cause of neonatal death continues to be neonatal sepsis. Sepsis-causing bacterial pathogens vary temporally and geographically and, with a rise in multidrug-resistant organisms (MDROs), pose a threat to the neonatal population. This was a single-center, retrospective study of very low birth weight (VLBW) infants with late-onset sepsis (LOS) admitted to a neonatal unit in South Africa. We aimed to calculate the prevalence of multidrug-resistant (MDR) infections in this population. The data collected included demographic and clinical characteristics, length of hospital stay, risk factors for MDRO and mortality, and microbiology results. Logistic regression was used to assess the association between prespecified risk factors with MDR infections and mortality. Of 2570 VLBW infants admitted, 34% had LOS, of which 33% was caused by MDROs. Infection with Acinetobacter spp., Pseudomonas spp., extended-spectrum beta-lactamase Klebsiella spp., or Escherichia coli was associated with the highest mortality in the LOS cohort. Infants with congenital infections (adjusted odds ratio [aOR], 5.13; 95% CI, 1.19-22.02; P = .028) or a history of necrotizing enterocolitis (aOR, 2.17; 95% CI, 1.05-4.49; P = .037) were at significantly higher risk for MDR infections. More than one-third of LOS cases in VLBW infants were caused by MDROs in this study. MDR infections cause substantial neonatal mortality. Antimicrobial stewardship programs, infection control protocols, and ongoing surveillance are needed to prevent further emergence and spread of MDR infections worldwide.

Comparative study of neonatal brain injury fetuses using machine learning methods for perinatal data

ObjectiveCTG is used to record the fetus's fetal heart rate and uterine contraction signal during pregnancy. The prenatal fetal intrauterine monitoring level can be used to evaluate the fetal intrauterine safety status and reduce the morbidity and mortality of the perinatal fetus. Perinatal asphyxia is the leading cause of neonatal hypoxic-ischemic encephalopathy and one of the leading causes of neonatal death and disability. Severe asphyxia can cause brain and permanent nervous system damage and leave different degrees of nervous system sequelae. MethodsThis paper evaluates the classification performance of several machine learning methods on CTG and provides the auxiliary ability of clinical judgment of doctors. This paper uses the data set on the public database UCI, with 2126 samples. ResultsThe accuracy of each model exceeds 80%, of which XGBoost has the highest accuracy of 91%. Other models are Random tree (90%), light (90%), Decision tree (83%), and KNN (81%). The performance of the model in other indicators is XGBoost (precision: 90%, recall: 93%, F1 score: 90%), Random tree (precision: 88%, recall: 91%, F1 score: 89%), lightGBM (precision: 87%, recall: 93%, F1 score: 90%), Decision tree (precision: 83%, recall: 86%, F1 score: 84%), KNN (precision: 77%, recall: 85%, F1 score: 81%). ConclusionThe performance of XGBoost is the best of all models. This result also shows that using the machine learning method to evaluate the fetus's health status in CTG data is feasible. This will also provide and assist doctors with an objective assessment to assist in clinical diagnosis.

The Kangaroo Method Treatment Effectively Increases Low Newborn Weight (LBW)

Background: LBW is one of the highest causes of neonatal death in developing countries. Indonesia ranks 8th based on the number of neonatal deaths per year according to WHO data. The Infant Mortality Rate (IMR) in Indonesia in 2019 was 72,000 babies and 19% of deaths were caused by premature and LBW babies. Many cases of death in LBW occur because babies who experience LBW are susceptible to exposure to nosocomial infections, tend to have co-morbidities and the body's organs are not ready to face the external environment and case management is not optimal. One cheap and easy solution that can be done when a baby has LBW is to apply the Kangaroo Method of Care (PMK). Methods: The design used in this study is Traditional Literature Review obtained from 3 data based, namely Pubmed, Science Direct, Google Scholar using inclusion and exclusion criteria. Keywords used in the literature search: Kangaroo-Mother care Method and Weight Gain and Infant, Low Birth Weight. Of the 14 journals found, the journal selection was carried out using PICOS, then analyzed one by one with the results of 12 journals from Google Scholar data and 2 journals from PubMed data.Results: The results of the article review found that the Kangaroo Method Treatment can be carried out in LBW from the age of 0 days with a minimum administration time of 1 hour a day, the implementation must be in accordance with the readiness of the mother and baby, and the maximum application can increase the baby's weight. Conclusion: Kangaroo-Mother care has been proven to be effective in increasing body weight in LBW babies so that FMD can be intervened in LBW babies

Effect of Video-assisted Teaching on Knowledge and Practice of Preterm Care Bundle amongst Mothers of Preterm Babies

Abstract Background: Preterm is defined as all births before the completion of 37 weeks of gestation. The complications of preterm birth are the largest direct cause of neonatal deaths, responsible for 35% of the world’s 3.1 million deaths per year. Aims: The aims of the study were to assess the effect of video-assisted teaching on knowledge and practice of preterm care bundle amongst mothers of preterm babies. Methods: Pre-experimental one-group pre-test–post-test design with purposive sampling was used to collect data from 30 samples admitted in level I neonatal intensive care unit of a tertiary care hospital in Kerala. The pre-test was done using a structured knowledge questionnaire and observational practice checklist, followed by video-assisted teaching on the preterm care bundle and reinforced with a demonstration of skills. Post-test was done on the 5th day. Results: In the pre-test, 21 (70%) of the samples had inadequate knowledge and 17 (56.67%) had inadequate practice, while in post-test, 29 (96.67%) had adequate knowledge and 30 (100%) had adequate practice on preterm care bundle. The calculated paired t-test value on pre- and post-test knowledge score was 29.24 and calculated paired t-test value on pre- and post-test practice score was 56.63, which was higher than the table value (t29 = 2.04, P &lt; 0.05). There was a significant positive correlation (r = 0.771, P &lt; 0.001) between knowledge and practice of preterm care bundle. There was a significant association (P &lt; 0.05) between pre-test level of knowledge on preterm care bundle with selected socio-demographic and clinical data variables such as area of residence and a highly significant association (P &lt; 0.001) between pre-test level of knowledge on preterm care bundle with parity. There was a significant association (P &lt; 0.05) between pre-test level of practice on preterm care bundle with selected socio-demographic and clinical data variables such as education, area of residence and a highly significant association (P &lt; 0.001) between pre-test level of practice on preterm care bundle with parity. During the study, an investigator found that video-assisted teaching was effective in improving knowledge and practice of preterm care bundle amongst mothers of preterm babies. Conclusion: Therefore, video-assisted teaching is an effective method for improving the knowledge and practice amongst mothers of preterm babies as a supportive measure in the NICUs.

STUDI KASUS: PENATALAKSANAAN ASFIKSIA SEDANG PADA BAYI BARU LAHIR DENGAN TEKNIK HAIKAP DI RSU AL-FATAH AMBON

Newborn deaths are caused by spontaneous and regular breathing failure immediately after birth, asphyxia is the second highest cause of neonatal death, which is 27%. The purpose of the case study was to find out the management of moderate asphyxia newborns, this case study was conducted at the AL-Fatah Hospital in Ambon. Mrs. X's baby who experienced mild asphyxia was given care by warming, positioning, sucking mucus, drying, positioning, assessing (HAIKAP) by paying attention to the baby's airway, stimulating his breathing reflexes, and maintaining the baby's body temperature. Which gave positive results with an increase in the Apgar Score to normal. So it is very important for a midwife to be able to manage newborns with asphyxia according to evidence-based.

The Main Casual Factors Associated with The Incidence of Asphyxia Neonatorum

Background: Asphyxia is the second most common cause of neonatal death after babies with low birth weight (LBW). The factors that can cause asphyxia include preeclampsia, premature birth, prenatal anemia, antepartum bleeding and premature rupture of membranes. Purpose: This study aimed to determine the main causative factors associated with the incidence of asphyxia neonatorum at RSUP Dr. M. Djamil Padang in 2021. Methods: This research was a quantitative research with an analytic approach with a cross sectional design, was conducted in the Medical Record Sub-Division of RSUP Dr. M. Djamil Padang in December 2022. The sample in this study were babies who were diagnosed with asphyxia totaling 132 people obtained by total sampling technique. Collection data were taken from patient medical records and analyzed univariately, bivariately (test chi square), and multivariate (logistic regression analysis) with 95% CI. Results: The result showed that 77.3% of patients had moderate asphyxia. The result of this study showed that majority of patients with severe asphyxia with preeclampsia mothers 60.0% (p=0.001), premature birth 76,7% (p=0.044), anemia mothers 53,3% (p=0.035), did not experience antepartum hemorrhage 83,3% (p=0.390), and premature rupture of membranes 73,3% (p=0.000). The most dominant factor was premature rupture of membranes with OR=34.988). Conclusion: It was concluded that there was a relationship between preeclampsia, premature birth, prenatal anemia, premature rupture of membranes, and there was no relationship between antepartum bleeding and neonatal asphyxia. The factor that has the most dominant influence on the incidence of neonatal asphyxia is premature rupture of membranes. Suggestions for health workers to maintain and improve services to patients, especially asphyxia neonatorum.

Hubungan Kelahiran Prematur dengan Kejadian Ikterus Neonatorum pada Bayi Baru Lahir di RSUD

According to data from the World Health Organization (WHO), the infant mortality rate (IMR) in the world in 2012 was 49 per 1000 live births, high risk infant or infant factors that increase the risk of perinatal or neonatal death is one of them is jaundice neonatorum or jaundice. neonatorum is the cause of neonatal death about 20-40% of all deliveries. Based on the results of a preliminary study conducted at the hospital, from 120 cases of premature birth there were 32 cases of neonatal jaundice. This study was to determine the relationship between premature birth and the incidence of neonatal jaundice in newborns. This type of research is correlational analytic with a case control design. The number of samples used in this study is 55 people in the case group and 55 people in the control group. The analysis used is univariate analysis and bivariate analysis. based on the results of statistical test analysis, it was found that in the case group or mothers who experienced premature birth, there were 32 babies (58.2%) who had neonatal jaundice and in the control group or the group of mothers who did not experience premature birth, they got 14.infants or (25.5%) who had neonatal jaundice. the results of the chi square test obtained a p-value of 0.001, it can be concluded that there is a significant relationship between premature birth and the incidence of neonatal jaundice. it is hoped that pregnant women will continue to routinely carry out antenatal care to prevent premature birth, for further researchers to be able to look for other variables related to the incidence of neonatal jaundice.

Increased newborn NICU admission for evaluation of hypoxic-ischemic encephalopathy during COVID-19 pandemic in a public hospital.

Prenatal and perinatal care of pregnant mothers has been adversely affected during the COVID-19 pandemic. Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal death and long-term neurological disabilities. Therapeutic hypothermia is effective for neonatal HIE. This study evaluated the effect of the pandemic on neonatal HIE. This retrospective single-center study compared neonatal HIE evaluation and hypothermia treatment between pre-COVID-19 pandemic (1 January 2018-31 December 2019) and COVID-19 pandemic (1 January 2020-31 December 2021) periods. Infants with abnormal neurological examination and or significant metabolic acidosis were admitted to NICU for evaluation of HIE and therapeutic hypothermia. Demographics, NICU admission and interventions, and neonatal outcomes were compared between infants born during the two periods using χ2, t-test, and Wilcoxon rank-sum test as appropriate. Statistical Process Control charts show the yearly proportion of infants evaluated for HIE and those treated with therapeutic hypothermia. From the pre-pandemic to the pandemic period, the proportion of infants that met HIE screening criteria increased from 13% to 16% (p < 0.0001), the proportion of infants admitted to NICU for HIE evaluation increased from 1% to 1.4% (p = 0.02), and the maternal hypertension rates of the admitted infants increased from 30% to 55% (p = 0.006). There was no difference in the proportions of the infants diagnosed with HIE (0.7% vs. 0.9%, p = 0.3) or treated with therapeutic hypothermia (0.2% vs. 0.3%, p = 0.3) between the two periods. There were no differences in the HIE severity and outcomes of the infants treated with therapeutic hypothermia between the two periods. During the COVID-19 pandemic, we observed a significant increase in NICU admission for HIE evaluation. While we did not find significant increases in neonatal HIE and the need for therapeutic hypothermia, larger studies are needed for a comprehensive assessment of the impact of the COVID-19 pandemic on neonatal HIE.

In silico Analysis of Two Novel Variants in the Pyruvate Carboxylase (PC) Gene Associated with the Severe Form of PC Deficiency.

Inborne errors of metabolism are a common cause of neonatal death. This study evaluated the acute early-onset metabolic derangement and death in two unrelated neonates. WES, Sanger sequencing, homology modeling, and in silico bioinformatics analysis were employed to assess the effects of variants on protein structure and function. WES revealed a novel homozygous variant, p.G303Afs*40 and p.R156P, in the PC gene of each neonate, which both were confirmed by Sanger sequencing. Based on the ACMG guidelines, the p.G303Afs*40 was likely pathogenic, and the p.R156P was a VUS. Nevertheless, a known variant at position 156, the p.R156Q, was also a VUS. Protein secondary structure prediction showed changes in p.R156P and p.R156Q variants compared to the wild-type protein. However, p.G303Afs*40 depicted significant changes at C-terminal. Furthermore, comparing the interaction of wild-type and variant proteins with the ATP ligand during simulations, revealed a decreased affinity to the ATP in all the variants. Moreover, analysis of SNP impacts on PC protein using Polyphen-2, SNAP2, FATHMM, and SNPs&GO servers predicted both R156P and R156Q as damaging variants. Likewise, free energy calculations demonstrated the destabilizing effect of both variants on PC. This study confirmed the pathogenicity of both variants and suggested them as a cause of type B PCD. The results of this study would provide the family with prenatal diagnosis and expand the variant spectrum in the PC gene,which is beneficial for geneticists and endocrinologists.

The effects of dual-strain probiotics on the weight gain in premature neonates of Kabul City: A randomized clinical trial

BackgroundPrematurity is prevalent worldwide and accounts for the leading cause of neonatal death. Preterm neonates face numerous challenges, including slow weight gain, prolonged hospital stays, and high mortality. Dual-strain probiotics containing Bifidobacterium bifidum and Clostridium butyricum can manage such complications of prematurity. Therefore, the present study was conducted to evaluate the effectiveness of dual-strain probiotics consisting of Bifidobacterium bifidum and Clostridium butyricum on the weight gain of preterm neonates in Kabul City. MethodsThis randomized clinical trial was conducted at the Neonatal Units of Malalai Maternity and Maiwand Teaching Hospitals in Kabul City. Finally, 84 preterm neonates were assessed for the effects of dual-strain probiotics. The clinical parameters were daily weight gain and the risks of feeding intolerance and neonatal mortality. Statistical analysis was performed by SPSS 26. ResultsForty-two premature neonates in the probiotics group and another forty-two preterm babies in the control group were investigated. In the probiotic group, 250 mg or 25 × 108 CFU of dual-strain probiotics dissolved in 1–3 ml milk were given twice daily for three weeks. At the time of intervention, the preterm neonates in the probiotics versus control group had a mean age of (7 ± 3.3 vs 6.8 ± 3.3 days; P = 0.69), weight of (1497.5 ± 272 vs 1483.3 ± 271 g; P = 0.8) and gestational age of (33.6 ± 2 vs 33 ± 2.4 weeks; p = 0.31). Gender distribution in the probiotics group was (boys 54.8%, girls 45.2%) and in the control group it was (boys 50%, girl 50%). The premature newborns in the probiotics versus control group had a higher mean daily weight gain (15.5 ± 9.4 vs 10 ± 7.9 g; P = 0.001), lower mean age to reach full enteral feeds (8.74 ± 3.08 vs 10.81 ± 3.43 days, P = 0.005) and lower mean hospital stays (10.02 ± 4.68 vs 12.81 ± 4.86 days, P = 0.009) . The risk ratios of feeding intolerance and mortality during the hospital stays were (RR=0.59, P = 0.71) and (RR=0.67, P = 0.5) in probiotics and non-probiotics groups respectively. ConclusionDual-strain probiotics consisting of Bifidobacterium bifidum and Clostridium butyricum significantly improved the daily weight gain, and decreased the time to full enteral feeding and admission days for premature neonates.

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.