Cause Of Neonatal Death Research Articles

Global, regional, and national estimates of the impact of a maternal Klebsiella pneumoniae vaccine: A Bayesian modeling analysis.

Despite significant global progress in reducing neonatal mortality, bacterial sepsis remains a major cause of neonatal deaths. Klebsiella pneumoniae (K. pneumoniae) is the leading pathogen globally underlying cases of neonatal sepsis and is frequently resistant to antibiotic treatment regimens recommended by the World Health Organization (WHO), including first-line therapy with ampicillin and gentamicin, second-line therapy with amikacin and ceftazidime, and meropenem. Maternal vaccination to prevent neonatal infection could reduce the burden of K. pneumoniae neonatal sepsis in low- and middle-income countries (LMICs), but the potential impact of vaccination remains poorly quantified. We estimated the potential impact of such vaccination on cases and deaths of K. pneumoniae neonatal sepsis and project the global effects of routine immunization of pregnant women with the K. pneumoniae vaccine as antimicrobial resistance (AMR) increases. We developed a Bayesian mixture-modeling framework to estimate the effects of a hypothetical K. pneumoniae maternal vaccine with 70% efficacy administered with coverage equivalent to that of the maternal tetanus vaccine on neonatal sepsis infections and mortality. To parameterize our model, we used data from 3 global studies of neonatal sepsis and/or mortality-with 2,330 neonates who died with sepsis surveilled from 2016 to 2020 undertaken in 18 mainly LMICs across all WHO regions (Ethiopia, Kenya, Mali, Mozambique, Nigeria, Rwanda, Sierra Leone, South Africa, Uganda, Brazil, Italy, Greece, Pakistan, Bangladesh, India, Thailand, China, and Vietnam). Within these studies, 26.95% of fatal neonatal sepsis cases were culture-positive for K. pneumoniae. We analyzed 9,070 K. pneumoniae genomes from human isolates gathered globally from 2001 to 2020 to quantify the temporal rate of acquisition of AMR genes in K. pneumoniae isolates to predict the future number of drug-resistant cases and deaths that could be averted by vaccination. Resistance rates to carbapenems are increasing most rapidly and 22.43% [95th percentile Bayesian credible interval (CrI): 5.24 to 41.42] of neonatal sepsis deaths are caused by meropenem-resistant K. pneumoniae. Globally, we estimate that maternal vaccination could avert 80,258 [CrI: 18,084 to 189,040] neonatal deaths and 399,015 [CrI: 334,523 to 485,442] neonatal sepsis cases yearly worldwide, accounting for more than 3.40% [CrI: 0.75 to 8.01] of all neonatal deaths. The largest relative benefits are in Africa (Sierra Leone, Mali, Niger) and South-East Asia (Bangladesh) where vaccination could avert over 6% of all neonatal deaths. Nevertheless, our modeling only considers country-level trends in K. pneumoniae neonatal sepsis deaths and is unable to consider within-country variability in bacterial prevalence that may impact the projected burden of sepsis. A K. pneumoniae maternal vaccine could have widespread, sustained global benefits as AMR in K. pneumoniae continues to increase.

Common Causes of Neonatal Death in Calabar, South-South Nigeria: An Autopsy Study

Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures.
 Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria.
 Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms.
 Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%).
 Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.

Diffusion kurtosis imaging and diffusion weighted imaging comparison in diagnosis of early hypoxic–ischemic brain edema

BackgroundHypoxic–ischemic encephalopathy (HIE) refers to cerebral hypoxic–ischemic injury caused by asphyxia during perinatal period, which is one of the important causes of neonatal death and sequelae. Early and accurate diagnosis of HIE is of great significance for the prognostic evaluation of patients. The purpose of this study is to explore the efficacy of diffusion-kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) in the diagnosis of early HIE.MethodsTwenty Yorkshire newborn piglets (3–5 days) were randomly divided into control group and experimental group. DWI and DKI scanning were performed at timepoints of 3, 6, 9, 12, 16, and 24 h after hypoxic–ischemic exposure. At each timepoint, the parameter values obtained by each group scan were measured, and the lesion area of the apparent diffusion coefficient (ADC) map and mean diffusion coefficient (MDC) map were measured. (For better interpretation of this study, we replaced the description of MD with MDC). Then, we completely removed the brain for pathological examination, and observed the state of cells and mitochondria in the ADC/MDC matching area (the actual area of the lesion), and the mismatch area (the area around the lesion).ResultsIn the experimental group, the ADC and MDC values decreased with time, but the MDC decreased more significantly and the change rate was higher. Both MDC and ADC values changed rapidly from 3 to 12 h and slowly from 12 to 24 h. The MDC and ADC images showed obvious lesions at 3 h for the first time. At this time, the area of ADC lesions was larger than that of MDC. As the lesions developed, the area of ADC maps was always larger than that of the MDC maps within 24 h. By observing the microstructure of the tissues by light microscopy, we found that the ADC and MDC matching area in the experimental group showed swelling of neurons, infiltration of inflammatory cells, and local necrotic lesions. Consistent with the observation under light microscope, pathological changes were observed in the matching ADC and MDC regions under electron microscopy as well, including collapse of mitochondrial membrane, fracture of partial mitochondrial ridge, and emergence of autophagosomes. In the mismatching region, the above pathological changes were not observed in the corresponding region of the ADC map.ConclusionsDKI’s characteristic parameter MDC is better than ADC (parameter of DWI) to reflect the real area of the lesion. Therefore, DKI is superior to DWI in diagnosing early HIE.

Ascertainment of causes of neonatal death using verbal autopsy in Rishikesh, Uttarakhand: A cross-sectional study.

India shares a huge burden of the total number of global neonatal deaths. The neonatal mortality rate in Uttarakhand is higher in comparison to the national rate. Understanding the causes and contextual factors that contribute to neonatal deaths is critical for developing a health programme and policy. Therefore, this study was aimed to ascertain causes of neonatal deaths using verbal autopsy in Rishikesh, Uttarakhand. A community-based cross-sectional study was conducted in Rishikesh, Uttarakhand from July 2018 to June 2019. The study participants were mothers or primary caregivers of deceased neonates. The verbal autopsy tool of the National Health Mission, Government of India was used to collect data. All neonatal deaths from July 2018 to June 2019 were included in this study. The cause of neonatal death was ascertained by two independent doctors. A total of 23 neonatal deaths could be traced during July 2018 through June 2019 in Rishikesh. One death was excluded from the study. Sixty-eight percent (15/22) of neonatal deaths occurred in the first week of life. Major causes of neonatal deaths were perinatal asphyxia (7/22), congenital malformation (6/22), and prematurity (4/22). Most (9/22) of the delays were in making a decision to seek medical care for neonates. The major causes of neonatal deaths were perinatal asphyxia, congenital malformation, and prematurity. Most of the deaths occurred during the early neonatal period.

Innate immune responses to enteric Escherichia colidictate neonatal sepsis outcomes

Abstract Late-onset neonatal sepsis (LOS), a leading cause of neonatal death, can result from pathogenic bacteria disseminating to the bloodstream from the intestinal microbiota. E. coliis the second most commonly isolated pathogen causing LOS. During sepsis, there are significant immune discrepancies between infants and adults, including elevated IL-6 levels in neonates, demonstrating the need for age-specific research. We have developed a murine model of LOS that uses clinical isolates of gut-resident E. coli, which results in rapid pro-inflammatory cytokine production within 6 hours and neonatal mortality within 2–3 days post-infection. Not all enteric E. coliresults in inflammation and mortality, and we have classified isolates as “commensal” or “pathogenic”. TLR4−/− mice infected with pathogenic E. colihave a delayed mortality to sepsis, suggesting innate bacterial recognition is required for acute inflammation. To further determine the source of this delay, we have begun investigating signaling pathways during bacterial infection. We found the immune signaling pathway NFκB/AP1 is consistently activated in murine macrophages by commensal and pathogenic bacterial strains. However, only pathogenic bacteria induce elevated IL-6 production by murine macrophages. Interestingly, this response required live bacteria, suggesting lipopolysaccharide alone from E. coliis not sufficient to recapitulate LOS inflammation. Our future directions will explore alternative signaling pathways that are activated uniquely during pathogenic infection and induce a robust inflammatory response. Through this work, we will determine the consequence of specific pro-inflammatory cytokines in neonatal mice during pathogenic infection. Research supported by R03 DK122187.

Report of an Experiment With a Fetal Ex-Utero Support System in Piglets.

Extreme prematurity remains one of the leading causes of neonatal death. An ex-utero treatment strategy that allows the fetus to develop beyond this period until capable of tolerating the transition to post-natal physiology would significantly impact the quality of care offered for this pre-viable patient population. In this study, we report our experience with an ex-utero support system for fetal pigswith the goal of support and survival for eight hours. Our experiment included two pigs at a gestational age equivalent to a 32-week human fetus. Following ultrasound assessment and delivery via hysterotomy, the fetuses were transferred to a 40 L glass aquarium filled with warmed lactated Ringer's solution and connected to an arteriovenous (AV) circuit that included a centrifugal pump and a pediatric oxygenator.Fetus 1 was successfully cannulated and survived for seven hours (expected maximum duration of eight hours). Fetus 2 died shortly after hysterotomy, secondary to failure at the cannulation stage. Our results suggest that ex-utero support of the premature fetal pig is feasible, contributing to a scarce body of evidence. However, further studies are needed before effectively translating an artificial placenta system into the clinical arena.

Management of preterm birth using protocols in a low resource setting.

Preterm birth is the leading cause of neonatal deaths and the second leading cause of death in children under five after pneumonia. The study aimed at improving the management of preterm birth through the development of protocols for standardization of care. The study was conducted in Mulago National Referral Labor ward in two phases. A total of 360 case files were reviewed and mothers whose files had missing data interviewed for clarity for both the baseline audit and the re-audit. Chi squares were used to compare results for the baseline and the re-audit. There was significant improvement in four parameters out of the six that were used to assess quality of care and these were 32% increase in administration of Dexamethasone for fetal lung maturity, 27% increase in administration of Magnesium Sulphate for fetal neuroprotection and 23% increase in anti-biotic administration. A 14% reduction noted in patients who received no intervention. However, there was no change in the administration of Tocolytic. The results of this study have shown that protocols standardize care and improve the quality of care in preterm delivery to optimize outcomes.

ASUHAN KEBIDANAN PADA BAYI Ny. Y DENGAN MELAKUKAN PENCEGAHAN INFEKSI PADA TALI PUSAT MENGGUNAKAN METODE TOPIKAL ASI

According to the World Health Organization (WHO) in 2017 found an infant mortality rate of 560,000 from live births caused by umbilical cord infection. The incidence of newborn infection in Indonesia ranges from 24% to 34%, and this is the cause of neonatal death which ranges from 24% to 34%, and this is the second cause of death after neonatal asphyxia which ranges from 49% to 60%. One way to treat the umbilical cord is the topical breastfeeding method. Breast milk has many immunological and anti-infective agents. The purpose of writing is to provide midwifery care for newborns by applying the topical breastfeeding method as a prevention of infection and to accelerate the release of the umbilical cord in Baby Ny. Y AT the Tanjung Balai Karimun Health Center. The design of care that has been given by the author is using a descriptive observational design with a case study approach. Data collection methods are participatory observation, interviews, measurements, documentation. The research instrument is the format of midwifery care. The results of the action showed that the treatment of the umbilical cord using topical breast milk made the umbilical cord dry and detached faster. It is hoped that the role of midwives in assisting mothers in caring for the umbilical cord in newborns is as a facilitator and counselor

Patterns of Infections among Extremely Preterm Infants.

Infections remain a leading cause of neonatal death, especially among the extremely preterm infants. To evaluate the incidence, pathogenesis, and in-hospital outcomes associated with sepsis among hospitalized extremely preterm infants born at 24-0/7 to 27-6/7 weeks of gestation, we designed a post hoc analysis of data collected prospectively during the Preterm Epo Neuroprotection (PENUT) Trial, NCT #01378273. We analyzed culture positive infection data, as well as type and duration of antibiotic course and described their association with in-hospital morbidities and mortality. Of 936 included infants, 229 (24%) had at least one positive blood culture during their hospitalization. Early onset sepsis (EOS, ≤3 days after birth) occurred in 6% of the infants, with Coagulase negative Staphylococci (CoNS) and Escherichia Coli the most frequent pathogens. Late onset sepsis (LOS, >day 3) occurred in 20% of the infants. Nearly all infants were treated with antibiotics for presumed sepsis at least once during their hospitalization. The risk of confirmed or presumed EOS was lower with increasing birthweight. Confirmed EOS had no significant association with in-hospital outcomes or death while LOS was associated with increased risk of necrotizing enterocolitis and death. Extremely premature infants with presumed sepsis as compared to culture positive sepsis had lower rates of morbidities. In conclusion, the use of antibiotics for presumed sepsis remains much higher than confirmed infection rates. Ongoing work exploring antibiotic stewardship and presumed, culture-negative sepsis in extremely preterm infants is needed.

Congenital diaphragmatic hernia survival in an English regional ECMO center

IntroductionCongenital diaphragmatic hernia (CDH) remains a cause of neonatal death. Our aims are to describe contemporary rates of survival and the variables associated with this outcome, contrasting these with our...

Effect of Zinc Supplementation in Prevention of Necrotizing Enterocolitis in Preterm Neonates

Necrotizing enterocolitis is a serious condition involving the gastrointestinal tract and is one of the most common causes of death in neonates. It occurs due to various factors including the altered immune response of the premature intestinal tract against gut microbiota, resulting in inflammation and damage to the gut. Objective: To find out the effect of Zinc in the prevention of necrotizing enterocolitis in very preterm infants in the first 2 weeks of life. Methods: It was a double-blind randomized control trial held in the Neonatology section of Pediatric Medicine unit-II, Mayo hospital Lahore. The duration of the study was 11 months after the approval of the synopsis from August 2019 to July 2020. A total of 94 patients were included in the studies (95% confidence level, 7% absolute precision). Probability sampling, a simple random sampling technique was used. The study included 94 patients, 28 weeks to 32 weeks of gestational age. Results: In this study, the mean age of neonates was 54.85±11.60 hours, 51(54.26%) patients were male whereas 43(45.74%) patients were females. A birth weight having <1 kg was observed in 20(21.3%) patients and a birth weight between 1-2 kg was observed in 49(52.1%) patients. Necrotizing enterocolitis was developed among 6(6.38%) patients. Among the zinc supplementation group, the NEC developed in 2(4.3%) patients whereas, among the placebo group, the NEC developed in 4(8.5%) patients (p-value=0.677).Conclusion: This study concluded that zinc supplementation did not prove any preventive effect against necrotizing enterocolitis in very preterm infants.

Risk Factors and Microbiological Outcome in Neonatal Sepsis: A Clinical Study

Infection is the predominant cause of neonatal deaths universally. Neonatal deaths (30-50%) every year is caused due to sepsis. Due to nosocomial infections and their associated morbidities, cost and mortality, betterment of neonatal outcomes is complicated as hospitals in developing countries are at major risk for the transmission of infection. The present study aimed to analyse sepsis risk factors and microbiological outcome in the NICU and post-natal ward. The study diagnosed the affected neonates as earliest possible so that suitable antibiotic treatment can be done without adding to the burden of antibiotic resistance. In this study, 94% of babies with neonatal sepsis were discharged and 6% of babies succumbed to the illness. Low birth weight between 1500-2500 grams was noted as an important contributing factor to sepsis in babies. PROM was found to be greater than 18 hours in (46%) of cases. Klebsiella pneumoniae was the common pathogen amongst gram negative bacteria in the present study and thus was the common cause of septicemia in neonates, and Coagulase negative Staphylococcus and Staphylococcus aureus were common bacteria among the gram-positive bacteria. A higher mortality rate in cases of late onset sepsis was observed and was explained probably due to prolonged NICU stay, multiple interventions such as mechanical ventilation, umbilical venous catheterization, and central lines.

Myricetin attenuates hypoxic-ischemic brain damage in neonatal rats via NRF2 signaling pathway.

Introduction: Hypoxic-ischemic encephalopathy (HIE) is a crucial cause of neonatal death and neurological sequelae, but currently there is no effective therapy drug for HIE. Both oxidative stress and apoptosis play critical roles in the pathological development of HIE. Myricetin, a naturally extracted flavonol compound, exerts remarkable effects against oxidative stress, apoptosis, and inflammation. However, the role and underlying molecular mechanism of myricetin on HIE remain unclear. Methods: In this study, we established the neonatal rats hypoxic-ischemic (HI) brain damage model in vivo and CoCl2 induced PC12 cell model in vitro to explore the neuroprotective effects of myricetin on HI injury, and illuminate the potential mechanism. Results: Our results showed that myricetin intervention could significantly reduce brain infarction volume, glia activation, apoptosis, and oxidative stress marker levels through activating NRF2 (Nuclear factor-E2-related factor 2) and increase the expressions of NRF2 downstream proteins NQO-1 and HO-1. In addition, the NRF2 inhibitor ML385 could significantly reverse the effects of myricetin. Conclusion: This study found that myricetin might alleviate oxidative stress and apoptosis through NRF2 signaling pathway to exert the protective role for HI injury, which suggested that myricetin might be a promising therapeutic agent for HIE.

Identification and verification of feature biomarkers associated with immune cells in neonatal sepsis

BackgroundNeonatal sepsis (NS), a life-threatening condition, is characterized by organ dysfunction and is the most common cause of neonatal death. However, the pathogenesis of NS is unclear and the clinical inflammatory markers currently used are not ideal for diagnosis of NS. Thus, exploring the link between immune responses in NS pathogenesis, elucidating the molecular mechanisms involved, and identifying potential therapeutic targets is of great significance in clinical practice. Herein, our study aimed to explore immune-related genes in NS and identify potential diagnostic biomarkers. Datasets for patients with NS and healthy controls were downloaded from the GEO database; GSE69686 and GSE25504 were used as the analysis and validation datasets, respectively. Differentially expressed genes (DEGs) were identified and Gene Set Enrichment Analysis (GSEA) was performed to determine their biological functions. Composition of immune cells was determined and immune-related genes (IRGs) between the two clusters were identified and their metabolic pathways were determined. Key genes with correlation coefficient > 0.5 and p < 0.05 were selected as screening biomarkers. Logistic regression models were constructed based on the selected biomarkers, and the diagnostic models were validated.ResultsFifty-two DEGs were identified, and GSEA indicated involvement in acute inflammatory response, bacterial detection, and regulation of macrophage activation. Most infiltrating immune cells, including activated CD8 + T cells, were significantly different in patients with NS compared to the healthy controls. Fifty-four IRGs were identified, and GSEA indicated involvement in immune response and macrophage activation and regulation of T cell activation. Diagnostic models of DEGs containing five genes (PROS1, TDRD9, RETN, LOC728401, and METTL7B) and IRG with one gene (NSUN7) constructed using LASSO algorithm were validated using the GPL6947 and GPL13667 subset datasets, respectively. The IRG model outperformed the DEG model. Additionally, statistical analysis suggested that risk scores may be related to gestational age and birth weight, regardless of sex.ConclusionsWe identified six IRGs as potential diagnostic biomarkers for NS and developed diagnostic models for NS. Our findings provide a new perspective for future research on NS pathogenesis.

Genetic studies in the Pakistani population reveal novel associations with ventricular septal defects (VSDs)

BackgroundWith prevalence up to 4%, Ventricular Septal Defect (VSD) is one of the leading causes of neonatal deaths. VSD is a common complex genetic disorder that has been associated with many genetic determinants. Variants from genes for the transcription factors including T-Box TBX5 and NFATc1 (nuclear factor of activated T cells, cytoplasmic 1), Vascular endothelial growth factor (VEGF), ISLET1 (encoded by the ISL1 gene) and enzyme MTHFR, a methylene tetrahydrofolate reductase were selected. Genetic risk score (GRS) is a widely accepted approach used to convert the genetic data into prediction and assessment tool for disease susceptibility.MethodsA total of 200 participants were recruited for the current study, 100 VSD patients and 100 controls. Genotyping of the ISL1: rs1017, NFATc1: rs7240256, VEGF: rs36208048, TBX5: rs11067075, and MTHFR: rs1801133 variants was performed using tetra primer ARMS PCR and PCR-RFLP. For the statistical analysis, the software SPSS version 23 was used. Genotypic frequencies of cases and controls were calculated using chi-square (χ²) whereas allelic frequencies were calculated by using the SNPStats tool. The association of GRS quartiles with VSD was examined using binary logistic regression. Adjusted p-value 0.01 was used as significance threshold for all analyses.ResultsThe ISL1 (OD: 0.242, CI: 0.158–0.37, p-value: 2.15 × 10− 4 :), NFATc1 (OD: 2.53, CI: 1.64–3.89, p-value: 2.11 × 10− 5), TBX5 (OD: 2.24, CI: 1.47–3.41, p-value:1.6 × 10− 4) and MTHFR (OD: 10.46, CI: 5.68–19.26, p-value: 2.09 × 10− 9:) variants were found to be in association with VSD. In contrast, the VEGF (OD: 0.952, CI: 0.56–1.62, p-value: 0.8921) variant did not show significance association with the VSD. For cases, the mean GRS score was 3.78 ± 1.285 while in controls it was 2.95 ± 1.290 (p-value: 0.479, CI: 0.474–1.190). Comparison of GRS between cases and control showed that mean GRS of cases was 1.90 ± 0.480 while in controls it was 1.68 ± 0.490 (p-value: 0.001, CI: 0.086–0.354). Higher quartiles were more prevalent in cases whereas lower quartiles were more prevalent in controls.ConclusionGRS of these five loci was strongly associated with VSD. Moreover, genetic risk score can provide better information for the association between variants and disease as compared to a single SNP. We also illustrated that the cumulative power of GRS is greater over the single SNP effect. This is a pilot scale study with a relatively small sample size whose findings should be replicated in a larger sample size for the unique local Pakistani population.

The relationship between miRNA-210 and SCN1B in fetal rats with hypoxic-ischemic brain injury.

Hypoxic-ischemic brain injury contributes to major neurodevelopmental disorders and is one of the leading causes of seizures, which substantially results in neurodevelopmental impairments with long-lasting outcomes and is one of the main causes of death in neonates. We aimed to investigate the correlation between miRNA-210 and SCN1B, a voltage-gated sodium channel gene, in brain tissue of fetal rats with hypoxic-ischemic brain injury. We found that after 10 min of hypoxia-ischemia, all reperfusion groups showed different degrees of damage. The degree of the injury increased in all the groups after 30 min of hypoxia-ischemia. Those changes include changes in the pericellular lumen, capillaries in the cortex, erythrocytes, enlarged pericellular lumen, the enlarged pericapillary lumen in the cortex, edema around glial cells, enlarged gap to form multiple necrotic foci, deformation of neurons, and loss of cell structure. The expression levels of HIF-1α, miRNA-210, and HIF-1α mRNA were higher in the hypoxic-ischemic groups than that in the control groups, among which the expression levels in the severe group were higher than that in mild group. SCN1B is down-regulated in both the mild and severe groups, and the lowest level was found at 30 min after hypoxia in both groups. MiRNA-210 plays a role in the development of hypoxic-ischemic encephalopathy (HIE) by regulating the expression changes of SCN1B. The brain tissue of fetal rats in the hypoxic-ischemic animal model showed pathological changes of brain injury.

New Born Care with Ayurveda: A Review

New born babies or neonates truly constitute the foundation of human life. They have unique health issues and problems due to structural and functional immaturity of various body organs depending upon their gestational age and birth weight. Neonatal death occurs in approximately 1 in 250 births. Africa and Southeast Asia represent approximately two thirds of neonatal deaths, with the largest number of new born deaths in South Asia and the highest rates of neonatal mortality in Sub-Saharan Africa, similar to child deaths. India contributes 25% of the world’s neonatal deaths. Three causes of neonatal death are responsible for approximately 75% of neonatal deaths: prematurity 28%, sepsis and pneumonia 26%, and asphyxia 23%. Care of the new born is described by both Ayurvedic and modern texts in detail. In ancient texts, Acharyas gave their opinions on every aspect of the care of new born (Navjat Shishu Parichariya) which starts from birth till new born attends full stability. The procedures involved in the Care of new born are Ulva parimarjana, Pranapratyagamana, Snana, Mukha vishodhan, Pichudharan, Garbhodaka vamana, Nala chedana, Jatakarma, Raksha karma, Suwarna prasana. With advancement of researches, all these techniques are getting scientific validation. Like Udaka Kumbha sthapana mentioned in Jatakarma can be understood with recently evolved “head cooling technique” for new born. Hence these or ancient wisdom regarding resuscitation, prevention of hypothermia, aspiration and infections and promotion of rooming in and early initiation of breast feeding will be dealt along with scientific evidences in this study.

Common Causes and Risk Factors for Neonatal Death in NICU in Tobruk Medical Center between July 2018 and July 2019, Libya

Background Of the 130 million babies born worldwide each year, an estimated 4 million die during the neonatal period. Of the total global neonatal mortality, 99% occurs in low- and middle-income countries, particularly in Africa and South Asia. The current study was designed to calculate the neonatal mortality rate (NMR), analyze the causes of neonatal deaths, and examine risk factors contributing to neonatal deaths in the neonatal unit of Tobruk Medical Center (TMC). Methods A case-control study was conducted on 180 newborns divided into two groups admitted to the neonatal intensive care unit (NICU) on the same day of delivery. The first group included 90 newborns who died before day 28 and the second group included 90 newborns who survived until the time of discharge and were selected randomly. The data of the patients were collected from the medical records of newborns admitted to the neonatal unit at TMC between July 2018 and July 2019. All data in this study were statistically analyzed using SPSS 23.0 for Windows (SPSS Inc., Chicago, IL, United States). Results The NMR among the studied neonates was 12.3 per 1,000 live births, and the death rate was 16.36% per 1,000 admissions. The most common causes of mortality were premature birth (55, 61%), birth asphyxia (18, 20%), and congenital anomalies (10, 11.2%). Less than 50% of the dead patients were on a mechanical ventilator. Premature birth and low birth weight patients are strong predictors of neonatal mortality; normal vaginal delivery had a higher risk of mortality than the other methods of delivery. Gender, maternal blood group, maternal age, and past obstetrical and medical history had no positive correlation with mortality except for antepartum hemorrhage. Conclusions The study found that the rate of neonatal mortality is similar to that of other hospitals in developing countries and the most common cause of neonatal death was premature birth, and premature birth and low birth weight were the main risk factors for death.

Prevalence and factors associated with preterm births among postnatal mothers at Soroti Regional Referral Hospital, Eastern Uganda

BackgroundGlobally, prematurity is the leading cause of death in neonates and therefore a major contributor to the under 5-year mortality. The study assesses the prevalence and risk factors associated with preterm birth at a Regional Referral Hospital in Eastern Uganda. MethodsThis was a descriptive cross-sectional study conducted at a Regional Referral Hospital in Eastern Uganda. A questionnaire was used to capture data on maternal socio-demographic features, and obstetrical causes of preterm birth. Additional information was got from maternal medical records. In total, 350 mother-baby pairs were studied. Bivariate and multivariate logistic regression models were fitted so as to establish the factors associated with preterm birth. A p-value < 0.05 was considered statistically significant. ResultsPrevalence of preterm birth at Soroti Regional Referral Hospital was 24.6% (86/350). Factors associated with preterm birth included: Fewer than 3 antenatal attendances (aOR = 3.115, 95% CI [1.659–5.849], P = 0.038), twin gestation (aOR = 6.973, 95% CI [1.128–43.097], P = 0.016), antepartum hemorrhage (aOR = 4.743, 95% CI[806–12.458], P < 0.001) and PPROM (aOR = 18.902, 95% CI[7.267–49.167], P < 0.001). Maternal mid upper arm circumference (MUAC) measurement ≥24 cm was a protective factor against preterm birth (aOR = 0.155, 95% CI[0.0686–0.352], P < 0.001). ConclusionPreterm births in Soroti-RH in Eastern Uganda were associated with poor maternal nutrition status, low antenatal attendance, twin gestation, antepartum hemorrhage, and preterm premature rupture of membranes. Health education on proper nutrition and routine monthly antenatal visits by healthcare workers is important for early screening and detection of high risk pregnancies.

Risk Factors of Low-Birth-Weight Baby in Indonesia

Introduction: LBW (Low Birth Weight) gets more intentions from many governments over the world because it is one of significant factors that may increase under-five mortality and infant mortality. The global prevalence of low birth weight (LBW) is still high (15.5%) where most of them (96.5%) are living in developing countries. Although In Indonesia the prevalence of LBW is considered low, it is steadily increasing should be considered: in 2007 5.4%; 5.7% in 2013, to 6.2 % in 2018. In 2020, the most common cause of neonatal death is low birth weight (LBW). BBLR in East Java reached 3.7%. Objection: To know the risk factors of LBW prevalence based on maternal age, number of pregnancy, gender, gestational age, fetal presentation, mode of delivery, SPE, PROM, and anemia in PKU Muhammadiyah Mojoagung public hospital, East Java. Method: This study is an retrospective cross-sectional study design study in PKU Muhammadiyah Mojoagung public hospital during Desember 2021 till November 2022. Purposive sampling method used to obtain the samples from medical records that fit to inclusion and exclusion criteria (n=100). Data was analyzed with SPSS statistics used chi-square, fisher, kruskal wallis, and logistic regression analytic method. Result: A total of 100 newborn were included during study period. The regression test showed significant result at maternal age &lt;20/&gt;35 years (p=0,000, OR 25.726, 95%CI 4.746-139.456) and anemia (p=0,002, OR 13.355, 95%CI 2.581-69.088) with LBW prevalence. Conclusion: maternal age and anemia risk factors that significant lead to LBW prevalence in PKU Muhammadiyah Mojoagung public hospital, East Java.