Early Babies Research Articles

Poor weight gain and its predictors among preterm neonates admitted at Muhimbili National Hospital in Dar-es-salaam, Tanzania: a prospective cohort study

BackgroundPreterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates. Postnatal poor weight gain, which can contribute to mortality, can be influenced by feeding practices, medical complications and quality of care that is provided to these high-risk neonates. This study aimed to investigate the proportion and predictors of poor weight gain among preterm neonates at Muhimbili National Hospital (MNH), from September 2018 to February 2019.MethodsA hospital-based prospective cohort study involving preterm neonates with Gestation age (GA) < 37 weeks receiving care at MNH. Eligible preterm, were consecutively recruited at admission and followed up until discharge, death or end of neonatal period. Poor weight gain was defined as weight gain less than 15 g per kg per day. The risk factors associated with poor weight gain were evaluated. Predictors of poor weight gain were evaluated using a multivariate analysis. Results were considered statistically significant if P -value was < 0.05 and 95% confidence interval (CI) did not include 1.ResultsA total of 227 preterm neonates < 37 weeks GA, with male to female ratio of 1:1.2 were enrolled in the study. The overall proportion of preterm with poor weight gain was 197/227 (86.8%). Proportion of poor weight gain among the early and late preterm babies, were 100/113 (88.5%) and 97/114 (85.1%) respectively. Predictors of poor weight gain were low level of maternal education (AOR = 2.58; 95%Cl: 1.02–6.53), cup feeding as the initial method of feeding (AOR = 8.65; 95%Cl: 1.59–16.24) and delayed initiation of the first feed more than 48 h (AOR = 10.06; 95%Cl: 4.14–24.43). A previous history of preterm delivery was protective against poor weight gain (AOR = 0.33; 95% Cl: 0.11–0.79).Conclusion and recommendationPoor weight gain was a significant problem among preterm neonates receiving care at MNH. This can be addressed by emphasizing on early initiation of feed and tube feeding for neonates who are not able to breastfeed. Health education and counselling to mothers focusing on feeding practices as well as close supervision of feeding especially for mothers experiencing difficulties in feeding their preterm will potentially minimize risk of growth failure.

Urinary Levels of Cathepsin B in Preterm Newborns.

Increased investment in perinatal health in developing countries has improved the survival of preterm newborns, but their significant multiorgan immaturity is associated with short and long-term adverse consequences. Cathepsin B, as a protease with angiogenic properties, may be related to the process of nephrogenesis. A total of 88 neonates (60 premature children, 28 healthy term children) were included in this prospective study. We collected urine samples on the first or second day of life. In order to determine the concentration of cathepsin B in the urine, the commercially available enzyme immunoassay was used. The urinary concentrations of cathepsin B normalized with the urinary concentrations of creatinine (cathepsin B/Cr.) in newborns born at 30–34, 35–36, and 37–41 (the control group) weeks of pregnancy were (median, Q1–Q3) 4.00 (2.82–5.12), 3.07 (1.95–3.90), and 2.51 (2.00–3.48) ng/mg Cr, respectively. Statistically significant differences were found between the group of newborns born at 30–34 weeks of pregnancy and the control group (p < 0.01), and between early and late preterm babies (PTB) (p < 0.05). The group of children born at 35–36 weeks of pregnancy and the control group did not differ significantly. This result suggests that the elevated urinary cathepsin B/Cr. level may be the result of the kidneys’ immaturity in preterm newborns.

Bubble CPAP (Continuous Positive airway pressure) therapy as a primary mode of respiratory support in preterm newborns with mild to moderate respiratory distress syndrome

Background: Respiratory distress syndrome (RDS) is an important cause of morbidity and mortalityin preterm infants. Bubble CPAP when used appropriately, is more cost-effective, non-invasive,requires less training and has a lower risk of complications. However, not all preterm infants withRDS respond to CPAP. Aims: To study the immediate outcome of preterm infants with mild tomoderate respiratory distress syndrome on Bubble CPAP. To study the safety and effectiveness of B-CPAP and to identify the risk factors associated with its failure. Setting: NICU, Department ofpediatrics, Mamata general hospital and medical college, Khammam. Design- Prospectiveobservational study Material and Methods: This duration bound study was conducted fromFebruary 2018 to February 2020. Based on the inclusion criteria 73 Preterm babies with mild tomoderate respiratory distress syndrome requiring respiratory support were included in this study.Details of birth history, use of antenatal steroids, gestational age, type of delivery, birth weight,Downes score and chest X-ray were recorded. And the effectiveness and outcome of bubble CPAPwere studied. Results: Out of the total of 73 cases, 53(72.60%) were treated successfully, while20(27.40%) failed bubble CPAP. Conclusion: Bubble CPAP is the safe primary mode of respiratorysupport in Preterm newborns with mild to moderate RDS, more effective with early Initiation and inPreterm babies born to mothers with the use of antenatal steroids.

Neonatal and infant readmissions for late preterm and early term babies in Ontario and England: a cohort study using linked population-level healthcare data

ABSTRACTBackgroundBabies born late preterm (34-36 weeks gestation) or early term (37-38 weeks) are at increased risk of unplanned readmissions compared with full-term babies. We examined differences in neonatal and infant outcomes in England and Ontario.&#x0D; MethodsLinked maternity-baby hospitalisation data were extracted from two universal healthcare systems, Ontario (n=702,565; 2005-2013) and England (n=1,165,375; 2011-2013). We modelled rates of unplanned readmissions within 30-days post-discharge of delivery, and readmissions, emergency department (ED) visits, deaths and total inpatient days within 12-months post-discharge, adjusting for neonatal, maternal and delivery factors.&#x0D; ResultsThe median newborn length of stay was 4 and 5 days in Ontario and England respectively for late preterm babies, and 2 days in both countries for early term babies. Early neonatal readmissions were lower in Ontario: 4.8% of early term and 7.2% of late preterm babies compared with 8.3% and 11.4% respectively in England (p&lt;0.05). Within 12-months post-discharge, 9.6% of early term and 13.5% of late preterm babies were readmitted in Ontario compared with 24.0% and 30.5% in England (p&lt;0.05); total inpatient days per 100 babies were 36.5 for early term and 61.9 for late preterm (Ontario) compared with 62.7 and 107.6 (England). Infant mortality (0.1-0.4%) and ED visits (40-44%) were similar between countries.&#x0D; ConclusionsUnplanned readmissions and total inpatient stay are significantly higher in England than Ontario for early term / late preterm babies, despite similar ED attendances and lengths of newborn stay. Further investigation of differences in healthcare practices between countries should evaluate access to paediatric primary care and thresholds for admission.

An Early Study of Early Babies

An Early Study of Early Babies