High Neonatal Mortality Research Articles

Right to left ventricular volume ratio is associated with mortality in congenital diaphragmatic hernia

BackgroundCongenital diaphragmatic hernia (CDH) is associated with high neonatal mortality. We performed this study to test the hypothesis that left ventricular (LV) and right ventricular (RV) volumes assessed by three-dimensional echocardiography may be associated with mortality in CDH.MethodsThis study was a single-center retrospective cohort study involving 35 infants with CDH. RV and LV end-diastolic volume (RVEDV and LVEDV, respectively) were measured by three-dimensional echocardiography and were corrected by birth body weight (BBW) on day 1. RVEDV/BBW, LVEDV/BBW, and LVEDV/RVEDV were compared between CDH survivors and non-survivors. Receiver-operating characteristic curve analysis was performed to assess the predictive ability for mortality of the echocardiographic parameters.ResultsComparing CDH non-survivors (n = 6) with survivors (n = 29), respectively, RVEDV/BBW was significantly larger (2.54 ± 0.33 vs 1.86 ± 0.35 ml/kg; P < 0.01), LVEDV/BBW was significantly smaller (0.86 ± 0.21 vs 1.22 ± 0.33 ml/kg; P < 0.001), and LVEDV/RVEDV was significantly lower (0.34 ± 0.06 vs 0.66 ± 0.18; P < 0.001). The area under the curve for LVEDV/RVEDV was the largest (0.98).ConclusionsThree-dimensional echocardiographic volume imbalance between the RV and LV was remarkable in CDH non-survivors. The LVEDV/RVEDV ratio may be associated with mortality in CDH.ImpactMortality with congenital diaphragmatic hernia (CDH) is high, and evaluating left and right ventricular structures and functions may be helpful in assessing the prognosis.Three-dimensional (3D) echocardiography indicated that the left ventricular end-diastolic volume/right ventricular end-diastolic volume ratio within 24 h after birth was associated with mortality in CDH infants.The usefulness of this ratio should be validated in prospective multicenter studies involving larger numbers of patients.

Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia.

Quality of care around childbirth can reduce above half of the stillbirths and newborn deaths. Northeast Namibia's neonatal mortality is higher than the national level. Yet, no review exists on the quality of care provided around childbirth. This paper reports on baseline assessment for implementing WHO/UNICEF/UNFPA quality measures around childbirth. A mixed-methods research design was used to assess quality of care around childbirth. To obtain good saturation and adequate women opinions, we purposively sampled the only high-volume hospital in northeast Namibia; observed 53 women at admission, of which 19 progressed to deliver on the same day/hours of data collection; and interviewed 20 staff and 100 women who were discharged after delivery. The sampled hospital accounted for half of all deliveries in that region and had a high (27/1,000) neonatal mortality rate above the national (20/1,000) level. We systematically sampled every 22nd delivery until the 259 mother-baby pair was reached. Data were collected using the Every Mother Every Newborn assessment tool, entered, and analyzed using SPSS V.27. Descriptive statistics was used, and results were summarized into tables and graphs. We reviewed 259 mother-baby pair records. Blood pressure, pulse, and temperature measurements were done in 98% of observed women and 90% of interviewed women at discharge. Above 80% of human and essential physical resources were adequately available. Gaps were identified within the WHO/UNICEF/UNFPA quality standard 1, a quality statement on routine postpartum and postnatal newborn care (1.1c), and also within standards 4, 5, and 6 on provider-client interactions (4.1), information sharing (5.3), and companionship (6.1). Only 45% of staff received in-service training/refresher on postnatal care and breastfeeding. Most mothers were not informed about breastfeeding (52%), postpartum care and hygiene (59%), and family planning (72%). On average, 49% of newborn postnatal care interventions (1.1c) were practiced. Few mothers (0-12%) could mention any newborn danger signs. This is the first study in Namibia to assess WHO/UNICEF/UNFPA quality-of-care measures around childbirth. Measurement of provider-client interactions and information sharing revealed significant deficiencies in this aspect of care that negatively affected the client's experience of care. To achieve reductions in neonatal death, improved training in communication skills to educate clients is likely to have a major positive and relatively low-cost impact.

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.

A comparative study of head circumference and foot length as a measure of low birth weight in neonates

Background: Birth weight is the single most important indicator of survival, growth and overall development of the child. New-borns with less than 2.5 kg birth weight are termed as low birth weight (LBW). Approximately 28% babies in India are LBW. LBW is associated with high neonatal morbidity and mortality. Early diagnosis of LBW and apt intervention can lead to favourable outcome. The 70-80% of births take place either at home or at peripheral hospitals. Measuring birth weight is difficult in India due to resource limited set up. There is a need of alternative methods to detect LBW which should be simple, handy, quick and cost effective. Hence, we decided to do study of correlation of calf muscle circumference and chest circumference with birth weight to determine LBW in new-borns. Aim of the study was to study head circumference and foot length in diagnosing LBW babies. Objectives were to correlate above-said anthropometric parameters with birth weight and to decide indicator with better correlation with birth weight amongst head circumference and foot length Method: Its a cross sectional study conducted in tertiary care centre in North Maharashtra. The 162 new-borns (34- 42 weeks gestation) were included in Study. Birth weight, head circumference, and foot length were measured with appropriate scientific method. Results are analyzed with SPSS software and Microsoft excel. Results: Cut-off value to detect LBW is 31cm and 8.2 cm for head circumference and foot length respectively. Head circumference had better correlation (r=0.73) as compared to foot length (r=0.30). Head circumference has 87% sensitivity and 68% specificity as compare to foot length which has 74.8% sensitivity and 46.8% specificity respectively. Conclusions: Head circumference and foot length circumference can be used to determine LBW, though larger study with a greater number of patients is needed to establish precise correlation.

Mother's care-seeking behavior for neonatal danger signs from qualified providers in rural Bangladesh: A generalized structural equation modeling and mediation analysis.

Neonatal deaths contribute to nearly half (47%) of under-five mortality globally and 67% in Bangladesh. Despite high neonatal mortality, care-seeking from qualified providers for newborn danger signs remains low. Identification of direct and indirect factors and their pathways affecting care-seeking will help to design a well-targeted intervention. This study assessed the direct, indirect, and total effect of the predictive factors on neonatal care-seeking in Bangladesh. This was a cross-sectional baseline household survey conducted in 14 districts of Bangladesh in 2019 with 17,251 recently delivered women (RDW) with a live birth outcome in the preceding 15 months. We used a two-stage stratified cluster sampling process to select the samples from 14 districts. We investigated the inter-relationship of maternal background characteristics, maternal health utilizations, child/neonate factors, health service delivery-related factors and newborn danger sign knowledge with newborn care-seeking practices and estimated the direct, indirect, and total effects using Generalized Structural Equation Modeling (GSEM) and mediation analysis. p-value = 0.05 was considered statistically significant. The result of the mediation analysis was reported in Log Odds (LOD). The positive LOD (LOD > 0) implies a positive association. Half of the mothers (50.8%) reported a neonatal illness and among them, only 36.5% mothers of sick neonates sought care from qualified providers. Our mediation analysis showed that maternal health utilization factors, i.e., 4 + antenatal care visits (ANC) from a qualified provider (LOD: 0.63, 95% CI: 0.49, 0.78), facility delivery (LOD: 0.74, 95% CI: 0.30, 1.17) and postnatal care (PNC) from a qualified provider (LOD: 0.50, 95% CI: 0.21, 0.78) showed the highest total effect over other factors domains, and therefore, were the most important modifiable predictors for qualified neonatal care-seeking. Other important factors that directly and/or indirectly increased the chance of newborn care-seeking from qualified providers were household wealth (LOD: 0.86, 95% CI: 0.70, 1.02), maternal education (LOD: 0.48, 95% CI: 0.32, 0.63), distance to nearest health facility (LOD: 0.20, 95% CI: 0.10, 0.30), community health worker's (CHWs) home visits during ANC (LOD: 0.24, 95% CI: 0.13, 0.36), neonatal danger sign counseling after delivery (LOD: 0.20, 95% CI: 0.06, 0.34) and women's knowledge of neonatal danger signs (LOD: 0.37, 95% CI: 0.09, 0.64). The inter-relationship and highest summative effect of ANC, facility delivery, and PNC on newborn care-seeking suggested the maternal care continuum altogether from ANC to facility delivery and PNC to improve care-seeking for the sick newborn. Additionally, referral training for unqualified providers, targeted intervention for poorer households, increasing CHWs home visits and neonatal danger sign counseling at the facility and community should also be considered.

Assessment of Neonates with Extended Sick Neonate Score (ESNS) for Predicting Mortality in a Tertiary Care Center in Dharwad, Karnataka, India: A Prospective Cohort Study

Introduction: High neonatal mortality rates may be attributed to the lack of early recognition of severe illness, early and safe referral, and proper care. Therefore, there is a need to develop a simple, cost-effective scoring system that can be quickly applied to newborns referred from peripheral to tertiary care settings in resource-constrained areas. The Extended Sick Neonate Score (ESNS) is one such scoring system used to assess the severity of illness in critically ill neonates and predict their outcomes. Aim: To evaluate the effectiveness of the Extended Sick Newborn Score in predicting outcomes for neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: This prospective cohort study included 122 outborn neonates admitted to the NICU of SDM College of Medical Sciences and Hospital in Dharwad, Karnataka, India, from June 2021 to June 2022. All the required parameters for scoring, such as respiratory effort, heart rate, mean blood pressure, axillary temperature, capillary filling time, random blood sugar, SpO2, Moro reflex, and modified Downe’s score, were assessed and documented in a predesigned proforma. The ESNS was calculated upon admission to predict the outcomes. Statistical analysis included ANOVA test and independent t-test, using SPSS version 17.0 and MS Excel. Results: The study evaluated a total of 122 neonates, including 78 males and 44 females. Of these, 99 were term neonates and 23 were preterm neonates. The mean age for term neonates was 8.5 days ±8.6, and for preterm neonates, it was 4.1 days ±4.3. Term neonates with an ESNS Score ≤11 exhibited higher mortality, while preterm neonates with an ESNS score ≤12 showed higher mortality. The sensitivity and specificity of the ESNS score in predicting death were 78.57% and 99.07%, respectively. The ESNS score at admission was significantly lower in non-survivors compared to survivors, and it demonstrated a positive correlation with the outcome. Conclusion: This study found a significant correlation between the ESNS score at admission and in-hospital mortality. The use of the ESNS score is an acceptable method for risk stratification and prognosis of newborns in the NICU.

Determinants of neonatal deaths in Indonesia: A national survey data analysis of 10,838 newborns

BackgroundNeonatal mortality is one of the key impediments in achieving global sustainable development goals, especially in lower middle income countries (LMICs). As an LMIC with the highest reported neonatal mortality rate in Southeast Asia, Indonesia faces inequitable distribution of health facilities across the archipelago. Therefore, in this paper, we aim to evaluate the determinants of neonatal mortality rate in Indonesia to search for better strategies to overcome this problem. MethodsWe conducted an analysis of the 2017 Indonesia Demographic Health Survey dataset of 10,838 live-born infants born from singleton pregnancies in 2017. Using a hierarchical approach, multivariate analysis was conducted to identify potential factors (including socioeconomic, household, and proximate determinants) that contributed to neonatal mortality. ResultsThe lack of participation in postnatal care [odds ratio (OR) = 20.394, p = 0.01)] and delivery complications other than prolonged labour (OR = 2.072, p = 0.02) were the maternal factors that significantly associated with increased risk of neonatal death. Regarding neonatal factors, low-birth-weight infants appeared to be more vulnerable to neonatal death (OR = 12.489, p = 0.01). ConclusionLow participation in postnatal care, development of labour complications, and low birth weight were associated with higher neonatal mortality. It implies that in a limited resource and geographically challenging country such as Indonesia, improving the quality and optimizing services of public hospitals with equitable distribution of quality health care services in all regions should be prioritized in the efforts of reducing neonatal mortality rate.

Clinical and bacteriological profile of culture-negative and culture-proven neonatal sepsis in Palembang, Indonesia

Culture-negative and multidrug-resistant neonatal sepsis frequently occur in developing countries and complicate neonatal sepsis management. These conditions contribute to a high neonatal mortality rate and accelerate the misuse of antibiotics. However, the extent of culture-negative and multidrug-resistant neonatal sepsis in developing countries remains poorly characterized. This study aims to describe culture-negative and culture-proven neonatal sepsis epidemiology and the antimicrobial resistance patterns in Palembang, Indonesia. A retrospective review of the medical records of all neonatal admissions between January 2016 and December 2018 was conducted at a tertiary-level referral hospital in Indonesia. The maternal and neonatal characteristics and microbiological results of the identified sepsis cases were obtained and analyzed. Three hundred and fifty-six neonatal sepsis cases were admitted from 2016 to 2018, accounting for 14.1% of neonatal hospital admissions. The percentages of early-onset and late-onset sepsis were comparable (49.7% vs. 50.3%), with an 18.1% case fatality rate. The proportion of culture-negative sepsis was 44%. The mortality rates between culture-proven and culture-negative sepsis cases did not differ statistically (p = 0.11). Coagulase-negative staphylococci (30.9%), Klebsiella pneumoniae (18.1%), and Acinetobacter spp. (10.7%) were the most frequently isolated pathogens. Overall, 62.6% of all isolated organisms were multidrug-resistant bacteria, with a high prevalence of extended-spectrum cephalosporin-resistant and carbapenem-resistant strains. Culture-negative sepsis accounts for a significant proportion of neonatal sepsis cases. Early- and late-onset and culture-negative and culture-proven neonatal sepsis contribute to a comparable proportion of neonatal sepsis morbidity and mortality. There is an alarmingly high prevalence of resistance to extended-spectrum cephalosporin and carbapenem in neonatal sepsis cases.

506. Neonatal CD8+ T Cells Demonstrate PD-1 Dependent Impairment Following Human Metapneumovirus Infection

Abstract Background Human metapneumovirus (HMPV) is a leading cause of pediatric acute respiratory illness, accounting for 14.2 million acute lower respiratory tract infections and 500,000 hospitalizations per year in children less than 5 years of age globally. Infants and neonates are particularly susceptible to severe HMPV disease. Our prior studies in adult mice demonstrated CD8+ T cells were critical for clearance of HMPV infection, although these cells show impaired function due to PD-1:PD-L1 signaling. However, the immune system in the neonatal lung skews towards an anti-inflammatory and tolerogenic response when compared to adults. We therefore sought to explore the roles CD8+ T cell and PD-1 signaling in neonatal mice to recapitulate the population at highest risk. Methods C57BL/6 or Pdcd1-/- pups were infected intranasally with 1.0x106 PFU/g of a clinical isolate of HMPV (TN94-49) on day of life 4-6. Viral burden was assessed via plaque assay and cellular responses were characterized by multispectral flow cytometry. Results HMPV infection led to stunted weight gain in pups compared to mock-infected controls. HMPV-infected neonatal mice had a robust innate immune response comprised of neutrophils, CD103+ dendritic cells, and interstitial macrophages, all of which demonstrated upregulation of PD-L1. From an adaptive perspective, neonatal mice mounted an antigen-specific CD8+ T cell response and resolved HMPV infection by day 8 post-infection. Similar to our prior studies in adult mice, neonatal CD8+ T cells upregulated expression of several inhibitory receptors, such as PD-1, LAG-3, and TIM-3. Neonatal CD8+T cells demonstrated limited effector cytokine production, such as IFN-γ and granzyme B, following ex vivo stimulation with a class I HMPV-specific peptide. Pdcd1-/- mice (lacking PD-1) also mounted an antigen-specific CD8+ T cell response, but had markedly increased production of IFN-γ and granzyme B. Conclusion These data demonstrate that PD-1 signaling on CD8+ T cells constrains the antiviral response in a novel model of neonatal respiratory viral infection. Understanding the mechanisms that inhibit neonatal anti-viral responses could present opportunities for novel therapeutic strategies for common infections with high morbidity and mortality in neonates and infants. Disclosures John Williams, MD, GlaxoSmithKline: Advisor/Consultant|Quidel: Advisor/Consultant.

Women’s Experiences of Respectful Maternity Care during Facilitybased Childbirth in Benin City, Southern Nigeria

Background: Respectful maternity care (RMC) is an effective strategy for improving the quality of care experienced by women during facility-based childbirth. A lack of RMC is a key factor driving both the low proportions of facility-based deliveries and high maternal and neonatal mortality. This study was conducted to assess the experiences and predictors of RMC among women of reproductive age in Benin City, Edo State.&#x0D; Methods: A descriptive cross-sectional study was carried out among mothers in Benin City, who had facility-based childbirth within three months of the study. Respondents were selected using a two-stage sampling technique. Data was collected using a structured interviewer-administered questionnaire. RMC was assessed using 15-item RMC scale in four domains and analysed using IBM SPSS version 22.0. Binary logistic regression was conducted to determine significant predictors of RMC. A p-value &lt;0.05 was considered statistically significant.&#x0D; Results: A total of 393 women with a mean age (SD) of 33.42 (7.4) years participated in the study. Overall, 141 (35.9%) of respondents experienced RMC. Friendly care, abuse free care, timely care and discrimination free care were experienced by 147 (37.4%), 211 (53.7%), 252 (64.1%), and 124 (31.6%) respectively. Formal education [AOR = 0.318 (0.106-0.956)], primiparity/multiparity [AOR = 0.527 (0.294-0.945)] and use of public facility for childbirth [AOR = 1.623 (1.047-2.516)] were significant predictors of RMC.&#x0D; Conclusion: The proportion of respondents who experienced RMC was low in the studied population. Effective communication and engagement of health care providers is essential for the provision of RMC in all contexts and settings.

Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to-7]). Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.

Risk factors & perinatal outcomes of major depression during pregnancy: A population-based study during 2010-2020 in two major cities of Pakistan.

Ever since the world came into being different factors and circumstances contributed in a deteriorating fashion to mental health, and depression is the commonest of mental disturbance and incapability. We aimed to identify the risk factors for perinatal outcomes of maternal depression. Data extracted was from two important cities of Pakistan i.e Islamabad and Karachi, and the numbers are 500,000 and 800,000 respectively. The timeline of the information was from 2010 to 2020 to signify a decade. Women with active pregnancy and depression were included. Chisquare analysis was run to predict which factors had a significant impact on depression. Odds ratio was separately run on the significant factors. Regression analysis was done to describe the relationships between independent variables and each other. The most preferred procedure of delivery was cesarean section in Islamabad and more than 500,000 in Karachi. Low-income women in Karachi had a mean depression score of 12.4 while men with the same socioeconomic class had a score of 23.4. 15.7 females in Islamabad reported medications taken during pregnancy & 34.9 females from major depression group. Mean of 87.9 individuals from Islamabad reported living with husband from no serious depression during pregnancy. In Population of Islamabad, Previous pregnancies and birth weight in comparison with depression is significant having p value 0.00. Maternal age, fetal sex & gestational age are also significant indicators of whether a woman is depressed or not. Apgar scores & violence in relation to depression are significant in Karachi Population having p values of 0.049 and 0.028. Female health and neonatal care should be a serious concern, but unfortunately in spite of progression in the field of medicine the low income or third world countries don't have sufficient awareness and due to that Pakistan still reports high maternal and neonatal mortality rates.

Impact of socioeconomic factors and health determinants on preterm birth in Brazil: a register-based study

BackgroundMore than 15 million children are born preterm annually. While preterm survival rates have increased in high-income countries. Low- and middle-income countries, like Brazil, continue to battle high neonatal mortality rates due to a lack of adequate postnatal care. Globally, neonatal mortality is higher for preterm infants compared to those born at term. Our study aims to map and analyze the spatial, socioeconomic, and health coverage determinants related to preterm birth in Brazil in order to understand how spatial variations in demographics and access to primary care may affect preterm birth occurrences. MethodsUsing publicly available national-level data from the Brazilian health system for 2008–2017, we conducted an ecological study to visualize the spatial distributions of preterm birth along with socioeconomic status, the structure of health services, and primary care work process, each consisting of multiple variables reduced via principal component analysis. Regression models were created to determine predictive effects of numeric and spatial variation of these scores on preterm birth rates.ResultsIn Brazil, preterm birth rates increased from 2008–2017, with small and rural municipalities frequently exhibiting higher rates than urban areas. Scores in socioeconomic status and work process were significant predictors of preterm birth rates, without taking into account spatial adjustment, with more positive scores in socioeconomic status predicting higher preterm birth rates (coefficient 0.001145) and higher scores in work process predicting lower preterm birth rates (coefficient -0.002416). Geographically weighted regression showed socioeconomic status to be a more significant predictor in the North, with the work process indicators being most significant in the Northeast.ConclusionsResults support that primary care work process indicators are more significant in estimating preterm birth rates than physical structures available for care. These results emphasize the importance of ensuring the presence of the minimum human resources needed, especially in the most deprived areas of Brazil. The association between social determinants of health and preterm birth rates raises questions regarding the importance of policies dedicated to foster equity in the accessibility of healthcare services, and improve income as protective proxies for preterm birth.

Abstract 15019: Safe Implantation of Remote Pulmonary Artery Pressure Monitoring System (CARDIOMEMS) in a Pregnant Patient With Severe Heart Failure

Introduction: Heart failure (HF) in pregnancy is associated with high maternal and neonatal mortality. Remote pulmonary artery pressure (PAP)-guided management of HF has been shown to reduce hospitalizations and mortality in HF patients. However, PAP monitoring systems (CardioMEMS) have not been implanted during pregnancy. We describe the first case of safe implantation of CarioMEMS in a pregnant patient with HF. Case report: A 38-year-old female with past medical history of non-ischemic cardiomyopathy with an ejection fraction of 15%, left ventricular thrombus, pulmonary hypertension, and atrial fibrillation was found to be 14 weeks pregnant by the obstetrician, and her HF medications were appropriately discontinued. The patient was continued on metoprolol, amlodipine, and enoxaparin and was advised to terminate the pregnancy due to high risk of maternal mortality, however, she decided against it. An interdisciplinary team of obstetricians and cardiologists managed the patient during her pregnancy. As the pregnancy progressed, the patient had multiple hospitalizations due to decompensated HF. To optimize her hemodynamic status and guide diuretic therapy, a decision to implant CardioMEMS was made after a risk-benefit discussion, at 23 weeks of gestation. A long wire and sheath were used from a femoral venous access to limit fluoroscopy. A right heart catheterization was performed, and cardiac filling pressures and output were measured. Minimal contrast (7.5 ml of iodixanol) was used to perform selective pulmonary artery angiography and the sensor was implanted according to manufacturer recommendations. Total fluoroscopic exposure during the procedure was 11.2 minutes (183 Gy-cm2). Patient’s diuresis and afterload reduction was adjusted based on PAP. Conclusion: Remote PAP monitoring system can be safely implanted in pregnant patients using limited contrast and fluoroscopic exposure to proactively manage heart failure.

Benckiser’s hemorrhage following a vasa previa rupture: An uncommon case report

Background: Vasa praevia is an uncommon but very serious condition that is characterized by the presence of vessels belonging to the fetal circulation in the amniotic membranes surrounding the internal cervical os below the fetal presenting part. These vessels are at risk of rupture in active labor, or when the membranes spontaneously or artificially rupture, which can result in an acute fetal exsanguination and death. The prenatal diagnosis is thus of paramount importance, allowing a prophylactic cesarean section and therefore avoids severe Benckiser’s hemorrhage responsible for very high neonatal mortality.

The delivery of essential newborn care in conflict settings: A systematic review.

Although progress has been made over the past 30 years to decrease neonatal mortality rates, reductions have been uneven. Globally, the highest neonatal mortality rates are concentrated in countries chronically affected by conflict. Essential newborn care (ENC), which comprises critical therapeutic interventions for every newborn, such as thermal care, initiation of breathing, feeding support, and infection prevention, is an important strategy to decrease neonatal mortality in humanitarian settings. We sought to understand the barriers to and facilitators of ENC delivery in conflict settings. We systematically searched Ovid/MEDLINE, Embase, CINAHL, and Cochrane databases using terms related to conflict, newborns, and health care delivery. We also reviewed grey literature from the Healthy Newborn Network and several international non-governmental organization databases. We included original research on conflict-affected populations that primarily focused on ENC delivery. Study characteristics were extracted and descriptively analyzed, and quality assessments were performed. A total of 1,533 abstracts were screened, and ten publications met the criteria for final full-text review. Several barriers emerged from the reviewed studies and were subdivided by barrier level: patient, staff, facility, and humanitarian setting. Patients faced obstacles related to transportation, cost, and access, and mothers had poor knowledge of newborn danger signs. There were difficulties related to training and retaining staff. Facilities lacked supplies, protocols, and data collection strategies. Strategies for improved ENC implementation include maternal and provider education and increasing facility readiness through upgrades in infrastructure, guidelines, and health information systems. Community-based approaches may also play a vital role in strengthening ENC.

Clinical profile of a cohort of neonates with seizures: Association between semiology, etiology, and electroencephalographic findings.

Seizures are the most common sign of neurologic dysfunction, reflecting a wide variety of central nervous system disorders. A retrospective cross-sectional study of neonates with a clinical diagnosis of seizures was conducted in order to verify relationships between clinical aspects and EEG findings. Patients were divided into 3 groups according to the EEG recording available as: 1) with confirmatory ictal EEG; 2) with altered but non-ictal EEG; and 3) without any EEG recording. Variables related to pregnancy and birth history, neonatal complications, and seizure semiology (by video or clinical description) were compared to EEG findings. 97 neonates were included (39.1% preterm, 54.6% male), 71 with available EEG data (56.3% with ictal EEG). The group without EEG presented clinical characteristics significantly different from the others such as extreme prematurity, low birth weight, and higher neonatal mortality (P = 0.002, 0.001, and 0.003, respectively). The most common etiology was hypoxic-ischemic encephalopathy (HIE) (46.4%) followed by vascular disorders, which predominated in extremely preterm neonates (P = 0.006). Sequential seizure was the most common type (44.6%) and was more frequently identified in term neonates (46%). In 51.2% of the ictal recordings the main finding was electrographic seizure without clinical manifestation. Discharge using antiseizure medication was higher among those with ictal or altered non-ictal EEG (P < 0.001). HIE is still a frequently etiology for neonatal seizures. Even if the patients in the sample were not under continuous EEG, the substantial proportion of electrographic seizures without clinical manifestations detected suggests the importance of continuous EEG monitoring in neonates at increased risk of seizures.

Social Autopsy a Tool for Maternal and Perinatal Death Surveillance and Response (MPDSR) Reporting in Pakistan

Social autopsy is a relatively new technique to report non-biological causes of death along with biological causes, which accounts for 12/15 maternal deaths in Pakistan, through direct interaction with the community. Pakistan had a highest neonatal mortality in the entire world. A significant number of unreported cases contributed to the high prevalence of neonatal and maternal mortality. Pakistan is one of the top 10 nations that contribute to 60% of maternal and perinatal deaths worldwide which demands social autopsy adoption in Pakistan. Information acquired by social autopsy will therefore be useful in developing any efforts to stop or treat causes linked with death. Social autopsy is a way of health promotion as it encourages individual and communal behavioral change and contributes in achieving United Nations Sustainable Development Goal (SDG) 3.1 by reducing maternal and perinatal death mortality by 2030 and 2035 respectively. In discussion with the family of a woman and community, health workers examine the social reasons of death and pinpoint reforms that are required. In Bangladesh, Brazil, Tanzania, India and Nigeria, maternal and perinatal deaths have been lowered due to adoption of social autopsy. Pakistan has embraced verbal autopsy, but it is an ineffective technique which just deals with the medical cause of death. Maternal and perinatal deaths are not just because of medical causes, it is also the result of interactions between several social, cultural and economic factors. Government of Pakistan is just spending 0.8% of its GDP on health. Standard of primary maternity care is generally unsatisfactory. Only 25% basic health units have qualified staff. Government of Pakistan should create a provincial MPDSR committee, strengthen the health care network and pilot social autopsy in Pakistan to meet SGD goal 3.

Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study in a tertiary care hospital in eastern zone of West Bengal

Background: Neonatal sepsis remains a leading cause of morbidity and mortality among neonates and clinical manifestations are non-specific. Delayed identification and inappropriate treatment remain as key factors causing high neonatal mortality. Increasing emergence of multidrug-resistant organisms reduces antibiotic options. Hence there is a need for institutional guidelines based on local microbial prevalence and their antibiotic susceptibility patterns.Methods: Blood cultures were collected from all suspected cases prior to the initiation of antimicrobial therapy. Neonatal sepsis with positive blood culture cases is included in the study.Results: Among 170 neonate blood culture was positive in 41 neonates (preterm - 71% and term neonate - 29%). Early onset neonatal sepsis (EONS) constituted 61% and Late onset neonatal sepsis (LONS) constituted 39%. Respiratory distress, hypoglycaemia, seizures, lethargy were more common presentations in EONS while cellulitis, sclerema, septic arthritis, loose stool, vomiting, blood in stool, hyperthermia and recurrent apnoea were more common presentations in LONS. Gram positive organisms constituted 51.2%, gram negative organisms were 46.3%, fungi were 9.8% of total pathogens. Among gram positive cons (43.9%) was most common while amongst gram negative Klebsiella (22%) was most common. Candida peliculosa was the most commonly isolated fungus. Cons, staphylococcus and enterococcus were seen to be 100% sensitive to linezolid. Enterococcus also showed 100% sensitivity to vancomycin, teicoplanin and tigecycline. Gram-positive bacteria showed the highest sensitivity to linezolid and vancomycin. Acinetobacter baumanii showed 80% sensitivity to gentamicin, 60% sensitivity to tigecycline and colistin. E. coli showed 66% sensitivity to tigecycline.Conclusions: We were able to analyze common causative pathogens, associated risk factors, and the antibiotic susceptibility pattern of neonatal sepsis.

An Overview of Rift Valley Fever Vaccine Development Strategies.

Rift Valley fever (RVF) is a mosquito-borne viral zoonosis that causes high fetal and neonatal mortality in ruminants and a mild to fatal hemorrhagic fever in humans. There are no licensed RVF vaccines for human use while for livestock, commercially available vaccines are all either live attenuated or inactivated and have undesirable characteristics. The live attenuated RVF vaccines are associated with teratogenicity and residual virulence in ruminants while the inactivated ones require multiple immunisations to induce and maintain protective immunity. Additionally, nearly all licensed RVF vaccines lack the differentiating infected from vaccinated animals (DIVA) property making them inappropriate for use in RVF nonendemic countries. To address these limitations, novel DIVA-compatible RVF vaccines with better safety and efficacy than the licensed ones are being developed, aided fundamentally by a better understanding of the molecular biology of the RVF virus and advancements in recombinant DNA technology. For some of these candidate RVF vaccines, sterilizing immunity has been demonstrated in the discovery/feasibility phase with minimal adverse effects. This review highlights the progress made to date in RVF vaccine research and development and discusses the outstanding research gaps.