Neonatal Illness Research Articles

'This sickness is not hospital sickness': a qualitative study of the evil eye as a source of neonatal illness in Ghana.

Previous research has described the evil eye as a source of illness for pregnant women and their newborns. This study sought to explore the perceptions of the evil eye among mothers whose newborns had experienced a life-threatening complication across three regions of Ghana. As part of a larger, quantitative study, trained research assistants identified pregnant and newly delivered women (and their newborns) who had survived a life-threatening complication at three tertiary care hospitals in southern Ghana to participate in open-ended, qualitative interviews about their experiences in March-August 2015. All interviews were audio-recorded and transcribed verbatim into English and analysis using the constant comparative method of theme generation. A total of 37 mothers were interviewed, 20 about neonatal illnesses and 17 about maternal illnesses. Six of the 20 mothers interviewed about their newborn's illnesses spoke at length about the evil eye being a potential cause of newborn illness. The evil eye was described in a variety of terms, but commonalities included a person looking at a pregnant woman, her newborn baby, the baby's clothes and even the mother's food, causing harm, even unintentionally. Prevention required mothers covering themselves while pregnant and keeping the baby away from others until it was old enough to ward off the evil eye. Treatment required traditional medicine, yet some indicated that allopathic medicine could help. The evil eye appears to serve a social control mechanism, encouraging pregnant women to dress modestly, stay indoors as much as possible and behave appropriately. The evil eye is a pervasive, universally understood phenomenon across three regions of Ghana, even amongst a hospitalized population receiving allopathic health care for life-threatening complications of childbirth. Understanding the role of the evil eye in newborn illness attribution is important for clinicians, researchers and programmatic staff to effectively address barriers to care seeking.

Case-based learning in integrated management of neonatal and childhood illness

Background: This complete-enumeration, before-and-after type of study (without controls) was conducted on 61 third-year medical students at Rajiv Gandhi Medical College, Thane, Maharashtra state to study the difference in cognitive domain scores after attending lecture-based learning (by a pre-test) and after attending case-based learning (by a post-test).Methods: After approval from the institutional ethics committee, the purpose of the study was explained to third-year medical students and written informed consent was obtained. After curriculum-based lectures on integrated management of neonatal and childhood Illness, a pre-test was administered wherein each student was asked to fill up case sheets for five case scenarios. The maximum marks obtainable were 10 marks per case (total 50 marks). Case-based learning was conducted in two sub-groups comprising 31 and 30 randomly assigned students by the same faculty and students in each sub-group were exposed to identical case scenarios. The post-test was conducted using case scenarios and case sheets that were identical to that of the pre-test.Results: The overall mean score increased and the difference between the case-wise pre-test and post-test scores of both female (n=35) and male (n=26) students was highly significant (p <0.00001). However, the gender differences in pre-test score (Z=1.038; p=0.299) and post-test score were not significant (Z=0.114; p=0.909).Conclusions: Using case scenarios augmented the cognitive domain scores of participating students and the gender differences in scores were not statistically significant. The post-test scores showed higher variability. Remedial educational interventions would be required for students who obtained low scores in the post-test.

Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

BackgroundWhile obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined. ObjectiveA systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy. DesignA comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included. Main outcome measuresOutcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores. ResultsThirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent. ConclusionsBariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.

Delayed illness recognition and multiple referrals: a qualitative study exploring care-seeking trajectories contributing to maternal and newborn illnesses and death in southern Tanzania

BackgroundMaternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death.MethodsWe conducted 48 in-depth interviews (16 participants who experienced maternal illnesses, 16 mothers whose newborns experienced illness, eight mothers whose newborns died, and eight family members of a household with a maternal death), and five focus group discussions with community leaders in two districts of Mtwara region. Thematic analysis was used for interpretation of findings.ResultsOur data indicated relatively timely illness recognition and decision-making for maternal complications. In contrast, families reported difficulties interpreting newborn illnesses. Decisions on care-seeking involved both the mother and her partner or other family members. Delays in care-seeking were therefore also reported in absence of the husband, or at night. Primary-level facilities were first consulted. Most respondents had to consult more than one facility and described difficulties accessing and receiving appropriate care. Definitive treatment for maternal and newborn complications was largely only available in hospitals.ConclusionsDelays in reaching a facility that can provide appropriate care is influenced by multiple referrals from one facility to another. Referral and care-seeking advice should include direct care-seeking at hospitals in case of severe complications and primary facilities should facilitate prompt referral.

Neurodevelopment medium-term outcome after parechovirus infection

AimHuman parechoviruses (HPeV) are responsible for fever without a source (FWS), sepsis-like illness and encephalitis in neonates and children under 3 months of age. Short-term outcome is generally good, but there is great concern about medium and long- term outcome of infants after HPeV infection. The aim of this study is to assess the medium-term outcome in infants following HPeV infection without encephalitis. MethodsPatients who suffered HPeV infection involving cerebrospinal fluid were evaluated twice using Ages and Stages Questionnaire-3 (ASQ-3). The first evaluation was conducted at least one year after the infection and the second one year later. ResultsSixteen patients were evaluated in the first assessment, and three of them presented mild alterations in motor function domains. Moreover, hypotonia was observed in the neurologic exam in one case, and hemiparesis in another case. In the second assessment fifteen patients were included, and only the patient with hemiparesis continued presenting gross motor disfunction, with complete recovery of the remaining patients. InterpretationWe have observed a good medium-term prognosis in infants after HPeV infections, with improvement of mild motor alterations after at-home intervention. Infants who suffer HPeV infection without encephalitis seem to have a better prognosis than those with encephalitis.

Etiology, presenting features and outcome of children with non-cirrhotic portal vein thrombosis: A multicentre national study

ObjectivesNon-cirrhotic portal vein thrombosis (PVT) is a main cause of portal hypertension in children. We describe the characteristics at presentation and outcome of a cohort of patients with PVT to determine clinical features and predictors of outcome. MethodsWe recorded: (1) Associated factors: prematurity, congenital malformations, neonatal illnesses, umbilical vein catheterization (UVC), deep infections, surgery; (2) congenital and acquired prothrombotic disorders; (3) features at last follow up including survival rate and need for surgery. Results187 patients, mean age at diagnosis 4 ± 3.7 years, had a history of prematurity (61%); UVC (65%); neonatal illnesses (79%). The diagnosis followed the detection of splenomegaly (40%), gastrointestinal bleeding (36%), hypersplenism (6%), or was incidental (18%). Of 71 patients who had endoscopy at presentation 62 (87%) had oesophageal varices. After 11.3 years’ follow up 63 (34%) required surgery or TIPS. Ten-year survival rate was 98%, with 90% shunt patency. Spleen size, variceal bleeding and hypersplenism at presentation were predictors of surgery or TIPS (p < 0.05). ConclusionPVT is associated with congenital and acquired co-morbidities. History of prematurity, neonatal illnesses and UVC should lead to rule out PVT. Large spleen, variceal bleeding and hypersplenism at presentation predict the need for eventual surgery in a third of cases.

Integrated Management of Newborn and Childhood Illness (IMNCI) Strategy and its Implementation in Real Life Situation.

To meet the sustainable development goals (SDG) target of reducing under-five mortality to 25 per 1000 live births, concerted efforts are required to end all preventable deaths of newborns and children under 5 y of age. There is evidence to support Integrated Management of Neonatal and Childhood Illness (IMNCI) as a cost- effective strategy which can improve child survival. IMNCI has 3 components- capacity building of health workers, health system strengthening and improving community and family practice. For best results, all three components of the IMNCI strategy should be implemented in a coordinated fashion. IMNCI implementation in india has been uneven. The main focus has been on capacity building and with little attention on system strengthening or improving community practices. Ill- sustained funding and poor monitoring and supervision system were additional factors which are major challenges. Since evidence based interventions remain same, IMNCI remains as relevant today as before. It would be appropriate to redesign it as per current needs and implement it with more planning with committed budget and inbuilt measures of quality improvement along with supportive supervision.

Leptospirosis: An important infectious disease in North American horses.

North American horses are commonly exposed to Leptospira organisms. Leptospira Bratislava is the most common infecting serovar but this serovar has not been confirmed to cause clinical disease in North American horses. Leptospira Pomona type kennewicki is responsible for most of the clinical diseases (leptospirosis) in North American horses. Leptospirosis is most commonly associated with diseases of the placenta and fetus, the kidneys and the eyes in horses. In-utero infections in pregnant mares may result in abortion, neonatal illness or birth of an antibody positive healthy foal. Acute renal failure in younger horses and recurrent uveitis in adult horses are other well documented clinical syndromes of leptospirosis. Abortions, neonatal disease and acute renal failure are caused by a subacute infection, while horses with Leptospira associated recurrent uveitis develop ocular disease months or years after the initial Leptospira infection. Diagnosis of Leptospirosis is made by a combination of antigen or antibody testing methods. Mares that abort following Leptospira infection have no additional clinical signs at the time of abortion but may shed the offending Leptospira spp. in the urine for several weeks. Antibiotic treatments are sometimes used in hopes of decreasing Leptospira shedding in infected horses or prophylactically in exposed pregnant mares but documentation of efficacy is lacking. Horses with Leptospira - associated acute renal failure can be successfully treated with antibiotics and supportive care. Recurrent uveitis is commonly associated with leptospirosis in North American horses and although horses may have chronic intraocular infection triggering an immune disease, systemic antimicrobial therapy has not been effective in eliminating the organism from the eye. An equine approved Leptospira Pomona type kennewicki vaccine is now available in North America.

Prelacteal feeding practice and its associated factors among mothers of children age less than 24\u2009months old in Southern Ethiopia

BackgroundAlthough Pre-lacteal feeding is a barrier for implementation of optimal breastfeeding practices and increases the risk of neonatal illness and mortality, still it is continued as a deep-rooted nutritional malpractice in developing countries. In Ethiopia pre-lacteal feeding continued as one of the nutritional malpractices in newborns. Therefore the aim of this study was to assess pre-lacteal feeding practice and its determinants among mothers of children less than 24 months of age in Sodo zuria district, Wolaita zone, Southern Ethiopia.MethodsCommunity-based cross-sectional study was conducted from February 15, 2017 to March 12, 2017 in Sodo zuria district, Wolaita zone, Southern Ethiopia. Five hundred five (505) mothers of children aged less than 24 months were selected by multistage randomized sampling technique and the data were collected by using interview based structured questionnaire. Descriptive statistics, binary and multivariable logistic regression analysis were employed to identify the factors associated with pre-lacteal feeding practices. Variables with a p-value < 0.05 were identified as statistically significant factors.ResultsThe prevalence of pre-lacteal feeding practice was 20.6%. The common type of pre-lacteal feeding given was plain water; 38(7.7%) and the major reason was insufficient breast milk 32(6.5%). Mothers living with extended family type (AOR = 10.64, 95% CI: 1.05, 10.71), Lack of breastfeeding counseling (AOR = 5.16, 95% CI: 1.76, 15.13) and mothers who avoid colostrum (AOR = 9.72, 95% CI: 3.46, 27.30) were statistically significant positive predictors of pre-lacteal feeding practice.Conclusion & RecommendationPre-lacteal feeding is commonly practiced in Soddo zuria district. Mothers who live with extended family type, mothers who did not get breastfeeding counseling and mothers who avoid colostrum were statistically significant positive predictors of pre-lacteal feeding practice. Therefore, strengthening breastfeeding counseling about the risks associated with pre-lacteal feeding and colostrum feeding intervention should be integrated. Promotion of intensive nutrition education program, on the benefit of colostrum by giving special emphasis to extended family mothers should be implemented in the community.

Neonatal microbiome: A complex, invisible organ and its evolving role in neonatal illness and beyond

Neonatal microbiome is a complex amalgamation of millions of organisms harboring inside and outside the body with a pivotal role in neonatal physiology and pathology. Yet it is a relatively less-discussed topic in day-to-day practice. With its origin right from the womb, it has its own genetics, weight and is responsible to maintain homeostasis. As the field of neonatology has grown exponentially over the last few decades, the understanding of neonatal microbiome has grown on par with it. With more and more evidence revealing its seminal role during the neonatal period and beyond, it is not only leaving us amazed but also cautious. How far we realize this super organ's importance in our patient cohort and what role should we play assisting this large family with millions of members to grow symbiotically and prevent posing any threat our tiny little babies need to be discussed. This article was written to make the neonatologist aware of the neonatal microbiome, how it develops right from the womb and its evolution over a period. The article also sensitizes the reader on its role in various neonatal diseases, especially necrotizing enterocolitis and what neonatologist should be doing in the intensive care unit while this is happening.

Assessment of knowledge and practical skills among integrated management of neonatal and childhood illness program healthcare personnel in primary healthcare centers

Background: Integrated management of neonate and childhood illness (IMNCI) guidelines are a simplified system of diagnosis and treatment design for the use by the health workers with limited training. The IMNCI aims to reduce death and illness and to promote growth and development among children under 5 years of age and target acute causes of childhood death. Objectives: To study the knowledge and performance of doctors and healthcare workers about IMNCI program and assess the adherence of doctors and healthcare workers to IMNCI guidelines for managing childhood disease. Materials and Methods: The study is a cross-sectional study conducted in primary healthcare centers in Babylon Governorate from February to May 2019 on 130 healthcare personnel using a predesignated semi-structured questionnaire including sociodemographic characteristics and knowledge and practice domains about IMNCI. Results: The mean age of participants was 37.8 ± 10 years and the age category of ≥40 years was the most prevalent (40.8%). While 31.5% aged 20–29 years of age, 27.7% aged 30–39 years of age. The female gender was more dominant among the study sample as 112 (90.8%) of them were females compared to 18 (9.2%) males. Regarding occupation of the study sample, 28.5% of them were family medicine specialists, 27.7% paramedical staff, 23.8% graduate doctors, and 20% were general practitioners. 62% had serving more than 1–10 years while <7.7% had serving <1 year. 76.2% had training in IMNCI while 23.8% without IMNCI training. 56% of total study sample had fair knowledge level, 37% had poor knowledge level, while 7% only had good knowledge. More than 28% had fair practice while 72% had poor practice. Conclusion: This study showed that the majority of healthcare personnel had fair knowledge about IMNCI while practical skills were poor.

Utilization of Integrated Management of Neonatal and Childhood Illness (IMNCI) Guidelines and Associated Factors among Nurse at Public Health Institutions in West Arsi Zone, South East Ethiopia

Background: World health organization (WHO) and United Nations for Children‘s fund (UNICEF) in the early 1990s developed Integrated Management of Childhood Illness (IMCI), a strategy designed to reduce child mortality and morbidity in developing countries. This study is aimed at assessing factors associated with utilization of IMNCI protocol by nurses West Arsi Zone, Oromia Region, Ethiopia. Methods: An institutional based cross-sectional study was conducted on a total of 185 nurses who were included from health facilities selected using simple random sampling technique. Data was coded, entered and cleaned using Epi-data 3.1 and exported to SPSS version 22 for analysis. Univariate and bivariate analysis was performed. Multivariate analysis was also done to control for possible confounding variables. Results: Data were obtained from 185 nurses, of which 131 (70.8%) were males. More than half 103 (55.7%) of the respondents was aged between 25-29 years. The mean (± SD) age was 26.65 ± (1.7) with the range of 20-43 years and 107 (57.8%) were diploma nurses. The overall IMNCI protocol utilization was 58.7%. In multivariate analysis, the odd of IMNCI utilizations among nurses who had attended IMNCI training were 2.76 times higher compared to nurses who had not attended IMNCI training [AOR=2.76, 95% CI:1.388, 5.51]. Nurses who had practice of always referring chart booklet during every case management process were three times more likely to utilize IMNCI protocols [AOR=2.95, 95% CI: 1.48, 5.89] compared to their counterparts. Conclusions: The proportion of IMNCI utilizations in the selected districts was low and less than the WHO recommendations. Training and frequent referring of chart booklet were found to significantly associate with the utilization of the IMNCI protocols. Therefore the emphasis should be given to the provision of IMNCI training to the nurse by the stakeholders and motivating the nurses to always refer chart booklet, in order to enhance proper utilization of the protocols.

Treatment by untrained providers among sick infants in rural Odisha, India.

This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants. In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice. A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form - designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers. A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics - cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.

Predictors in profile of referred newborns for their outcome in a tertiary newborn referral facility

Background: This study was aimed to assess newborn referral and factors contributing to outcome of referred newborns.Methods: This prospective observational study was conducted in a tertiary newborn referral facility for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and assessed in terms of demographic profile, transport characteristics, physiological variables. Investigations, management of neonatal illness was done as per standard management protocols, they were followed up to their outcome.Results: Out of 2000 enrolled referred newborns, 30.10% were expired. Mean gestational age for survived newborns was 36.54±2.92 (SD) weeks, for expired newborns 35.24±3.99 (SD) weeks. Mean weight for survived newborns 2312.27 gms ±555.71 (SD), for expired newborns 1936.71 gms ±665.67 (SD). Out of total 60.05% newborns transported from periphery, had higher mortality i.e. 35% as compared to newborns transported from urban place i.e. 25%. Mean transport duration for survived newborns 61.94 minutes ±55.18 (SD), for expired newborns 89.51 minutes ±88.94 (SD). Prolonged CRT was observed in 57.45% newborns, grunting 19.70%, Cyanosis 11%, gasping 7.6%, apnea 5%, respiratory distress 39.80%, hypothermia 74.95%, and 25.50% required resuscitation on admission. Unattended delivery, self-arranged mode of transport, prolonged CRT, respiratory distress, apnea , hypothermia on admission, weight on admission(&lt;1500gms), hypoglycaemia and duration of transport more than 1 hour found statistically significant independent variables associated with mortality of referred newborns.Conclusions: A significant number of neonatal deaths can be prevented, if referral system is structured and organized. Improper referral leads to poor physiological profile of referred newborns, which leads to their poor outcome. There are many independent variables which are affecting the outcome of referred newborns. These independent variables can be taken care in holistic way once the referral system is cultured and nurtured in existing health system.

Prognostic Validity of Red Cell Distribution Width in Neonatal Sepsis

Background Neonatal sepsis is one of the most critical illness in neonates that is responsible for a great proportion of morbidity and mortality in neonates so early diagnosis and identification of high risk cases is a challenging aim of our study. The purpose of this study was to investigate the prognostic value of red cell distribution width (RDW), in neonatal sepsis at the time of admission to neonatal intensive care unit (NICU). Materials and Methods This prospective case control study included 3 groups divided into Group 1: Neonates with sepsis (78 neonates), Group 2: Neonates with severe sepsis (42 neonates) Group 3: Neonates as a control group (60 neonates) were gender, gestational and postnatal ages matched. Red cell distribution width was determined for all included neonates. The score for neonatal acute physiology (SNAP II) was determined within 12 hours of admission to the NICU. Results One hundred and two sepsis newborns (85%), including 66 (64.7%) cases from sepsis group and 36 (35.3%) cases from severe sepsis group, the mortalities were 15.4% (n= 12), and 71.4% (n= 30) for group 1 and 2, respectively. The incidence of RDW increase in survivors group (45.7%) was significantly lower than in the non- survivors group (92.9%, n=39). The score for neonatal acute physiology (SNAP II) was positively correlated with RDW increase in newborns (r= 0.735 and p<0.05), and the mortality was positively correlated with RDW increase (r= 0.598 and P<0.05). Conclusion In our studyRDW is a helpful prognostic marker for early diagnosis of neonatal sepsis and identification of high risk cases.

Lung Ultrasound for the Differential Diagnosis of Respiratory Distress in Neonates

Background: Respiratory distress (RD) is the most common neonatal illness. Lung ultrasound (LUS) is a technique previously tested in neonatal studies on RD, but literature regarding its routine clinical applicability is still lacking. Objective: To assess the concordance between LUS performed by neonatologists with different training levels and chest X-ray (CXR) for the diagnosis of RD in newborns during the first 24 h of life. Methods: We enrolled newborns with RD during the first 24 h of life. Patients underwent LUS and CXR. LUS and CXR diagnosis were compared to evaluate concordance. Twenty percent of patients received two LUS (one from an experienced and one from a novice sonographer) to calculate the interobserver agreement. The difference in time needed to reach a diagnosis with LUS and CXR, and from novice and expert operators, was measured. Results: We studied 124 patients; 134 diagnoses were reported. The concordance between LUS and CXR diagnosis was 91% (95% CI 86–96%) with a κ statistic of 0.88 (95% CI 0.81–0.94). The median time to diagnosis was shorter for LUS (9.5 min, IQR 5–15) than for CXR (50 min, IQR 33–64) (p < 0.0001). In 25/124 patients, LUS was performed by both novice and experienced sonographers with complete concordance. The median time to diagnosis was shorter for expert (9 min, IQR 5–15) than novice operators (15 min, IQR 10–20) (p < 0.0002). Conclusion: LUS and CXR have a high concordance in the differential diagnosis of neonatal RD in the first 24 h of life. LUS has a shorter operation time than CXR.

Analysis of factors associated with changing general practice in the first 14 years of life in Wales using linked cohort and primary care records: implications for using primary care databanks for life course research

IntroductionPrimary care electronic health records (pcEHRs) are a valuable resource for life course research, however loss to follow up due to changing practices has received little attention. We investigated factors associated with changes in registration and record continuity in the Secure Anonymised Information Linkage (SAIL) databank, with ~80% practice coverage.&#x0D; Objectives and ApproachWe analysed linked pcEHRs for 1834 (882 girls) Millennium Cohort Study (MCS) participants, resident in Wales and with parental consent to health record linkage at the age seven MCS interview. We studied time from first to next general practice (GP) registration in Wales by fitting Cox proportional hazards models, and estimated mutually-adjusted hazard ratios (aHRs) for the following factors: child (sex, ethnicity, mode of delivery, gestation, birthweight, neonatal illness, wheeze, longstanding illness); maternal (age, education, lone parent status); household (income, housing tenure, residential mobility, urban/rural residence); GP type (SAIL-contributing/-non-contributing). Analyses were weighted for survey design (Stata: Release 15; StataCorp LP).&#x0D; ResultsThere were 3065 Welsh GP registrations for 1834 children. By age 5 years, 25% of children changed GP at least once, with 1070 (58.3%), 477 (26.0%) and 287 (15.7%) registered with 1, 2, 3+ GPs respectively up to 14 years of age. Children with older mothers (aHRs; 95% CI: 0.96; 0.95, 0.98; per year) or those residing in rural areas (0.75;0.56,0.99) were less likely, and those whose first registration was not with a SAIL contributing GP (2.16;1.60,2.93), whose mothers had no educational qualifications (1.40;1.15,1.71), or had recently changed address (1.62;1.21,2.16) more likely, to change GP. 305 (16.6%) children had never registered with a SAIL-contributing GP. Of 403 children initially registered with a SAIL contributing GP who then changed GP, 66.7% re-registered with a SAIL contributing GP.&#x0D; Conclusion/ImplicationsGeographically contiguous primary care databanks, such as the SAIL databank, enable a high proportion of children to be reliably followed over time despite changing GP. Similar analyses of databases based on geographically disparate volunteer GPs are needed to quality assure their suitability for life course epidemiology research.

Cord serum bilirubin as a predictor of neonatal hyperbilirubinemia in healthy term and late preterm neonates

Background: Icterus neonatorum is the most common neonatal illness occurring in the first 7 days of life. It is the most important cause for hospital readmissions during the early neonatal period and also the cause for neonatal morbidity. In this study our main objective is, to find out that whether detecting umbilical cord blood bilirubin levels soon after birth, will help to identify the development of significant jaundice in early neonatal period which requires immediate interventionMethods: This was a prospective observational study carried out among 150 term and preterm babies. Their cord bilirubin level were estimated. Jaundice was determined by using yellowish appearance of eyes, skin and Kramer score. Statistics employed include Chi-square test and receiver operator characteristic curveResults: Study participants enrolled into the study was 150. Cord serum bilirubin was significantly associated with Kramer score and yellowish discoloration of eyes and skin and not significantly associated with sex, mode of delivery, gestational age and birth weight. When cord serum bilirubin was compared against the occurrence of clinical jaundice, sensitivity was found to be 58.33%, specificity was 96.49% positive predictive value was 84% and negative predictive value was 88%. Receiver operator characteristics curve indicated that the area below the curve was 0.842.Conclusions: Cord serum bilirubin can be used as a screening tool to identify the neonatal jaundice in both term and late preterm babies. Present study has shown increased specificity than sensitivity which warrants further exploration.

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BackgroundNeurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.Methods and findingsWe assessed 3,964 children (with almost equal number of boys and girls distributed in 2–<6 and 6–9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6–9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2–<6 year olds ranged from 2.9% (95% CI 1.6–5.5) to 18.7% (95% CI 14.7–23.6), and for any of nine NDDs in the 6–9-year-old children, from 6.5% (95% CI 4.6–9.1) to 18.5% (95% CI 15.3–22.3). Two or more NDDs were present in 0.4% (95% CI 0.1–1.7) to 4.3% (95% CI 2.2–8.2) in the younger age category and 0.7% (95% CI 0.2–2.0) to 5.3% (95% CI 3.3–8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5–11.2) and 13.6% (95% CI 11.3–16.2) in children of 2–<6 and 6–9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6–9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.ConclusionsThe study identifies NDDs in children aged 2–9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Echocardiographic predictors of neonatal illness severity in fetuses with critical left heart obstruction with intact or restrictive atrial septum.

Neonates with critical left heart obstruction and intact atrial septum (IAS) or restrictive atrial septum (RAS) are at risk for hypoxia within hours of birth and remain a group at high risk for mortality. Prenatally diagnosed fetuses with critical left heart obstruction and IAS or RAS with follow-up from January 1, 2005, to February 14, 2017, were included. Primary outcome was a composite measure of severe neonatal illness (pH<7.15, venous pH<7.10, bicarbonate<16mmol/L, lactic acid>5mmol/L, or median oxygen saturation<60% within 2hours of birth). Of 68 live born fetuses, 52 (76.5%) had hypoplastic left heart syndrome, 14 (20.5%) had critical aortic stenosis, and two (3%) had complex anatomy with mitral stenosis/atresia. There were 27 (39.7%) fetuses with IAS and 41 (60.3%) with RAS. Severe neonatal illness was present in 36 (52.9%). The strongest discriminators for severe neonatal illness were a pulmonary vein A:R VTI≤2.7 (P<0.001, AUC 0.93) and larger pulmonary vein diameter (P=0.025, AUC 0.77). A:R VTI≤2.7 predicted death or transplant (log-rank P=0.03). In neonates with hypoplastic left heart syndrome and IAS or RAS, A:R VTI≤2.7 is predictive of severe neonatal instability. This threshold can help guide resource planning, delivery management, and improve fetal intervention criteria.