Intrapartum Asphyxia Research Articles

Assessing Implementation of Helping Babies Breathe Program Through Observing Immediate Care of Neonates at Time of Delivery

BackgroundTraining in neonatal resuscitation has been shown to reduce deaths related to intrapartum asphyxia. Helping Babies Breathe (HBB) is a simulation-based program focusing on training healthcare providers (HCPs) in immediate neonatal care including stimulation, initiating bag mask ventilation (BMV) in the absence of breathing by 1 min of life, and delayed (30–60 s after birth) umbilical cord clamping (DCC). Data on implementation of HBB posttraining are limited.ObjectiveTo determine time from birth to spontaneous breathing, cord clamping, and initiation of BMV in a setting where the majority of HCPs are HBB trained.MethodsTwo research nurses observed deliveries conducted in two referral hospitals. Timing included the onset of breathing, cord clamping, and initiation of BMV. Deliveries were grouped according to the mode of delivery.ResultsIn total, 496 neonates were observed; 410 (82.7%) neonates cried or had spontaneous breathing (median time 17 s) soon after birth, 25/86 (29%) of neonates not breathing responded to stimulation, 61 (12.3%) neonates required BMV, and 2 (0.4%) neonates required chest compression and/or adrenalin. Neonates delivered by cesarean section (CS) took longer to initiate first breath than those delivered vaginally (median time 19 vs. 14 s; p = 0.009). Complete data were available in 58/61 (95%) neonates receiving BMV, which was initiated in 54/58 (93%) cases within 60 s of life (the “Golden Minute”). Median time to cord clamping was 74 s, with 414 (83.5%) and 313 (63.0%) having cord clamped at ≥ 30 and ≥ 60 s, respectively. Factors associated with BMV were CS delivery [odds ratio (OR) 29.9; 95% CI 3.37–229], low birth weight (LBW) (birthweight < 2,500 g) (OR 2.47; 95% CI 1.93–5.91), and 1 min Apgar score < 7 (OR 149; 95% CI 49.3–5,021). DCC (≥ 60 s) was less likely following CS delivery (OR 0.14; 95% CI 0.02–0.99) and being LBW (OR 0.43; 95% CI 0.24–0.77).ConclusionApproximately 83% of neonates initiated spontaneous breathing soon after birth and 29% of neonates not breathing responded to physical stimulation. BMV was initiated within the Golden Minute in most neonates, but under two-thirds had DCC (≥60 s). HBB implementation followed guidelines, suggesting that knowledge and skills taught from HBB are retained and applied by HCP.

Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs

ObjectiveIntraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous...

Ischemic hypoxic encephalopathy: The role of MRI of neonatal injury and medico-legal implication

Hypoxic ischemic encephalopathy is one of the major causes of neonatal death and neurological disability in the child, and represents the most common birth injury claim. Intrapartum asphyxia often leads to several long-term sequalae, such as cerebral palsy and/or developmental delay, epilepsy. Through the neuroimaging it’s possible to identify and define the different lesioned pictures and provide useful elements to establish the moment in which the damage occurred; indeed, timing of injury is a key element in the legal arena. Magnetic resonance imaging (MRI) is emerging as one of the most important tools in identifying the etiologic of neonatal encephalopathy as well as in predicting long-term outcomes.The aim of this study is to evaluate all MRI tests performed in a group of infants and young patients with possible neonatal encephalopathy, in order to determine the role of MRI in perinatal hypoxic-ischemic damage and the specific patterns that can point towards a diagnosis of the time of the damage’s onset. Another goal is to assess the role of MRI in cases subject to legal-medical ligation. Since the advent of hypothermic neuroprotection, new malpractice allegations have arisen, including the failure to initiate cooling in a timely manner. In all cases, documentation of the status of the baby at birth, including a thorough neurologic exam, can be extremely helpful to the later defence of a malpractice claim, which might occur years later.

Hypoxic-Ischemic Encephalopathy-Induced Seizure in an 11-Year-Old Female

Hypoxic-ischemic encephalopathy (HIE) typically manifests in the neonatal period. The degree of hypoxia following intrapartum asphyxia determines the structural changes in the brain, which can cause functional deficits in the affected child leading to developmental deficits and recurrent seizures. Management requires physical therapy, occupational therapy, and anti-seizure medications. We present a rare case of an 11-year-old female with a past medical history of epilepsy and cerebral atrophy secondary to hypoxic injury at birth. The patient presented to the hospital following a witnessed seizure and loss of consciousness for one hour. Given the past medical history and clinical findings, it was determined that a mild-to-moderate encephalopathic process resulted in a lower seizure threshold. HIE can manifest beyond the neonate years mainly due to the structural changes within the brain. Therefore, it is essential to understand aspects of HIE beyond the neonate years to manage this condition for a better patient outcome.

Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid

Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartumasphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS.However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult. OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid. We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020). We included studies enrollingnon-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began.Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium. Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; andpersistent pulmonary hypertension.We used the GRADE approach to assess the certainty of evidence. We included four studies (enrolling 581 neonates) in the review.All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation.Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risksof MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-causeneonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE(RR 1.05, 95% CI 0.68to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF.We are also uncertain as to the effect of tracheal suctionon other outcomes such as incidenceof mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates),persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06;3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05;3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence. We are uncertain about the effect of tracheal suctionon theincidence of MAS and its complications amongnon-vigorous neonates born through MSAF.One study awaits classification and could not be included in the review.More research from well-conducted large trials is needed to conclusively answer the review question.

Comparison of Uncontrolled and Device-Induced Therapeutic Hypothermia in Newborn Infants with Hypoxic Ischemic Encephalopathy

Background.Newborninfants who have undergone severe birth asphyxia have a high risk of neurological disorders and death. The most effective method for the treatment of hypoxic ischemic encephalopathy caused by intrapartum asphyxia is therapeutic hypothermia, or targeted temperature management. Currently, there are no large studies comparing its different methods, therefore theaim of our studywas to compare the effectiveness of device-induced and uncontrolled therapeutic hypothermia in newborn infants who underwent intrapartum asphyxia.Materialsand methods.Studydesign:weconducteda retrospective, longitudinal, cohort study in 39 newborn infants born in severe asphyxia and receiving uncontrolled therapeutic hypothermia (group 1), and in 48 newborn infants born in severe asphyxia and receiving device-induced therapeutic hypothermia (group 2). Statistical data processing was carried out using standard techniques.Results.The body temperature in newborn infants of both groups was reduced to 33.5 °C within the first hour, but when using uncontrolled therapeutic hypothermia, the body temperature fluctuated from 32 to 35 °C. Device-induced therapeutic hypothermia has a more effective neuroprotective effect as compared to uncontrolled hypothermia (p&lt; 0.05) and more rapidly stabilizes metabolism in newborns due to a decrease in lactate levels (p &lt; 0.05). In newborns device-induced therapeutic hypothermia stabilizes hemodynamics more quickly compared to uncontrolled therapeutic hypothermia (p &lt; 0.05). Device-induced therapeutic hypothermia reduces the period of hospitalization in the neonatal intensive care unit (p &lt; 0.05), the risk of cerebral edema (p &lt; 0.05) and of the repeated episodes of seizures (p &lt; 0.05).Conclusion.Using uncontrolled therapeutic hypothermia causes a high risk of unintentional fluctuations in rectal temperature towards both hypothermia and rewarming, which can aggravate the severe condition of newborn infants. Device-induced therapeutic hypothermia has a more effective neuroprotective effect.

MICROBIAL LANDSCAPE OF THE NEONATAL INTENSIVE CARE UNIT: A RETROSPECTIVE ANALYSIS

Objective. To investigate the structure, antenatal and intranatal risk factors and results of treatment of neonatal sepsis.Materials and methods. This study used analysis of 137 case histories of newborns from 2015 to 2019. We evaluated maternal risk factors, intrapartum asphyxia, duration of treatment, number of days on mechanical ventilation, the presence of sepsis, necrotic enterocolitis, mortality.Results and discussion. Most children were over 2500 g (69.3%). In infants with a birth weight lower than 1500 g were 10.9%. 70.8% of newborns received in the first 24 hours after birth. From the moment of admission to the department, among all infected children was 71%, mortality was 14%. In children under 29 weeks of gestation, the risk of developing sepsis is 17.2 times higher. (р˂0.001) In children under 1 kg of weight, the risk of manifestation of sepsis is 42.2 times higher. (р˂0.001)The maternal colonization have the risk of developing a child’s infection is 4.36 times higher. (р˂0.001)With a diagnosis of sepsis most infants were more than 2.5 kg and mortality remained significantly high 31.6-36.8% in all weight groups (0.00001), depending on birth weight.The majority of the applicants were children over 37 weeks, but mortality was significantly higher in the group from 29-37 weeks (0.00001), depending on the term of gestation.Among the studied mothers, up to 53% were maternal colonization and in this group the mortality of children was significantly higher than 23% (p=0.020).However, in the group of children where there were signs of ascending infection of the placenta (there were 25%) mortality was still significantly higher by 1.4 times, 32% (p=0,008).Conclusions. The risk of developing neonatal sepsis was increased in ascending infection (clinical chorioamnionitis) in 6.65 times, (р˂0.001), the presence of a coagulase-negative culture by 5.83 (р˂0.011) and invasive respiratory therapy by 18.52 times. (р˂0.002) Mortality rates are affected by gestational age OR=13.81 (р˂0.001), birth weight 1-1.5 kg OR=13.15 (р˂0.001), 1.5-2.5 kg OR=2.86 (р=0.043), maternal factors (vaginal colonization, ascending infection) OR=3,22 (р˂0.023), infection of placental membranes OR=4,32 (р˂0.008), the presence of sepsis OR=15,56 (р˂0.001), necrotic enterocolitis OR=8,06 (р˂0.001) and CoNS OR=4,98 (р˂0.033).

Spontaneous Foetal Intracranial Haemorrhage: Scrutinising the Inscrutable

The incidence of major Intracranial Haemorrhage (ICH) is not the common finding in a post-mortem of stillborn. Subdural haemorrhage is mainly associated with obstetric trauma. Minor subarachnoid haemorrhage is observed in cases of intrapartum asphyxia and prematurity. It is very uncommon to find ICH in a foetus who has died before onset of labour. ICH is rare in low risk patient with no history of trauma, hypertensive disorder of pregnancy, coagulation disorder and drug abuse. Here, authors presents a case of 30-year-old female patient whohad uneventful pregnancy till term when she had sudden intrauterine foetal demise without any precipitating cause. Autopsy of the foetus revealed spontaneous ICH, which included subdural and subarachnoid haemorrhage along with scalp haematoma.

Umbilical Coiling Index, A Predictor of Perinatal Outcome

Umbilical cord (UC) represents the “life source”, or the “entry and exit” point of humans which is the only source of energy. It is essential for the development, well-being, and survival of the nourishing baby. The characteristic of the coiling of the umbilical cord makes the cord a structure that is both flexible and strong and provides resistance to external forces which could compromise the blood flow to the foetus. UC is vulnerable to kinking, compressions, traction, and torsion, which may affect the intrauterine life and perinatal outcome due to coiling. One complete spiral of 360º of the umbilical vessels around each other is defined as Umbilical Coil. Abnormal coiling is defined as UCI less than the 10th percentile (i.e., Hypocoiled cord), UCI more than the 90th percentile (i.e., Hypercoiled cord), and the UCI between 10th and 90th percentile is Normocoiled cord. According to the literature studies, hypercoiled cords are usually associated with intrapartum foetal acidosis and asphyxia, foetal growth restriction, vascular thrombosis, and cord stenosis while the increased incidence of foetal demise, intrapartum FHR deceleration, low APGAR scores, preterm delivery, chorioamnionitis, structural and chromosomal abnormalities, and operative delivery have been associated more with hypocoiled cords. Hence, if the umbilical coiling index can be measured reliably in utero by ultrasound antenatally, then in future, it might become a promising prognostic marker for a better pregnancy and adverse foetal outcome.

Fetal physiology cardiotocography training, a regional evaluation

IntroductionCardiotocography (CTG) has its limits in detecting fetal acidosis and intrapartum asphyxia. Our aim was to evaluate a CTG training programme based on fetal physiology in the Mediterranean perinatal network. MethodsProfessionals from 41 maternity units of the Mediterranean network were invited to participate in a CTG masterclass based on fetal physiology in March 2019 and October 2019. They were asked to react to three practical cases by a physiological approach before the training course (T0), one month after (T1) and six to seven months after (T2). The mean scores were compared by using a mixed model including lapse of time to evaluation, profession of participants and level of the maternity unit as fixed effects. ResultsA total of 248 professionals from 32 maternity units finally participated in the organizational audit. By using a mixed model, we found a significant improvement of the mean score at T1=6.44/10 compared to T0=4.97/10 (p<0.0001), and a significant improvement of the mean score obtained at T2=6.17/10 compared to T0 (p<0.0001). T2 scores were not significantly different from T1 scores (p=0.143). DiscussionA CTG training programme based on fetal physiology showed a significant improvement in the professionals’ interpretation of CTG at short term and stable results at long term. Continuing medical education could help maintain and improve knowledge to ensure neonatal safety.

Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia.

Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.

Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: A retrospective analysis

To undertake a retrospective perinatal death audit and assessment of avoidable factors associated with stillbirths among a cohort of women in two provinces in Papua New Guinea. We used data from an ongoing cluster-randomized crossover trial in 10 sites among 4600 women in Papua New Guinea (from 2017 to date). The overarching aim is to improve birth outcomes. All stillbirths from July 2017 to January 2020 were identified. The Perinatal Problem Identification Program was used to analyze each stillbirth and review associated avoidable factors. There were 59 stillbirths among 2558 births (23 per 1000 births); 68% (40/59) were classified "fresh" and 32% as "macerated". Perinatal cause of death was identified for 63% (37/59): 30% (11/37) were due to intrapartum asphyxia and traumatic breech birth and 19% (7/37) were the result of pre-eclampsia. At least one avoidable factor was identified for 95% (56/59) of stillbirths. Patient-associated factors included lack of response to reduced fetal movements and delay in seeking care during labor. Health personnel-associated factors included poor intrapartum care, late diagnosis of breech presentation, and prolonged second stage with no intervention. Factors associated with stillbirths in this setting could be avoided through a package of interventions at both the community and health-facility levels.

EHBB/mHBS-DHIS2: Mobile Virtual Reality Provider Training in Helping Babies Breathe®

Background: Intrapartum asphyxia accounts for the deaths of around 280,000 babies per year. Helping Babies Breathe® (HBB) is an evidence-based global neonatal resuscitation training program. HBB utilizes an in-person dissemination model. However, there are challenges to maintaining training fidelity, data collection, and continuous learning and improvement. Aim: The objective is to develop and test an integrated mobile virtual reality (VR) simulation application (eHBB) and data collection tool (mHBS) for healthcare worker training in neonatal resuscitation. Methods: eHBB, a VR training application developed on the Unreal™ platform and accessible on mobile devices …

Newborn Liver Functions as an Adjunct Biomarker in Timing Fetal Neurologic Injury

Background: We hypothesized that in the presence of an intrapartum hypoxic ischemic insult, redistribution of cardiac output away from the hepatic circulation will result in unique patterns of hepatic dysfunction dependent on the degree and duration of the hypoxic ischemic insult. We evaluated the rise and clearance of Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) in term newborns with three common patterns of hypoxic ischemic encephalopathy as an adjunct biomarker in timing of fetal neurologic injury. Methods: We identified 230 term newborns with image proven hypoxic ischemic encephalopathy with profound neurologic impairment over a 30 year period from multiple institutions. Eighty four had liver transaminases in the first 72 hours of life to evaluate patterns of rise and clearance. Results: A total of 215 AST, 220 ALT and 204 NRBC values were collected. Similar to NRBC’s, the general trend was the more chronic asphyxia, the more elevated transaminases are shortly after birth with delayed clearance often beyond 48 hours of life. In acute profound intrapartum injury, liver transaminases demonstrated minimal rise with rapid normalization. There was no difference between groups regarding gender, gestational age and birthweight. Conclusion: No single proven biomarker is diagnostic of neonatal encephalopathy but newborn AST/ALT measured shortly after birth and daily for three days can provide additional evidence based medicine to confirm or refute allegation of acute intrapartum asphyxia.

Comparación de tres sitios de muestreo sanguíneo para la evaluación fisiometabólica en el lechón

Blood drawing of newborn piglets is necessary for physio-metabolic profiles assessment, and to determine gas change levels in it, what it is used in various phenomena diagnosis, such as, intrapartum asphyxia a non-infectious condition that causes a high rate of neonatal mortality in pigs. This study aimed to test three of the most common blood sampling sites used in piglets: umbilical cord (UC), retro-orbital sinus (ROS), and cava vein (VC), besides determining the differences among them, concerning to physio-metabolic variables and the acid-base balance. Thirty-two healthy non-asphyxiated piglets were randomly selected, coming from nine eutocic farrowing to carry out the three sampling sites. All of the physio-metabolic concentrations determined showed basal values within normal fetal ranges corresponding to the sampling site. However, UC values were more suitable for gas exchange diagnosis in asphyxia due to their similarity with physiological parameters of a normal newborn (pCO2= 36.10 ± 2.03, pO2= 32.68 ± 3.03), whereas for the metabolic profile (glucose and lactate) ROS values were more accurate for measuring a common lactate and glycaemia profile than the other sites. Therefore, when a physio-metabolic profile is required, the methodological approach of the blood-sampling site should be adequate to obtain the data needed for research following planned objectives and subsequent interpretation.

Challenges to improve antenatal and intrapartum care in South Africa.

The major causes of maternal and perinatal deaths have been well described in South Africa. These causes are related to HIV infection, placental insufficiency and intrapartum asphyxia. The health system failures that most commonly lead to preventable mortality are related to managing hypertensive disorders in pregnancy (HDP), detecting fetal growth restriction antenatally and managing labour effectively by providing caesarean delivery to those who need it and avoiding it in those who do not. Improving antenatal and intrapartum care are vital aspects in efforts to improve survival, but to achieve this the following challenges need to be overcome:managing the increased antenatal care contacts needed to detect HDPcreating a next level of expertise, and access for women to high-risk carecreating the environment for respectful care and companionship in labourmanaging labour as physiologically as possibledetecting and managing placental insufficiency.This article provides some exciting solutions to these health system barriers.

Social determinants and causes of child mortality in Pakistan: Analysis of national demographic health surveys from 1990 to 2013.

The aim of the study was to define social determinants, causes and trends in child mortality from 1990 to 2013 in Pakistan. Understanding social determinants, causes and temporal trends in child mortality can inform strategies aimed at improving child health in low and middle income countries. We characterised temporal trends and social determinants of child mortality in Pakistan using national demographic health survey data (1990-1991, 2006-2007 and 2012-2013). We analysed national data to generate regional estimates of health programme effectiveness. The annual rates of reduction for child mortality between 1990 and 2013 were estimated as follows: neonatal (-0.33% per annum), post-neonatal (3.13% per annum), infant (0.9% per annum), child (2.47% per annum) and under 5 (1.19% per annum). Bivariate analyses of 2013 data showed that living in Punjab or Balochistan province, belonging to lowest wealth quintile, lack of maternal education, previous birth interval < 2 years, first birth order and below average birth size were associated (p < 0.05) with greater risk of child mortality in Pakistan. Common factors associated with child mortality were fever, diarrhoea and pneumonia, while among stillbirths, intrapartum asphyxia, unexplained antepartum and antepartum maternal disorders were most frequent. Child survival strategies should integrate leading biosocial indicators and causes of death. Further research is needed to define the role(s) of social factors in child health and survival. These data should inform the implementation of cost-effective interventions for child survival and advance targeting of interventions to populations at increased risk of child mortality.

Caffeine administered to pregnant sows improves piglet vitality, gas exchange and body weight gain

Intra-partum asphyxia is the most common non-infectious etiology limiting the performance of neonate piglets. Previous studies indicate caffeine (orally and subcutaneously) reverses the effects of intra-partum asphyxia in neonate piglets. In this study, there was investigation of whether use of a novel therapeutic protocol for administering caffeine subcutaneously to pregnant sows would improve the newborn piglets’ vitality, physio-metabolic profiles and body weight gain. Sows were randomly divided into two groups (n = 10 each). Caffeine or NaCl 0.9% was administered 2 days pre-farrowing. Physio-metabolic profiles were measured using blood from the anterior vena cava. The vitality of piglets was evaluated immediately after birth. Piglets (n = 180) were weighed at birth and on days 7, 14 and 21 of lactation. Caffeine positively affected the vitality of the piglets, as indicated by greater vitality scores than that for the control group (8.72 ± 0.12 compared with 7.28 ± 0.16, P < 0.001). Metabolic values were similar between groups, but pO2 values were greater in the piglets with greater vitality scores treated with caffeine (19.10 ± 0.82 compared with 14.49 ± 1.42, P < 0.01), indicating increased respiratory rates. Body weight gain at day 21 was greater in the piglets treated with caffeine that had greater vitality scores than the control piglets having greater vitality scores (6.87 ± 0.18 compared with 6.52 ± 0.25 kg, P < 0.05). Caffeine administration before birth improves the vitality and respiratory capacity of piglets, increasing their adaptation to extra-uterine environment.

Diagnosis and management of postpartum hemorrhage and intrapartum asphyxia in a quality improvement initiative using nurse-mentoring and simulation in Bihar, India.

BackgroundIn the state of Bihar, India a multi-faceted quality improvement nurse-mentoring program was implemented to improve provider skills in normal and complicated deliveries. The objective of this analysis was to examine changes in diagnosis and management of postpartum hemorrhage (PPH) of the mother and intrapartum asphyxia of the infant in primary care facilities in Bihar, during the program.MethodsDuring the program, mentor pairs visited each facility for one week, covering four facilities over a four-week period and returned for subsequent week-long visits once every month for seven to nine consecutive months. Between- and within-facility comparisons were made using a quasi-experimental and a longitudinal design over time, respectively, to measure change due to the intervention. The proportions of PPH and intrapartum asphyxia among all births as well as the proportions of PPH and intrapartum asphyxia cases that were effectively managed were examined. Zero-inflated negative binomial models and marginal structural methodology were used to assess change in diagnosis and management of complications after accounting for clustering of deliveries within facilities as well as time varying confounding.ResultsThis analysis included 55,938 deliveries from 320 facilities. About 2% of all deliveries, were complicated with PPH and 3% with intrapartum asphyxia. Between-facility comparisons across phases demonstrated diagnosis was always higher in the final week of intervention (PPH: 2.5–5.4%, intrapartum asphyxia: 4.2–5.6%) relative to the first week (PPH: 1.2–2.1%, intrapartum asphyxia: 0.7–3.3%). Within-facility comparisons showed PPH diagnosis increased from week 1 through 5 (from 1.6% to 4.4%), after which it decreased through week 7 (3.1%). A similar trend was observed for intrapartum asphyxia. For both outcomes, the proportion of diagnosed cases where selected evidence-based practices were used for management either remained stable or increased over time.ConclusionsThe nurse-mentoring program appears to have built providers’ capacity to identify PPH and intrapartum asphyxia cases but diagnosis levels are still not on par with levels observed in Southeast Asia and globally.

Intrapartum Asphyxia in Relation with the Risk for Developing of Cerebral Palsy

Intrapartum Asphyxia in Relation with the Risk for Developing of Cerebral Palsy