LBW Neonates Research Articles

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Background KMC is a global standard for LBW and preterm neonates, supported by evidence for reducing morbidities and mortality. Integrated into India’s Newborn Action Plan since 2014, aiming for single-digit neonatal mortality by 2030, KMC practices in India have not reached the optimal levels. Hence, we attempted to study the KMC practices in tertiary care NICUs across India. Methods A cross-sectional online national survey among neonatologists in level III NICUs in India was conducted. Utilizing Google Forms and a structured questionnaire of 30 questions on KMC, one respondent per unit participated. Results Of the 110 NICUs invited to participate, a total of 52 units responded (47.3%). All units have a written KMC policy and conventionally provide KMC to neonates with BW < 2000 g, while 36.5% units provide KMC for neonates with BW between 2000 and 2500 g. Though 86.5% of NICUs provide KMC to infants on respiratory support, only 13.5% practice KMC for mechanically ventilated neonates. The time to initiate KMC within 48–72 hours is prevalent in 44.2% of NICUs, with 54% of NICUs providing an average KMC duration of 4–8 hours/day. A significantly lower percentage of NICUs (28.9%) have a KMC follow-up program. Conclusion The study highlights the need to boost the ongoing KMC training programs for HCWs to increase the coverage of KMC for LBWs and sick preterm neonates. This includes requiring more uniform and structured KMC practices across the country, especially upscaling of infrastructure, earlier initiation and longer duration of KMC, better monitoring of neonates in KMC, and strengthening the follow-up program.

Predictors of time to full enteral feeding in low birth weight neonates admitted to neonatal intensive care unit: a prospective follow up study

BackgroundSurvival of LBW infants has increased in recent years because of novel perinatal interventions, but the introduction and advancement of enteral feeds for low birth weight infants is challenging. In Ethiopia the proportion of low birth weight infants is thought to be 17.3%. The purpose of this study was to determine the time to full enteral feeding (FEF) and its predictors in LBW neonates admitted to neonatal intensive care unit in selected hospitals of Addis Ababa, Ethiopia.MethodAn institutional based prospective follow up study was conducted from March 15 to June 15, 2022 among 282 LBW neonates admitted to six randomly selected hospitals. Both primary and secondary data was used by interviewing mothers and prospective medical chart review of neonates. The Cox regression model was used and variables having a p-value less than 0.05 with 95% CIs in a multivariable analysis were declared as statistically significant association with time to full enteral feeding.ResultOut of 282 neonates involved in this study, 211 (74.8%) of them reached at FEF. The overall median time to full enteral feeding was 5 days. Predictors significantly associated with time to full enteral feeding were educational level, birth weight, cesarean delivery, hospital acquired infection, being on antibiotics, age at initiation of trophic feeding, routine gastric residual evaluation and NICU location (hospital).ConclusionsThis study demonstrated the difficulty of understanding which low birth weight neonate will attain FEF in a timely manner and factors that affect time to FEF. There is a delay in full enteral feeding achievement among low birth weight neonates and there is a great deal of heterogeneity of practice among health care providers regarding feeding of infants as it was evidenced by a variation in feeding practice among hospitals. Nutrition should be considered as part of the management in neonatal intensive care units since low birth weight neonates are developing edematous malnutrition while they are in the NICU. There should be standard feeding protocol to avoid heterogeneity of practice and additional study should be conducted for each categories of GA and BW with long follow up time.

Risk factors associated with low birth weight at the Northern Regional Hospital in Belize. July-December, 2021

Low birth weight is a significant challenge for public health. It represents one of the most important aspects that can affect a newborn to experience satisfactory growth and development. Objective: to describe the risk factors for low birth weight in pregnant women treated at the Northern Regional Hospital, Orange Walk, Belize, for a period of six months. Method: A descriptive, retrospective study was carried out, with an epidemiological approach, of 27 mothers having newborns weighing <2500 g, between July and December 2021. Results: 65% of the newborns with LBW occurred in the second semester of the year, being August, September and December the most affected months. Dystocic births (C-sections) had the highest incidence, and most of the patients came from rural areas. Urinary tract infection had the highest incidence in almost all age groups, followed by anemia and hypertension as the three more prevalent comorbidities. Low maternal weight gain can be also considered as predictor for LBW. Conclusions: Improvement of preconceptional and prenatal care is essential to prevent LBW neonates and to decrease the high morbidity and mortality associated to this condition.

Establishment of the early prediction models of low-birth-weight reveals influential genetic and environmental factors: a prospective cohort study

BackgroundLow birth weight (LBW) is a leading cause of neonatal morbidity and mortality, and increases various disease risks across life stages. Prediction models of LBW have been developed before, but have limitations including small sample sizes, absence of genetic factors and no stratification of neonate into preterm and term birth groups. In this study, we challenged the development of early prediction models of LBW based on environmental and genetic factors in preterm and term birth groups, and clarified influential variables for LBW prediction.MethodsWe selected 22,711 neonates, their 21,581 mothers and 8,593 fathers from the Tohoku Medical Megabank Project Birth and Three-Generation cohort study. To establish early prediction models of LBW for preterm birth and term birth groups, we trained AI-based models using genetic and environmental factors of lifestyles. We then clarified influential environmental and genetic factors for predicting LBW in the term and preterm groups.ResultsWe identified 2,327 (10.22%) LBW neonates consisting of 1,077 preterm births and 1,248 term births. Our early prediction models archived the area under curve 0.96 and 0.95 for term LBW and preterm LBW models, respectively. We revealed that environmental factors regarding eating habits and genetic features related to fetal growth were influential for predicting LBW in the term LBW model. On the other hand, we identified that genomic features related to toll-like receptor regulations and infection reactions are influential genetic factors for prediction in the preterm LBW model.ConclusionsWe developed precise early prediction models of LBW based on lifestyle factors in the term birth group and genetic factors in the preterm birth group. Because of its accuracy and generalisability, our prediction model could contribute to risk assessment of LBW in the early stage of pregnancy and control LBW risk in the term birth group. Our prediction model could also contribute to precise prediction of LBW based on genetic factors in the preterm birth group. We then identified parental genetic and maternal environmental factors during pregnancy influencing LBW prediction, which are major targets for understanding the LBW to address serious burdens on newborns' health throughout life.

The relationship between COVID-19 vaccination status in pregnancy and birthweight

Despite findings that maternal COVID-19 infection in pregnancy is associated with low birth weight (LBW; weight < 2,500 grams), previous studies demonstrate no difference in LBW risk between COVID-19 vaccinated and unvaccinated pregnant persons. Few studies, however, have examined the association of unvaccinated, incomplete, and complete vaccination on LBW, and they have been limited by small sample sizes and lack of adjustment for covariates. We sought to address key limitations of prior work and evaluate this association between unvaccinated, incomplete, and complete COVID-19 vaccination status in pregnancy and LBW. We predicted a protective association of vaccination on LBW that varies by number of doses received. We performed a population-based retrospective study using the Vizient® clinical database, which included data from 192 hospitals in the United States. Our sample included pregnant persons who delivered between January 2021 and April 2022 at hospitals that reported maternal vaccination data and birth weight at delivery. Pregnant persons were categorized into three groups: unvaccinated; incompletely vaccinated (one dose of Pfizer or Moderna); or completely vaccinated (one dose of Johnson & Johnson or ≥ two doses of Moderna or Pfizer). Demographics and outcomes were analyzed using standard statistical tests. We performed multivariable logistic regression to account for potential confounders between vaccination status and LBW in the original cohort. Propensity score matching was used to reduce bias related to likelihood of vaccination, and the multivariable logistic regression model was then applied to the propensity score matched cohort. Stratification analysis was performed for gestational age and race/ethnicity. Of the 377,995 participants, 31,155 (8.2%) had LBW, and these participants were more likely to be unvaccinated than those without LBW (98.8% versus 98.5%, p < 0.001). Incompletely vaccinated pregnant persons were 13% less likely to have LBW neonates compared to unvaccinated persons (odds ratio 0.87, 95% confidence interval 0.73-1.04), and completely vaccinated persons were 21% less likely to have LBW neonates (odds ratio 0.79, 95% confidence interval 0.79-0.89). After controlling for maternal age, race/ethnicity, hypertension, diabetes, lupus, tobacco use, multifetal gestation, obesity, use of assisted reproductive technology, and maternal/neonatal COVID-19 infections in the original cohort, these associations remained significant for only complete vaccination (adjusted odds ratio 0.80, 95% confidence interval 0.70-0.91) and not incomplete vaccination (adjusted odds ratio 0.87, 95% confidence interval 0.71-1.04). In the propensity score matched cohort, pregnant persons who were completely vaccinated against COVID-19 were 22% less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals (aOR 0.78, 95% CI 0.76-0.79). Pregnant persons who were completely vaccinated against COVID-19 were less likely to have LBW neonates compared to unvaccinated and incompletely vaccinated individuals. This novel association was observed among a large population after adjusting for confounders of LBW and factors influencing the likelihood of receiving the COVID-19 vaccine.

Growth Parameters and Follow up of Low-Birth-Weight Healthy Newborn Discharged from Post Natal Ward of Dr. BRAMH Raipur till 4 Month of Age

Introduction: LBW is known to be associated with subsequent health issues such as poor anthropometric growth in childhood. Late catch-up growth of preterm infants throughout childhood linked to an adverse health outcome. The aim of this study is to study the growth parameters of healthy low birth weight neonates discharged from post-natal ward. Material and methods: This was a hospital based prospective cross-sectional study conducted in year of 2022 in the department of pediatrics at Pt JNMCH, Raipur. Vitally stable LBW neonates were recruited in the study. The sample size calculated was 140. At the time of birth anthropometric measurement i.e. head circumference, length, weight was taken. Follow up was done again at 1.5 month, 2.5 month and 3.5 month. Informed consent was taken form care takers prior to inclusion in the study. Results: In present study 140 newborns were followed up for their growth. The mean difference between birth weight at birth and at 1.5 months was 1.150 kg (p&lt;0.01), at 1.5 months and weight at 2.5 months was 1.129 kg (p&lt;0.01) and at 2.5 months and weight at 3.5 months was 1.436 kg (p&lt;0.01). Type of feed wise mean weight gain at 1.5 months was highest on those on formula feed, mother milk and those on mixed feed. Male had higher mean weight gain than female. Conclusion: The present study concluded that postnatal lactation counseling leads to higher weight gain in infants as compared to those on formula feed.

Physiological and electrophysiological evaluation of the hearing system in low birth weight neonates treated with cholestin: a cohort study

BackgroundInfections in neonates are mainly caused by sepsis and are the most important complications of low birth weight. In the treatment of these infections, it is common to use broad-spectrum antibiotics such as cholestin. Cholestin can cause changes in the latency of brainstem-evoked response waves. The current cohort study tried to investigate the probability of changes caused by cholestin in LBW neonates and benefiting from two common tests to identify the hearing system in neonates after treatment by cholestin and compared them with a control group.MethodsThe study was an exposure-based cohort, during which hearing damage caused by receiving cholestin was evaluated in 104 low birth weight neonates, in two groups (52 exposure and 52 no-exposure to cholestin). OAE and ABR tests were performed at the age of 3 months to identify complications in two groups and their results were compared.ResultsThe absolute latency of waves I, III, and V in the brainstem evoked response test with an intensity of 80 dB Hl showed a significant difference in the exposure group with the control group. The interpeak latency of the waves as well as the effect of the drug on the gender of the infants did not show significant differences with the control group.ConclusionCholestin did not affect the axonal or synaptic transmission time of the auditory nerve to the brainstem. It is possible that the simultaneous presence of risk factors, such as the use of cholestin, low birth weight, noises in the intensive care unit, and other unknown factors, can be effective in the change of the absolute latency of waves.

Low Birth Weight and Associated Factors among Newborn Babies - A Comparative Cross-Sectional Study

Objectives: Mortality and morbidity rate of low-birth-weight babies are major public health concerns worldwide. The main objective of this study was to determine the associated factors that are related to low birth weight.&#x0D; Methods: A comparative cross-sectional study was carried out from January 2021 to December 2021 among 208 mothers who delivered babies in two tertiary level hospitals in Dhaka city. Data were collected by using a pretested semi-structured interview-guided questionnaire and analyzed by SPSS 23 version software. &#x0D; Results: Significant associations were found between the low birth weight and some factors: babies delivered in rural areas (p=0.021), less educated mothers (p=0.018), and mothers having a low monthly income (p=0.007). Moreover, birth weight of the neonates was significantly associated with the number of antenatal visits (p=0.016) and intake of nutritional supplements by the mothers in last pregnancy (p=0.000). The mothers who took nutritional supplements in their last pregnancy had a lower proportion to deliver LBW (40%) that were significantly associated with nutritional status and birth weight (p=0.000). The mothers having low BMI had a higher rate of delivering LBW neonates (75%). A significant positive correlation was found between BMI of the mother and birth weight of the index child (r=0.243, p&lt;0.001).&#x0D; Conclusion: These study findings will guide us in paying special attention to the associated risk factors of low birth weight that will assist to formulate an intervention to prevent LBW by improving antenatal care and overall maternal health.

Clinical profile of low-birth-weight neonates admitted in NICU: a tertiary care hospital-based study

Background: LBW is defined as weight at birth less than 2.5kg irrespective of gestational age. LBW neonate remains at much higher risk of morbidity and mortality than normal birth weight baby. Morbidity and mortality among LBW babies are a major health problem in our country, so it’s important to identify risk factors. Methods: A prospective observational study was conducted on 153 extramural LBW neonates admitted in Neonatal intensive care unit of civil hospital, BJ medical college Ahmedabad from April 2021 to January 2022. Results: Out of 153 neonates, 94 (61.4%) were preterm, appropriate for gestational age and 59 (38.6%) were small for gestational age including 41 (26.8%) term and 18 (11.8%) preterm. 16 (10%) were extremely LBW neonates and 28 (18%) were very low birth weight neonates. 77 (53%) neonates were late preterm and term gestational age. Most common indication of NICU admission was respiratory distress syndrome in 53 (27.8%) followed by sepsis 35 (18.4%), neonatal hyperbilirubinemia 22 (11.6%), birth asphyxia 15 (7.8%) and prematurity+LBW 16 (8.4%). Conclusions: Majority of LBW babies were preterm AGA babies. Respiratory distress syndrome, sepsis, birth asphyxia, prematurity and neonatal hyperbilirubinemia are major causes of admission. While, Respiratory distress syndrome, sepsis and birth asphyxia were common causes of expires. Respiratory distress syndrome is most common cause of morbidity and mortality in low-birth-weight babies. Appropriate and effective use of oxygen delivery system, surfactant, safe, early and effective transportation of neonates should be advised.

We are facing some barriers: A qualitative study on the implementation of kangaroo mother care from the perspectives of healthcare providers.

Health systems at all levels are under pressure to provide comprehensive and high quality of care based on the best evidencebased interventions. The kangaroo mother care (KMC) is one way to care for Low Birth Weight babies (LBW) especially in developing country where the rates of preterm and LBW neonates are higher and the resources are limited. The purpose of this paper is to explore healthcare providers' perspectives of kangaroo mother care implementation in perinatology ward in the rural surgical hospital of East Java Province, Indonesia. We conducted an in-depth interviews to identify KMC implementations. Ten healthcare providers engaged with KMC were interviewed. Data was analyzed using a thematic analysis. Healthcare providers reported positives perceptions of KMC and acknowledged their important roles to give education. The barriers in implementing the KMC including the level of knowledge and the age of the mother of LBW babies. KMC as a method of treating LBW babies is effective intervention care of preterm and LBW babies. This research provides information regarding the need of supports from all levels in KMC implementation.

Mode of Delivery and Neonatal Outcome in Adolescent Pregnancy (13-16 Years Old) Associated with Anemia.

Background: Adolescent pregnancy represents an important public-health problem due to its maternal and fetal outcomes. Adolescent patients are predisposed to multiple obstetrical complications, including anemia and preterm birth which has a higher incidence among this population; withal, in the specialty literature, anemia is considered to be a risk factor for preterm delivery; furthermore, multiple studies have demonstrated that a very young age is an independent risk factor for preterm birth. Objectives: The study aims to reveal if anemia during adolescent pregnancy has a negative impact on the time and mode of delivery and newborns’ outcomes. Patients and methods: We performed a retrospective multicentric study on adolescent pregnancy. We analyzed 172 patients aged between 13 and 16 years who delivered in two large tertiary hospitals between 1 October 2018 and 15 April 2022. We divided the patients into two groups—a study group (n = 64) with anemia and a control group (n = 108) without anemia. We evaluated the modes of delivery, the times of birth, and the neonatal outcomes by 1-min newborn’s Apgar score, neonatal intensive-care unit (NICU) admission, and the newborns’ weights. Results: The rate of cesarean section was higher in patients with anemia than in the control group (45.31% vs. 38.88%, p < 0.001). We found that patients between 13 and 16 years diagnosed with anemia have a higher risk of preterm birth than those without anemia (35.93% vs. 21.29%, p < 0.001); however, an increased rate of LBW neonates was observed in the anemic adolescent group ≤14 years (p < 0.001). Regarding the newborns’ 1-min Apgar score, NICU admission, no statistically significant differences were recorded between the two groups according to the severity of anemia. In the anemic patients’ group, prenatal screening was identified in 9.37% of cases, while in the control group, in 16.67% (p = 0.034), which represents negative predictive factors, along with a low socio-economic status for the presence of anemia in young adolescent patients. Conclusions: Anemia is a risk factor for preterm birth, LBW, and cesarean section in young adolescent pregnancy. The association of lack of prenatal care and low socio-economic status worsens maternal and neonatal outcomes.

Haemoglobin and iron store status in low birth weight babies and effect of early iron supplementation on them A randomized and open label study

Deficiency of iron affects multiple organ systems, and poor neurodevelopment is the most worrisome effect. Low birth weight neonates are more likely to develop iron deficiency anemia than term counterparts. The guidelines for supplementation of iron in LBW neonates are poorly defined with varying recommendations pertaining to the intiation. Hence this study focuses on the effect of early iron supplementation and iron store status in them.In this randomized open label interventional study, 48 LBW neonates (EI group) were administered iron supplementation (at 2 weeks or earlier when full feeds were achieved), and other 48 were controls. All neonates were assessed for hemoglobin level, RBC count and iron status indicators (Hematocrit, Serum Ferritin) at or after 6 weeks of postnatal age. The post-intervention values of mean haemoglobin (cases 12.68±1.51g/dl, Controls – 11.38 ± 1.03g/dl), mean serum ferritin (cases: 238.45 ng/ml, CONTROLS- 175.68 ng/ml), mean RBC count (cases: 3.94 million/mm, and mean hematocrit (cases: 33.16±3.75%, controls 34.04±3.45%)were noted, and the % change at 6 weeks follow up in mean Hb among - 25.19%, 31.45% (0.01); % change in mean ferritin at follow up: cases 15.13%, controls 32.99% (0.001); % change in mean RBC count at follow up: cases 19.21%, 33.82% (0.001)] when compared to pre- inetervention values was noted. Though the haematological parameters decreased in both groups, the levels were comparatively higher in the cases compared to the controls, and iron store status was better in early iron-supplemented infants. Iron supplementation in LBW neonates started as early as 2 weeks postnataly, improves the iron stores and decreases the risk of iron deficiency in these infants.

Evaluating the Sensitivity and Specificity of Echocardiography in Determining the Appropriate Position of Peripherally Inserted Central Catheters in Infants

Background: In this study, we aimed to evaluate the accuracy of echocardiography compared to plain radiography in determining the appropriate line tip position of peripherally-inserted central catheters (PICC). Also, we aimed to evaluate the relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and related complications with PICC line tip position. Methods: In this prospective observational study, which was performed in the neonatal intensive care units of teaching hospitals affiliated with Iran University of Medical Sciences in 2019, 50 out of 96 neonates were non-randomly selected based on inclusion criteria. The radiographic and echocardiographic tests were simultaneously performed, and the data were analyzed. Results: The findings of this study showed that there was an agreement between radiography and echocardiography in determining the PICC line tip position in 43 neonates (86%). The sensitivity and specificity of echocardiography in determining the ectopic position of the catheter were 81% and 77%, respectively. In 32 neonates (64%), a second radiograph prevented the following line manipulation using echocardiography. In addition, there was no significant relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and PICC line complications. Conclusions: The results of the present study showed that echocardiography was a useful tool for determining the position of the catheter’s tip in LBW neonates. It also minimizes radiation exposure on subsequent radiographs and obviates the need for additional radiographs following catheter manipulation by echocardiography.

Efficacy of Kangaroo Mother Care among Low Birth Weight Newborns at a Tertiary Care Hospital: A Cross-Sectional Study

Aim: To assess the efficacy of Kangaroo Mother Care (KMC) among low birth weight neonates at a tertiary care hospital&#x0D; Study Design: A cross-sectional study&#x0D; Place and Duration. The Kangaroo mother care ward, CMC Children Hospital, Larkana from August 2019 to February 2020.&#x0D; Methodology: Total 345 low birth weight patients were included. Newborns were kept in KMC position. Axillary temperature was measured during KMC position. Stratification of study variables was done while post-stratification chi-square test or independent sample student t-test was employed to see the impact of effect modifiers on the outcome (efficacy) considering p-value ≤0.05 as significant.&#x0D; Results: Out of a total of 345 LBW neonates, there were 198 (57.4%) boys and 147 (42.6%) girls. The mean age of neonates was 12.01\(\pm\)7.68 days while majority 177 (51.3%) were aged less than or equal to 10 days. The mean body weight was 1997.22\(\pm\)243.48 grams. The mean gestational age was noted to be 35.35\(\pm\)1.37 weeks. There were 104 (30.1%) neonates who belonged to rural areas while 241 (69.9%) were from urban areas. The mean mother’s temperature was 37.58\(\pm\)0.98 C. The mean room temperature was 33.11\(\pm\)2.59 C. The mean initial temperature was 35.40\(\pm\)0.48 C. The efficacy of KMC was observed to be in 242 (70.1%) cases.&#x0D; Conclusion: The KMC was found to be effective and useful in caring LBW neonates. Further advantages of KMC are low cost, promotion of exclusive breast-feeding and increased mother’s confidence in handling LBW babies.

Effect of Phototherapy on Biochemical Markers of Neonates with Unconjugated Hyperbilirubinemia

BACKGROUND&#x0D; Hyperbilirubinemia is one of the commonest clinical problems encountered in the neonatal period, especially during the first week of life which can be classified into unconjugated &amp; conjugated hyperbilirubinemia. Phototherapy plays an important role in the treatment of neonatal hyperbilirubinemia. The study intended to evaluate changes in serum electrolyte levels in neonates undergoing phototherapy for exaggerated physiological hyperbilirubinemia.&#x0D; METHODS&#x0D; A prospective cross-sectional observational study was conducted in a tertiary care teaching hospital from April 2020 to March 2021 on neonates born after achieving gestational age of 28 weeks.&#x0D; RESULTS&#x0D; A significant incidence of hypocalcaemia was noted in neonates post phototherapy (19.2 %; P-value &lt; 0.001). The incidence of hypocalcaemia was higher in preterm (31.7 %) than the term (8.6 %) and at low birth (41.7 %) than in normal-weight (10.6 %). It was also found to be much more when the duration of PTH was &gt; 24 hours (28.6 %) as compared to the duration of PTH when less than 24 hours (12.2 %). No adverse events due to hypocalcaemia were noted. The incidence of hyponatraemia and hypokalaemia after phototherapy was found to be non-significant (P values 0.371 and 0.301 respectively) before and after phototherapy.&#x0D; CONCLUSIONS&#x0D; The study thus does not recommend any calcium supplementation over and above the prescribed guidelines recommended by AAP and NNF. However, in view of higher incidence, LBW and preterm neonates may be considered for monitoring and calcium prophylaxis on an individual basis.

Effects of Intermittent Kangaroo Mother Care on Low-Birth-Weight Neonates: A Retrospective Before-and-After Study

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome.&#x0D; Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome.&#x0D; Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42).&#x0D; Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.

Burden and risk factors associated with low birth weight among newborns in a tertiary care hospital Karachi, Pakistan

Background: Birth weight is one of the significant determinants of perinatal survival and infant morbidity and illnesses during early childhood. The burden of LBW neonates in the developed world is around 7%, whereas it is more than double at around 16.5% in developing countries.Methods: The retrospective cross-sectional study was conducted at the Indus Hospital and Health Network, Karachi, Pakistan. Data was extracted through the electronic medical record (EMR) with specific coding related to LBW from 1st January 2019 to 31st December 2020.Results: Our study showed LBW disease burden of 7.61% equated to 7% in the developed world while, in contrast with LBW prevalence in the developing countries, 16.5%. Gestational diabetes, pregnancy-induced hypertension, and primigravida are the major risk factors associated with LBW.Conclusions: Our study concludes that antenatal care is one of the major aspects to decrease the incidence of LBW, especially in primigravida. By estimating LBW, we can plan early detection and prompt interventions against this problem, reducing the burden of morbidity and mortality in neonates.

Phototherapy &amp; Exchange Transfusion in Neonatal Intensive Care Unit of Pediatric Hospital Kirkuk

Background: Jaudice is observed in first week of life in most neonates, it is usually benign but untreated severe indirect hyperbilirubinemia is potentially toxic to nervous system of neonates. Aim of study: Asses effect of some factors on modality of therapy in neonatal jaundice (phototherapy, exchange transfusion). Prematurity & Low birth weight is discussed in some detail. Methods: This cross sectional study was carried out at neonatal intensive care unit {NICU} of pediatric general hospital Kirkuk from first of March 2018 to first of September 2018 on 307 neonates admitted to hospital,154 of them had jaundice, these neonates were divided to those who had received phototherapy & those who had exchange transfusion, then divided to: term & preterm, normal weight & low birth weight, male & female, then the modality of therapy in each of these groups was analyzed & studied. Results: It was found that 307 neonates were admitted to NICU, 154 neonates (50.1%) of total admission to neonatal intensive care unit were due to jaundice, 115 neonate (74.6%) received phototherapy, 39 neonate (25.4%) had exchange transfusion. 100 neonates were male (64.9%) & 54(35.1%) were female. Phototherapy is used more frequently in preterm 28(77.7%) & 23(85.2%) LBW neonates than exchange transfusion, which was used in 8(22.3%) preterm & 4(14.8%) LBW. When the association between gestational age and type of therapy is statistically analyzed there was no significant association. No significant association between gender of baby and type of therapy was found. There was no significant association between weight of neonate & type of therapy. Conclusion: Fifty per cent of admissions to NICU were due to jaundice. Exchange transfusion is still used in relatively height percentage in NICU at Pediatric General Hospital Kirkuk because of late presentation of neonates with jaundice to medical team. Lack of awareness about the toxic effects of high bilirubin on the developing brain among families in our society. In addition old, over used phototherapy equipment in hospital, reduce the effectiveness of phototherapy.

Single-Center Comparison of Outcomes Following Cardiac Surgery in Low Birth Weight and Standard Birth Weight Neonates

To compare outcomes between low birth weight (LBW; <2.5kg) and standard birth weight neonates undergoing cardiac surgery. A single-center retrospective study of neonates undergoing cardiac surgery with cardiopulmonary bypass from 2012 to 2018. LBW neonates were 1:2 propensity score-matched to standard birth weight neonates (n=93 to n=186) using clinical characteristics. The primary and secondary outcomes were survival to hospital discharge and postoperative complications, respectively. After matching, regression analyses were conducted to compare outcomes. The LBW group had a higher proportion of premature neonates than the standard birth weight group (60% vs 8%; P<.01) and were less likely to survive to hospital discharge (88% vs 95%; OR, 0.39; 95% CI, 0.15-0.97). There was no difference in unplanned cardiac reoperations or catheter-based interventions, cardiac arrest, extracorporeal membrane oxygenation, infection, and end-organ complications between the groups. Among LBW infants, survival was improved at weight >2kg. LBW is a risk factor for decreased survival. LBW neonates weighing >2kg have survival comparable to those weighing >2.5kg.

OUTCOME OF LOW BIRTH WEIGHT NEONATES WITH RELATION TO EARLY ANEMIA.

Background: Weight of newborn is a universal predictor of health during childhood. Haematological prole varies with period of gestation in low birth weight neonates i.e., &lt;2500 grams. They have different haematological prole as compared to normal birth weight neonates. Aim of this study is to relate early morbidity and mortality of low birth weight neonates and their haemoglobin at days 1, 4 and 7. Materials and methods: A prospective cross-sectional study was conducted from January 2019 to June 2020 on children weighing below 2500 grams admitted within 24 hours of birth in Department of Paediatrics, SGRDIMSR, Amritsar. A total of 110 neonates were enrolled in this study following the inclusion and exclusion criteria. Haemoglobin levels of these were measured on days 1, 4 and 7. The data obtained was compiled and analysed to reach valid conclusions in relation to outcome in form of morbidity and mortality of the subjects. Results: Among 110 neonates majority belong to category of birth weight between 1500-2500 grams (70%). Lowest mean haemoglobin levels were seen in ELBW (&lt;1000 grams) neonates. Fall in haemoglobin from day 1 to 7 in all the neonates was seen and was statistically signicant. Anaemia was signicantly related to PNA and mortality. Lowest mean haemoglobin values were seen in neonates with PNA as a morbidity on day 7 (13.04±2.32). Neonates who died had even lower haemoglobin level on day 7 (12.17±2.03). Conclusion: It was concluded that ELBW neonates had higher risk of early anaemia as compared to LBW and VLBW neonates. Anaemia was also signicantly present in neonates who died and those who had PNA. Thus early anaemia is associated with PNA, ELBW and Mortality.