Mortality In Low Birth Weight Infants Research Articles

Acceptability of the Kangaroo Mother Care at the University Hospital of Treichville in Côte d'Ivoire.

Kangaroo Mother Care (KMC) is a low-tech, highimpact intervention for preterm and low-birth-weight newborns. In 2019, Côte d'Ivoire opened its first KMC unit. We wanted to determine KMC's acceptability in Côte d'Ivoire after a year. This qualitative study used semi-structured interviews in September 2020 at the Teaching Hospital of Treichville's first KMC unit. Mothers of preterm and low birth weight babies who received KMC were studied. Deductive (TFA-driven) framework analysis was performed. Coded using Nvivo 12. KMC was acceptable overall. Mothers knew KMC's goal and benefits, including self-confidence and breastfeeding benefits. Most women reported that the method was easy to implement and were confident in implementing KMC at the unit or in the household, even though some of them found KMC not aligned with their cultural values. Some mothers, especially housewives and self-employed, highlighted the benefits of KMC, but they must have given up. Our study highlighted the need to increase KMC awareness, advocacy, education, and training for pregnant women and the community to reduce preterm and low birth weight infant mortality and morbidity.

Quality improvement initiative to improve the duration of Kangaroo Mother Care in tertiary care neonatal unit of South India

BackgroundIndia has the highest number of preterm births and maximum number of deaths due to prematurity. Chengalpattu Government Medical College had 11 593 deliveries annually in 2020, of which 2252...

Evaluation of T-piece resuscitator in the delivery room management of pre-term neonates with respiratory distress syndrome in resource-limited settings: A pre-post intervention study.

The aim of our study was to evaluate the impact of the T-piece resuscitator in the delivery room management of pre-term neonates in a resource-limited setting. We compared the incidence rates of delivery room intubation, surfactant replacement therapy, pulmonary air leak syndrome, and pre-term very low birth weight infant mortality, before and after T-piece use. Bi-monthly neonatal resuscitation training sessions were conducted for healthcare providers during the study period. We emphasized hands-on experience with the T-piece resuscitator and delivery room early respiratory care practices during the post-intervention epoch. Our pre- and post-intervention data recorded statistically significant decline in delivery room intubations, a 32% decrease in surfactant replacement therapy, and a 57% decrease in air leaks in pre-term neonates. However, the use of T-piece resuscitator did not have a statistically significant effect on pre-term very low birth weight infant mortality.

Pijat Bayi Cara India dan Johnson Meningkatkan Berat Badan Bayi Lahir Rendah

Low birth weight infant mortality is one of the causes of high infant mortality (AKB) in Indonesia. Infant mortality can be prevented by improving the quality of the baby's health through growth and development. One of the efforts to improve the quality of baby health. The study aims to prove the difference in BBLR BB increase through Indian and Johnson way baby massage. The method used is Quasy Experimen with pretest-posttes design. The population is a low birth weight baby born in RSIA Pertiwi Makassar period July – September 2018. The study sample numbered fourteen that met the criteria. Seven babies were massaged the Indian way and seven babies were massaged johnson's way. Massage is done twelve times at intervals three times a week. Fifteen minutes at a time. The instruments used are baby scales and observation sheets. Univariate data analysis showed the average increase in BB for Indian way baby massage was fifty-one percent,while theaverage weight gain for Johnson's way of baby massage was fifty-three percent. Statistical tests with mann-Whitney U, showed that there was no significant difference in BBLR BB increases between indian and johnson massage. The conclusion of this study is the indian and Johnson way baby massage can both increase BB BBLR.

Care For Small Babies: A DOH Policy-in-waiting

Care For Small Babies: A DOH Policy-in-waiting

Mothers’ Knowledge of Kangaroo Mother Care for Premature Infants and Related Factors

This study aims to describe premature infants’ mothers’ knowledge of kangaroo mother care (KMC) and related factors to identify methods for improving maternal and child health programs. This descriptive cross-sectional research was carried out at Bach Mai Hospital from October 2019 to March 2020 to interview 60 mothers with premature babies on KMC and some related factors. The research results show that 94.8% of the interviewed mothers were aware of KMC’s necessity; 91,78% of them knew about KMC, of which, only 8.3% without prior knowledge of KMC. In terms of sources of knowledge, 58.2% of the mothers learned about KMC from relatives or friends; via the Internet - 45.5% and 18.2% through health workers. The number of mothers -university graduates having prior knowledge about KMC was with p <0.05. The study recommends promotion of mothers’ education on the role and effect of KMC for premature infants, especially among those with a modest education level.
 Keywords
 Kangaroo mother care, preterm delivery, premature infants.
 References
 [1] R. Dawar, S. Nangia, A. Thukral et al., Factors Impacting Practice of Home Kangaroo Mother Care with Low Birth Weight Infants Following Hospital Discharge, J Trop Pediatr, Vol. 65, No. 6, 2019, pp. 561-566, https://doi.org/10.1093/tropej/fmz007.[2] A. C. Agudelo, J. L. D. Rossello, Kangaroo Mother Care to Reduce Morbidity and Mortality in Low Birthweight Infants, Cochrane Database Syst Rev, No. 8, 2016, pp. 111-116, https://doi: 10.1002/14651858.CD002771.[3] Y. Takubo, T. Nemoto, Y. Obata et al., Effectiveness of Kangaroo Care for a Patient with Postpartum Depression and Comorbid Mother-Infant Bonding Disorder, Vol. 2019, 2019, pp. 1-6, https://doi.org/10.1155/2019/9157214.[4] E. Akbari, N. B. Erez, M. Rodrigues et al., Kangaroo Mother Care and Infant Biopsychosocial Outcomes in The First Year: A Meta-Analysis, Early Hum Dev, Vol. 25, No. 122, 2018, pp. 22-31, https://doi.org/10.1016/j.earlhumdev.2018.05.004.[5] N. T. Nam, N. T. Dung, D. T. Anh et al., Characteristis Structure of Diseases in Neonatal at Pediatric of Department of Bachmai Hospital, Bachmai Clinical Jounral, Vol. 112, 2019, pp. 28-37 (in Vietnamese).[6] D. Kommers, M. Broeren, G. Oei et al, Oxytocin Levels in the Saliva of Preterm Infant Twins During Kangaroo care, Biol Psychol, Vol. 137, 2018, pp. 18-23. https://doi.org/10.1016/j.biopsycho.2018.06.009.[7] R. B. Garcia, A. Spilker, D. Goyal, Skin to Skin Contact: Newborn Temperature Stability in the Operating Room, MCN Am J Matern Child Nurs, Vol. 43, No. 3, 2018, pp. 158-163, https://doi.org/10.1097/NMC.0000000000000430.[8] F. Cavallin, G. Segafredo, D. Pizzol et al, Thermal Effect of a Woolen Cap in Low Birth Weight Infants During Kangaroo Care, Pediatrics, Vol. 141, No. 6, 2018, pp. 156-159, https://doi.org/ 10.1542/peds.2017-3073.[9] M. Evereklian, B. Posmontier, The Impact of Kangaroo Care on Premature Infant Weight Gain, J Pediatr Nurs, Vol. 34, 2017, pp. 10-16, https://doi.org/ 10.1016/j.pedn.2017.02.006.
 

Comparison of referral neonatal scores in predicting the risk of death in premature and low birth weight infants

Objective To compare the value of three neonatal referal scoring systems in predicting the risk of mortality in preterm and low birth weight infants. Methods Six hundred and fourty-nine premature neonates-fetal age <37 weeks and birth weight <2 500g infants were transported to the neonatal intensive care unit of Hunan Children′s Hospital from January 1 to December 31, 2016.The score of transport risk index of physiologic stability(TRIPS), mortality index for neonatal transportation(MINT)score and transport related mortality score(TREMS)were conducted for them. Results TRIPS, MINT and TREMS scoring systems of the death group were significantly higher than those of the survival group(P<0.001). In the multivariate Logistic regression analysis, systolic blood pressure, reaction of foot hit and the intubation of respiratory in the TRIPS entered the regression equation.The birth weight, blood pH value and whether intubation when contacted in the MINT score were included in the equation.Hypotension, hypoxemia and hypercapnia of TREMS were entered the regression equation, indicating these factors were the independent risk factors for death in preterm and low birth weight infants.The area under the receiver operating characteristic and 95%CI of TRIPS, MINT and TREMS were 0.843(0.796, 0.889), 0.796(0.722, 0.871)and 0.712(0.639, 0.786), respectively. Conclusion The TRIPS is more accurate than MINT and TREMS in predicting the risk of referral mortality in referaling preterm and low birth weight infants. Key words: Preterm and low birth weight infants; Transporting scoring system; Mortality risk assessment; Transport risk index of physiologic stability; Mortality index for neonatal transportation score; Transport related mortality score

Probiotics for prevention of suspected sepsis in low birthweight infants.

Commentary on: Sinha A, Gupta SS, Chellani H, Maliye C, Kumari V, Arya S, Garg BS, Gaur SD, Gaind R, Deotale V, Taywade M, Prasad MS, Thavraj V, Mukherjee A, Roy M. Role of probiotics VSL#3 in prevention of suspected sepsis in low birthweight infants in India: a randomised controlled trial. BMJ Open 2015; 5: e006564. Low birthweight (LBW) is an important indirect cause of neonatal mortality and infections. Considering nearly 30% prevalence of LBW in India and nearly one-third of these neonates dying due to sepsis, even a modest decline in the incidence of sepsis due to a preventive intervention could potentially avert thousands of neonatal deaths 1. Amongst the immunotherapeutic agents for sepsis prevention, probiotics have attracted both interest and debate in the past decade 2, 3 with many institutions using probiotics routinely 4. A review of the level of evidence for probiotics in preterm infants suggests no side effects and long-term outcomes are reassuring 5. The concept of probiotics being helpful in prevention of sepsis seems interesting and novel because few interventions have been proven to be effective in preventing sepsis in LBW infants, apart from exclusive breastfeeding and hand hygiene 6, 7. This study aimed to estimate reduction in incidence of suspected sepsis in zero- to two-month-old LBW infants with a daily supplementation of probiotic VSL#3 (10 billion colony-forming units over a period of 30 days). This intervention, if proven to be efficacious, could be an important public health intervention for prevention of neonatal infections. The study showed no significant reduction in the risk of suspected sepsis (PSBI) diagnosed by the fieldworker. In the un-pre-specified subgroup (weighing 1500–1999 g), the reduction in risk of PSBI was statistically significant. This study was a community-based randomised trial from with high rates of follow-up and good adherence to treatment in both groups. There are, however, a few important limitations which need to be considered before presuming a possible beneficial role of probiotic administration in LBW infants for prevention of sepsis. First, the findings of statistically significant reduction in PSBI in the subgroup weighing 1500–1999 g might be a chance finding because of the small numbers involved. Second, suspected sepsis in itself is not an objective outcome. The significant difference in the subgroup analysis makes it imperative to interpret the results with caution. Third, there was no statistical difference in the colony counts in the two groups on days 1, 21 and 60. The authors mention the absence of an interaction effect between the treatment and the birthweight group which is not clear. Fourth, the intervention initiated on days 3–7 cannot address the risk of early-onset sepsis (EOS), an important cause of morbidity and mortality in LBW neonates. Hence, it may be incorrect to interpret this modest decline in the incidence of sepsis being attributed to due to preventive intervention with probiotics. To conclude, this study suggests possible modest beneficial effect in the subgroup of infants weighing 1500–1999 g. The results underscore the need of a larger study with sufficient power to conclusively evaluate the role of probiotics amongst LBW infants in a population at high risk of mortality from sepsis. Assuming the overall mortality in low birthweight infants to be 20% and the addition of probiotics shall decrease this rate by an absolute value 5% (to 15%); nearly 945 infants will be required in each group (assuming study power to be 80%). https://ebneo.org/2017/01/probiotics-for-prevention-of-suspected-sepsis-in-low-birthweight-infants None. None.

Effect of exposure to ambient Particulate Matter (PM2.5) onAdverse Infant Outcomes: An ecological study.

Background Air pollution including ambient air pollution is a global concern attributed to nearly 4.3 million annual deaths worldwide. The model projections based on emission scenarios indicate that this contribution could double by 2050. Ambient fine particulate matter PM air pollution is a major risk factor for ill health and death. Our research explores the association between ambient level of particulate matter 2.5PM2.5 and adverse infant outcomes in capital cities of Low and middle-income countries LMIC and high-income countries HICs.Objectives To estimate the level of PM2.5 across selected LMICs and High-income countries HICs and to establishascertain the predictors of ambient air pollution correlated with adverse infant outcomes. Methods Through an ecological study that included data at country-level from the Global Burden of Diseases 2015 we assessed the exposure to PM2.5 of capital cities of selected LMICs using custom-built software. The primary outcomes of interest were low birth weight infant mortality rate and the incidence of pneumonia. We developed a linear regression model to evaluate the relationship between mean PM2.5 and the outcomes of interest. In this model we have controlled for demographic indicators as female literacy rate smoking habits usage of solid fuel and exclusive breastfeeding. The data on exposure is the realtime data that we obtained for the year of 2017 but the outcome we have is extracted from the recently published Global Burden of Diseases data of 2015.Results Higher levels of PM2.5 levels in the capital cities of LMICsoccurmainly in Dhaka Bangladesh Jakarta Indonesia followed by Hanoi Vietnam. We found significant association between PM2.5 and Low birth weight infant mortality however PM2.5 was significantly associated with incidence of Pneumonia. There is limited causal inference due to the ecological nature of the study.Conclusion The need for individual-level prospective studies is imperative in nature to determine the causal relationship between the burdensome ambient air pollution and adverse infant outcomes especially in LMICs. nbsp

Determinants of Mortality among Low Birthweight Infants During Hospitalization in Karangasem District Hospital

Background and purpose: Infant mortality rate in Indonesia is still high and is largely related to low birthweight (LBW) infants. Previous studies reported the socio demographic and clinical factors as determinants of mortality of LBW infants, but rarely examined factors related to their health services. This study aimed to determine the demographic, clinical and health services as determinants of mortality of LBW infants during hospitalization.Methods: This study was a retrospective using cohort data of medical record of LBW infants in Karangasem Hospital since January 2012 to October 2014. Logistic regression was done to determine the relationship between demographic, clinical and health services factors with LBW infants’ mortality.Results: The proportion of mortality among LBW infants during hospitalization was 12.12%. Most parents (64.6%) live in good access to health services. The proportion of female infants (51.4%) was higher than male. LBW infants who were born in hospital (85.7%) greater than born outside hospital. Vaginal delivery (75.3%) was greater than C-section. Preterm infants (57.1%) was greater than at term with median of birthweight was 2100 grams. Proportion of asphyxia, respiratory distress syndrome (RDS), sepsis, hypoglycemia and hypothermia, respectively 24.1%, 4.66%, 0.78%, 7.92% and 3.73%. Variables associated with LBW mortality were increasing of 50 grams of birthweight, asphyxia, RDS and referred infants.Conclusion: The mortality of LBW infants during hospitalization was 12.12% with increasing of 50 grams of birthweight, asphyxia, RDS and referred infants found as determinant factors.

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether evidence is available to support the use of KMC in LBW infants as an alternative to conventional neonatal care before or after the initial period of stabilization with conventional care, and to assess beneficial and adverse effects. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches in CENTRAL (Cochrane Central Register of Controlled Trials; 2016, Issue 6), MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin American and Caribbean Health Science Information database), and POPLINE (Population Information Online) databases (all from inception to June 30, 2016), as well as the WHO (World Health Organization) Trial Registration Data Set (up to June 30, 2016). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google Scholar. Randomized controlled trials comparing KMC versus conventional neonatal care, or early-onset KMC versus late-onset KMC, in LBW infants. Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. Twenty-one studies, including 3042 infants, fulfilled inclusion criteria. Nineteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early-onset KMC with late-onset KMC in relatively stable LBW infants. Sixteen studies evaluated intermittent KMC, and five evaluated continuous KMC. KMC versus conventional neonatal care: At discharge or 40 to 41 weeks' postmenstrual age, KMC was associated with a statistically significant reduction in the risk of mortality (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (RR 0.35, 95% CI 0.22 to 0.54; five trials, 1239 infants), and hypothermia (RR 0.28, 95% CI 0.16 to 0.49; nine trials, 989 infants; moderate-quality evidence). At latest follow-up, KMC was associated with a significantly decreased risk of mortality (RR 0.67, 95% CI 0.48 to 0.95; 12 trials, 2293 infants; moderate-quality evidence) and severe infection/sepsis (RR 0.50, 95% CI 0.36 to 0.69; eight trials, 1463 infants; moderate-quality evidence). Moreover, KMC was found to increase weight gain (mean difference [MD] 4.1 g/d, 95% CI 2.3 to 5.9; 11 trials, 1198 infants; moderate-quality evidence), length gain (MD 0.21 cm/week, 95% CI 0.03 to 0.38; three trials, 377 infants) and head circumference gain (MD 0.14 cm/week, 95% CI 0.06 to 0.22; four trials, 495 infants) at latest follow-up, exclusive breastfeeding at discharge or 40 to 41 weeks' postmenstrual age (RR 1.16, 95% CI 1.07 to 1.25; six studies, 1453 mothers) and at one to three months' follow-up (RR 1.20, 95% CI 1.01 to 1.43; five studies, 600 mothers), any (exclusive or partial) breastfeeding at discharge or at 40 to 41 weeks' postmenstrual age (RR 1.20, 95% CI 1.07 to 1.34; 10 studies, 1696 mothers; moderate-quality evidence) and at one to three months' follow-up (RR 1.17, 95% CI 1.05 to 1.31; nine studies, 1394 mothers; low-quality evidence), and some measures of mother-infant attachment and home environment. No statistically significant differences were found between KMC infants and controls in Griffith quotients for psychomotor development at 12 months' corrected age (low-quality evidence). Sensitivity analysis suggested that inclusion of studies with high risk of bias did not affect the general direction of findings nor the size of the treatment effect for main outcomes. Early-onset KMC versus late-onset KMC in relatively stable infants: One trial compared early-onset continuous KMC (within 24 hours post birth) versus late-onset continuous KMC (after 24 hours post birth) in 73 relatively stable LBW infants. Investigators reported no significant differences between the two study groups in mortality, morbidity, severe infection, hypothermia, breastfeeding, and nutritional indicators. Early-onset KMC was associated with a statistically significant reduction in length of hospital stay (MD 0.9 days, 95% CI 0.6 to 1.2). Evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care, mainly in resource-limited settings. Further information is required concerning the effectiveness and safety of early-onset continuous KMC in unstabilized or relatively stabilized LBW infants, as well as long-term neurodevelopmental outcomes and costs of care.

Low birth weight profiles at H. Boejasin Hospital, South Borneo, Indonesia in 2010-2012

Background The prevalence of low birth weight (LBW) is still high in Indonesia. Intrauterine growth restriction (IUGR) and prematurity are the most frequent causes. Prematurity has higher mortality rate. Cultural diversity has an impact on regional LBW profiles in Indonesia. However, data on LBW is unavailable in South Borneo.Objective To describe the LBW profiles and in-hospital mortality of newborns at H. Boejasin Hospital, South Borneo.MethodsThis was a cross-sectional study using secondary data from medical records and neonatal registry at H. Boejasin Hospital, Pelaihari, South Borneo from 2010 to 2012. Subjects were newborns with birth weight &lt;2,500 grams. Categorical data was presented in percentages, while survival analysis was assessed by Kaplan-Meier test. The difference among groups was analyzed with log-rank test.Results The proportion of LBW was 20.2% of total live births and the mortality rate was 17.3%. Mortality rates according to birth weight category was 96% in &lt;1000 g group, 62% in 1,000-1,499 g group, 19% in 1,500-1,999 g group, and 4% in 2,000-2,499 g group. The highest hazard ratio was in the &lt;1,000 gram birth weight group (HR 40.21), followed by the 1,000-1,499 gram group (HR 12.95), and the 1,500-1,999 gram group (HR 4.65);(P&lt;0.01). Asphyxia, hyaline membrane disease (HMD), and sepsis were the most common causes of mortality (at 50%, 21%, and 16%, respectively).Conclusion The prevalence of LBW in this study is quite high and mortality of LBW infants is significantly different between each low birth weight category. [Paediatr Indones. 2016;56:155-61.].

All-Cause Mortality of Low Birthweight Infants in Infancy, Childhood, and Adolescence: Population Study of England and Wales.

BackgroundLow birthweight (LBW) is associated with increased mortality in infancy, but its association with mortality in later childhood and adolescence is less clear. We investigated the association between birthweight and all-cause mortality and identified major causes of mortality for different birthweight groups.Methods and FindingsWe conducted a population study of all live births occurring in England and Wales between 1 January 1993 and 31 December 2011. Following exclusions, the 12,355,251 live births were classified by birthweight: 500–1,499 g (very LBW [VLBW], n = 139,608), 1,500–2,499 g (LBW, n = 759,283), 2,500–3,499 g (n = 6,511,411), and ≥3,500 g (n = 4,944,949). The association of birthweight group with mortality in infancy (<1 y of age) and childhood/adolescence (1–18 y of age) was quantified, with and without covariates, through hazard ratios using Cox regression. International Classification of Diseases codes identified causes of death. In all, 74,890 (0.61%) individuals died between birth and 18 y of age, with 23% of deaths occurring after infancy. Adjusted hazard ratios for infant deaths were 145 (95% CI 141, 149) and 9.8 (95% CI 9.5, 10.1) for the VLBW and LBW groups, respectively, compared to the ≥3,500 g group. The respective hazard ratios for death occurring at age 1–18 y were 6.6 (95% CI 6.1, 7.1) and 2.9 (95% CI 2.8, 3.1). Male gender, the youngest and oldest maternal age bands, multiple births, and deprivation (Index of Multiple Deprivation score) also contributed to increased deaths in the VLBW and LBW groups in both age ranges. In infancy, perinatal factors, particularly respiratory issues and infections, explained 84% and 31% of deaths in the VLBW and LBW groups, respectively; congenital malformations explained 36% and 23% in the LBW group and ≥2,500 g groups (2,500–3,499 g and ≥3,500 g groups combined), respectively. Central nervous system conditions explained 20% of deaths in childhood/adolescence in the VLBW group, with deaths from neoplasms and external conditions increasingly prevalent in the 1,500–2,499 g and ≥2,500 g birthweight groups. The study would have benefited had we had access to information on gestational age and maternal smoking, but since the former is highly correlated with birthweight and the latter with deprivation, we believe that our findings remain robust despite these shortcomings.ConclusionsLBW is associated with infant and later child and adolescent mortality, with perinatal factors and congenital malformations explaining many of the deaths. By understanding and ameliorating the influences of upstream exposures such as maternal smoking and deprivation, later mortality can be decreased by reducing the delivery of vulnerable infants with LBW.

Appropriate delivery mode and timing of termination for pregnancy with low birth weight infants

To investigate the delivery mode and perinatal outcomes of low birth weight infants in mainland China, and to explore the appropriate delivery mode and timing of delivery. Clinical data of 103 678 babies delivered from Jan 1(st) to Dec 31(th), 2011 in 39 hospitals in mainland China were analyzed retrospectively. The 39 hospitals located in 7 administrative regions, including Northeast, Northwest, North, Central, East, South and Southwest China. (1) The average birth weight of the newborns was (3 263 ± 540) g. Among them, 7 474 cases were diagnosed low birth weight infants, with the incidence of 7.209% (7 474/103 678). There were 2.328% (2 214/95 116) full-term low birth weight infants and 61.434% (5 260/8 562) preterm low birth weight infants. (2) From week 28 to week 36, the cesarean section rate of low birth weight infants increased with the increasing of gestational weeks. The cesarean section rate of full-term low birth weight infants were 61.14% (1 139/1 863), which was higher than that of normal birth weight infants (52.947%, 45 108/85 195). The differences were statistically significant (P < 0.01). (3) The constitution of the indication of cesarean section showed that social factor and maternal factor were 10.73% (443/4 128) and 48.91% (2 019/4 128) for low birth weight infants, respectively. While for the normal birth weight infants, they were 27.70% (12 495/45 108) and 38.60% (17 412/45 108), respectively. There was statistically significant difference (P < 0.01). (4) The emergency cesarean section rate of full-term low birth weight infants was 41.09% (468/1 139), which was higher than that of normal birth weight infants (31.09%, 14 024/45 108). The difference was statistically significant (P < 0.01). (5) The rates of stillbirth, neonatal asphyxia and the mortality of full-term low birth weight infants were 2.36% (44/1 863), 6.12% (114/1 863), and 3.17% (59/1 863), respectively. Those of normal birth weight infants were 0.11% (94/85 195), 1.41% (1 201/85 195), and 0.14% (119/85 195), respectively. The differences were statistically significant (P < 0.01). (6) The stillbirth rate and mortality of low birth weight infants born by cesarean delivery were significantly lower than those born by vaginal delivery. The rate of neonatal asphyxia (17.95%) and other morbidity (3.61%) among low birth weight infants born by cesarean section in week 28 to week 33(+6) were significantly lower than those born by vaginal delivery (30.09%, 6.62%, respectively). (7) With the increase of gestational age, the incidence of neonatal asphyxia and stillbirth decreased. The incidence of neonatal asphyxia (39.22%) and stillbirth (23.28%) was most seen in 28 to 29 gestational weeks, which decreased to 9.08% and 2.88% in 34 gestation weeks. Low birth weight is one of the leading causes of adverse perinatal outcomes and cesarean section. To decrease the incidence of low birth weight, individualized management should be performed according to the gestational age and fetal condition. Extending the gestational age to at least 34 weeks may avoid iatrogenic preterm labor and improve the neonatal survival rate.

G259(P) A systematic review ofhealth worker-led interventions to reduce mortality in low birth weight neonates in low and middle-income institutional settings

Aim The majority of the 3.3 million annual neonatal deaths worldwide occur because proven and simple interventions dependent upon skilled human resources are not implemented. 60–80% of these deaths occur in low birth weight (LBW) neonates less than 2.5 kg, with 96.5% of the 20 million LBW neonates being born in the developing world. The aim of this research is to carry out the first systematic literature review on health worker-led interventions to reduce mortality in LBW neonates in institutional settings in low and middle-income (LMIC) countries. Methods We conducted a systematic review of studies meeting our inclusion and exclusion criteria until October 2014 (Figure 1). We searched Pubmed/MEDLINE, Popline, and Cochrane databases utilising a combination of the search terms “low birth weight” or “small for gestational age” and “mortality” and “intervention”. We included all studies of health worker led facility-based postnatal interventions in LMIC that assessed the outcome of neonatal mortality in LBW infants. We excluded articles with abstracts not available, articles that were not in English, and research with subjects not human or subjects not infants. Results We identified six studies reporting LBW neonatal mortality outcomes for health worker led interventions or a package of interventions in institutional settings in LMIC (Table 1). We employed the Hierarchy of Evidence framework, which evaluates health care interventions, to rank the strength of research evidence as excellent, good, fair or poor (Table 2). Only one study received an excellent ranking, the systematic review on kangaroo mother care (KMC), which included randomised controlled trials that demonstrated a statistically significant decrease in neonatal mortality rates. Conclusion The literature review demonstrates the limited evidence on health worker-led facility-based postnatal interventions to decrease mortality in LBW infants. Even where adequate evidence exists for impact of interventions on LBW mortality, for example, KMC, there has yet to be consistent scale-up. Further research is necessary utilising more rigorous methodology to ascertain effectiveness of interventions, as well as to identify cost-effective and sustainable strategies to allow for widespread implementation and dissemination of proven interventions.

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

Kangaroo mother care (KMC), originally defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional neonatal care. The standard search strategy of the Cochrane Neonatal Group was used. This included searches in MEDLINE, EMBASE, LILACS, POPLINE, CINAHL databases (all from inception to March 31, 2014) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2014) In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google scholar. Randomized controlled trials comparing KMC versus conventional neonatal care, or early onset KMC (starting within 24 hours after birth) versus late onset KMC (starting after 24 hours after birth) in LBW infants. Data collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group. Eighteen studies, including 2751 infants, fulfilled inclusion criteria. Sixteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early onset KMC with late onset KMC in relatively stable LBW infants. Thirteen studies evaluated intermittent KMC and five evaluated continuous KMC. At discharge or 40-41 weeks' postmenstrual age, KMC was associated with a reduction in the risk of mortality (typical risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.92; eight trials, 1736 infants), nosocomial infection/sepsis (typical RR 0.45, 95% CI 0.27 to 0.76), hypothermia (typical RR 0.34, 95% CI 0.17 to 0.67), and length of hospital stay (typical mean difference 2.2 days, 95% CI 0.6 to 3.7). At latest follow up, KMC was associated with a decreased risk of mortality (typical RR 0.67, 95% CI 0.48 to 0.95; 11 trials, 2167 infants) and severe infection/sepsis (typical RR 0.56, 95% CI 0.40 to 0.78). Moreover, KMC was found to increase some measures of infant growth, breastfeeding, and mother-infant attachment. There were no significant differences between KMC infants and controls in neurodevelopmental and neurosensory impairment at one year of corrected age. Sensitivity analysis suggested that the inclusion of studies with high risk of bias did not affect the general direction of findings or the size of the treatment effect for the main outcomes. The evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care mainly in resource-limited settings. Further information is required concerning effectiveness and safety of early onset continuous KMC in unstabilized or relatively stabilized LBW infants, long term neurodevelopmental outcomes, and costs of care.

Characteristics and outcomes of low birth weight infants in Bali

Background The prevalence and the mortality of low birthweight infants are still high. Low birth weight (LBW) births areresponsible for newborn death. LBW infants are easier to sufferserious health problems and death. Lower infant body weightand younger gestational age are determinants of greater risk ofmortality.Objective To determine the characteristics of LBW infants andtheir outcomes in Sanglah Hospital, Denpasar.Methods This prospective study was conducted on all LBWinfants in the nursery from their time of admission until dischargefor the year of 20 11..Results There were 120 LBW infants admitted to SanglahHospital fromJanuary 2011 to December 2011. The prevalenceofLBW was 8.9%. The birth weight group of 1500􀁰2499 gramshad the highest number of infants (79.2%). The gestational agegroup of 33􀁰36 weeks had 53.3% of the infants, while 68.3% ofthe LBW infants were of the appropriate gestational age. Themost common method of delivery was normal spontaneousdelivery (70%). Moderate asphyxia was observed in 25% of thesubjects, while severe asphyxia was observed in 22.5% of subjects.The mortality rate was 24.2%.Conclusions The prevalence of LBW of all newborns in ourhospital was 8.9%. Severe asphyxia was observed in 22.5% ofsubjects. The mortality rate of the LBW infants was 24.2%. OurLBW infants were most cormnonly in the categories of birth weightof 1500􀁰2499 grams, gestational age was between 33􀁰36 weeks,appropriate for gestational age, as well as delivered spontaneously.[Paediatr lndanes. 2012,52:30003].

Cochrane Review: Kangaroo mother care to reduce morbidity and mortality in low birthweight infants

AbstractBackgroundKangaroo mother care (KMC), originally defined as skin‐to‐skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants.ObjectivesTo determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional neonatal care.Search methodsThe standard search strategy of the Cochrane Neonatal Group was used. This included searches of MEDLINE, EMBASE, LILACS, POPLINE, CINAHL databases (from inception to January 31, 2011), and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2011). In addition, we searched the web page of the Kangaroo Foundation, conference and symposia proceedings on KMC, and Google scholar.Selection criteriaRandomized controlled trials comparing KMC versus conventional neonatal care, or early onset KMC (starting within 24 hours after birth) versus late onset KMC (starting after 24 hours after birth) in LBW infants.Data collection and analysisData collection and analysis were performed according to the methods of the Cochrane Neonatal Review Group.Main resultsSixteen studies, including 2518 infants, fulfilled inclusion criteria. Fourteen studies evaluated KMC in LBW infants after stabilization, one evaluated KMC in LBW infants before stabilization, and one compared early onset KMC with late onset KMC in relatively stable LBW infants. Eleven studies evaluated intermittent KMC and five evaluated continuous KMC. At discharge or 40 ‐ 41 weeks' postmenstrual age, KMC was associated with a reduction in the risk of mortality (typical risk ratio (RR) 0.60, 95% confidence interval (CI) 0.39 to 0.93; seven trials, 1614 infants), nosocomial infection/sepsis (typical RR 0.42, 95% CI 0.24 to 0.73), hypothermia (typical RR 0.23, 95% CI 0.10 to 0.55), and length of hospital stay (typical mean difference 2.4 days, 95% CI 0.7 to 4.1). At latest follow up, KMC was associated with a decreased risk of mortality (typical RR 0.68, 95% CI 0.48 to 0.96; nine trials, 1952 infants) and severe infection/sepsis (typical RR 0.57, 95% CI 0.40 to 0.80). Moreover, KMC was found to increase some measures of infant growth, breastfeeding, and mother‐infant attachment.Authors' conclusionsThe evidence from this updated review supports the use of KMC in LBW infants as an alternative to conventional neonatal care mainly in resource‐limited settings. Further information is required concerning effectiveness and safety of early onset continuous KMC in unstabilized LBW infants, long term neurodevelopmental outcomes, and costs of care.Plain Language SummaryKangaroo mother care to reduce morbidity and mortality in low birthweight infantsKangaroo mother care (KMC) is an effective and safe alternative to conventional neonatal care in low birthweight (LBW) infants mainly in resource‐limited countries.Low birthweight (LBW) (less than 2500 g) is associated with an increased risk of neonatal morbidity and mortality, neurodevelopmental disabilities, and cardiovascular disease at adulthood. Conventional neonatal care of LBW infants is expensive and needs both highly skilled personnel and permanent logistic support. The major component of KMC is skin‐to‐skin contact (SSC) between a mother and her newborn. The other two components of KMC are frequent and exclusive or nearly exclusive breastfeeding and attempt of early discharge from hospital. Compared with conventional neonatal care, KMC was found to reduce mortality at discharge or 40 ‐ 41 weeks' postmenstrual age and at latest follow up, severe infection/sepsis, nosocomial infection/sepsis, hypothermia, severe illness, lower respiratory tract disease, and length of hospital stay. Moreover, KMC increased weight, head circumference, and length gain, breastfeeding, mother satisfaction with method of infant care, some measures of maternal‐infant attachment, and home environment. There was no difference in neurodevelopmental outcomes at one year of corrected age.

Prevention of Transfusion-Transmitted Cytomegalovirus in Low–Birth Weight Infants (≤1500 g) Using Cytomegalovirus-Seronegative and Leukoreduced Transfusions

The transfusion-transmitted cytomegalovirus (TT-CMV) can cause serious morbidity and mortality in low-birth weight infants (LBWIs). Transfusion-transmitted cytomegalovirus can be minimized in LBWIs born to cytomegalovirus (CMV)-seronegative mothers with the use of CMV-seronegative blood components. Despite evidence that has independently shown that either leukoreduction or the use of CMV-seronegative components mitigates TT-CMV, the potential efficacy of combining these 2 strategies has not been substantiated in very LBWIs (<1500 g) born to either CMV-seronegative or CMV-seropositive mothers. Nonetheless, the serious risks of CMV infection posed by allogeneic transfusions and the broad implementation of universal leukoreduction have made this combination strategy the de facto clinical standard for transfusion of LBWIs. Although preferred, this combined approach has not been validated in clinical trials and, thus, warrants a large prospective study to determine whether this is the optimal transfusion tactic or if additional safety measures are necessary to prevent TT-CMV in LBWIs born to both CMV- seronegative and CMV-seropositive mothers. The aim of this prospective birth cohort study, therefore, is to estimate the incidence of TT-CMV in 1300 LBWIs (≤1500 g) who receive CMV-seronegative plus leuko-reduced blood products to evaluate the effectiveness of this coupled strategy. Conducted in Atlanta, GA, this study has been registered at the US National Institutes of Health (ClinicalTrials.gov no. NCT00907686).

Morbidity and mortality of low birth weight infants in the New Born Unit of Kenyatta National Hospital, Nairobi

Morbidity and mortality of low birth weight (LBW) infants at Kenyatta National Hospital (KNH) has previously been found to be high. Other centres have shown that even with lack of neonatal intensive care facilities, selective interventions can be implemented that improve neonatal survival rates. It is important to identify those factors at KNH that when selectively modified, will improve the quality of care hence survival rates. To quantify the morbidity and mortality of LBW infants in KNH. To audit the quality of care and identify factors that can be selectively modified to improve the quality of care and improve the currently low survival rates. Retrospective study utilising case notes. New born unit, Kenyatta National Hospital, Nairobi. All LBW infants admitted to the NBU at KNH from January to December 2000. Out of an expected 694 files, 533 (77%) were studied. The male to female ratio and LBW to VLBW ratio was 1:1 respectively. Small for gestational age (SGA) accounted for 11.6%. Overall mortality was 57.4% (574/1000 admissions) while mortality for SGA was 37%. Infants born out of KNH had significantly higher mortality (p=0.0047). Compared to Caeserian delivery, infants born via spontaneous vertex delivery had higher mortality (p=0.0087). The leading diagnoses on admission or death were respiratory distress(69%), apnoeic attacks (42%) suspected sepsis and jaundice (37% each), hypothermia(27%) and anaemia(17%). By time of death or discharge, 43% had no laboratory investigations done. While 37% had suspected sepsis, only 14% had blood culture done. Antibiotics were started in 460 (86%) of infants yet only 37% had diagnosis of suspected sepsis. Change of antibiotics was guided by culture and sensitivity reports in only 62(13.5%). Apnoeic spells were managed with rectal aminophyline in 156(29%) infants of whom 19(12%) survived. The terminal events for the dead infants included recurrent apnoeic spells. The only mode of nutrition was enteric feeding in 59% with breast milk, formula or pasteurized cows milk by nasogastric tube, breast feeding or cup feeding. Except for dextrose water, parenteral nutrition was not utilised. Of 63 infants dying with associated anaemia, 43(68%) were not transfused due to lack of reliable blood supply. Compared to previous studies, mortality of LBW infants in KNH- NBU has increased over the years. Improvement in supportive care as regards nutrition, temperature regulation, laboratory back up and respiratory support is recommended. There is a place for trial of kangaroo mother care and simple continous positive airways pressure administration methods. There is a need to ascertain the efficacy of the method of aminophyline administration.