Neonatal Care Unit Research Articles

Poor power quality is a major barrier to providing optimal care in special neonatal care units (SNCU) in Central India.

Background:Approximately 25% of all neonatal deaths worldwide occur in India. The Indian Government has established Special Neonatal Care Units (SNCUs) in district and sub-district level hospitals to reduce neonatal mortality, but mortality rates have stagnated. Reasons include lack of personnel and training and sub-optimal quality of care. The role of medical equipment is critical for the care of babies, but its role in improving neonatal outcomes has not been well studied. Methods:In a qualitative study, we conducted seven focus group discussions with SNCU nurses and pediatric residents and thirty-five key informant interviews and with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry of Health personnel in Maharashtra between December 2019 and November 2020. The goal of the study was to understand challenges to SNCU care. In this paper, we focus on current gaps and future needs for SNCU equipment, quality of the power supply, and use of SNCU equipment. Results:Respondents described a range of issues but highlighted poor power quality as an important cause of equipment malfunction. Other concerns were lack of timely repair that resulted in needed equipment being unavailable for neonatal care. Participants recommended procuring uninterrupted power supply (UPS) to protect equipment, improving quality/durability of equipment to withstand constant use, ensuring regular proactive maintenance for SNCU equipment, and conducting local power audits to discern and address the causes of power fluctuations. Conclusions:Poor power quality and its negative impact on equipment function are major unaddressed concerns of those responsible for the care and safety of babies in SNCUs in Central India. Further research on the power supply and protection of neonatal equipment is needed to determine a cost-effective way to improve access to supportive care in SNCUs and desired improvements in neonatal mortality rates.

Comparison of Bubble Continuous Positive Airway Pressure Versus Conventional Ventilation In Neonates with Respiratory Distress Syndrome

Aim: The use of positive airway pressure in babies with respiratory failure has been associated with significant reductions in respiratory failure, morbidity, and death. The two most popular CPAP techniques are bladder CPAP (B-CPAP) and ventilator-assisted CPAP (V-CPAP). We wanted to see if B-CPAP and V-CPAP have different survival rates and problems. Methods: This retrospective medical trial included 60 preterm babies between 1500- 2500 g who were hospitalized to Mayo Hospital's neonatal critical care unit for breathing difficulties between May 2019 and April 2020. Between May 2019 and April 2020, they were hospitalized for respiratory distress. The patients were allocated to therapy groups at random. To calculate and evaluate survival rates, a survival analysis was done. To compare rates of survival. The t-test for sample data was used to assess the length of supplemental oxygen, hospital stay, and cost of hospital stay. Results: At 24 hours, the predicted survival rates in the B-CPAP and V-CPAP subgroups were 100% and 78%, correspondingly. The comparable results after 48 hours were 100% and 72%. Furthermore, the V-CPAP group's hospitalization expenditures were considerably greater than the B-CPAP groups. Conclusion: Based on our findings, B-CPAP was helpful in treating newborns with breathing difficulties and reduced the hospitalization. In addition to the usual benefits, the lower cost of B-CPAP may be a factor for its widespread use when contrasted to V-CPAP. Keywords: Bubble Continuous Positive Airway Pressure, Versus Conventional Ventilation, Neonates With Respiratory.

Predicting exclusive breastfeeding in maternity wards using machine learning techniques

Background and objectiveAdequate support in maternity wards is decisive for breastfeeding outcomes during the first year of life. Quality improvement interventions require the identification of the factors influencing hospital benchmark indicators. Machine Learning (ML) models and post-hoc Explainable Artificial Intelligence (XAI) techniques allow accurate predictions and explaining them. This study aimed to predict exclusive breastfeeding during the in-hospital postpartum stay by ML algorithms and explain the ML model’s behaviour to support decision making. MethodsThe dataset included 2042 mothers giving birth in 18 hospitals in Eastern Spain. We obtained information on demographics, mothers’ breastfeeding experiences, clinical variables, and participating hospitals’ support conditions. The outcome variable was exclusive breastfeeding during the in-hospital postpartum stay. We tested algorithms from different ML families. To evaluate the ML models, we applied 10-fold stratified cross-validation. We used the following metrics: Area under curve receiver operating characteristic (ROC AUC), area under curve precision-recall (PR AUC), accuracy, and Brier score. After selecting the best fitting model, we calculated Shapley’s additive values to assign weights to each predictor depending on its additive contribution to the outcome and to explain the predictions. ResultsThe XGBoost algorithms showed the best metrics (ROC AUC = 0.78, PR AUC = 0.86, accuracy = 0.75, Brier = 0.17). The main predictors of the model included, in order of importance, the pacifier use, the degree of breastfeeding self-efficacy, the previous breastfeeding experience, the birth weight, the admission of the baby to a neonatal care unit after birth, the moment of the first skin-to-skin contact between mother and baby, and the Baby-Friendly Hospital Initiative accreditation of the hospital. Specific examples for linear and nonlinear relations between main predictors and the outcome and heterogeneity of effects are presented. Also, we describe diverse individual cases showing the variation of the prediction depending on individual characteristics. ConclusionThe ML model adequately predicted exclusive breastfeeding during the in-hospital stay. Our results pointed to opportunities for improving care related to support for specific mother’s groups, defined by current and previous infant feeding experiences and clinical conditions of the newborns, and the participating hospitals’ support conditions. Also, XAI techniques allowed identifying non-linearity relations and effect’s heterogeneity, explaining specific cases’ risk variations.

The impact of neonatologist performed echocardiography in an Italian neonatal unit.

The main goal of neonatologist performed echocardiography is to timely assess hemodynamic changes in order to properly manage unsteady neonates. Detailed structural heart assessment remains the domain of pediatric cardiologists. Nonetheless, many neonatologists take on an additional role in diagnosis of congenital heart defects, mostly compelled by the lack of in-house pediatric cardiology services. The experience of neonatologist performed echocardiography in an Italian neonatal unit was reported and the risk benefit profile of this practice was discussed. We retrospectively reviewed the echocardiograms undertaken by the neonatologist on infants admitted to the neonatal unit and postnatal ward of the Hospital San Pio in Benevento, over a 2-year period. Details of scans and concordance between neonatologist and cardiologist were analyzed. A total of 160 echocardiographic studies were done by the neonatologist on 136 infants. The ECG was requested in a minority of infants. The most common reason for performing the echocardiogram was admission to the neonatal care unit. Around half of the echocardiograms were normal. The remaining scans resulted in functional and structural abnormalities, transitional changes, and doubtful findings. Cardiac anomalies were significantly more likely found in cases of echocardiograms performed for fetal indications. Only 28 patients were eventually referred to the cardiology services. The inter-rater agreement was satisfactory. The hemodynamic assessment of sick infants, as well as triaging and referral of neonates with structural heart diseases are valuable advantages of the echocardiography run by neonatologists.Collaboration with pediatric cardiologists and robust training and accreditation programs are essential to ensure safety and quality service.

Diagnostic utility of combined immature and total neutrophil counts along with C-reactive protein in early detection of neonatal sepsis: A cross-sectional study

IntroductionA timely diagnosis is critical for management of Neonatal sepsis. Blood Culture is considered to be the “Gold Standard” for its diagnosis, but it has some limitations. In recent times, highly sensitive and specific inflammatory markers like interleukins, ELISA, counter immune-electrophoresis etc. have been in use for its diagnosis. But these are impractical for developing countries, due to their high cost and requirement of sophisticated equipments. A combination of haematological parameters like total leucocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), platelet count and C-reactive protein (CRP) estimation provide an early diagnosis of bacteremia. This study was undertaken to evaluate the usefulness of the above mentioned parameters as indicators for early diagnosis of neonatal sepsis. Material and methodsIn the present cross-sectional study, we intent to analyse various hematologic parameters in 160 neonates admitted in the neonatal care unit of a tertiary care hospital in Delhi. We obtained data from the records of blood culture and complete blood counts of neonates from pathology and microbiology departments of the hospital. Out of 160 admitted neonates, 80 were taken as cases and remaining 80 were taken as controls. Medical records were studied to identify infants born at ≥ 34 weeks gestation. CBCs was analysed, blood cultures and CRP were done in department of Microbiology. CBC, CRP and Blood culture was done as per standard protocols and clinical assesment by paediatrician. The statistical analyses were performed using SPSS version 22 for windows. ResultsAmong 80 neonates, who were in early neonatal sepsis, 44 cases (55%) were females, and 36 (45%) were males. The Microbiological profile of 80 septic neonates was analysed. The I/T value, ANC and CRP values were significantly higher in the neonates suffering from sepsis as compared to the control group. Among 80 septic neonates (cases), 30 (37.5%) were having normal ANC while 50 (62.5%) were having increased ANC and 34 (42.5%) were having normal I:T ratio while 46 (57.5%) were having increased I:T ratio. Out of 80 septic neonates (cases), 18 (22.5%) were having normal CRP while 62 (77.5%) were having increased CRP. ConclusionANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in early diagnosis of neonatal sepsis. Although there are many serological markers available, ANC and I/T Ratio serves as a reliable predictor of neonatal sepsis. With a good sensitivity, high specificity and a good negative predictive value these parameters can therefore help in timely and early identification of neonatal sepsis.

Facility-based care of small and sick newborns: experiences with establishing a neonatal special care unit in Somaliland

Background The goal of the United Nations is a global neonatal mortality rate (NMR) lower than 12/1000 by 2030. In stark contrast, facility-based care of small and sick newborns is limited and substandard in many low-income countries (LIC). There is a need to identify broad packages of high-quality and low-cost, sustainable interventions suitable for scale-up in fragile states and high burden countries. This article describes the process, output, and experience of establishing a neonatal special care unit (NSCU) at a governmental hospital in Somaliland. Methods We collected data from administrative documents, staff experiences, patient registries, and primary caretaker interviews covering 164 admissions through 5 months and systematized the findings within the 6 building blocks of the health care system (WHO). Results Running an NSCU in a Somali context is both possible and feasible when implementers are willing to bridge gaps on all health systems building blocks simultaneously. A verified NSCU survival rate of 85% within the first year was achieved - in line with reputable neonatal wards in the wider Eastern Africa. General caretaker satisfaction was rated as “good.” Major challenges were lack of a national regulatory framework, including an effective funding allocation; staff unfamiliarity with detailed guidelines, protocols, and job descriptions; and poor availability of medicines and other neonatal disposables. For less than US$175 in running cost per patient, including staff salaries and major equipment replacements, 75% of small and sick newborns received admission-to-discharge curative care. Public demand for facility-based newborn care was quickly growing during the implementation phase. Neonatal nurses quickly drift to nongovernmental and urban employers without a persistent and deliberate overcapacity in training courses and a strong public retention policy. A 100% service coverage in Somaliland will require dedicated wards (NSCU) with equipment at all hospitals with a labor ward, and training and deployment of about 400 neonatal nurses. Conclusions The described package of interventions may have the potential for further scale-up to district hospitals in Somaliland. Policymakers and hospital administrators should strive for a stronger national regulatory, administrative, and technical framework in neonatal curative care, facilitating the simultaneous development of all of WHO’s 6 health systems building blocks. We expect many of the findings to be transferable to the wider Somalia and other fragile LIC.

Supporting Immunization Uptake during a Pandemic, Using Remote Phone Call Intervention among Babies Discharged from a Special Neonatal Care Unit (SNCU) in South India.

COVID-19 has impacted children’s immunization rates, putting the lives of children at risk. The present study assesses the impact of phone-call counseling, on immunization uptake during the pandemic. Families of babies discharged from the SNCUs in six government centers in three South Indian states were recruited. Calls were made 10 days after the immunization due date. Missed vaccinees were counseled and followed up on 7 and 15 days. Of 2313 contacted, 2097 completed the survey. Respondents were mostly mothers (88.2%), poor (67.5%), and had secondary level education (37.4%). Vaccinations were missed due to the baby’s poor health (64.1%), COVID-19 related concerns (32.6%), and lack of awareness (16.8%). At the end of the intervention, the immunization uptake increased from 65.2% to 88.2%. Phone-call intervention can safely support immunization and lower the burden on health workers.

Current Status and Future Directions of Neuromonitoring With Emerging Technologies in Neonatal Care.

Neonatology has experienced a significant reduction in mortality rates of the preterm population and critically ill infants over the last few decades. Now, the emphasis is directed toward improving long-term neurodevelopmental outcomes and quality of life. Brain-focused care has emerged as a necessity. The creation of neonatal neurocritical care units, or Neuro-NICUs, provides strategies to reduce brain injury using standardized clinical protocols, methodologies, and provider education and training. Bedside neuromonitoring has dramatically improved our ability to provide assessment of newborns at high risk. Non-invasive tools, such as continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS), allow screening for seizures and continuous evaluation of brain function and cerebral oxygenation at the bedside. Extended and combined uses of these techniques, also described as multimodal monitoring, may allow practitioners to better understand the physiology of critically ill neonates. Furthermore, the rapid growth of technology in the Neuro-NICU, along with the increasing use of telemedicine and artificial intelligence with improved data mining techniques and machine learning (ML), has the potential to vastly improve decision-making processes and positively impact outcomes. This article will cover the current applications of neuromonitoring in the Neuro-NICU, recent advances, potential pitfalls, and future perspectives in this field.

Antihypertensive Drugs and Perinatal Outcomes in Hypertensive Women Attending a Specialized Tertiary Hospital.

ObjectivesWe sought to identify the most commonly used antihypertensive medications in pregnant women and to determine the impact of these medications on perinatal (maternal and fetal) outcomes.MethodsThe medical records of 484 hypertensive pregnant women who attended a tertiary university hospital during the study period were retrospectively evaluated for eligibility. Singleton pregnancies of women on antihypertensive medications and who delivered in the hospital were included in the study.ResultsA total of 210 women (mean age of 32.4±5.6 years and mean body mass index of 34.0±8.1 kg/m2) were eligible for inclusion in the study. The most prevalent subtype of hypertension was preeclampsia (41.4%). Low birth weight (LBW), preterm delivery (PTD), intrauterine growth restriction (IUGR), small for gestational age (SGA), respiratory distress syndrome, and neonatal care unit admissions were significantly higher in women with preeclampsia than in the women with other types of hypertension. Labetalol was the most commonly prescribed antihypertensive drug. There were 101 (48.1%) women on combined therapy. LBW, PTD, IUGR, SGA, respiratory distress syndrome, absent end diastolic flow, neonatal care unit admission, preeclampsia, and high dependency unit admissions of mothers were significantly higher in the women who received combined therapy.ConclusionsLabetalol was the most commonly prescribed antihypertensive drug in this cohort, and women on combined antihypertensive medications had significantly higher maternal and fetal complications. A larger prospective study including hypertensive women with or without antihypertensive medications in more than one center is needed to evaluate the effect of these drugs on perinatal outcomes.

Patterns and Determinants of Blood and Blood Products Transfusion in Neonate: An Experience of Single Institute

BACKGROUND: Neonates requiring intensive care are among the most frequently transfused group of patients. Indications for blood transfusion in neonates could be physiological or pathological. However, despite frequent blood transfusions in neonates in Iraq, there is a paucity of studies on its indications and patterns among neonates in our setting. AIM: The aim of the study is to shed light on the details of giving blood and blood products in the unit of neonate in Children Welfare Teaching hospital, Baghdad and the justifications for giving and its complication. PATIENTS AND METHODS: A descriptive study (cross-section study) includes all neonates admitted to neonatal care unit in Children Welfare Teaching Hospital. The study includes a group of newborns who were blood transfused during their admission to hospital, over a period of 6 months from October 1, 2019 to March 30, 2020. All data were collected from each patient and recorded in predesigned forma, these data include patient’s clinical data and analyzed using descriptive statistics. RESULTS: A total number of cases admitted over a period of 6 months were 862. One hundred and forty neonates received blood and its products transfusion, (61.4%) were male and (38.6%) were female, (62.9%) received packed red blood cells (PRBCs) followed by (18.6%) received exchange transfusion, (11.4%) received Fresh frozen plasma and (7.1%) received platelets. Most neonates received blood products transfused at (3–4) weeks. Post-natal age and were term babies (37–41) weeks. Gestational age mostly received PRBCs. CONCLUSIONS: Most neonates with a high rate of blood and blood product transfusion were males, term, need assistant ventilation, and transfused at 3–4 weeks postnatal age.

Amniopatch Treatment in Spontaneous Previable Preterm Rupture of Membranes with Neonatal Outcomes

Objective: To evaluate the efficiency of amniopatch application in previable preterm rupture of membranes (pPPROM) between 17-23 gestational weeks of pregnancy. Methods: 30 pregnants with previable preterm rupture of membranes were given amniopatch as therapy option instead of termination.After one week of antibiotics and bed rest the volunteers were applied amniopatch under sonographic guidance by infusion of 100 mL of 0.9% Isotonic solution alternate infusions of platelets, normal saline and FFP with a total of 100cc of each maximally were given into amniotic cavity. During infusion, in the event of bradycardia, the infusion was stopped. Results: 38 amniopatches were applied to 30 pPPROM patients. 7 aborted, 17 gave an immature birth and 6 gave preterm birth None reached to term. Alive birth rate was %23, All of them were born prematurely with changing durations in Neonatal Intensive Care Unite (NICU). In the 7 alive newborns duration of NICU differed (10 days-91 days) with a mean of 44,5 days. Deepest vertical pocket normalized in only 4 of the 30 patients (13,3%) after one week. There were 2 ablatio plasenta cases, none born alive. Cesarean section rate was 6/30 (%20). Maternal complications were endometritis (5/30, 16%), chorioamnionitis 4/30 (13%) all cured with antbiotic regimens in one week, none had sepsis. Conclusion: Results of amniopatch treatment in pPPROM are not convincing, although you restore the amnion a little bit, the etiopathogenesis and underlying factors still exist and cause premature birth, resulting in neonatal complications.

Influence of Maternal Region of Birth on Placental Pathology of Babies Born Small.

Background: Placental pathology is a common antecedent factor in infants born small for gestational age. Maternal region of birth can influence rates of SGA. Aims: To determine the association of maternal region of birth on placental pathology in babies that are born small, comparing a South Asian born population with Australia and New Zealand born women. Materials and methods: A retrospective cohort study was conducted at Monash Health, the largest public health service in Victoria. Mother-baby pairs above 34 weeks’ gestation and birth weight less than 10th centile born in 2016 were included. Placental pathology reports and medical records were reviewed. Statistical analyses of placental and selected neonatal outcomes data were performed. Results: Three hundred and eleven small for gestational age babies were included in this study, of which 171 were born to South Asian mothers and 140 to Australian and New Zealand mothers. There were no significant differences in gestational age at birth between the groups (38.7 (1.6) vs. 38.3 (1.7) weeks, p = 0.06). Placental pathology (macroscopic and microscopic) data comparisons showed no significant differences between the two groups (81% major abnormality in both groups). This was despite South Asian small for gestational age babies being less likely to require admission to a special care nursery or neonatal intensive care unit (35 vs. 41%, p = 0.05), or have a major congenital abnormality (2.3 vs. 4.3%, p = 0.04). Conclusion: In this observational study, maternal region of birth did not have an influence on placental pathology of babies born small, despite some differences in neonatal outcomes.

The glue that keeps everybody together: Peer support in mothers of young children with special health care needs.

BackgroundThe first years following diagnosis may be particularly challenging for parents and peer support from other parents of children with special health care needs may buffer their stress.MethodsThis qualitative interview study sought to explore the impact of early access to parental peer support and whether it leads to positive adaptation and improved family well‐being.ResultsFive mothers of young children with special health care needs from peer support organizations in two northern US states participated in interviews by telephone or Zoom. Themes of interest included professional scrutiny, going through the motions, someone who understands, learning and sharing, and one size does not fit all. Although most participants attributed positive changes in their emotional well‐being to the support they received, they were wary of extending the impact of peer support to their child and family.ConclusionsImplications for practice include embedding peer support programmes in neonatal care units and children's hospitals, as well as the addition of mindfulness practices to facilitate parental adaptation to disability and promote family well‐being.

Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda

BackgroundThe neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28/1000 and 27/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda.MethodsA cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities.ResultsThere was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, p = 0.017.ConclusionHealth facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.

Factors contributing to successful patent ductus arteriosus closure with first pharmacological course

Background Successful closure of patent ductus arteriosus (PDA) with ibuprofen or paracetamol as the first-line treatment has been reported, but little is known about factors affecting the closure rate.
 Objective To identify the closure success rate and contributing factors affecting a first course of pharmacological treatment in neonates with PDA.
 Methods A retrospective study was conducted in infants with isolated PDA treated with either ibuprofen or paracetamol and admitted to our neonatal care unit from January 2017 until June 2020. Included infants had PDA on echocardiography and received ibuprofen or paracetamol therapy as the closure treatment. Oral ibuprofen was given at 10 mg/kg on first day, then 5 mg/kg on the 2nd and 3rd days; while paracetamol was given intravenously 15 mg/kg every 6 hours for 3 days. Echocardiographic evaluation was performed 3 days after first course of treatment.
 Results In total, 20 of 33 (60.6%) infants achieved PDA closure with the first course of treatment. Earlier age at the start of the first course of treatment (PR 7.7; 95%CI 1.2 to 47.7; P=0.035) and normal birth weight (PR 13.3; 95%CI 2.4 to 72.4; P=0.001) were significant factors contributing to PDA closure. However, PDA size did not affect closure rate (PR 2.0; 95%CI 0.4 to 8.5; P=0.46).
 Conclusion Pharmacological treatment seems to have a good success rate for PDA closure, with significant positive associations with earlier age at start of treatment and normal birth weight.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding

ObjectiveAssess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. MethodCross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. ResultsThe kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. ConclusionThe self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

Quality of Neonatal Care: A Health Facility Assessment in Balochistan Province, Pakistan.

IntroductionBalochistan is the largest of Pakistan's four provinces, yet it is also the poorest and most impoverished, particularly in terms of neonatal healthcare. In order to build and tailor strategies to improve neonatal outcomes, it is necessary to identify barriers and facilitators for interventions. Therefore, we conducted this study to provide an overview of neonatal healthcare quality and assess the structural capacity for the improvement and further development of neonatal healthcare facilities in Balochistan.MethodsA descriptive, observational, cross-sectional study was conducted in Balochistan, a province of Pakistan. The survey was designed to assess the level of staffing and facilities in the neonatal health care units. Data were gathered through trained staff either by in-person visits to the facility or via telephone.ResultsA total of 177 facilities were assessed in 25 districts of Balochistan. A majority (88.7%) of the facilities were from the public sector. Birth and neonatal care services were provided at only 63 (36%) of the assessed facilities and only three had newborn intensive care units (NICUs) with a 1:5 staff: patient ratio. Unfortunately, all NICUs lacked the basic advanced facilities. None of the hospitals had an infection control policy or staff nor any training program for doctors.ConclusionIn conclusion, healthcare facilities to manage neonatal patients requiring hospital care are extremely limited in Balochistan and the ones that are available have very limited resources. To improve the healthcare system in Balochistan, all stakeholders should be involved in the planning, decision-making, and implementation of healthcare programs at all levels to ensure sustainability and efficiency.

Risk Factors of Neonatal Pneumonia in Tertiary Hospital in Bali

Neonatal pneumonia is one of the most common infection in neonates which can causes death. Neonatal pneumonia occurs in babies since birth until the age of 28 days. Several risk factors are known to increase the incidence of neonatal pneumonia. However, there still unconclusive results on these factors. The purpose of this study is to determine the risk factors of neonatal pneumonia in tertiary hospital in Bali. This case control study with case group consisted of 70 neonates with neonatal pneumonia while the control group consisted of 70 healthy neonates. Data was collected from level I, II and III neonatal care unit at Sanglah general Hospital in January-June 2021. Descriptive and analytical analysis were performed. Multivariate analyses with logistic regression showed PROM >18 hours (RO 11.2; 95%CI 2.87-44.13), smelly green amniotic fluid (OR 19.9; 95%CI 3.31-120.07), low birth weight (OR 4.4; 95%CI 1.31-14.86) and APGAR score <7 (OR 36.5; 95% CI 11.47-116.37) were statistically significant for the occurrence of neonatal pneumonia. Smelly green amniotic fluid, PROM >18 hours, low birth weight, and APGAR score <7 are risk factors of neonatal pneumonia.

Clinicopathological study and immunohistochemical analysis of expression of annexin A5 and apelin in human placentae of gestational diabetes mellitus

Background and aimsGestational diabetes mellitus (GDM) is one of the commonest medical complications of pregnancy. Annexin A5 (ANXA5) is a protein, found in apical surfaces of syncytiotrophoblasts, which prevents fetal and placental vascular thrombosis in GDM. Apelin is a bioactive peptide which has been linked to GDM. The aim of the present study was to correlate macroscopic as well as microscopic changes and immunohistochemical expression of ANXA5 and apelin in placentae of GDM with maternal and neonatal clinical features and also to compare the results with those in matched controls. MethodsThis prospective observational study was undertaken for a period of one year from April 2020 to March 2021. It comprised of 42 patients of GDM. Gross features, microscopic features and intensity and grade of expression of ANXA5 and Apelin were analyzed in placentae of GDM. ResultsMorphological changes detected in GDM placentae included increased immature villi (16 cases, 38%), increased syncytial knots (36, 86%), perivillous fibrin deposition (20, 48%), fibrosis of villous stroma (20, 48%), presence of nucleated red blood cells (12, 28.5%) and hypervascularity (34, 81%). The extent of histopathological changes noted in GDM placentae was significantly higher than that in matched controls. GDM placentae showed significantly reduced expression of ANXA5 and Apelin in terms of grade and intensity when compared with matched controls. Reduced expression (mild intensity) of ANXA5 was noted in 22 GDM cases (52.3%) whereas apelin expression was of weak intensity in 26 (61.9%) cases. Among GDM patients, statistically significant association was noted between ANXA5 intensity and neonatal resuscitation, apelin grade and preterm birth as well as low birth weight and apelin intensity and requirement of treatment in sick neonatal care unit. ConclusionThe placental expression of the proteins, ANXA5 and Apelin, is altered in GDM though their exact pathogenetic mechanisms are yet to be understood. They can be targets for development of prophylactic and therapeutic agents in future.

Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study

BackgroundEarly initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding.MethodsThis pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge.ResultsPre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge.ConclusionsExpansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.