Neonatal Examination Research Articles

Prediction of Fetal Biliary Atresia Based on Second and Third-Trimester Ultrasound Characteristics.

To explore the diagnostic performance of prenatal ultrasound in the prediction of biliary atresia (BA). We prospectively collected cases of suspected biliary abnormalities in the 2nd trimester of pregnancy and performed a series (at least 3) of prenatal ultrasound examinations in the 2nd and 3rd trimester. The presence of the gallbladder was examined each time, and its size and shape were assessed if the gallbladder was visible. The existence of other abnormalities was carefully evaluated. Neonatal ultrasound examination was conducted within 1 month after birth, and clinical data were followed-up for 6 months after birth. Among the 41 895 patients, 298 were suspected to have biliary abnormalities, while 82 patients were excluded due to loss to follow-up or induced labor caused by other abnormalities. A total of 216 patients were included in this study, and 15 were diagnosed with BA. We summarized the ultrasound findings of the gallbladders and defined a high-risk gallbladder for the prenatal diagnosis of BA. This was demonstrated to have the best diagnostic performance as a single parameter, with an area under the curve of 0.914 (95 %CI: 0.869-0.948). In addition, higher incidences of biliary cysts, right hepatic artery dilation, echogenic bowel, and ascites were observed in BA fetuses. Logistic regression analysis showed that the combination of 5 parameters had better diagnostic performance, with an area under the curve of 0.995 (95 %CI: 0.973-0.999). The fetal gallbladder was found to be a critical feature for the identification of BA. Concomitant abnormalities could be helpful to improve the accuracy of the diagnosis.

Bladder exstrophy: An atypical journey of a rare case of an adult

Bladder exstrophy is a rare and complex malformation. Often associated with diverse deformations, an accurate diagnosis is a must for adequate management. In the African setting, especially in a remote area, delivery rarely occurs within a healthcare structure, thus reducing the chance of an early diagnosis. Due to a low density of specialists, people in rural areas refer to traditional healers for healthcare problems, the thing that delays the time to diagnosis. We report, according to the CARE guidelines (https://www.equator‐network.org/reporting‐guidelines/care/), a case of an 18‐year‐old male patient who was transferred to us for better management of a reddish hypogastric mass leaking urine. Initially considered as a congenital wound, his parents applied traditional products to heal it. Following the poor outcomes, the parents will consult several general physicians; unfortunately, no one gave a clear diagnosis. The clinical examination on admission revealed a good general condition and noted the presence of a reddish, ovoid structure of about 9 centimeters of the minor axis and 11 centimeters of the major axis in the hypogastric region allowing urine to flow in its upper part. The external genitalia examination revealed a retracted and short penis with urine exit at its base through the reddish structure. The patient was transferred outside the country for better management due to a lack of dedicated equipment. Although vesical exstrophy is a rare disease, an early diagnosis allows adequate management and good outcome. Thus, a well‐performed neonatal examination is required to avoid later diagnosis and complications.

Ethnic and sociodemographic correlates of developmental dysplasia of the hip in newborns from Yucatan, Mexico.

To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects. Retrospective, population-based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model. Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first-borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section. Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015-2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.

Evaluation of pain and physiological stress during targeted neonatal echocardiography.

Targeted neonatal echocardiography (Tn-Echo) is a non-invasive examination which may cause pain/discomfort and physiological instability in neonates, but there is little evidence for the same. We conducted this study to evaluate whether targeted neonatal echocardiography causes pain or physiological stress to newborn infants. This cross-sectional study was conducted in a tertiary level NICU. Neonates undergoing targeted neonatal echocardiography were enrolled in this study. Pain was assessed using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after targeted neonatal echocardiography examination. Heart rate, oxygen saturation, perfusion index and blood pressure were also recorded at the same time points. A total of 88 neonates were enrolled. Mean (SD) PIPP-R score during Tn-Echo was 8.18 (2.6) versus 3.60 (1.8) and 4.24 (2.0) before and after respectively (p value < 0.001). Heart rate and respiratory rate were significantly higher during targeted neonatal echocardiography; oxygen saturation and perfusion index were significantly lower during targeted neonatal echocardiography. Preterm infants had higher PIPP-R score compared to term neonates before, during and after the Tn-Echo [8.76 (2.4) versus 6.81 (2.4); p value < 0.001]. Targeted neonatal echocardiography causes significant pain/discomfort and physiological instability in neonates.

Review on Different Methods of Serum Bilirubin Estimation

It is quite essential to estimate serum bilirubin in neonates with jaundice. The early prediction of jaundice is usually by observing the yellowish colour of the skin. Various methods of estimation of bilirubin have been developed and used for assessing the risk of jaundice.&#x0D; Jaundice is the common neonatal problem, that with the timely diagnosis, effective treatment and proper counselling to the mother can decrease the neonatal morbidity. Proper neonatal examination, breastfeeding advice to the mother, identifying the high risk groups, proper history elicitation, quick diagnosis and early intervention can reduce the incidence of jaundice and also prevent long term complications. The main goal is to prevent the risk of severe hyperbilirubinemia and for prevention of kernicterus. Hence there is a need for a sensitive, rapid and a reliable method for the assessment of serum bilirubin. These methods include both invasive and non-invasive analysis. Invasive methods involve estimation of serum bilirubin by obtaining a plasma or serum sample and non-invasive include the assessment of bilirubin using various instruments without the requirement of blood sample from the neonate.&#x0D; As the invasive method of bilirubin estimation needs more time for analysis to yield a result, many non invasive methods are being studied to find an effective tool which can give fast and accurate results ,thus making it an effective screening tool. This review article throws light on the different methods of estimating bilirubin levels in a neonate.

Expert consensus on the clinical practice of neonatal brain magnetic resonance imaging.

In recent years, magnetic resonance imaging (MRI) has been widely used in evaluating neonatal brain development, diagnosing neonatal brain injury, and predicting neurodevelopmental prognosis. Based on current research evidence and clinical experience in China and overseas, the Neonatologist Society of Chinese Medical Doctor Association has developed a consensus on the indications and standardized clinical process of neonatal brain MRI. The consensus has the following main points. (1) Brain MRI should be performed for neonates suspected of hypoxic-ischemic encephalopathy, intracranial infection, stroke and unexplained convulsions; brain MRI is not considered a routine in the management of preterm infants, but it should be performed for further evaluation when cranial ultrasound finds evidence of brain injury; as for extremely preterm or extremely low birth weight infants without abnormal ultrasound findings, it is recommended that they should undergo MRI examination at term equivalent age once. (2) Neonates should undergo MRI examination in a non-sedated state if possible. (3) During MRI examination, vital signs should be closely monitored to ensure safety; the necessity of MRI examination should be strictly evaluated for critically ill neonates, and magnetic resonance compatible incubator and ventilator can be used. (4) At present, 1.5 T or 3.0 T equipment can be used for neonatal brain MRI examination, and the special coil for the neonatal head should be used to improve signal-to-noise ratio; routine neonatal brain MRI sequences should at least include axial T1 weighted image (T1WI), axial T2 weighted imaging (T2WI), diffusion-weighted imaging, and sagittal T1WI or T2WI. (5) It is recommended to use a structured and graded reporting system, and reports by at least two reviewers and multi-center collaboration are recommended to increase the reliability of the report.

Towards an integrated neonatal brain and cardiac examination capability at 7 T: electromagnetic field simulations and early phantom experiments using an 8-channel dipole array

ObjectiveNeonatal brain and cardiac imaging would benefit from the increased signal-to-noise ratio levels at 7 T compared to lower field. Optimal performance might be achieved using purpose designed RF coil arrays. In this study, we introduce an 8-channel dipole array and investigate, using simulations, its RF performances for neonatal applications at 7 T.MethodsThe 8-channel dipole array was designed and evaluated for neonatal brain/cardiac configurations in terms of SAR efficiency (ratio between transmit-field and maximum specific-absorption-rate level) using adjusted dielectric properties for neonate. A birdcage coil operating in circularly polarized mode was simulated for comparison. Validation of the simulation model was performed on phantom for the coil array.ResultsThe 8-channel dipole array demonstrated up to 46% higher SAR efficiency levels compared to the birdcage coil in neonatal configurations, as the specific-absorption-rate levels were alleviated. An averaged normalized root-mean-square-error of 6.7% was found between measured and simulated transmit field maps on phantom.ConclusionThe 8-channel dipole array design integrated for neonatal brain and cardiac MR was successfully demonstrated, in simulation with coverage of the baby and increased SAR efficiency levels compared to the birdcage. We conclude that the 8Tx-dipole array promises safe operating procedures for MR imaging of neonatal brain and heart at 7 T.

Needs assessment of general practitioners in Pakistan: A descriptive cross-sectional survey.

With the growing and complex nature of medicine, it is imperative for physicians to update their knowledge and skills to reflect current standards of care. In Pakistan, 71% of primary care needs are met by general practitioners (GPs). GPs are not required to complete structured training and no regulatory mandates exist for continuing medical education. We conducted a needs assessment to evaluate the readiness for competency-based updating of knowledge and skills, and the use of technology by practicing GPs in Pakistan. A cross-sectional survey inviting registered GPs across Pakistan was administered online and in-person. Questions pertained to physician demographics, practice characteristics, confidence in knowledge and skills, and preferred modes of updating knowledge and barriers. Descriptive analyses were performed for GPs and patient-related characteristics and bivariate analyses to evaluate the relationship between parameters of interest. Of the 459 GPs who responded, 35% were practicing for <5 years and 34% reported practicing for >10 years. Only 7% had a post-graduate qualification in family medicine. GPs reported needing practice in neonatal examination (52%), neurological exam (53%), depression screening (53%), growth charts (53%) and peak flow meter use (53%), interpretation of electrocardiograms (ECGs, 58%) and insulin dosing for diabetes (50%). High workload (44%) was the most common barrier to updating clinical knowledge. Sixty-two percent used the Internet on a regular basis. Most GPs have no structured training and encounter gaps in knowledge and skills in clinical practice. Flexible, hybrid, and competency-based continuing medical education programs can be used to update knowledge and skills.

Análise da triagem auditiva de crianças expostas ao vírus Zika

ABSTRACT Purpose: to analyze the results of neonatal hearing screening examinations in newborns with and without microcephaly, exposed to the Zika virus, without other risk indicators for hearing loss, and verify the association between screening results, sample characteristics, and the gestational trimester when exposure took place. Methods: a descriptive cross-sectional study. Subjects included in the study had no risk indicator for hearing loss other than microcephaly, and presented, along with their mothers, positive RT-PCR results, respectively at birth and during pregnancy. The transient evoked otoacoustic emission and brainstem auditory evoked potential examinations were applied by the researcher between March 2016 and December 2017. Newborns failed the screening when they failed at least one retest in at least one ear. The data were descriptively analyzed, using the Fisher exact test; p-values equal to or lower than 0.05 were considered significant. Results: out of the 45 subjects, 30 (66.7%) were females, 6.7% were likely to have sensorineural hearing loss, with or without auditory neuropathy spectrum disorder - which was possibly present in only one ear of one of these three subjects. Failure in the screening was statistically significant in subjects with at least one of the congenital Zika syndrome characteristics and subjects with subcortical calcification and brain cortex thinning, macular chorioretinal atrophy with focal pigmentary mottling, and hypertonia with symptoms of extrapyramidal involvement. The gestational trimester of exposure was associated with screening results. Conclusion: the responses in screening point to the possibility of hearing loss in newborns with and without microcephaly, whereas the presence of microcephaly was not significant to examination failures. Exposure in the first gestational trimester indicated a possible relationship with screening failures.

Type 2 innate immunity drives distinct neonatal immune profile conducive for heart regeneration.

Aims: Neonatal immunity is functionally immature and skewed towards a TH2-driven, anti-inflammatory profile. This neonatal immunotolerance is partly driven by the type 2 cytokines: interleukin-4 (IL-4) and interleukin-13 (IL-13). Studies on neonatal cardiac regeneration reveal the beneficial role of an anti-inflammatory response in restoring cardiac function after injury. However, the role of an imbalanced immune repertoire observed in neonates on tissue regeneration is poorly understood; specifically, whether IL-4 and IL-13 actively modulate neonatal immunity during cardiac injury.Methods and results: Neonatal mice lacking IL-4 and IL-13 (DKOs) examined at 2 days after birth exhibited reduced anti-inflammatory immune populations with basal cardiac immune populations like adult mice. Examination of neonates lacking IL-4 and IL-13 at 2 days post cardiac ischemic injury, induced on the second day after birth, showed impaired cardiac function compared to their control counterparts. Treatment with either IL-4 or IL-13 cytokine during injury restored both cardiac function and immune population profiles in knockout mice. Examination of IL-4/IL-13 downstream pathways revealed the role of STAT6 in mediating the regenerative response in neonatal hearts. As IL-4/IL-13 drives polarization of alternatively activated macrophages, we also examined the role of IL-4/IL-13 signaling within the myeloid compartment during neonatal cardiac regeneration. Injury of IL-4Rα myeloid specific knockout neonates 2 days after birth revealed that loss of IL-4/IL-13 signaling in macrophages alone was sufficient to impair cardiac regeneration.Conclusions: Our results confirm that the TH2 cytokines: IL-4 and IL-13, which skews neonatal immunity to a TH2 profile, are necessary for maintaining and mediating an anti-inflammatory response in the neonatal heart, in part through the activation of alternatively activated macrophages, thereby permitting a niche conducive for regeneration.

Findings of ocular examinations in healthy full-term newborns.

To assess the anterior and posterior segments of full-term neonates over a 1.5-year period. The findings of full-term neonates who underwent ophthalmological examinations between June 2019 and December 2020 were analyzed, and the results were retrospectively recorded. The study comprised 2972 neonates with a mean birth week of 38.7 ± 1.2 weeks and a mean birth weight of 3235 ± 464 g. The neonates were examined on an average of 49.3 ± 18.9 postnatal days. Of the examined neonates, 185 (6.2%) showed abnormal ophthalmological findings, the most prevalent of which were retinal hemorrhage in 2.3% (n=68) and white changes in the peripheral retina in 1.9% (n=55) of the neonates. Cases of optic disc pathologies (n=20), choroidal nevus (n=10), iris-choroidal coloboma (n=5), subconjunctival hemorrhage (n=6), non-specific retinal pigmentary change (n=4), congenital cataract (n=3), posterior synechia (n=3), iris nevus (n=3), corneal opacity (n=1), choroidal coloboma (n=1), iris coloboma (n=1), buphthalmos (n=1), anophthalmos (n=1), microphthalmia (n=1), lid hemangioma (n=1), and vitreous hemorrhage (n=1) collectively accounted for approximately 2% of all neonates. Pathologies that could potentially impair vision, which were detected by ophthalmological examination, accounted for 1.2% of all neonates (n=37). The most prevalent finding of the ophthalmological examinations of neonates in the present study was retinal hemorrhage. Ophthalmological examinations of neonates can help in identifying diseases that may affect their vision and are curable or may lead to amblyopia in the long term.

Clinicopathological Spectrum of Testicular and Paratesticular Lesions

Background: Both neoplastic and non neoplastic conditions affect the testis. Although non neoplastic testicular lesions are more common, still most of the published studies are done on testicular neoplasms only. Hence the present study was undertaken to study histopathological spectrum of testicular and paratesticular lesions, their age distribution and clinical presentation. Materials and Methods: This is a retrospective study of 77 cases of orchidectomy specimens, testicular biopsies and paratesticular lesions received in the department of Pathology. Results: Non neoplastic testicular lesions were more common than neoplastic (90.1% Vs 9.8%) with majority in the second and third decade. Undescended testis comprised 46.1% of the total orchidectomy specimens followed by Torsion/Infarction testis (15.3%). None of the undescended testis showed tumour deposits unlike western countries. Majority of patients presented with empty scrotum (31.16%) and testicular/scrotal swelling (18.11%). Only 5 cases of testicular neoplasm were diagnosed during the study period amounting to only 1.42 cases per year. All were germ cell tumours (4 classic seminoma and 1 yolk sac tumour). Conclusions: Non neoplastic testicular lesions were more common than neoplastic lesions. Complete neonatal examination for testicular descent should be mandatory to avoid late presentations and future malignancies. Germ cell tumours formed the bulk of testicular tumours.

Section 10 - Paediatric and neonatal history and examination

Section 10 - Paediatric and neonatal history and examination

Spontaneous enteroscrotal fistula following an incarcerated inguinal hernia in a neonate: Case report and literature review.

IntroductionIn Africa, frequent delays in seeking medical attention due to cultural considerations and lack of financial support could explain some particular clinical presentations. An enteroscrotal fistula following an incarcerated inguinal hernia is a rare condition in neonates.Presentation of caseA 21-day-old infant was brought to our consultation for persistent stool discharge from the right scrotum for three days. The parents reported an inguinoscrotal swelling that had been evolving for ten days before admission and became painful two days later. He was diagnosed with a case of enteroscrotal fistula. After correction of electrolytes disorders, a laparotomy was performed through a right lower transverse incision. Operative findings were strangulated inguinal hernia with ileal perforation. Resection and end-to-end ileo-ileal anastomosis was performed. He was discharged from the hospital on the 6th post-operative day. No recurrence within the first year of follow-up.DiscussionThirteen cases have been reported in the literature until now. Most of them were from developing countries, including ours.ConclusionEarly seeking medical attention of incarcerated inguinal hernias is necessary to reduce their morbidity and mortality. Paediatricians should emphasize providing adequate information, education and communication during routine examinations of neonates. We advocate the popularization of universal health insurance to facilitate health care.

Coarctation of the Aorta: Delay in Diagnosis and Referral Basis from Infancy to Adulthood

To assess the role of neonatal pulse oximetry screening and other bases of referral for patients of all ages with aortic coarctation referred to a tertiary care medical center. Medical records were reviewed for 200 consecutive patients diagnosed and treated for CoA in either 2006-2011 or 2015-2019, before and after mandated pulse oximetry screening, respectively. In both groups, ∼50% of patients were diagnosed within the first 5days. Diagnosis by fetal echocardiography was more frequent in the 2015-2019 group (30.5% vs 20.5%; P<.03); obstruction often developed only as the ductus arteriosus closed. In each group, ∼25% of patients were diagnosed at age >1year and 7% had an incidental diagnosis. Pulse oximetry screening was documented as abnormal in only 8 of 47 patients and was not performed in those with a fetal diagnosis. Evaluation of a murmur was the second most frequent basis for referral. Moderate to severe left ventricular dysfunction occurred mainly in infants in the first month, with a similar frequency in the 2 groups; these patients often had tachypnea or poor weight gain. Decreased femoral pulses or systemic hypertension were infrequently documented by referring physicians. Hypertension typically was ascribed to a renal or essential basis. Exercise symptoms occurred mainly in patients age >10years. Although fetal echocardiography and neonatal pulse oximetry contribute to the diagnosis of coarctation, physical examination has an important complementary role. Evaluation of peripheral pulses on initial and early follow-up neonatal examinations, along with consideration of coarctation in any patient with hypertension, are needed to improve timely detection.

Place & Person involved in delivery: Factors leading to delay in diagnosis of Anorectal Malformation in Newborns.

ABSTRACTObjective:To determine the frequency of place of delivery and person detecting the anomaly among newborn babies presenting with delayed diagnosis of anorectal malformation (ARM).Methods:This is a Descriptive Cross-Sectional Study, conducted at Department of Paediatric Surgery, National Institute of Child Health (NICH) Karachi, from February 19, 2019 to August 18, 2019. All patients with ARM who were diagnosed beyond two hours of life (Delayed diagnosis) were included in the study. Chi square test was applied for comparison of categorical variables.Results:Total 110 patients were enrolled in this study. Nineteen (17.3%) patients were delivered at home, while 91 (82.7%) were delivered at the hospital. The first person detecting the anomaly was grandmother (n=25) or a non-medical person in 58 patients (52.7%), 52 were diagnosed by a medical personal either primarily in 31 cases (28.2%) or secondarily by a neonatologist in 21 cases (19.1%).Conclusion:It is concluded that Non-medical person detected ARM mainly despite the babies being delivered mostly at the hospital, indicating the need for meticulous neonatal examination.

Clinical features and echocardiographic findings of isolated foramen ovale restriction in foetuses

Isolated restrictive foramen ovale (rFO) without complex heart defects is a rare pathology. There may be difficulties in managing this situation, which can lead to right heart enlargement, tricuspid regurgitation and hydrops findings in the foetus. We conducted a retrospective analysis of 8451 foetuses. 7883 (93.2%) had a structurally normal heart or minor heart disease, 18 (0.22%) of which had a diagnosis of isolated rFO. Nine patients with neonatal echocardiographic examination were included in the study. In 8 (88.8%) patients, it was stated that a decision to give birth should be made at the time of presentation. Evaluating postpartum echocardiographic examinations, 7 (77.7%) patients had normal or minor defects. The decision of delivery made at the right time during follow-up is critical to determine the prognosis. IMPACT STATEMENT What is already known on this subject? The data about the prenatal diagnosis of isolated rFO is limited. What the results of this study add? We conducted a retrospective analysis of 8451 foetuses. 7883 (93.2%) foetuses had a structurally normal heart or minor heart disease, 18 (0.22%) of which had a diagnosis of rFO. Nıne patients with foetal and postnatal follow-up and echocardiographic findings were examined in the study. The group's median gestational age at admission was 35.0 weeks (range: 27.0–39.0 weeks). The delivery decision was made in 8 (88.8%) patients at the time of admission. Evaluating postpartum echocardiographic examinations, 7 (77.7%) patients had normal or minor defects. Additionally, one patient was diagnosed with cardiomyopathy, and the other patient was diagnosed with functional pulmonary atresia. No death occurred in any foetus during follow-up. What the implications are of these findings for clinical practice and/or further research? Isolated rFO, a rare condition in the foetus, is generally well-tolerated in foetal life. However, the right heart enlargement, tricuspid regurgitation, or hydrops findings can be seen in patients. The decision of delivery made at the right time during follow-up is critical to determine the prognosis.

Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in Northeastern Brazil

ObjectiveTo assess the performance of a basic mid-trimester fetal ultrasound scan protocol for the diagnosis of congenital anomalies by calculating its accuracy, sensitivity, and specificity. MethodsThis longitudinal cohort study involved singleton pregnant women recruited at the mid-trimester fetal ultrasound scan through the postnatal evaluation of congenital anomalies. Pregnant women who underwent a routine mid-trimester ultrasound scan for fetal abnormalities at 20–24 weeks of gestation were enrolled in this study. After childbirth, we searched their medical records on gestational outcomes and neonatal examination records, as well as complementary medical examinations, to assess the ultrasound performance in diagnosing congenital malformations. ResultsWe included 967 pregnant women in the study population, and prenatal ultrasound scans detected congenital abnormalities in 67 fetuses (6.9%). Among newborns, 54 (5.6%) were postnatally diagnosed with malformations. The overall sensitivity and specificity of the mid-trimester ultrasound scan for congenital malformation detection were 61.1% and 96.3%, respectively, with an accuracy of 94.3% (p < .05). ConclusionThe mid-trimester ultrasound scan had good accuracy in the detection of congenital malformations, although the overall sensitivity does not support it as the only screening test for anomalies throughout pregnancy.

Concordance of Congenital Heart Defect in Monozygotic Twins in Brazil

Tetralogy of Fallot (TOF) consists of four cardiac changes: interventricular communication, pulmonary stenosis, aortic dextroposition and right ventricular hypertrophy. The prevalence is 0.1 per 1,000 live births. A primiparous mother with gestational age of 38 weeks came to the emergency. At the time, it was verified in her twin pregnancy that one fetus had TOF, thus a pregnancy interruption was scheduled for the following day. In the neonatal physical examination of both, localized acrocyanosis, regular heart rhythm with the [...]

THE RELATIONSHIP BETWEEN MATERNAL AND CHILD HEALTH SERVICES WITH THE PREVALENCE OF STUNTING BASED ON THE BASIC HEALTH RESEARCH IN INDONESIA

ABSTRACTStunting is a linear growth disorder considered as a serious health problem in Indonesia, where its prevalence is related to maternal and child health (MCH) services. This study aimed to compare the coverage of maternal and child health services between two surveys and analyze how they relate to the prevalence of stunting. The study used aggregate data from the 2013 and 2018 Basic Health Research Reports using a cross-sectional approach. The research sample spanned to 34 provinces in Indonesia. Stunting prevalence was taken as aggregate data from individuals based on height-for-age z-scores (HAZ). The independent variable was the achievement of MCH service indicators. Data analysis used variance measures, correlations, simple linear regression, and paired T-tests. The results found variations in the prevalence of stunting, with 25.4% in 2013 and 25.1% in 2018. There was a 7.4% decrease in severe stunting prevalence between 2013 and 2018, but the decrease was not significant (p = 0.506). The analysis results of the 2013 Basic Health Research showed that MCH service indicators related to stunting prevalence were coverage of antenatal care, iron consumption, delivery by health personnel, delivery in health facilities, postpartum maternal health services, low birth weight (LBW) prevalence, neonatal examination, complete immunization, health card ownership, and growth monitoring. The analysis results of the 2018 Basic Health Research showed that MCH indicators were related to the prevalence of antenatal care coverage, delivery by health personnel, and delivery in health facilities, postpartum maternal health services, LBW prevalence, neonatal examination, and complete immunization. There was a significant increase in the coverage of MCH services from 2013 and 2018 (p &lt; 0.0001), except for the coverage of Fe tablet consumption, the prevalence of stunted birth babies, ownership of health cards, provision of vitamin A, and provision of colostrum. The better the coverage of MCH services, the lower the stunting prevalence. Efforts to improve the MCH service programs are required to reduce the prevalence of stunting for Indonesian children. Keywords: stunting, children under five years old, coverage of maternal and child health services