Neonatal Illness Research Articles

Comparing nSOFA, CRIB-II, and SNAPPE-II for predicting mortality and short-term morbidities in preterm infants ≤32 weeks gestation

Background Neonatal illness severity scores are not extensively studied for their ability to predict mortality or morbidity in preterm infants. The aim of this study was to compare the Neonatal Sequential Organ Failure Assessment (nSOFA), Clinical Risk Index for Babies-II (CRIB-II), and Score for Neonatal Acute Physiology with Perinatal extension-II (SNAPPE-II) for predicting mortality and short-term morbidities in preterm infants ≤32 weeks. Methods In this retrospective study, infants born in 2017–2018 with gestational age (GA) ≤32 weeks were evaluated. nSOFA, CRIB-II, and SNAPPE-II scores were calculated for each patient, and the ability of these scores to predict mortality and morbidities was compared. The morbidities were categorized as mod/sev bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) requiring surgery, early-onset sepsis (EOS), late-onset sepsis (LOS), retinopathy of prematurity (ROP) requiring treatment, and severe intraventricular hemorrhage (IVH). Calculating the area under the curve (AUC) on receiver operating characteristic curves (ROC) analysis to predict and compare scoring systems’ accuracy. Results A total of 759 preterm infants were enrolled, of whom 88 deceased. The median nSOFA, CRIB-II, and SNAPPE-II scores were 2 (0, 3), 6 (4, 8), and 13 (5, 26), respectively. Compared with infants who survived, these three scores were significantly higher in those who deceased (p < 0.05). For predicting mortality, the AUC of the nSOFA, SNAPPE-II, and CRIB-II were 0.90, 0.82, and 0.79, respectively. The nSOFA scoring system had significantly higher AUC than CRIB-II and SNAPPE-II (p < 0.05). However, short-term morbidities were not strongly correlated with these three scoring systems. Conclusion In infants ≤32 weeks gestation, nSOFA scoring system is more valuable in predicting mortality than SNAPPE-II and CRIB-II. However, further studies are required to assess the predictive power of neonatal illness severity scores for morbidity.

Predictive values and correlation of CRIB Score II and perfusion index in assessment of severity of illness in sick preterm neonates: An observational study.

Perfusion index (PI) and CRIB (Clinical risk index of babies) Score II both are minimally invasive tools for prediction of mortality and morbidity in sick neonates. This study aims to know the predictive values of both PI and CRIB Score II in assessment of severity of illness in preterm neonates of 28 to 32 weeks and their correlation. PI and CRIB II Score of 125 sick preterm neonates admitted in NICU were assessed within 12 hours of admission. Severity noted in form of outcome. Correlation between PI and CRIB Score II were observed. Receiver operating characteristic (ROC) curve were plotted for PI and CIRB Score II with outcome (discharged vs expired). Area under curve for perfusion index was 0.776 at 95% confidence interval. Optimum cutoff point based on ROC curve was 1.65 with sensitivity of 84%., specificity of 37.2% with positive predictive value of 70% and negative predictive value of 57%. Area under curve for CRIB Score II was 0.622 (p value < 0.028), optimum cut off point based on ROC curve for CRIB II score was 3.5 with sensitivity 79.10% of specificity of 40% positive predictive value is 43.03% and negative predictive value of 76.9%. Spearman's correlation coefficient between PI and CRIB II score was -0.272 and p value is 0.002. This study concluded that perfusion index (p < 0.001) is better for predicting the severity compared to CRIB II score (p < 0.028). A weak negative correlation exists between PI and CRIB II score (r = -0.272).

A Study to Assess the Effectiveness of Educational Package in Terms of Knowledge Regarding Essential New Born Care among Mother in the Postnatal Wards of Selected Hospital, Nadiad

BACKGROUND: The neonatal period, covering the first 28 days of life is a vital stage marked by significant physiological changes and the new borns adjustment to the crucial for the baby’s survival and long term health. Proper new born care is essential in decreasing neonatal illness and death promoting healthy growth and development. Worldwide neonatal mortality is a major public issue, especially in low and middle income nations. The World Health Organization (WHO) reports that nearly 2.4 million children die within their first month of life annually, with most of these deaths happening within the first week. Infection are a leading cause of neonatal mortality, responsible for about one-third all neonatal deaths. New born are practically vulnerable to infection due to their underdeveloped immune system. Education on essential new-born care, covering aspects like infection prevention, breastfeeding thermal care, and immunization, plays a critical role in decreasing these fatalities. Postnatal wards offer a special chances to educate mothers about essential new-born care. During this period mothers are typically more open to learning and incorporating new practice that can benefit their infants. Tailored educational programs designed for postnatal mothers of essential new-born care practice and encourage their adoption. AIM This study assess the effectiveness of an educational package design to enhance mothers' knowledge regarding essential new born care in selected hospital in Nadiad. OBJECTIVE: To evaluate the impact of an educational package on mothers' knowledge about essential new born care in post natal wards. METHODS A quasi experimental study design was employed. The study include 40 mothers in post natal wards from selected hospital in Nadiad. Participants were divided into two groups: An experimental group receiving the educational package and a control group receiving standard care. Pre-test and post- test knowledge assessments were conducted using a structured questionnaire. INTERVENTION: The educational package comprised informative flip book interactive session focus on essential new born care such as breast feeding, hygiene, immunization and recognizing dangerous sign.RESULTS: The pre-test knowledge scores of both groups were comparable. Post intervention, the group showed a significant increase on knowledge scores compared to the pre- test. Statistical analysis using paired T test revealed that the educational package effectively improved mother’s knowledge of essential new born care (p&lt; 0.05). The educational package significantly enhanced mother’s knowledge regarding essential new born care in post natal wards. Implementing such educational interventions can improve new born health outcomes by empowering mothers which crucial care. Further studies are recommended to assess long term retention of knowledge and its impact on new born health.

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial

BackgroundProvision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.MethodsThe effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.DiscussionWe hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.Trial registrationClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.

Comparison of CRIB-II with SNAPPE-II as a Predictor of Mortality and Neurodevelopmental Outcome at 12 Months of Age for Newborns ≤32 Weeks of Gestational Age

Premature births before 32 weeks of gestation pose a significant challenge in perinatal healthcare. The global incidence of premature births is on the rise. To ensure appropriate care and resource allocation, assessing the severity of neonatal illnesses is crucial. In this context, the study assessed CRIB-II and SNAPPE-II, two widely used scoring systems for newborn illness severity. These systems consider both perinatal and postnatal variables, providing comprehensive assessments. This prospective observational study conducted in an Eastern Indian tertiary care children’s hospital between February 2021 and August 2022 aimed to evaluate and compare the predictive capabilities of two scoring systems, CRIB-II and SNAPPE-II, for in-hospital mortality and long-term neurodevelopmental outcomes in preterm infants born before 32 weeks of gestational age. Results showed that both CRIB-II (AUC of 0.862, 95% CI: 0.745-0.939) and SNAPPE-II (AUC of 0.919 95%, CI: 0.816-0.975) demonstrated similar predictive abilities for neonatal mortality (difference: 0.057, 95% CI: -−0.044 to 0.16, P value .268). However, when it came to predicting long-term neurodevelopmental outcomes at 12 months of corrected gestational age, SNAPPE-II maintained significance, while CRIB-II did not. The discrepancy in their performance over time emphasizes the complexity of predicting long-term outcomes in very preterm infants. To conclude, this study suggests that CRIB-II and SNAPPE-II are comparable in predicting neonatal mortality. Given their similarity, CRIB-II may be preferred for its practicality in high-capacity NICUs. However, further research is needed to assess these systems’ utility in comparing later neurodevelopmental outcomes and to explore the impact of new factors on their predictive accuracy.

Determinants of Adverse Pregnancy Outcomes among Women Attending Antenatal Care-Clinic in Public Health Facilities in Nyando Sub-County, Kenya

Adverse pregnancy outcome (APO) refers to gestation results other than vaginal birth, which include premature birth, miscarriage and low birth weight which are main causes of maternal and neonatal illness and death. In Kenya, the maternal mortality ratio stands at 355 deaths per 100,000 live births. In Kisumu County maternal mortality rate stands at 495 per 100,000 live births per year and Nyando Sub-County has the second- worst record of adverse pregnancy outcomes. Therefore, the current the current study assessed the determinants of adverse pregnancy outcomes among women attending 4 selected public health facilities in Nyando Sub-County. In this multicenter hospital-based cross-sectional study, n=301 women who delivered at the 4 randomly selected hospitals Nyando Sub-County hospital and visited the ANC department at least twice were systematically randomly recruited from November 2022 to September 2023. Data was collected using pre-tested and structured questionnaire which consisted of sections of demographic and obstetric characteristics. Presence of at least one maternal complication was used to determine the presence of APO. SPSS version 27 was used for data analysis. Chi-square ( 2) was used to compare proportions based on pregnancy outcomes as normal and adverse. Association between socioeconomic status and APO, obstetric factors and APO as well as ANC visits and APO were determine using Binary logistic regression. Of the 301 participants, 96 (31.9%) had normal pregnancy outcome (NPO) while 205 (68.1%) had APO. Woman’s age, parity, marital status, family income and education were associated with APO p=0.001, p=0.001, p=0.001, p=0.001 and p=0.04 respectively. With regard to obstetric factors, women of between 16-35 years were less likely to develop APO [OR=0.410, 95% CI=0.260-0.670, p=0.001]. In terms of gestation period with 37 weeks as the reference group, women with 28-37 weeks of gestation are less likely to develop APO [OR=0.114, 95% CI=0.132- 0.497, p=0.001]. The study did not find any association with the number of ANC visits [OR=0.39 95% CI=0.36-1.26, p=0.314] however, women visiting ANC in the second trimester less likely to develop APO [OR=0.221, 95% CI=0.142-0.927, p=0.001]. Therefore, both sociodemographic and obstetric factor affect pregnancy outcome and early ANC visit is associated with better or normal pregnancy outcome.

Cooking fuel use and respiratory health of women and children in rural Ballabgarh, Haryana.

Household air pollution arising from combustion of unclean fuels during cooking activities causes serious respiratory health effects. This study investigated patterns of household cooking fuel use and its effect on respiratory health status of women and children. A cross-sectional study was conducted in rural households of Ballabgarh, Haryana during December 2019 to January 2020 among 18-45 years old women and their children having age between 6 and 59 months. A total of 450 households were selected using simple random sampling. Cooking fuel use was categorised as unclean (Wood, dung cakes, crop residues) and clean (LPG and electricity). The classification of mixed fuel use (predominantly unclean or clean) was based upon duration of unclean fuel use ≥ 2.5h per day. The clinical history and physical examination was done using a semi-structured questionnaire. Assessment of respiratory health status of women participants was done using peak expiratory flow meter and presence of pneumonia in children was evaluated as per Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines. Overall use of unclean cooking fuels was predominant in 59.6% of households and 71.8% of households had mixed fuel use. Only clean fuel use was in 11.3% of households. Nasal stuffiness, breathing difficulty and cough were observed among 13.1%, 10.5% and 8.5% among women while the common respiratory symptoms in children were cough (27.8%) and runny nose (22.9%). As compared to clean fuels, women using unclean fuels were more likely to have any respiratory symptom (aOR 3.0, 95% CI: 1.5-6.0) and impaired pulmonary functions (adjusted OR 1.9, 95% CI: 1.2-2.9). Cooking fuel use was not associated with respiratory symptoms and presence of pneumonia in children living in the households. Cooking with unclean fuel continues to be prevalent in the households of rural Ballabgarh and adversely affects the respiratory health of women indicating strengthening of initiatives promoting clean fuel use.

Outcome of Neonatal Registry Through Electronic Medical Registry at Neonatal Intensive Care Units, Children's Hospital of Ain Shams University

Abstract Background The neonatal mortality rate is 19 deaths per 1000 live births worldwide. Studies have shown that neonatal registry network systems can provide the necessary data for establishing evidence- based strategies to decrease the complications in high-risk neonates and consequently reduce neonatal mortality rate. Aim of the Work To determine the frequency and distribution of neonatal critical illnesses in Neonatal Intensive Care Unit (NICU) of Ain Shams University. Patients and Methods This descriptive study was conducted in NICU, Children's Hospital, Ain Shams University. The data collected from initiated neonatal registry through electronic medical record to reach sample size number (381) patients. The current study was conducted after approval by the Department of Pediatrics, and the local Ethics and Research Committee, Faculty of Medicine, Ain Shams University. Results The mean ± (SD) age at admission was 5.52 ± 6.9 days, gestational age was 36.19 ± 2.47 weeks, more than half of our patients were males (55.6%) and females represented in (44.4%). Two- thirds (64.2%) of our participants were full term, and preterm were only (35.7%). The main etiology of NICU admission was respiratory disease (35.7%), followed by neonatal sepsis (25.2%), neonatal jaundice (21%), congenital anomalies (12.3%), CNS diseases (6.8%), inborn errors of metabolism (1%) and mortality rate was 10.5%. Four cases had inborn errors of metabolism in the form of: Maple syrup urine disease (one case), organic academia (one cases) and 2 cases referred to genetic clinic for further assessment. Congenital heart diseases in our study was reported in (7.9%) of neonates. The main etiology among them was reported in following order: PDA / pulmonary hypertension (26.7%), VSD (13.3%), Fallot tetralogy (10%), transposition of great arteries (10%), supraventricular tachycardia (6.7%) then many etiologies represented in 3.3% as Ebstein anomaly, right single ventricle, heart block, pulmonary artery stenosis, arrhythmia, tricuspid atresia and left hypoplastic heart disease. Conclusion This study showed the ability of the electronic medical record to store large amounts of data which creates a potential for information overload in the intensive care (ICU) setting. This will stimulate and facilitate research on neonatal critical illness and its management, mortality and morbidity outcomes of neonates admitted to NICUs in Children's Hospital, Ain Shams University, Egypt.

Knowledge and Perception of Community Based Integrated Management of Neonatal and Childhood Illnesses among Medical Students at a Medical College: A Descriptive Cross-sectional Study.

Community-Based Integrated Management of Neonatal and Childhood Illnesses (CBIMNCI) is the integrated approach for the management of children's common health concerns in outpatient primary health care settings and interventions at the family and community level. This study aimed to assess the knowledge and perception regarding CB-IMNCI in medical students studying in the clinical phase of a medical college. A descriptive cross-sectional study was conducted from February to June 2023 among 218 clinical-year medical students after obtaining ethical clearance from the Institutional Review Committee (Reference number: IRC-LMC-04/M-022). A self-administered questionnaire with CB-IMNCI-related multiple-choice questions was used for data collection and the responses to knowledge-related questions were evaluated using a predefined answer key. The results were expressed in terms of the number and percentage of the participants who answered each questions correctly. Of the 218 students, 111 (50.92%) were male and 107 (49.08%) were female. Among the participants, 164 (75.23%) (70-80% at 95% Confidence Interval) demonstrated basic knowledge of CB-IMNCI, successfully answering 50% or more of the questions. Among the males, 81 (72.97%), and among the females, 83 (77.57%) had basic knowledge of CBIMNCI. In terms of semester-wise distribution, 33(53.22%) in the 5th semester, 43 (82.69%) in the 7th semester, 41 (80.39%) in the 9th semester and 47 (88.67%) were able to answer 50% or more of the questions correctly. This study showed that one fourth of the students lack the basic knowledge about CB-IMNCI. It suggests the need for further work to enhance effectiveness of pre-service CB-IMNCI training.

Challenges to implementation of IMNCI strategy in First Level Care Facilities.

Objective: To assess IMNCI implementation strategy and identify challenges towards effective implementation in first level care facilities of district Jamshoro. Methodology: This mixed method research was carried out from Jan 2020 to March 2020 at Rural Health Centers (RHC) in District Jamshoro using semi-structured, pre-tested, written questionnaires after taking due approval and written informed consent from respondents. The respondents (representing different cadres of healthcare providers i.e., medical officers (male &amp; female), lady health workers (LHWs), vaccinators, pharmacists and 13 administrative staff. The data obtained (pertaining to perception and views regarding IMNCI implementation and availability of relevant logistics for service provision) was analyzed using SPSS version 22.0 for windows. Results: The mean age of the sample stood at 42 (SD ± 4) years with a majority comprising of male, dispensing/nursing staff with a mean work experience of 13.2 years (SD ± 1.1) Pneumonia was deemed the commonest childhood problem by most respondents, followed by malaria and others uniformly across all catchments. The understanding regarding IMNCI was common (despite the absence of formal training) yet often, the strategies were not implemented while caring for children. Conclusion: Effective implementation is a seldom sight with many challenges, including but not limited to shortage of human resource and a rather limited supply of medicines. Thus, efforts must be dedicated at ensuring an ample human resource and a consistent supply of necessary medication. Keywords: IMNCI, Childhood Illness, Neonatal Illness, Integrated Management, Primary care facility.

Assessing Clinical Profile and Short-term Outcomes of Neonates Retrieved by Neonatal Transport Service and Their Co-relation with Neonatal Severity Illness Scores: An Observational Study

Introduction: Newborn transport is a key component of neonatal perinatal care, and its delay is attributed highly to neonatal mortality. Aim: Our study aimed to assess the clinical profile and short-term outcomes (&lt;48 hours of admission) and to apply the severity illness scores to know the impact on outcomes of retrieved neonates. We used Transport Risk Index of Physiological Stability (TRIPS II) score to correlate with short-term morbidities and Score of Neonatal Physiology Perinatal Extension (SNAPPE II) to correlate with overall outcomes of retrieved neonates. Materials and Methods: It was an observational study done on 160 out-born neonatal retrievals over 13 months by a dedicated transport team at a level III NICU in Bengaluru, India. A validated TRIPS II score was recorded pre-transport, at Admission and at 12 and 24 hours of admission, and the SNAPPE II score was recorded at admission. An ROC curve was used to predict the utility of these scores. Results: Among 141 eligible neonates, the common indication for transport was respiratory distress syndrome 57 (40.4%). Extreme pre-terms (&lt;28 weeks; p = .001) and ELBW (&lt;1000 g; p = .001) are associated with an increased mortality rate. The area under the curve (AUC) for TRIPS II in predicting pulmonary bleed (AUC of ROC 0.866, 0.833, 0.823, 0.836), IVH (0.776, 0.79, 0.78, 0.77), worsening of respiratory settings (0.786, 0.814, 0.78, 0.79), and increase in ionotropic support (0.882, 0.904, 0.904, 0.902) at pre-transport, at admission, at 12 hours, and at 24 hours, respectively, was good. The AUC for SNAPPE II was 0.895, which is good in predicting mortality. Conclusion: A dedicated neonatal transport service can reduce the mortality rate significantly to 7.8%. TRIPS II and SNAPPE II scores were good in predicting the morbidities and mortality in retrieved neonates.

Evaluating the Clinical Risk Index for Babies (CRIB) II Score for Mortality Prediction in Preterm Newborns: A Prospective Observational Study at a Tertiary Care Hospital.

Neonatal mortality is an issue that affects both the developed and developing world. It is very important in the neonatal intensive care unit (NICU) to do the assessment of the severity of neonatal illness, which in turn helps in estimating and preventing mortality in the NICU by improving healthcare control and by rational use of resources. This research was carried out to evaluate how effectively theClinical Risk Index for Babies (CRIB) II score can predict mortality rates among newborns treated in our NICU. Methodology: This prospective observational study spanned one year, commencing in October 2021 and concluding in September 2022, within the confines of our NICU. The CRIB II score calculation was performed for included newborns, and the outcomes of the newborns were compared. A receiver operating characteristic (ROC) curve was obtained to ascertain the optimal CRIB II cut-off score for predicting mortality. Within the designated research timeframe, 292 neonates were admitted to the NICU. Forty-four newborns were enrolled in the study. Preterm neonates who died had higher CRIB II scores than those who survived, and their median (IQR) was 6 (1-12) vs. 9.5 (5-14) (p=0.0003). The estimate for the area under the curve was 0.83 (95% CI 0.68-0.92), and the odds ratio of 2.56 suggests neonates with a higher CRIB II score have higher chances of mortality. The CRIB II score is very good at predicting mortality in preterm newborns.

Telemedicine and Pediatric Care in Rural and Remote Areas of Middle-and-Low-Income Countries: Narrative Review

ObjectivesCaring for children in low- and middle-income countries (LMIC) can be challenging. This review article aims to explore role of telemedicine in supporting pediatric care in LMIC.MethodologyA narrative review of existing English and Spanish literature was conducted to assess role of telemedicine to support pediatric care in LMIC.ResultsBeside medical education and direct pediatric care, telemedicine can provide sub-specialties consultations without extra burden on families. Additionally, telemedicine can help in lowering under-5 mortality by supporting neonatal care, infectious illnesses, and non-communicable diseases (NCDs). Telemedicine can be a gate for universal coverage for all children at a lower cost. For over a decade, it has been implemented successfully and sustained in a few LMIC. However, challenges in implementing telemedicine are enormous. Still, opportunities arise by using simpler technology, low-width band internet, smartphones, instant messaging applications and solar energy. COVID-19 pandemic facilitated acceptance and applicability of telemedicine worldwide including LMIC. Nevertheless, governments must regulate telemedicine by issuing policies and ensuring employment of local experts when possible to meet local resources and cultural competency.ConclusionTelemedicine has proven successful in improving pediatrics care. Many LMIC should take advantage of this innovation to promote equity and access to high quality pediatric care.

Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation.

Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.

Ethical and Legal Issues Surrounding Genetic Testing in the NICU.

Clinicians practicing in a modern NICU are noticing an increase in the proportion of patients who undergo genetic testing as well as changes in the types of genetic testing patients receive. These trends are not surprising given the increasing recognition of the genetic causes of neonatal illness and recent advances in genetic technology. Yet, the expansion of genetic testing in the NICU also raises a number of ethical questions. In this article, we will review the ethical issues raised by genetic testing, with a focus on the practical implications for neonatologists. First, we outline the complexities of measuring benefit, or utility, for neonatal genetic testing. Next, we discuss potential harms such as inequity, unexpected findings, disability biases, and legal risks. Finally, we conclude with a discussion of ethical issues related to consent for genetic testing. Throughout this article, we highlight solutions to challenges toward the ultimate goal of minimizing harms and maximizing the substantial potential benefits of genetic medicine in the NICU.

Determinants of Stunting Among Children Under Five Years in Indonesia: Evidence from the 2021-2022 Demographic and Health Survey

At the global level, the prevention of stunting is one of the Sustainable Development Goals (SDGs). Indonesia is currently working towards achieving the second Sustainable Development Goal, which entails ending hunger, ensuring food security, improving nutrition, and supporting sustainable agriculture. As a part of this objective, efforts are being made to decrease the prevalence of stunting in children by 2025. Attention towards stunting is crucial as it can adversely affect children's physical and cognitive development well into adulthood if not addressed appropriately. This paper conducted a literature review from various sources, with a focus on google scholar and prioritizing sources from the last five years, as well as research on the population in Indonesia. It was determined through the analysis of several sources that maternal, child, and environmental factors pose various risks for stunting in Indonesia. Maternal factors that may play a role in child development include the mother's age, upper arm circumference, height, breastfeeding or complementary feeding practices, early initiation of breastfeeding and food quality during pregnancy. A history of low birth weight or prematurity, male sex, neonatal illness, frequent and recurrent diarrhea, infectious diseases, and lack of immunization are among the child factors associated with developmental outcomes. Factors such as living in a low socio-economic environment, limited family education, especially maternal education, insufficient household income, open defecation in rivers, gardens or inadequate latrines, consumption of untreated drinking water and high exposure to pesticides are also associated with the prevalence of stunting.

Red Blood Cell Transfusion Practice Pattern Before and After Implementation of a Local Restrictive Transfusion Protocol in a Neonatal Intensive Care Unit

Background: A restrictive red blood cell (RBC) transfusion guideline was established in 2019 in a neonatal intensive care unit (NICU), suggesting a hemoglobin concentration threshold of 7 g/dL. Objectives: (a) To determine its impact on the number of RBC transfusions and donor exposure; (b) to characterize RBC-transfusion determinants and justifications. Study Design: Single-center retrospective historical control study comparing all neonates consecutively admitted to the NICU during two five-month periods: 401 patients in 2013 before and 402 patients in 2021 after restrictive guideline implementation. Possible determinants were assessed via logistic regressions and justifications via a questionnaire. Results: In 2021, 9.2% of neonates received at least one RBC transfusion compared to 13.5% in 2013 ( p = .075). Adherence to protocol thresholds was 50%. Implementation of a restrictive transfusion protocol had some impact on determinants related to neonatal morbidity and illness severity and some impact on justifications being mainly based on hemoglobin value. Conclusion: Our study demonstrates that the implementation of a restrictive RBC transfusion protocol tended to decrease transfusion rates and donor exposure in the NICU, but the trend was not statistically significant. Future work should focus on improving protocol adherence.

Neonatal and Infant Illnesses and Health Seeking Behavior Among Hilly (Porja) Tribal Community: A Qualitative Observational Study

Objectives: The study explores the health-seeking behavior for neonatal and infant illnesses of the Porja hilly tribe in Andhra Pradesh, India. Methods: This study was a community-based qualitative observational study conducted from July 2022 to February 2023. In-depth interviews ( n = 31) were conducted with parents of neonates and infants. Two focus group discussions (involving 12 each) were conducted to validate the findings with other female family members such as, grandmothers. Data collection was carried out by using a semi-structured questionnaire on traditional practices and basic socio-demographic characteristics along with an in-depth interview guide for undertaking qualitative interviews. Results: Qualitative findings were analyzed using the thematic framework approach, followed by the analysis of data from the field notes. Three themes (along with six sub-themes) were generated: (a) Early essential care, (b) Emergency of hospital care, (c) Effective Ethnomedical/Ritualistic Care (not requiring hospital care) which explained the tribal parents’ ways of care and treatment for their neonates and infants from various morbidity and mortality risks. Discussion: Culture-specified traditional beliefs play crucial roles in shaping the neonatal and infant health of indigenous hilly tribal communities. Preserving the beneficial traditional methods and preventing harmful practices can help improve the overall child health status in such resource scanty settings with inadequate neonatal services.

The Impact of Alternate Methodological and Structural Assumptions on Results of Cost-effectiveness Analysis: Empirical Evidence using Three Indian Economic Evaluations.

Despite advancement in methods and application of economic evaluations (EEs), there are several uncertainties. To assess the impact of alternate methodological and structural assumptions for four key principles of EE, on the results of cost-effectiveness analysis. Three previously published model-based EEs were used: (1) Integrated Management of Neonatal and Childhood Illnesses (IMNCIs) intervention; (2) intervention for multiple myeloma, and (3) safety-engineered syringes (SES) intervention. A series of empirical analyses was undertaken to assess the impact of alternate assumptions for discount-rate, time-horizon, study perspective, and health outcome measure, on incremental cost-effectiveness ratio (ICER), and interpretation of cost-effectiveness. Increasing discount rate resulted in an increase in ICERs, for all three case-studies; however, there was no change in the conclusions. Using shorter time-horizons resulted in a significant increase in ICERs, the multiple myeloma intervention remained cost-ineffective, SES intervention became cost-ineffective, whereas IMNCI intervention remained cost-effective, despite a three-fold increase in ICER. On using disability adjusted life years instead of quality adjusted life years, ICERs increased to 0.04, 2 and 4 times for SES, IMNCI and multiple myeloma interventions, respectively. On analyzing results from a societal perspective, a decline in ICERs was observed. The decline was significant for IMNCI where the intervention turned dominant/cost-saving. In the other two case-studies decline in ICERs was modest, 32% for multiple myeloma, and 4% for SES. We observed a significant impact of using alternate assumptions on ICERs which can potentially impact resource-allocation decisions. Our findings provide strong argument in favor of standardization of processes and development of country-specific guidelines for conduct of EE.

Comparing different scoring systems for predicting mortality risk in preterm infants: a systematic review and network meta-analysis.

This study aimed to compare the predictive values of eight scoring systems (Neonatal Critical Illness Score [NCIS], Neonatal Therapeutical Intervention Score System [NTISS], Clinical Risk Index for Babies [CRIB], Clinical Risk Index for Babies II [CRIB-II], Score for Neonatal Acute Physiology Perinatal Extension [SNAPPE], Score for Neonatal Acute Physiology Perinatal Extension II [SNAPPE-II], Score for Neonatal Acute Physiology [SNAP], and Score for Neonatal Acute Physiology II [SNAP-II]) for the mortality risk among preterm infants. The Embase, PubMed, Chinese Biomedical Database, Web of Science, and Cochrane Library databases were searched to collect studies that compared different scoring systems in predicting the mortality risk in preterm infants from database inception to March 2023. Literature screening, data extraction, and bias risk assessment were independently conducted by two researchers. Subsequently, the random-effects model was used for the network meta-analysis. A total of 19 articles were included, comprising 14,377 preterm infants and 8 scoring systems. Compared to CRIB-II, NCIS, NTISS, SNAP-II, and SNAPPE-II, CRIB demonstrated better predictive efficiency for preterm infant mortality risk (P < 0.05). Relative to CRIB, CRIB-II, and SNAPPE, SNAP-II had worse predictive efficiency for preterm infant mortality risk (P < 0.05). The surface under the cumulative ranking curve of the eight scoring systems was as follows: CRIB (0.980) > SNAPPE (0.718) >SNAP (0.534) >CRIB-II (0.525) >NTISS (0.478) >NCIS (0.422) >SNAPPE-II (0.298) >SNAP-II (0.046). The CRIB scoring system showed the highest accuracy in predicting preterm infant mortality risk and was simple to perform. Therefore, CRIB selection can be prioritized in clinical practice. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=434731, PROSPERO (CRD42023434731).