Neonatal Mortality Research Articles

Fifteen Years of Neonatal Therapeutic Hypothermia: Clinical Trends Show Unchanged Post-Rewarming Outcomes despite Reduction in Hypoxic-Ischemic Encephalopathy Severity

Introduction: Hypoxic-ischemic encephalopathy (HIE) affects 1–2 per 1,000 births and is associated with mortality and long-term neurodevelopmental challenges. At present, therapeutic hypothermia (TH) is the only neuroprotective intervention for these infants. This study examines whether HIE severity, clinical management during TH, and post-rewarming outcomes have changed since its introduction 15 years ago. Methods: Neonatal characteristics, HIE severity, management during TH, and post-rewarming MRI of all infants with HIE undergoing TH between 2008 and 2023 were compared across three five-year epochs. Linear regression was used to estimate annual changes over time. Results: In total, 252 infants underwent TH. Median gestational age (39.5 weeks), birth weight (3,376 g), and time to start TH (4.25 h) remained stable over time. Apgar score at 5 min (p = 0.031) and lowest pH <1 h postpartum (p = 0.020) increased over time. Thompson score at 1–3 h decreased across epochs (p = 0.046). There was an increase in percentage with normal-mild aEEG background patterns on admission (p = 0.041) and a decrease in aEEG-confirmed seizures (p < 0.001) and antiseizure medication (p < 0.001). Inotropic support decreased (p = 0.007), and use of invasive mechanical ventilation decreased over the last 5 years. Mortality (28.6%) and post-rewarming composite adverse outcome (i.e., neonatal mortality and/or adverse MRI score) (37.9%) remained unchanged. Number of infants seen at 2-year follow-up increased (p < 0.001). Conclusion: Over the last 15 years, we treated more infants with milder HIE, as indicated by lower Thompson and milder aEEG scores, and the need for invasive cardiorespiratory support declined. However, there were no improvements in composite adverse outcome (mortality and/or adverse MRI score).

Predicting the effect of nosocomial infection prevention on neonatal mortality and hospital stay in Ethiopia: a prospective longitudinal study

BackgroundNeonatal Nosocomial infections (NNIs) are a significant cause of morbidity and mortality for neonates in an intensive care unit. Neonatal causes of death in healthcare facilities are attributed to different factors. We aimed to investigate factors associated with NNIs, estimate the burden of NNIs, and assess how the prediction effects help to save medical mortality and length of hospital stay.MethodA prospective longitudinal study was conducted and data were collected from January 2022 to June 2022 from Jimma University Medical Center (JUMC). The data were gathered in a variety of ways, including an in-person interview with the patient’s caregiver, direct observations of neonatal patients, and a review of the study participants’ charts. This study includes patients aged 3 to 28 days who were admitted to the JUMC neonatal ward and stayed for at least 48 h. Multi-state model formulation and multivariate logistic regression were used for data analysis.ResultsA total of 545 neonates were included out of 688, and 30% (n = 164) of them acquired nosocomial infections (NIs); 98 (33%) of infected patients were born prematurely; and 71 (31.4%) were underweight at birth. NIs were higher in neonates with long hospital stay (AOR: 1.16, 95%CI: 1.13–1.20), use of urinary catheters (AOR: 3.09, 95%CI: 1.55–6.15), and undergoing surgical procedures (AOR: 2.42, 95%CI: 1.13–5.17). Patients who developed NIs had a higher risk of death (HR: 2, 95% CI: 1.31, 3.04). The burden of neonatal NIs was determined to have a risk of 0.3, a mortality rate of 9.6%, and an average duration of hospital stay of 14.6 days. Competing risk regression suggests that neonates with NIs have a significantly higher risk of death than those who are not infected (HR: 16.42, 95% CI: 8.70-30.98, p < 0.001). Assumed prevention that decreases the NIs rate in half would result in 101 lives and 1357 patient days saved from 10,000 neonatal inpatients.ConclusionUrinary catheterization and surgical procedure increased neonatal NIs. Longer hospital stay can increase the risk of NIs and can also result from the NIs. Our finding indicated that effective prevention of NIs could help reduce neonatal deaths and their hospital stays.

Incidence of Acute Kidney Injury in Asphyxiated Neonates and Its Relationship with Severity of Hypoxic-Ischemic Encephalopathy: Experience from a Medical College Hospital, Bangladesh.

Background: Perinatal asphyxia (PNA) is one of the leading causes of neonatal morbidity and mortality in Bangladesh. Among others, hypoxic-ischemic encephalopathy and acute kidney injury are two common complications of perinatal asphyxia. Morbidity and mortality increases when PNA is associated with these two complications. Objective: The objectives of the study were to determine the incidence of acute kidney injury (AKI) among asphyxiated neonates associated with various stages of hypoxic-ischemic encephalopathy (HIE) and to find out the relationship between AKI and HIE stages. Materials and Methods: This cross-sectional study was conducted in the neonatal unit of Jalalabad Ragib-Rabeya Medical College Hospital, Sylhet, between the periods of January 2018 and June 2018. A total of 130 newborns admitted in the neonatal ward within 24 hours of age with perinatal asphyxia and hypoxic-ischemic encephalopathy were included in the study by the consecutive sampling method. Serum creatinine level was measured at 24 hours after birth. AKI was considered if serum creatinine level was ³1.5 mg/dL. Result: Among 130 neonates, 35.4% had HIE stage-I, 56.1% had HIE stage-II and 8.5% had HIE stage-III. AKI was present in 12.3% of the asphyxiated neonates. There were no significant relationship between AKI and demographic variables like gender, birth weight, and place of delivery, mode of delivery and parity of the mothers. AKI was significantly associated with HIE stage-II and stage-III compared to HIE stage-I (p=0.02). The mean serum creatinine level was significantly higher in HIE stage-II and stage-III than HIE stage-I (p=0.001). Among the study neonates, 28.5% died. There was no significant relationship between death and AKI (p=0.74). The Pearson correlation test revealed no statistically significant relationship between serum creatinine levels and hospital stay. Conclusion: The incidence of acute kidney injury was 12.3% among asphyxiated newborn associated with HIE. Frequency of AKI significantly associated with severity of HIE. BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 24-29

Homeostatic Macrophages Prevent Preterm Birth and Improve Neonatal Outcomes by Mitigating In Utero Sterile Inflammation in Mice.

Preterm birth (PTB), often preceded by preterm labor, is a major cause of neonatal morbidity and mortality worldwide. Most PTB cases involve intra-amniotic inflammation without detectable microorganisms, termed in utero sterile inflammation, for which there is no established treatment. In this study, we propose homeostatic macrophages to prevent PTB and adverse neonatal outcomes caused by in utero sterile inflammation. Single-cell atlases of the maternal-fetal interface revealed that homeostatic maternal macrophages are reduced with human labor. M2 macrophage treatment prevented PTB and reduced adverse neonatal outcomes in mice with in utero sterile inflammation. Specifically, M2 macrophages halted premature labor by suppressing inflammatory responses in the amniotic cavity, including inflammasome activation, and mitigated placental and offspring lung inflammation. Moreover, M2 macrophages boosted gut inflammation in neonates and improved their ability to fight systemic bacterial infections. Our findings show that M2 macrophages are a promising strategy to mitigate PTB and improve neonatal outcomes resulting from in utero sterile inflammation.

Metabolic biomarkers of neonatal sepsis: identification using metabolomics combined with machine learning

BackgroundSepsis is a common disease associated with neonatal and infant mortality, and for diagnosis, blood culture is currently the gold standard method, but it has a low positivity rate and requires more than 2 days to develop. Meanwhile, unfortunately, the specific biomarkers for the early and timely diagnosis of sepsis in infants and for the determination of the severity of this disease are lacking in clinical practice.MethodsSamples from 18 sepsis infants with comorbidities, 25 sepsis infants without comorbidities, and 25 infants with noninfectious diseases were evaluated using a serum metabolomics approach based on liquid chromatography‒mass spectrometry (LC‒MS) technology. Differentially abundant metabolites were screened via multivariate statistical analysis. In addition, least absolute shrinkage and selection operator (LASSO) and support vector machine recursive feature elimination (SVM-RFE) analyses were conducted to identify the key metabolites in infants with sepsis and without infections. The random forest algorithm was applied to determine key differentially abundant metabolites between sepsis infants with and without comorbidities. Receiver operating characteristic (ROC) curves were generated for biomarker value testing. Finally, a metabolic pathway analysis was conducted to explore the metabolic and signaling pathways associated with the identified differentially abundant metabolites.ResultsA total of 189 metabolites exhibited significant differences between infectious infants and noninfectious infants, while 137 distinct metabolites exhibited differences between septic infants with and without comorbidities. After screening for the key differentially abundant metabolites using LASSO and SVM-RFE analyses, hexylamine, psychosine sulfate, LysoPC (18:1 (9Z)/0:0), 2,4,6-tribromophenol, and 25-cinnamoyl-vulgaroside were retained for the diagnosis of infant sepsis. ROC curve analysis revealed that the area under the curve (AUC) was 0.9200 for hexylamine, 0.9749 for psychosine sulfate, 0.9684 for LysoPC (18:1 (9Z)/0:0), 0.7405 for 2,4,6-tribromophenol, 0.8893 for 25-cinnamoyl-vulgaroside, and 1.000 for the combination of all metabolites. When the septic infants with comorbidities were compared to those without comorbidities, four endogenous metabolites with the greatest importance were identified using the random forest algorithm, namely, 12-oxo-20-trihydroxy-leukotriene B4, dihydrovaltrate, PA (8:0/12:0), and 2-heptanethiol. The ROC curve analysis of these four key differentially abundant metabolites revealed that the AUC was 1 for all four metabolites. Pathway analysis indicated that phenylalanine, tyrosine, and tryptophan biosynthesis, phenylalanine metabolism, and porphyrin metabolism play important roles in infant sepsis.ConclusionSerum metabolite profiles were identified, and machine learning was applied to identify the key differentially abundant metabolites in septic infants with comorbidities, septic infants without comorbidities, and infants without infectious diseases. The findings obtained are expected to facilitate the early diagnosis of sepsis in infants and determine the severity of the disease.

Maternal and neonatal outcomes of congenital syphilis at a tertiary care center in Turkey; a retrospective observational study

Background Maternal syphilis (MS) can lead to significant maternal morbidity and neonatal morbidity and mortality if inadequately treated. This study is aimed to retrospectively analyse the maternal and neonatal outcomes of pregnant women diagnosed with MS at our clinic. Materials and Methods We accessed the medical records of 64 cases diagnosed with MS between 2020 and 2022 from our hospital database and the perinatology clinic archives in this retrospective observational study. Case distributions by years, sociodemographic characteristics, and maternal and neonatal outcomes were recorded. Results The distribution of MS cases was 16 (25.0%) in 2020, 20 (31.25%) in 2021, and 28 (43.75%) in 2022. The mean age of the patients was 26.4 ± 6.3 years, mean BMI was 23.36 ± 3.14, the smoking rate was 31.25%, and the majority of patients were educated to primary level (37.5%). Most were housewives (43.75%), lived in urban areas (43.75%), and had lower-level incomes (68.75%). In addition, 43.75% received adequate maternal treatment, the caesarean delivery rate was 43.25%, 31.25% had preterm births, and the mean birth weight was 2956.36 + 514.46 g. CS was largely diagnosed during delivery or the postpartum period (43.75%). Fifty percent of patients were in the latent stage, gestational hypertension and preeclampsia were present in four case each (6.25%), and gestational diabetes mellitus in eight (12.5%). Twenty babies (31.25%) were admitted to the neonatal intensive care unit, eight (12.5%) had congenital anomalies, 12 had foetal growth restriction (18.25%), stillbirth was present in four (6.25%) case, and early neonatal death in four (6.25%). Conclusions Delayed diagnosis and inadequate treatment of MS can lead to significant maternal and neonatal morbidity and mortality. Well-planned antenatal care services should be provided for all expectant mothers in order to reduce these adverse outcomes.

EFFECTIVENESS OF MAGNESIUM SULFATE IN TERM NEONATES HAVING PERINATAL ASPHYXIA

In Pakistan, neonatal mortality and morbidity are remarkably high. Birth asphyxia (perinatal asphyxia) is one of the main contributors to this, apart from prematurity, sepsis and other causes. Objective: To assess the effectiveness of magnesium sulfate in term neonates having perinatal asphyxia Methods: This Randomized Controlled Trial was carried out at the Department of Pediatrics, Sheikh Zayed Hospital Rahim Yar Khan from July 2023 to December 2023. The overall sample size was 130 patients (65 patients in each group). Neonates in group A received MgSO through I/V, 3 doses 250mg/kg/dose, 24 hours apart along with standard treatment. Group B was a control group that received 20 ml of normal saline infusion at the same interval with similar supportive and symptomatic treatment with regular monitoring. The outcome in terms of mortality, seizure, early initiation of feed, time to the establishment of full oral feeding, duration of seizures and duration of hospital stay were assessed. All the data was analyzed by using SPSS version 25.Results: In the current study, a total of 130 neonates were enrolled. Among them, moderate asphyxia was observed in 90 (69.23%) patients whereas severe perinatal asphyxia was observed in 40(30.77%) patients. In group A, the mean level of serum magnesium in neonates with moderate asphyxia was 2.81 (±0.20) mEq/L while in neonates with severe asphyxia, it was 2.89 (±0.61) mEq/L. The moderate asphyxia patients in group-A showed significant statistical improvement in terms of seizure control (hours) (14.11±1.22 vs 18.11±1.56; P=0.01), normal cry appearance (Days) (11.1±0.12 vs 13.11±1.29; p=0.03), normal activity appearance (Days) (11.9±0.02 vs12.00±1.51; p=0.01), full oral feed acceptance by sucking (Days) (13.31±0.99 vs 14.61±1.51; p=0.01) and mean hospital stay duration (Days) (14.99±1.66 vs 16.21±1.11; p 0.02). Conclusion: Our study concludes that in asphyxiated newborns, postnatal magnesium sulphate infusion is safe and likely to enhance the short-term neurological prognosis in cases with moderate-grade encephalopathy.

Exploring the Experiences, Cultural Values, and Perceptions of Mothers of Hospitalized Newborns in Malawi: An Integrative Review of the Literature.

Sub-Saharan Africa has the world's highest rates of neonatal mortality. Mothers are critical to the survival of these at-risk newborns. The aim of this integrative review is to appraise the published literature on the experiences, cultural values, and perceptions of mothers of hospitalized newborns in Malawi to inform future research. This integrative review utilizes Whittemore and Knafl's review model. CINAHL, PubMed, and Academic Search Elite databases were searched. Five summarizing themes were identified across ten articles relating to the mother as a caregiver, experiences of mother as a caregiver, cultural observations and perceptions of the mother, influence of others on the mother, and discrimination and stigma. Mothers' experiences of having a newborn requiring hospitalization in Malawi are complex. Results indicate a need for more studies to understand the experiences of mothers of newborns requiring hospitalization in Malawi in order to provide culturally congruent newborn care.

Prevalence, Mortality, and Associated Anomalies in Esophageal Atresia: A Retrospective Study of Finnish Population Data (2004-2017).

The aim of the study was to investigate the prevalence of esophageal atresia (EA), frequency of associated anomalies, and mortality from 2004 to 2017 in the Finnish population. We hypothesized the Spitz classification and the presence of other congenital malformations would predict mortality in patients with EA as well as assumed the survival to be high among patients with EA. This retrospective, population-based study was based on the registries maintained by THL Finnish Institute for Health and Welfare and Statistics Finland. The cases were identified and classified according to the World Health Organization's International Classification of Diseases and Health Related Problems (ICD) revisions 9 and 10 (ICD-9 and ICD-10) codes and accompanying written diagnoses. Associated anomalies were classified based on the EUROCAT criteria, and minor anomalies were excluded. All statistical tests were performed as a two-sided significance level set at p < 0.05. The chi-square or Fisher's exact test was utilized for categorical variables. The change in prevalence rates during the study period was evaluated with linear regression. In total, 337 cases with EA were identified including 295 (87.5%) live births, 17 (5.0%) stillbirths, and 25 (7.4%) terminations of pregnancy. The total prevalence for EA in Finland was 4.17/10,000 births with no significant change during the study period, p = 0.35. Neonatal mortality was 5% (n = 15) and 1-year survival was 91.5%. Mortality was associated with syndromic cases (p = 0.002). The Spitz classification predicted neonatal mortality better than cardiac anomalies alone (p < 0.001 and p = 0.6, respectively). Type C was the most common atresia type (65.9%) followed by type A (14.8%) and B (6.8%). The most common group of associated malformations were heart defects (35.0%) followed by other gastrointestinal tract malformations (15.3%) and limb anomalies (12.2%). Syndromic cases (12.2%) were associated with type A and B atresias (p = 0.001). VACTERL association was observed in 16.6% of the cases. The overall prevalence of EA remains stable and relatively high in Finland. Despite the high prevalence of co-occurring malformations, the overall survival rate is high. Spitz classification predicted neonatal survival well.

Trends in the quality of antenatal care in India: Patterns of change across 36 states and union territories, 1999-2021.

Antenatal care (ANC) quality is important to maternal and neonatal mortality. However, trends in the quality of ANC received by pregnant women in India have been understudied. This paper seeks to fill this gap by examining the long-term patterns nationwide and the state-specific prevalence of inadequate ANC quality received by pregnant women in India. We utilised data from four National Family Health Surveys (NFHS) conducted in 1999 (NFHS-2), 2006 (NFHS-3), 2016 (NFHS-4), and 2021 (NFHS-5) across India's 36 states/union territories (UTs). The sample includes mothers who had given birth within three years (NFHS-2) and five years (NFHS-3, NHFS-4, and NFHS-5) before each survey. We define inadequate ANC quality as not completing seven essential ANC services (weight measurement, blood pressure measurement, urine sampling, blood sampling, provision of iron supplements, provision of tetanus vaccination, and ultrasound scans) during pregnancy. We calculated the standardised absolute change to quantify the change in the share of women receiving inadequate quality ANC nationally and by each state/UT. Additionally, we estimated the population headcount of mothers who received inadequate-quality ANC in 2021 and identified the socioeconomic correlates associated with inadequate ANC quality. The prevalence of inadequate ANC quality substantially declined between 1999-2021, from 84.8% (95% confidence interval (CI) = 84.1-85.5) to 28.8% (95% CI = 28.5-29.2). However, between-state inequality in ANC quality has increased over this time. We identified a weak correlation between prevalence and population headcounts in 2021. Socioeconomically disadvantaged groups exhibited a higher prevalence of inadequate quality of ANC than less disadvantaged groups. The proportion of pregnant women receiving inadequate ANC quality has decreased over time throughout India. However, multi-faceted efforts at national and state levels are necessary to enhance the effectiveness of existing policies. Additionally, innovative and targeted approaches are required to ensure the timely and equitable provision of high-quality ANC.

Trends in operative vaginal delivery rates: A 20-year retrospective analysis in Ireland.

SynopsisForceps delivery rates are increasing significantly, with a significant decrease in vacuum‐assisted delivery, with no change in neonatal morbidity or mortality.

Most babies born at a French hospital before 26 weeks survived with good outcomes.

The aim of this French study was to determine the neonatal morbidity, mortality and neurodevelopmental outcomes when infants born at the limit of viability reached 2 years of corrected age. We then compared the results with national and international cohorts. This study focused on 294 French infants born from 22 to 25 weeks of gestation in a single tertiary perinatal centre from January 2010 to December 2019. We used data on neonatal mortality and morbidity to calculate the survival rates of infants without moderate to severe neurodevelopmental and sensory deficits at 2 years of corrected age. These outcomes were compared with data from contemporary epidemiological studies of similar populations. Nearly two-thirds (60.5%) of the infants survived to discharge, with varying rates based on their gestational ages, and 57.3% had no severe neonatal morbidity. The vast majority (90.4%) of the 166 alive and available at 2 years of corrected age were free of moderate to severe neurodevelopmental impairment. Our survival rates exceeded a national French cohort study, but were closely aligned with international cohorts. These findings highlight the importance of incorporating local data into ethical decision-making about life-saving treatment for infants at the limit of viability.

Antenatal corticosteroids for late small-for-gestational-age fetuses.

To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS). A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6weeks at a tertiary university-affiliated hospital, fromMarch 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality. The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79-5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17-3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2-7days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed toACS (29.2 vs. 22.0 %, p=0.560). Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity.

Clinical Study of Eclampsia Patients in Early Age Group of Women Admitted into DMCh between July 2023 to December 2023

Background: Eclampsia, characterized by the onset of seizures in women with preeclampsia, is a significant cause of maternal and neonatal mortality, especially in low-resource settings like Bangladesh. Young women, particularly those in their teenage years, are especially vulnerable to this life-threatening condition due to socio-economic and health factors. Objective: This study aims to assess the clinical outcomes of eclampsia patients aged 15 to 20 years admitted to Dhaka Medical College Hospital (DMCh) between July 2023 and December 2023. Method: A cross-sectional study was conducted at DMCh, focusing on young women diagnosed with eclampsia. Patients admitted with symptoms of preeclampsia or eclampsia after 20 weeks of gestation were included. Detailed clinical evaluations and sociodemographic data were collected, including obstetric history and predisposing factors. Diagnostic tests were performed, and management protocols were followed, including the administration of magnesium sulfate. Maternal and neonatal outcomes were monitored, including mode of delivery and complications. Results: The majority of eclampsia patients (39.13%) were aged 17-18 years, followed by 35% aged 15-16 years, with a significant proportion being primigravida (55%). Most cases occurred between 36-38 weeks of gestation (35%). Antepartum eclampsia accounted for 90% of cases, and 80% of deliveries were via cesarean section. Maternal outcomes revealed a 77% improvement rate, while neonatal outcomes showed an 80% survival rate, despite a 15% stillbirth rate. Conclusion: The findings indicate that eclampsia predominantly affects young, primigravida women in late gestation, with significant implications for maternal and neonatal health. The high incidence of cesarean deliveries and notable stillbirth rates highlight the need for improved prenatal care and postnatal monitoring in this vulnerable population. Addressing these gaps could help reduce the burden of eclampsia in young women in Bangladesh.

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.

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).

Improving Post-discharge Weight Gain Among Neonates received Kangaroo Mother Care: Two Years Experience of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: “Kangaroo Mother Care” is an effective alternative care strategy for preterm and low birth weight babies. It also causes substantial reduction of neonatal mortality due to hypothermia. Objective: To observe the status of ongoing kangaroo mother care service in a tertiary care hospital and its outcome. Material and method: This retrospective study was carried out over the period of 1st July 2020 to 30th June 2022. Newborns who received kangaroo mother care in neonatal intensive care unit and postnatal ward of Bangabandhu Sheikh Mujib Medical University, Dhaka during the study period, were enrolled in this study. Results: A total of 384 (97% of eligible candidates) newborn received kangaroo mother care. Kangaroo mother care was provided both in Neonatal intensive care unit (86% of total admission) and also in the postnatal ward. Mean gestational age was 32.02+2.85 weeks (28 weeks-41 weeks) and mean weight of starting KMC was 1367.48 g (730 g – 1970 g). Average age of initiating KMC was 6 days (ranging from 1 to 13 days of age). Mean duration of providing KMC was 6 hours and 50 minutes. More than two third (74.4%) patients came for follow up. During each follow up, an increasing trend was observed regarding weight gain and mean weight gain was 15.9+1.2 g/ kg/day. Conclusion: Kangaroo mother care was provided to most of the eligible patients and persistent weight gain was observed among all KMC candidates after discharge.

Pay for a free service, access to cesarean section in the slums of Dakar

BackgroundIn sub-Saharan Africa, equitable access to cesarean section remains a major challenge for reducing maternal and neonatal mortality, particularly among disadvantaged populations. This situation is further exacerbated in slums, where women face significant financial barriers to accessing expensive healthcare services, such as cesarean. Within this context, this paper aims to study access to emergency cesarean services among women living in the slums of Dakar, considering the free cesarean policy implemented in Senegal since 2005.MethodQuantitative data were collected using a cross-sectional retrospective approach, from 18 health facility managers and 260 women living in slums in Dakar who had undergone cesarean delivery between July and December 2022. The surveys aimed to collect socio-demographic data on women and the costs they paid to have a cesarean section, as well as on the application of the policy of free caesarean sections by public health facilities. The data were processed using Stata.ResultsThe results indicated that poor women residing in Dakar slums do have access to emergency cesarean section services in public health facilities. However, a significant portion of these women come from impoverished households and lack higher education, making them more vulnerable to financial constraints when seeking a C-section. Despite cesarean sections being performed primarily based on medical necessity, regardless of the woman's economic status, ethnicity, or educational background, women often find themselves having to pay substantial amounts to undergo the procedure. This is particularly concerning, as cesarean sections are intended to be entirely free in public health facilities in Senegal. Health facility managers attribute this financial burden to the State, which recurrently delays reimbursements for cesarean sections, forcing them to charge women higher prices for the procedure.ConclusionA more rigorous enforcement of the policy for free cesarean section could greatly enhance access to this obstetric practice for women living in the slums of Dakar.

Neonatal mortality among disaggregated Asian American and Native Hawaiian/Pacific Islander populations.

We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data. We used 2015-2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternalclinical, and neonatal risk factors. Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors. Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.

Factors Associated with Intra Hospital Neonatal Mortality: A Case Study of the Neonatology Department at the Regional Hospital Center of Agadir (Morocco)

Background: Neonatal mortality (NNM) has significantly decreased in developed countries. However, it remains a major public health issue and a particular challenge in developing countries, with Morocco being no exception, as its NNM rate remains high. Objectives: This study aims to identify factors associated with NNM within the Neonatology Department at the Regional Hospital Center of Agadir. Methods: An analytical cross-sectional study design was chosen. To determine factors associated with early NNM, we employed binary logistic regression in both univariate and multivariate analyses, including all statistically significant variables in the multivariate model. Results: Three hundred and eight deceased neonates were included. The intra-hospital NNM rate was 17.4%, 95% CI (13.2 - 21.7), during the period from 2018 to 2021. A predominance of early NNM (81.8%). 52.3% were females. 47.7% of the deceased had low birth weight. 65.9% of the cases had an Apgar score &lt; 7. 44.2% were resuscitated. The factors that were statistically associated with the risk of early NNM were as follows: Admission age ≤ 1 day (aOR: 17.87; 95% CI: 5.78 - 55.29), neonatal admission age 2 - 7 days (aOR: 6.64; 95% CI: 1.68 - 26.30). Intra-hospital referral (aOR: 4.49; 95% CI: 1.59 - 12.65); emergency consultations (aOR: 4.25; 95% CI: 1.28 - 14.01). Conclusions: Neonatal mortality remains a major public health challenge in Morocco. Different risk factors associated with NNM have been identified. Addressing these factors could reduce neonatal deaths in low-resource countries. For this reason, we need to intensify our efforts to develop reliable and precise approaches.