Neonatal Ward Research Articles

Blood-Biomarkers for Glucose Metabolism in Preterm Infants.

This was an exploratory, prospective, longitudinal, cohort study that aimed to establish "healthy" reference levels related to growth parameters and glucose metabolites in preterm infants. This was conducted to further investigate growth and metabolic disturbances potentially related to neonatal illness. The study sample consisted of 108 preterm infants born before 32 weeks in 2018-2019 in the Capital Region of Denmark. Repetitive blood samples were acquired at the neonatal wards, while clinical data were obtained from the regional hospital medical record system. Thirty-four "healthy" preterm infants (31%) were identified. The "ill" infants were divided into four subgroups dependent on gestational age and small for gestational age. Reference levels for the growth parameters and metabolic biomarkers glucose, albumin, and adiponectin, and two glucose control indicators, glycated albumin and fructosamine, were determined for the "healthy" and "ill" subgroups. The "ill" extremely preterm infants had increased glucose levels (mean difference 0.71 mmol/L, 95% CI 0.23; 1.18 mmol/L) and glycated albumin (corrected; %) (mean difference 0.92 mmol/L, 95% CI 0.38 mmol/L;1.47 mmol/L) compared to the "healthy" infants. In "ill" extremely preterm infants and "ill" very preterm infants born small for gestational age, levels of biomarkers containing proteins were decreased. In the "Ill" extremely preterm infants and infants born small for gestational age, postnatal growth was continuously decreased throughout the postconceptional period. The short-term glucose-control indicator, glycated albumin (corrected; %), reflected well the high glucose levels due to its correction for the depleted plasma-protein pool.

Exploring the potential factors affecting the type of pathogens responsible for urinary tract infection in neonatal hyper bilirubinemia

Background: Unexplained neonatal hyperbilirubinemia may be the newborns’ sole clinical presentation of urinary tract infection (UTI). Objective: We aimed to determine the potential factors affecting the type of pathogens responsible for UTI in neonatal hyperbilirubinemia. Methods: This cross-sectional study retrospectively evaluated newborns admitted to the neonatal ward of Bandar Abbas Children’s hospital, between 2016 and 2018. Newborns with hyperbilirubinemia and culture-confirmed UTIs were included in the study. The following data were extracted from patients’ medical records: demographics and anthropometrics, type of delivery, newborn’s feeding, clinical manifestations, urine sampling method, and laboratory test results, including total bilirubin and urine culture. Results: Of the 96 neonates with hyperbilirubinemia and positive urine culture in this study, 63 (65.6%) were male. Their mean age was 13.60 ± 6.00 days. Escherichia coli (E. coli) was the most common pathogen isolated from the urine cultures (33.3%), followed by Klebsiella (24%). Age, sex, gestational age, birth weight, type of delivery, newborn’s feeding, clinical manifestations, total bilirubin levels, and urine sampling method were not associated with the type of pathogens isolated from urine culture (P>0.05). Conclusions: Most urine cultures from newborns with hyperbilirubinemia were positive for E. coli. None of the potential factors evaluated in this study were correlated with the type of pathogens responsible for UTI in neonates with hyperbilirubinemia.

Absolute Neutrophil Count in Diagnosis of Neonatal Sepsis : A Hospital Based Cross Sectional Study

Background : Sepsis is the leading cause of neonatal death in developing countries. Delay in initiating treatment can considerably increase the morbidity and mortality. So early diagnosis is important.Traditional methods such as blood culture do not provide a rapid diagnosis. Absolute neutrophil count is one of the important hematological markers for diagnosis of sepsis. The purpose of the study to see the absolute neutrophil count in diognosis of neonatal sepsis.
 Materials and methods: This is a hospital based cross sectional study conducted from January to June 2014. A total of 100 sick neonates admitted in the Neonatal ward of Chattagram Maa Shishu O General Hospital (CMSOGH) with suspected neonatal sepsis (Based on history and physical examination) constituted the study population. Investigation sent for Absolute neutrophil count, C-reactive Protein (CRP) and blood culture. The collected data was analyzed by statistical software packages SPSS method version 15.
 Results: A total of 100 sick neonates of both sexes with suspected sepsis were enrolled in this study, out of which most of the patient showed neutropenia (66%), C-reactive protein positive 65% and blood culture positive 33%. Within the Creactive protein positive patients 78.8% patient had neutropenia (c2 =17.711, p= .001). From blood culture positive patients 85% showed neutropenia (c2 =8.510, p= 0.014).
 Conclusion: Neutropenia is a common hematological finding in neonatal sepsis along with other screening test and neutropenia is more significant than neutrophilia.
 Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 66-70

Various Mode of Presentation of Oligohydramnios in Patients Admitted in BSMMU: A Hospital Based Study

Introduction: Oligohydramnios is a pregnancy disorder characterized by a shortage of amniotic fluid volume. It is a rather common obstetric complication that has severe effects on the health of both the mother and the fetus. Early identification is essential for prompt diagnosis and therapy because the clinical appearance of oligohydramnios can vary greatly. This study aimed to investigate the various modes of presentation of oligohydramnios in patients admitted to Bangabandhu Sheikh Mujib Medical University (BSMMU), a tertiary care hospital in Bangladesh. Methods: This prospective observational study was carried out on the admitted patients at the Department of Gynaecology and Obstetrics in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from February to July 2008 (6 months). A total of fifty women (N=50) having Oligohydramnios in pregnancy were included in the study. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for Social Sciences (SPSS) Version 25.0.The ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: The mean age of the mothers was 25.8 years and two-fifths of the mothers (20, 40.0%) belonged to 21-25 years old. Twenty-three mothers (23, 46.0%) were nulliparous. Of fifty mothers (N=50), eighteen (18, 36.0%) had borderline oligohydramnios and thirty-two (32, 64.0%) had severe oligohydramnios. Normal CTG tracing was found in eighteen patients (18, 36.0%) and abnormal CTG was found in thirty-two patients (32, 64%) (p < 0.01) which was statistically significant. Among the alive babies after initial resuscitation, twenty-three babies (23, 50.0%) were required to get admitted. Twelve admitted babies (12,52.2%) stayed in the neonatal ward for <7 days and among them one baby (1,8.3%) died, nine babies (9,39.1%) were treated for 7—21 days, among them two babies (2,22.2%) could not survive and two babies were treated for more than 21 days but could not survive. Conclusion: According to the findings, severe oligohydramnios was linked to a higher risk of cesarean delivery, higher APGAR ratings, and probable issues that would necessitate neonatal admission and care.

Term-born infants with a perinatal stroke frequently had seizures and were prescribed anti-seizure medication at discharge.

We investigated the prevalence of seizures in term-born infants with a perinatal stroke in Swedish neonatal wards, assessed the anti-seizure medication prescribed and determined the accuracy of diagnostic codes. This cross-sectional study used data from the Swedish Neonatal Quality Register. The cases were infants born at ≥37 weeks in 2009-2018 and admitted to a neonatal ward in Stockholm County with a stroke diagnosis, confirmed by their medical chart. The controls were all Swedish infants born during those years. There were 76 infants with a confirmed perinatal stroke: 51 ischaemic and 25 haemorrhagic. Seizures were documented in 66/76 (87%) of infants with a stroke and 0.2% of the controls. Anti-seizure medication was administered to 64/66 (97%) infants with a stroke and seizures. In 60 cases, the drugs administered were specified, with phenobarbital used in 59/60 cases (98%). More than one drug was administered to 25/60 (42%) infants and 31/60 (52%) were discharged with anti-seizure medication. The positive predictive value for the stroke diagnostic codes was 80.5% (95% CI 76.5-84.5). Seizures were common in infants with a perinatal stroke. More than one anti-seizure drug was often required and many infants were on anti-seizure medication at discharge, against Swedish recommendations.

Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care.

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families. This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care. Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals. A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents. Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes. The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.

Genotypic shift in rotavirus associated with neonatal outbreaks in Seoul, Korea.

Rotavirus group A (RVA) is a causative agent of acute gastroenteritis among young children worldwide, despite the global expansion of rotavirus vaccination. In Korea, although the prevalence of RVA has been reduced among young children owing to vaccination, nosocomial infections still occur among neonates. The aim of this study was to investigate the molecular epidemiology of RVA strains associated with several neonatal outbreaks in Seoul from 2017 to 2020. Clinical and environmental samples were collected and screened for the presence of RVA using ELISA and PCR targeting VP6, respectively. RVA-positive strains were genotyped via RT-PCR and subsequent sequencing of VP4 and VP7 and were phylogenetically compared with RVA strains from other countries. During 2017-2020, a total of 15 RVA outbreaks occurred at neonatal facilities (six in hospital neonatal wards and nine in postpartum care centers) in Seoul, and only two RVA genotypes were detected: G4P[6] and G8P[6]. G8P[6] emerged in Seoul November 2018 and immediately became the predominant genotype among neonates, at least up to 2020. Phylogenetic analysis revealed that the G8P[6] genotype in this study was closely related to G8P[6] strains first identified in Korea in 2017, but differed from G8P[6] strains detected in Africa. A novel G8P[6] genotype of RVA strains has emerged and caused outbreaks among neonates in Seoul. Continued surveillance for circulating RVA genotypes is imperative to monitor genotype changes and their potential risks to public health.

Adverse Effects of Topiramate in Neonate with Moderate to Severe Perinatal Asphyxia: A Randomized Controlled Trial

Introduction: A harmful pregnancy condition that harms both the mother and the fetus is perinatal asphyxia. It frequently happens as a result of challenges during labour, including protracted or challenging delivery, concerns with the umbilical cord, placental abnormalities, or maternal health conditions. Topiramate, an anticonvulsant, works through a variety of different methods. Topiramate looks to be effective as a neuroprotective agent as well as an anti-seizure medication in animal models of newborn brain injury. Angiogenesis, neurogenesis, and neuronal anti-apoptotic pathways are all stimulated and regulated by topiramate. In light of this, this observational study was conducted to ascertain Topiramate's negative consequences in kids with mild to moderate neonatal hypoxia. Methods: This observational case-control study was carried out in the Neonatal ward and ICU of Dhaka Shishu Hospital from April 2015 to March 2016. A total of 64 neonates were enrolled in this study and were assigned Group A -the interventional group (n=32) received topiramate and standard treatment protocol, and Group B or the control group (n=32) received only standard treatment protocol. The data were analyzed according to standard procedure. Results: Among the study neonates, based on sex in case and control groups, respectively, seventeen (17,53%) and twenty-one (21,66%) neonates were male, and fifteen (15,47%) and eleven (11,44%) neonates were female. Statistically, the sex distribution between groups was not significant (p=0.44). USG finding of the neonates after treatment was normal in 12 (48%) and 13(41%), and abnormal in 20(32%) and 19 (59%) neonates in the control and case groups, respectively. Out of 27 neonates in the control group, 11 (41%) were neurologically normal, and 16 (59%) had abnormal neurological findings. Out of 29 neonates in the case group, 24 (73%) were neurologically normal, and 5(17%) showed abnormal neurological findings. Statistically, significant variation ..

Echocardiographic parameters predicting spontaneous closure of ductus arteriosus in preterm infants.

To evaluate the value of echocardiographic parameters in predicting early spontaneous closure of ductus arteriosus in premature infants. 222 premature infants admitted to the neonatal ward of our hospital were selected, and patent ductus arteriosus was detected by echocardiography 48 h after birth. On the 7th day, whether the ductus arteriosus was closed naturally in this cohort was observed. The infants whose ductus arteriosus were not closed were identified as the PDA group (n = 109), and the other infants were included in the control group (n = 113). The echocardiographic parameters of the two groups of premature infants at 48 h after birth were single-factor statistically and Pearson correlation analyzed, and the parameters with statistically significant differences in single-factor analyzed were selected for multivariate logistic stepwise regression analysis. The ductus arteriosus shunt velocity and the pressure difference between the descending aorta and the pulmonary artery (ΔPs) in the PDA group were lower than those in the control group (P < 0.05). The pulmonary artery pressure (PASP) in the PDA group was higher than that in the control group (P < 0.05). According to the multivariate logistic stepwise regression analysis, only the maximum shunt velocity of ductus arteriosus was correlated with early spontaneous closure of ductus arteriosus in 48 h first echocardiographic parameters (P = 0.049). The receiver operating characteristic (ROC) curve indicates the optimal critical point of echocardiographic ductus arteriosus shunt velocity in premature infants 48 h after birth was 1.165 m/s. Echocardiographic parameters are of great value in predicting the early spontaneous closure of ductus arteriosus in premature infants. In particular, the ductus arteriosus shunt velocity is correlated with the early spontaneous closure of ductus arteriosus.

Evaluation of facial anthropometric characteristics in infants born in north of Iran

ObjectiveAnthropometric measurements of newborns are essential indicators of their health, as natural changes throughout their lives limit them. This study aimed to investigate the morphological characteristics of the head and facial region of newborns using internationally accepted cephalometric techniques. MethodsA descriptive and cross-sectional study was conducted on 1225 one-day-old, full-term, clinically healthy infants born at Shahid Sayad Shirazi Hospital, Gorgan. Two nurses from the neonatal ward were trained in the correct method of measuring anthropometric indicators. They were evaluated and confirmed by a pre-test within 24 h of the baby's birth. ResultsThe mean cephalic index was 74.8 ± 9.11 in males and 74.43 ± 9.63 in females, while the mean prosopic index was 82.57 ± 9.72 and 83.14 ± 9.89, respectively. The Fars, Turkman, and Sistani ethnic groups had different mean cephalic and prosopic indices, with the dolichocephalic type being the dominant type in both sexes and all ethnic groups. The hyperbrachial cephalic type was rare. The prosopic hyperauricular type was the dominant type based on the prosopic index, and the leptoprosobic type was rare in both genders and ethnic groups. ConclusionThe study found significant differences in the main dimensions of the head and face among the three ethnic groups of Fars, Turkmen, and Sistani living in Gorgan city. These findings suggest that ethnicity can impact the diversity of newborns' head and face shapes.

Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria.

The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.

Anthropometric Measurements of Singleton Live Full-Term Newborns in Comparison to Who Standard at University of Gondar Comprehensive Specialised Hospital, Ethiopia.

Anthropometry is a universally applicable, non-expensive, rapid and noninvasive technique used to evaluate and reflect the nutritional status of an individual. Anthropometric measurements of newborns reflect their general health, nutritional status and future survival by tracking trends in growth and development over time. It has also considerable significance in terms of determining the risk of death and extra uterine complications. Most previously conducted studies assessing newborn anthropometry had used birth weight as the sole parameter. But it is apparent that other anthropometric measurements, such as length and head circumference, are also important in predicting short-term and long-term outcomes. So this study assesses anthropometric measurements of singleton live full-term newborns at University of Gondar comprehensive specialised hospital, Ethiopia. Hospital-based cross-sectional study was conducted among 333 newborn from 5 June to 11 July 2022, in the maternity and neonatal ward of University of Gondar comprehensive specialised hospital. A systematic random sampling technique was employed to select the study participants. The Kobo toolbox software platform was used for data collection, and STATA software version 16 was used for analysis. The mean birth weight, length and head circumference of the newborns in the current study were 2977 grams (95% CI: 2935.7, 3018.3), 47.05 centimeters (95% CI: 46.72-47.37) and 34.7 centimeters (95% CI: 34.6, 34.88), respectively. The prevalence of SGA (< 10th percentile) and LGA (> 90th percentile) was 20.12% and 6.01%, respectively. Independent samples t-test was done to see the association of newborn sex with anthropometric indices, and the result showed that the difference was statistically insignificant in all of anthropometric parameters. This study of normal reference values will provide basic step for future standardisation of Ethiopian term newborns anthropometric parameters to be used for accurate assessment of newborns.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Antifungal Stewardship Programs in Children: Challenges and Opportunities.

Association of duration of skin-to-skin contact after cesarean delivery in China: a superiority, multicentric randomized controlled trial

In China, rates of early initiation and exclusive breastfeeding are low. The high cesarean section rates further contribute to low breastfeeding outcomes. Skin-to-skin contact (SSC), a key component of Early Essential Newborn Care, is known to be associated with improved breastfeeding initiation and exclusivity; however, the necessary duration has not been subjected to an RCT. To determine the association of duration of SSC after cesarean section on breastfeeding outcomes and maternal and neonatal health outcomes in China. A multi-centric RCT was conducted at four hospitals in China. 720 participants ≥37 gestational weeks with singleton pregnancy receiving elective cesarean section, using epidural anesthesia or spinal anesthesia or combined spinal-epidural anesthesia were randomly divided into 4 groups at the ratio of 1:1:1:1. The control group received routine care. Intervention group 1 (G1), 2 (G2) and 3 (G3) received 30, 60 and 90 minutes of SSC immediately after cesarean section, respectively. Between January 3 and October 14, 2021, 659 participants were recruited, including 173 in control group, 176 in G1, 146 in G2, and 164 in G3. Among G1, G2 and G3, the rate of early initiation of breastfeeding within 60 minutes of birth was 56%, 71% and 72%, compared to 22% in control group (p<0.001). The exclusive breastfeeding rate at discharge were 69%, 62% and 71%, compared to 57% in control group (p=0.003). EENC practices were associated with reduction in postpartum blood loss and NICU or neonatal ward admission (p< 0.001, p=0.022) . Our findings highlight that prolonged SSC after cesarean section was associated with higher initiation and exclusive breastfeeding at discharge. It also found associations with reduced postpartum blood loss and NICU or neonatal ward admission.

Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation.

Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months. A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014-2015. In Denmark, health visitors routinely conduct free home visits throughout infants' first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables. The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97-1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73-0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77-0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35-36 weeks; n = 3,139) (1.31; 95% CI 1.12-1.54), as opposed to among early term (gestational age 37-38 weeks; n = 19,171) (0.84; 95% CI 0.77-0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83-0.94). The associations seemed to persist at four months. Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.

Postnatal SARSCOV2 Infection in Neonates, Characteristics and Outcomes: An Observational Study

Background: Many aspects of the severe acute respiratory syndrome coronavirus 2 (SARSCoV2) pandemic in 2019 have been unclear, especially in newborns, and reports of neonatal diseases are usually associated with perinatal infection. Objectives: The purpose of this study was to evaluate clinical and para-clinical manifestations in newborns that contracted the infection after birth. Methods: This observational research was conducted from October 2020 to March 2022 to examine postnatal SARSCoV2 infection in infants admitted to the NICU or neonatal ward at the Children’s Medical Center in Tehran, Iran. Inclusion in the study was open to neonates who had positive RT-PCR results postnatally. Results: In total, 55 newborns were confirmed to have postnatal SARSCOV2. Fever was the most frequently observed symptom, with 35 (61%). Necrotizing enterocolitis was seen in 18% of neonates, and 30% of them were preterm. Neutropenia was seen in 34% of cases, with five cases having severe neutropenia. All neonates had a normal platelet count. Twenty percent of patients showed C - reactive protein higher than 6 mg/L. Two newborns had co-existing bacterial urinary tract infections. Our neonates didn't require antiviral, anticoagulant, or corticosteroid medications, and they recovered while receiving only supportive care. Everyone in the group of newborns was discharged without complications, and there were no deaths. Conclusions: The high rate of fever, high C- reactive protein, and neutropenia in SARSCoV2 neonates suggests that more observational research is needed to compare these symptoms to bacterial sepsis to avoid the overuse of antibiotics in these patients.

Determinants of Intrapartum Still Birth and Early Neonatal Death in a Periurban Hospital

Stillbirth and early neonatal death is quite high in Bangladesh. The current study was undertaken to find out sociodemographic and pregnancy related risk factors that may exist with cases of stillbirth and death during first 7 days of life. This was a cross sectional study conducted at Institute of Child and mother health (ICMH) between February to June 2015. Mothers delivered still birth baby at ICMH and whose babies were admitted in neonatal ward immediately after birth for delay to cry were enrolled consecutively. Data was collected by interviewing mothers and reviewing hospital records using structured questionnaire. Follow up was done till 7 days. Data analysis was done with SPSS version 14 Among a total 116 mothers 83.6% came from rural areas, 48.2% belong to 20-25 years age group with mean age 23±5 year, 46.6% had primary education, 89.7% were primipara, and 62.9% had more than 4 antenatal visits in index pregnancy. Common pregnancy related problems were anaemia (85.3%), preeclampsia (41.4%), less fetal movement (31.9%), polyhydramnios (13.8%), oligohydramnios (12.9%), premature rupture membrane (58.6%), prolong labour 48.3%), malpresentation (8.6%) and urinary tract infection in 12.1%. About 69.8% delivered at hospital, 59% had normal vaginal delivery, instrumental delivery 17.2% and caesarean section in 24.1%. About 57.8% babies were born preterm. and 55.1% were low birth weight. During first 7 days of life 32% developed neonatal sepsis and 32.8% died. Cause of death as recorded was perinatal asphyxia (55.17%), hypoxic ischemic encephalopathy 17.2%, low birth weight with perinatal asphyxia in 35.6% and meconium aspiration syndrome 4.5%. Stillbirth and early neonatal deaths are obstetric catastrophe and has common overlapping risk factors. Risk specific interventions with special emphasis on improvement of quality of care throughout the phases of pregnancy, delivery and postpartum period is recommended&#x0D; Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 10-17

Baseline status regarding compliance with neo-BFHI recommendations in South African neonatal wards: a cross-sectional survey

BackgroundIn 2009, the World Health Organization and the United Nations Children’s Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group.AimTo determine the level of compliance with the recommendations outlined in the “Baby-friendly Hospital Initiative for neonatal wards” (Neo-BFHI) in the South African neonatal wards.MethodIn this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24.ResultsThe South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant “togetherness”), respectively. Level 1 and 2 care facilities scored significantly higher than level 3.ConclusionAlthough South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals.

Temperature Monitoring in Children: An Agreement Study

Background: Noncontact infrared thermometer (NCIT) measures temperature rapidly and noninvasively. It is commonly used at forehead, but other potential sites such as axilla and abdomen are yet to be explored. We assessed agreement of temperature recordings of axillary temperature by glass mercury thermometer (the “gold standard”) with axillary temperature by the digital thermometer as well as with NCIT at forehead, axilla, mid abdomen, and at right hypochondriac areas. Methods: Neonates and children below 5 years admitted in neonatal and pediatrics wards were enrolled in the study through convenience sampling. For each participant, temperature was measured using NCIT at forehead, mid abdomen, right hypochondrium, and right axilla as well as using digital thermometer at right axilla and using glass mercury thermometer at right axilla. The agreement between methods was presented as mean difference (95% limits of agreement) using Bland-Altman analysis. Results: Total 400 temperature readings were taken for each method from 132 participants. There was a good agreement between mercury axillary with digital axillary in both the groups, that is, neonates and children (&gt;1 month to 5 years) (Mean difference [95% limits of agreement] = –0.046 [–0.26 to 0.169]°C and –0.028 [–0.183 to 0.128]°C, respectively). While for all the methods using NCIT, there was a poor agreement with mercury axillary temperature in both the groups. Conclusion: Agreement between axillary temperatures using digital and glass mercury thermometers was good, while agreements between the axillary temperature using glass mercury thermometer with NCIT readings at different sites were poor in neonates and children below 5 years.

Bacterial Aetiology of Neonatal Sepsis and Antimicrobial Resistance Pattern at the Regional Referral Hospital, Dar es Salam, Tanzania; A Call to Strengthening Antibiotic Stewardship Program.

The diagnosis of neonatal sepsis in lower-income countries is mainly based on clinical presentation. The practice necessitates empirical treatment with limited aetiology and antibiotic susceptibility profile knowledge, prompting the emergence and spread of antimicrobial resistance. We conducted a cross-sectional study to determine the aetiology of neonatal sepsis and antimicrobial resistance patterns. We recruited 658 neonates admitted to the neonatal ward with signs and symptoms of sepsis and performed 639 automated blood cultures and antimicrobial susceptibility testing. Around 72% of the samples were culture positive; Gram-positive bacteria were predominantly isolated, contributing to 81%. Coagulase-negative Staphylococci were the most isolates, followed by Streptococcus agalactiae. Overall, antibiotic resistance among Gram-positive pathogens ranged from 23% (Chloramphenicol) to 93% (Penicillin) and from 24.7% (amikacin) to 91% (ampicillin) for Gram-negative bacteria. Moreover, about 69% of Gram-positive and 75% of Gram-negative bacteria were multidrug-resistant (MDR). We observed about 70% overall proportion of MDR strains, non-significantly more in Gram-negative than Gram-positive pathogens (p = 0.334). In conclusion, the pathogen causing neonatal sepsis in our setting exhibited a high resistance rate to commonly used antibiotics. The high rate of MDR pathogens calls for strengthening antibiotic stewardship programs.