Neonatal Well-being Research Articles

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies.

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

A methodological proposal for midwifery education: Asking, Learning, Telling, and Embracing Diversity (ALTE)

ObjectiveThis study addressed the imperative for educational methodologies that effectively cultivate an understanding of diverse cultures within midwifery education curricula, particularly focusing on culture-based practices in the professional milieu. The primary objective was to develop a comprehensive methodology for the integration of cultural competence acquisition into midwifery undergraduate education. This study endeavoured to introduce and critically assesses an educational approach tailored to facilitate the acquisition of cultural competence and sensitivity among midwifery students. DesignThe Asking, Learning, Telling, and Embracing Diversity (ALTE) method, which was developed for use in the “History and Philosophy of Midwifery” course curriculum, was evaluated within the framework of instructor experiences and feedback from students. SettingKocaeli University Faculty of Health Sciences, Department of Midwifery in Türkiye. ParticipantsA cohort of midwifery students enrolled in the History and Philosophy of Midwifery course between 2011 and 2016 (N = 95). FindingsThe ALTE method, which is characterized by a student-cantered approach and active participation facilitation, presents an opportunity to enhance student engagement and foster active learning. Student feedback underscored that ALTE, emphasizing active participation, is perceived as an instructive and enriching educational approach, diverging from conventional didactic teaching methods. The ALTE method has emerged as an effective instrument for instilling cultural competence within midwifery education. Key conclusionsThe implementation of the ALTE method empowered midwifery students from diverse geographical backgrounds to discern varied cultural codes and traditional practices. This methodology facilitated the identification of commonalities across regions, exploration of preserved cultural values, and scrutiny of potential advantages, disadvantages, and risks associated with such practices concerning maternal and neonatal well-being. Notably, ALTE exhibited commendable efficacy in fostering cultural sensitivity, active learning, acquisition of communication and presentation skills, peer learning, development of cultural competence, and critical thinking skills.

A deep dive into neonatal well-being and anesthesia in cesarean sections: From procedure to outcome.

This observational study analyzed data from 502 participants undergoing cesarean section (CS) procedures at an obstetrics and gynecology department, aiming to explore anesthesia practices, neonatal outcomes, and demographic characteristics within the cohort. Participants, aged 17 to 59 years with a mean age of 32.23 years, were enrolled based on the clinical necessity for cesarean delivery during the study period. Informed consent was obtained from each participant or their guardians before data collection, which included detailed demographic information, medical histories, specifics of the cesarean section procedure, and APGAR scores of neonates immediately postbirth (at 0 and 5 minutes). Primary outcomes focused on APGAR scores, critical indicators of neonatal health, while secondary outcomes included the distribution of patient ages, reasons for cesarean sections, and the administration of Bupivacaine during anesthesia. Data were rigorously analyzed using descriptive and inferential statistics to summarize participant demographics, anesthesia practices, and neonatal outcomes. Statistical methods included measures of central tendency and dispersion, correlation analyzes to explore associations between variables, and regression models to identify predictors of neonatal APGAR scores. The study identified a range of indications for cesarean sections, with common reasons including fetal distress and maternal health complications. Findings indicated an average APGAR score of 7.02 at 0 minutes and 7.84 at 5 minutes, reflecting generally favorable immediate neonatal outcomes. Anesthesia protocols predominantly involved Bupivacaine, with doses ranging from 1.8 to 2.2 mL, administered based on clinical requirements. In conclusion, this study underscores the importance of comprehensive data collection and rigorous statistical analysis in evaluating cesarean section procedures. Future research could further explore long-term neonatal outcomes and refine anesthesia protocols to optimize maternal and neonatal health during cesarean deliveries.

Neonatal wellbeing and timing of brain injury in term and late preterm cerebral palsy.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.15829

The Influence of Economic Stability on Neonatal and Family Well-Being.

Economic stability is one of the five domains of determinants of health influencing the well-being of families and communities. In this column, the impacts of economic instability, including poverty, employment, food insecurity, and housing instability, will be described. These challenges have unique impacts during pregnancy and the early years, with inequitable and accumulating health burdens over a lifetime. Actions that nurses can take within the NICU setting are described and opportunities for community and policy advocacy are identified.

Quieting the neonatal intensive care unit: A quality improvement initiative.

The neonatal intensive care unit (NICU) is vital for preterm infants but is often plagued by harmful noise levels. Excessive noise, ranging from medical equipment to conversations, poses significant health risks, including hearing impairment and neurodevelopmental issues. The American Academy of Pediatrics recommends strict sound limits to safeguard neonatal well-being. Strategies such as education, environmental modifications, and quiet hours have shown to reduce noise levels. However, up to 60% of the noises remain avoidable. High noise exposure exacerbates physiological disturbances, impacting vital functions and long-term neurological outcomes. Effective noise reduction in the NICU is crucial for promoting optimal neonatal development. To measure the sound levels in a NICU and reduce ambient sound levels by at least 10% from baseline. A quasi-experimental quality improvement project was conducted over 4 mo in a 20-bed level 3 NICU in a tertiary care medical college. Baseline noise levels were recorded continuously using a sound level meter. The interventions included targeted education, environmental modifications, and organizational changes, and were implemented through three rapid Plan-Do-Study-Act (PDSA) cycles. Weekly feedback and monitoring were conducted, and statistical process control charts were used for analysis. The mean noise values were compared using the paired t-test. The baseline mean ambient noise level in the NICU was 67.8 dB, which decreased to 50.5 dB after the first cycle, and further decreased to 47.4 dB and 51.2 dB after subsequent cycles. The reduction in noise levels was 21% during the day and 28% at night, with an overall decrease of 25% from baseline. The most significant reduction occurred after the first PDSA cycle (mean difference of -17.3 dB, P < 0.01). Peak noise levels decreased from 110 dB to 88.24 dB after the intervention. A multifaceted intervention strategy reduced noise in the NICU by 25% over 4 months. The success of this initiative emphasizes the significance of comprehensive interventions for noise reduction.

Prevalence and outcomes of neonates with severe COVID-19: An observational study at Children’s Hospital 1 in Ho Chi Minh City, Vietnam

Objective: To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes. Methods: We conducted an observational cross-sectional study at Children's Hospital 1 (CH1) from July 25, 2021, to May 31, 2022. All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included. We classified neonates with COVID-19 into 2 groups: mild/moderate and severe for analysis. Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables. Results: This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results. The severity COVID-19 rate among neonatal cases was found to be 13.6% (12/88), with a corresponding mortality rate of 1.1% (1/88). All severe cases showed lung abnormalities as evident on chest X-ray images. In addition to respiratory symptoms, a higher incidence of gastrointestinal manifestations, such as vomiting and diarrhea, was observed in the severe group, indicating a compelling association. The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications. Conclusions: The COVID-19 pandemic has had a substantial impact on the well-being of neonates. The management of COVID-19 in this population presents significant challenges.

Association of obesity and overweight with the risk of preeclampsia in pregnant women: an observational cohort study.

According to the World Health Organization, obesity is considered a pervasive global epidemic with significant medical and social implications. In antenatal mothers, the prevalence varies from 40% in Western countries to 12% in India which leads to life-threatening complications-preeclampsia and eclampsia. This study delves into the association between body mass index (BMI) and preeclampsia, among primi antenatal mothers with pregnancy-induced hypertension (PIH). An observational cohort (prospective) study was conducted among 150 primi antenatal mothers with pregnancy-induced hypertension in Government Headquarters Hospital, Tamil Nadu, India. Demographic data, body mass index, and pregnancy outcomes were assessed. Statistical analysis was performed using the SPSS 28.0 version. Among 150 pregnant women, 63 (42%) were overweight, and 13 (8.7%) were obese. Higher BMI was significantly associated with maternal complications, especially preeclampsia (P < 0.001). Moreover, other complications such as abruptio placenta, pulmonary edema, eclampsia, and postpartum hemorrhage were not significantly associated with BMI. The study calls attention to the persistent link between BMI and preeclampsia, emphasizing the need for comprehensive strategies aligned with the Sustainable Development Goal. Despite ongoing efforts, the study suggests a lack of substantial change in the prevalence of preeclampsia associated with increased BMI, prompting the exploration of innovative interventions to address weight-related factors during pregnancy for improved maternal and neonatal well-being.

Improving Maternal and Neonatal Health Outcomes of Women Through Deep Antenatal Education Analysis With Health Belief Model

This ponder investigates the adequacy of antenatal instruction programs in making strides maternal and neonatal wellbeing results, pivotal measurements for surveying advance towards Economic Improvement Objective 3. Despite restorative progressions, maternal and neonatal horribleness and mortality rates stay concerning, particularly in moo- and middle-income nations. Antenatal instruction programs, planned to prepare hopeful moms with basic information and aptitudes, are proposed interventions. While a few ponders appear stamped enhancements in maternal self-efficacy and infant care hones, others uncover constrained effect on key wellbeing markers. Understanding the components contributing to these results is pivotal. Socially delicate programs custom fitted to populaces and the mode of conveyance impact viability. Integration into broader healthcare models and continuous back encourage upgrades impact. A precise survey and blend of existing investigate uncover solid relationships between the number of antenatal sessions gone to and viability scores. Relapse examination underscores the positive relationship between participation and program adequacy, maternal wellbeing results, and neonatal wellbeing results. Expanding the number of antenatal sessions essentially upgrades both maternal and neonatal wellbeing results, with factual examination demonstrating a coefficient of 0.3292 for program adequacy, 0.3433 for maternal wellbeing results, and 0.3283 for neonatal wellbeing results, all with p-values &lt; 0.005. These discoveries offer profitable experiences for policymakers and healthcare suppliers pointing to make strides open wellbeing mediations.

Comparative Analysis of Therapeutic Showers and Bathtubs for Pain Management and Labor Outcomes-A Retrospective Cohort Study.

Hydrotherapy, including the use of therapeutic showers and bathtubs, has been studied for its potential benefits in labor pain management. Previous research has indicated that hydrotherapy can alleviate pain, but comparative studies between therapeutic showers and bathtubs are scarce. Objective: This study aims to compare the effects of therapeutic showers and bathtubs on pain perception, labor duration, use of epidural analgesia, and maternal and neonatal outcomes during labor. Methods: A total of 124 pregnant women were included in this study. Participants were divided into two groups: those who used a therapeutic shower and those who used a bathtub during labor. Pain levels were measured using a visual analog scale (VAS). Labor duration, use of epidural analgesia, types of delivery, maternal outcomes (postpartum hemorrhage, perineal status, maternal hypotension, fever, and breastfeeding), and neonatal outcomes (APGAR scores, fetal heart rate, complications, and neonatal unit admissions) were recorded and analyzed. Results: Both the therapeutic shower and the bathtub effectively reduced pain perception, with the bathtub showing a greater reduction in VAS scores. The therapeutic shower group experienced a significantly shorter labor duration compared to the bathtub group. The majority of participants in both groups did not require epidural analgesia, with no significant differences between the groups. There were no significant differences in the types of delivery. Maternal outcomes indicated a lower incidence of perineal tears and episiotomies in the therapeutic shower group. Neonatal outcomes, including APGAR scores and fetal heart rate, were similar between the groups, with no significant differences in complications or neonatal unit admissions. Conclusions: Both therapeutic showers and bathtubs are effective for pain relief during labor, with the bathtub showing a higher reduction in pain intensity. The therapeutic shower is associated with a shorter labor duration and a lower incidence of perineal tears and episiotomies. Both methods are safe for neonatal well-being, making hydrotherapy a viable non-pharmacological option for pain management in labor. However, the therapeutic shower may offer additional benefits in terms of labor duration and maternal outcomes.

The Impact of Midwifery-Led Care on Birth Outcomes in Low-Risk Pregnancies

Purpose: This study aims to investigate the impact of midwifery-led care on birth outcomes in low-risk pregnancies. Research Design and Methodology: Utilizing a qualitative research approach grounded in a comprehensive literature review, this study synthesizes existing knowledge on midwifery-led care. A systematic search and analysis of peer-reviewed articles, clinical reports, and grey literature were conducted to explore the efficacy of midwifery-led care compared to conventional medical care. Findings and Discussion: The findings highlight the significant reduction in medical interventions associated with midwifery-led care, along with the promotion of physiological childbirth and enhanced maternal and neonatal well-being. Key factors such as continuity of care, patient-provider relationships, and cultural competence play crucial roles in optimizing outcomes. Implications: Policy implications include the integration of midwifery care into mainstream healthcare systems, investment in midwifery education, and advocacy for legislative support to ensure equitable access to high-quality maternity care.

Improving the quality of neonatal health care in Ethiopia: a systematic review.

Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.

A nasal chemosensation-dependent critical window for somatosensory development.

Nasal chemosensation is considered the evolutionarily oldest mammalian sense and, together with somatosensation, is crucial for neonatal well-being before auditory and visual pathways start engaging the brain. Using anatomical and functional approaches in mice, we reveal that odor-driven activity propagates to a large part of the cortex during the first postnatal week and enhances whisker-evoked activation of primary whisker somatosensory cortex (wS1). This effect disappears in adult animals, in line with the loss of excitatory connectivity from olfactory cortex to wS1. By performing neonatal odor deprivation, followed by electrophysiological and behavioral work in adult animals, we identify a key transient regulation of nasal chemosensory information necessary for the development of wS1 sensory-driven dynamics and somatosensation. Our work uncovers a cross-modal critical window for nasal chemosensation-dependent somatosensory functional maturation.

The Interplay of Anemia and Cardiovascular Disease in Pregnant Women and APGAR Scores of their Newborn: A Retrospective Study in Pregnant Women

Objectives: The implications of maternal anemia extend beyond the immediate physiological consequences; moreover, the consequences of maternal anemia are not limited to the mother alone. It may lead to low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores. It, further, adds up to higher incidence of morbidity rates in neonates. The objective of the study is to assess the prevalence and severity of anemia during pregnancy, to establish a correlation between maternal hemoglobin (Hb) levels and APGAR scores in newborns, and determine the association between cardiovascular disease and severity of anemia. Materials and Methods: A retrospective study was conducted at a private medical college in Bareilly from March 2022 to March 2023. The study focused on pregnant females aged 15–49 years who were admitted and delivered within the facilities of the private medical college during this period. Pregnant females with pre-existing chronic conditions affecting Hb levels were excluded from the study. A total of 130 subjects were included in the study, and their Hb levels and APGAR scores at 1 min were considered for analysis. Results: The results show a spearmen rank correlation coefficient (r) = 0.575 between maternal Hb levels and APGAR scores at 1 min, indicating a significant positive relationship (P &lt; 0.05). Infants born to mothers with moderate anemia exhibited the highest prevalence of low APGAR scores (&lt;4), highlighting the potential impact of maternal anemia on immediate neonatal well-being. No significant association was found between cardiovascular diseases in pregnancy and severity of anemia. Conclusion: The findings indicate that the optimization of maternal Hb levels is a critical intervention to ensure a healthier start for the neonate. This study provides a crucial foundation for evidence-based practices in maternal healthcare and neonatal well-being. Focus on improving maternal Hb provides multifaceted benefits both in mothers and neonates.

Navigating Perinatal Challenges: A Comprehensive Review of Hepatitis B Viral Infection and Pregnancy Outcomes.

Hepatitis B viral infection poses a significant challenge during pregnancy, as the risk of vertical transmission carries serious consequences for both maternal and neonatal well-being. This comprehensive review delves into the intricacies surrounding hepatitis B infection during the perinatal period, shedding light on its impact on pregnancy outcomes and stressing the necessity of addressing it within the broader framework of perinatal care. By scrutinizing current evidence, diagnostic methodologies, management techniques, and preventive measures, this review emphasizes the urgent need for enhanced screening protocols, timely interventions, and augmented public health initiatives. Notably, key findings underscore the elevated likelihood of chronic hepatitis B virus (HBV) infection in infants and its enduring implications for the health of both mothers and newborns. The imperative call to action advocates for a multifaceted approach, engaging healthcare professionals, policymakers, and public health agencies to optimize strategies for management and prevention, thereby striving for improved outcomes for pregnant women and their infants affected by hepatitis B viralinfection.

Explore Parent’s Perception Regarding Role of Nurse as an Educator in an Intensive Care Unit Punjab Pakistan: A Qualitative Study

Background: The neonatal intensive care unit (NICU) environment is highly stressful for both neonates and their family caregivers. The quality of interaction between caregivers and medical staff can significantly influence caregiver trust and satisfaction, which are crucial for the effective care and recovery of the neonate. Objective: This study aims to assess the perceptions of family caregivers regarding the role of nurses as educators in a NICU in Punjab, Pakistan, focusing on the communication strategies employed by nurses and the support infrastructure available to caregivers. Methods: This qualitative study involved semi-structured interviews with 14 family caregivers of neonates hospitalized in the Allama Iqbal Teaching Hospital's NICU. Participants were selected based on their intensive involvement in the care of their hospitalized newborns. Data were analyzed using content analysis to explore the themes related to nursing care quality as perceived by the caregivers. Results: Caregivers generally perceived the nursing care as excellent, noting particularly the professionalism and empathy of the nursing staff. However, issues such as inadequate hospital infrastructure, particularly sleeping facilities for caregivers, and occasional lapses in communication and caregiving flexibility were identified as areas needing improvement. The study also highlighted the critical role of timely and accurate information provided to caregivers in reducing anxiety and enhancing their involvement in the care process. Conclusion: Effective communication and adequate support infrastructure are essential in enhancing caregiver trust and satisfaction in the NICU setting. Improving these areas can significantly impact the recovery and well-being of both neonates and their families.

“Unlocking the potential of colostrum: A call to action for neonatal health in Pakistan”

ProblemThe use of colostrum faces unwarranted neglect in Pakistan, leading to significant wastage despite its pivotal role in neonatal health. This article addresses the pressing issue of Colostrum underutilization and its detrimental impact on the well-being of newborns. BackgroundColostrum is rich in essential nutrients and immune factors, but it is inexplicably discarded due to prevalent cultural misconceptions and insufficient awareness. This wasteful trend contributes to heightened risks of infant morbidity and mortality. Question, hypothesis, or aimCan a strategic and culturally sensitive awareness initiative, such as the “Pakistan Colostrum Plan,” effectively curb colostrum wastage by reshaping cultural attitudes and practices? We hypothesize that through targeted outreach efforts, a profound understanding of colostrum's myriad benefits will permeate communities, resulting in tangible behavioral shifts. ConclusionAmplifying awareness regarding colostrum's nutritional significance emerges as an imperative mission. The “Pakistan Colostrum Plan” outlines a comprehensive strategy to combat wastage, emphasizing the importance of early colostrum feeding for neonatal well-being. This editorial aspires to contribute to a healthier future for Pakistani infants by tackling the root causes of colostrum underutilization.

Lithium management around delivery: a retrospective observational cohort study

IntroductionDuring the perinatal period lithium is proven effective as maintenance therapy and to prevent postpartum psychosis. Pregnancy affects all aspects of kidney physiology altering the pharmacokinetics of lithium. To minimize the risk of both maternal and neonatal complications around delivery, several authors have provided clinical advice on lithium dosing around delivery: decreasing dose by 30-50%, suspend lithium therapy 24-48 hours before scheduled cesarean section or induced delivery or even discontinuing lithium after first signs of labour.ObjectivesTo evaluate the validity of these recommendations by investigating 1) maternal lithium serum concentrations changes around delivery, 2) the lithium trasplacental passage at delivery and 3) the association between neonatal lithium serum concentration at delivery and neonatal outcomes.MethodsPsychopathologically stable women with a singleton pregnancy (n=66) who used lithium around delivery, were included in this retrospective observational cohort study (HCB/2020/1305). All women were advised to suspend lithium administration at the onset of labour in the event spontaneous deliveries. Study date: demographic, psychiatric, obstetric and neonatal outcomes for each mother-infant pair obtained from the hospital medical records.Lithium serum concentrations were determined by means of an AVL 9180 electrolyte analyzer based on the ion- selective electrode (ISE) measurement principle. Limit of quantification (LoQ) was 0.20 mEq/L.ResultsThe most common psychiatric diagnosis was a bipolar disorder type I (n=54, 90%). Forty mothers (61%) were on lithium monotherapy. Mean (SD) umbilical cord and intrapartum maternal lithium serum concentration was 0.59 (0.13) mEq/L and 0.55 (0.13) mEq/L respectively. There was a strong positive correlation between umbilical cord and maternal lithium serum concentrations (Pearson correlation coefficient 0.95 (95%IC: 0.91,0.97). In a subsample (N=22) a paired t test indicates that the maternal serum lithium concentrations at delivery were significantly lower (mean difference=0.19 mEq/L, 95%CI=0.13-0.25) than those during obtained the day before delivery hospitalization, after a mean (SD) of 31.29 (±11.92) hours (SD=11.92) have elapsed since the taking the last dose of lithium prior to delivery. Four women (6%) relapsed early postpartum.There were no significant differences between lithium monotherapy (N=18/40) and polytherapy (N=11/26) groups with regard to acute neonatal complications (p&gt;0.05). The only acute neonatal complication associated to umbilical cord lithium serum concentration was hypotonia [0.712 (0.298) vs. 0.534 (0.214) (F=5.065; df=1,60; p=0.028)].ConclusionsWhen lithium is used around delivery, maternal and neonatal well-being can be maximized by maintaining maternal serum lithium concentrations at the minimal effective level and discontinuing briefly when presenting to hospital for delivery.Disclosure of InterestNone Declared

Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers.

Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality. This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges. Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations. This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times.

Assessment of knowledge about neonatal danger signs among primiparous women at discharge from healthcare facilities.

This study explores the evaluation of knowledge regarding neonatal danger signs (NDS) among first-time mothers in Pakistan during their discharge from healthcare facilities. The investigation aimed to establish connections between their understanding of NDS and factors such as sociodemographic background, prenatal check-ups, and educational measures. Considering the persistently high neonatal mortality rates in low- and middle-income nations, recognizing maternal NDS awareness becomes crucial for promoting early medical attention and reducing neonatal health risks. Existing research highlights the role of maternal knowledge in shaping neonatal well-being; however, gaps in knowledge remain prevalent, especially among first-time mothers. Using a cross-sectional approach, data were gathered through structured questionnaires, revealing significant relationships among maternal NDS awareness, sociodemographic aspects, prenatal care, and educational interventions. It is noteworthy that first-time mothers demonstrated lower NDS knowledge than mothers with multiple childbirth experiences, while those with higher education displayed greater awareness The effects of educational interventions were diverse, and antenatal visits were linked to enhanced knowledge. This study highlights the significance of focused treatments that target knowledge deficiencies, which can empower women and contribute to the reduction of infant health problems and mortality. encouraging further exploration of effective strategies to augment maternal knowledge and proactive healthcare-seeking behaviors.