Neonatal Well-being Research Articles

Peri-operative Neonatal Resuscitation – Need of the Hour

Perioperative neonatal resuscitation (PoNR) is a specialized care process designed to ensure the stability and well-being of neonates in the perioperative period. Due to their unique physiological characteristics and vulnerabilities, neonates require focused care before, during, and after surgery and anesthesia. The PoNR addresses challenges related to the neonate’s unique anatomy and physiology and accompanying medical and surgical conditions. A dedicated neonatal anesthesiologist is critical for providing the best care. This article explores the scope, steps, and scenarios of PoNR and tries to establish the need for PoNR to ensure the best outcome in these neonates.

Does Early Initiation of Labor Epidural Analgesia Affect Labor Outcomes? A Randomized Clinical Trial

Background: Although epidural analgesia (EA) is a popular and effective method for pain relief during labor, significant controversy exists in terms of the impact of EA on labor outcomes and the best time for initiation of EA. Here, we aim to explore the effects of early initiation EA on the labor process in nulliparous at-term pregnant women.
 Methods: A total of 240 nulliparous women enrolled in this study. The early epidural (EE) group (n=120) consisted of women in the latent phase of labor and the late epidural (LE) group (n=120) were in the active phase of labor. Each group received 16 ml of 0.125% preservative-free isobaric bupivacaine with 50 µg fentanyl (total: 17 ml) as a primary bolus dose in the epidural space for labor analgesia and an intermittent bolus of 5-10 ml of the primary solution was administered via a catheter. The length of labor, rate of cesarean section (CS), neonatal well-being, and infant Apgar scores were recorded.
 Results: There were no statistically significant differences between the two groups regarding the duration of the first (p=.43) and second (p=.54) phases of labor. No statistically significant differences were observed between the two groups in terms of the rate of CS (p=.21), causes for CS (p=.24), and neonatal Apgar scores (p=0.84).
 Conclusion: Initiation of EA during early labor did not result in increased CS or instrumental vaginal deliveries, and did not prolong labor duration.

Unintended Consequences: Exploring Iatrogenic Injuries in Cesarean Section Deliveries

Cesarean delivery (CD), or C-section, which prevents injury and death in mothers and babies at higher risk of complicated deliveries, like any surgery, does carry a risk of complications. By reviewing the medical literature and analyzing documented CD cases, we examined the spectrum of iatrogenic injuries, including unintentional injuries, affecting both maternal and neonatal outcomes. This case report describes iatrogenic bladder damage after CD in a 31-year-old woman who had a previous emergency CD two years ago. This case calls for a comprehensive approach to minimize iatrogenic risks and optimize maternal and neonatal well-being during repeat СD.

Impact of oil massage on newborn behavioural responses in rural India.

The initial weeks of a newborn's life are marked by rapid physiological and behavioural adjustments as the infant adapts to the external environment. This critical period necessitates attentive care, prompting exploration into traditional practices such as oil massage, which holds cultural significance and is believed to enhance neonatal well-being. Despite its prevalence, empirical evidence supporting the efficacy of oil massage remains limited. This study, conducted in a rural setting, aims to bridge traditional practices with evidence-based care, exploring the impact of oil massage on newborn behavioural responses. A quasi-experimental design involving 60 newborns (30 in each group) assessed behavioural responses through a pre and post-test approach. Results indicate a significant improvement in selected behavioural responses among newborns receiving oil massage, emphasizing its potential integration into routine care. The control group showed a pre-test mean of 14.83 (SD = 2.41) and a post-test mean of 16.23, while the experimental group exhibited a pre-test mean of 15.83 (SD = 1.80) and a post-test mean of 26.07. T-test values of 5.194 for the control group and 26.137 for the experimental group were indicative of statistically significant changes. The study contributes insights into neonatal care practices, urging further exploration of contextual intricacies and demographic influences on newborn behaviour.

The role of nursing in neonatology: specialized care for newborns

Introduction: In the field of neonatology, nursing plays a crucial role in providing specialized care and comprehensive support to newborns and their families. This research focuses on a detailed exploration of the nursing role in neonatology and its significance in newborn care, given its impact on child health. Objective: To comprehensively analyze the role of nursing in neonatology, identifying its key contributions to newborn care and its impact on neonatal health outcomes. Methodology: The PRISMA methodology is employed to conduct a systematic review of relevant studies on neonatal nursing. This involves defining inclusion and exclusion criteria, searching for studies in academic databases, selecting relevant studies, extracting key data, assessing methodological quality, and conducting qualitative analysis. Results: The review of articles highlights the critical role of neonatal nursing in newborn care. Their competence in critical situations is emphasized, where their dedication and skills are essential for stabilizing and promoting the well-being of neonates in delicate conditions. Conclusions: The comprehensive analysis of studies underscores the crucial function of neonatal nursing in newborn care. Neonatal nursing professionals are indispensable in critical situations, where their competence and dedication are crucial for the stabilization and well-being of neonates.

Breast milk oxycodone concentrations in mothers given oxycodone for post-Caesarean delivery pain management.

Both effective analgesia and early breastfeeding play an important role in maternal and neonatal well-being after Caesarean delivery. We studied controlled-release oxycodone tablet treatment for postoperative pain management and determined the excretion of oxycodone into breast milk. Controlled-release oxycodone/naloxone 10/5-mg tablets (n = 21) or controlled-release oxycodone 10-mg tablets (n = 22) were administered to mothers twice a day for the first 3days after elective Caesarean delivery as a part of multimodal analgesia. Maternal plasma and breast milk samples were collected daily. Oxycodone, noroxycodone, oxymorphone and noroxymorphone concentrations were analysed with ultra-performance liquid chromatography-mass spectrometry. Maternal pain intensity was recorded with an 11-point Numeric Rating Scale (0-10). Neonatal oxycodone exposure was estimated by simulating five different exposure scenarios, including the highest possible exposure through breast milk. The mean oxycodone and noroxycodone milk-to-maternal plasma ratios were 3.2 and 3.0, respectively. A strong correlation was found between plasma and breast milk oxycodone (R2 = 0.87) and noroxycodone concentrations (R2 = 0.91). In the simulated highest neonatal exposure scenario, the neonate's maximum plasma concentration was estimated to be 5.4ng/mL and the estimated weight-adjusted infant oxycodone dose was less than 10% of the maternal dose. Pain intensities were similarly low between the two treatment groups. The oxycodone dose received from colostrum and breast milk during the first three postoperative days after Caesarean delivery is assumed safe for healthy, term neonates, but in extreme cases it is possible for the neonate to receive a dose through breast milk that may elicit opioid effects.

Methicillin resistant staphylococcus aureus infection in neonates- a major concern and a call for action.

Methicillin-Resistant Staphylococcus aureus (MRSA) is both a human commensal and a pathogen that causes neonatal infection which is associated with significant morbidity and mortality. Its genetic flexibility and versatility have equipped it with the ability to develop resistance to numerous antibiotics. Outbreaks of infections in neonatal intensive care units as well as community infections have been reported mostly in developed countries. However, there is a paucity of data on neonatal MRSA infection in developing countries. The study aims to highlight cases of MRSA infection, describe the clinical presentation, and outline the antibiotic susceptibility pattern among term neonates in our facility. It was a prospective cross-sectional hospital-based study carried out from October 2018 to July 2019. A total of 248 term neonates with suspected sepsis were enrolled in the study and had their blood samples taken for investigations including blood culture. Bacterial identification and antibiotic susceptibility patterns were carried out using MicrobactTM24E (Oxiod UK) and Staph ID and modified Kirby-Bauer disk diffusion technique respectively. Out of the 248 subjects enrolled in the study, 34.2% had proven sepsis, with Staphylococcus species accounting for 56.4% of these cases. Among those with staphylococcal sepsis, 56.3% were found to have MRSA infection. Notably, the majority (94.4%) of cases originated from outside the hospital, presenting as neonatal sepsis with non-specific clinical features. Sensitivity testing revealed that ciprofloxacin and chloramphenicol were the most effective antibiotics against the identified pathogens. The presence of MRSA infections in neonates poses a critical public health threat. This trend underscores the emergence of antimicrobial resistance, potentially compromising treatment efficacy and jeopardizing neonatal well-being. Urgent and decisive measures are necessary to curb this trajectory.

Exploring the Microbial Landscape of Neonatal Skin Flora: A Comprehensive Review.

This comprehensive review explores the intricate landscape of the neonatal skin microbiome, shedding light on its dynamic composition, developmental nuances, and influential factors. The neonatal period represents a critical window during which microbial colonization significantly impacts local skin health and the foundational development of the immune system. Factors such as mode of delivery and gestational age underscore the vulnerability of neonates to disruptions in microbial establishment. Key findings emphasize the broader systemic implications of the neonatal skin microbiome, extending beyond immediate health outcomes to influence susceptibility to infections, allergies, and immune-related disorders. This review advocates for a paradigm shift in neonatal care, proposing strategies to preserve and promote a healthy skin microbiome for long-term health benefits. The implications of this research extend to public health, where interventions targeting the neonatal skin microbiome could potentially mitigate diseases originating in early life. As we navigate the intersection of research and practical applications, bridging the gap between knowledge and implementation becomes imperative for translating these findings into evidence-based practices and improving neonatal well-being on a broader scale.

Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya

ObjectiveTo understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi.DesignQualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16).SettingsWe conducted our research in Kilifi County in Kenya’s Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C.Data analysisData were analyzed in NVivo 12, using both inductive and deductive approaches.ResultsHigh ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate’s skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as “having no peace”. Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care.ConclusionsHigh ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings.

Maternal Needs and Priorities in Neonatal Intensive Care Environment: A Cros- sectional study in the UAE


 
 
 Background: HospitalizaBon of neonates in the Neonatal Intensive Care Unit (NICU) pre- sents significant stress and adaptaBon challenges for mothers. Understanding their needs is crucial for opBmal care, as unmet needs can adversely affect both maternal and infant health outcomes.
 Purpose: This study aims to systemaBcally assess the maternal needs and prioriBes in the NICU seRng, emphasizing the significance of maternal well-being in neonatal care.
 Methods: Employing a cross-secBonal survey design, we engaged 200 mothers of hospi- talized neonates in Al Qassimi Women and Children Hospital, Sharjah. The Maternal Needs Inventory, comprising 25 items across five dimensions (Assurance, Proximity, InformaBon, Support, and Comfort), was uBlized. Mothers rated their needs and listed their top five prioriBes.
 Results: Assurance needs emerged as paramount, with 87.2% of mothers highlighBng them as criBcal. Comfort needs were deemed least important (52.4%). A significant associaBon was noted between maternal needs and certain demographic variables, underscoring the diversity of maternal experiences in the NICU.
 Conclusion: The Maternal Needs Inventory proves to be an effecBve tool in recognizing and addressing mothers’ needs in the NICU. Addressing these needs is vital for fostering a family-centered care approach, crucial for both maternal and neonatal well-being.
 
 

Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis.

Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82). The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

Neonatal outcomes associated with tobacco, alcohol, and crack use during pregnancy in three Neonatal Intensive Care Units.

Despite the prevalence of substance use during pregnancy, studies focusing exclusively on Neonatal Intensive Care Units (NICU) admissions remain limited. This study investigates the impact of maternal use of tobacco, alcohol, and/or crack, on neonatal outcomes among infants admitted to three Brazilian NICUs. Additionally, the investigation explores the impact of substance use on DNA damage in newborns. Over a one-year period, data from 254 newborns were collected through medical records, accompanied by blood samples. Findings revealed that 16.1% of newborns had mothers reporting substance use during pregnancy. Significant associations were found between maternal substance use and adverse neonatal outcomes, including low birth weight, preterm birth, and sexually transmitted infections. Maternal variables linked to substance use encompassed non-white skin color, low education, non-masonry housing, lower income, diseases in other children, and fewer prenatal consultations. Notably, neonatal DNA damage showed no significant association with substance use. Our results underscore the substantial impact of maternal substance use on NICU-admitted infants, emphasizing the necessity for targeted interventions that address both neonatal health and maternal well-being, thereby underscoring the crucial role of comprehensive care in NICU settings.

Neonatal well-being and timing of brain injury in persons with cerebral palsy born at term or late preterm.

To describe the distribution of neuroimaging patterns in a term/late preterm population-based cohort with cerebral palsy (CP), ascertain associations between neuroimaging patterns and neonatal well-being, estimate the proportion with antenatal or perinatal timing of neuropathology, and apply this information to the understanding of common mechanisms of brain injury and causal pathways. The cohort for this observational study comprised 1348 persons born between 1999 and 2017 in Victoria, Australia. Using algorithms designed for the study, neonatal well-being and timing of brain injury were tabulated for the whole cohort and across neuroimaging patterns and birth epochs. Clinical and demographic profiles, neonatal well-being, and timing of brain injury differed across neuroimaging patterns. An estimated 57% of the cohort had a complicated neonatal period. Timing of brain injury was antenatal in 57% and perinatal in 41%. A decrease in the relative proportions of perinatal timing of brain injury was observed over a period when the rates of CP in live births at term decreased. This study begins to bridge the knowledge gap about causation in CP, moving towards better description of the main mechanisms of brain injury and their contribution within CP cohorts, and facilitating the ability to monitor changes over time and the success of preventive measures. In a population-based, term/late preterm cohort with cerebral palsy, 57% had a complicated neonatal period. In the same cohort, 57% had presumed antenatal timing of brain injury. The relative proportion with perinatal injury decreased over time.

MATERNAL AND FETAL OUTCOMES IN HELLP SYNDROME AT 23 WEEKS GESTATION: SYSTEMATIC REVIEW

Introduction: Hypertensive disorders, affecting 5-10 of pregnancies, are a leading cause of maternal and perinatal mortality. Preeclampsia-eclampsia, a syndrome contributing to significant global deaths, demands prompt identification and management, particularly in resource-limited settings. Detecting and addressing early and late-onset preeclampsia are crucial for maternal and neonatal well-being. HELLP syndrome, a severe complication of preeclampsia, presents diverse symptoms and risks, with a maternal mortality rate as high as 24 Understanding its outcomes in pregnancies before 23 weeks is essential to guide better management strategies for improved maternal and neonatal health in such critical cases. Methods: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 15 results. After looking at the titles and summaries, we found 6 papers that fit our criteria. At first, we excluded one articles because they were written in a review style. But after reading the full papers carefully, we included four papers in our final analysis. These papers included a retrospective observational study and several case reports. Conclusion: Occurrences of HELLP syndrome without associated hypertensive disorders and recurrent intrahepatic ruptures at extremely premature gestational ages are rare but pose significant risks to mothers and newborns. Swift diagnosis, pregnancy termination, and continuous monitoring are crucial to address early-onset HELLP syndrome, emphasizing the need for immediate attention and prompt management.

A Sustainable Translational Sheep Model for Planned Cesarean Delivery of Contraction-Free Ewes

We evaluated whether the sheep constitutes a useful translational model to evaluate anatomical and surgical aspects of cesarean delivery (CD) from a human medical perspective with the aim of both maternal and neonatal well-being. Our hypothesis was that CD in contraction-free ewes is not associated with major complications. Primary endpoint was the transferability of anatomical conditions and surgical techniques of CD from the ewe to the human. Secondary endpoints were maternal and fetal survival, occurrence of retained fetal membranes, metritis, mastitis, or wound infections. Forty-eight Merino ewes were delivered by CD after 95% gestation (142–144 days). Both ewes and newborn lambs were cared for intensively after the delivery. Ovine uterine anatomy during CD appeared slightly different but comparable to the human uterus. Uterine incisions were mostly performed in the uterine horns, not in the uterine corpus. The ovine uterine wall is thinner than in humans. All ewes survived without any major complications. Seventy-seven (88.5%) out of 87 live-born lambs survived without any complications. The contraction-free ewe constitutes an appropriate and safe model to evaluate anatomical and surgical aspects of CD from a human medical perspective. We present a step-by-step manual for successfully planned cesarean delivery for sheep including the perioperative management illustrated with photographs and a five-minute video. With adequate planning and a reasonable number of staff, it is possible to safeguard both maternal and neonatal survival. This sustainable translational medicine model offers additional potential for the offspring to be used for further research studies (e.g., transgenerational inheritance research).

Preferences of pregnant individuals to undergo labor after one cesarean in southern China.

Labor after cesarean (LAC) remains an optional delivery method among healthy pregnant individuals. Exploring women's attitudes, preferences, reasons for previous cesarean delivery, and the incentives underlying pregnant individuals' preferences could help us understand their choice of delivery mode. In this study we evaluated the preferences and attitudes of eligible pregnant women regarding participation in a LAC in Foshan, China. A cross-sectional survey was conducted among 438 pregnant individuals with one prior cesarean delivery (CD) who attended their antenatal examination at a tertiary hospital in southern China, between November 1, 2018, and October 31, 2019. Information on demographic characteristics, obstetric data, preferences for LAC, and incentives for LAC were analyzed. Overall, 85.4% (374/438) of women preferred LAC if they did not have contraindications before delivery, whereas 12.3% (54/438) refused and 2.3% (10/438) were unsure. Participants reported that the most important factors affecting their willingness to undergo LAC were safety indicators (i.e., "ability of hospitals to perform emergency cesarean delivery" [score of 9.28 ± 1.86]), followed by accessibility indicators (i.e., "priority bed arrangements" [score of 9.17 ± 1.84]). Logistic regression analysis indicated that neonatal wellbeing with the prior CD was an independent influencing factor (OR = 2.235 [95%CI: 1.115-4.845], p = 0.024) affecting willingness to access LAC in the subsequent pregnancy. We found a high preference for LAC among pregnant individuals without contraindications before delivery in southern China. Healthcare providers need to ensure access to LAC and increase pregnant individuals' LAC willingness through high-quality shared decsision-making in alignment with patient preferences.

Role of gestational age and maternal biological factors in early term neonatal morbidity.

The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95% CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95% CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks. The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being.

Adequacy of sedation analgesia to support the comfort of neonates undergoing therapeutic hypothermia and its impact on short-term neonatal outcomes.

We aimed to evaluate (1) whether sedation analgesia (SA) used during therapeutic hypothermia (TH) was efficient to support the wellbeing of neonates with hypoxic-ischemic encephalopathy, (2) the SA level and its adjustment to clinical pain scores, and (3) the impact of inadequate SA on short-term neonatal outcomes evaluated at discharge. This was an observational retrospective study performed between 2011 and 2018 in two level III centers in Alsace, France. We analyzed the wellbeing of infants by using the COMFORT-Behavior (COMFORT-B) clinical score and SA level during TH, according to which we classified infants into four groups: those with excess SA, adequate SA, lack of SA, and variability of SA. We analyzed the variations in doses of SA and their justification. We also determined the impact of inadequate SA on neonatal outcomes at discharge by multivariate analyses with multinomial regression, with adequate SA as the reference. A total of 110 patients were included, 89 from Strasbourg university hospital and 21 from Mulhouse hospital. The COMFORT-B score was assessed 95.5% of the time. Lack of SA was mainly found on the first day of TH (15/110, 14%). In all, 62 of 110 (57%) infants were in excess of SA over the entire duration of TH. Most dose variations were related to clinical pain scores. Inadequate SA was associated with negative short-term consequences. Infants with excess of SA had a longer duration of mechanical ventilation [mean ratio 1.46, 95% confidence interval (CI), 1.13-1.89, p = 0.005] and higher incidence of abnormal neurological examination at discharge (odds ratio 2.61, 95% CI, 1.10-6.18, p = 0.029) than infants with adequate SA. Adequate SA was not easy to achieve during TH. Close and regular monitoring of SA level may help achieve adequate SA. Excess of SA can be harmful for newborns with hypoxic-ischemic encephalopathy who are undergoing TH.

Labor Analgesia in Obese and Morbidly Obese Parturients: A Nationwide Register Analysis in Finland From 2004 to 2018

(Anaesthesia. 2022;77:351–353) Maternal obesity rates are increasing, which is concerning for the short-term maternal and neonatal well-being during vaginal and cesarean delivery. A recent study found obese and morbidly obese parturients had increased use of neuraxial blocks compared to their nonobese counterparts (76% vs. 68%). Rates in Finland in 2018 were only 60%, so this study aimed to further analyze and report the use of labor analgesia in obese and morbidly obese parturients in Finland.

THE EFFECTIVENESS OF PRENATAL YOGA AS COMPLEMENTARY THERAPY ON BIRTH OUTCOMES

Chilbirth may be a life-changing experience for women that can have an impact on them both emotionally and physically and leave them with lifelong memories. Preparing for childbirth from the beginning of pregnancy helps women manage their prenatal anxiety and produce healthy birth outcomes. The study literature is reviewed on databases from 2017-2023 of Science Direct, Cochrane Library, PubMed, and Google Scholar with inclusion and exclusion criteria. The result of analysis from 15 articles selected, it is concluded that prenatal yoga is significantly helping to shorten the labor duration in vaginal birth, lessen labor pain, decrease premature delivery, and significantly decrease the possibility of perineal tear, and improve the neonatal wellbeing.