Newborn Care Research Articles

Examining priorities and investments made through the Global Financing Facility for maternal and newborn health: a sub-analysis on quality

ABSTRACT Improving quality of care could avert most of the 4.5 million maternal and neonatal deaths and stillbirths that occur each year. The Global Financing Facility (GFF) aims to catalyse the national scale-up of maternal and newborn health (MNH) interventions through focused investments. Achieving impact and value for money requires high, equitable coverage and high quality of interventions. This study examines whether the rhetoric of increasing coverage together with quality has informed investment strategies in MNH through a secondary analysis of 25 GFF documents from 11 African countries. The analysis shows that the country GFF-related documents incorporate some MNH-related quality of care components; however, there is a lack of clarity in what is meant by quality and the absence of core MNH quality of care components as identified by the World Health Organization’s MNH quality framework, especially experience of care and newborn care. Many of the Investment Cases have a more diagonal focus on MNH service delivery considering the clinical dimensions of quality, while the investments described in the Project Appraisal Documents are primarily on horizontal structural aspects of the health system strengthening environment. The GFF is at the forefront of investing in MNH globally and provides an important opportunity to explicitly link health systems investments and quality interventions within the MNH continuum of care for optimal impact.

A Longitudinal Observation of Antenatal Milk Expression in Mothers of Infants with Congenital Anomalies.

Background: For mothers of infants with congenital anomalies, antenatal milk expression (AME), known as hand expression during late pregnancy, allows mothers to contribute to their newborn's care through colostrum collection. However, research is limited by self-report of AME adherence and colostrum volume. Objective: This study examined the ability of participants to adhere to a recommended protocol on AME for any removal and measurement of colostrum during late pregnancy. Materials and Methods: A prospective, longitudinal, observational design was used. Our recommended protocol involved hand expression of 5 minutes per breast for a total of 10 minutes for each AME session twice per 24 hours for any colostrum from 37 0/7 weeks gestation until birth. Women received AME education, completed milk logs, and attempted AME. The study team verified all colostrum volumes. Results: Nineteen women (10 nulliparous) participated, with 13 (68%) carrying infants with major organ system defects and 6 (32%) carrying infants with congenital heart defects. Most participants (52.6%) completed more than half but fewer than all AME sessions. Seven participants (36.8%) fully adhered, completing two AME sessions daily until hospital admission. Eighteen participants (94.7%) could remove milk (80-100% of the time). The 24-hour colostrum volume (median 0.35 mL, interquartile range [IQR] 0.065-0.845) and the total colostrum volume (median 3.99 mL, IQR 1.35-6.82) from AME varied. Conclusions: Among a small group of women of infants with congenital anomalies, adherence to a recommended protocol is feasible but varied by AME session frequency. Most women could collect colostrum for future infant feeding.

From Thesis to Scientific Articles: Publication of Neonatal Research in Ecuador

Objective: To determine the proportion of scientific articles published by health professionals in Neonatology services in Ecuador in the last 20 years. Theoretical framework: Perinatal research is a priority in public health. Writing a thesis allows students to acquire research skills. Publishing these findings in indexed journals ensures their validity and relevance, becoming references for future studies, systematic reviews, hospital protocols and clinical guidelines. Method: Bibliometric study that examined the temporal evolution, research design, language, affiliations, keywords, journals and academic degrees of thesis writers. The search was carried out in databases and repositories from the last 20 years, using Zotero, Mendeley, Rayyan and R for the analysis. Results and Discussion: It was identified that 13% of the theses were published in indexed journals in Ecuador. (79%) corresponded to postgraduate studies in pediatrics and neonatology. Almost half (48.97%) were published in local journals and the majority (63.69%) in Spanish. The low rate of scientific publication is a common problem in Spanish-speaking countries. Ecuador contributes only 0.11% of world publications. Research implications: Strengthen research training for students and encourage other professionals involved in newborn care to publish their theses. Originality/Value: The publication of theses as scientific articles contributes to the advancement of knowledge. This process broadens the scope of research, enhancing its impact and application in clinical practice and evidence-based decision-making.

Factors associated with essential newborn care practices among non-institutional births in urban Bangladesh: evidence from Bangladesh Urban Health Survey 2021

ABSTRACT Background Non-institutional births remain prevalent in low- and middle-income countries, associated with a majority of adverse maternal and child health outcomes, including maternal and child mortality. Ensuring essential newborn care (ENC) practices for these non-institutional births is crucial for reducing these adverse outcomes. This study aimed to identify the prevalence, and factors associated with the adoption of ENC practices among non-institutional births in urban Bangladesh. Methods A total of 2,165 children’s data were analyzed, extracted from the 35,186 ever-married women interviewed in the 2021 Bangladesh Urban Health Survey. Six ENC components and their level (lowest/none, moderate, and highest) were considered as the outcome variables. Several socio-demographic factors were considered as the explanatory variables. Multivariate binary and multinomial logistic regression model were used to explore the association between outcome and explanatory variables. Results Approximately 49% of all mothers reported practicing the highest level of ENC. Among the individual components, the highest adherence was observed for the use of a disinfected instrument to cut the umbilical cord (90%). The likelihood of adopting the highest level of ENC practices was higher among mothers with relatively higher education and wealth quintiles and lower among those residing in slum and other urban areas of city corporations compared to non-slum areas. Mothers living in the Khulna and Sylhet divisions had a lower likelihood of adopting the highest level of ENC practices. Conclusion Awareness building programs are needed to educate the population, particularly mothers, about the importance of practicing ENC for improving maternal and child health outcomes.

8620 Prevalence of Osteopenia of Prematurity and Risk Factors in Neonatal of Maternity Hospital

Abstract Disclosure: D.M. Bastos: None. J.G. Bastos: None. A.C. Bastos: None. Introduction: The osteometabolic disease of prematurity (ODP), formerly known as osteopenia of prematurity, corresponds to a disorder of bone mineralization in the neonatal period in very low birth weight premature newborns. The estimated prevalence is about 30% when the birth weight is less than 1,500 grams and around 60% when it is less than 1,000 grams. There is no specific clinical picture, and it can present with mild manifestations, growth deficit, or even evolve with severe rickets and fractures. To qualify the care of premature newborns (NB) in our Service, we question what is the local prevalence of ODP and what are the clinical, biochemical, or imaging risk factors that are potentially related to a greater predisposition to this condition. Objective: Evaluate the prevalence of ODP and recognize potential risk factors in NBs in a neonatal ICU of a reference maternity hospital in Curitiba/ PR. Method: Retrospective longitudinal study, with analysis of medical records of patients born with a gestational age less than 34 weeks and birth weight less than 1,500 grams, born between January/2013 to August/2016. Discussion: Prematurity is the significant factor, followed by low birth weight, for osteopenia. Newborns (NB) with a birth weight below 1500g should receive 40mg/Kg of calcium and 50 mg/Kg of phosphorus. Supplementation of human milk should be started from 15 days of life or when oral intake reaches 100ml/Kg per day (1g/20 ml of milk). In this study, the classification of the growth curve and prevalence by sex were divergent with the literature. The most vulnerable are those with parenteral nutrition or prolonged fasting, as the adequate diet is the basis of prevention and treatment, similar data being found, as well as association with prolonged use of diuretic, presence of sepsis diagnosis and bronchopulmonary dysplasia. However, there is still a lack of specific and sensitive markers for early diagnosis and treatment. Conclusion: The prevalence of Osteopenia of Prematurity was lower than that found in the literature. The risk factors bronchopulmonary dysplasia and use of diuretics were statistically significant when evaluated in patients with osteopenia. However, no relationship was found between ODP and sepsis, as well as a relationship between ODP and Necrotizing Enterocolitis. Regarding the days kept fasting, use of TPN and Use of antibiotics, a longer duration of use was obtained when compared with the group that did not develop the disease. Presentation: 6/3/2024

Psychometric properties of the Turkish version of the developmental care scale for neonates with congenital heart disease.

Developmental care for newborns with congenital heart disease (CHD) improves cardiac and respiratory patterns. According to the American Heart Association, developmental care in newborns with CHD is important for improving neurodevelopmental outcomes. This study aimed to evaluate the validity and reliability of the Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease. This was a methodological, descriptive study conducted with 169 nurses from a tertiary-level NICU. The Demographical Information Form and the Developmental Care Scale for Neonates with Congenital Heart Disease were used to collect the data. The scales' language and content validity, construct validity, and internal consistency were also assessed. The scale consists of 31 items and four subscales. Factor loadings ranged from 0.44 to 0.82 and explained 65% of the total variance. Fit indices indicate that the model is acceptable. Cronbach's α was 0.95 for the entire instrument, 0.91 for developing the external environment subscale, 0.94 for assessing family well-being, 0.86 for the caregiver activities toward the neonate, and 0.82 for the basic need subscale. Item-total correlations ranged between 0.34 and 0.75, according to the item analysis results. The Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease is valid and reliable. The use of this scale could improve the performance of neonatal intensive care nurses in providing developmental care to newborns with CHD as well as the quality of care.

The Effect of Implementation of Skin Care Guidelines on Nurses’ Knowledge Regarding Skin Care and Incidence of Skin Injuries Among Neonates at a Private Tertiary Care Hospital

Background: Skin care of sick newborns is important because skin acts as a barrier to prevent neonates from infections which may lead to neonatal morbidity and mortality. The highly technological environment of the neonatal intensive care unit (NICU) makes them vulnerable to loss of skin integrity. In acute care setting maintenance of skin integrity is considered as an established quality indicator representing nursing care. Aim of Study: The study aimed to determine the effect of skin care guidelines on nurses’ knowledge related to skincare and the incidence of skin injuries among neonates. Methodology: Pre-post quasi-experimental study was conducted in the NICU of a private tertiary care hospital. A consecutive sampling technique was used. The intervention comprised educational sessions and demonstrations of skin care practices from AWHONN skin care guidelines. The data on the nurses’ knowledge were collected through self-developed and self-administered questionnaires. Skin injuries were recorded on a checklist through observation for 1 month before and after the intervention. A paired sample t-test was used for comparing knowledge and continuous demographical variables. While the incidence density ratio was calculated for skin injuries. Results: There was a statistically significant improvement in the nurses’ knowledge of skin care from pre (mean 15.06 ± 5.16) to post (mean19.40 ± 5.17) measurement P-value .001. Incidence density rate of skin injuries reduced from 19% to 3% after the implementation of skin care guidelines. Conclusion: Through the implementation guidelines nurses’ knowledge and practices regarding skin care improved while skin injuries among neonates were reduced.

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

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

A Study To Assess Knowledge Regarding Newborn Care Among Primigravida Mothers Of Selected Areas Of Imphal East, Manipur

The birth of the baby is one of life's most wondrous moments. Neonate is the period between the ages of birth to 28th days of life. This comes under the infancy period. The first few weeks after delivery is the most critical time for newborns. Newborn care is extremely important for their development and overall health and wellness. Lack of knowledge regarding newborn care, and identification of risk factors can lead to an increase in neonatal mortality and morbidity rate. Materials and Methods: A descriptive cross-sectional study was conducted to assess the knowledge regarding newborn care among primigravida mothers of Takhel Awang Leikai, Imphal East, Manipur, 2022. Structured Interview Schedule to assess demographic data and knowledge regarding newborn care. Result: Non-random purposive sampling techniques were used to collect the data. Most women, i.e. 46%, had moderate knowledge, 34% had adequate knowledge, and 20% had inadequate knowledge regarding newborn care among primigravida mothers. The study reveals a significant association between the respondent's age and educational status with the level of knowledge regarding newborn care among primigravida mothers. Conclusion: The present study shows, there was moderate knowledge regarding newborn care among primigravidae mothers. In the current scenario, it is important to raise awareness about newborn care among expectant mothers and eligible couples by providing effective health education and similarly, emphasis on appropriate practice on newborn care may also be included in primary education. They need to be informed about the available services that help to

Women ‘s perception on the quality of maternal and newborn care during the COVID-19 pandemic in German-speaking countries: Findings from the IMAgiNE EURO project comparing data from Germany, Switzerland and Austria

ProblemRestrictions during the COVID-19 pandemic compromised maternal and newborn care. BackgroundCountries in the German speaking area share several clinical care guidelines but differed significantly in the strictness of COVID-19 protective measures. AimTo investigate the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic in the German-speaking area and explore associations between the reorganisational changes due to COVID-19 and QMNC, as described with WHO Standards-based Quality Measures. MethodsAs part of the IMAgiNE EURO study (ClinicalTrials.gov: NCT04847336), we conducted an online survey on the QMNC in the German-speaking area, including women who gave birth in Germany, Switzerland, and Austria. Descriptive statistics, Spearman rank correlation coefficient and multivariable quantile regression were used. FindingsOut of a total of 70,721 women accessing the online questionnaire, 1,875 were included (Germany: n = 1,053, Switzerland: n = 494, Austria: n = 328). Significant differences across countries were found in Quality Measures. In Switzerland, women scored Quality Measures more favourable than in Germany and Austria in all four sub-indexes of QMNC. In Austria, Quality Measures gaps in the sub-index ‘Experience of care’ were higher. The sub-index ‘Reorganisational changes due to COVID-19′ correlated weakly to strongly with the other sub-indexes (between r = 0.33 and r = 0.62, p < 0.001 for all correlations). DiscussionMidwives and other health professional should pay particular attention to the provision of respectful, high-quality care. ConclusionTo effectively improve QMNC, further research is essential to monitor the quality of care and develop targeted interventions beyond the COVID-19 pandemic addressing inherent challenges in the organisation and delivery of care.

Infants Born at Late Preterm Gestation: Management During the Birth Hospitalization

To examine the admission practices, frequency of common clinical morbidities, and rates of medical intervention in infants born at 34-36 weeks gestational age (GA, late preterm). This retrospective, single institution, cohort study analyzed electronic health records of infants born late preterm from 2019 through 2021. Infants with anomalies necessitating neonatal intensive care unit admission were excluded. Analysis included descriptive and inferential statistics. The study included 1022 infants: 209 (21%) 34 weeks GA; 263 (26%) 35 weeks GA; and 550 (54%) 36 weeks GA. Sixty-three percent of infants at 35 weeks GA and 78% of infants of 36 weeks GA remained in well newborn care throughout the birth hospitalization; infants born at 34 weeks GA were ineligible for well newborn care. The need for respiratory support was 32%, 18% and 11% in infants of 34, 35, and 36 weeks GA, respectively. Supplemental tube feeds were administered in 55%, 24%, and 8% of infants of 34, 35, and 36 weeks GA, respectively. Most infants born at 34 weeks GA (91%) were placed in an incubator; this was less frequent in infants at 35 (37%) and 36 weeks (16%). Tachypnea, hypoglycemia, and hypothermia were noted in 40%, 61%, and 57% of infants, respectively. A subset of these infants (30% with tachypnea, 23% with hypoglycemia, 46% with hypothermia) required medical intervention for these abnormalities. This single center study provides an outlook on the care of infants born late preterm. Multi-center studies can contextualize these findings in order to develop clinical benchmarks and quality markers for this large population of infants.

Social Determinants of Health and Timing of Tracheostomy for Severe Bronchopulmonary Dysplasia

To estimate the association of ZIP code-level social determinants of health (SDoH), specifically household income, education level, and unemployment rate, with post-menstrual age (PMA) at tracheostomy placement in patients with severe bronchopulmonary dysplasia (BPD). This was a retrospective observational study of infants born <32 weeks' gestation and discharged from a Children's Hospitals Neonatal Consortium newborn intensive care unit. Patients were diagnosed with severe BPD and received tracheostomies before discharge. Maternal ZIP code at admission was linked to that ZIP code's SDoH via the 2021 US Census Bureau 5-year data. Unadjusted and adjusted analyses were completed with separate models fit for each SDoH marker. 877 patients received tracheostomies at median (interquartile) 48 (44-53) weeks' PMA. In multivariable models, patients in the highest education groups received tracheostomies earlier (OR: 95% CI = 0.972: 0.947-0.997, p=0.031), and non-Hispanic Black patients received tracheostomies later compared with non-Hispanic White patients (OR: 1.026; 95% CI =1.005-1.048, p=0.017). For household income and unemployment, the PMA at tracheostomy did not differ by SDoH or race. For all three models, male sex, small for gestation status, and later PMA at admission were associated with later PMA at tracheostomy. For each SDoH marker, significant inter-center variation was noted as several centers had independently increased PMA at tracheostomy. Education at the ZIP code-level influenced PMA at tracheostomy after adjusting for patient and clinical factors. Adjusted for each SDoH studied, significant differences were noted among centers. Factors leading to the decision and timing of neonatal tracheostomy need further evaluation.

Healthcare Needs of Provincially Uninsured Migrant Families with Newborn Infants: A Qualitative Descriptive Study

Aim: This project aimed to explore the healthcare needs of provincially uninsured migrant families with newborns receiving care at a nurse practitioner (NP)-led clinic in Montreal, Quebec, Canada. The findings of this study are intended to guide primary healthcare professionals and administrators in understanding and addressing the specific needs of these families, enabling them to tailor their services appropriately. Background: Newborns of provincially uninsured migrant families in Quebec can experience delays in accessing provincial health insurance, preventing timely access to primary care services. In Montreal, a publicly funded NP-led clinic was created to enable newborns without provincial health insurance to access recommended well-baby visits in the first 4 months of life. There exists a paucity of literature on the specific healthcare needs of uninsured families with newborn infants, making tailored care difficult. Methods: A qualitative descriptive study was undertaken. Semi-structured interviews were conducted with the parents of provincially uninsured Quebec-born newborns being treated at a NP-led clinic. Ten interviews were conducted with a total of 13 participants between October 2023 and January 2024. Socio-demographic data were collected. Content analysis was undertaken to identify important themes. Findings: Two overarching themes were identified including (a) healthcare service needs related to newborn care, maternal postpartum care, and family healthcare; (b) healthcare access needs related to navigating the local healthcare system, transportation, and provincial health insurance. Conclusion: Provincially uninsured migrant families with newborns in Quebec face barriers to accessing healthcare. This study provides information on the healthcare services and access-related needs of these families and provides recommendations including how NP-led clinics can facilitate access to the healthcare services needed by these families.

Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.

Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. ISRCTN registration number: 59931298.

Clinical and statistical analysis of the course of preterm birth based on the materials of communal enterprise «Regional Perinatal Center of the Rivne Regional Council» in 2013–2023 years

One of the priority tasks of modern medical science and practice is the preservation of reproductive health and the gene pool of the nation. It is especially difficult to perform this task during the russian war in Ukraine, which has been going on for more than ten years. According to sociologists, the outcomes of a low birth rate for the country will be catastrophic precisely because of the war.One of the reasons for the decline in the quality of health in the future is the increase in the specific weight of premature births, the frequency of which, according to the World Health Organization, has increased in Ukraine already after six months of full-scale war.The objective: to conduct an analysis of the course of premature births in the conditions of war based on the materials of the communal enterprise (CE) “Regional Perinatal Center of the Rivne Regional Council” for 2013–2023.Materials and methods. A retrospective clinical and statistical analysis of 2,742 histories of pregnancy and childbirth of women who were in labor between 22/0–36/6 weeks of gestation in obstetric departments of the communal enterprise “Regional Perinatal Center of the Rivne Regional Council” in 2013–2023 was carried out.Results. According to CE “Regional Perinatal Center of the Rivne Regional Council”, a progressive decrease in the total number of births by 41.9% was observed in the Rivne Region from 2013 to 2023. At the same time, in the general population of women giving birth, the specific rate of premature births did not have a tendency to increase.In the structure of preterm births, early and late preterm births prevailed. The specific gravity of very early preterm births, which are the most unfavorable for perinatal outcomes, did not have a sustained upward trend. At the same time, the frequency of too early premature births among residents of districts and territorial communities of the Rivne region has significantly increased (2013 – 19 (79.2%) cases, 2023 – 17 (100.0%) cases; p&lt;0.05).Every second premature birth occurred within the first day of hospitalization of a pregnant woman, while the specific rate of such too early premature births increased by 3.4 times during the analyzed period, which significantly worsens the chances of survival of newborns and is the reason for their high perinatal morbidity.The number of premature births in pregnant women with multiple pregnancies remains stable. Every third preterm birth took place on the background of early premature rupture of the fetal membranes, while a significant increase in the frequency of this complication was found in women who gave birth at 22/0–27/6 weeks of pregnancy.Traditionally, the specific rate (55.7–57.5%) of surgical delivery by caesarean section of pregnant women and mothers with premature births remains high, which contributed to a reliable reduction of the perinatal mortality rate of premature babies by 13.7% due to the reduction of antenatal losses. Indicators of early neonatal death were formed at the expense of newborns from too early and early premature births in the same ratio.Conclusions. According to thedata of CE “Regional Perinatal Center of the Rivne Regional Council”, there was a progressive decrease in the birth rate in the Rivne Region with a simultaneous stabilization of the number of premature births. The widespread use of a holistic approach during the medical care of pregnant women and the introduction of modern methods of care for premature newborns ensured a significant decrease in the rate of perinatal death of premature infants due to the reduction of antenatal losses.

The illness severity scores can predict the need for respiratory and inotropic support in newborns with critical congenital heart malformations

Background and objectives. The illness severity scoring systems have been developed and validated to assess mortality risks based on clinical conditions and aid critical patient decision-making. Dextro-transposition of the great arteries (D-TGA) and coarctation of the aorta (CoA) are critical congenital heart defects that require medical treatment from birth and surgical repair in the neonatal period. The study aimed to compare the values of three scoring systems in predicting the need for respiratory and inotropic support for newborns with D-TGA and CoA. Materials and methods. An observational study was conducted on inborn infants diagnosed with D-TGA and CoA admitted to the newborn intensive care unit (NICU) within 12 hours of birth at a referral unit for congenital heart disease between January 2018 and December 2020. Newborns with D-TGA and CoA who died within the first 24 hours of birth, outborn infants, and those with a late diagnosis were excluded. For each patient, the Clinical Risk Index of Babies (CRIB-II), Score for Neonatal Acute Physiology-II (SNAP-II), and Score for Neonatal Acute Physiology-Perinatal Extension-II (SNAPPE-II) were calculated. Results. A total of 69 newborns were included in the current study, 30 (43.48 %) of whom were infants with D-TGA (D-TGA Group) and 39 (56.52 %) with CoA (CoA group). Newborns who required respiratory support had significantly higher CRIBII scores (3.03 ± 0.63 vs. 1.34 ± 0.19; p = 0.001), SNAP-II scores (26.61 ± 13.96 vs. 12.43 ± 9.98; p = 0.001), and SNAPPE-II scores (33.04 ± 2.91 vs. 14.47 ± 12.35; p = 0.001) compared to those who did not require it. Significantly higher CRIB-II (3.22 ± 0.67 vs. 1.56 ± 0.23; p = 0.003), SNAP-II (22.91 ±14.57 vs. 14.28 ± 1.58; p = 0.003), and SNAPPE-II (28.82 ± 17.95 vs. 16.58 ± 13.85; p = 0.003) scores were also associated with the need for inotropic support. When comparing the predictive efficiency of illness severity scores for detecting the risk of needing respiratory and inotropic support, they are more effective at predicting the need for ventilation and less effective at predicting the need for inotropes. Conclusions. The illness severity scores can effectively predict the need for pre-surgery interventions. Their simplicity makes them suitable for routine use.

Promotive and Preventive Programs for Health Workers and Mothers on Newborn Umbilical Cord Care to Prevent Infection During the Neonatal Period

Umbilical cord infections can be prevented by caring for the umbilical cordproperly. The data regarding proper and correct umbilical cord care of newborn babiesby mothers in North Sumatra Province is limited. Hence, this community serviceaimed to determine the proportion of knowledge in umbilical cord care for newbornbabies using the open-dry cord care method. Thew community service project washeld on August 24, 2023, in Pematang Siantar City, North Sumatra Province. In thisactivity, we provided counseling on the open-dry cord care method for umbilical cordcare by presentation and discussion using modules, posters, and leaflets. We used apre-test and post-test questionnaire to assess the knowledge level of health workersand mothers. Participant demographic data and results are presented in the form ofproportion data. This counseling was attended by 150 participants consisting of 52health workers and 98 mothers. Before the counseling, 39 health workers and 93mothers did not know how to take care of the umbilical cord properly. After thecounseling, the knowledge of umbilical cord care using the open-dry cord methodincreased by 15.4% for health workers and 24.5% for mothers. Based on the results,over 80% of participants were found to have had a satisfactory level of knowledgeabout umbilical cord care after the counseling session. This community serviceprogram should be conducted regularly to further enhance the knowledge of healthworkers and mothers on proper umbilical cord care.

Clinical profile of newborns admitted in Special Newborn Care Unit of a tertiary teaching hospital of Arunachal Pradesh: A Retrospective Cross Sectional Study

Introduction: The neonatal period presents the greatest daily risk of death compared to any other stage of childhood. Objective: To study the clinical profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary teaching hospital of a tribal area. Materials and Methods: A retrospective case record analysis of all admissions between January 2017 to December 2022 was done based on medical record data. The neonates with complete record were included in the study. Results: Total of 1476 newborns were admitted from the year 2017 to 2022 in SNCU of TRIHMS, out of which, 860 (58.3%) patients were male and 612 (41.5%) were females. 84.4% admissions were inborn and 15.6% were outborn patients. Major causes of admission were neonatal jaundice (22.4%) followed by prematurity (15.4%), neonatal sepsis (15.1%) and birth asphyxia (11.4%). The outcome rates for survival, referral, deaths and LAMA were 79.3%, 9.7%, 5.8% and 5.1% respectively. The leading causes of mortality were birth asphyxia (22.3%), prematurity (21.2%) and sepsis (11.8%). Conclusion: In our SNCU, common causes of deaths are birth asphyxia, prematurity, sepsis respiratory distress syndrome and congenital heart disease. Enhancing antennal care, improving access to healthcare facilities, ensuring timely referral of high risk cases, building capacity and providing intensive interventional management can significantly reduce neonatal mortality and its associated complications. Surveillance and training interventions for managing these causes should be established and reinforced. Keywords: Neonates, morbidity, mortality, preterm, sepsis.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Early onset neonatal sepsis and its associatited factors: a cross sectional study

BackgroundSepsis is the 3rd leading cause of neonatal mortality in Ethiopia contributing to 16% of neonatal death. In a hospital study, neonatal sepsis was the leading diagnosis at admission and the second leading cause of neonatal death at the neonatal intensive care unit. Among other factors repeated vaginal examination during labor is known to contribute to sepsis in low-income settings. However, there is limited evidence in the Ethiopian setting.ObjectiveThe objective of this study was to examine the association between early-onset neonatal sepsis and repeated vaginal examinations.MethodsThe study was conducted at Gandhi Memorial Hospital, a public maternity and newborn care hospital. We followed 672 mother-newborn pairs by phone until 7 days of age to detect clinical sepsis. Data were analyzed using SPSS version 20 software. Adjusted odds ratio risk (AOR) with a corresponding 95% confidence interval (CI) was used to show the strength of associations and variables with p-value < 0.05 were considered to be statistically significant.ResultsThe incidence of early-onset neonatal sepsis was found to be 20.83% (95% CI 17.60, 24.00). Having a frequent vaginal examination (four or more times) during labor and delivery, prolonged rupture of membranes, induced labor and gestational age < 37 weeks were strongly associated with the development of early-onset neonatal sepsis, (AOR 2. 69;95 CI: 1.08, 6.70) AOR 5.12(95% CI 1.31, 20.00), AOR of 5.24 (95% CI 1.72, AOR4.34 (95% CI 1.20, 15.68), 16.00), respectively.ConclusionFrequent digital vaginal examination prolonged rupture of membranes, induced labor and gestational age < 37 weeks significantly increases the risk of early onset neonatal sepsis. We also recommend further study using neonatal blood culture to better diagnose early onset neonatal sepsis objectively.