Newborn Interventions Research Articles

Rationale and approach to evaluating interventions for newborn care in low- and middle-income countries.

Introduction The neonatal period is the most vulnerable time in a child's life, contributing to almost half of all deaths in children under 5 years. Many of these deaths are preventable and are mainly caused by preterm birth, birth asphyxia, or serious infections. Over the past decade, the evidence base for interventions to prevent and manage these causes of neonatal mortality and morbidity in low- and middle-income countries (LMICs) has expanded significantly. This growth calls for a comprehensive and systematic approach to synthesizing the available evidence. This paper describes the methodological approach taken before and during the conduct of the systematic overviews and reviews included in this supplement. Methods Alongside consultation with a newborn technical advisory group, the overall evidence synthesis approach began with an extensive literature scoping exercise to establish a universe of interventions that were relevant to neonatal health and survival, and to identify the associated systematic reviews examining their effectiveness. Three main approaches were taken to synthesize the evidence based on the availability of prior evidence. New systematic reviews were conducted for topics lacking an existing comprehensive synthesis. Existing systematic reviews with search dates prior to 2020 were updated. High-quality, up-to-date systematic reviews were used without modification. In all cases, trial data from studies conducted in LMICs were sought and prioritized for analysis. Conclusion A comprehensive approach to summarizing the best available evidence for newborn intervention effectiveness is described.

Extremity Ischemia after Peripheral Vascular Intervention in Newborns with Congenital Heart Disease: Our Single Center Experience

Extremity Ischemia after Peripheral Vascular Intervention in Newborns with Congenital Heart Disease: Our Single Center Experience

Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis.

Evidence supporting the benefits of delayed cord clamping is increasing; however, there is no clear recommendation on cord management during newborn resuscitation. This study aimed to investigate the effects of resuscitation initiated with an intact umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal outcomes. Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns receiving initial stabilization steps before and after cord clamping. Twelve studies met our inclusion criteria, with six RCTs included in the quantitative analysis. No statistically significant differences were found in delivery room parameters, in-hospital mortality, or neonatal outcomes between the examined groups. However, intact cord resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping prior to resuscitation group (MD 6.67%, 95% CI [-1.16%, 14.50%]). There were no significant differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI [0.34, 12.30], IVH: RR 1.25,95% CI [0.77, 2.00]). Intact cord management during resuscitation appears to be a safe intervention; its effect on early complications of prematurity remains unclear. Further high-quality RCTs with larger patient numbers are urgently needed. Initiating resuscitation with an intact umbilical cord appears to be a safe intervention for newborns. No statistically significant differences were found in delivery room parameters, in-hospital mortality, and neonatal outcomes between the examined groups. The utilization of specialized resuscitation trolleys appears to be promising to reduce the risk of intraventricular hemorrhage in preterm infants. Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.

Effects of holistic nursing interventions in newborns with hypoxic-ischemic encephalopathy

Effects of holistic nursing interventions in newborns with hypoxic-ischemic encephalopathy

Impact of national health insurance and socioeconomic disparities on newborn hearing screening performance in South Korea: A nationwide population-based evaluation

ObjectivesThis study aimed to assess the impact of national health insurance coverage on newborn hearing screening (NHS) outcomes by analyzing hearing questionnaires from the National Infant Health Check-up Program (NIHCP) in South Korea. MethodsThis study evaluated the performance and referral rates of NHS using nationwide data from 814,875 infants enrolled in the 4-month NIHCP from January 2017 to December 2019. This period encompasses the periods before and after the National Health Insurance in South Korea began covering NHS expenses in October 2018. The study also investigated household income levels to determine their relationship with participation in the NIHCP and NHS outcomes. ResultsThe performance of NIHCP increased year-on-year, with NHS performance rates increasing from 88.5 % in 2017 to 91.5 % in 2019. Analysis by household income level revealed that the medical benefit recipients’ group had the lowest NHS performance rate of 81.9 % in 2019, whereas that of the higher income level group exceeded 90 %. The NHS referral rate remained consistent at 0.9 % nationally during the study period. ConclusionThe inclusion of NHS in national insurance coverage positively influenced its performance rates across South Korea. Nevertheless, the data indicate the need for more focused and customized support for low-income families to enhance early hearing detection and interventions in newborns and infants.

Interventions in newborns with neonatal sepsis in the neonatal intensive care unit

Neonatal sepsis is a clinical syndrome caused by bacteria, fungi, or viruses, characterized by signs and symptoms of a systemic infection that appears within 28 days of life and is the reason for hospitalization of the patient. Through the nursing care methodology, quality care was managed, with safe support, favoring improvement and protecting the patient's health. The objective of this work was to apply the nursing care process to a newborn with neonatal sepsis based on the 11 functional patterns of Maryori Gordon. Qualitative study, a single type of case, which includes a neonate in critical condition, where all phases of the care process are observed: the assessment is carried out within the framework of expert validation, the diagnosis and planning are carried out considering the NOC, NIC, NANDA classification and again the performance and evaluation are determined by the difference between the final score and the respective bases. Six forms of change were found, of which three were prioritized: active exercise, elimination, and metabolic nutrition. Eleven nursing diagnoses were also identified, of which three were prioritized: gas exchange alteration, hydroelectrolyte balance alteration and risk of nutritional imbalance: less than the body requirements according to the SSPFR format (symptoms, signs, problems, associated factors/ risk factors /connected); after care, change scores of +1, 0, and +1 were obtained. It was concluded that after recognizing the real and potential problems of the patient, five phases of the care process were developed, which lead to the stabilization of the patient, for which the success of the care was based on the timely identification of the patient's problems, needs, and implementation of treatment.

The Impact of Physiotherapy on the Developmental Progress of Preterm Infants Hospitalized in the Intensive Care Unit

Introduction: Every year, worldwide, 14.9 million babies are born prematurely. Therefore, these children are at greater risk of respiratory, cardiac, and neurodevelopmental disorders. Purpose: The purpose of the study was to investigate the effectiveness of physiotherapy intervention in premature newborns and whether the utilized techniques promote their normal development Patients: the study population consisted of 20 randomly selected neonates. The 20 neonates were randomly divided into two groups, the intervention group (Group A, 10 neonates) and the control group (Group B, 10 neonates). Methods: In the newborns of the intervention group (A), an intervention was carried out that focused on the correct positioning in a "nest" (imitation of intrauterine experience), on the changes of supine, prone, right, and left side positions, on the reduction or elimination of stress signs and passive mobilization in the supine position. Oxygen saturation (SpO2) and heart rate were continuously recorded, as well as neurodevelopmental assessment and recording of any feeding problems. weight gain, but also the length of stay of newborns in the hospital. Results: Oxygen saturation was clearly improved in premature neonates who followed respiratory physical therapy as well as improved (decreased) heart rate. Neurological examination in the neonates of the intervention group was normal and none showed feeding problems. It was also found that the newborns in the intervention group had a more stable rate of weight gain compared to the newborns in the control group. Conclusions: It is considered necessary to implement early intervention programs to prevent or minimize the negative effects of prematurity on the respiratory and neurodevelopmental development of newborns

IJCM_72A: A study on newborn care practices and associated factors influencing their health in urban slums of Kurnool city, Andhra Pradesh.

Background: Neonate is essential time for child to grow. Worldwide, Neonatal mortality are estimated to be about 3 million due to insufficient care. In 2021, 2.3 million neonates have died in first four weeks of life, roughly 6400 neonatal deaths per day. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality. Newborn care practice interventions can prevent neonatal deaths. Understanding the community and traditional newborn care practices is necessary to implement effective programme for promotion of newborns health. Hence present study was done to describe selected newborn care practices in urban slums of Kurnool. Objectives: To assess Newborn-Care Practices and to determine the relationship between Newborn-Care Practices and selected socio-demographic variables. Methodology: A Community-based, Cross-sectional study was done among 220mothers who were residing in urban slums of Kurnool City, Data were collected between October 2023 to November 2023 using Semi-structured questionnaire by Simple Random sampling technique. IEC permission was obtained. Written informed consent was obtained from participants. Data were analyzed using SPSS-Version23. Results: Mothers who were practicing delayed-bathing were observed in the age group 18-24 years 135(61.36%)followed by 25-30 years 60(27.2%),the difference was statistically significant(x2=9.84)(p=0.043),Safe cord care practices were observed more among 18-24 years132(60%),it was found to be statistically significant(x2=23.5)(p=<0.001). Early initiation of breast feeding was more common among age group 18-24 years93(42.2%), it was found to be statistically significant(x2=6.51)(p=0.039). Conclusion: The practice of essential newborn care still needs to improve in Bareilly; There is strong need to implement community-based interventions to improve the newborn care practices & to reduce the high-risk newborn care practices like unsafe cord care, delayed breast feeding, early bathing, Prelacteal feeding & discarding colostrum need through health workers.

Development of capability lists for neonatal critical care at three levels in China: a modified Delphi study

BackgroundThe standardised management of neonatal critical care centres can help improve health outcomes of vulnerable newborns. Guidance is required to update evidence related to construction and management of neonatal critical...

Presurgical Use of Hypoxic Mixture for Systemic Perfusion Improvement in Neonates With Complex Congenital Heart Disease: A Systematic Review and Meta-Analysis.

Oxygen therapy is essential for the survival of preterm babies and critically ill newborns; however, it has the potential to cause harm through hypoxemia or hyperoxemia. Newborns with complex congenital heart diseases (CHD) suffer from oxygen fluctuations due to the disease and its treatments, altering pre and postnatal development. The objective of this study is to evaluate the evidence for using a hypoxic mixture to decrease pulmonary over-circulation and improve systemic perfusion before surgical interventions in newborns with complex CHD that course with pulmonary over-circulation and systemic hypoperfusion. A search was conducted in PubMed, EMBASE, LILACS, Scielo, Taylor and Francis, SAGE, and Science Direct databases from 2000 to 2022 by two independent authors, including articles with hypoxic mixture treatment in observational studies or trials, with pre-treatment and post-treatment measurements in the same patient, or two groups or more comparisons. Six articles were selected, with a total of 75 patients. The primary outcome was improved systemic circulation and decreased pulmonary over-circulation measured directly with Qp/Qs and indirectly with oxygen saturation and cerebral near-infrared spectroscopy (NIRS). In addition, we performed a meta-analysis for oxygen saturation and cerebral NIRS. Oxygen saturation was the value uniformly reported; three studies reported a significantly lower oxygen saturation after the hypoxic mixture. The cerebral NIRS was measured in 4 studies, with inconsistent results. After using the hypoxic mixture, the Qp/Qs calculation was lower in the two studies but was not statistically significant. The meta-analysis for oxygen saturation showed a fixed effect post-hypoxic therapy of -0.7 (-1.06; -0.35), p < 0.001. The meta-analysis of two studies that measured cerebral NIRS did not show a statistically significant difference at 12 and 24 hours. In conclusion, this is the first systematic review and meta-analysis regarding the pre-operative use of hypoxic gas mixtures for newborns with complex congenital heart disease. Treatment results in lower oxygen saturations, but there is a lack of evidence of improvement in systemic perfusion. The utilization of this therapy is controversial, and better evidence is necessary.

Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India.

Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.

Preterm Birth: A Review of Its Early Diagnosis and Prevention

Preterm birth, a major global healthcare concern, is characterized by infants being born before completing 37 weeks of gestation. Accurate diagnosis and effective interventions are critical to managing this complex issue. This abstract provides an overview of the diagnosis and prevention of preterm birth, focusing on risk assessment, diagnostic techniques, and various interventions for mothers and newborns. The diagnostic process involves evaluating risk factors, clinical history, and the assessment of potential membrane rupture. Techniques such as speculum examination, the Nitrazine test, the Fern test, ultrasonography, and the Placental Alpha Microglobulin-1 test play vital roles in identifying membrane rupture and infection. Additional diagnostic markers include cervical ultrasonography and fetal fibronectin testing. Prevention strategies include lifestyle changes, maternal therapies, and antenatal interventions. Smoking cessation programs, low-dose aspirin, antenatal corticosteroid therapy, progesterone supplementation, magnesium sulfate, and antibiotic treatment are employed to reduce the risk of preterm birth. Cervical cerclage, another surgical intervention, is recommended in specific cases.&#x0D; For preterm newborns, immediate and effective care is vital. This includes thermal care, early breastfeeding, infection prevention, and respiratory distress syndrome management. These interventions are crucial in reducing infant mortality and morbidity associated with preterm birth. Efforts to diagnose and prevent preterm birth are essential in improving the well-being of both mothers and their newborns. A comprehensive approach, combining accurate diagnosis and effective interventions, can make a significant impact in reducing the burden of preterm birth on healthcare systems and families.&#x0D; Keywords: Preterm birth, infants, gestation, potential membrane rupture

Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study.

To estimate the effect of antenatal corticosteroids on newborn respiratory morbidity in twins. Regression discontinuity applied to population-based birth registry data. British Columbia, Canada, 2008-2018. Twin pregnancies admitted for birth between 31+0 and 36+6 weeks of gestation. During our study period, Canadian clinical practice guidelines recommended antenatal corticosteroid administration for imminent preterm birth up to 33+6 weeks. We used a logistic model to compare the predicted risks of our outcomes among pregnancies admitted for birth immediately before this clinical cut-point (higher probability of exposure to antenatal corticosteroids) versus immediately after it (lower probability). Our primary outcome was a composite of newborn respiratory distress or in-hospital death. Our secondary outcome was a composite of newborn respiratory intervention or in-hospital death. Among 2524 pregnancies (5035 liveborn twins), 47% of admissions before 34+0 weeks of gestation were exposed to antenatal corticosteroids but only 4.2% of admissions after this cut-point were exposed. The risk of newborn respiratory distress or in-hospital mortality increased abruptly at 34+0 weeks, corresponding to a protective effect of treatment (risk ratio [RR] 0.69, 95% CI 0.53-0.90; risk difference [RD]-12 cases per 100 births, 95% CI -20 to -4.1). There was no clear evidence for or against an effect on newborn respiratory intervention or in-hospital death (RR 0.89, 95% CI 0.70-1.13; RD -4.2 per 100, 95% CI -13 to +4.2). Our findings provide evidence for the effectiveness of antenatal corticosteroids in preventing adverse newborn respiratory outcomes in twins.

High-Sensitivity Cardiac Troponin and the Management of Congenital Heart Disease in Newborns and Infants.

Early cardiac interventions in newborns and infants suspected for congenital heart disease (CHD) decrease morbidity and mortality. After updating current evidence on the use of cardiac troponins (cTn) in the context of CHD for risk stratification at early ages, we discuss relevant issues, starting from the evidence that only the measurement of the cTnT form is useful in this population. In newborns/infants with CHD, the cTnT concentration increase is correlated with: (a) cardiac stress and hemodynamic parameters, but not with the type of CHD; (b) volume overload/right ventricular pressure overload; (c) postoperative hypoperfusion injury and mortality; and (d) effects of cardioprotective strategies. For infants with CHD, high-sensitivity cTnT (hs-cTnT) concentrations >25 ng/L are an independent predictor of poor outcomes. Transitioning from cTnT to hs-cTnT in newborns/infants improves the identification of: (a) physiopathological mechanisms and factors that increased hs-cTnT early after birth; (b) myocardial injury, even when subclinical; (c) identification of patients requiring immediate therapeutic interventions; and (d) 99th percentile upper reference limits (URLs). However, no reliable URLs are currently available to allow the detection of myocardial injury associated with CHD in newborns/infants. Additional data evaluating the clinical value of hs-cTnT in the risk stratification of newborns/infants with CHD who may suffer myocardial injury is needed. Validating the measurement, possibly in amniotic fluid samples, and improving the interpretation of hs-cTnT concentrations in the prenatal period, at birth and within 1 year of age are crucial to change CHD mortality/morbidity trends in the pediatric population.

The effect of emergency obstetric and newborn care training interventions on knowledge and skills of midwifery students prior to graduation in Kenya: A quasi-experimental study using a non-randomised controlled study design

IntroductionImproving access to emergency obstetric and newborn care (EmONC) improves maternal and newborn health. However, there is evidence that the pre-service midwifery training curriculum is deficient in developing countries. PurposeThis study measured the effectiveness of pre-service Emergency obstetric care training intervention package on the knowledge and skills of final year midwifery students in Kenya. MethodsThe study was a quasi-experimental controlled trial (ISRCTN 74563398) with one control and two intervention arms (full and partial), involving 12 Kenya Medical Training Colleges (KMTCs) and 381 final year midwifery students. Intervention arms’ KMTCs received EmONC skills training equipment, training of lecturers on teaching methods, EmONC and clinical supervision skills, (and 12 months of mentoring for full intervention arm). Control arm KMTCs had no intervention. Students’ knowledge and practical skills scores 12 months after the bundle of interventions were analysed using mixed effects linear models. ResultsA statistically significant difference was detected between the study arms for the practical skills test (p < 0.001) but not for the knowledge test (p = 0.23). The odds of achieving scores of 80 % or higher in the knowledge test was significantly higher in the full intervention group A compared to the control group OR 3.2 (1.1 – 9.8), p < 0.05. The scores in the skills tests were significantly higher in the intervention groups A and B compared to the control group 14.5 (4.2 – 24.9), p < 0.001 and 24.9 (14.5–35.2) respectively. ConclusionThe pre-service EmONC intervention package was effective in improving the knowledge and skills of final year midwifery students.

A concept analysis of immediate newborn care within 48 h of birth: A facility based

BackgroundImmediate newborn care interventions provided by midwives within 48 h of birth are invaluable in the reduction of neonatal morbidity and mortality. The purpose of this concept analysis is to clarify the meaning of immediate newborn care within 48 h of birth in relation to its attributes, antecedents, consequences and empirical referents. MethodsWalker and Avant’s (2019) framework was used to analyze the concept. The framework consist of the following steps: selecting a concept; determining the aims of the analysis; identifying all the uses of the concept; identifying the defining attributes; identifying and constructing model, borderline, related and contrary cases; identifying antecedents and consequences; and finally defining empirical referents. ResultsThe attributes of immediate newborn care are up to date knowledge, proficiency in skills, effective communication, willingness, responsibility, compassionate, honesty, commitment, resilience, touch and patience. The identified antecedents are availability of adequate midwives, pre-service and in-service training, availability of functioning equipment and supplies, regular supervision, follow up and mentorship. The consequences include: improved provider's performance, client/caretaker's satisfaction, provider's growth and satisfaction, and reduction in neonatal morbidity and mortality. ConclusionImmediate newborn care within 48 h helped in highlighting interventions that can be implemented immediately after child birth in order to reduce neonatal deaths.

Percepção de profissionais de enfermagem sobre o cuidado prestado ao neonato com estomia de eliminação intestinal

Abstract Objectives To understand the perception of the nursing team of the neonatal unit about the care provided to hospitalized newborns with intestinal ostomy and to discuss the factors that interfere in nursing care. Method Exploratory and descriptive study, with a qualitative approach. Eight nurses and eight nursing technicians who work in a Neonatal Unit in Rio de Janeiro took part. Data were collected between April and June 2022, through semi-structured interviews and content analysis. Results Two categories emerged: “perceptions of the nursing team regarding the care of hospitalized newborns with intestinal ostomies and family health education”; and “facilitating and hindering aspects of nursing care for newborns with intestinal ostomy and the importance of continuing education in the setting of the Neonatal Unit”. Conclusion and implications for practice The management of newborns with intestinal ostomies is current and involves nursing care with the stoma and skin of the newborn, extending to the practice of health education for family members. The management of complications, the unavailability of materials and fragmented care are challenging. This finding can support the development of systematized nursing interventions for newborns and their parents in the neonatal unit.

Practices of essential newborn care endorsed for every newborn and interventions recommended for pre-term babies in selected government hospitals of Colombo District, Sri Lanka

Introduction: World Health Organization (WHO) has identified essential newborn care interventions to improve the care of every newborn. In 2015, the WHO published evidence-based guidelines to improve pre-term birth. Though Sri Lanka also adheres to these recommendations on interventions to improve pre-term birth outcomes, coverage of them have not yet been assessed for the country and there is no recent assessment of essential newborn care coverage as well.Objectives: To describe the practice of essential newborn care (ENC) for babies born pre-term and WHO recommended interventions to improve pre-term birth outcomes in government hospitals of Colombo District.Methods: A descriptive cross-sectional study with two components was conducted in seven government hospitals with obstetric and neonatal care facilities in Colombo District in 2017-2018. The first component describes the coverage of essential newborn care (ENC) assessed by direct observation among convenient sample of 77 deliveries. The second component assessed the practice of recommended interventions to improve pre-term birth. Data were extracted by pre-intern doctors from the medical records using a checklist on 510 pre-terms. Descriptive analysis was done.Results: In relation to ENC, among 77 deliveries, preparation before delivery was satisfactory and it was &gt;90%. Overall, the practice of immediate newborn care interventions were satisfactory, but a low coverage was found for maternal abdomen delivery 31(40.3%), delayed cord clamping 39 (50.6%), temperature measurement 8(10.4%), educating about vitamin K 29 (37.7%), breastfeeding counselling 40 (51.9%) and delayed weighing 26 (33.8%). Practising recommended pre-term interventions was satisfactory except for the use of magnesium sulphate which was received by only 38 (60.3%) and kangaroo mother care was given for only 74 (57.8%).Conclusions &amp; Recommendations: Most of the ENC practices and adhering to recommended interventions for pre-term were satisfactory except for a few. A refresher course of care for the preterm baby and ENC is recommended to the labour room staff.

Pengaruh Inisiasi Menyusui Dini (IMD) Terhadap Hipotermi Pada Bayi Baru Lahir Peningkatan Produksi ASI Pada Ibu Post Partum

Infant deaths generally occur in the early neonatal period due to hypothermia. The incidence of hypothermia in newborns is quite high, globally ranging from 8.5-52%, an estimated 17 million newborns experience hypothermia in developing countries. The incidence of hypothermia in newborn babies is 92.3%, the infant mortality rate due to hypothermia is 6.3%. One intervention to minimize the incidence of hypothermia in newborn babies is to initiate early breastfeeding. The aim of the research was to determine the effect of early initiation of breastfeeding on hypothermia in newborn babies at the Bakti Timah Karimun Hospital. The research method used a pre-experiment with a one group pretest-posttest design. The sampling technique was purposive sampling with 14 respondents. The measuring instruments in this study were a digital axillary thermometer, standard operating procedures (SOP) for early breastfeeding initiation and observation sheets. Data analysis using paired sample t-test. The results of the paired sample t-test found a p-value = 0.000 (p&lt;0.05), so it can be concluded that there is an influence of early initiation of breastfeeding on hypothermia in newborn babies in the Midwifery Room at Bakti Timah Karimun Hospital. Early initiation of breastfeeding can be used as an intervention for newborns to minimize the incidence of hypothermia

Effectiveness of saline solutions in surgical interventions in newborns

BACKGROUND: In recent years, neonatal surgery has been developing and improving, among other things, because of a deeper study of anesthesiological approaches and the introduction of acquired knowledge into the daily practice of an anesthesiologist-resuscitator. One of the basic factors that influence treatment outcomes in the future is a thorough study of infusion therapy methods in newborns, considering the anatomical and physiological characteristics of the neonatal period.&#x0D; AIM: This study aimed to examine the electrolyte balance, acid–base state, and hemodynamic parameters in newborns, depending on the choice of basic infusion medium during surgery.&#x0D; MATERIALS AND METHODS: A prospective study was conducted in 99 newborns. All children were given an infusion of saline solutions of 10 mL/kg/h during surgery. Groups I, II, and III were administered intraoperatively with isotonic Sterofundin, saline solution, and Ringer’s solution, respectively. A hypotonic sodium chloride solution of 0.45% was administered to 11 children. The indicators of the acid–base state and electrolyte composition of the venous blood, hemodynamic parameters, and need for perioperative inotropic support were evaluated.&#x0D; RESULTS: A tendency to hyponatremia was detected in children who were infused with 0.45% sodium chloride hypotonic solution, which resulted in the abandonment of further recruitment of children in the group and the implementation of this study option. After surgery, the pH-compensated state was maintained in all three groups. Moreover, metabolic disorders in the form of a decrease in bicarbonates and ВE were recorded in all groups. Electrolyte disturbances were detected in all groups, whereas electrolyte balance was most often registered in group I. In groups II and III, common ionogram findings included a decrease in potassium and an increase in sodium, chlorine, and calcium levels. In the analysis of the hemodynamic parameters, no significant statistical difference was recorded during surgery when comparing the groups infused with different saline media.&#x0D; CONCLUSIONS: In this study, no significant differences were found in the indicators of acid–base state and hemodynamic parameters when using different saline solutions as basic intraoperative infusion therapy in newborns. Regarding the electrolyte balance, the most common complications were hypokalemia, hypernatremia, and hyperchloremia in the 0% saline group.