Newborn Special Care Unit Research Articles

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.

Factors Associated with Newborn’s Survival: A Cross-Sectional Study at two Districts of Bihar

Family Participatory Care (FPC) is a relatively new concept adopted in SNCUs in India. Its effect on survival outcomes of sick newborns has not been studied much. As such newborn mortality studies are rare due to their large sample scale requirement. This is one of the few studies which have been conducted using primary data on this subject in India. In our study, we have found similar causes of death among newborns as published by renowned studies. Study findings highlighted that FPC may reduce newborn mortality by reducing the length of stay at the facility, newborn growth, and survival outcome of sick neonates, especially Kangaroo mother care and exclusive breastfeeding are key components of FPC, and help in reducing newborn deaths. Objectives: Family Participatory Care (FPC), a cost-effective innovation implemented in Special Newborn Care Units (SNCUs) where vulnerable newborns are treated, is a well-established concept akin to Family Centered Care (FCC) in developed nations. The study aims to assess the impact of FPC on the survival rates of sick neonates in SNCUs. The study explored the factors associated with the care of sick neonates after discharge from SNCU that adapted FPC and that did not adapt FPC. Methods: A multistage random sampling method was used to examine sick neonates and newborns discharged from Special Newborn Care Units (SNCUs) in selected districts of Bihar namely Nalanda SNCU with Family Participatory Care (FPC) and Vaishali SNCU without FPC. Findings: The study found a notable variance in the rate of newborn mortality between the district implementing Family Participatory Care and the district that did not implement FPC, with the former experiencing nearly double the rate of newborn deaths. 11 key factors (maternal, household, family support, newborn health-related) attributing towards newborn survival status were identified in this study. Novelty: Family Participatory Care (FPC) is a relatively new concept in India, and this is one of the few studies that have been conducted on this subject. Keywords: Neonatal death, Family Participatory Care, Newborn Survival, Newborn Care, Family participation in Newborn care

Serum Electrolytes and Calcium Levels in Neonates Receiving Phototherapy for Neonatal Jaundice

Background: Neonatal Jaundice (NJ) is one of the most common causes of neonatal admission. Phototherapy is an important treatment modality for NJ. However, this treatment modality may itself result in changes of different biochemical parameters. The study aimed to evaluate the changes in serum electrolytes (Sodium, potassium and chloride) and calcium in neonates receiving phototherapy for NJ. Materials and methods: One hundred and two term neonates admitted to the Special Care Newborn Unit, Chattogram Medical College Hospital for the management of NJ by phototherapy were enrolled in this prospective observational study. Serum bilirubin, sodium, potassium, chloride and calcium were measured before and after 48 hours of phototherapy and compared. Results: The mean gestational age and mean age of admission of the neonates were 38.6±0.6 weeks and 6.42 ± .67 day respectively. The mean sodium, potassium and calcium level before therapy was respectively, 138.4±1.8 mmol/L, 4.1±0.3 mmol/L and 8.8±0.3 mg/dl. There was significant decrease in the level of mean sodium (136.4±1.6 mmol/L), potassium (3.8 ± 0.3 mmol/L) and calcium (8.4±0.4 mg/dL) after phototherapy. All neonates had normal level of serum calcium, sodium, potassium and chloride before phototherapy. After 48 hours of phototherapy, 46 (45.1%) of them had abnormal values with the incidence hypocalcaemia, hyponatraemia and hypokalemia respectively in 21.6%, 25.5% and 10.8% of the neonates. Conclusion: Neonates undergoing phototherapy are at risk of developing hyponatraemia, hypokalaemia and hypocalcaemia. Closed monitoring is essential to observe the changes in sodium, potassium and calcium and should be managed accordingly. IAHS Medical Journal Volume 6(2) December 2023; 83-86

Ultrasonographic Assessment of the Thymus Among Neonates Admitted in a Special Newborn Care Unit of a Medical College Hospital in Eastern India.

The thymus is essential for the maturation of T-lymphocytes, crucial for adaptive immunity. In neonates, thymic development is influenced by factors such as gestational age, birth weight, birth length, etc. Ultrasonography offers a non-invasive method to assess thymic size and morphology. However, there is limited research on thymic ultrasonography among neonates in Eastern India. This study aimed to investigate the ultra-sonographic characteristics of the thymus in neonates admitted to a Special Neonatal Care Unit (SNCU) in Eastern India and its correlation with certain clinical and anthropometric variables. Conducted from May to July 2024, this cross-sectional observational study involved 80 neonates admitted to the SNCU at the College of Medicine & Sagore Dutta Hospital. Thymic ultrasonography, using an Esaote MylabX7 ultrasound machine with a 3-11 MHz linear probe (Esaote, Genoa, Italy), measured thymic length, width, anteroposterior (AP) dimension, sagittal area, and thymic index. Clinical data, including gestational age, birth weight, birth length, and antibiotics received, were collected from medical records. Pearson's correlation coefficient and linear regression analysis were used to examine correlations and predictors of thymic dimensions. The cohort consisted of 45 boys (56%) and 35 girls (44%). The average birth weight was 2,626 grams for boys and 2,639 grams for girls. The median gestation period was 38 weeksfor both groups. Thymic measurements did not significantly differ by gender. Correlation analysis revealed significant relationships between thymic dimensions and neonatal anthropometric measurements. Birth weight showed a strong positive correlation with thymic length (r = 0.486) and width (r = 0.233). Linear regression identified birth weight as a significant predictor of the thymic index (p < 0.001), explaining 21.2% of the variance. This study provides insights into the factors associated with thymic size in neonates, highlighting the critical role of birth weight in thymic development. Future research should explore additional variables influencing thymic size and consider larger sample sizes to enhance model explanatory power and its potential role in immunity.

A Hybrid Form of Telemedicine and Quality Improvement: A Unique Way to Extend Intensive Care Services to Neonates.

To evaluate the impact of hybrid support (tele-mentoring and conventional support) on adverse outcome among neonates admitted to 10 special newborn care units (SNCUs) in Chhattisgarh. This before-and-after study was conducted at 10 SNCUs in Chhattisgarh in 2022. Conventional support was given earlier and later, that was supplemented with tele-rounds which were carried out using Skype technology. The principal investigator (PI) visited each unit for one day per month to kickstart quality improvement (QI) projects and provide guidance. Patient outcome data were collected on clinical sepsis proportion, IV fluid usage, antibiotic usage, length of stay, referral and mortality. A total of 2807 babies across 10 units were assessed. This was retrospectively correlated with 5169 babies in these units in the year before the intervention was started. The percentage of clinical neonatal sepsis cases decreased from 53.4% to 29.4% (P < 0.05). IV fluid usage dropped from 40% to 22.2% (P < 0.05). The initiation and continuation of kangaroo mother care (KMC) increased from 55.5% to 93.8% (P < 0.05). The average length of stay decreased from 5.5 ± 0.97 d to 4 ± 0.2 d (P < 0.05). Oxygen utilization decreased from 39.3% to 33.6% (P < 0.05). The proportion of antibiotic usage decreased from 50.2% to 39.7% (P < 0.05). The mortality rate decreased from 8.18% to 6.99% (P < 0.05). Referral rate decreased from 13.12% to 11.93% (P < 0.05). The implementation of a QI package through hybrid support, which includes tele-mentoring, supportive supervision visits, and local QI project advocacy, proves to be an effective approach in enhancing newborn intensive care.

A Rare Case of Early Onset Neonatal Sepsis by Burkholderia Cepacia In Special Care Newborn Unit of a General Hospital

A Rare Case of Early Onset Neonatal Sepsis by Burkholderia Cepacia In Special Care Newborn Unit of a General Hospital

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p&lt;0.0001). Sepsis is more prevalent in out born unit (p&lt;0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p&lt;0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

Endotracheal Tube Aspirate Microscopy and Culture vs CDC Criteria for Early Diagnosis of VAP in Special Newborn Care Units

Endotracheal Tube Aspirate Microscopy and Culture vs CDC Criteria for Early Diagnosis of VAP in Special Newborn Care Units

Vayu bubble continuous positive airway pressure is a promising solution with favorable treatment outcomes for respiratory distress syndrome in newborns: a qualitative study in Bangladesh.

According to Bangladesh Demographic and Health Survey (2022), neonatal mortality, comprising 67% of under-5 deaths in Bangladesh, is significantly attributed to prematurity and low birth weight (LBW), accounting for 32% of neonatal deaths. Respiratory distress syndrome (RDS) is a prevalent concern among preterm and LBW infants, leading to substantial mortality. The World Health Organization (WHO) recommends bubble continuous positive airway pressure (bCPAP) therapy, but the affordability and accessibility of conventional bCPAP devices for a large number of patients become major hurdles in Bangladesh due to high costs and resource intensiveness. The Vayu bCPAP, a simple and portable alternative, offers a constant flow of oxygen-enriched, filtered, humidified, and pressurized air. Our study, conducted in five health facilities, explores the useability, acceptability, and perceived treatment outcome of Vayu bCPAP in the local context of Bangladesh. A qualitative approach was employed in special care newborn units (SCANUs) of selected facilities from January to March 2023. Purposive sampling identified nine key informants, 40 in-depth interviews with service providers, and 10 focus group discussions. Data collection and analysis utilized a thematic framework approach led by trained anthropologists and medical officers. Service providers acknowledged Vayu bCPAP as a lightweight, easily movable, and cost-effective device requiring minimal training. Despite challenges such as consumable shortages and maintenance issues, providers perceived the device as user-friendly, operable with oxygen cylinders, and beneficial during referral transportation. Treatment outcomes indicated effective RDS management, reduced hospital stays, and decreased referrals. Though challenges existed, healthcare providers and facility managers expressed enthusiasm for Vayu bCPAP due to its potential to simplify advanced neonatal care delivery. The Vayu bCPAP device demonstrated useability, acceptability, and favorable treatment outcomes in the care of neonates with RDS. However, sustained quality service necessitates continuous monitoring, mentoring and retention of knowledge and skills. Despite challenges, the enthusiasm among healthcare providers underscores the potential of Vayu bCPAP to save lives and simplify neonatal care delivery. Development of Standard Operating procedure on Vayu bCPAP is required for systematic implementation. Further research is needed to determine how the utilization of Vayu bCPAP devices enhances accessibility to efficient bCPAP therapy for neonates experiencing RDS.

Patterns of neonatal admissions and mortality among neonates admitted to special neonatal care units: a two-year cross-sectional study at selected special neonatal care units in Odisha, India

Background: Odisha has built 44 special newborn care units to treat severely sick infants at various levels. This study aimed to determine morbidity and mortality profiles among neonates admitted to the SNCUs and extend efforts to improve outcomes by investigating crucial variables. Methods: We conducted a cross-sectional descriptive study on all neonates admitted to SNCUs of 4 districts (Balangir, Kalahandi, Koraput, and Rayagada) between two calendar years (January 2020 and December 2021). We collected data on epidemiology, clinical presentation, and neonatal and maternal characteristics. We used Microsoft Excel to analyze categorical and continuous variables, with the Chi2 test for proportion comparison. Results: 17615 neonates were admitted in 2020-2021, 58% below one day and 59% male. ST babies were predominant. Outborn unit had 52% admissions, with 67% full-term and 31% pre-term. 74% of outborns used government vehicles for transportation. Most diagnoses were birth asphyxia, HIE, neonatal jaundice, low birth weight, and neonatal sepsis. The study found that 43% of neonates died from hypoxic ischaemic encephalopathy /perinatal asphyxia, 22% from Sepsis, 12% from extremely low birth weight babies, and 9% from prematurity. The Chi2 test showed a statistically significant difference in survival rates between doctors and dai, with a 91% survival rate and a 71% survival rate. Conclusions: Birth asphyxia was found to be the most essential cause of morbidity and mortality. Regular training at district levels is crucial for ensuring proper newborn care, including warmth, feeding, cleanliness, and prevention of asphyxia, to reduce preterm birth and low birth weight.

IJCM_419A: Profile of neonates admitted to Special Newborn Care Unit (SNCU) of a Tertiary Care Hospital attached to a medical college in Mangalore

Background: Neonatal Mortality Rate (NMR) is a value which plays a vital role in gauging the effectiveness and advancement in healthcare pertaining to newborns. The alarmingly high rate promotes the need of further development of better medical facilities. One such facility is the Special Newborn Care Unit (SNCU). Objective: This study targets the analysis of factors contributing to the mortality of neonates and aims at coming up with solution to tackle the issue Methodology: A facility based retrospective study was carried out based on information from medical records of neonates admitted to the SNCU from a tertiary care hospital. Results: The 1038 neonates admitted it was found that nearly half of the neonates admitted had low birth weight (48.2%) contrary to maturity where 37.9 % were preterm. Most of the admissions were due to neonatal jaundice (46.6%) followed by low birth weight (15.2%) and respiratory distress syndrome (10.3%). Of the 85 neonates who expired, the leading causes were respiratory distress syndrome (21.2%), sepsis (14.9%), Hypoxic Ischemic Encephalopathy (12.9%), major congenital malformations (12.9%) and extreme low birth weight 11 (12.9%). Conclusion: The expansion of services and technology provided by SNCUs is of great importance in the development of healthcare for the nation. The growth of better antenatal health care, seamless referral systems along with identification of alarming conditions requiring admission to SNCUs immediately after birth form the pillars of confronting the goal of decreasing the NMR.

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

“Special Newborn Care Unit” Quality Care Assessment Using SNCU Quality of Care Indices (SQCIs) at Aspirational Districts, Odisha, 2020-2022

Introduction: Special newborn care unit (SNCU) Quality of Care Indices (SQCIs) are specific indicators that help in assessing and evaluating the quality of care provided to newborns in SNCUs. Aims and Objectives: The study described the quality of care at SNCUs in aspirational districts of Odisha by using 7 quality of care indices, 2020-2022. Materials and Methods: We conducted a cross-sectional descriptive study on all newborns who received care at SNCUs of 10 aspirational districts in Odisha using the data from the SNCU online database for 2020-2022. Every quarter of the year, all the parameters were extracted and entered into an already designed spreadsheet. The 7 indices generated the SQCI score. We used MS Excel (2021) for data analysis. Results: A total of 50,226 admissions were registered. Perinatal asphyxia caused the significant morbidity (14,421, 29%). Throughout the 12 quarters, composite SQCI showed satisfactory performance (0.59-0.66). Rational admission of all units was good, and their scores were 0.71 to 0.87. Mortality in normal weight babies showed good performance. The Low Birth Weight Admission Index score ranged from 0.22 to 0.30, that is, unsatisfactory performance. During 2020 to 2022, the overall composite SQCI score of the 10 SNCUs corresponded to satisfactory care (0.56-0.68). Conclusion: SQCI is an essential tool for assessing the SNCU quality evaluation. It should be regularly used at the district level to enhance quality care. Health facilities’ preparedness for managing perinatal asphyxia is to be studied.

Morbidity and mortality pattern of admitted newborn in Special Newborn Care Unit at district hospital, Siddharthnagar, Uttar Pradesh

Background: Special newborn care unit is formed to give facility based newborn care at district hospital. It is essential to know the competence of Special newborn care unit. The purpose of this study is to study the morbidity and mortality pattern of admitted newborn in Special Newborn Care Unit at district hospital, Siddharthnagar, Uttar Pradesh. Material and methods: Hospital based secondary data collected from Special Newborn Care Unit of the district hospital of Siddharthnagar, Uttar Pradesh. The study period was from September 2020 to December 2020. The sample size for this study was 360 admitted newborn. Univariate and bivariate analysis done to get expected result. Kappa agreement is also used to show agreement between initial and final diagnosis of morbidity. Results: The most predominant cause of morbidity among newborn was Perinatal Asphyxia (44.4%). Around 72.5% of admitted newborn successfully discharged from hospital and 7.8 % of admitted newborn died. The relative risk of mortality was highest from low birth weight. There is 87% of agreement between initial diagnosis and final diagnosis of morbidity with p-value &lt; 0.0001. Conclusion: A high proportion of newborns suffer from perinatal asphyxia. There is scope and need for a reduction of mortality of admitted newborns. This study will help hospital administration improve the healthcare situation of admitted newborns.

Factors Leading to Newborn's Admission to Neonatal Intensive Care Unit &amp; Their Outcome

Background: The neonatal phase, which is the first 28 days of an infant’s life, is a vulnerable period due to many reversible severe illnesses. Nearly 3.5 million babies in India are born too early, 1.7 million babies are born with birth defects, and one million new-borns are discharged each year from Special New-born Care Units. These new-borns remain at high risk of death, stunting and developmental delay. Objectives: This study was aimed to assess factors leading to admission of newborns to Neonatal Intensive care Unit, their outcome and predictors for neonatal mortality. Methods: Quantitative- retrospective survey method was adopted for the study. The data was retrieved from the records of 440 babies admitted at Shree Sardar Smarak Hospital, Bardoli from 1st February, 2022 to 31st January, 2023. Results: The majority 260(59.1%) of babies admitted were delivered by primi mothers, 406(92.3%) were term at the time of delivery, 218 (49.5%) were delivered through normal vaginal delivery &amp; 234(53.2%) babies were male. LBW (20%) which ranged from 900 gm to 2200 gm was the most common and tachypnea (0.5%) was the least common reason for admission. Concerning to neonatal outcome, majority 426 (96.81%) babies survived and 14 (3.18%) were not able to survive. The crude odds ratio with a 95% confidence interval (CI) and p-value &lt;0.05, showed that age of mother, parity, gestational age at the time of delivery and mode of delivery were significantly related with neonatal survival status. Conclusion: Understanding the reasons for admission to NICU and predictors for neonatal mortality is significant for planning health services, improving the quality of care and reducing neonatal mortality rate. Keywords: Factors leading, NICU admission, neonatal outcome, predictors

Clinical Outcome in Newborns after Omission of Heart Rate Counting Step vs Standard Neonatal Resuscitation: A Randomised Controlled Trial

Introduction: In all Neonatal Resuscitation Program (NRP) scenarios, Heart Rate (HR) counting is essential to assess the response to resuscitation. Undue delay in initiating Positive Pressure Ventilation (PPV) due to the time taken in HR counting may increase the risk of hypoxic injury and infant mortality. Aim: To observe whether omitting the HR counting step in the First Golden Minute (FGM) and early initiation of PPV affects outcomes. Materials and Methods: The present Randomised Controlled Trial (RCT) was conducted in the Special Newborn Care Unit (SNCU), GSVM Medical College, Kanpur, Uttar Pradesh, India, from September 2020 to March 2022. A total of 67 newborns were included, with 34 in the control group (group 1) and 33 in the intervention group (group 2). In the control group, neonatal resuscitation was performed according to Facility-based Newborn Care (FBNC) guidelines, while in the intervention group, only the HR counting step was omitted from the FGM. Both groups of newborns were assessed for outcomes including normal baby, baby developing Hypoxic Ischaemic Encephalopathy (HIE) stage I, II and III, and death. Data was compiled and analysed using percentages for categorical variables. Continuous variables were analysed using mean and standard deviation of Z score and Student’s t-test. A p-value less than 0.05 was considered statistically significant. Results: The mean gestational age was 38.3±5.8 weeks in group 1 and 37.9±6.1 weeks in group 2. Gender distribution was almost equal, with 19 (56%) female newborns in group 1 and 17 (52%) female newborns in group 2. The mean total time from birth to the end of PPV (in seconds) was significantly lower in group 2 (63.47±7.09) compared to group 1 (78.18±8.36), with a p-value of &lt;0.001. Clinical outcomes in group 1 included 10 (29.41%) normal babies, 12 (35.29%) with HIE-I, 5 (14.71%) with HIE-II, 5 (14.7%) with HIE-III, and 2 (5.88%) deaths. In group 2, the outcomes were 14 (42.42%) normal babies, 6 (18.18%) with HIE-I, 8 (24.24%) with HIE-II, 4 (12.12%) with HIE-III, and 1 (3.03%) death. Conclusion: The present study demonstrated that even after omitting the HR counting step from the FGM, the outcomes in terms of HIE and death are similar to those observed after following the standard NRP protocol.

Gender Difference in Community’s Health Care Seeking Behaviour towards Male and Female Newborns in Today’s Scenario- A Cross-sectional Study

Introduction: The sex ratio is a crucial social indicator to assess the level of equality between men and women. In several aspects, the gender difference between men and women is the major expression of social and cultural trends of the society. Aim: To analyse sex ratio at birth and the gender difference in health seeking behaviour among newborns and the natural survival advantage of female newborns by studying the admission, discharges, mortality, follow-up and Leave Against Medical Advice (LAMA) in Special Newborn Care Unit. Materials and Methods: This cross-sectional study was conducted in Netaji Subash Chandra Bose Medical College and Hospital, Madhya Pradesh and Lady Elgin Hospital, Madhya Pradesh from July 2017 to June 2019. The total number of newborns included in the study was 37,256. The difference in male and female newborns in terms of birth, LAMA, morbidity, mortality and follow-up were studied. The monthly statistical data were entered in an excel sheet. The data were analysed using SPSS version 22.0 for Windows. The mean values of the monthly percentage were compared gender-wise using the t-test. Results: Out 20108 male newborns and 17,148 female newborns advised for follow-up care, 1897 females (mean-14.64, SD- 11.47) and 3029 males (mean-16.94, SD-12.47) came for follow- up care. The gender difference was statistically significant (p ≤0.001). Females (mean outborn unit-3.07, inborn unit-1.05) took LAMA more than males (mean outborn-2, inborn-0.84) which was statistically significant (outborn: p≤0.001, inborn: p=0.0254). This imples less health seeking behaviour towards females. Mortality (p-value: outborn-0.0041, inborn-0.0105) and morbidity (p≤0.001) were lesser in females compared to males which was statistically significant. These factors imply natural survival advantage in females. Conclusion: The present study concludes that the health seeking behaviour was less towards female newborns despite their natural survival advantage which plays an important role in the declining sex ratio.

The Effect of Vitamin D Supplementation as Adjuvant to Phototherapy versus Phototherapy Alone on Neonatal Jaundice: A Randomised Controlled Trial

Introduction: Neonatal jaundice, or neonatal hyperbilirubinaemia, is a common and significant concern among newborns globally. Given that phototherapy is the primary treatment for neonatal jaundice, exploring alternative adjunctive treatments is beneficial. Aim: To observe the impact of vitamin D supplementation as an adjuvant therapy alongside phototherapy in managing neonatal jaundice. Materials and Methods: A hospital-based double-blinded randomised controlled trial was conducted at the Special Newborn Care Unit (SNCU) in Department of Paediatrics, G.R. Medical College, Gwalior, Madhya Pradesh, a tertiary care neonatal centre in North India, over a two-year period (April 2020 to March 2022). The study included 70 newborns with neonatal jaundice, divided into two groups: one receiving phototherapy and vitamin D (Group 1), and the other receiving phototherapy alone (Group 2). The average levels of bilirubin were compared at baseline, 48 hours, 96 hours, and 120 hours in the two groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) 22.0, calculating frequency, percentage, mean, Standard Deviation (SD), and applying the independent t-test for comparison. A p-value less than 0.05 was considered statistically significant. Results: The mean total serum bilirubin at admission in Group 1 was 18.58±1.76 mg/dL, and in Group 2 was 17.77±2.01 mg/ dL, with a p-value of 0.077. At 48 hours, the levels in Group 1 were 15.11±1.99 mg/dL, and in Group 2 were 14.69±1.53 mg/ dL, with a p-value of 0.339. At 96 hours, the levels in Group 1 were 14.75±5.62 mg/dL, and in Group 2 were 13.16±1.49 mg/ dL, with a p-value of 0.237. At 120 hours, the levels in Group 1 were 8.90±4.66 mg/dL, and no patients were observed in Group 2. The study found that vitamin D as an adjuvant to phototherapy did not significantly impact the rate of decline of serum bilirubin, and the duration of phototherapy was not affected significantly. Conclusion: The study concludes that vitamin D, as an adjuvant to phototherapy, does not significantly affect the rate of decline of serum bilirubin, and it does not alter the duration of phototherapy when comparing both groups.

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Early Predictors of Ventilator Associated Pneumonia in Preterm Neonates Admitted in a Special Newborn Care Unit

Forecasting of neonatal mortality trend at a special new-born care unit in Odisha, India: A time-series analysis

New born mortality is a public health problem in the state of Odisha. Newborn mortality is a dynamic process and variations in mortality are observed temporally and seasonally, and also across health facilities. Prior knowledge of mortality burden can enable health system’s readiness in terms of resources allocation and timely intervention, thereby improving the chances of survival of sick newborns admitted in the hospitals. Hence, this study aimed to examine temporal trends of newborn mortality in a Special Newborn Care Unit of Saheed Laxman Nayak Medical College and Hospital (SLNMCH) in Odisha and forecast a short-term monthly projection.The Box-Jenkins approach was used to fit a seasonal autoregressive integrated moving average (SARIMA) model to the monthly recorded mortality among the hospitalized new borns in the SNCU during 2016-2020. The best-fit model for forecasting was found based on the Akaike Information Criterion.The time-series analysis revealed a modest upward trend in newborn mortality rate among SNCU admitted newborns, with peaks in the late winter and late summer months. The seasonal ARIMA (0,1,1)(1,1,1)12 model offered the best fit for time-series data. This model predicted the monthly percentage of mortality in SNCU admitted newborns in the range of 9% to 35% with respective 95% confidence interval for two years period (2021-2022).SARIMA models are useful for monitoring newborn mortality and provide an estimate of temporal trends and seasonality. The models are helpful for predicting occurrence of mortality in the SNCU of SLNMCH and could be useful for developing early warning systems. It may help in early detection, timely treatment, and prevention of serious complications in admitted sick newborns.