Newborn Special Care Unit Research Articles

Prevalence of skin lesions in special newborn care unit: A single centre study

Prevalence of skin lesions in special newborn care unit: A single centre study

Congenital cutis laxa with ileus and cleft lip and palate

Cutis laxa is a heterogeneous group of disorders related to abnormalities in elastic tissues. A full-term male neonate, appropriate for gestational age, was admitted in the special newborn care unit because of cleft lip and cleft palate. The baby then developed abdominal distension with feed intolerance, which is a well-described complication of cutis laxa. The baby also developed occipital decubitus ulcers within the 1st week of life. To our knowledge, this is the first reported case of decubitus ulcers in the case of cutis laxa.

Leave against medical advice from SNCU of a teaching hospital in Garhwal, Uttarakhand, India

Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU).Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.

Assessment of epidemiological profile of neonatal seizure cases admitted to a tertiary health center of Odisha, India: a cross-sectional study

Background: Neonatal seizures are common manifestations of neurologic dysfunction in newborns. The incidence of seizures in neonatal period is higher than any other period of life. It is one of the common causes of admission to special newborn care unit. Therefore, it has been decided to assess the epidemiological profile of neonatal seizure.Methods: A cross-sectional study was conducted from January2017 to June 2018, in the SNCU of MKCG Medical College and Hospital, Berhampur. A total of 300 neonates admitted to SNCU with clinically apparent seizure were the study population and convenient sampling method was used for selecting them. The approval was taken from IEC MKCG Medical College to carry out the study. The data was collected by using a pretested proforma from parents and hospital records. Verbal informed consent was taken from parents. The data so collected was analysed in the department of Pediatrics.Results: Out of the total 300 babies, 66% were males, 61.34% were early neonates,77% babies were of primi mothers,76% of babies were outborn . 62.12% of babies were born by vaginal route. HIE was most common (88%) cause of seizure. Out of the all seizure types, subtle seizure was most common (87.67%), followed by clonic seizure (35.67%). Various maternal risk factors were present in 81.81 % of cases. Most common risk factor was anemia (50.57%).18.93% of cases were born with history of obstructed labor/prolonged labor. Overall mortality was 8%.Conclusions: Neonatal seizures are important causes of morbidity and mortality in newborns. Prevention of HIE and maternal risk factors along with early use of an effective drug with minimum side effects are the ways to overcome this problem.

Profile of retinopathy of prematurity in late preterm newborn in a district level special newborn care unit of Eastern India

Background: The aim of this study was to analyse the incidence, severity and risk factors of retinopathy of prematurity in late preterm newborn at a district level SNCU in eastern India.Methods: The initial examination was carried out at 3 weeks of postnatal age or at 31weeks of post-conceptional age, whichever was later. Retinopathy was graded into stages and zones as per the ICROP classification. Those who had ROP were examined every week till regression occurred or till they reached criteria for laser treatment which was type I Prethreshold ROP as per ET ROP guideline. Risk factors for the development of ROP were determined by reviewing maternal and perinatal history and hospital case records.Results: 212 late ptreterm newborn were examined. The incidence of ROP in late preterm was 16.51% (35 out of 212 newborn). Incidence of stage I ROP was 6.60 % (14 newborn had stage I ROP). Incidence of stage II ROP was 6.60% (14 had stage II ROP). None had stage III ROP. 7 had APROP. Incidence of APROP was 3.30 %. 5 out of 14 newborns with stage II ROP (35.71%) required laser treatment. All newborn with APROP required both laser and Anti VEGF treatment. Overall 34.28% of late preterm with ROP required treatment. There was no difference in gestational age and birth weight in late preterm with and without ROP. There was significant difference in the duration of oxygen therapy in late preterm with and without ROP (6.657±2.531days vs 0.694±1.397 days, p<0.001). In stepwise logistic regression analysis-use and duration of oxygen, birth asphyxia and anemia were found to be significant risk factors of ROP in late preterm.Conclusions: ROP is common in late preterm newborn in developing country like India.

Antenatal Corticosteroids for Women at Risk of Imminent Preterm Birth in 7 sub-Saharan African Countries: A Policy and Implementation Landscape Analysis.

Every year approximately 15 million babies are born prematurely and nearly 1 million die due to preterm birth complications. Evidence shows that antenatal corticosteroids (ACS) can be used to improve preterm birth outcomes in particular clinical settings. We conducted a policy and implementation landscape analysis of ACS use for women at risk of imminent preterm birth in 7 low-income countries. A study framework and situation analysis tool were developed based on the World Health Organization (WHO) recommendation for ACS use among women at risk of preterm birth. The study was conducted in the Democratic Republic of the Congo, Ethiopia, Malawi, Nigeria, Sierra Leone, Tanzania, and Uganda. Primary data were collected through key informant interviews. Secondary data were gathered from publicly available sources, a survey of health management information system indicators, and demographic data from the Every Preemie-SCALE country profiles for preterm and low birth weight prevention and care. All 7 countries are using ACS for women at risk of imminent preterm birth. The majority of countries include language on ACS use in clinical protocols or standard treatment guidelines; however, none include language on accurately measuring gestational age. For 2 of the 5 countries with national standards for ACS use, the upper gestational age limit for ACS use exceeded the WHO recommendation of 34 weeks. There are gaps in national guidance on how to determine if a woman is at risk of imminent preterm birth. Few countries include guidance that indicates ACS is contraindicated in the presence of infection. The majority of countries reported that facilities providing ACS meet comprehensive emergency obstetric and newborn care standards, and all countries reported the availability of some form of special newborn care or neonatal intensive care units at facilities providing ACS. Countries recognize challenges to access to high-quality maternal and newborn care that fulfill clinical care preconditions required for safe and effective ACS use. Key informants recommended support for clinical guidelines and provider training on ACS use, inclusion of obstetric indications for dexamethasone and betamethasone in national essential medicine lists, collecting and using ACS-related data, and improving the quality of maternal and newborn care, including specialized newborn care.

The Impact of Special Care Newborn Unit on Routine Neonatal Care Practices and Survival of Neonates in 250-Bed General Hospital, Sirajganj

To address the high infant and neonatal mortality rate in Bangladesh, government has adopted policy to ensure care for neonates from community to tertiary level of health care delivery system. Our country has achieved 4 MDG targets well before 2015. However the pace of reduction of neonatal mortality is much lower than that of older children. For that reason government of Bangladesh through Ministry of Health and Family Welfare established Special Care Neonatal Unit (SCNU) at secondary and tertiary level facilities to improve management of sick newborn. The aim of this study was to evaluate the impact of creating SCNU at district hospitals on newborn care practices and to evaluate the contribution of SCNU in improved neonatal survival. It was an observational study conducted from May 2016 to October 2016at 250-bed General Hospital, Sirajganj. Hospital database was accessed to note the number of neonatal admissions, number of referral to higher centers and neonatal mortality. A questionnaire was prepared to interview mothers of children admitted in SCNU and general pediatric ward. A total of 355 mothers were interviewed. There was a significant reduction in neonatal mortality rate after the establishment of SCNU. There was also significant improvement in the knowledge and awareness among mothers regarding various aspects of neonatal care because of the SCNU.TAJ 2017; 30(2): 65-68

Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda.

BackgroundGlobally, there were 2.7 million neonatal deaths in 2015. Significant mortality reduction could be achieved by improving care in low- and middle-income countries (LMIC), where the majority of deaths occur. Determining the physical readiness of facilities to identify and manage complications is an essential component of strategies to reduce neonatal mortality.MethodsWe developed clinical cascades for 6 common neonatal conditions then utilized these to assess 23 health facilities in Kenya and Uganda at 2 time-points in 2016 and 2017. We calculated changes in resource availability over time by facility using McNemar’s test. We estimated mean readiness and loss of readiness for the 6 conditions and 3 stages of care (identification, treatment, monitoring-modifying treatment). We estimated overall mean readiness and readiness loss across all conditions and stages. Finally, we compared readiness of facilities with a newborn special care unit (NSCU) to those without using the two-sample test of proportions.ResultsThe cascade model estimated mean readiness of 26.3–26.6% across the 3 stages for all conditions. Mean readiness ranged from 11.6% (respiratory distress-apnea) to 47.8% (essential newborn care) across both time-points. The model estimated overall mean readiness loss of 30.4–31.9%. There was mild to moderate variability in the timing of readiness loss, with the majority occurring in the identification stage. Overall mean readiness was higher among facilities with a NSCU (36.8%) compared to those without (20.0%).ConclusionThe cascade model provides a novel approach to quantitatively assess physical readiness for neonatal care. Among 23 facilities in Kenya and Uganda, we identified a consistent pattern of 30–32% readiness loss across cascades and stages. This aggregate measure could be used to monitor and compare readiness at the facility-, health system-, or national-level. Estimates of readiness and loss of readiness may help guide strategies to improve care, prioritize resources, and promote neonatal survival in LMICs.

Disease Pattern and Outcome of Neonates at Special Newborn Care Unit (SNCU) of Pokhara Academy of Health Science (PAHS), Nepal

Aims: This study was conducted to identify the causes and the outcome of neonates admitted to SNCU of Western Regional Hospital.Methods: A retrospective study was conducted at SNCU of western Regional Hospital, a referral tertiary centre of Western Region of Nepal from March 2016 to March 2017.Results: Total of 1144 neonates were admitted in NICU comprised of 562 (49.12.%) neonatal sepsis, 164 (14.33%) neonatal hyperbilirubinemia, 120 (10.48%) birth asphyxia, 109 (9.52%) premature, 92 (8.04%) Meconium Aspiration Syndrome, 96 (8.39%) Congenital anomalies and 14 (1.22%) necrotizing enterocolitis. Out of neonatal sepsis, 20.62% were early onset and 28.49% late onset conditions. Among Birth asphyxia, 102 (85.00%) were of HIE I& II and 18 (15%) of HIE III. Overall mortality observed was 3.32%. Those who required mechanical ventilation had higher mortality (87.50%) than the cases that were kept for CPAP (14.81%).Conclusions: Neonatal Sepsis, birth asphyxia, prematurity and Neonatal hyperbilirubinemia were major causes for admission in SNCU.

Study on morbidity pattern of neonates admitted to special new born care unit of M.K.C.G. medical college hospital with special reference to hypoglycemia

Background: Children under five are most fragile group of population and so subjected to high mortality and morbidity. Among them, neonatal group is highly suseptible due to poor adaptation of their premature organ system. Neonatal hypoglycemia is a common co-morbid condition contributing to mortality. The objective of the study was to assess the etiology and clinical profile of neonatal hypoglycemia among the neonates admitted to special newborn care unit and to assess the co-morbidity pattern among them.Methods: Type of study was hospital based cross-sectional study at SNCU of MKCG Medical College Berhampur, Odisha. Sample size was 204 neonates who developed hypoglycaemia (blood glucose level <40 mg/dl). Study period was 2016-2017 statistical tests used-percentage and proportion. Statistical software used- SPSS 16 version.Results: Out of total 2616 admission during study period, the incidence of hypoglycemia was 7.79%.52% were male babies and 58% were out borns. Among the maternal causes, anemia was the most common cause (37.7%). Low birth weight was highest (55.8%) among neonatal factors. Jitteriness and tremor were the major symptoms (32.5% cases). Lethargy and poor feeding were presenting symptoms (19.6% cases). On analysing the outcome, 7.8% neonate died and 78.4% recovered.Conclusions: Being a common co morbid condition and presented with other neonatal problems it is more seen among outborn males and anemic mothers. Cause may be delay in initiation of feeding and interruption of feeding on the way during referral. However proper counseling should be given to caretaker of referral case about feeding on the way. Early detection of hypoglycemia is important to reduce mortality and prevent future sequelae in sick newborns.

A Quality Improvement Initiative for Early Initiation of Emergency Management for Sick Neonates

To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates. Quality improvement project over a period of twenty weeks. Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India. All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm). We used a stepwise Plan-do-study-act (PDSA) approach to initiate treatment within 30 min of receiving sick newborns. After baseline phase of one month, a quality improvement (QI) team was formed and conducted three PDSA cycles (PDSA I , PDSA II and PDSA III) of 10 d each, followed by a post-intervention phase over 3 months. Percentage of sick babies getting early emergency management at SNCU triage. 309 neonates were enrolled in the study (56 in baseline phase, 88 in implementation phase and 212 in post- intervention phase). Demographic characteristics including birthweight and gestational age were comparable among baseline and post intervention cohorts. During implementation phase, successful early initiation of management was noted among 47%, 69% and 80% neonates following PDSA I, PDSA II and PDSA III, respectively. In comparison to baseline phase, the percentage of neonates receiving treatment within 30 minutes of arrival at triage increased from 20% to 76% (P<0.001) and the mean (SD) time of initiation of treatment decreased from 80.8 (21.0) to 19.8 (5.6) min (P<0.001) during post-implementation phase. Hospital mortality (33% vs 15%, P=0.004) and need for ventilator support (44% vs 18%, P<0.001) were also significantly lower among post intervention cohort in comparison to baseline cohort. Stepwise implementation of PDSA cycles significantly increased the percentage of sick newborns receiving early emergency management at the SNCU triage, thereby resulting in better survival.

Study of morbidity and mortality profile in special care newborn unit at tertiary care teaching institute in Vadodara, Gujarat, India

Background: The development of a country is defined by its healthcare status especially the maternal and child health. Neonatal Mortality Rate in India has always been an area of concern again due to logistic issues in implementation of preventive and curative programs in a large and diverse country as ours but has shown a slow but steady fall in the last 2 decades. The current NMR of Gujarat is 25.4/ 1000 live births (2016) which is similar to the national NMR. The goal is to bring down NMR to single digit. Several measures are being taken to address these goals. The objective is to study the morbidity and mortality profile of newborns admitted to the Special Newborn Care Unit at GMERS Medical College and Hospital, Gotri, Vadodara between January 2017 and December 2017.Methods: Retrospective study was carried out at the Special Newborn Care Unit (SNCU), Department of Pediatrics, GMERS Medical College admitted in the period between January 2017 to December 2017. Both inborn and out born admissions were included. Newborns admitted in SCNU were analyzed for causes of morbidity and mortality.Results: 1039 neonates were admitted over a period of 1 year. The gender distribution was 1.5:1 (M: F). 54% admissions were out born. 62% were Low Birth Weight out of which 14% were term SFD vs.86% were premature. Majority of admission in SNCU were Neonatal hyperbilirubinemia 38%, followed by Sepsis in 23%, RDS in 16%, Perinatal asphyxia 15%. Congenital anomalies were reported in 3% newborns. The outcome rates for Survival, LAMA and death were 75%, 06% and 19%. The most common cause for mortality was sepsis (40%) followed by birth asphyxia (21.4%) and RDS (12.2%).Conclusions: The leading cause of morbidity were Sepsis, Birth asphyxia, Respiratory Distress Syndrome and prematurity. Sepsis was the leading causes of mortality in present study followed by Birth asphyxia and RDS. Leading causes of mortality in the study are preventable and curable. Therefore, surveillance and training interventions aimed at management of these causes should be established and strengthened.

CORRELATION OF ACUTE PHYSIOLOGICAL PARAMETERS WITH IMMEDIATE OUTCOME AMONG NEONATES TRANSPORTED TO SPECIAL CARE NEWBORN UNIT: A PROSPECTIVE STUDY

Background: Several sick neonates require transfer to tertiary level care neonatal unit for treatment. The facilities of neonataltransport in India are not optimal and the newborn thus transported can become hypothermic, hypoxic, and/or hypoglycemicwhich can affect the neonatal outcome. These parameters can be maintained during transport by adopting simple measures. Aim:Study impact of acute physiological parameters during transfer of neonates on their immediate outcome by using TOPS score.TOPS Score -temperature, oxygensaturation, perfusion (assessed by capillary refill time), blood Sugar. Materials and Methods:This prospective observational study was conducted at the special care newborn unit, Indore enrolling 513 transported neonates.TOPS scoring for each neonate was done at admission, and then the parameters of the TOPS score were correlated with theoutcome at 48 h of admission. Results: A total of 513 transported newborns were assessed, 48.73% newborns were hypothermic,33.91% had poor perfusion, 28.46% were hypoxemic, and 22.22% were hypoglycemic. Hypoxemia and hypoglycemia had thehighest sensitivity (93.39% and 80.18%, respectively) while hypoglycemia had the highest specificity (92.87%). Conclusion:TOPS score is a useful and easy to use the method to assess the physiological status and predict early mortality in transportedneonates.

Clinical features and characteristics of retinopathy of prematurity in developing countries

Retinopathy of prematurity (ROP) is an emerging cause of childhood blindness in the developing countries. The low and middle-income countries are facing common challenges in the midst of the ‘third epidemic’ of ROP. Improvement in neonatal care facilities has increased survival of preterm babies. Lack of awareness and non-uniform standards of care in the ever-increasing number of neonatal intensive care units (NICUs) and special newborn care units (SNCUs) has resulted in this surge of ROP. Apart from low birth weight and the degree of prematurity, use of unblended supplemental oxygen, sepsis, anemia and blood transfusion are important risk factors associated with ROP in developing countries. Atypical forms of aggressive posterior ROP (APROP) are seen in heavier birth weight babies in the developing countries. Prevention of ROP by good quality neonatal care, timely diagnosis by mandatory ROP screening in NICUs and training manpower for laser treatment of ROP requires close collaboration between the neonatologists, ophthalmologists and the policy makers. Team approach and inter-disciplinary co-ordination are keys in a nation’s drive to fight this preventable cause of blindness.

A Step toward Healthy Newborn: An Assessment of 2 Years' Admission Pattern and Treatment Outcomes of Neonates Admitted in Special Newborn Care Units of Gujarat.

Context:Facility Based Newborn Care (FBNC) is a key strategy to improve child survival, especially in newborn care where neonatal mortality rate (NMR) is stagnant in declining. Gujarat has achieved considerable amount of reduction in child deaths, but neonatal health requires attention. The study was aimed to assess the admission pattern of Special Newborn Care Units (SNCUs) which supports decision-making.Settings and Design:A cross-sectional descriptive analysis was done from secondary data of the SNCU reports on the aspects of admission patterns, morbidity, and mortality pattern. The reports had been analyzed on various critical variables.Results:In 2015–2016, Gujarat has operationalized forty SNCUs by saturating each district with at least one SNCU. The study found near proportions of (53%) inborn – (47%) outborn admission and 44% admission of female. Out of 69,662 admissions, 67% were discharged, 16% died, 10% leaving against medical advice, and 7% referred to higher centers. Major reasons for admission were respiratory distress syndrome (RDS) (22%) and infection (21%). Similar pattern in mortality found as final diagnosis of deaths was RDS (23%) and infection (21%). The proportion of neonatal deaths in outborn was high compared to inborn.Conclusion:Strengthening of FBNC is essential to address neonatal mortality. NMR is of prime focus because the health interventions needed to tackle NMR differ from those needed for infant mortality rate and under-five mortality rate. This accentuates the need for focused attention on facility- and community-based child health interventions along with quality maternal health services and robust referral mechanisms to all delivery points.

Is phototherapy stressful? A study to compare the stress of neonates in single and double-surface phototherapy

Objectives: The aim of this study is to compare the stress level of neonate undergoing double-surface (DS) and single-surface (SS) phototherapy. Study Design: This was a prospective observational study. Study Setting: Neonates with indirect hyperbilirubinemia on phototherapy in Special Newborn Care Unit of Christian Hospital, Chhatarpur, Madhya Pradesh, India (A Unit of Emmanuel Hospital Association, New Delhi). Materials and Methods: The stress level of neonate under DS and SS phototherapy was assessed with COMFORT-B scale. The neonate was assessed before the start of phototherapy (zero hours) and was further assessed at 2, 6, 12, and 24 h of phototherapy. Results: A total of 94 neonates were included in the study, of which 56 (59.5%) are term and 38 (40.5%) are preterm. The maximum COMFORT-B scale score was 23, and the minimum score was 7. The mean COMFORT-B score was marginally higher with DS phototherapy at all hours of phototherapy, but it is not statistically significant. Similar observations were noted among terms and preterms. Conclusion: There is no additional stress to neonates in DS phototherapy compared to SS phototherapy.

A study to evaluate the functioning of Special Care Newborn Unit (SNCU) established at a District Hospital

The Neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up to provide quality level II newborn-care services in several district hospitals to meet this challenge. The units are located in some districts where the burden of neonatal deaths is high, and access to special newborn care is poor. A cross-sectional survey was conducted to assess the availability of human resources, equipment, and quality care. Descriptive statistics were used for analyzing the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of first year of operationalization of SNCU as the base. The Average Neonatal Mortality Rate reduced from 1.29% before the start of SNCU in 2012 to 0.845% after 1 year of start of SNCU in Rajouri district during 2013-14 study periods. Proportional mortality due to sepsis and low birth weight (LBW) declined significantly over a period of one year (LBW <2.5 kg). The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. Repair and maintenance of equipment were a major concern. It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to human resources, maintenance of equipment, and maintenance of asepsis remain.

Macrosomic births in abuja: A case-control study of predisposing factors and early neonatal outcome.

Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja. Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births. The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia. Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.

Observation on neonatal apnea in relation to aetiopathogensis and their outcome

Background: Apnea is nearly universal among preterm infants, but neither the apnea burden nor its clinical associations have been systematically studied. This study was aimed to estimate the frequency of apnea in newborn, at different gestational age and birth weight and establish different etiological factors of apnea in newborn and their outcome. Methods: The present study was conducted on neonates admitted in Special Newborn Care Unit, Department of Pediatrics, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India between April, 2014 to September, 2016. All neonates at risk of apnea ( 2500 gm was 38.88, 15.09, 6.45 and 0.49 per 100 live births respectively (statistically significant, p value < 0.001). In our study commonest causes of apnea was infection (51.02%) and apnea of prematurity (29.59%) (Statistically significant, p value < 0.001). The mean birth weight and gestation were 1434.34gm and 31.6 weeks for the infection group and 1117.41gm and 30.34 weeks for the apnea of prematurity group in our study. The survival rate in babies with apnea of prematurity was 72.41% (p <0.001) as compared to 32% (P <0.001) in apnea due to infection group. The percentage of survival in < 1000 gm, 1000-1499 gm, 1500-2499 gm and 2500gm was 22.85,55,60 and 100 percent respectively (p value < 0.001). Conclusions: Infection and apnea of prematurity are common causes of apnea in newborn. All babies ≤ 32 weeks gestation needs to be closely monitored for apnea. Apneic spells occurring in infants at or near term are always abnormal and are nearly always associated with serious causes. Apnea due to sepsis carries a poor prognosis.

Solar powered baby/infant radiant warmer installed in neonatal intensive care unit in a Tertiary Care Hospital

Context: Hypothermia is common in infants born at hospitals (32%–85%) and at homes (11%–92%). Hypothermia does not lead to mortality directly; it contributes globally to newborn survival mostly as comorbidity of neonatal infection, preterm birth, low birth weight babies, and asphyxia, even in tropical countries such as India. The problem of low birth infants is 30% in our country. One of the estimates of reducing neonatal deaths is to provide warmth to the baby. By giving warmth to the baby either skin to skin contact or incubator or open care system, the potential impact in reducing the neonatal deaths is estimated at 1.8%–42%. Aim: India is going through energy crisis, a solar powered baby warmer was thought of to prevent hypothermia in the newborn care. Setting and Design: An open care infant warmer was planned to connect to solar rooftop photovoltaic (PV) panels in a Neonatal Intensive Care Unit (NICU), in a tertiary hospital in New Delhi. The PV system was designed for about 10 h of working, to generate for approximately 4 kWh of energy per day. Methods: Solar panels were connected to one open care radiant warmer with an inbuilt energy meter in a NICU in a tertiary care hospital in New Delhi. Energy meter was also connected to the AC mains/grid to know if any current is drawn from the grid. Energy meter readings were taken at the time of installation of solar radiant warmer and at the end of 368 days at the end of all the seasons. Results: The solar powered radiant warmer was successfully installed in the NICU and fully functional since December 10, 2012. The preliminary energy consumption study shows that PV panels of 1.2 kWp were more than enough to run one radiant warmer. At least two radiant warmers could be connected in the panel size used. There is no running cost as the electricity saved in the 1st year was equal to the cost solar panel and cost of radiant warmer. Conclusions: The solar powered baby warmer is environment-friendly. In rural areas where power supply is erratic and where there is plenty of sunshine, this product will help in the care of high-risk infants in Level II special care newborn units in district hospital and neonatal stabilizing units in subdistrict levels at primary health center and community health center.