Newborn Unit Research Articles

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.

Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia.

Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.

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

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality.

Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.

Family Centered Care: The Perspective of Nurses in the Neonatal Intensive Care Unit of Tamale Teaching Hospital, Ghana: A Qualitative Exploration

Background: Family-Centered Care is a care approach in which healthcare professionals collaborate with the patient's family to plan and make decisions regarding the patient's treatment. Family-Centered Care is widely acknowledged and documented as the optimal care approach for neonatal practice. Despite the growing use of this method, there is a lack of research on the perspectives of healthcare professionals and carers regarding Family-Centered Care. The study aimed to evaluate the viewpoints of nurses regarding FCC in the newborn critical care unit at the Tamale Teaching Hospital.&#x0D; Methodology: The study utilised an exploratory descriptive design employing a qualitative technique, in which focus group talks were held among participants. The material was transcribed and processed via thematic and content analysis techniques.&#x0D; Findings: Approximately majority of the participants demonstrated awareness of the idea of Family-Centered Care, which they elaborated upon through two main themes namely provision of care for both the patient and their family, and Involvement of relatives in the care of the patient.&#x0D; Recommendations: Majority of participants expressed that Family-Centered Care was not practiced in their unit. Nevertheless, all participants unanimously concurred that the approach had the potential to yield positive results in terms of patient care outcomes.

Predictors of Hydrops Fetalis Infants by Mode of Delivery

BACKGROUND: Hydrops fetalis is a fetal condition associated with higher perinatal and neonatal mortality and morbidity. The overall survival rate from the diagnosis is today estimated to be 27% despite advanced intrauterine and neonatal care. Factors that contribute to poor perinatal and neonatal outcomes have been identified; however, little is known about the existing specific predictor tool of perinatal outcome by mode of delivery. &#x0D; OBJECTIVE: the study aimed to determine whether cesarean section does improve the perinatal outcomes of hydrops fetalis infants.&#x0D; STUDY DESIGN: This was a retrospective cohort study that retrieved 102 medical records of pregnancies complicated by hydrops fetalis. For all those women, the transabdominal ultrasound was performed during pregnancy as part of the standard diagnostic modality of intrauterine hydrops fetalis. All pregnant women’s and their newborn’s medical records were retrieved and reviewed to collect information related to the outcomes as per the mode of delivery either by cesarean section or vaginal delivery. Based on the severity of fetal disease as described by obstetric ultrasound findings, pregnant women were divided into 4 groups: mild, moderate, moderately severe, and severe hydrops fetalis. The significance of the obtained data was set at two-tailed p&lt;0.05. The chi-squared test was used to compare categorical between groups based on outcomes. Fisher’s exact test or Monte Carlo correction was used for chi-squared analysis when more than 20% of the cells had an expected count &lt;5. The odds ratio and 95% confidence interval for perinatal adverse outcomes were calculated using logistic regression.&#x0D; RESULTS: The incidence of hydrops fetalis was estimated to be 1.1% in this cohort study. The non-immune hydrops fetalis was the common type, accounting for 75.6% of all cases. Perinatal mortality occurred in 55.9% and the 7-day survival was estimated at 44.1%. The mortality rate was 66.1% in non-immune hydrops fetalis. There was a statistically significant association between the mode of delivery and the overall survival (pv-0.04). However, survival was increased in class I and class II (55.0%), while survival was equally observed in classes III and IV (22.5%). There was a statistically significant association between the class and survival (pv &lt;.001). Birth weight of ≥3000 grams was associated with reduced poor perinatal outcomes at 0.3% (pv-0.02, 95% CI=0.14 -0.85). Similarly, admission to the newborn unit was associated with reduced mortality by 2.5% (pv-0.04, 95% CI=1.0 - 6.4).&#x0D; CONCLUSION: Cesarean section delivery does not improve the perinatal outcomes of hydrops fetalis newborns and it should be considered only for maternal concerns. The predictor tool of perinatal outcomes of hydrops fetalis infant per mode of delivery is a useful tool to assist in decision-making and predict the perinatal outcome of hydrops fetalis per mode of delivery.&#x0D; &#x0D;

“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

Effect of Breast Milk Feeding on Retinopathy of Prematurity in Neonates Less than 1800 Grams: A Cohort

Introduction Human milk has many antioxidants like Docosahexaenoic acid (DHA), inositol, and vitamin E that combat oxidative stress deregulating VEGF which is implicated in the pathogenesis of retinopathy of prematurity (ROP). Thus, it is biologically plausible that human milk is protective towards ROP. Aim and objective The study aimed to find the association between ROP and breast milk feeding. Methodology The prospective cohort study was carried out for 18 months at the Newborn unit, SJH. In our study, mothers were asked to maintain a feeding diary (type of milk fed) and history was taken from the mother regularly. Each neonate was later assigned a feeding category including exclusively breast milk fed, more than 50% breast milk fed, more than 50% top milk-fed, and exclusively top milk fed. At four weeks of age, all these neonates were called to undergo screening for ROP. In the case of immature retina, neonates were followed up for repeat fundus exams and results were included in the study. Result A study on 521 neonates between birth weight of 1–1.8 kgs found that predominant breast milk feeding reduces the chance of any stage ROP (needing repeat screening or intervention). The total incidence of any stage ROP in this study was noted to be 16.2% where 4.1% of total neonates from the predominantly breastfed group as compared to 37.8% from the predominantly top-fed group developed any stage ROP. Conclusion Breast milk feeding has a significant benefit in reducing any stage ROP and ROP needing intervention, thus it has the potential to prevent a significant cause of childhood blindness. What is already known – Breast milk feeding may be protective towards ROP What the study adds – Breast milk feeding is independently protective towards ROP

Spectrum of Neonatal Surgical Emergencies at a Government Tertiary Care Centre in Madhya Pradesh: An Observational Study

Introduction: This impoverished region of India, where the majority of the population suffers from poverty and malnourishment, lacks data regarding the epidemiological pattern for surgical congenital abnormalities to date. Hence, there is a dire need to gather epidemiological data on newborn surgical emergencies, which has been lacking. Aim: To study the epidemiological data of neonatal patients requiring emergency surgery and to evaluate the variables affecting morbidity and mortality in emergency newborn surgery cases. Materials and Methods: This retrospective observational study was carried out at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India from October 2018 to August 2022. Case records of emergency surgical interventions in neonates presenting to the Emergency Department under the age of 30 days of life were reviewed. The outcomes, postoperative morbidity, and mortality were noted. The data was presented descriptively using frequency and percentages. Results: In the present study, the male-to-female ratio was 1:1.2, the mean age was 4.9 days±4.1 days, and the mean birth weight was 2025±635 grams. Anorectal Malformations (ARM), 178 (37.71%) and Oesophageal Atresia (EA), 133 (27.8%) were the most prevalent congenital abnormalities in the current investigation, followed by other congenital gastrointestinal anomalies. Nonetheless, the remarkably elevated prevalence of pouch colon among patients with ARM deserves particular attention. In compared to a well- prepared Neonatal Intensive Care Unit (NICU), an inadequately equipped Sick Newborn Care Unit (SNCU) with a small nursing staff represents inadequate infrastructure for the management of a surgical neonatal emergency. Conclusion: The majority of patients died from postoperative septicaemias, accounting for 35.5% of the mortality rate among these neonates who underwent emergency surgery. A large percentage of infant mortality in underdeveloped nations like India might be avoided with proper perioperative care, especially for surgical infants.

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

Role of Serum Lactate Clearance as a Predictor of Mortality and Morbidity in Neonatal Sepsis: A Prospective Cohort Study

Introduction: Neonatal sepsis is a global healthcare concern, which is more prevalent in developing countries. However, surprisingly, biomarkers with good sensitivity and specificity to predict mortality and morbidity are lacking. Higher levels of serum lactate are observed in patients exposed to an inflammatory response, but its practical use remains limited. Therefore, the author aimed to investigate the relationship between serum lactate measurements and the severity of neonatal sepsis. Aim: To assess the role of serum lactate clearance as a marker to predict mortality and morbidity in neonatal sepsis. Additionally, the secondary aim was to evaluate the demographic profile of neonatal sepsis and understand the relationship between C-reactive Protein (CRP), Procalcitonin, and lactate clearance in neonatal sepsis. Materials and Methods: A prospective cohort study was conducted in the Sick Newborn Care Unit (SNCU) and Neonatal Intensive Care Unit (NICU) of Chittaranjan Seva Sadan, College of Obstetrics, Gynaecology, and Child Health in Kolkata, India, from June 2020 to May 2021. A total of 93 confirmed cases of neonatal sepsis were included in the study. Serum lactate levels were measured at the time of sepsis diagnosis and 48 hours after the first sample. Lactate clearance was calculated, and the neonates were followed till discharge or death. Various parameters, including complete blood count, CRP, Procalcitonin, culture, and Cerebrospinal Fluid (CSF), were assessed. The data obtained were statistically analysed using paired t-test, one-way Analysis of Variance (ANOVA), and Pearson’s Chi-square test. Results: A total of 93 neonates were included after meeting the inclusion and exclusion criteria. Among them, 10 neonates died, while 83 were successfully discharged. It was found that death was significantly associated (p&lt;0.0001) with lactate clearance. Total 9 (90%) of the deceased neonates had negative lactate clearance, while only 21 (25.3%) discharged neonates had negative lactate clearance. Lactate clearance was also significantly associated with the duration of hypoglycaemia (p=0.008), duration of Nil Per Mouth (NPM) (p=0.01), and need for reintubation (p=0.05). However, no association was found with the duration of hospital stay, duration of fluid therapy, duration of oxygen requirement, and need for ventilation. Conclusion: Lactate clearance showed a significant association with the risk of mortality in patients with neonatal sepsis. Therefore, lactate clearance can be used as a prognostic marker to identify sepsis. Early detection of sepsis can aid in proper management and subsequently reduce mortality

NEONATAL PAIN MANAGEMENT PRACTICES AMONG NURSES WORKING IN NEWBORN UNITS IN NYANZA AND WESTERN KENYA

Background: Newborn babies in the Neonatal Intensive Care Units (NICU) and Newborn Units (NBUs) undergo several procedures that cause a significant amount of pain. Nurses play an essential role in the implementation of pain assessment and management measures in neonates. However, while it remains widely known that nurses play an important role in neonatal pain management, nurses’ practices on the management of pain in neonates admitted in Newborn care units have not been widely published within the nursing science.&#x0D; Objectives: To evaluate neonatal pain management practices among nurses working in newborn units in Nyanza and Western Kenya.&#x0D; Methods: A descriptive cross-sectional study using qualitative and quantitative approaches was used targeting 89 nurses. The collection of data was done through semi-structured, self-administered questionnaires with both closed and open –ended questions. Qualitative data was collected through in-depth interviews. Data obtained was analyzed using the statistical package for social science (SPSS) version 22.0 software. The study assumed a confidence level of 95% and a (p) value equal to or less than 0.05 was considered significant. Qualitative data was analyzed through logic checks to understand the emerging themes. Descriptive statistical analysis was done using frequencies, percentage and means.&#x0D; Results: The study established that a small percentage of the nurses practiced pain management in neonates through use of non-pharmacologic (34.8%) and pharmacologic (28.1%) strategies. The commonly used non-pharmacologic strategies include changing of nappies (71.9%) and repositioning (68.5). Pain assessment was however seldom done.&#x0D; Conclusion: Following the results, the study concluded that nurses practice pain management in neonates by implementing non-pharmacological and pharmacological strategies. The commonly used pain management strategy in neonates is utilization of non-pharmacological strategies such as change of nappies repositioning and kangaroo mother care. However, gaps exist in knowledge and competency on neonatal pain management aspects and practice. The study therefore recommended enhancement of awareness on aspects of neonatal pain among nurses to facilitate improved pain management practices in neonates. Further strengthening of nurses’ knowledge and skills on pain management in neonates through attending scheduled short courses, workshops and on job training is recommended.&#x0D;

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.

Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya.

We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.