Neonatal Mortality Research Articles

Faktor-Faktor yang Berhubungan Kejadian Kekurangan Energi Kronik pada Ibu Hamil di UPTD Puskesmas Sungai Raya Aceh Timur Tahun 2024

The 2030 Sustainable Development Goals (SDGs) to end preventable newborn and under-five deaths with all countries striving to reduce the Neonatal Mortality Rate (NMR) to 12 per 1000 live births and reduce the Toddler Mortality Rate (IMR) to 25 per 1000 live births by 2030 (UNICEF, 2020). Based on the North Sumatra Central Bureau of Statistics, pregnant women who experienced SEZ in 2021 were 2,296 pregnant women, and in 2022 there was a decrease in the incidence of SEZ of 1,383 pregnant women, and in 2023 there was another increase of 1,765 pregnant women (BPS SUMUT, 2023). The type and design of quantitative analytical research through observational with case control study design is a study used to determine risk factors or health problems that are thought to have a close relationship with diseases that occur in the community. Age affects the occurrence of complications in third trimester pregnancy at Sungai Raya Health Center, East Aceh in 2024, where the results of the chi-square statistical test on maternal age are ρ = 0.006 <0.05. Parity affects the occurrence of complications in third trimester pregnancy at the Sungai Raya Health Center of East Aceh in 2024 where the results of the chi-square statistical test on parity are ρ = 0.020 <0.05. Gestational distance affects the occurrence of complications in third trimester pregnancy at the Sungai Raya East Aceh Health Center in 2024, where the results of data analysis using the chi-square test are ρ = 0.018 <0.05.

Prediction model for composite adverse pregnancy outcomes: Indonesia demographic health survey analysis

Adverse Pregnancy Outcome (APO) is the leading cause of infant mortality, particularly in low and middle-income countries. Despite no significant change in neonatal mortality rates in Indonesia over the past fifteen years, identifying the risk factors for APO can help healthcare professionals provide personalized interventions and support. This study aims to determine the determinants of APO risk in Indonesia. The cross-sectional study utilized the 2017 Indonesian Health Demographic Survey (IDHS), which included 9,752 women of reproductive age. APO, including low birth weight, early birth, and stillbirth, was the outcome of the study. The demographic characteristics and other risk factors were evaluated. To identify APO-risk-associated factors, we performed multiple logistic regression analysis. The results showed that low economic status (Adj. OR= 1.407; 1.153-1.716; p= 0.001)), living in rural areas (Adj. OR= 0.804; 0.663-0.976; p= 0.027), having a history of pregnancy or childbirth complications (Adj. OR= 4.563; 3.617-5.756; p= 0.0001), premature rupture of the membrane during pregnancy or after giving birth (Adj. OR= 1.351; 1.069-1.708; p= 0.012), antenatal visits <4 times (Adj. OR= 1.603; 1.123-2.288; p= 0.009), consumption of iron supplement tablets <90 days (Adj. OR= 1.275; 1.063-1.529; p= 0.009), and twin pregnancy (Adj. OR= 33.715; 18.587-61.153; p= 0.0001) significantly influenced the APO prevalence. The study concluded that APO risk is significantly impacted by poor obstetric history features, multiple births, low health service utilization, and sociodemographic factors. Early detection of these risk factors is essential for reducing neonatal death caused by APO.

Study of Correlation of Apgar Score and Thompson Score with Hepatic Function in Perinatal Asphyxia Affected Neonates—A Prospective Observational Study

Background: Perinatal asphyxia is one of the leading causes of neonatal morbidity and mortality in the country. It leads to multi-organ failure with brain involvement as the major organ of concern (hypoxic-ischemic encephalopathy). Hepatic dysfunction is also a feature of perinatal asphyxia. Objectives: To detect hepatic dysfunction in birth asphyxia. To correlate the liver damage with increasing severity of birth asphyxia and hypoxic-ischemic encephalopathy through Apgar score and Thompson score. Methods: In this prospective observational study, after ethical clearance and informed consent from the parents, babies of gestational age >35 weeks weighing >1.8 kg, Apgar score <7 at 1 minute received in the newborn unit of a tertiary care hospital in West Bengal, India were enrolled. Thompson’s score was assessed every day. The liver function test of these patients was assessed on days 1, 3, 10, and 15. Ultrasonography of the whole abdomen was performed on days 1 and 14 of life to rule out other probable causes of hepatic injury. Results: A total of 308 neonates were studied, of which Apgar score at 1 minute indicates that 99 (32.14%) of the newborns had severe birth asphyxia and the rest had moderate birth asphyxia. All the liver enzymes except total protein and albumin showed a significant rise on days 1 and 3 with increasing severity of asphyxia. This correlation was seen with Apgar score at 1 minute on day 1 with TSB (r = -0.256, P < .001), AST (r = -0.209, P < .01), ALT (r = -0.178, P < .002), ALP (r = -0.174, P < .002). As per Thompson score, total serum bilirubin, aspartate aminotransferase and alkaline phosphatase showed maximum correlation on days 1 (r = 0.253, P < .001, r = 0.187, P < .001 and r = 0.268, P < .001, respectively) and on day 3 (r = 0.159, P < .005, r = 0.231, P < .001, and r = 0.190, P < .002, respectively). Conclusion: Thompson score and Apgar score can be correlated to perinatal asphyxia-related hepatic injury.

Role of the GalNAc-galectin pathway in the healing of premature rupture of membranes

BackgroundPremature rupture of the membranes (PROM) is a key cause of preterm birth and represents a major cause of neonatal mortality and morbidity. Natural products N-acetyl-d-galactosamine (GalNAc), which are basic building blocks of important polysaccharides in biological cells or tissues, such as chitin, glycoproteins, and glycolipids, may improve possible effects of wound healing.MethodsAn in vitro inflammation and oxidative stress model was constructed using tumor necrosis-α (TNF-α) and lipopolysaccharide (LPS) action on WISH cells. Human amniotic epithelial cells (hAECs) were primarily cultured by digestion to construct a wound model. The effects of GalNAc on anti-inflammatory and anti-oxidative stress, migration and proliferation, epithelial-mesenchymal transition (EMT), glycosaminoglycan (GAG)/hyaluronic acid (HA) production, and protein kinase B (Akt) pathway in hAECs and WISH cells were analyzed using the DCFH-DA fluorescent probe, ELISA, CCK-8, scratch, transwell migration, and western blot to determine the mechanism by which GalNAc promotes amniotic wound healing.ResultsGalNAc decreased IL-6 expression in TNF-α-stimulated WISH cells and ROS expression in LPS-stimulated WISH cells (P < 0.05). GalNAc promoted the expression of Gal-1 and Gal-3 with anti-inflammatory and anti-oxidative stress effects. GalNAc promoted the migration of hAECs (50% vs. 80%) and WISH cells through the Akt signaling pathway, EMT reached the point of promoting fetal membrane healing, and GalNAc did not affect the activity of hAECs and WISH cells (P > 0.05). GalNAc upregulated the expression of sGAG in WISH cells (P < 0.05) but did not affect HA levels (P > 0.05).ConclusionsGalNAc might be a potential target for the prevention and treatment of PROM through the galectin pathway, including (i) inflammation; (ii) epithelial-mesenchymal transition; (iii) proliferation and migration; and (iv) regression, remodeling, and healing.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Surgical Tips for Robotic Assisted Laparoscopic Abdominal Cerclage: A Minimally Invasive Approach.

Preterm birth is the leading cause of perinatal and neonatal morbidity and mortality in the developed world. An important cause of preterm birth is cervical insufficiency, leading to membrane prolapse, premature rupture of membranes, and mid-trimester pregnancy loss. A cerclage can be placed vaginally or abdominally to treat cervical insufficiency. In cases of failed prior transvaginal cerclage (TVC), transabdominal cerclage (TAC) is the alternative. The procedure can be completed via laparoscopy or open approach. The suture is placed at the internal os giving greater structural support.1 In this article, we review the definition of cervical incompetence, we present the indications for TAC, we discuss the outcomes of minimally invasive TAC compared to open approach, and we review surgical tips and tricks for robotic assisted (RA) TAC placement that can be used prior to pregnancy or in early gestation. The included images delineate the surgical technique for safe placement of robotic assisted laparoscopic abdominal cerclage in the management of cervical insufficiency.

Pediatric Morbidity Among Black Haitians in Canada: A Longitudinal Cohort Study.

In the U.S., Black children have disproportionately elevated rates of pediatric morbidity compared with White children, but data are lacking for other countries. We studied the extent to which Black Haitians were at risk of pediatric morbidity in Canada. We analyzed a retrospective cohort of 736,498 children born in Quebec between 2008 and 2020. We identified Black Haitians using the mother tongue and birth country of parents. The outcome was mortality or hospitalization for infectious diseases, allergy, cancer, and other morbidity between birth and 12years of age. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for these outcomes, comparing Haitians with non-Haitians in Cox regression models adjusted for patient characteristics. Compared with non-Haitians, Haitians tended to have a greater risk of pediatric mortality, especially before age 2years (HR 1.56, 95% CI 1.00-2.45). However, Haitian children had a lower risk of hospitalization than non-Haitian children (HR 0.61, 95% CI 0.59-0.63). Haitians were less likely to be hospitalized for infectious diseases, allergies, appendicitis, cancers, fractures, dental caries, and ophthalmologic conditions. Hospitalization rates were low throughout childhood, even though Haitian children were more likely to be born preterm, develop severe neonatal morbidity, and have other adverse outcomes at birth. Haitian children have an elevated risk of neonatal morbidity and early childhood mortality, but lower risk of hospitalization compared with non-Haitians in Canada. The reasons for the disparity are unclear, but greater effort is needed to address potential gaps in healthcare among Black children.

Smartphone apps hold promise for neonatal emergency care in low-resource settings.

Many countries risk failing the Sustainable Development Goal to reduce neonatal mortality to 12 in 1000 live births before 2030, necessitating intervention. This scoping review assesses available evidence from studies implementing smartphone application-based education and clinical decision support in neonatal emergency care in low- and middle-income countries and describes applied assessment tools to highlight gaps in the current literature. A systematic search on 28 March 2024 of PubMed, Web of Science, and EMBASE identified original research papers published in peer-reviewed journals after 2014 in English. The evaluation was based on Kirkpatrick's framework. In total, 20 studies assessing eight different smartphone applications were included. Participants found applications acceptable and feasible in 11 of 14 studies. Knowledge and/or skills were improved in 11 of 12 studies. Behaviour was assessed in 10 studies by tracking app usage. Patient outcome was assessed in four studies, focusing on perinatal mortality, Basic Newborn Care outcomes and correct assessment of newborns. Data from included studies further strengthens hope that smartphone applications can improve neonatal mortality rates in low- and middle-income countries. However, further research into the effectiveness of these applications is warranted. This review highlights gaps in the current literature and provides guidance for future trials.

170: Higher Vasoactive Infusion Score and Lower pH during VA ECMO Trial Off Associated with Mortality in Neonates

170: Higher Vasoactive Infusion Score and Lower pH during VA ECMO Trial Off Associated with Mortality in Neonates

Myristica fragrans Houtt. methanol extract as a promising treatment for Cryptosporidium parvum infection in experimentally immunosuppressed and immunocompetent mice.

Cryptosporidiosis is a major waterborne disease affecting ruminants and humans worldwide. It causes diarrhea and neonatal mortality in buffalo calves, and watery diarrhea and mortality in children and immunodeficient patients. This study aimed to investigate the efficacy of Myristica fragrans methanolic extract in treatment of C. parvum infection in comparison with nitazoxanide (NZX) (a Food and Drug Administration-approved drug control) in immunosuppressed and immunocompetent mice. One hundred laboratory-bred male Swiss albino mice were equally divided into immunocompetent and immunosuppressed groups. Each group was further divided into five subgroups: (1) non-infected and non-treated control, (2) infected and non-treated control (infected with Cryptosporidium parvum oocysts 3 × 103), (3) NZX-treated (100 mg/kg, 200 μL/mouse), (4) M. fragrans Houtt. methanol extract-treated (500 mg/kg), and (5) combination-treated (NZX + M. fragrans extract). Number of oocysts/g of feces, serum immunoglobulin (Ig) G level, and interferon (IFN)-γ, and interleukin (IL)-4 levels were used to evaluate the therapeutic effect. C. parvum oocyst shedding in stool samples was significantly decreased in all treatment groups, with 79.7%, 81.2 %, and 85.5 % reduction in immunocompetent mice treated with NZX, M. fragrans, and their combination, respectively. In immunosuppressed mice, oocyst shedding was reduced by 77.7%, 80.5 %, and 83.7 % upon NZX, M. fragrans, and their combination treatments, respectively. The serum IgG level was lowest in mice treated with a mixture of M. fragrans and NZX, followed by those treated with NZX, and was highest in mice treated with M. fragrans alone. Regarding cytokine levels, all groups treated with M. fragrans had low levels of IFN-γ and IL4 on day 21 post-infection. Collectively, the treatment of cryptosporidiosis with M. fragrans extract was successful in mice, as demonstrated by the measured parameters. M. fragrans reduced C. parvum oocyst shedding and serum IgG, IFN-γ, and IL-4 levels in immunocompetent and immunosuppressed mice.

Machine-learning-based evaluation of the usefulness of lactate for predicting neonatal mortality in preterm infants

BackgroundUnlike in adult and pediatric patients, the usefulness of lactate in preterm infants has not been thoroughly discussed. This study aimed to evaluate whether the lactate level in the first hours of life is an important factor associated with neonatal death in very-low-birth-weight (VLBW) preterm infants. MethodsElectronic medical records from a level 4 neonatal intensive care unit in South Korea were reviewed to obtain perinatal and neonatal outcomes. Data on lactate levels of preterm infants in the first 12 h of life were collected. Neonatal mortality and morbidities were compared based on lactate levels. Subsequently, machine-learning models incorporating 20 independent variables, both with and without lactate, were compared for model performances and feature importance of lactate for predicting in-hospital mortality in the applicable models. ResultsOne hundred and sixty-eight preterm infants were included. Death rates on days 7 and 30 of life (D30-mortality) were significantly higher in infants with high lactate levels (≥3rd interquartile range) than in those with lower levels (<3rd interquartile range). Though statistically insignificant, the overall in-hospital mortality was more than twice as high in the high lactate level group than in the lower lactate level group. Based on the machine learning results, Random Forest, Gradient Boosting, and LightGBM models all showed greater area under the curves when lactate was included. Lactate consistently ranked in the variables of top five feature importance, particularly showing the greatest value in the Gradient Boosting model. ConclusionLactate levels during the early hours of life may be an important factor associated with in-hospital death of preterm VLBW infants. Based on the enhanced performance of the above-mentioned machine learning models, lactate levels in the early postnatal period may add to assessing the clinical status and predicting the hospital course in this population.

Planning of National Policies on Maternal and Neonatal Safety

&lt;p&gt;台灣近年來，因晚婚、晚孕等因素，致使高危險妊娠案例增加；加之以醫療技術進步，原本難以懷孕的超高齡女性、患有嚴重子宮肌腺症而必須切除病灶者、因免疫或血栓問題而重複流產者，皆在獲得治療後成功懷孕，卻也使得高危險妊娠現象頻發，母嬰傷亡事故居高不下。為此，國家擬定孕產兒安全相關政策，茲就相對重要者略為概述，以幫助快速瞭解政策之規劃。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;In recent years, factors such as delayed marriage and late pregnancies have increased the incidence of high-risk pregnancies in Taiwan. Following advancements in medical technology, women who were originally unlikely to conceive&amp;mdash;such as those of advanced maternal age, those requiring lesion removal due to severe adenomyosis, and those experiencing recurrent miscarriages due to immune or thrombotic disorders&amp;mdash;have successfully achieved pregnancy following treatment. However, such treatment has also led to a higher frequency of high-risk pregnancies, with maternal and neonatal mortality and morbidity rates elevated. In response to this problem, the Taiwanese government has formulated policies related to maternal and neonatal safety. A brief overview of the more critical policies is provided herein to facilitate a fast understanding of relevant national strategies.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Pattern Of Admission And Outcome Among Neonates Admitted Into The Special Care Baby Unit Of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: The neonatal disease pattern is a sensitive indicator of the availability, utilisation and effectiveness of mother and child health services in the community. Community based data are difficult to come by, so hospital based data most often is use to assess the burden of neonatal problems. Aim: To determine the pattern of morbidity, mortality and outcome of neonates admitted into the Special Care Baby Unit (SCBU) of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto from 1 st January 2022 to 31st December 2022. Methods: A hospital-based retrospective review of medical records of neonates admitted into the SCBU of UDUTH, Sokoto from 1 st January, 2022 to 31st December, 2022. Information retrieved included the biodata, place of birth, age at admission, diagnosis, duration of hospital stay and outcome. Data was analysed using SPSS version 22. Results: A total of 818 neonates were admitted during the study period, 393(48.0%) were males and 425(52.0%) were females giving a male to female ratio of 1:1.1. Most 606(74.1%) of the patients were out born. Birth Asphyxia 245(30.0%) was the main reason for admission, followed by prematurity 182(22.3%). Majority 653(79.2%) were discharged, 16(2.0%) left against medical advice, while 149(18.2%) of the admitted patients died. Prematurity related death 61(40.9%) and birth Asphyxia were the leading causes of death respectively. Majority 107(71.8%) of the deaths occur among the out-born. Conclusion: Birth asphyxia and prematurity related complications were the main reasons for neonatal admissions and the leading causes of death in this study. Most of the neonatal deaths were from preventable causes. Strengthening perinatal care, emergency obstetric services, facilities for improved preterm care should be provided in secondary and tertiary health facilities and improving the skills of health care providers on neonatal resuscitation are necessary to reduce neonatal mortality

Predictive Value of Esophageal Deviation Index for Clinical Outcomes of Patients With Left-Sided Congenital Diaphragmatic Hernia

PurposeThis study aimed to evaluate the prognostic value of postnatal esophageal deviation index (EDI) measured within the first 24 h of life for predicting mortality and morbidity in neonates with left-sided congenital diaphragmatic hernia (L-CDH). MethodThis retrospective study analyzed clinical data from 133 neonates with L-CDH admitted to Guangzhou Women and Children's Medical Center between January 2016 and January 2024. Patients were categorized into two groups based on outcomes: survivors (n = 108) and non-survivors (n = 27). Risk factors for mortality were identified using both univariate and multivariate analyses. A receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of EDI for mortality in L-CDH patients. Subsequently, patients were divided into two groups: those with an EDI> 16.1% and those with an EDI≤16.1%. The relationship between EDI and both mortality and morbidity was analyzed using Kaplan–Meier analysis, chi-square test, Fisher's exact test, and multivariate analysis. ResultsEDI (adjusted OR: 0.822, 95% CI 0.723–0.935; P = 0.003) was identified as the independent predictor of mortality through both univariate and multivariate logistic regression analysis. The ROC curve demonstrated that the area under the curve (AUC) for predicting the mortality was 0.854 (95%CI: 0.782–0.930) for EDI, with an optimal cut-off value of 16.125%. The cumulative mortality rate through Day 200 was higher in patients with an EDI>16.1% (P＜0.001). Among the 133 neonates with L-CDH, 24.8% had an EDI>16.1%. This was associated with significantly worse CDH characteristics, including a high incidence of intrathoracic stomach and a high occurrence of high-risk defect sizes (type C/D), (P＜0.001), as well as more severe pulmonary hypertension (P＜0.001). An EDI>16.1% was associated with higher mortality and a greater need for ECMO support compared to an EDI≤16.1% (P＜0.001). ConclusionEDI within the first 24 h of life in patients with L-CDH is associated with increased mortality and the need for ECMO, particularly when EDI exceeds 16.1%. Level of EvidenceIII.

Newborn community health advancements among Ethiopian Orthodox Christian women in North Gondar, Ethiopia: community-based randomised trial protocol

IntroductionDespite significant progress over past decades, neonatal and infant morbidity and mortality remain unacceptably high in Ethiopia. Simple interventions have been shown to improve the health of children and reduce...

A Practical, Systematic Approach to Genetic Diagnosis in a Fetus or Neonate with Congenital Anomalies.

Congenital anomalies contribute significantly to perinatal, neonatal, and infant morbidity and mortality. The causes of these anomalies vary, ranging from teratogen exposure to genetic disorders. A high suspicion for a genetic condition is especially important because a genetic diagnosis carries a risk of recurrence in future pregnancies. Various methods are available for genetic testing, and each plays a role in establishing a genetic diagnosis. This review summarizes a practical, systematic approach to a fetus or neonate with congenital anomalies.

Assessment of Knowledge and Attitudes of Parents Regarding Neonatal Jaundice in Abia State Children's Specialist Hospital, Umuahia, Nigeria: A Cross-Sectional Study.

Background Neonatal jaundice, characterized by the yellow discoloration of an infant's skin and eyes, is a common condition that affectsnewborns. It results from an elevated level of bilirubin in the blood and,when severe, if left untreated, can lead to complications such as acute bilirubin encephalopathy and kernicterus, which can cause permanent neurological damage or even death. In low-resource settings like Nigeria, delayed recognition and inadequate management of neonatal jaundice are significant contributors to neonatal morbidity and mortality. Parental knowledge and attitudes play a critical role in the early identification and timely intervention of neonatal jaundice. However, there is limited data on the awareness, understanding, and practices of parents regarding this condition in many regions, including Abia State, Nigeria. Aim This study sought to assess the knowledge and attitudes of parents at Abia State Children's Specialist Hospital, Umuahia, Nigeria, to inform strategies for improving early detection and management of neonatal jaundice. Research methodology This descriptive cross-sectional study was conducted at Abia State Children's Specialist Hospital. The study population included 385 parents (fathers and mothers) of neonates attending the pediatric and neonatal units. A systematic random sampling technique was used to select participants. Data were collected using a structured questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 25, (Released 2017; IBM Corp., Armonk, New York, United States). Results The study revealed that 226 (58.70%) of parents had heard about neonatal jaundice, with the main perceived cause being an immature liver (148, 38.44%). While 216 (56.10%) of the parents recognized neonatal jaundice as a serious condition when severe, only 72 (18.70%) were very confident in identifying its signs. Most parents (369, 95.84%) would seek medical help if they suspected jaundice in their baby, yet 288 (74.81%) believed in the effectiveness of traditional remedies. Educational level and gender were significantly associated with knowledge about neonatal jaundice (p = 0.002 and p = 0.001, respectively). Conclusion The findings highlight a moderate level of awareness but varying confidence in identifying neonatal jaundice among parents. The reliance on traditional remedies suggests a need for enhanced health education to improve knowledge of and attitudes toward neonatal jaundice management.

Vaginal screening for group B streptococcus using PCR in pregnant women with unknown colonization status: Impact on newborn monitoring for early-onset sepsis

BackgroundEarly-onset neonatal sepsis represents a diagnostic challenge, as it is a cause of neonatal mortality and morbidity. Guidelines for the prevention of group B streptococcus (GBS) infection recommend that all pregnant women must be screened for GBS carriage at the end of pregnancy, with intrapartum antibiotic prophylaxis being provided for GBS carriers. If vaginal culture is not available, GBS polymerase chain reaction (GBS-PCR) is an alternative option for this type of screening. In our unit, GBS-PCR is performed when pregnant women present to the delivery room with ongoing labor and with no results of culture GBS screening available. The main objective of this study was to evaluate the impact of the results of GBS-PCR on monitoring modifications in newborns of mothers with unknown GBS status. The secondary objectives were to confirm the feasibility of a GBS-PCR-based screening method in everyday practice and to evaluate the impact of GBS-PCR results on the modification of intrapartum antibiotic therapy in pregnant women. MethodA retrospective, single-center, observational study was conducted for 1 year. For dyads with GBS-PCR performed, changes concerning intrapartum antibiotic therapy and the newborn's monitoring were recorded. The feasibility of the method was evaluated by the delay between the GBS-PCR realization and the availability of the result; in addition, the number of GBS-PCR tests that could not be realized were collected. ResultsOverall, 60 GBS-PCR samples were tested for 60 pregnant women. Results were obtained for all samples, and the median duration to obtaining the GBS-PCR results was 70 min (60.8–87.2). These results were positive for 11 (18.3 %) women and led to monitoring modifications for two infants. In total, 27 pregnant women (45 %) had modifications in their antibiotic therapy due to the GBS-PCR results. ConclusionGBS-PCR was quickly available and the results led to changes in maternal antibiotic prophylaxis and in the monitoring level of the newborns.

The effect of birth timing manipulation around carnival on birth indicators in Brazil.

This paper studies the patterns and consequences of birth timing manipulation around the carnival holiday in Brazil. We document how births are displaced around carnival and estimate the effect of displacement on birth indicators. We show that there is extensive birth timing manipulation in the form of both anticipation and postponement that results in a net increase in gestational length and reductions in neonatal and early neonatal mortality, driven by postponed births that would otherwise happen through scheduled c-sections. We also find a reduction in birthweight for high-risk births at the bottom of the weight distribution, driven by anticipation. Therefore, restrictions on usual delivery procedures due to the carnival holiday can be both beneficial and detrimental, raising a double-sided issue to be addressed by policymakers.

Neonatal Resuscitation and Delivery Room Care: A Changing Global Landscape.

With 98% of neonatal deaths occurring in low- and middle-income countries (LMICs), leading health organizations continue to focus on global reduction of neonatal mortality. The presence of a skilled clinician at delivery has been shown to decrease mortality. However, there remain significant barriers to training and maintaining clinician skills and ensuring that facility-specific resources are consistently available to deliver the most essential, evidence-based newborn care. The dynamic nature of resource availability poses an additional challenge for essential newborn care educators in LMICs. With increasing access to advanced neonatal resuscitation interventions (ie, airway devices, code medications, umbilical line placement), the international health-care community is tasked to consider how to best implement these practices safely and effectively in lower-resourced settings. Current educational training programs do not provide specific instructions on how to scale these advanced neonatal resuscitation training components to match available materials, staff proficiency, and system infrastructure. Individual facilities are often faced with adapting content for their local context and capabilities. In this review, we discuss considerations surrounding curriculum adaptation to meet the needs of a rapidly changing landscape of resource availability in LMICs to ensure safety, equity, scalability, and sustainability.