Risk Newborns Research Articles

Can prophylactic oral dextrose solution prevent hypoglycemia in high risk newborns?

Prophylactic oral dextrose gel recommended to prevent hypoglycaemia in high risk babies is not readily available and affordable. This study was therefore conducted to find out if oral dextrose solution decreases the incidence of hypoglycaemia in high risk neonates. This study included 186 high risk newborns. Oral 10% dextrose 2ml/kg was given at 30 minutes, 2, 6 and 12 hours of life, along with direct breastfeeding. Capillary blood glucose measurement was monitored at 2, 6, 12, 24, 48 and 72 hours of life. Low blood sugar levels were confirmed by simultaneous venous blood sampling. Statistical tests used were chi square for proportions and ANOVA for means. Of the 186 high risk babies maximum babies were small for gestational age (n = 68, 36.5%). Among the high risk babies, 7 (3.7%) developed hypoglycaemia. All were asymptomatic. A higher proportion of hypoglycaemia was seen IUGR babies (n = 2/9, 22.2%) and in those delivered by caesarean section (n =3/71, 4.2%). Compared to the incidence of hypoglycaemia (7.2%) in the historical control group the incidence of hypoglycaemia (3.7%) in interventional group was lower though statistically not significant (p=NS). There is a decrease in the incidence of hypoglycemia in high-risk infants given prophylactic oral dextrose solution. However, this trend was not statistically significant.

Evaluation of the telemedical health care network “SAFE BIRTH” for pregnant women at risk, premature and sick newborns and their families: study protocol of a cluster-randomized controlled stepped-wedge trial

BackgroundThe Perinatal Center of the University Hospital Carl Gustav Carus Dresden has initiated the telemedical healthcare network “SAFE BIRTH” to coordinate and improve specialized care in non-metropolitan regions for pregnant women and newborns. The network incorporates five intervention bundles (IB): (1) Multi-professional, inter-disciplinary prenatal care plan; (2) Neonatal resuscitation; (3) Neonatal antibiotic stewardship; (4) Inter-facility transfer of premature and sick newborns; (5) Psycho-social support for parents. We evaluate if the network improves care close to home for pregnant women, premature and sick newborns.MethodsTo evaluate the complex healthcare intervention “SAFE BIRTH” we will conduct a cluster-randomized controlled stepped-wedge trial in five prenatal medical outpatient offices and eight non-metropolitan hospitals in Saxony, Germany. The offices and hospitals will be randomly allocated to five respectively eight sequential steps over a 30-month period to implement the telemedical IB. We define one specific primary process outcome for each IB (for instance IB#1: “Proportion of patients with inclusion criterion IB#1 who have a prenatal care plan and psychosocial counseling within one week”). We estimated a separate multilevel logistic regression model for each primary process outcome using the intervention status as a regressor (control or intervention group). Across all IB, a total of 1,541 and 1,417 pregnant women or newborns need to be included in the intervention and control group, respectively, for a power above 80% for small to medium intervention effects for all five hypothesis tests. Additionally, we will assess job satisfaction and sense of safety of health professionals caring for newborns (questionnaire survey) and we will assess families’ satisfaction, resilience, quality of life and depressive, anxiety and stress symptoms (questionnaire surveys). We will also evaluate the cost-effectiveness of ”SAFE BIRTH” (statutory health insurance routine data, process data) and barriers to its implementation (semi-structured interviews). We use multilevel regression models adjusting for relevant confounders (e.g. socioeconomic status, age, place of residence), as well as descriptive analyses and qualitative content analyses.DiscussionIf the telemedical healthcare network “SAFE BIRTH” proves to be effective and cost-efficient, strategies for its translation into routine care should be developed.Trial registrationGerman clinical trials register. DRKS-ID: DRKS00031482.

Results of a hybrid approach for high risk term newborn patients with interrupted aortic arch (IAA) with left ventricular outflow tract obstruction.

This study aims to share the results of critically ill newborn cases with interrupted aortic arch (IAA) and Left ventricular outflow tract (LVOT) obstruction (LVOTO) who underwent the hybrid approach, which consists of bilateral pulmonary artery banding and/or patent ductus arteriosus stenting, as first-line treatment. This retrospective study includes the results of high-risk term newborns whom we applied a hybrid approach due to IAA and LVOTO in our clinic between January 1, 2021 and December 31, 2021. The demographic characteristics, hybrid approach methods and results of the cases were evaluated. Nine cases underwent hybrid approach during the study period. The mean age and weight at interventions were 7 days (3-16 days) and 3280 g (2700-4300 g). Six of the patients were diagnosed with type B IAA, 2 with type A, and one with type C. LVOTO was present in 7 patients. The success rate for the procedures was 100%. No patients died during the procedure or within the first 5 days after the procedure or from reasons related to the procedure. The median length of the hospital stay after stent placement was 28 days (22-35 days) for discharged patients. Three patients died in interstage period, and 6 patients underwent total corrective surgery after a median of 7 months (4-10 months). The average LVOT diameter was increased from 3.1 mm to 4.8 mm before total repair surgery. The hybrid approach should be kept in mind for treating high risk newborns with IAA with LVOTO and high-risk newborns who are not suitable for single stage total corrective surgery.

Severe congenital T-lymphocytopenia may affect the outcome of neonatal intensive care.

Circular DNA segments TREC (T-cell receptor excision circles) formed during T-lymphocyte maturation in the thymus, are a sensitive marker of thymic lymphocyte production in a broader manner. Quantification using qPCR is proposed as a surrogate marker of T cell malfunction in various primary and secondary conditions in a non-SCID selected risk newborn population. We collected 207 dry blood spot samples during the years 2015-2018, from newly admitted risk newborns. TREC values calculated per 106 cells were determined and a cut-off values of 5th percentile was set. The positive control group consisted of patients (n=13) with genetically confirmed SCID. The median TREC value was 34,591.56 (18,074.08-60,228.58) for girls resp. 28,391.20 (13,835.01-51,835.93) per 106 cells for boys, P=0.046. Neonates born by C-section have been found to have higher TREC levels compared to neonates born by spontaneous delivery (P=0.018). In the group of preterm newborns (n=104), 3.8% had TREC value < 5th percentile, half of them died due to sepsis as opposed to no fatalities in preterm newborns with sepsis and TREC value > 5th percentile. In the group of term newborns (n=103) 9 children (8.7%) had TREC < 5th percentile, half of them were treated for asphyxia, with no fatal complications. TREC levels calculated for the 5th percentile of a risk neonatal group is suggested as a surrogate marker for increased risk of fatal septic complication. Early recognition of these newborns within a risk scoring system using TREC levels could lead to potentially lifesaving interventions.

EVALUATION OF CLINICAL, ETIOLOGICAL AND EEG PROFILE OF NEONATAL SEIZURE

Background: Neonatal seizure is a paroxysmal behavior caused by hyper-synchronous discharge of a group of neurons. Neonatal seizures are the most common overt manifestation of neurological dysfunction in the newborn. The electroencephalography (EEG) is an important tool in the evaluation of an infant with symptoms referable to the central nervous system. It provides an excellent and non-invasive method of assessing at risk newborns and of formulating a prognosis for long-term neurological outcome. Hence, this study was planned to evaluate clinical, etiological, and EEG profile of neonatal seizure and its corelation with developmental outcome. Methods: Prospective observational study was done among 71 cases of neonatal seizures patients admitted in Netaji Subhash Chandra Bose Medical College hospital from November 2014 to October 2015. All consecutive term and preterm neonates with documented seizure who were discharge from neonatal intensive care unit (NICU) with proper consent and counseling of parents were included in this study. Results: Total 71 newborns were enrolled, out of them 21% (n=15) were admitted within 24 h of birth, 42% (n=30) were admitted within 24–72 h, and 37% (n=26) newborn admitted at &gt;72 h of birth. Total number of male included were 56% (n=40), while female were 44% (n=31). Out of 71 newborn, 60 newborn (84%) had subtle seizure, 4 (6%) had tonic seizures, 2 (3%) clonic seizure, and 5 (7%) had subtle with clonic seizure. In our study, most common causes of seizure were birth asphyxia 50% (n=36), meningitis 15% (n=11), and hypoglycemia 13% (n=9). Other common cause are hypocalcemia 8.5% (n=6), kernicterus 2.8% (n=2), and intraventricular hemorrhage 1.5% (n=1). Conclusion: In our study, we have found that preterm babies appear to have adverse neurodevelopmental outcome due to any brain insult occurred during neonatal period. Onset of seizure was found to be important predicting factor for developmental outcome. Frequency of seizure also has impact on developmental outcome, newborns who have single episode of seizure had good developmental outcome.

Fecal Calprotectin Levels Dynamics in Newborns with High-Risk of Necrotizing Enterocolitis

Background. Necrotizing enterocolitis (NEC) is severe gastrointestinal disease in newborns, its early clinical symptoms are nonspecific. Fecal сalprotectin (Cp) is considered as one of the early biomarkers of NEC, thus, its use in newborns is poorly known.Objective. The aim of the study is to evaluate clinical significance of fecal Cp measuring as an early NEC marker in newborns. Methods. The prospective cohort observational study included high-risk newborns (gestational age (GA) ˂ 33 weeks and/or body weight ˂ 1500 g) and moderate risk newborns (GV≥ 33 weeks at suspicion on NEC) of NEC admitted to the neonatal intensive care unit on the 1st day of life. The Cp level was studied via immune colorimetric method on the 3rd and 7th days of life in high-risk children and in all children at NEC manifestation. All patients were divided into 2 main subgroups after the end of the follow-up period: newborns with developed NEC (a) and children without NEC (b). Obtained Cp values were compared between these subgroups.Results. There were no statistically significant differences in Cp levels at the 3rd and 7th days of life in the high-risk group of children with NEC and without NEC. However, it was noted that children without NEC showed a decrease in Cp levels on the 7th day, while children with NEC manifestation, indeed, had increased levels. Cp levels did not differ in the moderate risk group.Conclusion. Single measurement of Cp level in newborns of any GA is uninformative towards the NEC prognosis and diagnosis. However, evaluation of the Cp level dynamics at the 7th day of life compared to the 3rd day of life may be considered as a promising non-invasive method for prognosis of NEC manifestation in premature infants (GA&lt;33 weeks).

Developmental outcome of neonatal intensive care unit graduates born in tertiary care hospital in South India

Background: With the advancement in technology and advances in perinatal care, survival rates of high risk newborns have improve. Despite the reduction in neonatal mortality, chronic morbidities and adverse outcomes have not declined. These include cerebral palsy, cognitive delay, visual and auditory deficits signifying the need for regular monitoring of growth and development. Methods: Retrospective and prospective cohort study in a tertiary care centre in South India. Study duration of one year. Retrospective analysis of data of 190 high risk newborns admitted in NICU for more than 48 hours during the period 2012-2014. Neurodevelopmental outcome of these high-risk newborns at the age of 8-10 years. These were contacted and followed up for clinical assessment including motor and neurological function, visiomotor integrative skills, academic achievement, language, executive function, behavioral issues and child behavioral checklist applied. Findings described in simple descriptive manner. Results: In this study of 190 babies,139 babies were followed up for clinical assessment at the age of 8-10 years. From the follow up, 7.2% were diagnosed to have seizure disorder during childhood. 18.7% had hyperactive airway disease during childhood. 9.8% had academic problems, 5.8% had motor abnormalities, 2.9% had vision abnormalities requiring glasses from early childhood, 4.3% had gait abnormalities, 4.9% had speech related difficulties,17.3% had behavioral issues including excessive anxiety, withdrawal, aggressiveness. 1.2% had sleep problems, 21.6% babies had features of attention deficit hyperactivity disorder, 2.9% had features related to autism. Conclusions: Neonatal period is a critical period for proper neurodevelopment, having impact on child development. Babies with difficulties during transition period had higher immediate as well as long term morbidities. Long term morbidities included hyperactive airway disease/asthma, seizure disorder, academic problems, motor and gait abnormalities, behavioural abnormalities in childhood.

The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns.

To characterize hospitals where military-insured newborns received care and test the association of regional perinatal risk with neonatal intensive care unit (NICU) capacity. We identified birth hospitals for live newborns October 2015-December 2018 (n = 296,568) and assigned newborns to health service areas (HSAs). Perinatal risk factors and the number of neonatal special care beds and neonatologists were calculated at HSA levels. Cross-sectional correlation analyses assessed perinatal risk factors and capacity across HSAs. 27.0% (n = 10) of military birth hospitals had special care beds (intermediate and intensive) compared with 44.3% of civilian hospitals (n = 1224; p < 0.05). The number of special care beds and neonatologists per newborn varied more than twofold across regions and were only weakly associated with the proportion of higher risk newborns (R2 < 0.05). The lack of meaningful association of regional perinatal risk with NICU capacity poses challenges for effective specialized care among military-associated newborns.

RETINOPATHY IN HIGH-RISK NEWBORNS IN TERTIARY CARE HOSPITAL IN WESTERN INDIA

Aim: To study various factors of retinopathy in high-risk newborns Material &amp; Method All patients admitted in NICU/ high risk OPD with diagnosis of premature retinopathy. Fundus examination with direct ophthalmoscope, RETCAM the ndings were noted and analysed to rule out various serious causes of retinopathy of prematurity in high risk newborns. Results: A total 100 patients of retinopathy of prematurity were examined in premature babies. A signicant positive association of retinal changes and risk factors were analysed by taking p value, shers exact test. In this study 38 neonates developed hyperbilirubinemia, 30 newborn had apnea, 18 had alidosis, 16 cases suffered from septicaemia, 9 newborn required blood or blood production with retinopathy in high risk newborns.

Assessment of neonatal thermal cares: Practices and beliefs among rural women in West Guji Zone, South Ethiopia: A cross-sectional study.

A newborn has a limited capacity to maintain temperature when exposed to cold environment. Neonatal hypothermia, a common neonatal problem, carries high case fatality rate particularly if concurrently occurs with other neonatal problems. This study assessed neonatal thermal care practices and beliefs among rural women in west Guji Zone, south Ethiopia. A community based cross sectional quantitative study combined with qualitative study was undertaken in rural areas of west Guji Zone, Ethiopia. Randomly selected 388 rural mothers of infants less than 6 months old were participated in the quantitative study. Three focus group discussions were conducted among mothers of infants less than 6 months old. Quantitative data were collected by using structured and pretested Afaan Oromo version questionnaire adapted from relevant literatures. Qualitative data were collected by focus group discussion guide. The quantitative data were cleaned, coded and analyzed by SPSS version 20. Qualitative data were transcribed, translated, coded, and analyzed by thematic analysis approach. In general rural women believe that thermal protection of newborn is important. The findings show that approximately 75% and 85% of newborns were dried and wrapped respectively after delivery. However drying and wrapping of newborn are usually done after the first newborn's bath. Just over 84% of newborns were bathed within the first 6 hours of delivery and majority of them were bathed with warm water. About 69.1% and 57.7% of women put head cover to their newborns immediately after birth, and initiated breast feeding within one hour of delivery respectively. Skin to skin care of newborn is non-existent in the study area and perceived as an odd, frightening and potentially dangerous practice. Studied women practice some of the recommended neonatal thermal cares and believe in their importance in keeping newborn warm. However, practice and beliefs about delayed first bath is against standard recommendation, whereas skin to skin care is non-existent and perceived as an odd practice. Interventions to familiarize skin to skin care and reduce misconceptions surrounding it should be introduced into the study area to improve thermal cares of high risk newborns.

Perinatal presepsin assessment: a new sepsis diagnostic tool?

Perinatal sepsis constitutes a medical emergency and is still one of the major causes of mortality and morbidity. The possibility of an early diagnosis of sepsis isstill debated and controversial. In particular, clinical symptoms can be hidden by the association of sepsis with other perinatal diseases and/or by therapeutic strategies performed. In this context, there is evidence that the accuracy of standard of care diagnostic parameters (i.e. blood culture, C-reactive protein, procalcitonin) can be biased by additional confounding factors (gestational age, birth-weight, acute-chronic hypoxia). Therefore, the inclusion in clinical daily practice of new biomarkers of sepsis is of utmost importance. Of a panel of biomarkers, Presepsin (P-SEP) plays an important role in the development and response of the immune system and as an early marker of sepsis both in adult and pediatric patients. Therefore, in the present review we aim to offer an overview of the role of P-SEP in the early detection of perinatal sepsis as a trustworthy marker according to actual statements of official international institutions. Future perspectives regard the possibility of a longitudinal non-invasive biological fluids P-SEP assessment thus limiting the sample stress in high risk newborns.

Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda

BackgroundThe neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28/1000 and 27/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda.MethodsA cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities.ResultsThere was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, p = 0.017.ConclusionHealth facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.

“ASSESSMENT OF GESTATIONAL AGE BY NEW BALLARD'S SCORE AND ITS CORRELATION WITH FOOT LENGTH”

BACKGROUND – Foot length has been studied by various authors as proxy measurement which can be measured easily in sick and preterm newborns. This study was done to nd the correlation of foot length with gestational age and other anthropometric measurements (birth weight, head circumference and crown heel length). AIMS AND OBJECTIVES1. To study the correlation of foot length and gestational age among the neonates. 2. To study the correlation between foot length and other variables (gestational age, birth weight, head circumference and crown heel length) among the newborns. 3. To study if foot length can be used as a proxy measurement to gestational age and birth weight assessment. MATERIAL: A study sample of 350 live newborns born at MMIMSR, Mullana, Ambala was selected by simple random sampling technique METHODS: Study sample of 350 newborns was selected by simple random sampling technique born at MMIMSR, Mullana, Ambala from April 2020 to May 2021. Babies with limb deformities were excluded from the study group. Babies were grouped into term, preterm and post-term and gestational age was assessed by New Ballard score. These three groups were categorized in to small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) using Fenton growth chart. Correlation of foot length with gestational age and other anthropometric parameters were statistically analysed by correlation and regression analysis. RESULTS- In the study, male newborns were 55.1% and female were 44.9%. Of the 350 newborns, preterms were 32.9%, terms were 65.4% and post-term 1.7%. In the study group, 30.8% were low birth weight babies, 63.4% had birth weight in the range of 2.5- 4 kg and 0.9% had birth weight &gt;4 kg. The mean foot length was 7.301 cm with a range of 4.6-8.4 cms. Foot length correlated signicantly (p &lt; 0.05) with crown heel length, birth weight, gestational age and head circumference in the neonates. Maximum correlation was observed with crown heel length (r = 0.916) which indicates strong positive association between them, followed by birth weight (r = 0.912), gestational age(r = 0.902) and head circumference (r = 0.875). CONCLUSION- Foot length is a easy and reliable anthropometric measurement to assess birth weight and gestational age in neonates, especially who are ill. Foot length can be reliably measured by peripheral heath care workers and could be used effectively for identifying and referring high risk newborns.

Audiological results in newborn babies undergoing neonatal hearing screening at zonal hospital in western Maharashtra: A cross sectional study

To analyze the variation in audiological results with oto-acoustic emission (OAE) and auditory brainstem response (ABR) of term newborns with those at risk (preterm and newborns with hyperbilirubinemia). Auditory screening was conducted in 746 infants born in zonal hospital in western Maharashtra from May 2019 to May 2020. The cases included 633 healthy term, 71 preterm infants managed in the neonatal intensive care unit (NICU) and 42 newborns with hyperbilirubinemia. Hearing impairment was confirmed through a primary screening by OAE response followed by ABR. Based on these findings, we divided infants into pass and refer. 16 patients in ‘refer’ group were identified through our protocol out of 746 newborns. The incidence of the refer group was 11 out of 633 in term newborns, 3 out of 71 in preterm and 2 out of 42 in newborns with hyperbilirubinemia after OAE. Refer groups were subjected to further evaluation by ABR which was able to remove false positives and a final tally of 8 out of 11 term newborns, 2 out of 3 preterm were found to have hearing loss. Hence, we conclude that incidence of hearing loss detected by OAE in preterm and hyperbilirubinemia newborns was more as compared to term newborns and is significant. OAE followed by ABR is a good modality of audiological assessment in ruling out false positive cases.

Neonatal encephalopathy and potential lost opportunities: when the story fits, please cool

‘Sarah is a baby girl born by an emergency caesarean section following a period of observation for non-reassuring cardiotocographic recordings. She was initially ‘flat’ and received positive pressure ventilation for...

Efficacy of a multimodal nursing intervention strategy in the process of becoming a mother: A randomized controlled trial.

The lack of knowledge and skills for transitioning to motherhood places first-time mothers at greater risk of depression and stress, may lower their perceived self-efficacy and satisfaction with the maternal role, and potentially affects the mother-infant bond. The purpose of this study was to test the efficacy of a multimodal nursing intervention (AMACOMPRI), based on Mercer's Becoming a Mother Theory, in supporting the process of becoming a mother in first-time mothers of term infants. This study was a parallel-group, double-blind, randomized, controlled trial with a 4-month postpartum follow-up. The outcome measures were the process of becoming a mother, functional social support, mother-infant bond, and perceived maternal self-efficacy. Sixty-six first-time mothers completed the study: 33 in the intervention group and 33 in the control group. The intervention was effective in supporting the process of becoming a mother, with a large effect size (Cohen's d = 1.50) and higher scores on the Becoming-a-Mother Scale in the intervention group compared with the control group (intergroup difference 13.04 points; 95% confidence interval: 8.72-17.34). Participants in the intervention group demonstrated higher scores in functional social support, perceived maternal self-efficacy, and mother-infant bond. This study provides evidence for the efficacy of an innovative nursing intervention that supports the process of becoming a mother. Further testing of the intervention is required in different settings and first-time mothers of low and high risk newborns.

Predictive value of electroencephalogram, event-related potential, and general movements quality assessment in neurodevelopmental outcome of high-risk infants

Objective The objective of the study is to investigate the predictive value of electroencephalogram (EEG), event-related potential (ERP), and general movements (GMs) quality assessment in the neurodevelopmental outcome of high-risk infants at one year old. Methods EEG and ERP were performed in high-risk infants at four weeks old, and GMs quality was evaluated once at 4 weeks and once at 12 weeks. The Gesell score was used to assess neurodevelopment outcome at one year old. A comparative analysis of the effects of EEG, GMs, EEG + ERP, and EEG + ERP + GMs was used to predict high-risk neonatal neurodevelopmental outcome. Results Of 71 high-risk infants at the age of one year, 3 (4.23%) had cerebral palsy, 14 (19.72%) had psychomotor retardation, and 54 (76.05%) were normal. The sensitivity, specificity, positive predictive value, and negative predictive value of EEG + ERP + GMs method were 90.00%, 95.08%, 75.00%, and 98.31%, respectively, and these indexes were the highest among the four methods (EEG, GMs, EEG + ERP, and EEG + ERP + GMs). The kappa statistic for the reliability of predicting neurodevelopmental outcome of high risk newborns by the EEG + ERP + GMs method was substantial at 0.785, while the other three methods obtained relatively low Kappa values (0.599, 0.586, and 0.712, respectively). Conclusions The combination of EEG, ERP, and GMs quality assessment can greatly improve the prediction of neurodevelopmental outcome of high-risk newborns.

Role of Hearing Screening in High-Risk Newborns.

Hearing is one of the very important five senses. The most important period for language and speech development is generally regarded as the first three years of life. For the past 20 years, electrophysiological methods are most commonly used which include otoacoustic emission (OAE) and auditory brain stem response (ABR). Regardless of the screening method chosen, hearing screening, though critical, is only the first stage of a comprehensive early intervention plan. Screening alone is useless unless appropriate diagnostic testing services and high quality amplification and rehabilitation services are in place and are implemented in a timely fashion. Early screening does not substitute for further periodic childhood hearing screening. To screen the newborns which are high risk or born to high risk mother using optoacoustic emission and auditory brain stem response (ABR). Also to co-relate hearing loss with various risk factors involved in pre-natal, natal and post-natal. Methods: we conducted a prospective study with 100 high risk newborns in a tertiary care centre. First, all babies were screened using transient evoked otoacoustic emission(TEOAE). Babies not responsive in this were screening again after 14 days using TEOAE. Babies who were reffered to during this screening with TEOAE were subjected to further screening with ABR to confirm the diagnosis. Out of 100 infants, 73% infants passed first screening by TEOAE whereas 27% failed. those 27 infants which failed were screened after 14 days, of them, 3 (11.1%) infants failed the second screening and were referred. Further screening with BERA was conducted for 3 children who failed the second screening by TEOAE. Of them 1 (33.3%) infant passed the BERA whereas 2 infants failed. Test of significance observed no statistically significant association of OAE with prenatal risk factors in present study (p>0.05). whereas shows highly statistically significant association of OAE with natal (birth asphyxia, NICU admission and Apgar score at 5 minutes) and post natal (viral/bacterial infections) risk factors (p<0.01). New born hearing screening is important in recognizing babies born with congenital hearing loss. The screening protocol using OAE can be used in a two staged screening. This study aimed to detect the congenital hearing loss as early as possible and its association with various risk factors in high risk newborns and role of OAE and ABR as a screening tool. Timely diagnosis and intervention for hearing loss are not the reality throughout India. The population and professionals involved in childcare should be made aware of the impact of hearing loss, this could result in better outcome of neonatal hearing screening programs.

English

BACKGROUND Hearing loss is a chronic condition, and many cases can be detected in the neonatal period. Recognizing it early is of crucial importance as early auditory rehabilitation would help in child’s comprehensive development. We wanted to assess the prevalence of hearing impairment among high risk newborns admitted to inborn unit of tertiary care centre in Central Kerala and screen for the associated risk factors in these newborns. METHODS Thousand consecutive inborn neonates from Neonatal ICU, Department of Paediatrics, tertiary care centre in Thrissur, Kerala, detected as high risk by Joint Committee on Infant Hearing (JCIH) criteria were enrolled for the study from December 2011 to November 2012 after the approval by Institute’s Ethics Review Board. Risk factor assessment was done before enrolment. A qualified audiologist conducted the test on babies in soundproof chamber. DPOAEs (Distortion Product Otoacoustic Emissions) were used for initial testing after checking ears for debris. Those who failed in the first test were asked to come for a retest after 2 weeks. Those who failed in the retest were asked to report for Brainstem Evoked Response Audiometry (BERA). Those who were diagnosed as having hearing impairment were advised auditory rehabilitation as well as auditory verbal therapy. RESULTS Of the 1000 eligible neonates born in our hospital during the study period (December 2011 to November 2012) 69 were lost to follow up. Among the remaining 931 babies the frequency of hearing impairment was 0.8 %. Among the 931 neonates, 130 had absent response with the first OAE test contributing to 13.9 %. Twenty-one neonates had absent response to second OAE test out of 130 contributing to 16.1 %. The failure rate for second test is 2.2 % of the total population of 931 newborns. Eight of the 21 neonates who were subjected to BERA had severe hearing loss. The prevalence of hearing impairment was 8 per 1000. CONCLUSIONS The prevalence (percentage) of hearing impairment by two staged screening protocol is 0.8 %. Risk factors which were present in these babies were prematurity, low birth weight, low Apgar score, history of exanthematous fever in mother, neonatal jaundice, ototoxic medication history, craniofacial anomalies, and family history of deafness, meningitis and mechanical ventilation. KEYWORDS Otoacoustic Emissions, Brain Stem Evoked Response Audiometry, Risk Factors, Hearing Impairment, Neonates

Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries

BackgroundPreterm birth continues to be a major public health problem contributing to 75% of the neonatal mortality worldwide. Low birth weight (LBW) is an important but imperfect surrogate for prematurity when accurate assessment of gestational age is not possible. While there is overlap between preterm birth and LBW newborns, those that are both premature and LBW are at the highest risk of adverse neonatal outcomes. Understanding the epidemiology of preterm birth and LBW is important for prevention and improved care for at risk newborns, but in many countries, data are sparse and incomplete.MethodsWe conducted data analyses using the Global Network’s (GN) population-based registry of pregnant women and their babies in rural communities in six low- and middle-income countries (Democratic Republic of Congo, Kenya, Zambia, Guatemala, India and Pakistan). We analyzed data from January 2014 to December 2018. Trained study staff enrolled all pregnant women in the study catchment area as early as possible during pregnancy and conducted follow-up visits shortly after delivery and at 42 days after delivery. We analyzed the rates of preterm birth, LBW and the combination of preterm birth and LBW and studied risk factors associated with these outcomes across the GN sites.ResultsA total of 272,192 live births were included in the analysis. The overall preterm birth rate was 12.6% (ranging from 8.6% in Belagavi, India to 21.8% in the Pakistani site). The overall LBW rate was 13.6% (ranging from 2.7% in the Kenyan site to 21.4% in the Pakistani site). The overall rate of both preterm birth and LBW was 5.5% (ranging from 1.2% in the Kenyan site to 11.0% in the Pakistani site). Risk factors associated with preterm birth, LBW and the combination were similar across sites and included nulliparity [RR − 1.27 (95% CI 1.21–1.33)], maternal age under 20 [RR 1.41 (95% CI 1.32–1.49)] years, severe antenatal hemorrhage [RR 5.18 95% CI 4.44–6.04)], hypertensive disorders [RR 2.74 (95% CI − 1.21–1.33], and 1–3 antenatal visits versus four or more [RR 1.68 (95% CI 1.55–1.83)].ConclusionsPreterm birth, LBW and their combination continue to be common public health problems at some of the GN sites, particularly among young, nulliparous women who have received limited antenatal care services.Trial registration The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.Trial registration: The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.