Risk Newborns Research Articles

Amamentação no período de transição neonatal em Hospital Amigo da Criança

The objective of this study was to learn the breastfeeding rates in the neonatal transition period at a child-friendly hospital. A quantitative, exploratory, cross-sectional study was developed with 342 mother-baby pairs. Data were collected by means of interviews and analysis of medical records. Low breastfeeding rates were identified in the first hour of life of the newborns or neonatal reactivity period (53.2%). In the second transition period the rate was 20.7%, and 20.5% in the third period. Encouragement to breastfeeding is not appropriate for the phases of the neonatal transition period, as the rates for the first hour of life were expected to be higher than 90%, considering low risk newborns and births that occurred in a child-friendly hospital. Our findings indicate a need for adopting care strategies that favor the early contact and training of professionals at maternity hospitals toward the adequacy of breastfeeding to the neonatal transition period.

Neurodevelopmental outcome of high risk newborns discharged from special care baby units in a rural district in India.

BackgroundHigh risk newborns are most vulnerable to develop neuro-developmental delay (NDD). Early detection of delay in this group and identification of associated perinatal factors and their prevention can prevent disability in later life.Design and methodsObservational cohort study. Field based tracking and neuro-developmental screening of high risk newborns discharged between January 2010 to June 2012 from a district Hospital in India was conducted by a team of developmental specialists, using standardized tools like Denver Developmental Screening Tool II, Trivandrum Developmental Screening Chart and Amiel-Tison method of tone assessment. Associated perinatal factors were identified. Early intervention was initiated on those detected with NDD.ResultsDevelopmental delay was detected in 31.6% of study population. Prevalence of NDD was significantly higher in low birth weight (LBW, >2 kg), preterm (<36 weeks) and twins. Neonatal sepsis/meningitis and convulsions also showed significant association with NDD. Of the 134 with developmental delay, 61 were preterm, 80 LBW, with h/o sepsis in 52, convulsion in 14, birth asphyxia in 39 and jaundice in 14 neonates.ConclusionsIncidence of NDD among high risk newborns is significantly high with LBW, prematurity and neonatal illnesses are major contributors. Most NDDs go undetected in the early years of life. Improved perinatal care, early detection and early intervention at the grass root level will bring down incidence of developmental challenges in this vulnerable group.Significance for public healthThe public health significance of this study lies in the fact that a large proportion of high-risk newborns in rural India were detected with developmental delay and some preventable perinatal and neonatal factors like prematurity, low birth weight, sepsis and meningitis were found to be associated with the problem. So, it suggests that prevention of these perinatal factors, timely detection with proper screening methods and early intervention will help curb the burden of disability in the community. Once a disability develops in a child, the magnitude of the problem swells in all aspects: medical, social and economic. But much of this burden can be lessened if we intervene early, as a third of most disabilities are preventable. Moreover, if we can identify the perinatal factors leading to neonatal brain damage and prevent them, much of the neuro-developmental delay can be averted.

Expressions of Teenagers Under Palliative Care on Facebook: A Fresh Approach for Healthcare Professionals (S714)

Conversations were analyzed using the Roter Interaction Analysis System (RIAS), a quantitative tool for assessing content and quality of patient-provider communication. Each expressed thought is assigned to 37 mutually exclusive categories which are combined into 10 composite codes for analysis. Results. We analyzed 19 conversations with 31 family members and 23 clinicians. For 11/19, the primary clinician was just meeting the family, although 5/11 infants had been NICU patients for >1 month. Although 18/ 19 conversations included multiple clinicians, 91% of team dialogue was delivered by one or two clinicians. Clinicians contributed 65% of total dialogue; 56% of that dialogue focused on biomedical information. Parents rarely (5% of dialogue) asked questions about that information; clinicians asked even fewer (3.5% of dialogue) questions of the family. Conversations were longer with the presence of non-physician clinicians, but this did not increase dialogue about psychosocial information or increase parent engagement. Conclusions. To the best of our knowledge, this is the first study that directly observes parent-clinician discussions regarding high risk newborns. Even when interdisciplinary clinicians were present, discussion was heavily focused on biomedical information. Clinicians always talked more than parents, and no one asked many questions. Given this, it is difficult to assess shared understanding about an infant’s condition. Implications for Research, Policy, or Practice. Maximizing the value of interdisciplinary clinicians in NICU family meetings may require explicit strategies to integrate the perspectives and resources of individual team members. Methods to increase family engagement should be targeted.

Characterizing Parent-Clinician Discussions About Critically Ill Infants: Empirical Observation of Real-Time Conversations (S713)

•Describe interdisciplinary team communication behaviors in a NICU family meeting.•Describe family communication behaviors in NICU family meetings. Clinicians in the neonatal intensive care unit (NICU) must engage in clear and compassionate communication with families. Developing best practices for counseling, and for training clinicians in key communication skills, are hampered without empirical, observational data about how these conversations unfold. To observe and analyze how interdisciplinary NICU clinicians and parents navigate difficult conversations. We prospectively identified and audiotaped NICU family conferences about “difficult news.” Conversations were analyzed using the Roter Interaction Analysis System (RIAS), a quantitative tool for assessing content and quality of patient-provider communication. Each expressed thought is assigned to 37 mutually exclusive categories which are combined into 10 composite codes for analysis. We analyzed 19 conversations with 31 family members and 23 clinicians. For 11/19, the primary clinician was just meeting the family, although 5/11 infants had been NICU patients for >1 month. Although 18/19 conversations included multiple clinicians, 91% of team dialogue was delivered by one or two clinicians. Clinicians contributed 65% of total dialogue; 56% of that dialogue focused on biomedical information. Parents rarely (5% of dialogue) asked questions about that information; clinicians asked even fewer (3.5% of dialogue) questions of the family. Conversations were longer with the presence of non-physician clinicians, but this did not increase dialogue about psychosocial information or increase parent engagement. To the best of our knowledge, this is the first study that directly observes parent-clinician discussions regarding high risk newborns. Even when interdisciplinary clinicians were present, discussion was heavily focused on biomedical information. Clinicians always talked more than parents, and no one asked many questions. Given this, it is difficult to assess shared understanding about an infant's condition.

Assessment of the Essential Fatty Acids in Neonates at Risk for Atopy

Essential fatty acids (EFA) are the major components of cellular phospholipids (PLs), contributing to their stability and functions. They are also precursors of inflammation mediators such as prostaglandins and leukotrienes, and are involved in cellular immunoregulation. Most recent studies have stressed that EFA levels are important in various diseases. Several Authors have stated that patients with atopic dermatitis (AD) have altered EFA levels in plasmatic PLs, and showed clinical improvement after oral EFA administration. The aim of our work was to study EFA composition of PLs of cord blood lymphocytes in 32 newborns at risk for atopy, in order to correlate EFA levels at birth with total IgE values and with the onset of atopic disease. Thirty not at risk newborns were studied as controls. Our results demonstrate a significant decrease (p<0.0001) of arachidonic acid (AA) levels in lymphocytes of newborns at risk for atopy, compared to controls, whereas a not significant increase of linoleic acid (LA) was present. No reverse correlation between IgE values and AA levels was found, whereas the 6 month and 1 year follow-up have not shown any major alteration of total IgE values, on the contrary a normalization of AA levels in all but one child has been observed. Only this one child has developed AD. We stress that the preventive action on allergy development recognized to breast milk could be also due to its effect on the EFA composition of the PLs of cell membrane.

Anthropometric measurements of newborns

Background: Aims and objectives of the study were to record the anthropometric measurements of the new-borns (i) Birth weight (ii) Crown heel length, (iii) Head circumference, (v) Chest circumference, (vi) Ponderal index. Methods: This observational study includes a total no. of 2050 consecutive live singleton infants born between 28 to 42 weeks gestation in a 1 year period. Anthropometric parameters such as birth weight, crown heel length, head circumference, chest circumference and Ponderal index were recorded. Results: At term, mean birth weight and lengths were 2800 gm and 50 cm respectively. Similarly mean head circumference and chest circumference were 33.3cms and 31.2cms respectively. As per the study, Ponderal index was 2.2 at term. Conclusions: Anthropometric measurements obtained provide useful references for the care of new-born in our population. This would ultimately lead to identifying at risk new-borns and help in better management.

Developmental Dysplasia of the Hip: Optimal Ultrasound Screening Strategy Among High Risk Newborns

Musculoskeletal ultrasonography is becoming an attractive imaging modality for screening of high risk infants for DDH because of its advantages such as accessibility, low cost, rapid examination and ability to detect the soft tissues & cartilage which cannot be seen by conventional radiography. Hip ultrasonography has the ability not only to visualise the unossified parts of the newborn hip but also to show movement of the femoral head within the socket. Ultrsonographic screening of all newborns can identify cases at an earlier age and lead to earlier treatment and prevent complication. So we conclude that the hip ultrasound screening of high risk infants for developmental dysplasia of the hip is important for early diagnosis & treatment. The current study included 270 cases of high risk infants for DDH. Their ages ranged from 4weeks to 6 months. We found that the most prevalent risk factor for hip dislocation in our study was ceaserean section delivery followed by breech presentation and oligohydraminos. The mean value of Alpha angle of the right hip was high than that of the left hip, where mean values of Beta angle of left hip was high than that of right hip. Graf type degree Ia was the most frequent degree in the right & left hips followed by IIa in right hip and IIb in left hip. Caesarean section delivery was the most prevalent risk factor in Graf type degree Ia, IIa & Ib in the right hip and in Graf type degree Ia, IIa & IIb in the left hip. Clinical suspicion was more frequent in Graf type degree IIc. Positive family history & oligohydramnios were the most frequent risk factors in Graf type IIb in the right hip. Graf type Ia was the most frequent degree among both males & females in the studied group in the right and left hips. Among risk factors breech presentation and oligohydramnios were significantly higher in female infants than male infants while caesarean section was significantly higher in male infants than female infants. Normal degree of hip stability is the most frequent degree in the right and left hips by Harche dynamic technique.

Risk Factors for Discontinuation of Exclusive Breastfeeding by One Month of Postnatal Age Among High Risk Newborns: An Institution Based Case Control Study.

Beyond one month of age, there is generally a drop in the proportion of mothers providing exclusive breastfeeding to their infants. Infants with morbidities during neonatal period have been observed to be at higher risk of discontinuation. To enumerate the prevalent factors behind discontinuation of breastfeeding among high risk newborns by first month of life. A case control study conducted at high risk newborn followup clinic of a teaching medical institute in northern India between January and May 2013. Infants were divided on the basis of continuation (controls) or discontinuation (cases) of exclusive breastfeeding at one month of age. The socio-demographic factors along with maternal and neonatal medical factors were compared among groups. During the study period, 112 newborns were screened. Forty seven cases and thirty eight controls were enrolled and finally evaluated. Female gender of newborn, less educated mothers and large families were observed to be associated with discontinuation of exclusive breastfeeding during first month of life among high risk newborns. Requirement of parenteral fluids during hospital stay emerged as the only independent medical reason. As in healthy newborns, the socio-cultural factors overshadow the medical reasons for discontinuation of exclusive breastfeeding during first month of life among high risk newborns.

PO-0527 Impact Of Local Versus Nice Guidelines On Management Of Neonatal Early Onset Sepsis (eos)

Background and aims EOS is a major cause of neonatal morbidity and mortality that can progress rapidly with minimal clinical and laboratory signs. Early identification of at risk newborns and prompt antibiotic treatment is therefore crucial. In 2012, National Institute for Health and Care Excellence (NICE) guidelines for EOS were published. Our local guideline includes fetal distress (abnormal cardiotocography) and meconium stained liquor as risk factors. We compare the outcomes with NICE and local guidelines. Methods Retrospective analysis of infants ≥35 weeks gestation admitted to a level-3 NICU over 4 months with suspected sepsis classified to have presumed (PS) or confirmed sepsis (CS). Results Of 81 cases identified, 44(54.3%) had PS and 37(45.7%) CS. 23(28.4%) babies in poor condition at birth received antibiotics on clinical grounds. Of remaining 58 cases, 36(62.1%) had PS and 22(37.9%) CS. Using local guideline in PS, 9(25%) required antibiotics, 13(36.1%) observed and 14(38.9%) were low risk. With NICE guideline, 5(13.9%) received antibiotics, 8(22.2%) observed and 23(63.9%) low risk. Using local guideline in CS, 10(45.5%) required antibiotics, 4(18.2%) observed and 8(36.3%) low risk but with NICE guideline, 3(13.6%) received antibiotics, 8(36.3%) observed and 11(50%) low risk did not require antibiotics or observations. Meconium was more common in CS (12/37; 32.4%) versus PS (6/44; 13.6%). Abnormal cardiotocography was noted in 40.5% CS cases versus 25% in PS. Conclusions Local guidelines with fetal distress as a risk factor may enable earlier identification of EOS risk. Larger study may enable better evaluation of our antibiotic therapy and resource implications.

Risk factors and neonatal/infant mortality risk of small-for-gestational-age and preterm birth in rural Nepal

Objective: Our study seeks to elucidate risk factors for and mortality consequences of small-for-gestational-age (SGA) and preterm birth in rural Nepal. In contrast with previous literature, we distinguish the epidemiology of SGA and preterm birth from each other.Methods: We analyzed data from a maternal micronutrient supplementation trial in rural Nepal (n = 4130). We estimated adjusted risk ratios (aRR) for risk factors of SGA and preterm birth, and aRRs for the associations between SGA/preterm birth and neonatal/infant mortality. We used mutually exclusive categories of term-appropriate-for-gestational-age (AGA), term-SGA, preterm-AGA, and preterm-SGA (with term-AGA as reference) in our analyses.Results: Stunted (<145 cm) and wasted (<18.5 kg/m2) women both had increased risk of having term-SGA (aRR 1.36, 95% CI: 1.14-1.61, aRR 1.22, 95% CI: 1.09–1.36 respectively) and preterm-SGA (aRR 2.48, 95% CI: 1.29–4.74, aRR 1.99, 95% CI: 1.33–2.97 respectively), but not preterm-AGA births. Similar results were found for low maternal weight gain per gestational week. Those born preterm-SGA generally experienced the highest neonatal and infant mortality risk, although term-SGA and preterm-AGA newborns also had statistically significantly high mortality risks compared to term-AGA babies.Conclusions: SGA and preterm birth have distinct risk factors and mortality patterns. Maternal chronic and acute malnutrition appear to be associated with SGA outcomes. Because of high SGA prevalence in South Asia and the increased neonatal and infant mortality risk associated with SGA, there is an urgent need to intervene with effective interventions.

English

BACKGROUND: Since decades attempts have been made to find a simple alternative method of gestational age assessment in newborns. It is important for the early identification and reference of preterm newborns from a rural setup where no proper medical facilities are available to a higher centre. AIMS: To construct standard reference intrauterine growth charts of foot length measurement for infants of 28-42 weeks gestational age and to study the correlation of foot length with gestational age. SETTING & DESIGN: It is an observational study conducted in a tertiary care hospital. MATERIALS AND METHODS: The study group included 1000 consecutively live born singleton infants of 28-42 weeks of gestation. Data were recorded for the foot length according to gestational age. Using MS Excel spread - sheet, the mean, standard deviation, 3rd, 5th, 10th, 50th, 90th, 95th and 97th percentiles were calculated and percentile curves drawn. The correlation of foot length with gestational age was analyzed by applying correlation and regression analysis. Regression equation was derived to predict gestational age from foot length. Results: Foot length correlated very well with the gestational age with r = 0.93and regression equation obtained was: Y = 6.278 + 4.15X to predict gestational age(Y) from foot length(X). CONCLUSION: Foot length is a simple, quick and reliable anthropometric measurement to assess gestational age in neonates and can be used as a simple tool for identifying and referring high risk newborns by peripheral health workers in

Recognition and home care of low birth weight neonates: a qualitative study of knowledge, beliefs and practices of mothers in Iganga-Mayuge Health and Demographic Surveillance Site, Uganda.

BackgroundNeonatal mortality has remained persistently high worldwide. In Uganda, neonatal deaths account for 50% of all infant deaths. Low birth weight is associated with a higher risk of death during the neonatal period. Failure to recognize low birth weight and inappropriate home care practices increase the risk of morbidity and mortality in this high risk group. This study explored mothers’ knowledge, beliefs and practices in recognising and providing home care for low birth weight babies.MethodsThe study was carried out in Eastern Uganda. In-depth interviews were conducted with sixteen mothers of small babies who delivered in health facilities (10) or at home (6) two months prior to the study. Interviews were conducted in mothers’ homes using the local language. Interviewer notes and audio recordings were transcribed and translated to English. Content analysis was done using Atlas-ti software.ResultsRecognition of low birth weight by mothers when a baby is not weighed was difficult. Mothers were aware of the causes of low birth weight though some mothers believed in the influence of supernatural powers. Mothers who delivered in hospital had better knowledge of appropriate home care practices for low birth weight babies compared to mothers who delivered at home or in a lower level health facility. Practices related to cord care and keeping the baby warm were good while poor practices were noted concerning initiation and exclusive breast feeding, and bathing the baby. Low birth weight was not appreciated as a danger sign in newborns and therefore mothers did not seek health care. Some mothers who initiated good care practices for low birth weight newborns in the facilities did not sustain them at home.ConclusionsRecognition of low birth weight is still poor. This leads to inappropriate home care practices for these high risk newborns. Mothers’ knowledge and care practices can be improved through health education, and this should be extended to the community to reach mothers that deliver at home. Mechanisms to support mothers to sustain good practices should be put in place by taking advantage of existing village health teams and social support.

Neonatal screening for congenital cytomegalovirus infection in preterm and small for gestational age infants

Congenital cytomegalovirus (CMV) infection affects many organs: reticuloendothelial and central nervous system are particularly involved. Congenital CMV infection is the leading cause of non-genetic sensorineural hearing loss. Hearing impairment can be present at birth or it can occur months or even years after birth. It is as well an important risk factor for antenatal stillbirth, preterm birth and small for gestational age (SGA) condition. For these reasons we should early identify congenital CMV infection investigating at least at risk newborns such as preterm or SGA babies given that a simple and standardized method for a large scale screening program is lacking. In our study, we found an association between congenital CMV infection and preterm births (3.03%) and with SGA condition (3.7%). Consequently, routine CMV urine detection should be performed at least in all babies born before 37 weeks of gestational age and in term SGA newborns.

Epidemiologic Characteristics of Patients with Cerebral Palsy

Aim: The aim of this study was to determine the demographical and clinical features of patients with cerebral palsy (CP) attending to our outpatient or inpatient clinics. Materials and Methods: Children admitted to Inonu University Faculty of Medicine Department of Physical Medicine and Rehabilitation outpatient or inpatient clinics, Malatya, Turkey with the diagnosis of CP during the study period were included in the study. Age, sex, etiological factors, clinical classifications, and epidemiological characteristics such as socio-economic status as well as the problems associated with CP were analyzed in all patients. Results: Of the total of 130 patients with mean ages 51.05 ± 36.06 months, 51 were girls and 79 were boys. The most common etiologic risk factors were bleeding and presence of threatened miscarriage in prenatal period; asphyxia, low birth weight and prematurity in perinatal period; and neonatal convulsions and hyperbilirubinemia in the postnatal period. Consanguineous marriage was present in 24.6% of families. In clinical classification it was seen that 45 subjects were spastic quadriplegic (34.6%), 41 were spastic diplegic (31.5%), 15 were dyskynetic (11.5%), 14 were spastic hemiplegic (10.8%), 10 were mixed type (7.7%) and 5 were hypotonic/ataxic (3.8%). Conclusion: Prenatal risk factors constitute the foremost risk factors in CP etiology. CP incidence can be lowered by close follow up of the newborns who has been considered as high risk newborns due to the presence of risk factors during pregnancies or deliveries, and by increasing the number of neonatal intensive care units. Besides, it is important to raise public awareness about consanguinity marriages in our country.

Babies born to mothers with thyroid disease

Thyroid dysfunctions are the second most common endocrine disorders complicating pregnancy after diabetes mellitus. Maternal thyroid dysfunctions are associated with miscarriage, preeclampsia, eclampsia, placental abruption and preterm delivery. As maternal thyroxine is essential for fetal neurodevelopment, until the foetal thyroid gland starts to produce thyroid hormones in the second trimester of gestation, reduced availability of maternal thyroid hormones may impair neurogical development of the foetus. It has been reported decreased IQ in infants born to mothers with hypothyroidism or hypothyroxinemia. Maternal hypothyroidism, defined as an elevated TSH level with a decreased (overt) or normal (subclinical) levels of circulating free T4, is common during pregnancy with a prevalence ranging from 0.5% (overt) to 2.5% (subclinical). Serum TSH levels, using trimesterspecific reference ranges (first trimester <2.5 mIU/ml, second and third trimester <3 mIU/ml), is a reliable test of maternal thyroid function in pregnancy. As untreated overt hypothyroidism during pregnancy has been shown to be associated with an increased risk of miscarriage, preterm birth, low birth weight and impaired fetal neurocognitive development, treatment during pregnancy is mandatory. Treatment of subclinical hypothyroidism during pregnancy is not universally recommended however a recent paper by Negro et al. has shown that treatment reduces the occurrence of adverse outcomes in the mother and fetus. The most common etiology of maternal hypothyroidism is Hashimoto’s thyroiditis; other causes include prior treatment for hyperthyroidism (radioactive iodine or thyroidectomy) and iodine deficiency. The mother with Hashimoto’s thyroiditis may have TSH receptor blocking or rarely stimulating antibodies (TRab) causing transient neonatal hypo or hyperthyroidism. Maternal high TRab titres are associated to an higher risk of hypo /or hyperthyroidism but the antibody titre does not discriminate blocking from stimulating antibodies that may also be present at the same time. If maternal TRab titre is elevated or unknown cord blood should be evaluated at birth for TRab, FT4 and TSH levels. A physical examination (heart rate and presence of goitre) should always be performed. In case of elevated TRab titre, the newborn must be checked at 10–14 days of age for clinical signs of hypo or hyperthyroidism and TSH and FT4 levels should be measured again; a treatment with tiroxine (10 mcg/kg/day) should be considered in case of elevated TSH and reduced FT4 levels. If no TRab are detectable on maternal blood or if the maternal hypothyroidism is due to a congenital cause (aplasia or hypoplasia of the thyroid gland) the evaluation of TSH on filter paper at 3–4 days of life should suffice. However babies born to mothers with autoimmune thyroiditis may develop persistent hyperthyrotropinemia requiring thyroid hormone replacement therapy even if no TRab are detectable and TSH levels are normal at 3–4 days of life; in these cases a retesting of TSH levels on filter paper at 3–4 weeks of life is indicated. If maternal hypothyroidism is due to pre-pregnancy treatment for Graves’ disease (radioiodine, surgery) the newborn is at risk of neonatal thyrotoxicosis if maternal TRab are present. Overt maternal hyperthyroidism occurs in approximately 0.2– 0.4% of pregnancies and is defined as a serum TSH level below the trimester-specific reference range with elevated levels of free T4 and T3. As untreated overt hyperthyroidism during pregnancy has been shown to be associated with miscarriage, pre-eclampsia, preterm birth, fetal growth restriction and increased perinatal morbidity and mortality, treatment during pregnancy is mandatory. Subclinical maternal hyperthyroidism (reduced TSH levels with normal levels of free T4 and T3) is not associated with an increased risk of adverse events in the mother and the fetus, and treatment during pregnancy is not recommended. The most common etiology is Graves’ disease; other causes include gestational transient thyrotoxicosis, toxic adenoma, thyroiditis or excessive hormone intake. Neonatal Thyrotoxicosis due to maternal Grave’s disease is caused by the transplacental passage of thyroid stimulating antibody (TRab) present in mothers with Graves’ disease. Consequentely in babies born to mothers with active or inactive hyperthyroidism or family history of activating mutations of TSH receptor (rare), FT4, TSH and TRab levels should be evaluated on cord blood at birth; a physical examination for signs of thyrotoxicosis and presence of goitre should also be performed. Newborns are at high risk of neonatal thyrotoxicosis if the mother has clinical thyrotoxicosis requiring thionamide in the third trimester, has raised TRab during pregnancy, not assessed TRab, family history of TSH receptor mutation or evidence of fetal thyrotoxicosis. High risk newborns should be kept in hospital and observed checking again FT4 and TSH levels at 2–3 days of life; if the baby if well without signs of thyrotoxicosis he/she can be discharged even with pending results. Repeat the physical examination checking again

Avaliação do aleitamento materno de recém-nascidos prematuros no primeiro mês após a alta

The preterm baby has an immaturity in his sync's swallowing and sucking, which is obtained after 34 weeks of gestation. It is important identify the difficulties experienced by mother-child in the breastfeeding process during the hospitalization and after NICU's discharge. The objective was evaluating the breastfeeding process of preterm infants in the first month after discharge from the NICU. This is an exploratory-descriptive research with the case study method. Data was collected through observation of the breastfeeding at the NICU, during hospitalization and one month after hospital discharge, in the outpatient follow-up of the risk newborns. The major difficulties experienced by mothers in hospital and after discharge hospital were: pain while breastfeeding, engorgement; flat nipples and difficulty to keep the baby awake. Concerning the preterm babies, the difficulties were: maintain the baby alert during breastfeeding; sucking-swallowing pattern, breathing rate without coordination during breastfeeding, latch on reflex and position of the baby. The concern with breastfeeding should go beyond the period of hospitalization, it should be continued after discharge once this is the period in which the mother and her baby have more difficulty to adapt and she needs support to maintain the lactation and the breastfeeding.

Does facility-based newborn care improve neonatal outcomes? A review of evidence

Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality. To assess different factors that affect effectiveness of facility based newborn care on neonatal outcomes. Electronic search using key search engines along with search of grey literature manually. Observational and interventional studies published between 1966-Aug 2010 in English having a change in neonatal mortality as an outcome measure were considered. A total of 40 articles were fully reviewed for generating synthesized evidence. All were observational studies. The exposure variables that affected neonatal outcomes were grouped into three categories- regionalization of perinatal care (17 articles), strengthening of lower level neonatal facilities (12), and other miscellaneous factors (11). Regionalization played a key role in advancing newborn care practices. It increased in-utero transfer of high risk newborns and improved survival outcomes especially for very low birth weight neonates at level III facilities. It led to reduction in neonatal mortality owing primarily to enhanced survival of low birth weight infants. Strengthening of lower level units contributed significantly in reducing neonatal mortality. High patient volume (>2,000 deliveries/year), inborn status, availability of referral system and inter-facility transfers, and adequate nursing care staff in neonatal units also demonstrated protective effect in averting neonatal deaths. Countries investing in facility based newborn care should give impetus to establishing regionalized systems of perinatal care. Strengthening of lower level units with high case loads, can yield optimal reduction in NMR.

日本助産学会 エビデンスに基づく助産ガイドライン

日本助産学会は，健康なローリスクの女性と新生児へのケア指針を示したエビデンスに基づく助産ケア―分娩期2012を作成した。ガイドラインを普及させるため，本稿ではガイドラインの内容を紹介している。ガイドラインには，29項目のクリニカルクエスチョンが含まれ，それぞれのクリニカルクエスチョンには，エビデンスの記述，解説，引用文献が記述されている。病院，診療所，助産所において，助産師がガイドラインに示されたケア指針を採択することで，エビデンスに基づいたケア，女性を中心としたケアを推進することができる。

Congenital syphilis surveillance

Congenital syphilis (CS) is mainly a consequence of the lack of antenatal care and control of sexually transmitted infections.The bedrock of the prevention of CS is syphilis diagnosis by serological screening during pregnancy.Current Italian guidelines suggest that all the pregnant women should be tested in the first trimester. Due to the frequently absence of specific signs of infection at birth, laboratory tests are often the only method for a correct CS diagnosis. The aim of this study was to evaluate the usefulness of Treponema pallidum IgM Western Blot (WB) and Polymerase Chain Reaction (PCR) on cerebrospinal fluid (CSF) as an aid in the diagnosis of CS during a prospective surveillance study carried out at St. Orsola Hospital in Bologna, Italy, from November 2000 through June 2010. All pregnant women during pregnancy and at delivery were screened for syphilis by ARCHITECT® Syphilis TP, Abbott. Positive samples were further analysed by Treponema Pallidum Hemagglutination Test (TPHA) and Rapid Plasma Reagin (RPR) tests, Radim.An in-house Western Blot (WB) was also performed. Infants born to syphilis seropositive mothers were enrolled in a prospective follow up. At birth, tests were performed (including IgM WB). Infants with positive RPR tests at birth born to mothers not adequately treated received also a long bone radiograph as well as a complete CSF analysis, including Veneral Disease Research Laboratori (VDRL) (Siemens Healthcare Diagnostics) and PCR testing. All seroreactive infants received careful follow up examinations and serological testing at 0, 3, 6, 9, 12 months or until the tests became negative. In this study, positive syphilis serology was noted in 151 pregnant women delivering in our hospital. Fifteen women had never been adequately treated, and 9 out 15 gave birth to infected newborns.All these 9 infants had positive IgM WB results on serum samples. Two babies had characteristic long bone lesions at X-ray examination and 3 were born preterm. These observations confirmed that antenatal syphilis screening facilitates treatment during pregnancy and offsets vertical transmission; moreover, the use of IgM WB and careful CSF examination allowed the identification and treatment of high risk newborns.

Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study

BackgroundOrganizational improvement of neonatal intensive care units requires strict monitoring of preterm infants, including routine assessment of physiological functions of the gastrointestinal system and optimized procedures for the definition of appropriate discharge timing.MethodsWe conducted a prospective study on the effect of osteopathic manipulative treatment in a cohort of N = 350 consecutive premature infants admitted to a neonatal intensive care unit without any major complication between 2005 and 2008. In addition to ordinary care, N = 162 subjects received osteopathic treatment. Endpoints of the study were differences between study and control groups in terms of excessive length of stay and gastrointestinal symptoms, defined as the upper quartiles in the distribution of the overall population. Statistical analysis was based on crude and adjusted odds ratios from multivariate logistic regression.ResultsBaseline characteristics were evenly distributed across treated/control groups, except for the rate of infants unable to be oral fed at admission, significantly higher among those undergoing osteopathic care (p = .03). Osteopathic treatment was significantly associated with a reduced risk of an average daily occurrence of gut symptoms per subject above .44 (OR = 0.45; 0.26-0.74). Gestational age lower or equal to 32 weeks, birth weight lower or equal to 1700 grams and no milk consumption at admission were associated with higher rates of length of stay in the unit of at least 28 days, while osteopathic treatment significantly reduced such risk (OR = 0.22;0.09-0.51).ConclusionsIn a population of premature infants, osteopathic manipulative treatment showed to reduce a high occurrence of gastrointestinal symptoms and an excessive length of stay in the NICU. Randomized control studies are needed to generalize these results to a broad population of high risk newborns.