Sick Neonates Research Articles

Pregnancy-Specific Stress during the First Lockdown of the COVID-19 Pandemic: Assessing Face-to-Face versus Online Recruitment.

The study aims to assess pregnancy-specific stress among pregnant women in Spain during the first lockdown of the COVID-19 pandemic. Two samples of pregnant women from the south of Spain (Andalusia) were assessed using the Prenatal Distress Questionnaire (PDQ) and a sociodemographic and obstetric questionnaire. Group 1 (N = 155) was recruited face-to-face, whereas Group 2 (N = 78) was recruited online. Pregnancy-specific stress levels were significantly different in both groups. The face-to-face group (Group 1) had higher pregnancy-specific stress levels than the online group (Group 2). The online sample over-represents young adult pregnant women with high education levels and a high number of previous miscarriages. The face-to-face study seems more accessible to racially and ethnically diverse groups. The main concern among both groups was the risk of having a sick neonate. Research during the COVID-19 pandemic can benefit from using online resources to collect data to screen and identify perinatal mental health problems in a crisis environment. Nevertheless, researchers should be aware of the potential limitations this strategy can have, for example, certain groups of people may have limited access to the internet.

Evaluation of blood component transfusion in sick neonates- a retrospective study in a rural tertiary new-born care unit of Eastern India

Background: In recent past, blood transfusion in neonates has developed a lot improving the outcome particularly in premature and low birth weight babies. However, there are no globally followed standardised guidelines for neonatal blood transfusion. The present study conducted with the objective to evaluate the frequency, indications, complications and appropriateness of various blood components transfusion in sick newborn care unit (SNCU) of a resource poor setting.Methods: This retrospective, hospital based, single centre observational study is done in a tertiary care SNCU of a teaching hospital of eastern India. All SNCU admitted neonates who received blood/ blood component transfusion from October 2018 to September 2019 were evaluated for blood component usage and their indications and followed up throughout hospital stay. The data were statistically analysed using Microsoft Excel™ software.Results: In this study 219 neonates received a total of 359 bags of blood component transfusion. Out of these packed red blood cell (PRBC), fresh frozen plasma (FFP), random donor platelet and whole blood were 233 (64.90%), 97 (27.01%), 10 (2.78%) and 19 (5.29%) respectively. The major indications for transfusion were anaemia of prematurity (35.37%), sepsis (26.18%) and bleeding disorder (16.71%). The common transfusion-related complications observed in our study were cardiac abnormality (22.35%), electrolyte disturbance (6.40%) and hypoglycaemia (19.17%).Conclusions: Anaemia of prematurity was the foremost indication of transfusion. Multiple transfusions were associated with prematurity and low birth weight.

Lung ultrasound in neonates - An underused tool.

Point of care lung ultrasound (USG) can help in the diagnosis and management of critically sick neonates. It is based on seven simple principles that are comprehensive enough to diagnose all major lung pathologies. A compact small machine and a micro-convex or linear probe are the basic requirements to perform lung USG. In contrast to traditional USG principles, USG of the lung is based on artefacts. Some of the terminologies that are used to characterize normal lung include the pleural line, A-line, bat sign, lung sliding and seashore sign. Air/fluid mixture in varying ratios helps in diagnosis of normal lung, pneumothorax, interstitial syndrome (transient tachypnoea of newborn, respiratory distress syndrome, bronchopulmonary dysplasia), lung consolidation and pleural effusion.

Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate—expert consensus statement of the international crashing neonate working group

Sudden unexpected clinical deterioration or cardiorespiratory instability is common in neonates and is often referred as a “crashing” neonate. The established resuscitation guidelines provide an excellent framework to stabilize and evaluate these infants, but it is primarily based upon clinical assessment only. However, clinical assessment in sick neonates is limited in identifying underlying pathophysiology. The Crashing Neonate Protocol (CNP), utilizing point-of-care ultrasound (POCUS), is specifically designed for use in neonatal emergencies. It can be applied both in term and pre-term neonates in the neonatal intensive care unit (NICU). The proposed protocol involves a stepwise systematic assessment with basic ultrasound views which can be easily learnt and reproduced with focused structured training on the use of portable ultrasonography (similar to the FAST and BLUE protocols in adult clinical practice). We conducted a literature review of the evidence-based use of POCUS in neonatal practice. We then applied stepwise voting process with a modified DELPHI strategy (electronic voting) utilizing an international expert group to prioritize recommendations. We also conducted an international survey among a group of neonatologists practicing POCUS. The lead expert authors identified a specific list of recommendations to be included in the proposed CNP. This protocol involves pre-defined steps focused on identifying the underlying etiology of clinical instability and assessing the response to intervention.Conclusion: To conclude, the newly proposed POCUS-based CNP should be used as an adjunct to the current recommendations for neonatal resuscitation and not replace them, especially in infants unresponsive to standard resuscitation steps, or where the underlying cause of deterioration remains unclear.What is known?• Point-of-care ultrasound (POCUS) is helpful in evaluation of the underlying pathophysiologic mechanisms in sick infants.What is new?• The Crashing Neonate Protocol (CNP) is proposed as an adjunct to the current recommendations for neonatal resuscitation, with pre-defined steps focused on gaining information regarding the underlying pathophysiology in unexplained “crashing” neonates.• The proposed CNP can help in targeting specific and early therapy based upon the underlying pathophysiology, and it allows assessment of the response to intervention(s) in a timely fashion.

Admission and outcome patterns among neonates admitted to the Federal Police referral hospital's neonatal intensive care unit in Addis Ababa, Ethiopia

Background: The rate of morbidity and mortality in the neonatal period remains high in Ethio-pia. Assessing the Neonatal intensive care unit cases regularly is vital as the disease pattern and mortality are not known in the police population.Objective: The aim of this study was to identify the number, types, clinical features of sick neo-nates admitted and their discharge outcome at the neonatal intensive care unit of Federal police hospital, Ethiopia since the time of its establishment two years ago.Methods: A hospital-based cross-sectional retrospective review of medical records of sick neo-nates 0-1 month of age admitted to the neonatal unit at the Federal police Hospital, Addis Ababa Ethiopia from September 01, 2019 to October 30, 2021.Results: The medical records of all 155 sick neonates during the study period were included in this study. Among the estimated 3600 deliveries at federal police hospitals during the study peri-od, the neonatal admission rate was 155/3600 (4.3 %). The majority of neonates, 130 (83.9%), were admitted with the age less than 48 hours. Ninety-one (58.7 %) were male and 64(41.3 %) were female neonates making the male to female ratio 1.4:1. Prematurity accounts for 54 (34.8%) of admissions. Sepsis was the main reason for admissions 58 (37.4%), followed by birth asphyxia 12 (7.7%), and neonatal jaundice 10(6.4 %). On discharge, 133 (85.8%) were improved and dis-charged, 2(1.29%) left against medical advice, and 3(1.9%) were referred while 17(10.9%) of the admitted patients died.Conclusion: Prematurity related causes, neonatal infection and birth asphyxia were the main rea-sons for neonatal admissions and neonatal mortality was high in the first 24 hours of age. Neonatal admissions at Federal Police Hospital NICU mirror the national profile of Ethiopian Neonatal In-tensive Care Units. Due attention should be given to address these issues and to reduce mortality.

Sex differences in the care of the fetus in the mother's womb and the neonate on her lap: Evidence from demographic surveillance and survey data from Bangladesh

Valuation of sons over daughters introduces sex-biased health, economic, and socio-demographic inequalities in many societies. This study aims to examine fetus-sex differences in maternity services and sex differences in medical care for terminally ill neonates in Bangladesh, using secondary data from the Matlab Health and Demographic Surveillance System (HDSS), maintained by icddr,b since 1966 along with data from the Bangladesh Maternal Mortality and Health Care Survey (BMMS) 2016. The HDSS follows a well-defined rural population (0.24 million in 2018) to register vital events and migrations and records the use of maternity services for the index birth and medical care-seeking during the terminal illness of each death in verbal autopsy. The BMMS 2016 recorded maternity care and maternal complications for the last live birth of mothers in the same population (weighted n = 27,133; unweighted n = 26,939). Bivariate analyses estimated the use (in %) of maternity services for the index live births and medical services for terminally ill neonates for each socio-demographic variable. Logistic regression models estimated odds ratios (AORs) adjusted for socio-demographic variables and clustering of births to the same mothers. The HDSS registered 49,827 live births and 1,049 neonatal deaths during 2009–2018. We found similar prenatal care-seeking for male and female fetuses but higher facility delivery (AOR = 1.17, 95% CI: 1.12–1.23) and C-sections (AOR = 1.20, 95% CI: 1.15–1.25) for male fetus pregnancies, differences that remain after adjusting for maternal complications. Sex differences persisted in seeking care for terminally ill neonates. Trained provider consultation (AOR = 1.46, CI: 1.00–2.12); hospital admissions (AOR = 1.43, CI: 1.01–2.03); and dying in hospital (AOR = 1.91, CI: 1.31–2.78) were all higher for male neonates. Other variables positively associated with delivery care and medical care-seeking were lower birth order of the child, higher maternal education, and higher household wealth status. Policy and decision-makers need to be aware of gender disparities in maternity care and care of sick neonates and plan remedial actions.

Hemophagocytic lymphohistiocytosis - A fatal cause of persistent fever in neonates: A case series

Primary hemophagocytic lymphohistiocytosis (HLH) is a rare fulminant genetic disease with uncontrolled immune activation and multiorgan involvement. It is quite rare in neonates but a high index of suspicion is needed as the condition will present like sepsis and is associated with high mortality. Persistent fever is a prominent clinical feature. Genetic diagnosis is essential as the condition is autosomal recessive in familial types. Here, we report four cases of HLH diagnosed in the newborn period. We got an uncommon homozygous genetic mutation in STXBP2 involving exon 19, which has been reported only in very few cases. HLH should be considered as a differential diagnosis in any sick neonate who presents with prolonged fever with an unusual clinical course

Post-transport TOPS score as a predictive marker of mortality among transported neonates and its comparative analysis with SNAP-II PE

AimMultiple parameters are available to predict the outcome of critically sick neonates admitted in neonatal intensive care unit (NICU). Main aim of the study is to validate the role of TOPS, especially the post-transport TOPS score as a simplified assessment of neonatal acute physiology in predicting mortality among transported neonates admitted at level III NICU. Also, to compare the efficiency of post transport TOPS score with SNAP II PE in predicting mortality. MethodsA prospective study carried out with 85 neonates transported from various primary health care centres to level III NICU. Physiological status of the neonates was assessed with the help of pre and post transport TOPS scores. Post-transport TOPS score was recorded immediately after the admission and SNAP II PE within 24 h of admission at level III NICU. Receiver operating characteristics analysis was performed to observe the mortality prediction efficiency of TOPS score and was compared with SNAP II PE. Results64 neonates were died due to asphyxia and preterm birth (32%) related complications. Strong significant association with the mortality rate was found between the total post transport TOPS score (0.001) and SNAP II PE (0.003). The AUC, sensitivity and specificity of post transport TOPS score for a cut-off value ≤7 were 0.900, 87.5% and 80% and significant (<0.001) and for SNAP II PE for a cut-off value >12 were 0.913, 75.5% and 100% and is significant (<0.001). ConclusionTOPS score, especially the post transport TOPS score has an equally good prediction capacity of mortality similar like SNAP II PE among mobilised critically ill neonates. Hence, the TOPS score can be used as a simple and effective method to predict mortality risk among transported neonates immediately after admission at level III NICU.

Burden and Outcomes of Birth Asphyxia in Neonates Admitted to the Neonatal Intensive Care Unit of The Tamale Teaching Hospital

Objective: The aim of this study was to determine the burden, outcomes and factors associated with outcomes of birth asphyxia among sick neonates admitted to the Neonatal Intensive Care Unit (NICU) of the Tamale Teaching Hospital (TTH).Patients and Methods: A retrospective descriptive study design was used. Subjects included all neonates admitted to the unit with diagnosis of birth asphyxia, during the study period (January 2018-December 2019), who met the inclusion criteria. Descriptive statistics were presented in tables and graphs. Multiple logistic regression was used to identify independent predictors of mortality.Results: The prevalence of birth asphyxia was 17.6% of admissions. There were more males (594,60.3%) than females and most (707,74.3%) of the cases seen were inborn. Majority (617,63.3%) were delivered via spontaneous vaginal delivery. APGAR scores ≤ 3 wasseen in 259(26.3%) of the babies. The case fatality rate was 14.9% and more than half (78,53%) occurred within the first 24 hours of admission. Outborn babies were 2.7 times more likely to die from birth asphyxia compared to inborn babies(p-value=&lt;0.001). Babies with APGAR scores ≤ 3 were 3.9 times more likely to die compared to babies with APGAR scores 4-6 at one minute, (pvalue=&lt;0.001) and babies born to mothers &lt; 20 years of age were 2 times more likely to die as compared to older mothers (p-value=0.048).Conclusions: Birth asphyxia is common in our facility. Outborn babies, babies with one-minute APGAR score ≤3, and maternal age &lt; 20 years were significantly associated with mortality.

Approach to a Sick Neonate with Cholestasis in India

Approach to a Sick Neonate with Cholestasis in India

Evaluation of Modified Extended Sick Neonate Score to Predict In-Hospital Mortality among Newborns Admitted to Resource-Poor Settings in Rural India.

To devise a score based on eight extended sick neonatal score (ESNS) variables by adding two more variables, birth weight, and gestational age to check its efficacy. A retrospective study was conducted on 521 neonates admitted from January 2018 to June 2020 in the neonatal intensive care unit (NICU) of a tertiary care center. The proposed score has the following components, respiratory effort, heart rate, axillary temperature, capillary refill time, random blood sugar, pulse oximeter saturation, Moro reflex, modified Downes score, gestation age, and birth weight. Each was scored as 0, 1, and 2. The total score for each neonate was calculated from the records available and outcome documented. Receiver operating characteristic (ROC) curve was generated; and a cutoff score was derived to predict mortality and compared with modified sick neonatal score (MSNS). Modified ESNS has a strong correlation with the outcome. Area under the ROC curve was 0.995 (95% CI: 0.925-0.985) for modified ESNS and 0.933 (95% CI: 0.901-0.976) for MSNS. The optimum cutoff values for predicting mortality were 15.5 for modified ESNS and 12.5 for MSNS. For a cutoff score of ≤ 15, sensitivity and specificity were 86.27% and 86.60% for modified ESNS and 90.20% and 84.89%, respectively, for MSNS, in predicting mortality. Positive and negative predictive values were 41.12% and 98.31% for modified ESNS and 39.32% and 98.76%, respectively for MSNS. The modified ESNS can predict in-hospital mortality among neonates, with good sensitivity and specificity.

Nonvirilized external genitalia in a Nigerian female neonate with salt-wasting congenital adrenal hyperplasia

Abstract A 3-week-old female neonate presented with complaints of weakness and inability to feed. She had been delivered at a general hospital with a birth weight of 3.3 kg. She had jaundice, which was treated with phototherapy and resolved after 3 days. Pregnancy and delivery were uneventful. Parents identified her as female. Examination revealed hanging skin folds, dehydration, tachycardia, hyperpigmentation and swelling of the labial folds, no clitoromegaly, and no palpable gonads. She had lost 30% of her birth weight and was hypoglycemic. Serum investigations showed hyponatremia, metabolic acidosis, hyperkalemia, and hypocortisolemia with elevated testosterone and 17-hydroxyprogesterone. Pelvic ultra sound scan showed normal-sized uterus and no testes suggesting a diagnosis of salt-wasting congenital adrenal hyperplasia (CAH). She is being managed with hydrocortisone, fludrocortisone, and added salt to feeds. Labial swelling and hyperpigmentation have resolved and external genitalia is typically female in appearance. She is gaining weight and thriving. Salt-wasting CAH can present with adrenal crisis without obvious virilization of the external genitalia in the female neonate and can be diagnosed by scrutiny of electrolytes in the sick neonate.

Challenges of Management and Outcome of Neonatal Medical Emergencies in a Peripheral Hospital, Bangladesh

Background: Respiratory distress and desaturation remains a significant cause of neonatal intensive care admission ,althoughmanagement has evolved gradually over the years resulting in improving survival for the these neonates . Still 10% of neonatesrequire respiratory support immediately after delivery due to respiratory disorder, and up to 1% of neonates are in need ofresuscitation. Objectives: The aim of the study is to present some fundamental steps of emergency neonatal management which includerapid identification and admission , followed by assessment for respiratory distress, hypoxemia and hypoglycemia ,initialstabilization when required and early administration of medications. Methods: This hospital based retrospective study was conducted at Combined Military Hospital ,sylhet ,Bangladesh fromApril 2021 to September 2022 .A total 224 sick neonates shortly after delivery included for this study. Results: From April ,2021 to september 2022, 917 newborn were born, of which 224 neonates were identified and admitted as a emergency cases immediate after delivery at combined military hospital,sylhet .Immediately after admission around allcases were assessed for hypoxemia ,hypoglycaemia and hypothermia.Around 66% were hypoxemic (preterm 71.4% ,22.3%in full term and 6.2% in post term ).There was male predominance 55% .Respiratory distress syndrome (RDS ) was found to bethe commonest 35.7% causes followed by persistent pulmonary hypertension with large patent ductus arteriosus(PPHN withPDA) 17.8% ,septicemia 16.9% ,meconium aspiration syndrome (MAS) 8.9%, transient tachypnea of newborn (TTN) 8%,congenital pneumonia 4.9% ,perinatal asphyxia (PNA) 3.5% , large atrial septal defect (ASD) with ventricular setal defect(VSD) 2.6% and 1.75% was hypoglycemic .All babies received immediately oxygenation . Bubble CPAP was required in 90(40.1%) cases. Vascular access was established in all cases and 2.6% neonates received medications bycentral (femoral) line.Mortality was 2( 0.8%) in neonates with respiratory distress due to respiratory distress syndrome with multiple congenitalanomalies . 2(0.8%) cases referred to tertiary hospital (Combined Military Hospital,Dhaka ) requiring mechanical ventilation. Conclusion: Early and appropriate treatment seeking is one of the most important aspects for interrupting the pathways to neonatal deaths due to severe illness. In developing countries, the role of Paediatrician is multidimensional . paediatrician by early detection of risk factors and timely intervention can reduce significantly neonatal mortality rate.

Mothers’ Knowledge on Neonatal Jaundice attending a Neonatal Intensive Care Unit of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: Neonatal jaundice is one of the commonest conditions which require hospital admission in newborns.Objective:To assess the baseline knowledge and attitude of mothers about jaundice in newborn who attended Neonatal Intensive Care Unit (NICU) of a tertiary care hospital.Methods:This descriptive, cross-sectional study was conducted on 324 mothers who attended the Neonatal Intensive Care Unit (NICU)of Dr. M R Khan Shishu (Children) Hospital, Dhaka, Bangladesh, with their sick neonates. A face-to-face interview was done based on a pre-designed structured questionnaire.Results:Mean age of the respondents was 26.17±4.93 years. Most of them (76%) have heard about neonatal jaundice before the survey. Forty two percent mothers thought that it is a mild condition and does not require treatment (45%). Sunlight is the known treatment by most of mothers (65%).Conclusion: There is a serious knowledge gap among mothers regarding the perception, severity and treatment of neonatal jaundice. Education program is needed for pregnant women to increase awareness on this important neonatal issue.International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Page: 304-308

Hypothyroxinemia in sick term neonates and its risk factors in an extramural neonatal intensive care unit: a prospective cohort study.

Thyroid functions in the sick newborns may be altered in the first week of life. Transient hypothyroxinemia has been reported in these babies, which could be due to the immaturity of the hypothalamic-pituitary-thyroid axis or to acute illness. We conducted this study to estimate the incidence of hypothyroxinemia and determine its risk factors in sick term newborns. We analyzed free T4 (FT4) and thyroid-stimulating hormone (TSH) levels in sick term neonates (≤7 days of life) admitted to the neonatal intensive care unit. FT4 and TSH levels were estimated in the first week of life in all the enrolled neonates (N = 98) and then repeated at 14-21 days of life in 46 babies. Risk analysis was conducted using univariate and multivariate logistic regression, and numerical data was compared using the Mann-Whitney U test and t-test. Hypothyroxinemia was seen in 10 (10.2%) of the admitted term babies. Male gender, vaginal delivery, presence of hypoxic ischemic encephalopathy, and need for mechanical ventilation (>24 hours) were identified as risk factors. There was a significant negative linear correlation between FT4 level in the first week of life and duration of hospital stay. Hypothyroxinemia is common in sick term neonates.

High Magnitude of Neonatal Anemia Among Sick Newborns Admitted to University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

IntroductionAnemia is a global health problem that affects all ages, particularly children under five years. If not treated early, childhood anemia results in impaired growth, delayed cognitive development, and organ dysfunction. There is a scarcity of studies on the prevalence of anemia among hospitalized sick neonates, especially in developing countries.ObjectiveThis study aimed to determine the magnitude of anemia and associated factors among hospitalized sick newborns at the University of Gondar Comprehensive Specialized Hospital (UOGCSH).MethodsAn institutional-based cross-sectional study was conducted among admitted newborns from June 1 to September 30, 2020. All newborns whose gestational age (GA) ≥28 weeks and postnatal age ≤28 days, admitted to UOGCSH during the study period were included in the study. Data were collected by pediatric residents and a systematic random sampling technique was used to select the study participants. Statistical analysis was performed using SPSS version 20. Binary logistic regression was used to identify associated factors with neonatal anemia. P-value <0.05 was considered statistically significant.ResultsDuring the study period, 272 newborns were enrolled. The mean hemoglobin value was 15.74 ± 4.27 gm/dL. The prevalence of neonatal anemia in the study population was 30.1% (95% CI: 24.6–35.7). Neonatal age >7 days (AOR = 4.41, 95% CI: 1.86–10.5), maternal anemia (AOR = 9.93, 95% CI: 4.36–21.6), antepartum hemorrhage (AOR = 4.05, 95% CI: 1.54–10. 7), being multiple births (AOR = 4.70, 95% CI: 1.73–12.8), subgaleal hemorrhage (AOR = 7.56, 95%: 1.87–30.6), and hyperbilirubinemia (AOR = 3.84, 95% CI: 1.58–9.31) were associated with neonatal anemia.Conclusion and RecommendationThe prevalence of anemia among hospitalized newborns was high. The current study recommends that healthcare providers should screen anemia among sick newborns who had risk factors. Prevention of maternal anemia and early treatment of obstetric complications will reduce the burden of anemia in sick neonates.

Retrieval of a Broken Umbilical Artery Catheter in a Neonate

Background Umbilical arterial catheterization is an extremely useful tool in the premature, sick neonate for intensive monitoring and as a source of arterial blood sampling. We describe the case of an inadvertent breakage of an umbilical artery catheter (UAC), to replace it, and the potential complications that can arise. Case Report A premature 33-week infant weighing 1.965 kg was admitted to the neonatal intensive care unit (NICU) and had umbilical catheterization. An abdominal X-ray (AXR) was done following the procedure to confirm the position, and the UAC was found to be too low, between T11 and T12. In attempting to replace it, the UAC was transected, with the umbilical stump bleeding, and the internal tip not seen. The patient underwent laparotomy and examination under anesthesia revealed a UAC that was palpable in the right lower quadrant and fluoroscopy revealed a tip in the external iliac artery. This migrated with each subsequent palpation. Meticulous dissection revealed a catheter which was palpable in the right internal iliac artery. The bifurcation was cleared, and vascular slings applied, getting proximal and distal control. The vessel was opened, and the catheter retrieved in its 15-cm entirety. The vessel was repaired with 7/0 Prolene suture. Conclusions This case is intended to highlight that even a trivial procedure of UAC removal must be done carefully with appropriate instrumentation to prevent this complication. For retrieval of this type of vascular foreign body, an open technique can be used with the assistance of fluoroscopy. Endovascular retrieval techniques are also an option but are not available in our setting for this age group.

Virtual assessments of infection prevention and control practices in African neonatal facilities: A pilot study

Background: Evidence-based infection prevention and control (IPC) practices to reduce healthcare-associated infections in low- and middle-income countries may be difficult to implement due to lack of resources. We pilot-tested the feasibility of virtual assessments of IPC practices in African facilities caring for small and/or sick neonates for opportunities to improve IPC. Methods: We created a checklist (in English and French) to assess IPC practices in African facilities caring for small and/or sick neonates Results: In total, 10 sites participated in this pilot study. Among them, 3 sites had unreliable Internet connections, and all checklist items could be observed and scored in these videos and photos. The lowest scores occurred for kangaroo mother care (KMC) spacing and presence of screens (Table 1). Conclusions: This pilot study demonstrated the feasibility of using virtual assessments of IPC practices. We identified several potentially low-cost opportunities to improve IPC. We are recruiting additional sites to confirm the findings of this pilot study.Funding: Bill and Melinda Gates FoundationDisclosures: None

Usefulness of Neurosonogram in Critical Ill Neonates

The Cranial Neurosonogram is the preferred method for viewing the infant's brain. Ultrasound tools are portable and may be used at the NICU bedside. This corresponds to the concept of point-of-care testing. The difficulties associated with moving newborns to CT or MRI rooms are eliminated. Furthermore, ultrasound is less expensive than CT, has no radiation impact, and does not require sedation, which is required for MRI. Cranial sutures are still open in newborns, allowing us to glimpse within the brain using ultrasonography. A radiologist or neonatologist specializing in that profession should do the neurosonogram. The majority of the time, the course of therapy and subsequent care of the patient can be based on a Neurosonogram finding. Regardless of weight, height, or gestational age, any neonate who has a higher risk of morbidity or death due to fetal, placental, or maternal factors is classified as critically unwell. A sick neonate is defined as any neonate, regardless of birth weight, size, or gestational age, who has a greater than average risk of morbidity or mortality due to fetal, maternal, or placental anomalies or an otherwise compromised pregnancy within the first 28 days of life.

What is the Effect of Topical Breast Milk Application on Umbilical Cord Separation among Healthy Newborn Babies in the Middle East?

Umbilical cord care is variable all over the world and is informed by firm traditional practices that are passed down as culture. Breast milk has been proposed as a topical substance to the umbilicus as it is full of antibacterial properties. The analysis of four studies revealed a strong correlation between the use of topical breast milk and umbilical cord separation time among newborns in the Middle East. Comparing the results of the studies included in this review, breast milk is not only effective in shortening the separation time of the umbilical cord over dry cord care but is just as effective in reducing signs of infection as the antimicrobial chlorhexidine. These findings designate breast milk as an affordable, easy, and practical method of umbilical cord care. This is particularly useful in developing countries, where the risk of neonatal death due to infection is higher. The result is generalizable to healthy neonates born in a hospital setting, so more research about its practicality in rural areas as well as among sick neonates is suggested.