Sick Neonates Research Articles

Use of diuretics in the neonatal period.

The use of diuretics is extremely frequent in sick neonates, the more so in very premature newborn infants. The use of diuretics in patients whose kidney function is immature necessitates a thorough knowledge of renal developmental physiology and pathophysiology. This review presents the basic aspects of body fluid homeostasis in the neonate, discusses the development of kidney function, and describes the mechanisms involved in electrolyte and water reabsorption along the nephron. Diuretics are then classified according to the site of their action on sodium reabsorption. The use of diuretics in sodium-retaining states, in oliguric states, in electrolyte disorders, and in arterial hypertension, as well as in a few specific disorders, is presented. Common and specific adverse effects are discussed. Recommended dosages for the main diuretics used in the neonatal period are given. New developments in diuretic therapy are briefly mentioned.

Clinical profile of hypoglycemia in neonates admitted in neonatal intensive care unit of a tertiary care hospital

Background: This study was conducted to study the clinical profile of hypoglycemia in newborn and to determine the prevalence of hypoglycemia among neonates admitted in NICU.Methods: All newborns admitted in NICU were examined and those with hypoglycemia (GMR<45 mg/dl) were included in the study and observed. In neonates with risk factors blood sugar was screened at 2, 6, 12, 24, 48 and 72 hours of life or whenever symptoms suggestive of hypoglycemia developed in any neonates and for critically sick neonates blood sugar was screened in every 6 hour in active phase of illness. Any neonates with blood glucose level less than 45 mg/dl were analysed for maternal risk factors, neonatal risk factors and course in the NICU.Results: The prevalence of neonatal hypoglycemia was 14.9% among NICU admissions. The maternal risk factors were GDM, PIH, and PROM. The neonatal risk factors were prematurity, SGA, LGA and comorbid conditions which include perinatal asphyxia, sepsis, polycythemia, shock. The common symptoms were poor feeding, lethargy, jitteriness, convulsions, irritability, hypotonia and cyanosis. Majority of the neonates required only oral feeds for correction of hypoglycemia.Conclusions: Blood glucose screening in neonates with this risk factor is mandatory as many of the neonates were asymptomatic. The importance of early initiation of breast feeding to prevent hypoglycemia should be emphasized.

Normative Values for Auditory Brainstem Responses and Wave V Thresholds in Indian Neonates and Infants.

Click-evoked auditory-brainstem-response (ABR) is widely used for hearing screening in neonates and infants. However, their normative values are based on small studies. This retrospective study was done at a tertiary-care centre where click-ABR based screening is done in all newborns. ABR records (Nihon-Kohden machine, model MEB-9400K) of 420 healthy neonates (preterm 75; full-term 32) and infants (113) done over a period 4years (2014-2018) were analysed retrospectively. Sick neonates and those with Wave V threshold > 40dbnHL were excluded. Infants were divided into four groups based on post-conceptual age, Group A (75): 34-36 weeks; Group B (44): 37-40weeks; Group C (188):41weeks-1 month; and Group D (113): 1-6months. The mean absolute latencies for wave I, wave III, and wave V varied from 1.45-1.56 milliseconds (ms), 4.14-4.37ms, and 6.36-6.81ms respectively. Interpeak latencies for I-V and I-III varied from 4.91ms to 5.22ms and 2.69ms to 2.81ms respectively. Older infants had lower absolute and interpeak latencies. Late preterm babies were not different from term babies suggesting early maturation of brainstem pathways.

Contemplate enteroviral etiology: Not all neonatal sepsis syndromes are bacterial

Sepsis is one of the most common clinical diagnosis made in neonatal intensive care units. However, there are not so uncommon situations when the laboratory results do not support bacterial infections. Viral infections are under-recognized and often missed in sick neonates. We describe a case series of neonatal nonpolio enteroviral sepsis confirmed by the polymerase chain reaction. Although the first patient expired, early recognition of etiology in the index case helped control an outbreak.

Recurrent Tension Pneumopericardium in a Term Neonate on High-Frequency Ventilation

Background: Air leak syndrome (ALS) can be seen in sick neonates on positive pressure ventilation. Tension pneumopericardium is uncommon, but life-threatening if not promptly identified and treated. Needle decompression can be life-saving. Recurrent tension pneumopericardium is difficult to treat and ideally indicates the placement of a pericardial drain under fluoroscopic guidance. We describe an alternative technique of percutaneous drain placement using intrapericardial saline infusion when the transport of the neonate to a catherization laboratory was not feasible. Clinical Description: A neonate with hyaline membrane disease and persistent pulmonary hypertension of new-born on high-frequency mechanical ventilation developed recurrent tension pneumopericardium that caused hemodynamic compromise. Management: Emergency needle decompression was performed twice. Further recurrence necessitated pericardial drain placement under echocardiographic guidance. Rapid exit of air from the pericardial cavity made advancement of the guidewire challenging. A small amount of sterile saline was injected in the pericardial space to assist advancement following which placement of the pericardial drain was successful. Subsequently, the neonate had an uneventful course and was discharged after 3 weeks. Conclusion: Prompt recognition and management of ALS can be life-saving. Urgent needle decompression and pericardial drain placement can be performed under fluoroscopic (ideally) or echocardiographic guidance by trained personnel. Instillation of saline in the pericardial space may assist with pericardial drain placement.

Umbilical Vein Connection to Right Atriumwith Absent Ductus Venosus: A RareCongenital Defect

Introduction: An abnormal course of the Umbilical Vein (UV) is a rare anomaly and this can be associated with the congenital absence of the Ductus Venosus (DV), cardiac and extra-cardiac anomalies. The major clinical importance of these anomalies is the need to recognize them during prenatal and postnatal diagnostic studies and at the time of cannulation or catheterization of the umbilical vein in sick neonates. Through targeted examination of the fetal heart and the venous system, a correct prenatal diagnosis is possible. Case Report: A 25-year-old gravida 1 para 0 with type 1 diabetes mellitus at 21+6 weeks gestation referred for fetal echocardiogram because abnormal vessel was noted connecting the UV to the right atrium on the obstetric ultrasound by her maternal fetal medicine specialist. A diagnosis of drainage of the UV directly into the right atrium with absent DV and other minor cardia defects were made on the fetal echocardiogram. Preterm delivery occurred at 31+3 weeks gestation and had a favorable clinical course. Conclusion: An abnormal course of the umbilical vein is a rare anomaly and this can be associated with the congenital absence of the Ductus Venosus (DV), cardiac and extra-cardiac anomalies. Through a thorough and meticulous ultrasonographic assessment, the diagnosis can be made and that will be helpful in guiding the management of the rest of the pregnancy and counsel the family what to expect.

Important Newborn Cardiac Diagnostic Dilemmas for the Neonatologist and Cardiologist–A Clinical Perspective

Most congenital heart disease (CHD) is readily recognisable in the newborn. Forewarned by previous fetal scanning, the presence of a murmur, tachypnoea, cyanosis and/or differential pulses and saturations all point to a cardiac abnormality. Yet serious heart disease may be missed on a fetal scan. There may be no murmur or clinical cyanosis, and tachypneoa may be attributed to non-cardiac causes. Tachypnoea on day 1 is usually non-cardiac except arising from ventricular failure or a large systemic arteriovenous fistula. A patent ductus arteriosus (PDA) may support either pulmonary or systemic duct dependent circulations. The initially high pulmonary vascular resistance (PVR) limits shunts so that murmurs even from large communications between the systemic and pulmonary circulations take days/weeks to develop. At times despite expert input, serious CHD maybe difficult to diagnose and warrants close interaction between the neonatologist and cardiologist to reach a timely diagnosis. Such conditions include obstructed total anomalous pulmonary venous connections (TAPVC) and the need to distinguish it from persistent pulmonary hypertension in the newborn (PPHN)–the treatment of the former is surgical the latter medical. A large duct shunting right to left may overshadow a suspected hypoplastic aortic isthmus and/or coarctation. Is the right to left shunting because of severe aortic obstruction or resulting from a high PVR with little obstruction. The diagnosis of pulmonary vein stenosis (PVS) remains problematic often developing in premature infants with ongoing bronchopulmonary dysplasia (BPD), still being cared for by the neonatologist. While there are other diagnostic dilemmas including deciding the contribution of a recognised CHD in a sick neonate, this paper will focus on the above-mentioned conditions with suggestions on what may be done to arrive at a timely diagnosis to achieve optimal outcomes.

Newborn Screening-A Bolstering Step towards Quality Health in Neonates

Introduction: Newborn Screening (NBS) is considered the need of the hour for quality health in neonates. It is also important to understand that the rising trend of prevalence of inherited metabolic disorders and the various maternal factors that might influence genetic changes in the foetus in- utero affecting the neonatal outcome. Aim: The primary objective of the study was to determine frequency of Congenital Hypothyroidism (CH) and Glucose- 6-Phosphate Dehydrogenase (G6PD) deficiency in a most approachable tertiary care hospital. The secondary objectives were to find out impact of maternal factors on the frequency of the disease and the impact of the disorder on the neonate’s health. Materials and Methods: The cross-sectional study was conducted on 1282 neonates of 48 hours upto eight weeks of age. The Dried Blood Spot (DBS) specimens collected were analysed for Thyroid Stimulating Hormone (TSH) level and G6PD enzyme activity. Details of neonatal characteristics and antenatal history were documented. Prevalence of CH and G6PD deficiency was calculated and maternal and neonatal variables were analysed for association using Statistical Package for the Social Sciences (SPSS) version 20. Results: The prevalence of CH and G6PD were respectively 3.3/1000 and 6.6/1000 making the overall prevalence of metabolic disorders as 9.8/1000. A 27.3% had Low Birth Weight (LBW) and 62% had low Ponderal Index (PI). The odds for raised TSH was 6.62 times in sick neonates. The probability for high TSH in LBW babies was more by 94% and in female neonates by 18%. The neonates with higher TSH values depicted significant association with maternal age (p=0.016), gestational age (p=0.019) and maternal anaemia (p<0.001). Babies born by caesarean section showed twice the chances for screening positive for TSH. Conclusion: The high prevalence estimated in this study and association with maternal factors urges new queries and recommends an obligatory need for NBS program in this region.

Outcomes of Sick Neonates Transported to a Tertiary Care Hospital by a Trained Team, in Northern India

Introduction: In developing countries, like ours, the major causes of neonatal mortality are Prematurity, Birth asphyxia and Sepsis. Although institutional delivery and in utero transport of newborn is the safest way to transport but it is difficult to anticipate preterm deliveries and perinatal illnesses. Moreover, transport with a well equipped and manned team improves neonatal outcomes than self transport. Hence, with the above hypothesis this study was conducted to analyse the profile of newborn babies transported to our unit by our team. Aim: To study the outcome of the sick neonates transported by a well equipped and manned neonatal transport to a Tertiary Care Hospital, indications of transport and also evaluate their condition at arrival. Materials and Methods: This was a retrospective longitudinal descriptive study, including 101 extramural neonates who were transported by a well equipped and manned team, to a Tertiary Care Hospital in Northern India. Transport details along with demographic parameters and clinical features prior to transport and at arrival were recorded. Follow-up was done for all neonates till discharge or death. Transport, clinical variables and Score for Neonatal Acute Physiology-Perinatal Extension ll (SNAPPE-II) were correlated with outcome using logistic regression analysis. Results: Total 101 newborn infants were transported. Fifty- eight babies were term and 43 were preterm. Birth asphyxia, Meconium Aspiration Syndrome, Hyaline Membrane Disease, Transient Tachypnea of Newborn, Congenital Cyanotic Heart Disease, Neonatal Jaundice, Pneumonia, Hypoglycaemia, Preterm, Fever, Feed intolerance were the major indications for transport. Total 16 neonates died. Out of all babies at admission, 14.8% of babies were still hypothermic, 10.8% were still hypoxic, 4.9% were still hypoglycemic and 14.8% were still in shock. SNAPPE score >40, hypoglycaemia, hypothermia, hypoxia and shock correlated with poor outcome. Distance did not correlate with the outcome. Conclusion: Stabilising newborns prior to transport is crucial and neonatal transport is not dependent on distance. Hypothermia, hypoglycaemia, hypoxia and shock should be managed in neonates before and during transport as they affect their outcomes.

Epidemiology of newborn transport in India - The reality check

Background: Transporting sick neonates from the periphery to a tertiary care unit is a challenge and transport-related factors can have a bearing on their survival. These factors influence ultimate survival in resource poor settings. Objectives: The objective is to evaluate the transport characteristics for sick newborns from peripheral centers to tertiary care referral hospital. Methods: A prospective study was done with sick newborns transported to our tertiary care teaching hospital over a period of 1 year. The transport logistics were recorded in detail and analyzed. The analyses were repeated for preterm and term babies separately. Results: There were 36.32% preterm babies in the study cohort of 961 newborns. The descriptive profile of the newborns enrolled in the study has been presented along with descriptive summary of the newborn transport logistics. Approximately 23% of babies were born to teen age mothers. Some prereferral counseling was done for only about 20% babies and <1% had vitals monitored during transport. Prereferral stabilization was scarce and around 41% babies had labored breathing or gasping at admission. As many as, 47% babies had no prereferral intervention and 31% had no referral notes; in only 3.3% instances, there was clear prior intimation to the referral unit. Conclusion: Sick newborn transport logistics are to be improved for reducing neonatal mortality in resource poor settings.

Measurements of Rates and Parameters in Newborn Babies Fit for Discharge at a Tertiary Hospital in North-Western Nigeria

Introduction: The arrival of a newborn brings a mixture of excitement and anxiety, due to a wide variation in physical and physiologic findings. Neonatal morbidity and mortality remain alarmingly high in North-western Nigeria, and failure to recognize a sick neonate that needs medical attention contributes to these dire statistics. Therefore, an understanding of the variations of newborn parameters allows health-care personnel to address families' concerns and support parents. Materials and Methods: The study was a retrospective descriptive review of birth records, of live neonates delivered at a tertiary hospital who were referred for a pediatrician's assessment and subsequently certified stable and fit for discharge. Their parameters were described, and sub-groups were compared. Results: There were 224 newborns examined, with a male:female ratio of 1:1.1. Majority (99.1%) of the babies were examined within 24 h of life, and the mode of delivery was through cesarean section in 70.1% of the newborns. Their mean gestational age was 39.3 (±1.2 standard deviation [SD]) weeks, with 37 (16.5%) late preterm and 187 (83.5%) term babies. They had birth weight 3.1 kg (±0.6 SD) and 2.6 (±0.6 SD), P = 0.0001; length 49.2 cm (±2.9 SD) and 47.0 (±3.0 SD), P = 0.017; occipitofrontal circumference 34.6 cm (±1.7SD) and 33.6 (±1.3 SD), P = 0.001; respiratory rate 52 (±12 SD) and 54 (±14 SD), cycles (cpm) P = 0.291; heart rate 141 (±13SD) and 145 (±15SD) beats (bpm), P = 0.129; for the term and late preterm babies, respectively. Conclusions: Referred newborns who were assessed and certified stable and discharged, had comparable parameters, with average respiratory rate of 51 cycles, and heart rate of 140 beats. There were no statistical differences in the vital signs between late preterm and term newborns.

Supporting breastfeeding of small, sick and preterm neonates

Breastfeeding is associated with a risk reduction for several acute and chronic diseases in women and their infants. Health benefits of breastfeeding are especially important for small, sick and preterm infants. The objective of this article is to summarize essential steps for healthcare personnel and facilities to improve breastfeeding practices in this vulnerable population. Health facilities can support breastfeeding through the establishment of breastfeeding-supportive policies, staff training and the design of facilities to support rooming-in. Direct support to breastfeeding includes the provision of counseling to mothers at critical time points, skin-to-skin and kangaroo care, and support of responsive (on-demand) breastfeeding. Where direct breastfeeding is not possible, facilities should show mothers how to express their breastmilk and teach mothers alternative feeding modalities. Medically-indicated supplementation of small, sick and preterm may be needed in certain circumstances.

Bedside laparotomy in newborns -A single institute experience

Background/purpose: Intra hospital transfer of sick newborns is known to cause adverse events with potential morbidity. Interventions at the bedside in a sick neonate can reduce the need for transport and in turn, potential hazards of transfer. Our single institute experience of performing bedside laparotomies in unstable newborns is reported here. Materials and methods: Seven-year data was collected from electronic medical records. This was a retrospective comparative study with level III evidence. Twenty-eight neonates operated at bedside for intraabdominal sepsis due to Necrotising Enterocolitis (NEC), Spontaneous Intestinal Perforation (SIP), complicated meconium ileus and perforation secondary to atresias were included Group A. Group B had 60 neonates operated for similar indications in the conventional operation theatres. Results: The average corrected gestational age at surgery, associated co-morbidities, average volume of blood loss and duration of surgery were compared between the groups. Group A had lower weight at surgery (1098 vs 1872 gs), greater percentage of neonates on inotropic support (78% vs 20%) with requirement of High Frequency Ventilation (HFO) (50% vs none). A quarter of neonates (7 of 28) in Group A had NEC Totalis as against only one case in group B. There was 25% survival in group A and 76.67% in group B. The lower survival in group A can be attributed to lower weight at surgery, higher inotrope requirement and need for unconventional modes of ventilation. Conclusion: Bedside laparotomy is a feasible option in unstable neonates deemed unsuitable for transport.

A Study of Maternal Breast Feeding Issues during Early Postnatal Days

Background: The success in breast-feeding is dependent on early initiation and effective management of breast feeding problems during early postnatal days. Objectives: To identify breast feeding problems and their etiologies during early postnatal days until discharge from hospital. Methodology: Descriptive study done in a medical college hospital. One hundred and twenty mothers in early postnatal days were enrolled in the study. Sick mothers, sick neonates admitted in NICU for &gt;24 hours and where breast-feeding was contraindicated were excluded. Data was collected by direct interview with the mother by the investigators and were entered in the proforma. The questionnaire contained general information of the mothers, self-reported and observed problems about breast feeding. The first interview was carried out within 12 hours of delivery after taking informed consent. Follow up interviews were done on 24 hourly basis until discharge. Data was analyzed statistically. Results: Mothers were aged between 22 to 40 years with more than half in 26-30 years range. Majority were homemakers and educated up to high school. 31(25.8%) were primi mothers. 64(53%) had vaginal and 56(47%) had caesarean deliveries. 61.6% of the mothers knew about colostrum and its benefits. Most (98.3%) of the mothers felt that there is a need for education about breast-feeding. Majority had initiated breast feeds within an hour or at least within 4 hours (LSCS mothers). Insufficiency of milk and problems with latching, positioning and sucking were some of the problems noted. Though most of the problems were resolved before discharge, few persisted until discharge. Perceived milk insufficiency, latching problems and breast problems were higher in primi and found to be statistically significant. Objective problems like poor positioning, sucking etc were higher among primi and caesarean mothers. Even problems that remained at discharge were also more among them. Conclusions: Most common problems were positioning, emphasizing the need for teaching/training. Primi and delivery by LSCS were found to have higher feeding problems emphasizing the need to focus on these high risk groups. Doi: 10.28991/SciMedJ-2020-0204-4 Full Text: PDF

Prevalence and risk factors of dysnatremia in sick newborns admitted in neonatal intensive care unit: a cross-sectional study

Background: The objective of the study was to study the prevalence and various risk factors of dysnatremia in sick newborns admitted in neonatal intensive care unit (NICU).Methods: Cross sectional study conducted in Paediatric Department of tertiary care hospital from February 2016 to October 2016 which includes 384 neonates admitted to NICU during the study period. After informed consent, detailed history was taken and clinical examination carried out in both cases and controls. Blood investigations were done to diagnose sodium levels in sick neonates. Based on the corrected sodium values, the subjects were classified as having hyponatremia (serum sodium &lt;135 meq/l), hypernatremia (serum sodium &gt;145 meq/l) or normonatremia (serum sodium 135 to 145 meq/l).Results: The mean (SD) (range) serum sodium in sick newborns measured was 136.72 (6.7) (115-165) meq/l at a median (range) age of 56.97 (1-545) hours. Out of 384 sodium values obtained, 285 (74.2%) were sent on ≤3 days, 64 (16.7%) between 4th to the 6th day and 35 (9.1%) were sent on ≥7 days. The overall frequency of dysnatremia in 384 sodium values from 384 patients was 142 (37%). Hyponatremia was observed in 117 (30.5%) and hypernatremia in 25 (6.5%) of sodium values. Hyponatremia observed in term, low birth weight, very low birth weight and extremely low birth weight neonates were 16.4%, 25.2%, 67.2% and 100% respectively whereas hypernatremia were 10.1%, 4.6%, 3.4% and 0% respectively. Various risk factors for hyponatremia namely; prematurity, necrotizing enterocolitis, renal failure, birth asphyxia, sepsis, meningitis, vomiting/ nasogastric drainage.Conclusions: Hyponatremia are common in sick newborns in NICU.

Effect of Domperidone on Breast Milk Production in Mothers of Sick Neonates: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Objective: Mothers of many preterm babies are unable to produce sufficient milk for their babies during the prolonged hospitalization. Domperidone stimulates the release of prolactin, thereby increasing breast milk production. The primary outcome was to study the efficacy of domperidone in augmenting breast milk production in mothers with lactation failure (LF). The secondary outcomes included the effect of domperidone on prolactin levels, adverse effects of domperidone, and outcome on breastfeeding rates at discharge. Materials and Methods: This was a randomized, double-blinded, placebo-controlled trial where mothers with LF were either allocated domperidone (10 mg) or placebo, 2 tablets three times a day for 14 days. Milk volumes were recorded daily for 14 days. Serum prolactin levels were measured at the start and at day 7 of study. Results: Out of 166 women eligible for the study, 119 (71.7%) mothers were able to increase their breast milk production without pharmacological treatment after being counseled on the advantages of human milk and proper breastfeeding management. Forty-seven mothers were finally enrolled in the study; 24 in the domperidone group (DG) and 23 in the placebo group (PG). Breast milk production increased from a baseline of 156 + 141.1 to 400.9 + 239.2 mL in the DG and increased from a baseline of 175.8 + 150.7 to 260.5 + 237.5 mL in the PG, after 14 days (p < 0.01). The prolactin levels in the DG and PG increased from 72.85 (22.2-167.15) and 42.33 (14.02-93.54) ng/mL, respectively, to 223.4 (49.79-280.2) ng/mL (p = 0.005) in the DG and 60.08 (14.31-132.14) ng/mL (p = 0.232) in the PG on the 7th day of treatment. No adverse effects were recorded. Ninety-five percent of babies in the DG were exclusively breastfeeding at hospital discharge, compared with 52.4% in the PG (p = 0.008). Conclusion: Domperidone treatment can result in an increase in breast milk production with no adverse effects. The study was registered with the Thai Clinical Trials Registry ID TCTR2020091008.

Nucleated Red Blood Cells: Could They Be Indicator Markers of Illness Severity for Neonatal Intensive Care Unit Patients?

Background: We aimed to assess whether nucleated red blood cells (NRBCs) count could serve as a diagnostic and prognostic biomarker for morbidity and mortality in critically ill neonates. Methods: The association between NRBCs count and neonatal morbidity and mortality was evaluated in an observational cohort of critically ill neonates hospitalized in our neonatal intensive care unit over a period of 69 months. The discriminative ability of NRBCs count as diagnostic and prognostic biomarkers was evaluated by performing the Receiver Operating Characteristics (ROC) curve analysis. Results: Among 467 critically ill neonates included in the study, 45 (9.6%) of them experienced in-hospital mortality. No statistically significant difference was found with regards to NRBCs count between survivors and non-survivors, although the median value for NRBCs was sometimes higher for non-survivors. ROC curve analysis showed that NRBCs is a good discriminator marker for the diagnosis of perinatal hypoxia in neonates with area under the curve (AUC) [AUC 0.710; 95% confidence interval (CI), 0.660–0.759] and predominantly in preterm neonates (AUC 0.921 (95% CI, 0.0849–0.0993)) by using a cut-off value of ≥11.2%, with 80% sensitivity and 88.7% specificity. NRBCs also revealed significant prognostic power for mortality in septic neonates (AUC 0.760 (95% CI, 0.631–0.888)) and especially in preterms with sepsis (AUC 0.816 (95% CI, 0.681–0.951)), with cut-off value ≥ 1%, resulting in 81.6% sensitivity and 78.1% specificity. Conclusion: NRBCs count may be included among the early diagnostic and prognostic markers for sick neonates.

Implementierung eines neonatalen Schmerzassessmentinstruments auf einer neonatologischen Intensivstation - Ein Qualitätsentwicklungsprojekt.

Implementation of a Neonatal Pain Assessment Instrument at a Neonatal Intensive Care Unit - A Quality Improvement Project Abstract. Background: Optimal pain management is necessary in order to not jeopardize the development of preterm neonates. Aim: Implementation and evaluation of systematic and best possible pain assessment with the Bernese Pain Scale for Neonates for all preterm and sick neonates of a neonatal intensive care unit by nursing staff. Methods: The educational concept is based on three key strategies: knowledge translation (group- and one-on-one training), reflection (case conferences) and clinical training. The frequency of the use of the Pain Score was recorded before (T0) and after implementation (T1) and six months after completion of the project (T2). Results: Before the implementation (T0) the use of the Bernese Pain Scale was regulated by an internal guideline but its application could not be verified during the baseline period (fulfillment rate of 0 %). After implementation (T1) at least one assessment per shift per neonate could be achieved in 99.1 % of the cases. Nurses conducted 210 assessments on 38 neonates in T1. In follow-up (T2) six months after implementation fulfillment rate of 100 % in 34 neonates was achieved with 188 pain assessments. Conclusions: This implementation strategy was successful in establishing the assessment instrument in clinical practice.

Effects of Phototherapy on Hyperbilirubinemia and Serum Calcium Level in Neonates Admitted in a Tertiary Care Hospital

Background: Jaundice is most common problem in neonatal period. It is commonly managed by phototherapy. However, phototherapy may cause hypocalcaemia and create serious complications like convulsion. So, neonatal hyperbilirubinemia associated with hypocalcaemia has increased risk of neurotoxicity.&#x0D; Objective: To determine the effects of conventional single surface phototherapy on serum calcium and serum bilirubin in neonatal hyperbilirubinemia.&#x0D; Methodology: This longitudinal type of descriptive study was conducted in the neonatal unit of Rajshahi Medical College Hospital during January 2016 to December 2017. One hundred forty neonates both term and preterm with jaundice were included into this study. Conjugated hyperbilirubinemia, blood group, Rh incompatibilities, jaundice on 1stday, very LBW babies and very sick neonates were excluded from this study. All neonates were under conventional single surface phototherapy. Total calcium, direct and indirect serum bilirubin were estimated before starting phototherapy and serum calcium level and total bilirubin estimated every 24 hours interval . Results were analyzed statistically by paired student t’ test and z’ test.&#x0D; Results: Total serum bilirubin and calcium level fall significantly and among all groups after phototherapy. Mean SD of serum bilirubin 17.14±4.20 mg/dl before phototherapy and 13.37±3.80 mg/dl after receiving (p &lt;0.001). Mean SD of serum calcium level significantly decreased from baseline value of 9.45±10 mg/dl and 9.24±1.24 mg/dl after phototherapy. Analysis of complications revealed 19(13.6 %) developed hypocalcaemia and has significant difference between serum calcium level before and after phototherapy (p&lt;0.04).&#x0D; Conclusion: Total serum bilirubin and calcium level was reduced by single conventional phototherapy. Phototherapy causes hypocalcaemia in neonate but phototherapy associated hypocalcaemia causing convulsion was not noted.&#x0D; TAJ 2020; 33(1): 5-10

Determinants of care-seeking practice for neonatal illnesses in rural Bangladesh: A community-based cross-sectional study.

Proper utilization of skilled care services in neonatal illnesses is crucial to reduce neonatal morbidity and mortality. The study aimed to evaluate the level and factors associated with seeking care from skilled healthcare service providers for reported neonatal illnesses in rural Matlab, Bangladesh. This community based cross-sectional study was based on data from a randomly selected sample comprised of 2223 women who delivered live-born babies in 2014. Data were collected from June to October 2015 through a structured questionnaire. We used a multivariable logistic regression model and presented the results by adjusted odds ratios (AOR) with 95% confidence intervals (CI). Of the neonates, 1361 (61.2%) suffered from at least one complication, and among these, 479 (35.2%) sought care from skilled healthcare service providers. In the multivariable logistic regression analysis, the participants' husbands' educational level, number of antenatal care visits, and place of childbirth were significantly associated with seeking skilled care for reported neonatal illnesses. The care-seeking from skilled healthcare service providers for neonatal illness was more than two times higher (AOR = 2.26, 95% CI = 1.51-3.39) in the group in which the participants' husband had attended school for more than 10 years as compared to the group in which they had attended school for less than six years. The AORs of seeking skilled care were 1.93 (95% CI = 1.42-2.62) and 2.26 (95% CI = 1.51-3.39) with the mothers receiving two to three and four or more antenatal care services, respectively, compared to the mothers with no or one antenatal care visit. Women who gave birth at a health facility were three times (AOR = 3.24, 95% CI = 2.50-4.19) more likely to seek skilled care for sick neonates compared to those who gave birth at home. The utilization of skilled care for neonatal sicknesses was low in this rural setting in Bangladesh. The participants' husbands' higher school attendance, increased number of ANC visits, and facility delivery were positively associated with care-seeking from skilled healthcare providers for neonatal illness. The husbands with low school attendance should be targeted for intervention, and continue efforts to increase ANC coverage and facility delivery to improve neonatal health in this country's rural area.