Sick Newborn Care Unit Research Articles

Profile and risk factors of sight-threatening retinopathy of prematurity: Experience from SNCU in North India.

This research aimed to identify the clinical profile and risk factors of retinopathy of prematurity (ROP) among "at-risk" newborns treated at a sick newborn care unit (SNCU) located at high altitude in North India, with the intention of contributing to formulate regional and national ROP screening guidelines. In a prospective observational study from 2021 to 2022, outborn and inborn babies eligible for ROP screening were screened. Total 39/122 screened neonates had laser for Type 1 ROP, and 22/39 (56.4%) had aggressive ROP (AROP). The average birth weight (BW) was 1803.87 g, and the average gestational age was 34 weeks. Respiratory distress, bronchopulmonary dysplasia, sepsis, and apnea were present in 57.3%, 13%, 52.5%, and 25.4%, respectively. Sight-threatening ROP was present in 50% below 28+6 weeks, 27% between 29 and 30+6 weeks, 52% between 31 and 33+6 weeks, and 15% with gestation >34 weeks. Two babies with Type 1 ROP weighed >2 kg and one had AROP. Upon regression analysis, BW <1500 g, gestation <32 weeks, oxygen >48 h, clinical sepsis, total SNCU stay >14 days, continuous positive airway pressure support with oxygen >50%, and >10 days to achieve full feeds were associated with severe ROP. Caffeine to treat apnea and kangaroo mother care reduced ROP. None had short-term unfavorable outcome. With similar infrastructure and work force shortage in most SNCUs, these findings can be generalized. The burden of Type 1 and AROP is increasing, as seen in higher gestation and BWs. This needs revision of ROP screening criteria at local and national level. It is crucial to emphasize on the importance of pediatrician and ophthalmologist collaboration, early ROP screening, diagnosis, and treatment to stop disease progression to severe ROP.

Role of Serum Lactate Clearance as a Predictor of Mortality and Morbidity in Neonatal Sepsis: A Prospective Cohort Study

Introduction: Neonatal sepsis is a global healthcare concern, which is more prevalent in developing countries. However, surprisingly, biomarkers with good sensitivity and specificity to predict mortality and morbidity are lacking. Higher levels of serum lactate are observed in patients exposed to an inflammatory response, but its practical use remains limited. Therefore, the author aimed to investigate the relationship between serum lactate measurements and the severity of neonatal sepsis. Aim: To assess the role of serum lactate clearance as a marker to predict mortality and morbidity in neonatal sepsis. Additionally, the secondary aim was to evaluate the demographic profile of neonatal sepsis and understand the relationship between C-reactive Protein (CRP), Procalcitonin, and lactate clearance in neonatal sepsis. Materials and Methods: A prospective cohort study was conducted in the Sick Newborn Care Unit (SNCU) and Neonatal Intensive Care Unit (NICU) of Chittaranjan Seva Sadan, College of Obstetrics, Gynaecology, and Child Health in Kolkata, India, from June 2020 to May 2021. A total of 93 confirmed cases of neonatal sepsis were included in the study. Serum lactate levels were measured at the time of sepsis diagnosis and 48 hours after the first sample. Lactate clearance was calculated, and the neonates were followed till discharge or death. Various parameters, including complete blood count, CRP, Procalcitonin, culture, and Cerebrospinal Fluid (CSF), were assessed. The data obtained were statistically analysed using paired t-test, one-way Analysis of Variance (ANOVA), and Pearson’s Chi-square test. Results: A total of 93 neonates were included after meeting the inclusion and exclusion criteria. Among them, 10 neonates died, while 83 were successfully discharged. It was found that death was significantly associated (p&lt;0.0001) with lactate clearance. Total 9 (90%) of the deceased neonates had negative lactate clearance, while only 21 (25.3%) discharged neonates had negative lactate clearance. Lactate clearance was also significantly associated with the duration of hypoglycaemia (p=0.008), duration of Nil Per Mouth (NPM) (p=0.01), and need for reintubation (p=0.05). However, no association was found with the duration of hospital stay, duration of fluid therapy, duration of oxygen requirement, and need for ventilation. Conclusion: Lactate clearance showed a significant association with the risk of mortality in patients with neonatal sepsis. Therefore, lactate clearance can be used as a prognostic marker to identify sepsis. Early detection of sepsis can aid in proper management and subsequently reduce mortality

Spectrum of Neonatal Surgical Emergencies at a Government Tertiary Care Centre in Madhya Pradesh: An Observational Study

Introduction: This impoverished region of India, where the majority of the population suffers from poverty and malnourishment, lacks data regarding the epidemiological pattern for surgical congenital abnormalities to date. Hence, there is a dire need to gather epidemiological data on newborn surgical emergencies, which has been lacking. Aim: To study the epidemiological data of neonatal patients requiring emergency surgery and to evaluate the variables affecting morbidity and mortality in emergency newborn surgery cases. Materials and Methods: This retrospective observational study was carried out at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India from October 2018 to August 2022. Case records of emergency surgical interventions in neonates presenting to the Emergency Department under the age of 30 days of life were reviewed. The outcomes, postoperative morbidity, and mortality were noted. The data was presented descriptively using frequency and percentages. Results: In the present study, the male-to-female ratio was 1:1.2, the mean age was 4.9 days±4.1 days, and the mean birth weight was 2025±635 grams. Anorectal Malformations (ARM), 178 (37.71%) and Oesophageal Atresia (EA), 133 (27.8%) were the most prevalent congenital abnormalities in the current investigation, followed by other congenital gastrointestinal anomalies. Nonetheless, the remarkably elevated prevalence of pouch colon among patients with ARM deserves particular attention. In compared to a well- prepared Neonatal Intensive Care Unit (NICU), an inadequately equipped Sick Newborn Care Unit (SNCU) with a small nursing staff represents inadequate infrastructure for the management of a surgical neonatal emergency. Conclusion: The majority of patients died from postoperative septicaemias, accounting for 35.5% of the mortality rate among these neonates who underwent emergency surgery. A large percentage of infant mortality in underdeveloped nations like India might be avoided with proper perioperative care, especially for surgical infants.

Neurodevelopmental Outcomes in Preterm Babies: A 12-Month Observational Study.

Background Preterm births are a significant concern worldwide due to their association with both short- and long-term morbidity. Modern neonatal intensive care techniques have improved the survival of infants born at the brink of viability. However, there remain significant challenges concerning their neurodevelopment. A considerable proportion of very low birth weight infants exhibit significant motor deficits such as cerebral palsy or cognitive, behavioral, or attention disabilities. The consequences of these impairments, particularly given their life-long nature, can be severe for the affected individuals, families, and public health resources. Consequently, timely neurodevelopmental assessment is critical in recognizing delayed development and selecting infants for neurodevelopmental stimulation. This study aimed to estimate the neurodevelopment of preterm infants, identify influencing factors, detect at-risk groups, and refer/recommend early intervention when developmental delays are observed. Methodology This prospective, observational, hospital-based study done in the department of pediatrics, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, Gujrat, India included inborn and outborn preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) or the Sick Newborn Care Unit from their first day of life. The study period was from October 2020 to January 2021, and only neonates with an uncomplicated clinical course were included. Newborns were enrolled in a high-risk clinic, and follow-up appointments were scheduled at three, six, nine, and 12 months of corrected gestational age (CGA). We used the Baroda Developmental Screening Tool (BDST) to calculate the developmental quotient (DQ) at each appointment. This assessment involved parental interviews, observation of developmental milestones, and simple test demonstrations. The gathered DQ data at different ages were analyzed and compared across groups. Results Of 100 preterms enrolled, 62 preterms were followed up until 12 months of CGA. Thirteen patients out of the 62(approximately one-fifth) preterm neonates exhibited developmental delays at one year of CGA, most of whom were early preterm infants. Twenty-six patients (approximatelytwo-fifths) were delayed at three months of CGA, and thus 13 patients (half) showed catch-up growth and development. There was no statistically significant difference between the neurodevelopment of female and male infants. However, infants born to mothers with better socioeconomic status and higher education showed improved neurodevelopment. Conclusions Our study findings suggest that preterm infants discharged from the NICU exhibit poor neurodevelopmental outcomes, especially those born early preterm. This pattern indicates an inverse relationship between neurodevelopmental delay and the maturity of the neonate. Maternal education and socioeconomic status positively impacted the neurodevelopment of preterm NICU graduates. Thus, regularfollow-up (at least once every three months), early detection by a screening scale like the BDSTand intervention significantly improved neurodevelopmental outcomes.

Morbidity profile and outcome of new-born admitted in sick newborn care units of Uttar Pradesh, India

Introduction and aim. Reduction in child morbidity and mortality is result of upgradation of infrastructure and quality of public health care services. India alone accounts for 30% of the global neonatal deaths occur in India that occurs due to preventable cause. So, the aim of this study was to assess the pattern and status of neonatalmortality observed in SNCUs of Uttar Pradesh, India. Material and methods. Descriptive study was conducted based on secondary data obtained from sick new born care units (SNCU) online database from 89 Government-supported SNCUs of Uttar Pradesh, from April 2014 to March 2016. Data obtained included age, weight, sex, diagnosis, and outcome. Results. 22933 neonates admitted in SNCU were included in study with 14269 (62.2%) were males and 8664 (37.8%) females. Majority of the subject (20070; 87%) were in 0-5 days old age group. Most (72.5%) of admitted new-born improved and discharged. Low birth weight was significantly (χ 2 = 1334.2, p&lt;0.001) related with outcome. Birth asphyxia contributed to maximum (36.11%) number of deaths, followed by respiratory distress syndrome (25.21%), sepsis (15.38%), prematurity and extremely low birth weight (5.8%). Conclusion. Improved antenatal care, improved access to health facility, timely referral of high-risk cases, capacity building, intensive interventional management can reduce neonatal mortality and its complications. Study also warrants, in-depth community-based qualitative study to identify gender-specific, equity issues.

Profile and predictors of babies admitted to SNCUs of two tribal districts of Chhattisgarh.

The neonatal period is the crucial and vulnerable period of the human life cycle. Various research has been conducted worldwide that provide the baseline data on clinical profiles and predictors of outcomes of babies admitted to sick newborn care units (SNCUs). Nonetheless, studies on tribal areas and community outreach areas are rare. In the present study, predictors and profiles of patients admitted to SNCU, in the Dantewada and Bijapur districts of Chhattisgarh, India, were evaluated which shall help prioritize patient care and preventive approaches. This retrospective study was undertaken from January 2019 to December 2020 in the SNCUs of Dantewada and Bijapur. Neonatal and maternal characteristics, course during labor, treatment given to the neonates, and outcome data were obtained and analysed. In total, 1,531 neonates were enrolled in the study. Mothers had a mean age of 25.6 years (standard deviation [SD] ±4.9) with birth spacing less than 2 years (60.3%) and antenatal care (ANC) visits less than 4 (50.4%). Neonates were low birth weight (43.75%) and were home-delivered (15.8%). One hundred forty-nine neonates died. In the multivariate regression model, extremely low birth weight babies, less than 1 kg (odds ratio [OR]: 11.59 confidence interval [CI] 4.625-31.58), gestational age less than 34 weeks (OR: 2.13 CI 1.291-3.532), central cyanosis (OR: 10.40 CI: 3.269-32.35), duration of IV fluid > 3 days (OR: 2.16 CI 0.793-0.880), duration of antibiotic >3 days (OR 0.63 CI 0.408-0.979) were found to be independent predictors of mortality among neonates. The prevalence of newborns aged less than 12 h is higher among the study population. Birth asphyxia, prematurity, neonatal jaundice, and sepsis were fundamental and leading causes of morbidity. Preterm birth and low birth weight babies had significantly high mortality. The government needs to focus on marginalized communities with target-based interventions and policies.

Study of Referral Process of Neonates Admitted to Sick Newborn Care Units of Lucknow District

Background: Nearly 98% of total deaths in neonatal period occur in developing countries all over the world and are mainly caused by infection, asphyxia, LBW and prematuriy. Of all the neonatal deaths happening globally, nearly 30% occur in India. As per global reviews, nearly 15% newborns require facility based care, 10% newborns require SNCU treatment. Objectives: 1) To study the referral process of neonates admitted in Sick Newborn Care Units of Lucknow District. 2) To suggest measures (if, any) to improve the services provided for management of neonates in Sick Newborn Care Units. Methods: A descriptive cross sectional study was conducted among 360 neonates managed in Sick Newborn Care Units of district Lucknow. Out of 5 government SNCUs in Lucknow, 3 were randomly chosen. The schedule was pretested on 10 percent of the total sample of neonates admitted to SNCU. Results: Maximum (74.8%) referrals came from the health facility, 25.2 percent referrals were from the community. In majority (68.3%) of the referred neonates, symptoms appeared within 24 hours of birth. In majority (52.8%) of the cases, symptoms were first seen by doctor at health facility, only in 0.8 percent cases, symptoms were seen by ASHA. Most frequent (27.6%) symptom observed in referred neonate was difficulty breathing.

A study of antenatal, intranatal, and postnatal care of mothers in index pregnancy

Background: Most newborn deaths are preventable by improving quality of care during antenatal period and at delivery. Optimum maternal healthcare utilization, such as antenatal care (ANC) visits, skilled birth attendants or intranatal care, and postnatal care (PNC) services are associated with maternal health outcomes. Objectives: To study antenatal, intranatal, and PNC of mothers in index pregnancy. Materials and Methods: A descriptive cross sectional study was carried out among mothers of 360 neonates. Study was conducted in three government Sick newborn care units (SNCUs) of Lucknow district, which were randomly selected. The schedule was pretested on 10% of the total sample of mothers of neonates admitted to SNCU in Lok Bandhu Shri Raj Narayan Combined Hospital, Lucknow, to see for the accuracy of responses and to estimate the time needed. Three days a week were selected randomly for data collection. These 3 days were randomly allocated to collect data from three different SNCUs. One day was dedicated to collect data from one SNCU. Results: 95.8% mothers had at least one ANC checkup during index pregnancy. Majority (62%) of the mothers had more than 4 ANC visits during index pregnancy. Majority (69%) of mothers had their first ANC checkup in 1st trimester, 25.8% in 2nd trimester, only 5.2% had their first ANC checkup in 3rd trimester. Only 28.3% mothers received counseling on newborn care during index pregnancy. Majority (92.5%) of the deliveries were attended by doctor. It was seen that 72.8% mothers got counseling on newborn care in postnatal period. Conclusion: Extra efforts are needed to sensitize ASHA to counsel women regarding early registration, birth preparedness, adequate ANC, safe delivery, PNC, immunization of children etc and to mobilize the community and facilitate them in accessing these services.

A Study on Incidence, Pattern of Clinical Features, Laboratory Abnormalities and Outcome of Neonatal Polycythaemia in a Tertiary Care Hospital, Odisha, India

Introduction: Neonatal polycythaemia is a commonly encountered morbidity and mortality among neonates admitted to neonatal care units and sick newborn care units. Most affected infants have no clinical symptoms and signs, but neonates may present with lethargy, poor feeding, plethora, cyanosis and jaundice within 12-72 hrs. Aim: To find out the incidence and clinical manifestations of neonatal polycythaemia along with detection of disease by laboratory abnormalities. Materials and Methods: This was a hospital-based, prospective, observational study conducted in the Neonatal Care Unit of Sriram Chandra Bhanja Medical College, Eastern Odisha, India, in 1760 neonates, from October 2018 to September 2020. All neonates admitted through Outdoor and Emergency were included in this study irrespective of gestation, birth weight, maturity and mode of delivery with haematocrit &gt;65% at 12 hours of life. These polycythaemic babies were further categorised on the basis of maturity, gestational age, birth weight, gender and the clinical features, laboratory abnormalities were noted, Partial Exchange Transfusion (PET) when required was done through central route, the umbilical venous catheter was used for withdrawing blood while same amount of normal saline was replaced through a peripheral vein, and in asymptomatic cases additional fluid of 20 mL/kg was added to the daily fluid requirements either through enteral or parenteral route and outcomes were noted. Short-term outcome at 48 hours was measured by decreasing haematocrit with improvement of signs and symptoms. Chi-square test was employed to analyse the collected data using Statistical Package for the Social Sciences (SPSS) software version 20.0. The p-value &lt;0.05 was considered statistically significant. Results: Out of 1760 newborns enrolled, (n=75) were polycythaemic. The Incidence of polycythaemia was 4.26%), which was significantly higher among Small for Gestational Age (SGA) compared to Large for Gestational Age (LGA) neonates (p-value=0.0214). Clinical features in decreasing order were lethargy (66.6%), poor feeding (66.6%), Plethora (53.3%), cyanosis (40%) and jaundice (33.3%). Main laboratory abnormalities were hypoglycaemia (36%), hyperbilirubinaemia (28%), thrombocytopenia (22.66%) and hypocalcaemia (13.3%). Out of 75 polycythemic neonates, n=17 (22.67%) underwent PET and rest 58 (77.33%) neonates were treated with extra fluid of 20 mL/kg/day. Conclusion: Study showed that lethargy and poor feeding were the main presentation and hypoglycaemia as the major laboratory abnormality. The incidence of polycythaemia was high among SGA neonates and the response to partial exchange transfusion as well as extra fluid was good which was characterised by decreasing haematocrit values with improvement of signs and symptoms.

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.

Assessment of Health Status of Newborns Discharged From Sick Newborn Care Units of the Five Cyclone Fani Affected Districts of Odisha, India.

This study was undertaken to assess the health status of newborns discharged from Sick Newborn Care Units (SNCU) of the Cyclone Fani affected districts of Odisha, which is amongst the highest neonatal mortality rate states in the country. Cyclone Fani hit the coast of Odisha on May 3, 2019. This cross-sectional study was conducted in 5 districts and targeted the babies discharged from SNCU's from January to May 2019. A telephonic interview of the caregivers was conducted to assess the health status of the newborns. Data was collected in a web-based portal and analyzed by statistical package for social sciences SPSS (IBM Corp., Armonk, New York, USA). We inquired about 1840 babies during the study period but only 875 babies could be followed up, with the highest proportion of the babies from the most affected district. Out of 875 babies, 111 (12.7%) had 1 or more illnesses during follow up. Distance from the health facility and time constraints were the major reasons for not seeking health care. Of the babies, 35.7% were reported as being underweight. Poor breastfeeding (14.1%) and kangaroo mother care (31.7%) practices were reported. Only 32% of the babies were completely immunized. The health status of the babies discharged from the SNCUs was found to be poor. Newborn care can be strengthened by improving home-based and facility-based newborn care.

Quality of care assessment for small and sick newborns and young infants in Pakistan: findings from a cross-sectional study

IntroductionPakistan is facing a challenging situation in terms of high newborn mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of quality inpatient care for small and sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided and the readiness of inpatient care for NYIs in Pakistan.MethodsWe conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public sector health care facilities providing inpatient care for small and sick NYIs. We interviewed facility managers and health care providers by using structured questionnaires. We observed facility infrastructure and relevant metrics related to the quality of inpatient care such as types of infant care units and essential equipment, drugs, staffing cadre and facility management practices, quality assurance activities, essential services for small and sick NYI care, discharge planning, and support, quality of NYIs care record, and health information system.ResultsOf the 23 facilities assessed, 83% had newborn intensive care units (NICUs), 74% reported Special Care Units (SCUs), and only 44% had Kangaroo Mother Care (KMC) Units. All facilities had at least one paediatrician, 13% had neonatologists and neonatal surgeons each. Around 61 and 13% of the facilities had staff trained in neonatal resuscitation and parental counseling, respectively. About 35% of the facilities monitored nosocomial infection rates, with management and interdisciplinary team meetings reported from 17 and 30% of the facilities respectively preceding the survey. Basic interventions for NYIs were available in 43% of the facilities, only 35% of facilities had system in place to monitor nosocomial infections for NYI care. Most (73%) of reviewed records of NYIs at 1–2 days had information on the birth weight, temperature recording (52%), while only a quarter (25%) of the observed records documented danger signs. Mechanism to support discharge care by having linkages with community workers was present in 13% of the facilities, while only 35% of the facilities have strategies to promote adherence after discharge. Majority (78%) of facilities reported monitoring any newborn/ neonatal care indicators, while none of the sub-units within facilities had consolidated information on stillbirths and neonatal deaths.ConclusionThe study has demonstrated important gaps in the quality of small and sick NYI inpatient care in the country. To avert neonatal mortality in the country, provincial and district governments have to take actions in improving the quality of inpatient care.

Quality of Referral, Admission Status, and Outcome of Neonates Referred to Pediatric Emergency of a Tertiary Care Institution in North India.

Background:This study was planned to study the existing status of neonatal transport in North India after the introduction of National Ambulance Service (NAS). We evaluated the quality of referral, admission status, and outcome of referred neonates.Materials and Methods:We enrolled neonates admitted between March 2016 and October 2016, excluding neonates referred from the outpatient department. Information was collected from referral slips, interviewing accompanying persons and observation.Results:Sixty-one percent were referred from government hospitals with “sick newborn care units” contributing to maximum. The main mode of transport was ambulance in 80% and referral notes were available in the majority but incomplete in majority. Sepsis (39%), jaundice (16%), and birth asphyxia (13%) were the most common diagnoses. Half of the neonates were hemodynamically unstable. Twenty-seven percent had poor circulation, 15% were hypoxic, 9% hypoglycemic, and 8% hypothermic. Twenty-two percent either died or “left against medical advice” with a high probability of death.Conclusion:NAS is utilized for transporting neonates. However, there are quality gaps which need attention to develop it into efficient referral system.

Kangaroo Mother Care versus Prone Position in Preterm Neonates: A Non Randomised Clinical Study

Introduction: One of the major problems of preterm neonates is immature alimentation. This may lead to inadequate weight gain, higher chances of sepsis and increased mortality. Positioning during and after feeding affects nutritional tolerance. Kangaroo Mother Care (KMC) is a method of skin-to-skin contact between mother and neonate, claimed to improve infant outcomes. Aim: To compare prone and Kangaroo Mother Care positioning of preterm neonates of 28 to 32 weeks gestational age during orogastric tube feeding. Materials and Methods: The study was a non-randomized crossover clinical study, carried out at Sick Newborn Care Unit and Neonatal Intensive Care Unit (NICU), Department of Paediatrics, R.G. Kar Medical College and Hospital, Kolkata, India, from April 2020 to March 2021. The studied parameters included gastric residual volume (3 hours postprandial), vital signs like respiratory rate, heart rate, SpO2 level, body temperature, Capillary Blood Glucose (CBG), also comfort scores using a comfort scale. Total 110 preterm neonates of 28 to 32 weeks gestational age were sampled as per inclusion criteria and divided into two groups. Each group was fed by orogastric tube feeding in its respective position, in which they were kept for 3 hours. Vital signs, comfort scores and gastric residual volume were re-assessed. Groups were crossed over on the next day. Statistical analysis was done by t-test. Results: Of the total 110 neonates, KMC sample and prone position sample were compared after 3 hours. Heart rate was 147.5±4.3 and 151.08±9.1 beats per minute and respiratory rate 52.8±2.9 and 55.6±4.9 cycles per minute, which were lower in KMC than in prone position. There was better glycemic control {n=107 (97.27) and 80 (72.73) mg/dL}, higher comfort scores (11.2±1.1 and 10.1±2.0) and minimal to negligible gastric residuals (0.03±0.05 mL and 0.13±0.12 mL) in KMC position, when compared to prone position, respectively. Conclusion: Kangaroo mother care produced more stable physiological indices, and was more comfortable for preterm neonates and resulted in better feeding, absorption and metabolism.

Hydration Therapy to Improve Amniotic Fluid Index and its Association with Improved Obstetric Outcome in a Teaching Hospital of Eastern India

Introduction: Oligohydramnios is associated with fetal complications and a higher incidence of maternal operative morbidity. A study was planned to determine the effect of hydration therapy in the correction of oligohydramnios in pregnancy and to assess if improvement in amniotic fluid index (AFI) is associated with better obstetric outcomes. Materials and Methods: Analytical study with a prospective design, conducted over 1 year from July 2020 to December 2021. Pregnant women in their third trimester with singleton pregnancy and intact membranes, diagnosed to have oligohydramnios were the participants. All women undertook oral rehydration therapy. The proportion of women achieving posthydration cutoff values of AFI and single deepest vertical pocket, was recorded by abdominal ultrasound examination at 24, 48, and 72 h. Adequacy of hydration was assessed by urinary specific gravity, before and after hydration therapy. Results: There were 120 participants. The mean age of the participants was 25.6 years (standard deviation = 5.7). Majority were multigravida. About 60%–80% of women improved with hydration therapy and the proportion of women showing improvement increased with time. Women with uncorrected AFI (&lt;5 cm) at 24 and 48 h had significantly higher odds of preterm delivery, cesarean delivery, low-birth-weight baby, baby having 5 min Apgar score &lt; 6, higher likelihood of Sick Newborn Care Unit admission and neonatal death. Conclusion: Maternal hydration therapy can be of value to improve the fetomaternal outcome in pregnancies with oligohydramnios by preventing preterm termination and reducing cesarean deliveries with good neonatal outcomes. Such simple intervention can be home based and assures universal health coverage.

Comparison between two natural surfactant poractant alfa and bovine lipid extract in respiratory distress syndrome amongst preterm neonates-a quasi-experimental study

Background: A comparison study of two natural surfactants in preterm babies admitted in neonatal intensive care unit (NICU) and sick newborn care unit (SNCU) of a tertiary care hospital to find out efficacy and consequences.Methods: A Quasi-experimental study. InSurE technique applied for administering Poractant alfa (CUROSURF) and bovine surfactant (NEOSURF) in two comparison group of preterm neonates with respiratory distress syndrome (RDS) during May 2018 to April 2019. The need of mechanical ventilation, oxygen requirement (FiO2), duration of oxygen requirement and the consequences were assessed.Results: The CUROSURF is 6.67% more efficacious than NEOSURF in respect to less requirement of mechanical ventilation. The differences were found between two groups in terms of FiO2adjusted (33.49% vs 37.17%) and common side effects respectively but the difference of mean duration of oxygenation (69.8 hrs vs 111.9 hrs) was less and statistically significant in CUROSURF group. Mean duration of hospitalization (9.55 day’s vs 14.9 days) also were found to be less and statistically significant.Conclusions: Treatment with CUROSURF was associated with faster improving oxygenation, less additional doses, and decreased need of mechanical ventilation.

Severe coronavirus disease 2019 pulmonary disease in very low birth weight preterm babies

Severe coronavirus disease 2019 (COVID-19) in neonates is considered a rarity due to vertical transmission and most of the affected babies are asymptomatic. Here, we describe two severe cases of very low birth weight (VLBW) preterm babies in sick newborn care unit (SNCU) due to horizontal transmission. Case 1 describes a VLBW preterm baby (29 weeks) weighing 1300 g who was undergoing care in SNCU. He developed classical symptoms of cold in the form of nasal congestion with mild rhinorrhea, fever, and cough followed by severe prolonged hypoxia with full recovery. Case 2 describes another VLBW preterm (27.3 weeks) weighing 1175 g who was suffering from severe progressive hypoxia around same time. He was initially responsive to oxygen therapy but succumbed to refractory hypoxia later on. We conclude that severe COVID-19 pulmonary disease can occur in few unfortunate VLBW preterm neonates

Efficacy of eutectic mixture of local anesthetics in alleviating pain associated with lumbar puncture in newborns: a placebo compared randomized controlled trial

Background: Lumbar puncture (LP) is one of the most commonly encountered painful procedure in paediatric medicine. Research has shown that neonates too experience pain from noxious stimuli that can be more intense than what is experienced by an adult, and so have the right to receive safe, efficient and effective pain management. Objective was to determine efficacy of topical eutectic mixture of local anesthetics (EMLA) in alleviating pain associated with lumbar puncture among newborns admitted to sick newborn care unit (SNCU).Methods: The study was a one-year tertiary care teaching hospital-based randomised comparative double blinded trial among 42 neonates aged 32 weeks or more admitted to SNCU and required a diagnostic lumbar puncture, randomly assigned to one of two groups. Half hour before the procedure, 1 g of topical EMLA cream was applied to LP site in intervention group versus placebo in other group. At different stages, the heart rate, transcutaneous oxygen saturation level, and total behaviour score were captured on a video camera and rated using the neonatal facial coding system.Results: EMLA dramatically lowers pain sensitivity when compared to placebo. Total behavioural score means±standard deviation (SD) at the moment of needle insertion (EMLA: 1.05±1.24; placebo: 2.71±1.76, p≤0.001) and post procedural 5 minute later was (EMLA: 0.05±0.22; placebo: 0.81±0.92, p≤0.01). Similarly, oxygen saturation level when needle was in spinal place (EMLA: 96.76±2.45; placebo: 94.29±3.62, p=0.01) and post procedural 1 hour later was (EMLA: 98.81±1.94; placebo: 97.48±2.18, p=0.04). The heart rate of all newborns in both groups was greater than it was at baseline, although the difference was not significant.Conclusions: EMLA is an effective agent in reducing pain associated with LP among newborns.

Quality of inpatient care of small and sick newborns in Pakistan: perceptions of key stakeholders

BackgroundIn LMICs including Pakistan, neonatal health and survival is a critical challenge, and therefore improving the quality of facility-based newborn care services is instrumental in averting newborn mortality. This paper presents the perceptions of the key stakeholders in the public sector to explore factors influencing the care of small and sick newborns and young infants in inpatient care settings across Pakistan.MethodsThis exploratory study was part of a larger study assessing the situation of newborn and young infant in-patient care provided across all four provinces and administrative regions of Pakistan. We conducted 43 interviews. Thirty interviews were conducted with the public sector health care providers involved in newborn and young infant care and 13 interviews were carried out with health planners and managers working at the provincial level. A semi-structured interview guide was used to explore participants’ perspectives on enablers and barriers to the quality of care provided to small and sick newborns at the facility level. The interviews were manually analyzed using thematic content analysis.FindingsThe study respondents identified multiple barriers contributing to the poor quality of small and sick newborn care at inpatient care settings. This includes an absence of neonatal care standards, inadequate infrastructure and equipment for the care of small and sick newborns, deficient workforce for neonatal case management, inadequate thermal care management for newborns, inadequate referral system, absence of multidisciplinary approach in neonatal case management and need to institute strong monitoring system to prevent neonatal deaths and stillbirths. The only potential enabling factor was the improved federal and provincial oversight for reproductive, maternal, and newborn care.ConclusionThis qualitative study was insightful in identifying the challenges that influence the quality of inpatient care for small and sick newborns and the resources needed to fix these. There is a need to equip Sick Newborn Care Units with needed supplies, equipment and medicines, deployment of specialist staff, strengthening of in-service training and staff supervision, liaison with the neonatal experts in customizing neonatal care guidelines for inpatient care settings and to inculcate the culture for inter-disciplinary team meetings at inpatient care settings across the country.

Clinical profile and outcome of neonates admitted in sick newborn care unit with hypernatremic dehydration and association with breastfeeding in a tertiary care hospital in Northern India

Background: Neonatal hypernatremic dehydration is a very commonly seen potentially devastating condition. Inadequate breastfeeding, gastrointestinal losses, warm weather and improperly diluted mixed feeding are the main etiologies linked with neonatal hypernatremic dehydration. We conducted this study to evaluate the etiology, risk factors, clinical symptoms and outcomes of neonates admitted with hypernatremic dehydration and its association with breastfeeding from hilly region in northern India.Methods: The authors retrospectively studied records from extramural sick newborn care unit (SNCU) from April 2018 to June 2019. Inclusion criteria for the study included admitted neonates with documented hypernatremia (serum sodium level &gt;145 mmol/L). Results: Nine hundred and twenty-two neonates were admitted in sick newborn care unit during this study period. One hundred and three (13.39%) newborns were admitted with hypernatremic dehydration at the time of admission. All newborns had deranged kidney function tests at time of admission. Most commonly found presenting complaints were poor feeding (85.71%), fever (45.71%), loose stools (42.8%) and decreased urine output (8%). The mean (SD) sodium on admission was 154.04 (7.41) meq/L. The mean (SD) time taken to correct hypernatremia was 35.6 (14.6) hours. Six of total admitted newborn developed neurological complications (2 had developed cerebral venous thrombosis and 4 had developed seizures). Mortality rate was 4.4%. Top fed neonates (50.41%) had higher percentage of mean sodium level and acute kidney injury at time of admission.Conclusions: Hypernatremic dehydration is preventable and treatable condition. Looking in to and addressing etiology in a timely manner is main step in management. All mothers should be taught correct breastfeeding technique. More breast examination during prenatal and postnatal periods and careful neonatal weight record postnatally could decrease the incidence of neonatal hypernatremic dehydration. Top feeding should be discouraged and only exclusive breastfeeding for 6 months.