Neonatal Special Care Unit Research Articles

Role of surfactant therapy in reducing oxygen requirement and mortality among neonates suffering from respiratory distress syndrome: A Prospective study at Al – Batool teaching hospital in Diyala province

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is a breathing disorder characterized by a deficiency or inactivity of surfactant in the lungs of preterm and term babies and if not treated, it leads to serious complications like pneumothorax, emphysema, bronchopulmonary dysplasia and death. Objective: To estimate the effect of surfactant therapy on oxygen requirement and neonatal mortality as well as the incidence of RDS in the special care neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala Governorate. Patients and Methods: A sample of 2000 patients with signs and symptoms of RDS at the time of presentation was prospectively collected from the 1st of July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy, and continuous positive airway pressure (CPAP) were taken into consideration in assessing the outcome of RDS neonates. Results: There was a significant relationship between surfactant administrations, the period of staying on CPAP, and oxygen demand as the p-value was < 0.001 for both. Neonates who received surfactant had a lower mortality rate, with an incidence of 2.5%; the p-value was < 0.001. Incidence of neonatal RDS was 694 (34.7%). Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy should be routine in neonatal special and intensive care units. Proper use of surfactant (proper timing and mode of administration) reduces oxygen demand, the need for CPAP, hospitalization, and mortality among those neonates.

Ultrasonographic Assessment of the Thymus Among Neonates Admitted in a Special Newborn Care Unit of a Medical College Hospital in Eastern India.

The thymus is essential for the maturation of T-lymphocytes, crucial for adaptive immunity. In neonates, thymic development is influenced by factors such as gestational age, birth weight, birth length, etc. Ultrasonography offers a non-invasive method to assess thymic size and morphology. However, there is limited research on thymic ultrasonography among neonates in Eastern India. This study aimed to investigate the ultra-sonographic characteristics of the thymus in neonates admitted to a Special Neonatal Care Unit (SNCU) in Eastern India and its correlation with certain clinical and anthropometric variables. Conducted from May to July 2024, this cross-sectional observational study involved 80 neonates admitted to the SNCU at the College of Medicine & Sagore Dutta Hospital. Thymic ultrasonography, using an Esaote MylabX7 ultrasound machine with a 3-11 MHz linear probe (Esaote, Genoa, Italy), measured thymic length, width, anteroposterior (AP) dimension, sagittal area, and thymic index. Clinical data, including gestational age, birth weight, birth length, and antibiotics received, were collected from medical records. Pearson's correlation coefficient and linear regression analysis were used to examine correlations and predictors of thymic dimensions. The cohort consisted of 45 boys (56%) and 35 girls (44%). The average birth weight was 2,626 grams for boys and 2,639 grams for girls. The median gestation period was 38 weeksfor both groups. Thymic measurements did not significantly differ by gender. Correlation analysis revealed significant relationships between thymic dimensions and neonatal anthropometric measurements. Birth weight showed a strong positive correlation with thymic length (r = 0.486) and width (r = 0.233). Linear regression identified birth weight as a significant predictor of the thymic index (p < 0.001), explaining 21.2% of the variance. This study provides insights into the factors associated with thymic size in neonates, highlighting the critical role of birth weight in thymic development. Future research should explore additional variables influencing thymic size and consider larger sample sizes to enhance model explanatory power and its potential role in immunity.

Patterns of neonatal admissions and mortality among neonates admitted to special neonatal care units: a two-year cross-sectional study at selected special neonatal care units in Odisha, India

Background: Odisha has built 44 special newborn care units to treat severely sick infants at various levels. This study aimed to determine morbidity and mortality profiles among neonates admitted to the SNCUs and extend efforts to improve outcomes by investigating crucial variables. Methods: We conducted a cross-sectional descriptive study on all neonates admitted to SNCUs of 4 districts (Balangir, Kalahandi, Koraput, and Rayagada) between two calendar years (January 2020 and December 2021). We collected data on epidemiology, clinical presentation, and neonatal and maternal characteristics. We used Microsoft Excel to analyze categorical and continuous variables, with the Chi2 test for proportion comparison. Results: 17615 neonates were admitted in 2020-2021, 58% below one day and 59% male. ST babies were predominant. Outborn unit had 52% admissions, with 67% full-term and 31% pre-term. 74% of outborns used government vehicles for transportation. Most diagnoses were birth asphyxia, HIE, neonatal jaundice, low birth weight, and neonatal sepsis. The study found that 43% of neonates died from hypoxic ischaemic encephalopathy /perinatal asphyxia, 22% from Sepsis, 12% from extremely low birth weight babies, and 9% from prematurity. The Chi2 test showed a statistically significant difference in survival rates between doctors and dai, with a 91% survival rate and a 71% survival rate. Conclusions: Birth asphyxia was found to be the most essential cause of morbidity and mortality. Regular training at district levels is crucial for ensuring proper newborn care, including warmth, feeding, cleanliness, and prevention of asphyxia, to reduce preterm birth and low birth weight.

The ALSPAC fetal and neonatal resource: detailed data abstracted from the clinical records of the new-born.

In a previous Data Note, we outlined the data obtained from clinical obstetric records concerning many details of the pregnancies resulting in the births of the children in the Avon Longitudinal Study of Parents and Children (ALSPAC). Here we describe the data that have been abstracted from medical records concerning the fetus and neonate. Full details concerning the selection biases regarding the data abstracted are outlined in the previous Data Note. The records that have been abstracted, and described in this Data Note, concern the health of the fetus (measured in relation to the results of fetal monitoring, presentation at various stages of pregnancy, and the method of delivery) as well as the status of the newborn immediately post-delivery. Details of signs, symptoms and treatments of this population of new-born babies, as recorded in the clinical records, are described for the time during which they were in hospital or under the care of a designated midwife. These data add depth to the information collected from elsewhere concerning this period of the child's life: from the questionnaires completed at the time by the mother; and clinical details from neonatal intensive or special care units which will be detailed in a further Data Note.

Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study.

Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed. A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers, n = 547) or ceased dexamphetamine before the end of the second trimester (ceasers, n = 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (n = 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes. Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15; p = 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97; p = 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93; p = 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80; p = 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20; p < 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99; p = 0.042). Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.

Manchester Intermittent Diet in Gestational Diabetes Acceptability Study (MIDDAS-GDM): a two-arm randomised feasibility protocol trial of an intermittent low-energy diet (ILED) in women with gestational diabetes and obesity in Greater Manchester

IntroductionThe prevalence of gestational diabetes mellitus (GDM) is rising in the UK and is associated with maternal and neonatal complications. National Institute for Health and Care Excellence guidance advises first-line...

Evaluating an educational program for enhancing neonatal intensive and special care nurses’ and midwives’ competence with neonatal pain management: A quasi-experimental study

Competence in neonatal pain management is influenced by the clinician’s knowledge, attitudes, and skills. The impact of an educational program on enhancing competence among Thai neonatal nurses and midwives has never been explored. This study aims to evaluate the impact of an educational program to increase nurses’ and midwives’ competence in neonatal pain management in Thai neonatal intensive and special care units (NI/SCUs). A web-based learning package with pre-, post-, and follow-up online questionnaire was administered to 68 neonatal nurses and midwives. There was a substantial increase in the total mean scores of knowledge, attitudes, and perceived self-competence in the post- and follow-up phases compared to the pre-test phase (p < 0.001). The educational program had a significant impact on Thai NI/SCU nurse and midwife competence regarding neonatal pain management. Ongoing education is needed to sustain clinicians’ competence in this area.

Study of altered blood glucose levels in term neonate with sepsis

Neonatal hypoglycemia is common metabolic disorder. Hyperglycemia can also occur in other conditions like exogenous parenteral glucose administration, preterm, ELBW babies, stressed premature infants (requiring mechanical ventilation), hypoxia or neonatal diabetes mellitus. The major clinical problems associated with hyperglycemia are hyper osmolality and osmotic dieresis leading to alteration in cerebral auto regulation. Aim &amp; objective: To study the effect of hyperglycemia in term neonate with sepsis and compare it with hypoglycemia. It is a hospital based prospective observational study .The study was carried out in the special care neonatal unit and pediatric indoor of Department of Pediatrics, SCB Medical College, Cuttack and SVP Postgraduate Institute of Pediatrics, Cuttack during the period from September 2018 to August 2020. The number of cases of neonatal sepsis with normoglycemia hypoglycemia and hyperglycemia were, 90(44%), 67(32%), 52(24%) cases respectively. The total number of cases with proven sepsis (n=47) hyperglycemia accounts for 40.4%of cases followed by hypoglycemia 18 cases (38.3%) and normoglycemia seen in 10 cases (21.2%). Both hypoglycemia and hyperglycemia were associated with increased mortality rates at all thresholds but hyperglycemia was independently associated with increased odds of death in patients with neonatal sepsis compared to hypoglycemia.

Threshold and Correlation of Total Serum Bilirubin with Screening Automated Auditory Brainstem Response Among Newborns with Hyperbilirubinemia in National Hospital Abuja

Objective To determine the total serum bilirubin (TSB) cut-off value predictive of hearing impairment among newborns with hyperbilirubinemia at the National Hospital Abuja. Setting This was a cross-sectional study conducted in the Special Care Baby Unit (SCBU) and Neonatal Intensive Care Unit (NICU) of National Hospital Abuja between August 2020 and February 2021. Methods A universal sampling of eligible participants was done, and consent was obtained from the parent. Using the TSB and results of hearing screening carried out with the Otoport advance from Otodynamics®, the proportion of automated auditory brainstem response (AABR) screening failure was determined, and the receiver’s operating characteristics (ROC) curve coordinates were used to find the threshold bilirubin level for the risk of hearing loss. The Spearman-Rho correlation assessed the relationship between TSB level and AABR findings. Results 160 newborns below 28 days of age, delivered at 34 weeks gestation and above, who had clinical jaundice were recruited. The prevalence of screening AABR failure in at least one ear was 26.2%. The correlation between TSB and AABR was weakly positive (rs = .189, p = .093) and the TSB cut-off for AABR failure was 16.3 mg/dl (sensitivity 45.5%, specificity 81%, Youden’s-J statistic = 0.265). Conclusion The TSB threshold for AABR screening failure was 16.3 mg/dl, but TSB did not correlate well with screening AABR. Serum bilirubin above 15 mg/dl in late preterm and term neonates should be actively treated with phototherapy and/or exchange blood transfusions where feasible, particularly in resource-poor settings.

The changing bacteriological profile of neonatal sepsis in a tertiary care hospital – Emergence of Citrobacter septicemia

Neonatal Mortality Rate (NMR) is one of the indicators of health status of a nation and neonatal sepsis is one of the commonest causes of NMR contributing to 19% of all neonatal deaths in India. All over India, there is a gradually increasing trend of multi-drug resistant (MDR) pathogens in neonatal intensive care units (NICU) and special newborn care units (SNCUs) in tertiary care hospitals.To determine the changing trend in the bacteriological profile of neonatal septicemia and their antibiotic susceptibility pattern (AST).It is a retrospective study conducted on total 452 blood culture samples collected from SNCU over 1-year period from July 2017 to June 2018 in tertiary care government hospital. Organisms were identified by the standard protocol and their antimicrobial susceptibility testing was determined as per latest CLSI guidelines.out of 452 blood culture of neonatal septicemia patients, 138 cases (30.53%) were culture positive Most common isolated gram negative organism was spp. 55/138 (39.85%) followed by spp. 23/138 (16.66%). Most common isolated gram positive organism was 25/138 (18.11%) followed by Coagulase Negative Staphylococcus (CONS) (8.69%). Among gram negative isolates most sensitive antimicrobial was Imipenem (87.6%) followed by Levofloxacin (87.4%) and Piperacillin + Tazobactam (46%) and resistant to, Cotrimoxazole, Amoxicillin + clavulanate and 3rd generation Cephalosporins.spp. is the predominant organism of neonatal sepsis in the Indian subcontinent, although significant rise in proportion of spp. is occurring. High resistance to cephalosporins is a cause of concern, as they are one of the most common prescribed antibiotic groups.

Bacteriological Profile of Neonatal Septicaemia and Antibiotic Susceptibility Pattern of the Isolates Admitted in SCANU of a Tertiary Levels Hospital of North Bengal, Bangladesh

Introduction: Neonatal septicemia is one of the most common causes of infection and mortality in neonates, due to which 30–50% of neonates die each year in developing nations. Various studies have suggested that bacteremia occurs in 20% of neonates, and approximately 1% die due to neonatal sepsis. It affects newborns below 1 month of age and encompasses systemic infections including meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections. Objective: To assess the Bacteriological profile of neonatal septicaemia and antibiotic susceptibility pattern of the isolates admitted in SCANU of a tertiary levels hospital of North Bengal, Bangladesh. Methods: A prospective study was conducted including 50 suspected cases of septicemia admitted to the Special Care Neonatal Unit (SCANU) of the selected Department of Paediatrics, TMSS Medical College, Bogura Bangladesh July to December 2022. Demographic data included birth weight, gestational age, postnatal age, and treatment as well as survival outcome. Clinical and laboratory data included the number of days between birth and admission to the SCANU, admitting and discharge diagnoses, and pharmacological treatment. Data was analysed by percentages of each antibiotic used. And which organism was responsible for neonatal sepsis. Results: Total 50 cases clinically suspected neonatal sepsis were included in the study. The mean age was 8.33±7.36 days, mean birth weight was 2816.25±288.6gm, male were predominant which was 70%. Among gestational age of the Neonates having septicemia Preterm (&lt;37) 66% and Term (37 up to 42) 36%. Out of the 50 proven sepsis cases, 36 cases (72%) were early onset and 14 cases (28%) were late onset. In this study out of 50 cases 16 cases were culture positive septicemia which was 32%. Gram negative organism were predominant with 10 isolates (62.5%) in comparison to gram-positive 6 (37.5%) isolates was the most common S. aureus (25.0%) and E. coli (12.5%) among the organism isolated. Other organisms isolated were Staphylococcus Pneumoniae (6.3%), Staphylococcus epidermidis (18.7%), Proteus (18.7%), Listeria species (6.3%), Pseudomonas (6.3%), and Enterococci (6.3%). In this study, Staphylococcus aureus was the commonest organism isolated from both EOS (20%) and LOS (33.3%) followed by Staphylococcus epidermidis (10% &amp; 33.3%). Amoxiclave is highly sensitive to S. aureus &amp; E. coli. In this study, vancomycin showed 25.0% sensitivity to S. aureus but for Nitrofurantoin it was only 33.3%. The Listeria species isolates here were 100% sensitive to meropenum. In our study, ciprofloxacin showed 33.3% to 100% sensitivity to different isolates. Conclusion: In the present study, high bacterial resistance among the pathogens suspected to cause neonatal septicemia is demonstrated which can be controlled by prudent use of available antibiotics. This study suggests regular monitoring of the antimicrobial sensitivity of the causative organisms in a particular setting is very important.

Challenge Accepted: Retinopathy of Prematurity (ROP) During COVID-19.

The World Health Organization has identified retinopathy of prematurity (ROP) as one of the emerging causes of preventable childhood blindness in developing and middle-income countries. It is becoming a major public health problem in developing countries like India and China. ROP blindness in India is increasing due to the highest number of preterm births in the world, suboptimal neonatal care, lack of awareness, screening programs and treatmentnot in place, and increasing numbers of neonatal intensive care units (NICUs) and special newborn care units (SNCUs) opening all over the country without appropriate ophthalmic care. On top of it, heavier and late pretermbabies are developing severe ROP due to the variable quality of neonatal services and insufficient optimal eye care in the NICU and SNCU. The situation become more precarious during the coronavirus disease 2019 (COVID-19) pandemic, and it became a challenge to motivate health workers and parents to keep the screening and treatment of ROP babies in place.

Risk Factors for Hearing Loss in High-Risk Neonates at a Tertiary Care Centre in Central India: A Prospective Observational Study

Introduction: Hearing impairment and deafness are global issues that affect 5% of the world’s population, with nearly 34 million children requiring rehabilitation to address their hearing loss (HL). An approximately 10-20 fold higher incidence of audiological risk factors has been noted in Neonatal Intensive Care Units (NICUs), which translates that 2-5% of all newborns in NICUs may be affected. Early diagnosis of HL and intervention can be advantageous from the timely fitting of hearing aids or cochlear implants. Aim: The aim of this study was to evaluate the risk factors for HL in NICUs and Special Neonatal Care Units (SNCUs) at a tertiary care hospital in Central India. Materials and Methods: This prospective, observational, single-centre study was conducted from October 2019 to September 2021 in the Department of Paediatrics at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India. A total of 319 neonates at high risk for HL, discharged from NICUs and SNCUs, were included in the study. The association between risk factors like prematurity, low birth weight (LBW), Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex (TORCH) infections, neonatal asphyxia, neonatal sepsis, meningitis, exchange transfusion, assisted ventilation, and HL were studied. The chi-square test was used to assess the association between SNHL and risk factors. Results: The incidence of Sensorineural Hearing Loss (SNHL) was 3.76%. Neonatal asphyxia (p-value &lt;0.01), exchange transfusion (p-value &lt;0.001), TORCH infections (p-value &lt; 0.001), meningitis (p-value &lt;0.001), and assisted ventilation (p-value &lt;0.001) were found to be significant risk factors associated with SNHL. Conclusion: Based on the assessment of risk factors, it was concluded that neonates should undergo hearing screening tests within the first month of life, and a diagnosis should be made by three months of age. This allows specialists to initiate treatment and intervention by six months of age, helping children with impaired hearing avoid the harmful consequences of semantic deprivation.

Knowledge, attitudes, and perceptions of health-care workers about human milk banking in Singapore

Background: The use of human milk provides substantial short- and long-term benefits. With the establishment of the first donor human milk bank in Singapore, high-risk preterm and critically ill infants whose mothers have an inadequate milk supply can have access to pasteurized donor human milk. Materials and Methods: A self-administered anonymous questionnaire was conducted among doctors and nurses working in the special care unit and neonatal intensive care unit of KK Women's and Children's Hospital. The questionnaire was divided into three main sections, namely, demographics, knowledge assessment, and opinion. The aims of the survey were to assess the knowledge, attitudes, and perceptions of health-care workers on breast milk donation and milk bank, and to identify any differing perceptions among different racial and ethnic groups. Results: A total of 38 doctors and 140 nurses from various racial and religious backgrounds participated in this survey. More than 50% of respondents know the benefits of breast milk over formula milk; however, knowledge of the milk donation process and the effect of pasteurization on donated breast milk can be improved on. In the opinion section, 78.7% of survey respondents were supportive of the human milk bank. Sixty-eight (38.2%) respondents felt that recipients should receive milk from donors of the same race and ethnicity, whereas 56 (31.5%) disagreed and 53 (30%) were neutral. Conclusion: Donor human milk banking is well received and supported by health-care workers. Knowledge of milk donation, screening, pasteurization, and storage can be improved on. Further evaluation is required to determine the underlying concerns that different ethnic groups may have.

Overview of the cause, complications, immunity, therapy, medication, and certain behavioral changes of premature babies

Babies born before 37 weeks of pregnancy are considered preterm. Babies born prematurely are also referred to as “preemies” or “preterms.” India has the world’s highest rate of premature births. About 1.5 million babies are born prematurely every year. As they grow up, preemies will encounter a variety of challenges. Many children who die before the age of 15 do so due to complications related to their premature birth. Although researchers have yet to pinpoint what exactly causes premature birth, doctors have shown that maternal health plays a role. Preterm birth can be caused by a variety of circumstances, including those of the mother as well as those of the pregnancy and the fetus. There are special care nurseries and neonatal intensive care units worldwide that provide medical attention to premature infants. The infant is placed in an incubator, and all vital signs are monitored, as well as feeding tubes, blood transfusions, and other forms of resuscitation. Major problems, behavioral changes, and therapies for premature infants were covered in this article. Problems with breathing, heart, brain, digestive tract, eyes, ears, teeth, and blood are among the most common serious consequences. The behavior of premature infants is distinct from that of full-term children. They are unable to effectively interact with others due to a lack of emotional intelligence, social awareness, and communication abilities. Medication given to premature infants has the potential to promote growth and appropriate lung, heart, and circulation development. The administration of these drugs is conditional on the state of the infant.

The Clinical Significance of Extreme Leukocytosis among Newborns: A Retrospective Cohort Study.

The aim of the study is to examine the clinical significance of extreme leukocytosis (>40,000 cells/µL) at birth among neonates. Data were retrospectively collected on 208 infants with leukocytosis >40,000 cells/µL and on matched normal controls as determined in complete blood counts obtained on the first day of life. There were no significant group differences in birth weight, Apgar's score, timing of respiratory support, hospitalization in special care units or rehospitalization during the first month of life. All neonates with leukocytosis received antibiotics. The blood cultures of both groups were negative. A multivariate analysis showed that leukocytosis did not predict either the presence of symptoms associated with sepsis among neonates or hospitalization in a neonatal special care unit. Extreme leukocytosis on the first day of life is a poor predictor of infection. Clinicians should decide upon treatment according to risk factors and symptoms but not according to the degree of leukocytosis. · Extreme leukocytosis on the first day of life is a poor predictor of infection.. · Clinicians should decide upon treatment according to risk factors and symptoms.. · Leukocytosis was not predictive of a higher risk of morbidity in neonates..

Contributors and associated risk factors of neonatal mortality in a tertiary care hospital in the sub-Himalayan region of West Bengal

Background: Lack of revision of knowledge on the magnitude of problem, cause and factors associated with neonatal mortality hampering early interventions and thus preventing reduction of neonatal mortality rate in India. Neonatal mortality statistics are sensitive indicators of the utility, convenience and effectiveness of maternal child health service in the community. This study was done to see the mortality pattern of neonates and contributing factors at the special newborn care unit (SNCU) and neonatal intensive care unit (NICU) of a rural tertiary care hospital so that special attention to those cause and factors can lead to favourable outcomes.Methods: This was a cross sectional retrospective study done in the SNCU and NICU of rural tertiary care centre of West Bengal for a period of three years with neonates admitted before 28 days of life. Data were collected in pre-designed proforma by analysing the case sheets from the records section of the hospital. Results were analysed by descriptive analytical method.Results: Total 13738 babies were admitted in the study period (7143 inborn and 6595 outborn). Majority of the inborns (86.8%) and outborns (68.4%) were discharged during that period while 9.4% inborns and 19.5% outborns were expired and only those expired cases were included in this study. HIE/moderate-severe birth asphyxia (41.2%) was the major contributor of death in inborns but in outborns the most common contributor of death was sepsis/pneumonia/meningitis (34.8%). Prematurity and low birth weight were the most common associated risk factors in both the groups.Conclusions: This study delineating the mortality patterns and associated risk factors of neonates in a rural tertiary care hospital of West Bengal which is unique in its kind. Outcome analysis showed that neonatal mortality rate for outborn babies was higher than in relevant recent studies.

Risk factors of late-onset Neonatal Sepsis in Special Care Neonatal Unit of a Tertiary Care Hospital in Bangladesh

Introduction: Late-onset neonatal sepsis is one of the most common causes of neonatal deaths in hospital as well as community in developing country like Bangladesh. It can present asmeningitis, pneumonia, pyelonephritis, or gastroenteritis. Various risk factors play important role in its causation. In this study our main goal was to evaluate the risk factors of late onset neonatal sepsis in SCANU (Special Care Newborn Unit) of a tertiary care hospital. Methods: This cross-sectional study was done in the SCANU of Dr. M.R. Khan Shishu Hospital and Institute of Child Health, Mirpur-2, Dhaka for 6 months. A total of 59 neonates with late onset sepsis in SCANU were included during the study period. Results: The socio-demographic status of the neonates with late onset sepsis shows that, most of the neonates (44.1%) were between 24 to 28 days. Also, 54.24% patients were male and 57.6% patients belong to middle economic status group. In the study, 79.7% had Cough with respiratory distress followed by 23.7% had cough only, 6.8% had fever, 52.5% had vomiting, abdominal distension, and 8.5% patients had Jaundice. Only 1.7% patients used bottles for feeding. Among neonates, the highest (49.15%) came with the risk factor of poor hygiene. The Majority (95%) of low-birthweight neonates had patchy opacity resembling pneumonia in chest x-ray. Conclusion: Poor hygiene is a high-risk factor for neonates with late onset sepsis. Bottle feeding had comparatively higher risk in developing late onset sepsis than formula feeding with spoon. Poor cord care is another risk factor. J Bangladesh Coll Phys Surg 2022; 40: 257-262

Improving the Quality of Health Care in Special Neonatal Care Units of India: A Before and After Intervention Study.

We evaluated the efficacy of training health care workers (HCWs) in point-of-care quality improvement (POCQI) and a preterm newborn health care package (PHCP), followed by remote mentoring and supportive supervision in improving health care practices, neonatal survival, and morbidities in special neonatal care units (SNCUs). This pre- and postintervention quality improvement study was conducted at 3 SNCUs in Madhya Pradesh, India from February 2017 to February 2019. Clinical care teams comprising doctors and nurses from the study sites were trained in POCQI and the PHCP. The teams identified, prioritized, and analyzed problems and designed quality improvement initiatives at their respective health facilities. Change ideas were tested by the local teams using sequential plan-do-study-act cycles. Facilitators maintained contact with the teams through quarterly review meetings, fortnightly videoconferencing, on-demand phone calls, and group chat service. State SNCU coordinators made follow-up visits to supplement coaching. Study research staff independently collected data on admissions, health care practices, and outcomes of neonates. A total of 156 HCWs were trained in the POCQI methodology and PHCP. Sixteen quality improvement projects were formulated and implemented. Among 13,821 enrolled neonates (birth weight 2275±635 g; gestation: 35.8±2.8 weeks), improvement was seen in reduction of use of oxygen (36.1% vs. 48.0%; adjusted odds ratio [aOR]=0.60, 95% confidence interval [CI]=0.55, 0.66), antibiotics (29.4% vs. 39.0%; aOR=0.76, 95% CI=0.68, 0.85), and dairy milk (33.8% vs. 49.4%; aOR=0.34, 95% CI=0.31 to 0.38). Enteral feeds were started within 24 hours of admission in a larger number of neonates, resulting in fewer days to reach full feeds. There was no effect on survival at discharge from the hospital (aOR=0.93; 95% CI=0.80, 1.09). A collaborative cross-learning quality improvement approach with remote mentoring, coaching, and supportive supervision was successful in improving the quality of care at SNCUs.

Knowledge of nurses on neonatal sepsis: a tertiary teaching hospital-based study

Neonatal sepsis is a significant cause of morbidity and mortality in hospitalized newborns and premature infants. Therefore, knowledge of essential newborn Care (ENC) is important for a newborn's survival, growth and development.&#x0D; The aim of this study was to assess the knowledge of nurses regarding essential newborn care in our Special Care Neonatal Unit (SCNU).&#x0D; Methods: A descriptive cross-sectional study was conducted between 1st September 2021 and 30th November 2021 among the nurses working in SNCU of Government Medical College and Hospital (GMC), Doda, Jammu and Kashmir, India. Data were was collected using a pre-tested questionnaire by purposive sample. Collected data were checked, and coding was done and analyzed using SPSS 20 software.&#x0D; Results: 72.0 % of nurses were of the age group of 21–30 years. The majority (74 %) were females, 78 % had completed B Sc Nursing, and 66 % had experience of 2 to 4 years. Most of the nurses had good knowledge about ENC, about basic equipment’s used in SNCU, and about advanced equipment’s or procedures had less knowledge. All nurses answered bacteria correctly as a causative organism of neonatal sepsis.&#x0D; Conclusions: Most of the nurses working in the SCNU of GMC Doda had good knowledge regarding ENC. The knowledge appeared irrespective of their age, gender, religion, educational status, working place and special courses/training in neonatology.