ABSTRACT
When delivery is anticipated near the limit of viability, both the family and the caregiver are faced with many complex and ethicallychallenging decisions. It must be remembered that the decisions that are made are going to impact the entire life of the baby and thefamily. Such decisions should be based on the best available evidence about the prognosis for the infant. If the chance of mortality andserious morbidity for an infant is high (but not too high), parental discretion around provision of life-sustaining treatment is appropriate. Inthis article, we discuss issues on survival and outcomes of extremely premature infants, and the available guidelines
ABSTRACT
Objectives: To compare individual efficacy and additive effects ofpain control interventions in preterm neonates.Design: Randomized controlled trialSetting: Level-3 University affiliated neonatal intensive care unit.Participants: 200 neonates (26-36 wk gestational age) requiringheel-prick for bedside glucose assessment. Exclusion criteriawere neurologic impairment and critical illness precluding studyinterventions.Intervention: Neonates were randomly assigned to Kangaroomother care with Music therapy, Music therapy, Kangaroo Mothercare or Control (no additional intervention) groups. All groupsreceived expressed breast milk with cup and spoon as a baselinepain control intervention.Main outcome measure: Assessment of pain using PrematureInfant Pain Profile (PIPP) score on recorded videos.Results: The mean (SD) birth weight and gestational age of theneonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysisof variance showed significant difference in total PIPP scoreacross groups (P<0.001). Post-hoc comparisons using Sheffe’stest revealed that the mean (SD) total PIPP score wassignificantly lower in Kangaroo mother care group [7.7 (3.9) vs.11.5 (3.4), 95% CI(–5.9, –1.7), P<0.001] as well as Kangaroomother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4),95%CI (–5.1, –0.9), P=0.001] as compared to Control group.PIPP score was not significantly different between Control groupand Music therapy group.Conclusions: Kangaroo mother care with and without Musictherapy (with expressed breast milk) significantly reduces pain onheel-prick as compared to expressed breast milk alone. Kangaroomother care with expressed breast milk should be the first choiceas a method for pain control in preterm neonates.
ABSTRACT
Objective: We assessed the knowledge level and skills of trained ASHAs in providing home-based newborn care. Methods: 100 ASHA from two talukas of Anand district of Gujarat participated. Knowledge was assessed using a structured questionnaire while certain skills were assessed through direct observation on mannequins. Results: The mean (SD) knowledge score of the participants was 16.7(3.16) out of 34. The skills were satisfactory in 52%, 61%, 43%, and 68% of ASHA workers for temperature measurement, hand washing, weight measurement and skin-to-skin care, respectively. Large variability was observed in self–reported and field performance of ASHA workers. Conclusions: Knowledge and skills of Asha workers in this region were inadequate.