Neonatal resuscitation impact of neonatal resuscitation programmes on birth asphyxia, the actual situation

Each Year Billions of dollars have been spent on the various programmes for Maternal and child health services in collaboration with international organizations and hundreds of doctors and thousands of skilled [SBAs] birth attendants and lady heal workers have been trained. To evaluate the impact of neonatal resuscitation programs on the prevalence of birth asphyxia in a hospital which drains a large population of Punjab. Cross sectional. Department of Paediatric Medicine, Nishtar Medical College and Hospital, Multan from January 2008-December 2008. All newborns with a H/o failure to initiate or sustain respiration at birth or H/o associated convulsions who were admitted [referred or hospital based] with the diagnosis of Birth Asphyxia and a weight > 1.5 kg were included, still born and those with lethal congenital malformations were excluded. A questionnaire was designed after extensive review of literature and data recorded. The data of past 10 years for Birth Asphyxia was also collected from the hospital record and compared with the present results. In year 1998 a total of 722 Newborns were admitted our neonatal unit out of which 210 [29.0%] were diagnosed as Asphyxia Neonatorum. This number has progressively increased over the past 10 years with a total of 846 out of total 2079 newborns [40.78%] admitted in 2008 with a diagnosis of asphyxia. Out of the total 8461 patients, there were 69% Male and 31% Female with a M:F ratio of 2.2:1.46% were delivered by SVD [17.39% in Nishtar Hospital 15.21% by dais, 32.6% by Private doctors and 34.78% by LHV] and 54% were delivered by caesarian section, out of which 46.29% were delivered in Private hospitals and 54% in Nishtar Hospital. Overall 65% deliveries were in the private sector or at home and 35% in the government hospitals 60% babies had come from Multan and 40% from other town or cities. A H/o one or more antenatal visits was present in 68% of others. Out of total cases of B.A. 26% were in B.A Grade-159% in Birth Asphyxia Grade-II 15% in B.A Grade-lll. Out of this total 45% expired. As we are moving towards the 4[th] MDG and Pakistan strives to improve its health indicators and we claim to decrease the infant mortality, neonatal and perinatal mortality rate. The incidence of birth asphyxia rises with increased burden of, morbidity. Even though the principles of NRPs are recommended for international application, this program widely used in the developed world has not been properly disseminated in communities in the developing countries, especially Pakistan

Neonatal tetanus

To determine the prevalence of neonatal tetanus and frequency of factor leading to neonatal tetanus in patients visiting to Nishtar Hospital, Multan and comparing this data with the past since 2002. January 2009 to December 2011. Descriptive study [cross-sectional]. ln this study 64 patients with neonatal tetanus were observed over a period of 03 years from January 2009 to December 2011. The ages of babies were from 3-28 days. Mean age was 7.89 + 1.23 days the total number of cases rose significantly from 0.8% of total admission in 2002 to 1.71% in 2011. The commonest risk factor was delivery of baby conducted at home [100%]. 2 nd commonest factor was non immunized mothers, 95% of mothers were non immunized against tetanus in pregnancy. 5% were either partially immunized [received one dose of T.T] or showed vaccine failure despite 2 doses of immunization. ln 80% of the cases there were unskilled birth attendants who conducted deliveries. Among tools which were used to cut umbilical cord, blades were 45% knives were 30%, and scissors were 25%. Ghee application on cord was found to be present in 30% of the cases. While Surma applied on cord was 40%. As far as sex is concerned, 45% cases were females and 55% cases were males. Majority [70%] of cases were of normal birth weight [>2.5kg] while 30% cases were of low birth weight [<2.5kg]. lnability to take feed/lock jaw [95%], and fits [96%] were the two most common symptoms. 0ther less common symptoms were fever [70%] and generalized stiffness [85%]. All the patients were born at home by spontaneous vaginal delivery. The number of neonatal tetanus cases are increasing progressively despite the claims of wide coverage of Tetanus Toxoid Vaccination of female population by EPl. ln our setup the factors which lead to Neonatal Tetanus are; non immunization of mothers during pregnancy, home delivery, delivery by non skilled birth attendants, application of ghee/surma on umbilical cord and cutting of umbilical cord by unsterilized tools [scissors, kitchen knife, blade]. If proper immunization antenatal care and hygienic delivery practices are followed and all these factors are overcome, disease can be controlled and mortality can be reduced.

Hypoglycemia in newborns [a clinical study in 100 newborns at Nishtar hospital Multan]

This was a prospective open, clinical study, conducted in the Neonatal Unit, Department of Pediatric Medicine, Nishtar Hospital, Multan from 2001 to 2002. 100 consecutive newborns admitted were selected to detect hypoglycemia early and prevent the detrimental neurologic outcomes, in newborns. It was also aimed at identifying the common risk factors, relative incidence and clinical symptoms of hypoglycemia. 49% of these sick newborns were hypoglycemic with a male to female ratio of 1.5:1. Majority of newborns admitted on day 1 [67 out of 100] were hypoglycemic 50.7%. Major clinical symptoms, were lethargy, jitteriness, reluctance to feed, seizures hypothermia, hypotonia and cyanosis etc, whereas, major risk factors identified were, sepsis, preterm, IDM, birth asphyxia, jaundice, post tem and SGA. Hence it can be concluded that hypoglycemia is a common problem amongst the sick neonates. Babies of all gestational age are prone and the most common risk factors are, sepsis, low birth weight, post-maturity, IDM etc. and even the normal healthy infants who are asymptomatic can have hypoglycemia