Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative

Objective: To improve rate of skin-to-skin contact for earlyinitiation of breastfeeding at birth on operation table amonghealthy term and late pretem babies born by caesarean sectionsfrom 0% to 80% in eight weeks.Methods: A quality improvement initiative was undertaken atmaternity-newborn care unit of a tertiary-care hospital. A teaminvolving Neonatologists/Pediatricians, Obstetricians,Anaesthesiologists, and Nurses in concerned areas identifiedproblem areas using Fish bone analysis. Situational analysis wasdone through process flow mapping. Three Plan-do-study-actcyles were undertaken. Firstly, sensitization of personnel wasdone and a written policy was made. Secondly, maternalcounselling and procedural modifications were done. Lastly,efforts were made to improve duration of contact.Results: Rate of earlyskin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. Itwas 100% after sustainability phase after four months.Conclusion: Early skin-to-skin contact was achievable throughsensitization of all persons involved and simple proceduralchanges. Prolonging duration of contact remained a challenge.

Encephalitic presentation of Neonatal Chikungunya: A Case Series

Objective: To describe clinical features and early neurological outcomes in neonatalChikungunya. Methods: Clinical, pathological and radiological details of neonates with acuteencephalitic features and typical rash, later diagnosed as Chikungunya, are presented.Neurodevelopmental evaluation and imaging was done at discharge/three months. Results:Abnormal neurological examination with fever was typical presentation in all 13 babies with/without seizures/peri-oral rashes; 12 had persistent neurological abnormalities at discharge.A follow-up at three months revealed continued neurodevelopmental deficits. Neuroimagingabnormalities were seen in eight out of ten cases. Conclusions: Perinatal Chikungunyashould be considered in neonates presenting within first week with fever, encephalopathy andperioral rashes with/without seizures with history of maternal Chikungunya within last weekbefore delivery.