Assessment of existing referral system of newborn in Madhya Pradesh, India

Background: Objectives of present study was to assess receiving system of newborns, bed occupancies of referring facilities and receiving facility and assessment of rationality of referrals made by referring facilities to receiving facility leading to congestion at receiving facility. The study was conducted in Department of Pediatrics, Special Newborn Care Unit, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior, Madhya Pradesh.Methods: This study was a prospective observational study which was conducted for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and their receiving characteristics, bed occupancies of referring facilities and receiving facility, number of rationale and irrational referrals at receiving facility were statistically analysed.Results: Total referred newborns enrolled in the study was 2000. As receiving SNCU, of institute caters not only its nearby places, but also to distant districts of Madhya Pradesh, Rajasthan and Uttar Pradesh. SNCU wise receiving was in order of SNCU Morar (20.60%), Morena (19.40%), Bhind (5.70%), Dholpur (5.35%), Shivpuri (4.40%), Chattarpur (3.10%), Datia (1.20%), Sheopur (0.40%) and Jhansi (0.30%). Referring SNCU wise bed occupancy was in order of SNCU Guna (189.16%), Shivpuri (154%), Morena (72.33%), Bhind (71.63%), Sheopur (69.32%), Morar (64.15%) and Datia (62.11%). Referring SNCU wise case fatality was in order of SNCU Jhansi (100%), Sheopur (100%), Chattarpur (56.45%), Bhind (38.59%), Shivpuri (35.22%), Morena (33.76%), Dholpur (27.10%), Datia (25%), Morar (22.08%).Conclusions: Discordant bed occupancy at referring SNCU and receiving SNCU and low rationality of referrals are reason for congestion at receiving SNCU. Optimum utilization of beds and cordant bed occupancy between referring and receiving SNCU may improve the working conditions in SNCU and newborn outcome. Referral system should be close loop systemwith the provision of Down Referral.

Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study / Mortalidade para Cardiopatias Congênitas e Fatores de Risco Associados em Recém-Nascidos. Um Estudo de Coorte

Abstract Background: Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out. Objectives: To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period. Methods: A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors. Results: The risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock. Conclusion: Preterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.

Resumo Fundamento: As cardiopatias congênitas configuram o tipo mais comum de defeitos congênitos, sendo responsáveis por mais mortes no primeiro ano de vida do que em qualquer outra condição, quando etiologias infecciosas são excluídas. Objetivo: Avaliar a sobrevida e identificar os fatores de risco nos óbitos em recém-nascidos com cardiopatia congênita crítica e/ou complexa no período neonatal. Métodos: Realizou-se um estudo de coorte, aninhado a um caso-controle aleatorizado, considerando Intervalo de Confiança de 95% (IC95%) e nível de significância de 5%, pareado por sexo do recém-nascido e idade materna. Foram feitas buscas ativas de casos, entrevistas, análise de prontuário, avaliação clínica da oximetria de pulso (teste do coraçãozinho) e do ecoDopplercardiograma, bem como análise de sobrevida e identificação dos fatores de risco relacionados ao óbito. Resultados: Os fatores de risco encontrados foram recém-nascidos com menos de 37 semanas (Risco Relativo − RR: 2,89; IC95% 1,49-5,56; p = 0,0015), peso inferior a 2.500 g (RR: 2,33; IC95% 1,26-4,29; p = 0,0068), ocorrência de gemelaridade (RR: 11,96; IC95% 1,43-99,85; p = 0,022) e presença de comorbidade (RR: 2,27; IC95% 1,58-3,26; p < 0,0001). A taxa de incidência de mortalidade por cardiopatias congênitas foi de 81 casos por 100 mil nascidos vivos. A letalidade atribuída às cardiopatias congênitas críticas foi de 64,7%, com mortalidade proporcional de 12,0%. A taxa de sobrevida aos 28 dias de vida diminuiu em quase 70% nos recém-nascidos com cardiopatias congênitas. A principal causa de óbito foi o choque cardiogênico. Conclusão: Recém-nascidos prematuros, com baixo peso e presença de comorbidades apresentaram maior risco de mortalidade relacionada às cardiopatias congênitas. Esta coorte se extinguiu muito rapidamente, sinalizando para a necessidade de maior investimento em tecnologia assistencial em populações com este perfil.

Evaluación de la calidad de la atención de la taquipnea transitoria en recién nacidos afiliados al Seguro Médico Siglo XXI / Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program

Introducción: La evaluación de la calidad de la atención del recién nacido con complicaciones es un elemento indispensable para las estrategias de mejora orientadas a reducir las tasas de mortalidad neonatal. El objetivo de este trabajo fue evaluar la calidad de atención técnica e interpersonal en el manejo de la taquipnea transitoria del recién nacido (TTRN) de pacientes afiliados al Seguro Médico Siglo XXI. Métodos: Se realizó un estudio transversal en 61 hospitales de la Secretaría de Salud, que durante el primer semestre de 2011 reportaron al menos dos casos de TTRN. Se analizaron diferentes variables con respecto a la madre, el embarazo, el nacimiento y las complicaciones neonatales, así como intervenciones realizadas al recién nacido y condiciones de salud al egreso. Para medir la calidad de atención, se definieron y validaron indicadores de calidad en los ámbitos de la prevención, diagnóstico y tratamiento. Resultados: Se analizaron 256 expedientes de casos con diagnóstico de TTRN. El 8.9% de las madres tenía alguno de los factores de riesgo (asma, diabetes) y el 53.5% presentó complicaciones en el embarazo. El 60% de los casos de TTRN nacieron por cesárea; un tercio tuvieron bajo peso al nacimiento y el 14% fueron trasladados a otro hospital. En cuanto a los indicadores de calidad, en el rubro de prevención se identificó que en más del 90% se registraron los factores de riesgo (tabaquismo, asma, parto por cesárea); los de diagnóstico reflejaron que en el 86-98% se buscaron manifestaciones de insuficiencia respiratoria. Los de tratamiento lograron cifras satisfactorias para las medidas de monitorización y soporte. Conclusiones: Los resultados permiten considerar que la mayoría de los casos con TTRN recibieron un tratamiento apropiado. Es recomendable desarrollar estrategias efectivas, como reducir la creciente tasa de partos por cesárea, para prevenir la TTRN.

Background: Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". Methods: A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. Results: We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Conclusions: Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.

Nichos de oportunidad para la mejora en la atención médica de los niños afiliados al Seguro Médico para una Nueva Generación / Niches of opportunity for improving health care of children covered by "Medical Insurance for a New Generation"

Introducción. El enfoque del programa Seguro Médico para una Nueva Generación (SMNG) es brindar protección social y financiera gratuita para aquellas familias que carecen de un sistema de aseguramiento médico. El objetivo de este trabajo fue identificar nichos de oportunidad en el programa SMNG de México, para mejorar la atención médica de los niños financiados por este seguro. Métodos. Se calcularon y analizaron nueve indicadores de desempeño descritos en las reglas de operación del SMNG y se realizó una revisión documental conforme a lo normado por el Consejo Nacional de Evaluación de la Política de Desarrollo Social. Resultados. Tres indicadores de desempeño fueron deficientes. La revisión documental reveló algunas fallas en la calidad del llenado de la base de datos de 6,440 niños de 128 hospitales acreditados. De ellos, solamente 51.9% ingresaron en las primeras 24 horas de vida. La mortalidad global fue de 4.43%, con diferencias por entidades federativas de 0 a 18.8%, predominando hipoxia intrauterina, enterocolitis necrotizante y hernia diafragmática. De 108 enfermedades, 41 representaron 90.9% de los niños atendidos. Conclusiones. Se recomienda mejorar la eficiencia de tres de los indicadores de desempeño. Con respecto a la revisión documental, se requiere ampliar la información y la calidad de los datos clínicos consignados en la base de datos, promover un ingreso más oportuno de los niños al hospital y analizar las diferencias en la mortalidad entre las entidades federativas.

Background. The focus of the program "Medical Insurance for a New Generation" (SMNG) is to offersocial and economic protection and to eliminate costs for those families who lack medical insurance coverage. The objective was to identify niches of opportunity in the program to improve health care for children funded by the SMNG. Methods. With information provided by the SMNG, nine "performance indicators" were calculated and described in the rules of operation of the SMNG and a "documentary review" was carried out in accordance with the National Council of Social Development Policy Evaluation. Results. Three of the "performance indicators" were poor. The "documentary review" revealed some faults in the quality of completing the database of 6,440 children and 128 accredited hospitals. Of these, only 51.9% were admitted in the first 24 h of birth. Overall mortality was 4.43%, with differences according to federal entities from 0.0% to 18.8%. There was a predominance of intrauterine hypoxia, necrotizing enterocolitis and diaphragmatic hernia. From 108 diseases, 41 represented 90.9% of all children admitted. Conclusions. It is necessary to improve the efficiency of three of the "performance indicators:" in regard to the "documentary review" it will be required to expand information and the quality of the clinical information contained in the database; promote more timely admission of children to the hospital; and analyze mortality differences among the federal entities.

The mortality status of the neonates born at other maternities compared to that at Tu Du Hospital in 2003 year

Study on 229 newborn babies transferred from lower-level hospital into Neonatology Department of Tu Du Hospital. The results showed that: The main causes were respiratory distress, neonatal infection and asphyxia in premature infants, asphyxia and respiratory distress in the term infants. The more premature the newborn infants were, the earlier they were hospitalized. 157/229 infants were transferred into the hospital by rudimentary vehicles, the others were transferred by ambulance in which only 9.6% had oxygen supply. 163/229 patients (71.18%) were admitted in very serious status that required active intensive care and had high mortality rate