ABSTRACT
Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
ABSTRACT
Background: Neonatal mortality rate (NMR) is one of the major contributors to infant mortality rate. The neonatal mortality depends on many factors birth weight, gestational age, post-natal care; it also depends on maternal social and environmental conditions which contribute to the social determinants of maternal health. This study was taken up to identify maternal social determinants contributing to outcome among outborn neonates in order to reduce neonatal deaths. The present was conducted to assess the outcome among the outborn neonates and assess the maternal social determinants of health affecting the outcome.Methods: A cross sectional study conducted in sick newborn care units (SNCU), Hassan Institute of Medical Sciences, Hassan among all out born neonates. After taking prior written consent, all mothers/bystanders of outborn neonates were interviewed using predesigned, pretested semi-structured proforma. Social factors, environmental conditions and antenatal care affecting the maternal health were collected. Neonatal outcome data was collected from SNCU register. The mothers/bystanders of outborn neonates not willing to give consent and re-admitted neonates were excluded from the study. Data analysis was done using SPSS V20.0.Results: Of 353 outborn neonates admitted, 16.1% was mortality rate. Number of antenatal care visits, consumption of iron tablets, gestational age, high risk mother, staff attending delivery, birth weight, referral time (at p≤0.5) and distance from hospital, passive smoking exposure, maternal services utilization (at p-value <0.1) were significantly associated with poor outcome among outborn neonates.Conclusions: There is need for establishment of SNCUs at sub-divisional levels.
ABSTRACT
Background: Respiratory distress is a medical emergency responsible for most of the admissions in NICUs during neonatal period. It is a major contributor to neonatal morbidity and mortality and results from a variety of respiratory and non-respiratory etiology. It occurs in 0.96 to 12% of live births and responsible for about 20% of neonatal mortality. Aim of study to find out the proportion of patients with different etiology of respiratory distress in neonates.Methods: The present study is a prospective, descriptive study which was carried out at neonatal units attached to SMS Medical College, Jaipur. All the neonates with respiratory distress admitted in NICU admitted from April 2012 to March 2013were selected for the present study. Detailed history including antenatal history, natal history, postnatal history with thorough clinical examinations and investigations done in each case and were recorded in the performa.Results: A total of 500 neonates were admitted and among them 375 were inborn (delivered in our hospitals) and 125 out-born (referred to our hospitals from outside). In inborn group hyaline membrane disease (HMD) was the most common cause (32%) of respiratory distress and in out-born congenital pneumonia/septicaemia (34.4%). There was male preponderance in both inborn and out-born groups with male: female ratio 1.45:1 and 1.6:1 respectively.Conclusions: Majority of cases in both inborn and out-born groups were preterm (56.8% and 54.4% respectively) which emphasises the need for care of mother during antenatal period for prevention of premature delivery.
ABSTRACT
Regionalization of high-risk perinatal care has been advocated because intensive care for small and ill newborn infants lowers mortality and morbidity. This report is based on analysis of admissions to the Neonatal Intensive Care unit (NICU) at the Wonju christian Hospital during the 4-year period from January, 1988 to December, 1991. There were 786 inborn infants and 1155 outborn infants admitted to the NICU. The results of our study follow; 1) Mean gestational ages were 36.8 weeks in inborn infants and 39.0 weeks in outborn infants. Mean birth weight was 2.5kg in inborn and 3.0kg in outborn infants. 2) The high-risk maternal factors, such as cesarian section delivery, eclampsia, preeclampsia, multiple pregnancy and placental anomaly were significantly more frequent in inborn infants than in outborn infants. 3) Perinatal sphyxia, HMD and transient tachypnea of newborn (TTN) were more common in inborn than in outborn infants, but pneumonia, meconium aspiration syndrome, and seizure were more common in outborn infants. 4) The positivity of bacterial cultures in blood and urine was higher in outborn infants than in inborn infants. The most frequently isolated microorganism was staphylococcus species in both inborn and outborn infants. 5) Hospital days, duration of TPN, duration of mechanical ventilation, frequency of seizure, and frequency of transfusion were longer or more frequent in inborn than in outborn infants. 6) Mortality rate was higher in inborn infants than in outborn infants. 7) In outborn infants, mortality rate was higher in infants whose transporting time was longer than 2 hours than for infants within 2 hour distances. However, this difference was not statistically significant. 8) These findings suggest that many lower birth weight and severly ill infants were not transported to the NICU of Wonju Christian Hospital perhaps due to poor transport systems, distance or socio-economic status. In conclusion, the improvement of transporting systems and socio-economic conditions will be required within this region.