Exploring factors influencing Essential Intrapartum and Newborn Care (EINC) practice amongst Covid-19 suspected mothers: a qualitative study

BACKGROUND@#The practice of Unang Yakap or Essential Intrapartum and Newborn Care (EINC) during the COVID-19 pandemic poses a safety concern with regards to a newborn’s exposure to their COVID-19 suspected mother. @*OBJECTIVES@#This study aims to describe the experiences of COVID-19-suspected mothers and explore the factors influencing their decision to allow healthcare professionals to practice full EINC. Specifically, it aims to: 1) describe the experiences of mothers prior to, during, and immediately after delivery, and during postpartum care leading to their decision; and 2) explore the factors that influence the participant’s decision to practice EINC amidst the pandemic.@*METHODOLOGY@#For this phenomenological case study, online interviews with nine (9) participants were conducted using a 13-item questionnaire describing their experience. Thematic analysis using the inductive and semantic approach was conducted to identify the common themes or factors. @*RESULTS@#Of the nine (9) participants, five (5) experienced EINC, while four (4) did not. The COVID-19 status and the choice to undergo Unang Yakap were not a causal relationship. Two main influences, mother-related factors, and hospital-related factors, were identified and were found to have weight in decision-making. The mother-related factors include prior knowledge and perception towards EINC, COVID-19 status, personal beliefs, and information from social media; while the hospital-related factors are hospital facilities, hospital protocols, and HCW-patient relationship. @*CONCLUSION@#By delineating the different factors that influence mothers’ decisions, this study allows for the identification of possible bottlenecks in the practice of EINC, as well as effective and efficient means to encourage its practice.

A multicenter survey of critical neonatal care centers construction and treatment of critically-ill neonates at city- and county-level in Henan Province / 中国新生儿科杂志

Objective:To study the current status of critical neonatal care centers (CNCC) construction and treatment of critically-ill neonates at city- and county-level in Henan Province.Methods:A questionnaire survey was conducted in January 2022 to city- and county-level CNCC in Henan Province. The basic information of CNCC, ward settings, neonatal management in the Department of Obstetrics and the treatment of critically-ill neonates in 2019-2021 were analyzed.Results:A total of 188 questionnaires were sent and 183 (97.3%) eligible questionnaires were analyzed, including 30 from city centers and 153 from county centers. The bed occupancy rate in county centers was significantly lower than city centers (67.3%±24.1% vs. 86.1%±23.2%), and the doctor/bed ratio, doctor/rescue bed ratio and nurse/rescue bed ratio were significantly higher than city centers ( P<0.05). All city centers had set up independent Department of Neonatology and the number is 92.8% (142/153) in county center. For 80.9% (148/183) centers, neonates were managed in the Department of Obstetrics with consultations and referrals to the Department of Pediatrics and 19.1% (35/183) were managed in the Department of Pediatrics/Neonatology. The average number of deliveries and admissions to the Department of Neonatology in both city and county centers decreased year on year during 2019-2021, but the proportion of premature and low/very low birth weight infants treated in these centers increased year on year. During 2019-2021, the top three diseases treated at the city centers were neonatal respiratory distress syndrome, neonatal asphyxia and acute respiratory distress syndrome, while the top three diseases treated at the county centers were neonatal asphyxia, neonatal respiratory distress syndrome and meconium aspiration syndrome. The incidence of sudden infant death syndrome in city and county centers was (10~30)/100,000. Conclusions:The construction of CNCC in Henan Province is facing challenges such as decreased hospital admissions, increased critically-ill neonates, insufficient cooperation between Obstetrics and Pediatrics and waste of resources. Rationally allocated and optimised use of resources to improve the ability to treat critically-ill neonates is warranted.

A cross sectional study on the evaluation of MCH services provided by “ASHA” working at Urban Health Centers of Ahmedabad City, Gujarat

Introduction: National Rural Health Mission (NRHM) was launched by Indian Government with key feature of introduction of a new designated health care worker – “Accredited Social Health Activist” (ASHA) who acts as interface between community and public health system. Objectives: To assess knowledge about MCH related functions and to estimate status of support to beneficiaries by “ASHAs”, To Assess Quality of Home Based New Borne Care performed by ASHA and to find out impact of number of modular training rounds on knowledge and practices of ASHAs. Methodology: A cross-sectional study was conducted during February 2019 to December 2020 using a mixed approach, with a combination of quantitative and qualitative research methods after approval of institutional Ethics committee. All Urban Health Centres (UHC) under Municipal Corporation in Ahmedabad were covered. From each UHC, 2 ASHAs were selected by lottery method. So, total 144 ASHAs were selected from 72 UHCs. Performance assessment was done by direct interview with ASHA and their beneficiaries. Results: All 144 ASHAs were aware about responsibilities of Antenatal-women registration and Immunization. Nearly all ASHAs (99.3%) knew about task of PNC registration. Escorting to delivery and tertiary care centre, if complications arise was facilitated by 61.8% and 29.2% ASHAs respectively. Conclusion: All ASHAs were aware of their major responsibilities related to MCH and also providing same in their field area. Statistically significant association was observed between number of rounds for modular training undertaken by ASHAs and knowledge and practice of ASHAs in context to various components of MCH care.

Effect of a Quality Improvement Package on Reducing Newborn Mortality from 26 to 14 in a Himalayan North Indian State

Background: In India, newborn mortality remains high due to a number of factors, including poor quality of care at health facilities. The experience of executing complete neonatal care quality improvement (QI) package at selected hospitals in Himachal Pradesh and reduction in newborn mortality rate (NMR) is described in this study. Objective: The short-term objective was the participants’ retention of knowledge and skills, and the achievement of uniform QI objectives following training and after a minimum of 6 months. Overall reduction in NMR was long-term objective. Methods: Newborn care QI package was implemented according to India Newborn Action Plan over a period of 48 months from 2013 to 2016, through infrastructure, trainings, and supportive supervision. Results: Total 13 health facilities were upgraded; 350 staff nurses and medical officers were trained. The mean posttraining knowledge score was 75% compared to 29% in the pretraining test, and 63% 1 year later. The competencies of health workers in the care of high?risk babies and 12 QI targets had improved, resulting in a 46% reduction in neonatal mortality in the state across all gestations and weights based on sample registration survey. Conclusion: Implementation of a bundle of evidence-based practices in low-resource setting for health system strengthening for intrapartum and neonatal care was linked to changed care behaviors among health-care providers, and reduction in NMR.

Mother-Newborn Care Unit (MNCU) Experience in India: A Paradigm Shift in Care of Small and Sick Newborns

While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the efect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in fve hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the “mother–newborn care unit (MNCU).” Mother–newborn care unit or mother–newborn intensive care unit (M–NICU) is a facility where sick and small newborns are cared with their mothers 24 ×7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24×7, making the concept of zero-separation a reality.

Midwifery Students’ Acquisition and Retention of Essential Newborn Care Competencies: An Experimental Study

@#Introduction: Annually, over two million newborns die worldwide immediately after birth, mostly because of failure to initiate and sustain breathing. A significant decline in newborn deaths can be achieved by using proper essential newborn care (ENC) techniques. Competency-based education (CBE) could successfully build ENC skills. The purpose of the present study was to investigate the effect of applying CBE on Midwifery students’ knowledge and skills acquisition and retention of ENC. Methods: This quasi-experimental study recruited third-year under-graduate midwifery students (n=54). They were equally assigned to the interventional and control group. The interventional group was taught ENC by using CBE, whereas the control group was taught by using traditional methods. Students’ ENC knowledge was assessed three times using a multiple-choice question exam. The ENC skills were measured twice by using the Essential Neonatal Care Performance Checklist. Results: The intervention group exhibited significant ENC knowledge and skills, performance acquisition, and retention (p<0.001). Conclusion: CBE is a useful educational model for the acquisition and retention of ENC.

Selecting indicators for assessing the functionality of basic emergency obstetric and newborn care facilities in the Philippines: A Delphi process

Introduction@#To address the problem of high maternal death, the Department of Health implemented the Basic Emergency Obstetric and Newborn Care (BEmONC) services at the level of primary care health facilities. These are key life-saving interventions that treat obstetric emergencies. Over a decade later, we need to assess and improve the program’s implementation. @*Objective@#The study aims to select indicators for assessing the functionality of BEmONC facilities. @*Methods@#Electronic Delphi process was used to select the indicators. @*Results@#The two-round Delphi process was accepted by 21 respondents, with a 100% response rate. All 30 proposed indicators were retained following the criteria. @*Conclusion@#Thirty indicators to assess the functionality of BEmONC facilities have been selected through the consensus of an expert panel using the Delphi process. These indicators help evaluate BEmONC facilities, formulate policy, and guide new programs that promote maternal health.

The development of Basic Emergency Obstetric and Newborn Care (BEmONC) and Maternal Health in the Philippines: A historical literature review

Introduction@#Implementation of Basic Emergency Obstetric and Newborn Care (BEmONC) aims to curb maternal mortality. However, the Philippines failed to significantly reduce the maternal mortality rate (MMR) targeted in the Millennium Development Goals (MDGs). Currently, the country is still far from the targeted Sustainable Development Goals (SDGs). This review describes the historical development of BEmONC in the Philippines over the past 13 years and provides insights on its role in decreasing MMR. @*Methods@#We searched online for journal articles, publications, reports, policies, and other issuances related to BEmONC and maternal health in the Philippines. We accessed updates and data via correspondence with the Department of Health (DOH). Statistics were compiled from public databases. The identified citations were screened, appraised, synthesized, and analyzed in a historical approach. @*Results@#A direct result of the Emergency Obstetric Care Approach, BEmONC was developed to respond to the high MMR in the Philippines, in line with global efforts to improve maternal health. However, BEmONC functionality generally remained inadequate. @*Conclusions@#Although the provision of BEmONC services increased facility-based deliveries and skilled birth attendance during childbirth, this failed to decrease MMR and achieve targeted goals substantially. Further capacity-building is needed, especially in rural and resource-poor areas. Government issuances at the national and local levels should be aligned to complement each other. There should be a health systems approach that considers the building blocks of an efficient health care system and the social determinants that impact them.

Cuidados esenciales del recién nacido e infección posnatal por COVID-19 (SARS-COV-2): revisión sistemática / Essential newborn care and postnatal infection by COVID-19 (SARS-COV-2): systematic review

RESUMEN Objetivo: La incertidumbre de una posible transmisión posnatal por SARS-CoV-2 genera un desafío entre aplicar o evitar los cuidados esenciales del recién nacido para prevenir la transmisión. La revisión sistemática tiene como objetivo describir el impacto de los cuidados esenciales del neonato en la transmisión posnatal del SARS-CoV-2. Métodos: Se realizó una revisión sistemática en bases de datos electrónicas, se incluyeron estudios observacionales, serie de casos y reporte de casos. Dos investigadores de forma independiente evaluaron los criterios de inclusión, la calidad metodológica y la extracción de datos. Resultados: Se tamizaron 208 estudios para una inclusión final de 9 artículos relevantes. El reporte de transmisión del virus SARS-CoV-2 está centrado en la posibilidad de transferencia por la leche materna y ausencia de información acerca de la transmisión por otros cuidados esenciales, sin embargo, se observa un bajo uso en la práctica clínica de los cuidados esenciales del recién nacido hijo de madre con COVID- 19. Conclusiones: La información es limitada sobre la posible transmisión del SARS-CoV-2 a través de los cuidados esenciales del recién nacido, sin embargo, la pandemia ha impactado de forma importante los mismos. Según los hallazgos en la literatura, es mayor el beneficio de estas intervenciones y las recomendaciones científicas promueven su aplicación empleando las medidas de protección personal para la madre y el personal de salud.

ABSTRACT Objective: The uncertainty of a possible postnatal transmission by SARS-CoV-2 creates a challenge between applying or avoiding essential newborn care to prevent transmission. The objective of the systematic review is to describe the impact of essential neonate care on the postnatal transmission of SARS-CoV-2. Methods: A systematic review was carried out in electronic databases, observational studies, case series, and case reports. Two investigators independently assessed the inclusion criteria, methodological quality, and data extraction. Results: 208 studies were screened for a final inclusion of 9 relevant articles. The transmission report of the SARS-CoV-2 virus is focused on the possibility of transfer through breast milk and the absence of information about transmission by other essential care, however, a low use, in clinical practice, of essential care for the newborn child of a mother with COVID-19, is observed. Conclusions: Information is limited on the possible transmission of SARS-CoV-2 through essential newborn care; however, the pandemic has had a significant impact on them. According to the findings in the literature, the benefit of these interventions is greater, and the scientific recommendations promote their application, using personal protection measures for the mother and the healthcare personnel.

Carencias y variabilidad en la calidad de la atención a neonatos hospitalizados en México. Estudio transversal en 28 hospitales públicos / Deficiencies and variability in the quality of care for hospitalized neonates in Mexico. Cross-sectional study in 28 public hospitals

Resumen: Objetivo: Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Material y métodos: Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccionados al azar del Subsistema Automatizado de Egresos Hospitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según muestreo estratificado no proporcional. Resultados: Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la identificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones: La calidad de la atención a neonatos en hospitales es heterogénea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Abstract: Objective: To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods: Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as "standard compliance"/"non-compliance" by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results: No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is <50% on all other indicators. Conclusions: The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.

Validation of Edinburgh post natal depression scale in post-natal woman from a tertiary referral center in South India

Background: Pregnancy and childbirth are two most important life-changing events. Post-partum depression can affect mother and has a wide spectrum of presentation depending upon various social factors. Studies suggest that the incidence of postnatal depression among women of high social strata is 13-19% while the incidence is 11-42% among women with limited social support. The present study aims to study postnatal depression and its causes in a postnatal mother in all the aspects of social, physical, cultural and psychiatric grounds in the Indian scenario with the help of the Edinburgh postnatal depression scale (EPDS).Methods: From 1st July 2019 to 31st December 2019, a total 300 postnatal women between 1 to 6 weeks of the postpartum period participated and during their stay in the hospital responded to EPDS. The study was purposive sampling, and full consent of the study subjects was taken before the start of the study.Results: In this study, we found 20.1% of a woman affected by post-partum in South India. The higher percentage of severe depression was seen in the primary gravida (20%). The risk factors such as availability of postnatal care (with NICU admission), the woman with medical complications, late childbirth or delayed childbirth after marriage, multiparity, delivery via caesarean and nuclear family showed significant relationship (p<0.005) with depression.Conclusions: The present study, with a Post-natal depression of 20.1% along with the enumerated risk factors, suggest that the causes for postpartum depression (PPD) among working Indian woman, reflect a change to an urban-centric lifestyle. Further evaluation of these risk factors needs to be made and a routine screening of Postpartum depression (PPD) can help in improving maternal and child health.

Neonatal mid upper arm circumference as surrogate of birth weight

Background: Recording an accurate birth weight by primary health worker has been a problem in rural areas, leading to search for an alternative, inexpensive, age independent and noninvasive method to predict newborn birth weight and wellbeing. With this background I aimed to found out whether the neonatal-MUAC is associated with birth weight or not?Methods: This hospital based prospective observational study was conducted in SNCU and postnatal ward, Kamla Raja Hospital, G.R. Medical College, and Gwalior (M.P). A total of 1303 newborns were included in the study. The Mid upper arm circumference (MUAC) of newborns were taken and Birth weight recorded were filled in a proforma.Results: Total 1303 neonates were evaluated. The mean MUAC and birth weight in preterm was found to be 1854.80'387.3 and 7.47'0.9 as compared to full term newborn having mean birth weight(2818.95'328.1) and mean MUAC (9.58+0.7).The Pearson coefficient of correlation between neonatal MUAC (N-MUAC) and birth weight was found to be r= 0.987 and p<0.01. Birth weight can be predicted from regression equation: Birth weight (gms)=422.99 (N-MUAC) + (-1272.66). Cut-off value of neonatal mid upper arm circumference (N-MUAC) was found to be 8.85cm to predict low birth weight newborn.Conclusions: Birth weight of newborn can be predicted from neonatal mid upper arm circumference (N-MUAC) in areas where the conventional scale are not easily available for measuring the birth weight of newborn.

Home-based newborn care voucher initiative in Assam: An evaluation

Background: An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community. Objective: This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam. Methods: A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers. Results: Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns. Conclusions: HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.

Onsite mentoring of special newborn care unit to improve the quality of newborn care

Background: It has been possible to set up special newborn care units (SNCUs) and to improve the survival of newborns in India. However, several challenges remain affecting their effective functioning. Different approaches have been attempted and several policies have also been implemented to address this issue. Objectives: To evaluate the feasibility of implementing best practices in neonatal care by onsite mentoring in an SNCU over 4 months. Methods: The mentoring team was from a tertiary care hospital in Karnataka. The SNCU was functioning at the district hospital, catering to approximately 3500 live births per year. Onsite mentoring was carried out from August 2016 to November 2016. This was a prospective implementation research. Framework focused on infection control, preterm care, care at birth, advocacy for infrastructure and resources, and facility-based refresher training. Results: A total of 16 visits were done by the mentoring team and 2 weeks of in-house residency. There were improvements in hand hygiene compliance from 0% to 87.5%, in cleaner IV site (from 50% to 100%), decreased unnecessary oxygen administration (from 75% to 33.3%), decreased antibiotic usage (from 70.5% to 35.5%), decrease in the number of babies receiving >5 days of antibiotics (from 41.6% to 0%), and increased kangaroo mother care initiation rate from 0% to 41.6%. The facility got level IIA accreditation by the end of the intervention period. Conclusions: Onsite mentorship program of SNCU is feasible and planning should be contextual. With the problems being uniform across most facilities, the model could be replicated across the country.

A study on evaluation of ASHAs for their knowledge, attitude and practice towards newborn care in Howrah district of West Bengal

Background: : Accredited Social Health Activist (ASHA) is a trained female community health activist. ASHAs are local women trained to act as facilitator and promoters of health care in their communities. ASHA is trained to work as an interface between the community and the public health system. ASHA play an important role in newborn care to reduce their morbidity and mortality.Methods: Data were collected from ASHAs working in Shibbur area of Howrah District, west Bengal. The study sample consisted of 70 ASHAs working in the Shibpur area that fulfilled the inclusion criteria. A predesigned pretested questionnaire of ASHA was used to collect data in the study.Results: The mean age of ASHAs was 35.74 years. Only 32 (45.71%) had received middle level (class VIII) education. Only 45.71 % of ASHAs had good knowledge and practice regarding hypothermia and its complication and the procedure of providing warmth the baby after delivery. Only 57.1% of ASHA had good knowledge regarding counseling and problem solving on breast feeding. Only 38.57% had good knowledge and practices on identification and basic skill on management of Low Birth Weight (LBW) having birth weight of <2.5kg and pre-term baby (<37 weeks of gestation).Conclusions: In the present study, we found that Knowledge, Attitude and Practice of ASHAs were inadequate in some aspects of newborn care. This gap of knowledge should be taken seriously during training procedures so that effective knowledge and essential skill for newborn care can be imparted. During recruitment of ASHAs higher literally status should be given preferences.

An Assessment of Home-Based Newborn Care Plus Innovation in Six districts of Rajasthan: A Cross Sectional Comparative Analysis

Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices.

Morbidity and mortality pattern among babies admitted in special newborn care unit, Nellore, Andhra Pradesh, India

Background: India contributes to 25% of neonatal mortality around the world. In developing countries neonatal mortality is quite high despite of advances in perinatal and neonatal care. The establishment of Special Newborn Care Units (SNCU) has been quite essential in reducing the neonatal morbidity and mortality. This study was conducted to assess the outcome of SNCU at a newly commissioned tertiary care teaching hospital at Nellore District, Andhra Pradesh. Aim of this study the morbidity and mortality patterns in an SNCU at tertiary care teaching hospital.Methods: It was a Retrospective, Hospital based, Descriptive study which was done among neonates admitted to SNCU, Nellore District, Andhra Pradesh for a period of 1 year (January 2015-December 2015). All the neonates admitted to SNCU, Nellore District, Andhra Pradesh during the study period were included in the study. Data was recorded in a predesigned semi-structured proforma. the data was entered into excel-sheet and analyzed using SPSS software version 21.Results: A total of 1015 babies were included in the study. Almost half 592(58.32%) were born in this hospital(inborn) and 423(41.67%) babies were referred from peripheral hospitals and nursing homes (out born). about 3/4th 767(75.5%) of babies were admitted in the first 24 hours of life. Almost half (53.4%) of the study group were male and 46.6% were female. The chief causes of admission in SNCU were Respiratory Distress Syndrome (40.2%) followed by birth asphyxia (19.1%), sepsis (13.3%), Neonatal Jaundice (9.9%) and prematurity (6.6%). In our study 63.0% patients were discharged, 19.3% had left hospital against medical advice, 10.1% died and 7.6% were referred to other institutions for specialized treatment.Conclusion: Respiratory Distress Syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and HIE as the major causes of morbidity. Low Birth Weight and prematurity were the commonest contributors of death, therefore, attempts to prolong the pregnancy each week might improve the neonatal outcome considerably.

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.

Knowledge of newborn care practices among caregivers attending immunization clinic at a tertiary care centre of Lucknow: a cross-sectional study

Background: Essential newborn care (ENC) provides for an opportunity to assess the infant’s growth and development and counsel mothers regarding proper newborn care. Acquainting the caregivers with knowledge pertaining to dangers signs, hygienic practices, feeding, weaning, health and nutrition including growth and behaviour of children, might affect the rearing of their children. Therefore the present study aims to study the knowledge of caregivers in relation to newborn care.Methods: A descriptive cross sectional study was conducted among the caregivers attending the immunization clinic in a tertiary care centre (King George's Medical University) in Lucknow between January- March, 2016. A pretested and structured interview questionnaire was used to collect data and analysis was done using SPSS ver 16.0.Results: In Majority (75%) of the caregivers the knowledge regarding ENC was found to be average. Only 4% of the caregivers had good knowledge of ENC. Among the variables the association of knowledge of ENC and age of the caregiver< 30 years, general caste, level of education of the caregiver of high School and above, middle socioeconomic status, female sex of the newborn, birth order of 2 or more, >4 ANC visits and new born care not discussed in the VHND being conducted in the area were found to be statistically significantly.Conclusions: On the whole, the results of our study indicated that most of the caregivers were having unsatisfactory knowledge of child care practices. The present scenario can be improved through enhancing information education and counselling activities, training of health workers and mothers focusing on newborn health care practices.