Potentially better practices of nutrition in neonatal care units, where are we?

The objective of this study was to evaluate the system of nutritional and growth assessment in our neonatal unit. It had a retrospective, descriptive design. The settings were two neonatal intensive-care units of Kasr El Eini hospital, Kasr El Eini unit and mounira unit. The study population included 69 neonates admitted in the 2 units. The inclusion criteria were all neonates admitted and staying more than 48 hrs in kasr El Eini neonatal unit during January 2004 and January 2005, and comparable number of neonates admitted to El Mounira unit in January 2004. The gold standard of our nutritional assessment was [ministry of health and population neonatal care protocol for physicians]. We chose this protocol as it comprises the basic items of neonatal nutritional and growth assessment and it is the one followed in our units. In Kasr El Eini unit was unit weight measurements were 100% whether in January 2004 or January 2005 while it was 95% in Mounira unit. HC measurements on admission dropped from 26% to 13% and this was statistically non significant. In Mounira unit proper HC measurement was 9%. Length measurements on admission dropped from 26% to 8% in Kasr El Eini unit from January 2004 to January 2005 and were 0% in Mounira unit, and this was statistically significant. HC and length were not measured weekly or on discharge in either unit. Growth chart was not plotted for any baby in both units. Overall laboratory monitoring for nutritional assessment was better in Kasr El Eini unit than Mounira unit while caloric intake documentation was better in Mounira unit. Overall lab monitoring deteriorated from January 2004 to January 2005 in Kasr El Eini unit while caloric intake documentation improved. Improper laboratory results documentation increased from 13% to 50% from January 2004 to January 2005 in Kasr El Eini unit. In Mounira unit it was more, 55% and this was significant. There were discrepancies in documentation of weight between nursing and resident sheets in 17% of cases in Kasr El Eini unit whether in January 2004 or in January 2005compared to 32% in Mounira unit. The percentage of neonates who couldn't achieve their expected weight on discharge and their discharge weight were less than 10[th] centile was 22% in Kasr El Eini unit, January 2004, 25% in Kasr El Eini unit, January 2005, and 9% in Mounira unit, January 2004. However this doesn't signify better outcome than Kasr El Eini unit as most [73%] neonates included in the study from Mounira unit were full terms who are much easier to gain their proper weight while neonates included in the study from kasr el Eini unit were all preterm in January 2004 and 79% were preterms in January 2005. system of nutritional assessment is still not optimal in kasr El Eini neonatal units. Neonatal weight gain is also unsatisfactory and >20% of neonates in Kasr El Eini unit are discharged weighing < 10[th] centile of their expected weight. There should be a plan with short-and long-term goals, be developed as a multidisciplinary effort, and identify a systematic approach to evaluation of change. Nutrition practices should be integrated in the medical plan. Ongoing communication with staff comparing current practices with aimed practices is crucial for change. Evidence- based PBPs [potentially better practices] should then be implemented with ongoing appraisal

Neonatal home remedies in upper Egypt, how much do we know?

The objective of this study was to identify adopted home remedies given by mothers of lower socioeconomic classes to their babies in upper Egypt. The study was a qualitative research. The study population included mothers aged 18 to 40 years representative of the D/E socioeconomic classification [SEC]. the setting was urban and rural districts in each of the five governorates Giza, Menya, Assiut, Sohag and Qena. Thirty six neonatal medical terms were investigated. The results showed that more than 140 neonatal remedies were identified by this study, 10 were considered beneficial, 43 remedies of variable effect according to the circumstances and to the way they are applied and the rest were considered potentially harmful practices. In upper Egypt home remedies appear to be deeply seated beliefs propagating through generations and generally resorted to when any illness arises. The sources of remedies were an experienced old woman, usually a relative or a neighbor, a non professional practitioner or a religious figure. In some instances participants followed the advice of the pharmacist. It is important for physicians to be aware of the remedies used for the newlyborns, to understand the health belief system of the population being served. This will help ensure compliance with physician recommendations and promote a better therapeutic relationship between parents and provider and families can be educated about remedies that are potentially harmful

Cranial ultrasonographic screening of preterm newborn

The objective of this prospective, descriptive study was to screen all high risk preterms admitted in the neonatal intensive-care unit of Kasr El Einin hospital by transfontanellar sonography on days 1, 3 and 7 of life to identify the various cranial pathologies and to find the relationship between the abnormal sonographic data of the neonates and the maternal risk factors. The study population included 175 high risk preterms representing all high risk preterms admitted to Kasr El Eini intensive care unit having different perinatal risk factors during a 6 months period. The results showed that 65 preterms [37%] of the 175 included in the study had abnormal sonographic findings. Subependymal intraventricular hemorrhage [SE-IVH] was present in 25 cases [14% of all preterms screened], brain edema in 15 cases [9%], hypoxic ischemic changes in 7 cases [4%], posthemorrhagic hydrocephalus [PHH] in 6 cases [3.5%] as a complication of SE-IVH. Posthemorrhagic hydrocephalus [PHH] developed in 24% of preterms with SE-IVH [6 out of 25], subependymal cysts developed in 5 cases [3%], congenital hydrocephalus in 4 cases [2%], ventriculitis in 2 cases [1%] and agenesis of the corpus callosum in 1 case [0.5%]. Not a single case was diagnosed as having periventricular leukomalacia [PVL]. All cases of congenital hydrocephalus and agenesis of the corpus callosum were detected on day 1. Most cases of brain edema [80%] were also detected on day 1. In >/= 50% of cases with hypoxic ischemic changes, subependymal cyst and ventriculitis were detected on day 3. as for PHH, 80% of cases were detected on day 7. Many of the maternal risk factors were highly correlated with certain sonographic findings as eclampsia, diabetes mellitus, chorioamnionitis, antepartum hemorrhage, fever, abnormal presentation, multiple pregnancies, prelabour rupture of membrane [PROM] and traumatic delivery. Other maternal risk factors were not correlated with any of the sonographic findings as asthma, cardiac troubles, old age, hepatitis and polyhydramnios. None of the neurological manifestations was specific to a certain cranial pathology. There was a significant statistical difference between the mean I/T ratio among patients with ventriculitis compared to those without. However, no correlation was found between laboratory findings and SE-IVH. There was a significant difference among neonates with post hemorrhagic hydrocephalus and congenital hydrocephalus compared to those without as regard to survival. The richness of information obtained from screening of preterm infants by transfontanellar sonography which is obvious from the above results reveals the importance of cranial ultrasonography In the diagnosis of SE-IVH, hypoxic ischemic changes, brain edema, posthemorrhagic hydrocephalus, congenital hydrocephlus, ventriculitis, subependymal cysts and agenesis of the corpus callosum. Forth per cent of the preterms having cranial pathology were clinically well. For this besides, its safety and its accessibility, and in order to improve the outcome of the preterms, routinely screening all preterms on day 1, 3 and 7 of life is mandatory. Further weekly screening is recommended even if the initial sonographic findings were normal so as not to miss a case of PVL as the development of PVL may be delayed to weeks after birth

study of microbiological pattern of neonatal sepsis

The main of this [prospective] analytic study was to determine the microbiological pattern of bacterial infection in the neonatal intensive care unit of Kasr El Eini hospital, to investigate microbial colonization of neonates at birth before any interference and to examine whether surface cultures yielded information helpful in management. The study population comprised 70 high risk neonates whether full terms or preterm infants admitted to Kasr El Eini neonatal intensive care unit for a 6 months period from 1/3/2002 to 30/9/2002 babies with congenital anomalies were excluded from the study. The included neonates were subjected to laboratory studies as CBC, CRP, IT ratio, superficial cultures in the form of ear and throat swabs and deep culture in the from of blood culture. We defined neonatal sepsis by positive blood culture. The results showed that 70 out of 101 neonates included in the study developed sepsis [69.3%]. The incidence of early onset sepsis [49.5%] was higher than late onset sepsis [19.8%]. The highest incidence of sepsis was in the gestational age group 30 - <32 weeks and the weight group 1500 - <2500 grams. Clinical signs and laboratory investigation revealed no significance in relation to sepsis. The most prevalent organism recovered from blood culture was klebsiella [40%], followed by coagulase negative staph aureus, CONS [20%], staph aureus [15.7%] and enterobacter [15.7%]. Colonization detected by ear swabs was 68.5% in septic neonates and 64.5% in non septic neonates. The predominant organisms recovered from ear swabs in the septic group were CONS [38.6%] followed by staph aureus [18.6%] then klebsiella [5.7%]. Colonization detected by throat swabs was 55.7% in septic neonates and 42% in the non septic neonates. The most common organism recovered from throat swab in the septic group were klebsiella [15.7%] and E. coli [14.3%] followed by CONS and staph aureus [10%] each. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Results of throat swabs were more significant than ear swabs with higher matching with blood culture [21.4% in contrast to 8.5% for ear swabs]. Mortality among septic neonates was 44.2% and among non septic neonates was 25.8%. Incidence of sepsis was still high in our unit [69.3%]. Early onset sepsis was much-higher than late onset sepsis. Klebsiella was the predominant organism causing sepsis followed by CONS and staph aureus. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Throat swabs showed more matching with blood culture than ear swabs. Blood culture is still the gold standard for the diagnosis of neonatal sepsis