Clinical characteristics of neonatal and infant osteomyelitis and septic arthritis: a multicenter retrospective study

Abstract Objective: Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. Methods: A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. Results: Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). Conclusion: Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.

Prevalence and neonatal outcomes of preterm born at Garissa county referral hospital, Kenya

Background: Despite the significance of late preterm and early term neonates in neonatal health, comprehensive data on their prevalence, morbidity, mortality, and associated maternal sociodemographic and economic characteristics is grossly lacking in Garissa County, Kenya. This study aimed to determine the prevalence, morbidity, and mortality of late preterm (LPN) and early term neonates (ETN) born at Garissa County Referral Hospital (GCRH), relative to full-term neonates (FTN). Methods: Singleton live neonates in the three groups were enrolled. Prevalence was computed as percentages of births in each category relative to total singleton live births during the study period. Ordinal logistic regression analysis was used to assess morbidity patterns, with statistical significance set at p<0.05. Mortality rates were presented as total deaths per 1,000 live births within the first 28 days. Results: The LPN, ETN, and FTN had a prevalence of 8.47%, 11.86%, and 9.2%, respectively. Maternal age was significantly associated with gestational age (p=0.014; ?c=0.263), while other sociodemographic and economic characteristics were comparable across groups (p>0.05). LPNs had lower odds of respiratory distress diagnosis on day 1 compared to ETNs (OR=-1.68896; 95% CI: -3.012335 to -0.365593; p=0.012). Mortality rates were comparable among gestational age categories (p=0.649). Conclusions: Overall, the study shows that LPN and ETN are considerably prevalent in Garissa County and that, only maternal age impacts on gestational age. Targeted interventions, particularly for younger mothers, should be implemented to mitigate associated risks and improve neonatal outcomes.

How serum magnesium level is related to severity of asphyxia

Background: Perinatal asphyxia is a most common cause of neonatal death. Magnesium, the second most common intracellular cation, may play a role in neuroprotection.Methods: This observational study was undertaken in the Department of Gynecology and Pediatrics in GMC, Shahdol from January 2021 to June 2023. The term babies were included with congenital anomaly, diabetic mother, IUGR, and mother receiving magnesium therapy during labour were excluded. Data analysis was conducted using IBM SPSS statistical software (version 22.0).Results: Out of 46 newborns, mild to moderated asphyxia and severe asphyxia were presenting 32 (69.6%) and 14 (30.4%) cases respectively. HIE-I were 20 (43.5%), HIE II-16 (34.8%) and HIE III-10 (21.7%). The mean serum magnesium level in neonates with mild to moderate asphyxia was 2.1�3 and with severe asphyxia 1.5�5 respectively (p=0.001). Serum magnesium was significantly low in severe birth asphyxia as compared to mild to moderate (p=0.001) and level was significantly low in HIE stage 3. The difference in serum magnesium between HIE 1 and 3 and HIE 2 and HIE 3 was statistically significant (p=0.003 and p=0.009, respectively). A significant correlation between serum magnesium and Apgar score at 1 minute (Pearson抯 correlation coefficient, r=0.518, p=0.001) and score at 5 minutes was also statistically significant (Pearson抯 correlation coefficient, r=0.379, p=0.009).Conclusions: Neonates with severe asphyxia and HIE- grade III have significant hypomagnesemia. Asphyxia can lead to hypomagnesemia, and it is recommended to evaluate levels of magnesium in neonates with asphyxia as a routine test.

Prevertebral thoracic abscess in neonate- a previously unknown cause of respiratory failure in neonates: a case report

A prevertebral abscess is one of the serious infections of the prevertebral space. Prevertebral abscess cases are reported in children and adults. However, it has not been reported in neonates to date, and our team report a case of prevertebral abscess in a 17-day-old baby. A previously healthy term neonate with no antecedent risk factors and an evident source of infection presented with respiratory failure and repeated extubation failures. On evaluation, bronchoscopy revealed antero-posterior collapse of the trachea; further evaluation by computed tomography scan revealed a prevertebral thoracic abscess which was compressing the trachea. Surgical drainage and IV antibiotics led to complete resolution, and the neonate is doing well on follow-up. Prevertebral thoracic abscess is an uncommon cause of airway compression in the neonates. It is important to consider in the differential diagnosis of airway compression.

Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series

Abstract Objectives: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. Methods: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. Results: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). Conclusion: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Patterns of neonatal admissions and mortality among neonates admitted to special neonatal care units: a two-year cross-sectional study at selected special neonatal care units in Odisha, India

Background: Odisha has built 44 special newborn care units to treat severely sick infants at various levels. This study aimed to determine morbidity and mortality profiles among neonates admitted to the SNCUs and extend efforts to improve outcomes by investigating crucial variables.Methods: We conducted a cross-sectional descriptive study on all neonates admitted to SNCUs of 4 districts (Balangir, Kalahandi, Koraput, and Rayagada) between two calendar years (January 2020 and December 2021). We collected data on epidemiology, clinical presentation, and neonatal and maternal characteristics. We used Microsoft Excel to analyze categorical and continuous variables, with the Chi2 test for proportion comparison.Results: 17615 neonates were admitted in 2020-2021, 58% below one day and 59% male. ST babies were predominant. Outborn unit had 52% admissions, with 67% full-term and 31% pre-term. 74% of outborns used government vehicles for transportation. Most diagnoses were birth asphyxia, HIE, neonatal jaundice, low birth weight, and neonatal sepsis. The study found that 43% of neonates died from hypoxic ischaemic encephalopathy /perinatal asphyxia, 22% from Sepsis, 12% from extremely low birth weight babies, and 9% from prematurity. The Chi2 test showed a statistically significant difference in survival rates between doctors and dai, with a 91% survival rate and a 71% survival rate.Conclusions: Birth asphyxia was found to be the most essential cause of morbidity and mortality. Regular training at district levels is crucial for ensuring proper newborn care, including warmth, feeding, cleanliness, and prevention of asphyxia, to reduce preterm birth and low birth weight.

Intraventricular hemorrhage on mortality and neurological outcomes in premature infants

Background: Intraventricular hemorrhage (IVH) is the commonly encountered clinical event in preterm neonates which imposes significant morbidity and mortality. Although there is a rapid advancement in the neonatal care, IVH is the common cause of neonatal intensive care units admissions. The present study was carried out to evaluate the risk factors, mortality and neurological outcomes in preterm neonates with IVH.Methods: This was a prospective study conducted on 75 preterm neonates who were delivered before 37 weeks of gestation. The neonates were subjected to cranial ultrasound for the diagnosis of IVH and graded as per the severity. The neonatal and prenatal variables were recorded and analysed to find its association with IVH progression and mortality. Immediate neurological outcome was also assessed among the IVH preterm neonates. Results: In this study out of 75 preterm neonates, the prevalence of IVH was 18 (24%). The main neonatal factors for IVH are less gestational age at delivery, 28-31 weeks (p=0.001), birth weight <1500 gm (p=0.001), APGAR scores <5 at 1 and 5 minutes (p>0.05) and maternal factors associated with IVH is premature rupture of membranes (p=0.01). The mortality rate among the IVH preterm neonates was 7 (38.9%). The significant predictors of mortality were male gender (p=0.004), grade III and IV IVH (p=0.001) and birth weight (p=0.001). The main neurological outcomes observed were seizures and post-hemorrhagic ventricular dilatation.Conclusions: Increased severity of IVH, early gestational age and low birth weight were associated with mortality in preterm neonates with IVH.

A study of level of procalcitonin as marker of early onset sepsis in neonates

Background: Neonatal sepsis is one of the commonest causes of morbidity and mortality. It is one of the four leading causes of morbidity and mortality in India. The purpose of this study was to evaluate the levels of procalcitonin as a rapid diagnostic test, to identify those with infection as soon as possible, and to classify them into definitive, clinical, or no sepsis. The rise in Procalcitonin levels in the neonate with sepsis is very rapid. Hence, it can be used for the diagnosis of early onset neonatal sepsis. Objectives were to estimate the concentration of Procalcitonin for diagnosis of early onset neonatal sepsis and to compare the Procalcitonin levels amongst 3 categories of neonatal sepsis (definite, clinical and no sepsis).Methods: This is a hospital based analytical prospective study.Results: 104 babies with early onset sepsis were included in the study from the NICU in tertiary health care center. Procalcitonin is positive in 69 (66.35%) and negative in 35 (33.65%). Out of the total 69 neonates with Procalcitonin positive, 42 (60.8%) neonates are preterm and 27 (39.1%) are term neonates. Out of the total 35 neonates with Procalcitonin negative, 24 (68.5%) neonates are preterm and 11 (31.4%) are term neonates. There was no sepsis observed in 57 (54.8%) of cases, clinical sepsis was observed in 34 (32.6%) of cases and definite sepsis was observed in 13 (12.5%). The mean value of level of Procalcitonin in different categories of sepsis as determined from the data is 3.27 ng/ml in cases of No sepsis, 11.79 ng/ml in cases of clinical sepsis and 17.2 ng/ml in cases of definitive sepsis.Conclusions: Procalcitonin has good sensitivity and hence can detect most cases of neonatal sepsis and good negative predictive value. Procalcitonin contributes more significantly to the diagnosis of newborn septicemia when paired with additional testing and helps in identifying the categories of sepsis in neonates.

Clinical profile and outcome of acute kidney injury in preterm neonates in a level three neonatal intensive care unit

Background: Acute kidney injury is an important cause of neonatal mortality and morbidity. Preterm neonates, in particular are a vulnerable population as they are associated with various risk factors, predisposing them to multi-organ injury. Data on AKI in preterm neonates in India are limited. There are several gaps including the risk factors, demographic profile and associations with other comorbidities which remain unanswered. The objectives of this study were to study the clinical profile, outcomes and various associated risk factors of AKI in preterm neonates.Methods: It is a prospective observational study conducted in neonatal intensive care unit of a government medical college hospital in Rajkot, Gujarat, India. 300 preterm neonates with AKI were selected and demographic details, risk factors associated with AKI and outcomes were studied.Results: It was found that among 300 newborns under study, 82% were males, 92% had sepsis, 65% had respiratory distress syndrome, 32% had birth asphyxia, 29% had shock, 30% had exposure to nephrotoxic drugs, 54% had requirement for mechanical ventilation, 94% patients were discharged and 6% patients expired.Conclusions: The most common risk factor associated with AKI was sepsis. The other important risk factors are birth asphyxia, respiratory distress syndrome, and shock. Monitoring of serum creatinine can help in early detection of acute kidney injury.

Rapid neurodevelopmental assessment of newborn: a promise to ensure proper growth and development of all newborns in Bangladesh

Background: Neonates are susceptible to neurodevelopmental impairments due to various factors. The aim of the study was to use the n-RNDA tool to identify such impairments in neonates, enabling early interventions for improved outcomes.Methods: This facility-based cross-sectional study was conducted in Square Hospital Child Development Center from April 2019 to Nov 2021 with all neonates between ages of 15-28 days. A total 2928 neonates were enrolled and underwent n-RNDA assessment for detection of any types of neurodevelopmental impairments.Results: Among 2928 enrolled neonates, 8.1% exhibited neurodevelopmental impairments. Majority (60.6%) were from the NICU. Impairments varied across domains, with gross motor skills (99.2%) being most prevalent. Causes included respiratory distress syndrome (74%), sepsis (60%), and others. The study population was primarily urban (99.1%), with 100% parental literacy.Conclusions: The n-RNDA screening program for neonates facilitates early assessment, interventions, and long-term follow-up, potentially enhancing outcomes and quality of life. These findings advocate for policy development to institutionalize n-RNDA for early diagnoses and better outcomes in all neonates.

The breastfeeding support practices, related barriers and facilitators in the neonatal intensive care unit, Uttarakhand, India

Background: Within the bustling and stressful neonatal intensive care unit (NICU) environment, implementing Baby-friendly practices presents numerous challenges. Breastfeeding initiation and duration rates among NICU infants are lower compared to healthy full-term infants. Objectives were to explore breastfeeding support practices and related barriers and facilitators in the NICU.Methods: A retrospective study of 496 babies admitted to NICU of Sahota Superspeciality Hospital Kashipur, Uttarakhand during the time period March 2018 to February 2020 and examined maternal and infant factors. The 496 infants divided in two groups: group A: breast milk use at discharge (n=398) and group B: no breast milk use at discharge (n=98).Results: The incidence of morbidity factors like sepsis, chronic lung disease, retinopathy of prematurity, intraventricular hemorrhage, gastrostomy tube feeds at discharge, gavage feeds at discharge noted more among the babies of group of ‘no breast milk use at discharge’ compared to other group (p<0.05). The usage of donor milk and formula milk is significantly very less in babies of group ‘breast milk use at discharge’ compared to other group (p<0.05). Duration of hospital stay was very less in the group A compare to group B (p<0.05). Respiratory distress was the most common diagnosis among the babies of group A and apnea was the most common among babies of group B.Conclusions: Obstacles to maintaining breastfeeding in the NICU, which warrant focused efforts for enhancing practices, encompassed inadequate resources for facilitating parental involvement, impediments to expressing and providing maternal breast milk, and a notable prevalence of bottle-feeding supplemented with formula.

Kangaroo mother care verses oral sucrose for pain control in premature neonates on heel prick: a randomized control trial

Background: Preterm Neonates receiving intensive care are subjected to multiple painful procedures as part of their intensive care management. Pain leads to abnormal neurodevelopment, so it is extremely important to treat and reduce pain. Multiple studies have shown to be beneficial in pain control. Objective was to compare the efficacy of Kangaroo Mother Care with oral sucrose for pain management in premature neonates on heel prick.Methods: A total of 100 preterm neonates (28-36 weeks) who fulfill the inclusion and exclusion criteria were recruited for the study. Randomization was done and fifty participants per study arm were randomly assigned to the KMC and oral sucrose group. Preterm babies in the KMC group were given KMC for 15 minutes uninterrupted prior to heel prick. In oral sucrose group, two minutes prior to the procedure, baby received 0.5ml of 24% oral sucrose solution by syringe onto the tongue. The remainder of the total recommended dose was given as needed in small increments during the procedure. Assessment of pain done using PIPP. The post-procedural PIPP score was compared between KMC and oral sucrose groups.Results: Analysis of 100 preterm neonates (50 KMC and 50 oral sucrose) were done. Baseline variables were mean盨D gestational age 34.25�42 weeks, age 7.15�9 days, birth weight 1.72�32 kg. Post procedural PIPP score was less in KMC 5.16�58 group compared to oral sucrose 5.48�81 group but could not achieve statistical significance p=0.35, 95% CI=?0.99,0.35.Conclusions: KMC and oral sucrose are equally effective for pain management in premature neonates on heel prick but KMC is considered better compared to oral sucrose.

Exploration of pneumoperitoneum signs in neonates based on X-ray examination of bedside abdominal lying film / 实用放射学杂志

Objective To explore the pneumoperitoneum signs of neonates on the bedside abdominal lying film.Methods The pneumoperitoneum signs of 52 neonates on the bedside abdominal lying films were analyzed retrospectively.Results Among 52 neonates with pneumoperitoneum,2 cases had no perforation,and there were 50 cases of digestive tract perforation,with 22 cases of gastric perforation,17 cases of small intestinal perforation and 11 cases of large intestinal perforation.Congenital muscular defect of gastric wall and necrotizing enterocolitis(NEC)were the most common causes of perforation.Forty-three cases with anteroposterior films all had pneumoperitoneum signs;and in 9 cases with anteroposterior and lateral films,6 cases with anteroposterior and lateral films all showed pneumoperitoneum signs,while 3 cases showed pneumoperitoneum signs only on lateral films.Pneumoperitoneum signs included 38 episodes of liver falciform ligament signs,37 episodes of football signs,22 episodes of Rigler signs,21 episodes of round liver ligament signs,10 episodes of liver area bright shadows,9 episodes of inverted"V"signs,6 episodes of scrotal gas,5 episodes of triangular signs,4 episodes of Cupola signs and 1 episodes of dolphin sign.Two or more signs were seen in 46 cases and three or more signs were seen in 31 cases.There was no statistically significant difference in the pneumoperitoneum signs except for scrotal gas among the three groups of gastric,small intestinal and large intestinal perforations(P>0.05).Conclusion Various signs such as liver falciform ligament signs,football signs,Rigler signs and round liver ligament signs can be seen on the bedside abdominal lying film for neonates pneumoperitoneum,and understanding the above signs is conducive to rapid and accurate diagnosis.

Effect of early warning score combined with SBAR communication model on early warning of high-risk neonates / 现代临床护理

Objective To investigate the effect of early warning score system combined with(situation,background,ssessment,recommendation,SBAR)communication model in early warning of high-risk neonates,therefore to provide an effective communication method for an effective communication method to assess the changes of condition in neonates.Methods A before-after study model was adopted in the study.A total of 270 high-risk neonates admitted to the ward of the Department of Neonatology in a tertiary hospital between August and September 2022 were selected as research subjects.The high-risk neonates admitted in hospital in August were assigned in a control group,and those admitted in September were assigned in an trial group,with 135 neonates per group.Routine care was carried out in the control group,while early warning scoring combined with SBAR communication model were applied in the trial group on top of the cares offered to the control group.The occurrence of early warning events,concordance rate of nurse warning event and doctor handling events,and the satisfaction rate of doctors with the nursing performance were compared between the two groups.Results A total of 63.6%of early warning events were triggered by nurses in the control group,while it was 92.6%in the trial group,with a statistically significant difference between the groups(χ2=16.622,P<0.001).The consistency of handling of early warning events between the nurses and doctors in the trial group(Kappa coefficient=0.926)was higher than that in the control group(Kappa coefficient=0.641).The satisfaction rates of the doctors with the nurses about specialist knowledge,ability in emergency events,mastery of disease,timely observation of disease progress,collaboration between doctors and nurses,working enthusiasm,communication capability and the psychological quality in the trial group were all significantly higher than those in the control group[80.0%-95.0%vs.30.0%-55.0%,all P<0.01].Conclusions The Early Warning Score system combined with SBAR communication model can help nurses to accurately evaluate the changes of disease in neonates,complete the communication with doctors timely and effectively.It improves the observation,communication and handling capability among the nurses as well as the satisfaction rate of doctors with nursing work.

Correlation between neonatal retinal hemorrhage and changes in umbilical artery blood gas analysis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the correlation between neonatal retinal hemorrhage(RH)and changes in umbilical artery blood gas analysis.METHODS: A total of 312 full-term neonates born in our obstetrics department from January 2019 to December 2021 were selected as the study subjects. According to the RetCam III fundus examination results, 245 neonates who did not experience RH were included in the control group, while 67 cases with RH were found to be included in the RH group. In addition, neonates were grouped into I degree group(n=20), II degree group(n=29), and III degree group(n=18)based on the degree of RH. General clinical data and umbilical artery blood gas analysis indicators between the RH group and the control group were compared; the levels of umbilical artery blood gas analysis indicators in neonates with different degrees of RH, the relationship between pH and RH degree, and the influencing factors of neonatal RH were analyzed.RESULTS: There was no obvious difference in maternal age, average gestational week, fetal gender, parity, gestational diabetes, fetal birth weight, and amniotic fluid between the RH group and the control group(all P&#x003E;0.05), while there were obvious differences in delivery methods, gestational hypertension, forceps assisted delivery, neonatal asphyxia, and umbilical cord around the neck(all P&#x003C;0.05). The pH value, arterial blood sample partial pressure(PaO2)and base excess(BE)values of the RH group were obviously lower than those of the control group(all P&#x003C;0.01), while the arterial carbon dioxide partial pressure(PaCO2)was obviously higher than that of the control group(P&#x003C;0.01). There were obvious differences in umbilical artery blood gas analysis indicators among children with different degrees of RH(P&#x003C;0.05), and with the increase of the degree of RH, pH value, PaO2 and BE gradually decreased(P&#x003C;0.05), and PaCO2 gradually increased(P&#x003C;0.05). There was a negative correlation between the degree of RH and the pH of umbilical artery blood gas analysis(rs=-0.593, P&#x003C;0.05). The results of multivariate Logistic regression analysis showed that delivery method, gestational hypertension, forceps assisted delivery, neonatal asphyxia, umbilical cord entanglement, pH, PaO2, PaCO2, and BE were all influencing factors for the occurrence of neonatal RH.CONCLUSION: There is a close correlation between neonatal RH and changes in umbilical artery blood gas analysis, and umbilical artery blood gas analysis can be used for the diagnosis of neonatal RH, which can be used to guide clinical treatment.

Construction and validation of neonatal hypoglycemia risk prediction model / 中国现代医生

@#Objective To investigate the risk factors of neonatal hypoglycemia,establish the risk prediction model of neonatal hypoglycemia and test the effectiveness of the model.Methods Retrospective analysis was performed to collect clinical data of 727 newborns and pregnant mothers who were delivered in a Grade Ⅲ general hospital from October 2018 to August 2020.Univariate analysis and multivariate Logistic regression analysis were used to analyze related risk factors to construct prediction models.The clinical data of 150 newborns and pregnant women from September 2020 to February 2021 were selected to test the efficacy of the model.Results Multivariate Logistic regression analysis showed that feeding problems,neonatal hypothermia,neonatal complications,gestational diabetes and fetal distress were independent risk factors for neonatal hypoglycemia(P<0.05).The model verification results showed that the area under the curve(AUC)was 0.883,the sensitivity was 82.97%,the specificity was 88.35%,the positive predictive value was 76.47%,the negative predictive value was 91.92%,and the total accuracy of the model was 88.67%,which had a good prediction ability.Conclusion The prediction model established in this study has a good ability to predict the risk of neonatal hypoglycemia,which can be used to provide reference for early screening of high-risk groups of neonatal hypoglycemia and starting predictive nursing intervention measures.

The magnitude of birth injuries and associated factors among neonates admitted to neonatal intensive care units of selected public hospitals in central Ethiopia

BACKGROUND: Approximately half of the birth injuries are avoidable if appropriate and timely evidence based measures are taken. However, there is a paucity of studies in Ethiopia. Therefore, this study aimed to assess the magnitude of birth injuries and associated factors among neonates delivered in Central Ethiopia. METHODS: Multi-center facility-based cross-sectional study was conducted from March to April 2021. Systematic sampling method was used to select 344 mother-neonate pairs admitted to neonatal intensive care units in the included hospitals. Data were collected using face-to-face interview and review of medical records. Epi-info version 4.1 was used to enter data and SPSS version-25 for analysis. Descriptive statistics, binary and multivariable logistic regressions analyses with 95% CI were done. A cut off value of p-value < 0.05 was used to declare the statistical significance of variables. RESULTS: The magnitude of birth injuries was 24.7% (95% CI=24.7% - 24.8%). The majority 71.6 % of the neonates had soft tissue injuries while 16.6 % of them had birth asphyxia. Both birth asphyxia and physical trauma were encountered in 2.9 % of the neonates. Fetal mal-presentation (AOR=29.69, 95% CI =10.61 - 43.09), ANC follow­up less than four (AOR=3.2, 95% CI, 1.21-8.33), assisted childbirth (AOR =3.33, 95 % CI=1.003 -11.044) and short maternal height (AOR=4.85, 95% CI, (1.26-20) were significantly associated with birth injuries. CONCLUSION: The magnitude of birth injuries was higher than other similar studies in Ethiopia. Fetal malpresentation, antenatal care follow-up less than four, and short maternal height were significantly associated with birth injuries. Thus, promotion of full antenatal care follow-up, close monitoring of mothers during intrapartum period and timely clinical decision of labor and childbirth process of mal-presented children are recommended.

Effectiveness of planned teaching programme on knowledge regarding thermoregulation of neonates among B.Sc. nursing fourth year students of Sister Nivedita Govt. nursing college, IGMC, Shimla, Himachal Pradesh

Background: A newborn baby is a God抯 divine precious gift given to a mother. Immediately after birth thermal conditions of newborn dramatically change. Neonates should be nursed within their 憂eutral thermal environment�. Cold stress can cause serious metabolic consequences for all newborns. Health professionals have responsibility to ensure that thermoregulatory needs of the infant. Hence, current study was planned to access and to improve knowledge regarding Thermoregulation of Neonates among B.Sc. Nursing 4th year students.Methods: A pre-experimental one group pre-test post-test research design was used for the study. Total 30 B.Sc. Nursing 4th year students of Sister Nivedita Govt. Nursing College, IGMC Shimla (Himachal Pradesh) was taken as study sample. Convenient sampling technique was used. Ethical approval was taken from institutional ethical committee. A self-structured knowledge questionnaire of 30 questions was used to collect the data. After conducting pre-test, planned teaching programme was provided by using the power point presentation, and knowledge score of both pre-test and post-test was compared.Results: The level of knowledge regarding pre- test and post -test mean scores are 12.43 and 22.03 respectively. Paired t-test calculated value was 16.103 which was much higher than the table value at p<0.001.Conclusions: The study concluded that the Planned teaching programme was effective in increasing the knowledge of B.Sc. nursing 4h year students regarding thermoregulation of neonates.

Desarrollo del dolor fetal y neonatal / Development of fetal and neonatal pain

Resumen: El dolor es el principal síntoma reportado a nivel mundial, es la principal causa de sufrimiento humano. Se considera que para que un individuo sienta dolor deben estar presentes: nociceptores, neurotransmisores del dolor, vías que llevan el estímulo al cerebro, el tálamo y conexión con la corteza. Por un tiempo se consideró que en esta etapa no se contaba con la madurez suficiente del sistema nervioso para sentir dolor; sin embargo, en la actualidad hay evidencia de que el feto presenta dolor; y su presencia altera el desarrollo del sistema nervioso. La presente revisión proporciona una visión actualizada de la ontogenia del dolor fetal y neonatal.

Abstract: Pain is the main symptom reported worldwide, it is the main cause of human suffering. It is considered that for an individual to feel pain, the following must be present: nociceptors, pain neurotransmitters, pathways that carry the stimulus to the brain, the thalamus and connection with the cortex. For a time it was considered that at this stage the nervous system was not mature enough to feel pain, however, there is currently evidence that the fetus has pain; and its presence alters the development of the nervous system. This review provides an updated view of the ontogeny of fetal and neonatal pain.

Discharge against medical advice in the neonatal unit of Rivers State University Teaching Hospital, Nigeria: a two-year prospective study

Background: Discharge against medical advice (DAMA) is a silent contributor to neonatal morbidity and mortality in Nigeria. Parents' autonomous decision to discontinue medical care of their babies admitted remains an ethical contention that is frustrating for pediatricians and portends poor neonatal outcomes. DAMA remains a challenge arising from an interplay of parental and hospital-related factors. Hence, epidemiologic data are needed, where none previously exists. Aim of the study was to determine the prevalence, neonate and family sociodemographic characteristics, morbidity pattern and reasons for DAMA among neonates admitted to the Rivers State University Teaching Hospital.Methods: A prospective observational study was conducted among neonates admitted from April 2021 to March 2023.Results: Of 1830 neonatal admissions, 87 were discharged against medical advice giving a DAMA prevalence of 4.8%, of which 48 (55.8%) were females. Most, 66 (75.9%) were born at term, 51 (58.6%) had normal birth weight, 38 (43.7%) admitted at <2 hours of life and (41.4%) were above 2nd birth order. Forty-seven (54%) of mothers, 41 (47.1%) of fathers had tertiary education and 61 (70.1%) were of low/middle socioeconomic class. Neonatal sepsis (61.2%) and neonatal jaundice (31.8%) were the commonest morbidities. Most, 65 (74.7%) of DAMA cases occurred in the 1st week of life and the father 63 (73.3%) was the main requestor of DAMA. The commonest reason for DAMA was financial constraints 50 (57.5%).Conclusions: The prevalence of DAMA was 4.8%. Neonatal sepsis and neonatal jaundice were the commonest morbidity with financial constraints being the main reason for DAMA. The father was the requestor for DAMA in the majority of the cases.