Benefits of maternal participation in newborn nurseries.

OBJECTIVE: To evaluate the outcome of active involvement of mothers/mother substitutes in day-to-day care of high risk neonates admitted in a level II newborn care unit. METHODS: An observational study was carried out over a period of eleven years incorporating active participation of mothers/substitute in the day to day care of their sick neonates. The outcome is assessed in terms of mortality due to the three major illnesses (asphyxia, sepsis and prematurity) during this phase. The data is compared with that of a similar level II care centre where conventional neonatal care is practised. RESULTS: There is a significant and sustainable reduction in neonatal mortality due to the three major illnesses when the mothers are also involved in the neonatal care, in spite of a considerable increase in the number of admissions during this period. CONCLUSION: The concept of active participation of mother/substitute in neonatal nursery ensures 1:1 care at all times. It is a cheap and effective alternative to inadequacy of bed:nurse ratio (BNR).

Incidence and risk factors for neonatal hypoglycaemia in Kerala, India.

OBJECTIVES: To detect the incidence and risk factors that predicted the occurrence of neonatal hypoglycaemia and to identify neonates who require mandatory blood glucose screening during the first 48 h of life. DESIGN: Hospital based prospective study in a maternity centre in south India. SETTING: Labour room, postnatal wards and newborn nursery of the Institute of Maternal and Child Health, Medical College, Kozhikode, India. PATIENTS: Six hundred and four neonates were enrolled in the study by a systematic random sampling method from 1 August to 1 November 2002. INTERVENTION/MEASUREMENT: Random blood glucose levels were estimated by the standard glucose oxidase--peroxidase method on two occasions 24 h apart, during the first 2 days of life. Nineteen clinical characteristics of the mother-baby pair were analysed statistically in relation to the occurrence of hypoglycaemia. RESULTS: The incidence of neonatal hypoglycaemia in the present study group was 41/1000 live births. Eight variables strongly and independently predicted the risk of neonatal hypoglycaemia, at least one being present in 89.1% of the hypoglycaemic neonates. They included prematurity, low birthweight, maternal diabetes mellitus, delay in initiation of breastfeeding for more than 2 h postnatally, maternal pre-eclampsia and eclampsia, birth asphyxia, cold stress or hypothermia, and maternal oligohydramnios. CONCLUSIONS: Hypoglycaemia was a common problem in apparently normal asymptomatic babies. Apart from the classic 'text book risk factors', maternal oligohydramnios and a breastfeeding delay of more than 2 h after delivery predicted the risk of neonatal hypoglycaemia in this group. Mandatory blood glucose screening in babies with any one of the above mentioned risk factors serves as an easy and cost effective measure for the prompt identification of this condition.