Advances in international newborn screening / 中华实用儿科临床杂志

Newborn screening is an important national public health policy and measure to reduce birth defects and improve the quality of China′s birth population.In the early 1960s, Dr.Robert Guthrie of the United States invented the first newborn screening test, namely, semi-quantitative determination of phenylalanine in dry blood filter paper for screening phenylketonuria.In the 1990s, tandem mass spectrometry (MS/MS) began to be applied to the screening of genetic metabolic diseases in newborns.This technology enabled the detection of multiple diseases by one test, and increased the types of diseases detected.In the past 10 years, with the development of screening technology, the invention of new drugs, the improvement of treatment methods, and especially the application of new technologies such as newborn genetic screening, the source of mutations can be identified at the molecular level.Moreover, newborn screening is extended to patients who are not candidates for MS/MS.Many genetic diseases are able to be screened and diagnosed early.Effective management and quality control of newborn disease screening are prerequisites for improving the quality and accuracy of results.Secondary and multi-level detection strategies, different biochemical or biochemical genetic testing methods, and the integration of targeted and non-targeted multi-omics data have a wide range of applications and great clinical value.

Availability of maternal, newborn care and child health Services at primary health care unit during COVID-19 outbreak in Ethiopia

Background: The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods: A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result: During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion: Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

Ectopia cordis abdominal. Apropósito de un caso

Resumen Introducción: La ectopia cordis es una malformación congénita poco frecuente y grave caracterizada por el desplazamiento del corazón fuera de la cavidad torácica, Existe discreto predominio en el sexo femenino y se asocia a teratógenos no potentes y relacionado también a factores genéticos, su diagnóstico prenatal es muy importante y su pronostico es desfavorable en casi la totalidad de los casos. Objetivo: Describir el manejo con una paciente con ectopia cordis en Letsholathebe Memorial Hospital II Republica de Botswana. Descripción: Se describe el manejo por parte del pediatra y el cardiólogo desde su diagnóstico desde su nacimiento hasta sus ingresos hospitalarios. Conclusiones: Ectopia cordis es una malformación congénita rara que tiene un mal pronóstico incluso después del enfoque quirúrgico y su gravedad está relacionada con la presencia de otras anomalías.

ABSTRACT Introduction: Ectopia cordis is a rare and severe congenital malformation characterized by the displacement of the heart outside the chest cavity, there is discreet predominance in the female sex and is associated with non-potent teratogens and also related to genetic factors, its prenatal diagnosis is very important and its prognostic is unfavorable in almost all cases. Objective Describe management with a patient with ectopia cordis at Letsholathebe Memorial Hospital II Republic of Botswana. Description: It describes the management by the pediatrician and the cardiologist from his diagnosis from birth to his hospital admissions. Conclusions: Ectopia Cordis is a rare congenital malformation that has a poor prognosis even after the surgical approach and its severity is related to the presence of other abnormalities.

Presentación atípica de celulitis orbitaria en recién nacido / Typical Orbital Cellulitis Presentation in Newborn

La celulitis orbitaria representa una causa frecuente de inflamación de la órbita, constituyendo una urgencia médica que requiere un manejo multidisciplinario. Se presenta caso de una recién nacida con clínica de aumento de volumen en región bipalpebral derecha y fiebre de 24 horas de evolución. Al examen físico se evidencia proptosis de ojo derecho, aumento de volumen bipalpebral que impide la apertura del globo ocular en su totalidad con signos de flogosis y secreción purulenta en borde palpebral. Los laboratorios reportan leucocitosis y trombocitosis reactiva; tomografía de orbita muestra tumefacción y edema periorbitario derecho, aumento difuso de densidad grasa post-septal extra e intraconal, hallazgos sugestivos de celulitis orbitaria derecha. Se indica antibioticoterapia con vancomicina y cefotaxime, ameritando además drenaje de absceso, obteniéndose secreción purulenta, en la que se aísla Estafilococo aureus meticilino resistente. Siendo una patología inusual en este grupo etario, se recomienda la publicación de este caso(AU)

Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended(AU)

Current Scenario and Future Direction of Newborn Screening and Management Program for Phenylketonuria in Bangladesh

Abstract Phenylketonuria (PKU) is a correctable inborn error of metabolism which causes lethal intellectual delay and neurobehavioral anomalies. A screening package, especially for early recognition can support to regulate the PKU process of most patients. New-born screening program in any country focuses at the earliest detection of inheritance deficiency disorders in order to avoid the most severe repercussion by appropriate medication. This screening program needs a concomitant diagnosis and involves additional clinical research. Strategies from developed countries recommend that new-born screening should be done as soon as possible after birth before hospital/clinic discharge because if detected later, it conveys to significantly increase in disability as well as morbidity. Although exact protocol differs among different countries, testing procedures for PKU should be followed universally recognized in the developed world. Unfortunately, new-born screening program in Bangladesh is in lying-in room or possibly in pilot study in particular hospital, because the health-care system is classically targeted mortality (like childbirth complications) and transmittable morbidities (such as COVID-19) but not inborn frailties. Although policies and management of childbirth complications have been successfully lowered infant and mother mortality rates, the number of disabled babies increased tremendously. The study aims to investigate the current status of new-born screening (NBS) program of PKU in the Rajshahi Division Bangladesh, and focus on future plans to manage with life-long treatment. The primary challenges such as financial support for newborn screening, publicity, should be identified and implemented for national PKU-NBS policy as a role model of Bangladesh for developing countries.

Health policy and systems research capacity development to support maternal, newborn, child and adolescent health in West and Central Africa

Objectives: To examine how and why a South-South capacity development and networking program for leadership, research, practice and advocacy on maternal new-born, child and adolescent health and health policy and systems strengthening in West Africa and Cameroon worked and identify lessons for low- and middle-income countries. Design: Single qualitative case study drawing on data from document review, observations, key informant interviews and a deliberative workshop. Ethics approval for primary data collection was obtained from the Ghana Health Service Ethical Review Committee (GHS-ERC 012/10/18). Setting: West Africa and Cameroon Participants: Researchers, policy and programme managers and frontline health workers Interventions: Networking and capacity development Results: The programme made good progress in implementing many but not all planned capacity development and networking activities. The opportunity to network with other organisations and individuals and across countries, disciplines, and languages as well as to learn, to develop skills, and obtain mentorship support, were considered valuable benefits of the partnership. Human and financial resource constraints meant that not all planned interventions could be implemented. Conclusions: Lessons for health policy and systems research capacity building in LMIC include the potential of South-South partnerships, the need for dedicated resources, the potential of Sub-regional health organizations to support capacity building and recognition that each effort builds on preceding efforts of others, and that it is important to explore and understand where the energy and momentum for change lies.

A study of relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight

Background: An observational study was undertaken to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight.Methods: This study was done on 569 patients to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight. The data included was maternal serum samples (taken during peri-partum period) and neonatal birth weight. The primary objective of this project was to assess the vitamin D levels in maternal serum and to study its relationship, if any, with birth weight in the neonates.Results: A total of 569 samples of maternal serum were analyzed for serum 25(OH)D levels out of which 457(80%) mothers were found to have sufficient, 101(18%) insufficient and 11(2%) deficient Vitamin D levels as per US Endocrinological society guidelines. Out of total 569 newborns, 104 (18.27%) were low birth weight (LBW) and 465 (81.27%) were normal birth weight (NBW). Out of total LBW (104), 19(18.27%) were born to vitamin D deficient (VDD) mothers and 85 (81.72%) were born to vitamin D sufficient (VDS) mothers. Out of total NBW(465), 86(18.45%) were born to VDD mothers and 379 (81.17%) were born to VDS mothers. These results were not statistically significant (p=0.76456749).Conclusions: Maternal 25(OH)-vitamin D status during late pregnancy did not have any statistically significant effect on the neonatal birth weight.

Awareness and attitude regarding postnatal care and immunization practice among antenatal mothers

Background: Under 5 mortality is a key indicator of health status of the country. Optimum care in postnatal period with immunization as per recommended schedule and exclusive breastfeeding with appropriate technology are the most essential factors for optimum growth and development of the child and to prevent under five mortality. The study was done to assess the knowledge and attitude of antenatal mothers on vaccination and postnatal care.Methods: Total 150 pregnant women were required to answer a series of questionnaire related to demographic data, awareness and attitude towards postnatal care, breastfeeding and immunization.Results: Total 90% of the women are aware regarding immunization at birth, 87% of them got the information from a person, who is directly related to health system. Statistically 97.3% mother were aware about importance to keep the baby covered. Every 3 out of 4 women knew that breastfeeding to be started within 1 hour of life. Only 40% were aware that prelacteal feed should never be given to newborns and 74% of the women think that jaundice in newborn requires evaluation.Conclusions: There is a need to educate antenatal mothers about various aspects of immunization and postnatal care including breastfeeding.

Disease Pattern and Health Outcome among the Neonate in A NICU at Tertiary Care Hospital, Bangladesh

Background: According to the World Health Organization(WHO) and UNICEF under-five death rate, often known byU5MR, neonatal mortality are nearly two-thirds of infantmortality rate and one-third of under-five mortalities worldwide.Objective: The objective of the studywas to document theamount, disease pattern and outcome of patients admitted tothe neonatal intensive care unit (NICU). Data acquired from thepattern of admission and outcome may uncover variousaspects and should contribute and help in managingresources, infrastructure, and skilled hands for a far betteroutcome within the future.Methods: This retrospective study was done on 343 neonateswho were admitted at Uttara Adhunik Medical College andHospital, Dhaka within the neonatal intensive care unit (NICU)within the Department of Pediatrics from July 2017 to July2018.Results: 343 newborns admitted within 28 days of birth wereincluded in the study. Among them, 199 were male and 144female neonates, (Male: female11:0.42). The low birth weight(LBW) babies were 21.25%, very low birth weight (VLBW)4.66% and only 0.29% were extremely low birth weight (ELBW)in our study. Among the varied disease pattern of NICUadmission, Neonatal Jaundice was present in 98 (28.57%) ofneonates, Perinatal Asphyxia of 81 (23.62%) and NeonatalSepsis 43 (12.54%) being the foremost common causes ofneonates. The incidence of Respiratory Distress Syndromewas 38 (11.04%). The neonatal mortality rate found 6% in ourstudy. IUGR and Transient Tachypnea were also found the 2others commonest causes of neonatal admission in NICU. Lowbirth weight records had the very best cases death rate, whichindicates the necessity to develop an efficient group of excessin teaching hospitals that will provide highly specialized andfocused care to the present cohort of vulnerable neonates.Conclusion: This study has shown neonatal jaundice,perinatal asphyxia, and sepsis because of the predominantcauses of neonatal morbidity. Perinatal asphyxia and sepsisare preventable among three. Our health-care programsshould be directed toward addressing the danger factors withinthe community liable for the event of those three morbidities.The preterm and low birth weight babies had significantly highmortality even with standard intensive care; therefore, a robustand effective antenatal program with extensive coverage of allpregnant females specifically in outreach areas should bedeveloped which can help in decreasing preterm deliveries andalso lower the incidence of low birth weight babies.

The care provided by the family to the premature newborn: analysis under Leiningers Transcultural Theory / El cuidado realizado por la familia al neonato prematuro: análisis bajo la teoría transcultural de Leininger / O cuidado realizado pela família ao recém-nascido prematuro: análise sob a teoria transcultural de Leininger

ABSTRACT Objective: To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger's transcultural theory. Methods: Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® and the Bardin Content Analysis technique. Results: Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care. Conclusion: The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.

RESUMEN Objetivo: Analizar las prácticas de cuidado de los familiares de prematuros internados en una Unidad de Terapia Intensiva Neonatal a la luz de la teoría transcultural de Leininger. Método: Estudio cualitativo, descriptivo y exploratorio. Han sido realizadas observación participante y entrevistas semiestructuradas con 16 familiares de neonatos internados en la unidad neonatal de una maternidad pública, durante los meses de mayo y junio de 2019. Se ha utilizado el software denominado Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® y la técnica Análisis de Contenido de Bardin. Resultados: Emergieron dos categorías temáticas: Cuidado de la familia en la unidad neonatal; Suporte (in)eficaz para el cuidado compartido. Conclusión: La participación de las familias en el cuidado a los bebés aún es inestable, sin embargo debe ser elemento indisociable del cuidado culturalmente congruente, colaborando, así, con la recuperación integral del prematuro.

RESUMO Objetivo: Analisar as práticas de cuidado dos familiares de prematuros internados em uma Unidade de Terapia Intensiva Neonatal à luz da teoria transcultural de Leininger. Método: Estudo qualitativo, descritivo e exploratório. Foram realizadas observação participante e entrevistas semiestruturadas com 16 familiares de recém-nascidos internados na unidade neonatal de uma maternidade pública, durante os meses de maio e junho de 2019. Utilizou-se o software denominado Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® e a técnica Análise de Conteúdo de Bardin. Resultados: Emergiram duas categorias temáticas: Cuidado da família na unidade neonatal; Suporte (in)eficaz para o cuidado compartilhado. Conclusão: A participação das famílias no cuidado aos bebês ainda é instável, porém deve ser elemento indissociável do cuidado culturalmente congruente, colaborando, assim, com a recuperação integral do prematuro.

The care provided by the family to the premature newborn: analysis under Leininger's Transcultural Theory / El cuidado realizado por la familia al neonato prematuro: análisis bajo la teoría transcultural de Leininger / O cuidado realizado pela família ao recém-nascido prematuro: análise sob a teoria transcultural de Leininger

ABSTRACT Objective: To analyze the care practices of family members of premature infants admitted to a Neonatal Intensive Care Unit in the light of Leininger's transcultural theory. Methods: Qualitative, descriptive and exploratory study. Participant observation and semi-structured interviews were conducted with 16 family members of newborns, admitted to the neonatal unit of a public maternity hospital, during the months of May and June 2019. The software called Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® and the Bardin Content Analysis technique. Results: Two thematic categories emerged: Family care in the neonatal unit; (in)effective support for shared care. Conclusion: The participation of families in the care of babies is still unstable, but it must be an inseparable element of culturally congruent care, thus collaborating with the full recovery of the premature.

RESUMEN Objetivo: Analizar las prácticas de cuidado de los familiares de prematuros internados en una Unidad de Terapia Intensiva Neonatal a la luz de la teoría transcultural de Leininger. Método: Estudio cualitativo, descriptivo y exploratorio. Han sido realizadas observación participante y entrevistas semiestructuradas con 16 familiares de neonatos internados en la unidad neonatal de una maternidad pública, durante los meses de mayo y junio de 2019. Se ha utilizado el software denominado Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® y la técnica Análisis de Contenido de Bardin. Resultados: Emergieron dos categorías temáticas: Cuidado de la familia en la unidad neonatal; Suporte (in)eficaz para el cuidado compartido. Conclusión: La participación de las familias en el cuidado a los bebés aún es inestable, sin embargo debe ser elemento indisociable del cuidado culturalmente congruente, colaborando, así, con la recuperación integral del prematuro.

RESUMO Objetivo: Analisar as práticas de cuidado dos familiares de prematuros internados em uma Unidade de Terapia Intensiva Neonatal à luz da teoria transcultural de Leininger. Método: Estudo qualitativo, descritivo e exploratório. Foram realizadas observação participante e entrevistas semiestruturadas com 16 familiares de recém-nascidos internados na unidade neonatal de uma maternidade pública, durante os meses de maio e junho de 2019. Utilizou-se o software denominado Interface de R pour analyses Multidimensionnelles de Textes et de Questionnaire ® e a técnica Análise de Conteúdo de Bardin. Resultados: Emergiram duas categorias temáticas: Cuidado da família na unidade neonatal; Suporte (in)eficaz para o cuidado compartilhado. Conclusão: A participação das famílias no cuidado aos bebês ainda é instável, porém deve ser elemento indissociável do cuidado culturalmente congruente, colaborando, assim, com a recuperação integral do prematuro.

Epidemiological and bacteriological profile of neonatal bacterial infections seen in hospital pediatric in Antananarivo

Background: Neonatal bacterial infection is one of the leading causes of new-born morbidity and mortality. Bacterial ecology is not known in our unit, no study has been devoted to this subject. This work aimed to determine the germs responsible for neonatal bacterial infections and their level of sensitivity to the usual antibiotics.Methods: This is a retrospective descriptive study conducted in the Neonatology Department from January 1, 2018 to April 30, 2019 (16 months) including all newborns under 29 days hospitalized during the study period and possessing positive bacteriological results regardless of the site of collection (blood, urine, cerebrospinal fluid).Results: The diagnosis of neonatal infection was confirmed in 47 cases, i.e. 26.1% of suspicions of neonatal bacterial infection hospitalized during the study period. The female predominance was found with a sex ratio of 0.81. The most frequently isolated germs are, in order of frequency, coagulase-negative staphylococci (10 cases), Escherichia coli (7 cases), Enterobacter cloacae (5 cases), Klebsiella pneumoniae (5 cases) and Enterobacter aerogenes (5 cases). Of the 47 cases studied, 16 cases were multidrug-resistant infections including 7 cases i.e. 14.9% of nosocomial infections. The majority of Enterobacteria are strains producing broad spectrum beta lactamases (12 cases to 22). The molecules that remained effective were mainly Imipenem and Amikacin.Conclusions: Neonatal infection remains a real public health problem. The emergence of multi-resistant bacteria complicates the management. The knowledge of bacterial ecology on a wider population is an important asset in its prevention and management.

Exclusive breastfeeding: awareness, perceptions and practices among antenatal multigravida women

Background: Breastmilk is considered the most complete source of nutrition for the new-born as it contains all necessary components such as proteins, carbohydrates and fats, water, vitamins and minerals and immunological factors required for the new-born in appropriate amounts. Breastfeeding is advantageous to the infant as well as the nursing mother in many ways. There are various benefits to the new-born both immediate as well as in the long run.Methods: A multiple-choice questionnaire was used to interview the participants during data collection.Results: Using the IBM SPSS version 20 software, descriptive analysis of the categorical variables has been presented using frequency and percentage tables.Conclusions: Though the knowledge about exclusive breast feeding was not extraordinary among the participants, they had a very favourable attitude towards the same. Almost all patients were also extremely receptive and inquisitive during the session for discussion about the same.

Factors influencing early initiation of breast feeding among mothers in North Coastal Andhra Pradesh, India

Background: The benefits of breastfeeding for the health and wellbeing of the mother and babies are well documented. A recent trial has shown that early initiation of breastfeeding could reduce neonatal mortality, which would contribute to the achievement of the Millennium development goals. The positive effects of breastfeeding on the new-born’s health can be attributed to the components of breast milk, as well as the contact between mother and baby.Methods: This is a hospital based, cross sectional study conducted in the Department of Pediatrics and Department of Obstetrics and Gynaecology, at a tertiary care hospital in North Coastal Andhra Pradesh. Study period was one year between March 2018 to February 2019. 310 healthy term new-born babies of singleton pregnancy were included.Results: The prevalence of initiation of breast breastfeeding within one hour in this study is 48.7% (151 neonates). Hindu religion, literacy, urban residence, vaginal delivery, male child, breast feeding advice during antenatal period, birth spacing <2 years, not giving prelacteal feeds, absence of breast-feeding problems and maternal illness were found to have a significant association with initiation of breast feeding within 1 hour after delivery (p value <0.05).Conclusions: Innovative strategies like provision of breastfeeding counsellors in the hospital setup; constant counselling to mothers and their immediate relatives who take care of baby and mothers can increase early initiation of breast feeding.

Traditional beliefs and practices in newborn care among mothers in a tertiary care centre in Dehradun, Uttarakhand, India

Background: Neonatal care practices are different in different communities. Before any intervention planned to reduce mortality and mortality in community, understanding of local belief and practices is necessary. Some of the harmful practices need to be abandoned and good or harmless practices need to be appreciated. This study was conducted to understand the cultural beliefs and practices in newborn care among residents of Uttarakhand.Methods: This was descriptive, cross-sectional study carried out among 300 postnatal mothers admitted to the hospital. The data was collected using self-administered questionnaires. Statistical analyses of the data was done using SSPS version 22.0.Results: 4% of the mothers believed colostrum to be unsuitable for the newborn. 71% mothers were practicing daily baby massage. 71.3% believed that hot and cold foods can harm their baby’s health. 57.3% practiced application of Kajal on baby’s face. 74.7% of mothers would keep Knife under pillow and 16.7% match box under baby’s cloth. 5.3% mother believed in practice of branding. 81% of mothers accept to practice of pouring oil in baby’s ear. 22.3% mothers believed in isolating mother baby together for 30-40 days.Conclusions: Certain practices are still prevalent like Branding, discarding colostrum, Kajal application, pouring oil in baby’s ear and very restricted dietary regime of mothers. These practices need to be stopped by educating mothers and relatives in postnatal wards.

Comportamientos clínico y epidemiológico del bajo peso al nacer, en el Policlínico "Pedro Díaz Coello", Holguín, Cuba / Low birth weight clinical and epidemiological behaviors, at "Pedro Díaz Coello" Polyclinic, Holguín, Cuba

RESUMEN Introducción: el bajo peso al nacer (BPN) es un indicador relevante para la evaluación de los resultados de la atención prenatal, supervivencia infantil y salud, durante los primeros años de vida del nuevo individuo. Objetivo: determinar el comportamiento clínico-epidemiológico del BPN en un área de salud. Métodos: se realizó un estudio transversal en el Policlínico "Pedro Díaz Coello", del municipio Holguín, durante el período de enero del 2016 a diciembre del 2017. El universo estuvo constituido por 35 niños con BPN, de los cuales se tomó una muestra de 32. La información se obtuvo mediante la revisión de las gráficas estadísticas del área, historias clínicas obstétricas y de los recién nacidos. Se utilizó el porcentaje como medida de resumen. Resultados: el menor índice de BPN se logró en el año 2017 (3,64%). La Restricción del Crecimiento Intrauterino (RCI) representó el 75% de los casos, de los cuales 10 niños (31,25 %) eran pretérminos. El 56,25% de los recién nacidos tenían menos de 37 semanas. Los factores de riesgo gestacionales encontrados fueron: infecciones vaginales (53,13%) y del tracto urinario (40,63%), anemia (37,50%), desnutrición materna (34,38%), trastornos hipertensivos gestacionales (31,25%) y madres adolescentes (25%). Conclusiones: en el año 2017, el índice de BPN disminuyó en relación con años anteriores. La RCI fue la forma clínica predominante. Se destacaron los recién nacidos pretérmino. Predominaron las infecciones vaginales y del tracto urinario.

ABSTRACT Introduction: Low birth weight is fundamental to evaluate the results of prenatal assistance, infantile survival and new-born's wellbeing, during the first years of life. Objective: to determine low birth weight epidemiological and clinical behaviours, in a given health area. Method: a transversal study was carried out at "Pedro Diaz Coello" Polyclinic, Holguín, Cuba, from January 2016 to December 2017. Universe involved 35 low weight new-borns and a sample of 32. Information was obtained from obstetrics, newborn medical records and statistical graphs review of the area. Percentage was used as a summary measure. Results: lowest birth weight index was achieved in 2017 (3.64%). Intrauterine growth restriction (IUGR) represented 75% of the cases, 10 were preterm babies (31.25%). At birth, 56.25% neonates showed less than 37 weeks of gestational age. Pregnancy risk factors were: vaginal infection (53.13%), urinary tract infection (40.63%), anemia (37.50%), maternal undernutrition (34.38%), pregnancy hipertensive conditions (31.25%) and adolescent mothers (25%). Conclusions: IUGR was the predominant clinical form. Other associated risk factors were: vaginal infection and urinary tract infection.

The evaluation of effectiveness of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital: a before and after study

Background: Kangaroo mother care (KMC) is a standard of care for preterm and low birth weight babies. To implement KMC in institutional care it was often practiced inside intensive care unit and also in separate ward. In present study authors have tried to evaluate effect of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital.Methods: Uncontrolled study before and after establishment of separate kangaroo mother care ward comparing kangaroo mother care in sick new-born care unit versus kangaroo mother care in separate ward.Results: In separate ward, as compared to kangaroo mother care practice in sick newborn care unit, mean (SD) duration of kangaroo mother care increased from 5.3 (1.6) to 11.4 (7.4) hours/day (95%CI 5.0-7.1, p value <0.0001). Mean (SD) weight gain increased from 10.7 (7.0) g/day to 13.7 (11.1) g/day (95% CI 1.0-4.8, p value <0.0024). Incidence of sepsis diminished from 14.0% to 28.9% (95% CI 6.4-23, p value <0.0006). Exclusive breast-feeding rate at discharge (42.3% vs. 57.3%) (95% CI 4.8- 24.9, p value <0.0041) and follow up (49.4% vs. 65.0%) (95% CI 1-29.4, p value <0.0378) increased. Mortality also decreased in this group of patients (8.6% vs.2.3%) (95% CI-1.6-11.4, p value <0.0082).Conclusions: Kangaroo mother care ward is better place than sick new born care unit for providing kangaroo mother care in tertiary care hospital.

A study of gross congenital malformation at birth

Background: A congenital anomaly is a structural anomaly of any type that is present at birth. Congenital anomalies may be induced by genetic or environmental factors. Most congenital anomalies, however, show the familial patterns expected of multi-factorial inheritance. The aims and objective of this study were to study the incidence of visible congenital malformations at birth, to study risk factors, to find associated internal malformations.Methods: It is a retrospective cross-sectional study carried out in a tertiary care hospital affiliated to a medical college. The Inclusion criteria include all new-borns delivered in the hospital with visible congenital malformations examined within 48 hours of birth. Extramural babies were included if they had presented within 48 hours after birth. The Exclusion criteria include still births were excluded from the study.Results: Percentage of congenital malformation was 1.32%. Most common systems involved were musculoskeletal system (46.34%) followed by genitourinary system (21.34%) and gastrointestinal system (14.02%).Conclusions: All Babies with gross congenital malformation should be screened for internal malformation. The incidence of CNS malformation has reduced than observed in previous studies which suggest awareness about antenatal folic acid supplementation. Other than CNS anomalies, other system anomalies were not diagnosed antenatally despite antenatal ultrasound being done in maximum number of mothers, which suggest use of 3D or 4D scan antenatally.

Clinical profile and outcome of respiratory distress in newborns admitted in rural tertiary health care centre of Maharashtra, India

Background: Respiratory distress is most common symptom complexes seen in newborn infants lead to high mortality. The objectives were to study various etiological factors, maternal and neonatal risk factors for development of respiratory distress along with need for CPAP, mechanical ventilation and surfactant to assess the immediate clinical outcome in newborns.Methods: The study was conducted at Krishna Hospital and Medical Research Centre, Karad in period of January to August 2018. A total of 100 neonates who were admitted in NICU within 72 hours of life were studied by clinical examination and relevant investigations. The severity of distress was assessed by Silverman-Anderson scoring, Downe's scoring and APGAR scoring respectively for neonates.Results: It was observed that max, 90% of the distress cases were of respiratory in origin and high severity of distress was observed among 27% newborns. The proportion of respiratory distress was higher, 51% in males and low APGAR score was reported in 14% cases. Among respiratory etiology of respiratory distress, high proportion was of TTNB 35.55%. The maternal and new born factors like maternal age >30 years (32%), gestational age 28-30 weeks (87.5%), gravid 2 and 3 mothers (35%), female gender (32.6%), low birth weight (70%) developed severe distress respectively. The recovery rate of respiratory distress due to respiratory etiology was of 88.8%.Conclusions: Transient tachypnoea of new-born is the most common cause among new-borns with respiratory distress. New-borns with low gestational age, low birth weight baby, low APGAR score is more prone to develop severe respiratory distress.

Study of knowledge attitude practices and utilisation of existing health services by families with regard to newborn health at block level in rural India: a community based, cross sectional, observational study

Background: The present study was undertaken to identify KAP gaps and the objective of the study were to assessment of utilization of existing health service infrastructure at grass route level in rural community with regard to mother and neonatal care.Methods: A community based cross-sectional observational study. About 50 mother neonate pair residing in villages under study belonging to Dewas district, Madhya Pradesh.Results: Age old customs and practices of large family (80%), adolescent marriages (30%), high fertility (50%), poor housing and sanitation (48% or more) are still widely prevalent in rural India. Positive impact of NRHM with launch of JSSY and NSSK was seen in utilization of ANC services among beneficiaries with 100% ANC registrations, 98% institutional deliveries and 100% deliveries conducted by trained health professionals, prompt referral to SNCU. Birth weight was not known in 36% neonates and 18% had not received BCG vaccination. 22% were low birth weight and 22% neonate's required SNCU care. Government emergency transport facility in form of ambulance was either absent (36%) or not utilized (26%) by majority.Conclusions: Lacunae were seen to be persisting regarding awareness and utilisation of few components of maternal and neonatal health care especially in government sector in spite of launch of third phase of NRHM. This was evidenced by, lack of awareness of Obstetric USG facility at civil hospital, non-utilisation of ambulance service for transport, not knowing neonates birth weight and no neonatal follow up care and failure to vaccinate the neonate even till 3rd or 4th week of life.