Assessment of the implementation of respectful maternity care charter in North Central Nigeria (Federal Capital Territory and Kwara State): study protocol

Respectful Maternity Care (RMC) charter is one of the tools for ensuring quality of care in maternity services. Nigeria is a signatory to RMC charter; therefore, the charter is expected to be the standard of care. However, in Nigeria and other countries, reports of disrespectful maternity care abound; this discourages women from accessing facility-birth. Therefore, to improve the quality of care towards increase in uptake, it is expedient to assess the level of implementation of the RMC charter by key stakeholders for sustainability, impact and scale-up of charter-compliant maternity care in Nigeria. The study aims to assess the implementation of RMC charter in North-central Nigeria. The study is a mixed-method, cross-sectional study; the expected participants are key stakeholders in healthcare (Healthcare workers, Healthcare Administrators, Project Managers, Policy makers) in North-Central Nigeria (Federal Capital Territory and Kwara state). A multistage sampling technique would be used to enroll participants from 18 healthcare facilities (Primary, Private, Secondary and Tertiary) in rural and urban areas and Ministries of Health officials at local and state government levels. Expected outcomes: The study is expected to provide information on the current status of knowledge and implementation of the RMC charter in Nigeria. It would also identify the enablers and barriers to the implementation process and provide evidence for effective scale-up of the process in Nigeria. The outcomes will be widely disseminated to healthcare workers, health administrators and decision-makers in healthcare services through post-study meetings, conference presentations, journal publications and policy briefs for effective RMC charter implementation in Nigeria.

Transmídia na enfermagem pediátrica para orientações aos familiares no enfrentamento da COVID-19: relato de experiência / Transmedia en enfermería pediátrica para orientación a familiares en el enfrentamiento al COVID-19: relato de experiencia / Transmedia in pediatric nursing for guidance to family members in coping with COVID-19: experience report

Objetivo: descrever a experiência da transmídia na enfermagem pediátrica para orientações aos familiares sobre os cuidados aos recém-nascidos e às crianças no enfrentamento da covid-19. Método: relato de experiência sistematizado em cinco tempos (ponto de partida, perguntas iniciais, recuperação do processo vivido, reflexão de fundo e pontos de chegada), oriundo de um projeto de iniciação tecnológica, com dados do período de agosto 2021/junho 2022, sobre a publicação de conteúdos transmidiáticos, referentes aos cuidados na infância em tempos de covid-19, tendo como público-alvo os familiares de recém-nascidos e crianças. Resultados: conteúdos foram criados e publicados em diversas mídias sociais (Instagram, Facebook, Spotify, Youtube e WhatsApp), permitindo durante a pandemia, o compartilhamento, de forma convergente, de orientações científicas fidedignas e confiáveis. Conclusão: a transmídia na enfermagem pediátrica mostrou-se inovadora, dinâmica e proveitosa, além de baixo custo e grande potencial de abrangência.

Objective: to describe the experience of transmedia in pediatric nursing for guidance to family members on care for newborns and children in coping with covid-19. Method: experience report systematized in five stages (starting point, initial questions, recovery of the lived process, background reflection and points of arrival), from a technological initiation project, with data from the period of August 2021/June 2022, on the publication of transmedia content, referring to childhood care in times of covid-19, with the target audience being family members of newborns and children. Results: content was created and published on several social media (Instagram, Facebook, Spotify, Youtube and WhatsApp), allowing during the pandemic the convergent sharing of reliable scientific guidelines. Conclusion: transmedia in pediatric nursing proved to be innovative, dynamic and profitable, in addition to low cost and great potential for coverage.

Objetivo: describir la experiencia de transmedia en enfermería pediátrica para orientar a los familiares sobre el cuidado del recién nacido y del niño en el enfrentamiento al covid-19. Método: relato de experiencia sistematizado en cinco etapas (punto de partida, preguntas iniciales, recuperación del proceso vivido, reflexión de antecedentes y puntos de llegada), de un proyecto de iniciación tecnológica, con datos del período agosto 2021/junio 2022, a partir de la publicación de contenido transmedia, referente al cuidado de la infancia en tiempos de covid-19, siendo el público objetivo familiares de recién nacidos y niños. Resultados: se crearon y publicaron contenidos en diversas redes sociales (Instagram, Facebook, Spotify, Youtube y WhatsApp), que permitieron, durante la pandemia, compartir, de forma convergente, orientaciones científicas fidedignas y confiables. Conclusión: el transmedia en enfermería pediátrica demostró ser innovador, dinámico y fructífero, además de ser de bajo costo y con gran potencial de cobertura.

Mortalidad neonatal y las infecciones asociadas a la atención sanitaria / Neonatal mortality and healthcare-associated infections

Objetivo: Analizar la mortalidad neonatal y las infecciones asociadas a la atención sanitaria. Método: Se realizó una revisión sistemática de 15 artículos en PubMed y Scielo, los cuales se relacionan directamente con el objetivo de investigación. Conclusión: Las diferentes medidas de asepsia y antisepsia aplicados en UCIN y Neonatología, han disminuido la incidencia de IAAS, aunque, aún hay una alta tasa de mortandad por sepsis, neumonías y meningitis, las cuales provocan hasta una cuarta parte de todas las muertes de recién nacidos, siendo los más afectados los neonatos con un peso menor a 1500 gramos

Objective: To analyze neonatal mortality and healthcare-associated infections. Methods: A systematic review of 15 articles in PubMed and Scielo, which are directly related to the research objective, was carried out. Conclusion: The different asepsis and antisepsis measures applied in NICU and Neonatology have decreased the incidence of HAIs, although there is still a high mortality rate due to sepsis, pneumonia and meningitis, which cause up to a quarter of all newborn deaths, the most affected being neonates weighing less than 1500 grams.

Effects of early essential newborn care on breastfeeding and health outcomes of infants within 3 months of age / 中国新生儿科杂志

Objective:To study the effects of early essential newborn care (EENC) on breastfeeding and health outcomes of infants within 3 months of age.Methods:From September 2017 to September 2018, a prospective non-randomized controlled experimental study were carried out in 8 Women & Children's Hospital in Sichuan Province, including 1 municipal hospital and 3 county (district) hospitals as the intervention group and the other 1 municipal hospital and 3 county (district) hospitals as the control group. The intervention group received EENC and the control group received routine newborn care. Clinical data were collected after delivery and at the age of 1- and 3-month, including breastfeeding method, umbilical cord separation time, pneumonia, sepsis and diarrhea. Health outcome of the two groups were compared. The data were analyzed using SPSS 22.0.Results:There are 91.1% (278/305) of the newborns in the intervention group completed their first breastfeeding before their first mother-baby skin contact, compared with 33.3% (36/108) in the control group ( P<0.001). Exclusive breastfeeding rate before discharge in the intervention group was higher than the control group [(74.5% (228/306) vs. 55.0% (177/322), P<0.001]. The incidences of re-hospitalization and referred to other hospitals due to illness was lower in intervention group than the control group within 1 month of age [7.0% (19/272) vs. 13.3% (37/278), P=0.014]; Umbilical cord separation time in the intervention group was earlier than the control group [(8.3±2.9) d vs. (10.5±3.3) d, P<0.001]; No significant differences existed in the incidences of umbilical cord infection, pneumonia and diarrhea between the two groups ( P>0.05). The incidence of diarrhea in intervention group was higher than that the control group at 3 months of age ( P<0.05); No significant differences existed in the incidences of pneumonia and re-hospitalization and referred to other hospitals due to illness between the two groups ( P>0.05). There was no sepsis case in the two groups. Conclusions:EENC may improve exclusive breastfeeding rate before discharge, reduce the incidences of referral/hospitalization within 1 month and shorten the umbilical cord separation time without causing more infections.

Cardiomyopathy and cardiac function in fetuses and newborns of diabetic mothers

Abstract Objective: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. Method: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. Results: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p ≤ 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p ≤ 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p 0.001 in the fetuses and newborns respectively. Conclusion: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods.

Association between prenatal care adequacy indexes and low birth weight outcome / Associação entre índices de adequação de cuidado prénatal e desfecho de baixo peso ao nascer

Abstract Objective To investigate the association between prenatal care (PNC) adequacy indexes and the low birth weigth (LBW) outcome. Methods A total of 368,093 live term singleton births in the state of Rio de Janeiro (Brazil) from 2015 to 2016 were investigated using data from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos, SINASC, in Portuguese). Seven PNC adequacy indexes were evaluated: four developed by Brazilian authors (Ciari Jr. et al., Coutinho et al., Takeda, and an index developed and used by the Brazilian Ministry of Health - MS) and three by authors from other countries (Kessner et al., the Adequacy of Prenatal Care Utilization index - APNCU, and the Graduated Prenatal Care Utilization Index - GINDEX). Adjusted odds ratios were estimated for the PNC adequacy indexes by means of multivariate logistic regression models using maternal, gestational and newborn characteristics as covariates. Results When the PNC is classified as "inadequate", the adjusted odds ratios to the LBWoutcome increase between 42% and 132%, depending on which adequacy index is evaluated. Younger (15 to 17 years old) and older (35 to 45 years old) mothers, those not married, of black or brown ethnicity, with low schooling (who did not finish Elementary School), primiparous, with preterm births, as well as female newborns had increasing odds for LBW. The models presented areas under the receiver operating characteristic (ROC) curve between 80.4% and 81.0%, and sensitivity and specificity that varied, respectively, between 57.7% and 58.6% and 94.3% and 94.5%. Conclusion Considering all PNC adequacy indexes evaluated, the APNCU had the best discriminatory power and the best ability to predict the LBW outcome.

Resumo Objetivo Investigar a associação entre diferentes índices de adequação do cuidado pré-natal (PN) e o desfecho de nascimentos com baixo peso (BP). Métodos Foram investigados 368.093 nascimentos ocorridos no estado do Rio de Janeiro entre 2015 e 2016, utilizando-se as informações do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sete índices de adequação do cuidado PN foram avaliados: quatro propostos por autores nacionais (Ciari Jr et al., Coutinho et al., Takeda, e um índice atualmente em uso pelo Ministério da Saúde - MS), e três, por autores internacionais (Kessner et al., Adequacy of Prenatal Care Utilization index - APNCU, e Graduated Prenatal Care Utilization Index - GINDEX). As razões de chance ajustadas para BP foram estimadas considerando os índices de adequação do cuidado PN por meio de modelos de regressão logística, utilizando características maternas, da gravidez e do recém-nascido como variáveis de controle. Resultados As chances ajustadas para ocorrência de BP ao nascer aumentam de 42% a 132%, a depender do índice empregado, quando o cuidado PN é considerado inadequado. Mães entre 15 e 17 anos e entre 35 e 45 anos, sem companheiro, de cor parda ou preta, com ensino fundamental incompleto, e primíparas, com gestações pré-termo, além de bebês do sexo feminino são fatores de risco para os nascimentos com BP. Conclusão Entre os índices avaliados, o APNCU foi o que apresentou melhor poder discriminatório e capacidade de prever o desfecho de BP ao nascer.

What are the Barriers to Antenatal Care Utilization in Rufisque District, Senegal?: a Bottleneck Analysis

BACKGROUND: This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers. METHODS: Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal. RESULTS: Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization. CONCLUSION: To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.

Quality Improvement Approaches Associated with Quality of Childbirth Care Practices in Six Indian States

Objective: To compare the impact of quality improvement (QI)approaches and other health system factors (level of healthfacility, cadre of staff conducting the delivery, years of experienceof staff conducting the delivery, and time of day) on the quality ofsix elements of delivery and postpartum/postnatal care.Design: Cross-sectional study using external observers. Setting: 12 public health facilities in 6 states in India duringNovember 2014.Participants/patients: 461 deliveries in above facilities.Intervention: Facilities were chosen based on having receivedone day of QI training and at least six monthly QI coaching visits.Main Outcome Measure(s): (i) Administration of oxytocin withinone minute following delivery, (ii) immediate drying and wrappingof the newborn, (iii) use of sterile cord clamps, (iv) breastfeedingwithin one hour of birth, (v) mothers’ condition assessed between0 and 30 minute after delivery, and (vi) vitamin K given to infantswithin 6 hour of birth.Results: On multivariate analysis, facilities using QI approacheswith deliberate aims to address the processes of interest weremore likely to dry and wrap infants (OR 2.6, 95% CI: 2.1, 6.6),initiate early breastfeeding (OR 3.6, 95% CI: 2.1, 6.2) and conductpost-partum vitals monitoring (OR 2.7, 95% CI: 1.7, 4.2). Theother health system factors had mixed effects.Conclusions: Facilities using QI approaches to ensure all womenand babies receive specific elements of care provide that elementof care to a greater proportion than facilities not using QIapproaches for that element of care.

Management of Continuous Positive Airway Pressure in the Newborn: Impact of Lecture-based Interactive Workshops on Training for Neonatal Intensive Care Nurses / Manejo de la presión positiva continua en las vías respiratorias en el recién nacido: el impacto de talleres interactivos basados en conferencias sobre la formación de las enfermeras de cuidados intensivos neonatales / Manejo da pressão positiva contínua nas vias respiratórias no recém-nacido: o impacto de oficinas interativas baseadas em conferências sobre a formação das enfermeiras de cuidados intensivos neonatais

Objectives: The aim of this study was to determine how training imparted via structured workshops related to management of continuous positive airway pressure in the newborn affects the knowledge of neonatal intensive care nurses. Methods: A group of nurses attended an interactive lecture-based workshop on management of continuous positive airway pressure in the newborn. The nurses in question had accepted an invitation to the presentation prior to the training event. Information on the participants' differentiating features was collected via a questionnaire prepared by the researchers themselves. An evaluation of the nurses' knowledge on the subject was performed through a multiple choice questionnaire (MCQ) prepared by the researchers in relation to the literature. After the MCQ was prepared, it was mailed to experts in Turkey (7 people) and experts from abroad (5 people), and their opinions were considered. In light of their suggestions, the MCQ was given its final form and the number of questions was set at 20. The MCQ consisting of 20 questions was answered by the participants before and after the interactive workshop. The participants were not informed as to whether or not the test would be repeated after the training. Results: Thirty-six nurses from the neonatal unit took part in the study. Each question in the MCQ was considered as one (1) point. The maximum possible score on the test was 20. There was a significant improvement in the mean test score after the lecture, when compared to the pre-lecture score (Mean = 19.6, SD=0.8 vs. Mean =13.1, SD=3.0, P<0.001). Conclusions: A lecture-based inter active workshop on management of continuous positive airway pressure in newborns helps to improve nurses' knowledge. It also helps to overcome deficiencies in nurse training.

Objetivos: el objetivo de este estudio fue determinar cómo la formación impartida a través de talleres estructurados relacionados con el manejo de la presión positiva continua en las vías respiratorias en el recién nacido afecta el conocimiento de las enfermeras que trabajan en cuidados intensivos neonatales. Métodos: un grupo de enfermeras asistieron a un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido. Las enfermeras en cuestión habían aceptado una invitación para asistir a la presentación antes del evento de capacitación. La información sobre las características diferenciadoras de los participantes se recogió a través de un cuestionario elaborado por los propios investigadores. Una evaluación de los conocimientos de las enfermeras sobre el tema se llevó a cabo a través de un cuestionario de selección múltiple (CSM), el cual fue elaborado por los investigadores en relación con la literatura. El CSM fue enviado por correo a unos expertos en Turquía (siete personas) y unos expertos en el exterior (cinco personas), y sus opiniones fueron tomadas en cuenta. A la luz de sus sugerencias, al CSM se le dio su forma final y el número de preguntas se fijó en 20. El CSM, que consta de 20 preguntas, fue respondido por los participantes antes y después del taller interactivo. A los participantes no se les dijo si la prueba se repitió después del taller de formación. Resultados: treinta y seis enfermeras de la unidad neonatal participaron en el estudio. Cada pregunta en el CSM se consideró como un (1) punto. La puntuación máxima posible en la prueba fue 20. Hubo una mejora significativa en la puntuación de la prueba media después de la conferencia, si se compara con la puntuación preconferencia (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P <0,001). Conclusiones: un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido ayuda a mejorar el conocimiento de las enfermeras. También ayuda a superar las deficiencias en la formación de enfermeras.

Objetivos: o objetivo deste estudo é determinar como a formação ministrada nas oficinas estrturadas relacionadas com o manejo da pressão positiva contínua nas vias respiratórias no recém-nascido afeta o conhecimento das enfermeiras que trabalham em cuidados intesivos neonatais. Métodos: um grupo de enfermeiras participaram de uma oficina interativa baseada numa conferência sobre o manejo da pressão contínua nas vias respiratórias no recém-nascido. as enferemeiras em questão tinham aceitado um convite para comparecer à apresentação antes do evento de aperfeiçoamento. a informação sobre as características diferenciadoras dos participantes foi coletada por meio de um questionário elaborado pelos próprios pesquisadores. Uma avaliação dos conhecimentos das enfermeiras sobre o tema foi realizado mediante questionário de múltipla escolha (QME), o qual foi elaborado pelos pesquisadores de acordo com a literatura. o QME foi enviado por e-mail a sete especialistas na Turquia e a outros cinco no exterior, e suas opiniões foram consideradas. À luz das sugestões, o QME, que consta de 20 perguntas, foi respondido pelos participantes antes e depois da oficina interativa. Resultados: 36 enfermeiras da unidade neonatal participaram do estudo. Cada pergunta do QME foi considerada como (1) ponto. A pontuação máxima possível na prova foi 20. Houve uma melhora significativa na pontuação da prova média depois da conferência, se comparada com a pontuação pré-conferência (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P < 0,001). Conclusões: uma oficina interativa baseada numa conferência sobre o manejo da pressão positiva contínua nas vias respiratórias no recém-nascido ajuda a melhorar o conhecimento das enfermeiras e a superar as deficiências na sua formação.

Maximizing Benefits to Mothers and Newborn: an Ethical Analysis of Issues in Newborn Health Program Design.

This paper highlights on the aspects of bioethics principle of beneficence and equal value of human lives and the concept of distributive justice, mothers and women as seen through the lens of community based newborn health programs in developing countries. The Interagency Group of Safe Motherhood reveals a major reason for what women continue to die from pregnancy related disease is that they are discriminated and that the severe neglect of women’s health is a violation of their human rights. Following the bioethics principle of beneficence and to value the equal worth of human lives and the concept of distributive justice, all women including adolescents and pregnant women in same community must have been focused and addressed through a newborn health program. Even within a context with scarce resources, we need to remember that cost sharing and investment on maternal care, particularly antenatal counseling and delivery assistance, helps increasing newborn survival. Estimated over half of costs of newborn health program needs to be invested in maternal health aspects, to ensure effective successful program implementation to improve newborn survival.

Impact of Conditional Cash Transfers on Maternal and Newborn Health.

Maternal and newborn health (MNH) is a high priority for global health and is included among the Millennium Development Goals (MDGs). However, the slow decline in maternal and newborn mortality jeopardizes achievements of the targets of MDGs. According to UNICEF, 60 million women give birth outside of health facilities, and family planning needs are satisfied for only 50%. Further, skilled birth attendance and the use of antenatal care are most inequitably distributed in maternal and newborn health interventions in low- and middle-income countries. Conditional cash transfer (CCT) programmes have been shown to increase health service utilization among the poorest but little is written on the effects of such programmes on maternal and newborn health. We carried out a systematic review of studies on CCT that report maternal and newborn health outcomes, including studies from 8 countries. The CCT programmes have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers and reduced the incidence of low birthweight. The programmes have not had a significant impact on fertility while the impact on maternal and newborn mortality has not been welldocumented thus far. Given these positive effects, we make the case for further investment in CCT programmes for maternal and newborn health, noting gaps in knowledge and providing recommendations for better design and evaluation of such programmes. We recommend more rigorous impact evaluations that document impact pathways and take factors, such as cost-effectiveness, into account.

Financial Incentives and Maternal Health: Where Do We Go from Here.

Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives—performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers—summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

Study of pH and gas analysis of umbilical arterial blood and apgar score as indicators of newborn health / 영남의대학술지

Apgar score is most widely used evaluating indicator of newborn health, but it is very subjective. Umbilical cord blood gas analysis is more objective and effective than Apgar score in evaluation of newborn status. Cord blood gas was changed slightly by processing of time after fetal birth. This study was undertaken to observe objectiveness and effectiveness of umbilical arterial blood gas analysis and effects of time interval of cord clamping to newborn health with 122 pregnant women and their babies. We observed following results: 1. There were poor correlation between Apgar score and umbilical cord arterial blood analysis in evaluating of newborn health (P>0.05). 2. There was no clinical significance of Apgar score or umbilical arterial blood gas analysis as single indicator in evaluating of newborn health (P>0.05). 3. Gas analysis and pH of umbilical arterial blood was more helpful in evaluating of newborn health than Apgar score. 4. There were no significant effects of time interval of umbilical cord clamping to newborn health. 5. If there were no indications of early umbilical cord clamping, cord blood sampling at immediately after birth without cord clamping was more effective to evaluate newborn status.