[Assessment of the state and future of basic neonatal resuscitation equipment, in first-line health facilities in Senegal after 3years]. / Évaluation de l'état et du devenir du matériel de base destiné à la prise en charge du nouveau-né à la naissance dans les structures sanitaires périphériques au Sénégal, après un recul de trois ans.

BACKGROUND: Neonatal mortality is a major public health problem. The main causes are infections, prematurity and asphyxia at birth. In view of reducing this high mortality, primary healthcare facilities were equipped with basic equipment for the care of newborns and their key workers were trained in essential newborn care. Three years after this implementation, the present study assesses the state and conditions of use of this basic equipment intended for taking care of newborns at birth. METHOD: This assessment was conducted from 16 March to 3 April 2009. It was based on observations and interviews on a sample of healthcare facilities. RESULTS: Healthcare facilities were generally equipped with ventilator bags and masks (87%) (60/69). In more than half of the healthcare centers (20/38), they were not used often because the workers were renewed and not educated in their use. They were practically all in good condition. Eighty-five percent (59/69) of healthcare facilities had at least one aspirator, generally adapted to newborns (negative pressure, 100 mmHg). The maintenance of the material was globally satisfactory because the aspirator bottles were most often clean. As for the aspirator tubes, they were always available but a few cases of supply rupture were observed in some healthcare centers. The warming table was available in only 52% (36/69) of healthcare facilities. Fifteen tables did not comply with initial specifications. CONCLUSION: This assessment highlights that the basic equipment intended for newborn care was generally available, functional and maintained well after 3 years. This strategy could be scaled up in order to contribute to reducing the newborn mortality.

Integrating quality postnatal care into PMTCT in Swaziland.

Swaziland's prevention of mother-to-child transmission (PMTCT) programme is linked to maternal and newborn health (MNH) services, but is mainly focussed on HIV/AIDS. Existing MNH services are inadequate, especially postnatal care (PNC) of mothers and babies, with delayed postnatal visits occurring at 4-6 weeks after delivery. Fifty-seven percent of staff in seven Swazi health facilities were trained in promoting and providing early PNC. A final evaluation showed a 20-fold increase in the number of visits coming for an early postnatal visit (within the first three days after birth). A direct observation of the client-provider interaction showed a significant increase in the competence of the health workers related to postnatal examinations, and care of mothers and babies (p<0.05- < 0.01). The percentage of women breastfeeding within one hour of delivery increased by 41% in HIV-positive mothers and 52% in HIV-negative mothers. Cotrimoxazole prophylaxis for HIV-exposed infants increased by 24%. Although, health workers were observed providing counselling, maternal recall of messages was deficient, suggesting the need for additional strategies for promoting healthy behaviours. High-quality integrated PMTCT programmes and MNH postnatal services are feasible and acceptable, and can result in promoting early postnatal visits and improved care of both HIV-positive and HIV-negative mothers and their babies.

Association between Endothelial Biomarkers and Arterial Elasticity in Young Adults - The CARDIA Study.

BACKGROUND: Reduced arterial elasticity and endothelial dysfunction both may indicate early cardiovascular (CV) disease in young adults. Pulse waveform analysis estimates large (LAE) and small (SAE) artery elasticity noninvasively. We assessed the associations between LAE and SAE and markers of endothelial dysfunction and CV risk factors. METHODS: The Coronary Artery Risk Development in Young Adults (CARDIA) assessed arterial elasticity and other characteristics cross-sectionally in 389 men and 381 women aged 27-42 years in 1995 (CARDIA year 10) and circulating levels of P-selectin and soluble intercellular adhesion molecule 1 (sICAM-1) in 2000. We adjusted for variables included in the estimation of arterial elasticity (year 10 height, body mass index, age, heart rate, and blood pressure) and other year 10 characteristics. RESULTS: Mean adjusted SAE was 8.5 vs. 7.6 ml/mmHg x100 in those with urine albumin/creatinine ratio 25; p(trend) =0.008). Mean LAE was 25.6 vs. 24.2 ml/mmHg x10 in the lowest vs. highest quintile of P-selectin (p(trend) =0.004). sICAM-1 was unrelated to either LAE or SAE. Plasma triglycerides were inversely related to LAE (p(trend) =0.029). Cigarette smokers had lower SAE than nonsmokers (p(trend) = 0.009). CONCLUSION: In addition to smoking and triglycerides, biomarkers for endothelial dysfunction were associated with impaired LAE and SAE in young adults.

A controlled trial of alternative methods of oral feeding in neonates.

BACKGROUND: Some neonatal units are introducing use of cup and traditional feeding devices for feeding young infants although they have been not been evaluated objectively. Hence this controlled trial of the use of the bottle, cup and a traditional feeding device ('paladai') was undertaken in neonates. METHOD: The study comprised of 100 infants including full-term normal weight infants (n = 66), term growth retarded infants (n = 20), and preterm infants (n = 14). All three methods were tried on every infant by the same nurse for a particular baby, so that each infant served as his/her control and in order to avoid the effect of major influencing factors. Parameters evaluated were the volume ingested, duration of the feed, degree of spilling and satiety. RESULTS: The infants took the maximum volume in the least time and kept quiet longest with the paladai. The findings were particularly significant in the group including all the categories of infants. Spilling was the highest with the cup, especially with preterm infants.

Expression of the mcrA gene of Escherichia coli is regulated posttranscriptionally, possibly by sequestration of the Shine-Dalgarno region.

The polypeptides encoded by the mcrA gene were analysed using a T7 expression system. Cloned fragments of 1.6 and 1.0 kb displayed an McrA+/RglA+ phenotype and directed synthesis of a 31-kDa polypeptide. A derivative of these clones altered at an internal HindIII site displayed an McrA+/RglA- phenotype and directed production of a 23-kDa polypeptide. Smaller inserts displayed McrA-/RglA- phenotypes, though a 0.7-kb insert did direct production of a 24-kDa polypeptide. A construct carrying the 1.0-kb mcrA insert yielded a single 1.3-kb transcript. The mcrA transcript was found to start from C, G, T and G, namely the fourth, fifth, sixth and seventh nucleotides (nt), respectively, downstream from the last nt of the putative -10 region. Two mcrA transcriptional/transational fusions were made in the pT7-7 expression vector and the protein encoded by these constructs were analysed. Regulation of mcrA expression was studied by quantitative Northern analysis of RNA from various mcrA clones. Together with a computer analysis of the translation initiation region in these mRNAs, the results suggest that the expression of mcrA may be regulated at the translational level.

Poliovirus antibody titres, relative affinity, and neutralising capacity in maternal milk.

Varying titres of secretory IgA antibodies to poliovirus type 1 were found previously in the milk of unvaccinated, lactating Pakistani mothers during two different years, reflecting the antigenic exposure on mucosal membranes. To study further the changes in the extent and the form of antigenic exposure reflected in the human milk, human milk samples from Pakistani, Indian, Japanese, and Swedish mothers were collected. The quality and the neutralising capacity of the antibodies was also studied. Secretory IgA, IgG, and IgM antibodies to poliovirus type 1 were determined using enzyme linked immunosorbent assay (ELISA) and relative affinity was measured in ELISA by elution with potassium thiocyanide. Microneutralisation tests were also performed. The higher secretory IgA antibody titres to poliovirus type 1 in the unvaccinated, naturally exposed Pakistani and Indian mothers' milk, compared with the Swedish and Japanese mothers, presumably reflect the epidemiological situation in these countries. Neutralising capacity and the relative antibody affinity seemed to be higher both in the Pakistani mothers and the group without natural exposure but only given inactivated poliovirus vaccine, that is the Swedish mothers, than the group meeting only live vaccine strains, that is the Japanese mothers.

Delayed contact and breast feeding.

Fifty two mother-infant pairs were studied. Of these, twenty six belonged to the normal vaginal delivery group where babies were roomed in with their mothers immediately after birth. Twenty six belonged to the cesarean group where the mother and baby were separated for 2.8 +/- 1.0 days. The social support was comparable in the two groups. No significant difference was found in the number of mothers breast feeding their infants at four weeks postpartum.

Maternal participation in the care of the high risk infant: follow-up evaluation.

Fifty mothers of high risk infants admitted to the Neonatal Special Care Unit were followed up to the postnatal age of 2.5 mo +/- 15 days. Twenty five mothers (Group I) had stayed in the nursery with the infant for a period of 4.8 +/- 4.6 days until the discharge of the infant, providing expressed milk and participating in the non-specialised care of the infant. The other 25 mothers (Group II) remained separate from their babies for the duration of the latter's stay in the hospital although some of the mothers did come off and on to give expressed human milk and at times handle their infants. Family features such as parental age, educational and occupational status, and presence of residential elder women, were similar in the two groups. Infant characteristics too, such as sex, birth weight, and early neonatal morbidity were also comparable. Operative deliveries and maternal problems were as expected more in the separated group. The duration of the infants' hospital stay was also more in the latter (9.5 +/- 3.5 vs 6.3 +/- 3.9 days; p greater than 0.05). Subsequent to their discharge, mothers who had stayed with the infant identified the following benefits of their stay--acquiring of knowledge relevant to infant care especially hygiene (19) and their personal involvement in the care of their infant (12), both of which they said increased their self confidence in looking after the babies after discharge, and provision of breast milk round the clock (17).(ABSTRACT TRUNCATED AT 250 WORDS)

Sucking on the 'emptied' breast: non-nutritive sucking with a difference.

A simple method to promote the use of human milk and subsequent breast feeding in low birthweight infants was evaluated in 32 babies. In the 'intervention' group (n = 16; mean (SD) weight 1559 (228) g and length of gestation 33.2 (1.8) weeks), infants were allowed to suckle at the breast when their general condition permitted after as much milk as possible had been expressed, and were then given the full required feeds by tube. Full breast feeding was started as soon as the infant could suck adequately. Sixteen control infants (mean (SD) weight 1605 (198) g and length of gestation 34.1 (2.4) weeks), were breast fed in the conventional manner only after it had been established that they could suck well; until then they received all their feeds by tube. After discharge the mean (SD) periods of exclusive and total breast feeding were longer in the group that had received the intervention (3.7 (1.3) and 5.1 (2.2) months, respectively) than among the controls (1.9 (0.6) and 3.3 (1.9) months, respectively). This 'intervention' method helps to promote milk formation, provides sucking experience for low birthweight infants without interfering with their nutritional intake and consequent weight gain, and encourages subsequent breast feeding with its well recognised advantages.

Differences in level and avidity of secretory IgA antibodies in breast milk of Swedish, Indian and Japanese mothers to soybean protein.

Colostrum was collected from Swedish, Indian and Japanese mothers. The samples were as a mean, collected 4.00-4.25 days after delivery of term infants. The level of specific IgA antibody to 2S, 7S and crude soybean antigen were measured by the enzyme-linked immunosorbent assay (ELISA). The avidity of the IgA antibodies to 7S soybean antigen was also measured with an ELISA system using different molarities of potassium thiocyanate for elution of the specific IgA antibody from solid phase-bound antigen. The level of specific IgA antibody to 7S and crude soybean antigen in the milk of the Indian mothers was significantly higher than in the milk of the Japanese mothers (p less than or equal to 0.01). In contrast, the avidity expressed as the molarity of KSCN for 50% elution of IgA antibody to 7S soybean antigen in the milk of the Japanese mothers was significantly higher than in the milk of the Indian mothers (p less than 0.01).

Influence of cesarean section on mother-baby interaction.

Fifty two mother-infant pairs were studied. Twenty six of these were delivered by the normal vaginal route (NVD group) and twenty six by Cesarean section (CS group). The NVD babies were roomed in with their mothers soon after birth whereas the CS babies had a mean separation of 2.8 +/- 1.0 days. The mother baby interaction was evaluated by (a) direct observation of the mother's behaviour during feeding, (b) observation of mother's behaviour during BNBAS (Brazelton Neonatal Behaviour Assessment Scale) on her baby, and (c) interview of the mother with attachment questions. Mothers in the NVD group showed significantly greater affectionate behaviour and encompassing compared to mothers in the CS group. They (NVD mothers) were more often involved in the care-taking activities of their babies and scored significantly higher for the interview implying a greater mother-baby attachment in this group.

Cesarean section and delayed contact: effect on baby's behaviour.

Fifty two babies were assessed by the Brazelton Neonatal Behaviour Assessment Scale (BNBAS) first at 24-48 hours after birth and next at 28 days of age. Of these 26 belonged to the normal vaginal delivery (NVD) group where the babies were roomed in with their mothers immediately after birth. The other 26 were delivered by Cesarean Section (CS) and had a mean separation of 2.8 +/- 1.0 day from their mothers. Babies in the NVD group performed better for the interactive processes at both the initial and follow-up assessment. They were more active initially and on follow up. Although no differences were obtained at the initial assessment for organisational processes (physiological response to stress and state control) the follow up revealed that the NVD babies smiled more, cried less and were less irritable.

A simple method of evaluation of jaundice in the newborn.

This paper evaluates a simple tool, the icterometer, in assessing jaundice in the newborn. The instrument consists of a perspex scale with yellow stripes of increasing intensity, numbered 1-5, alternating with transparent areas through which the infant's blanched skin colour can be seen and compared with the coloured stripes. The scale was found to be useful for more objective screening of neonatal jaundice, particularly in decreasing the number of blood samples to be taken for serum bilirubin. The present study suggests that serum bilirubin estimation can be avoided when the icterometer readings on the face are 3 or less, unless there is a rapid rise in jaundice within 24-36 h. However, a reading on the sole of even 1 is significant and requires assessment by trained staff for blood sampling and/or phototherapy. The instrument may also be useful to peripheral staff in developing countries when deciding on referral to specialist centres and to staff in specialist centres for screening cases of neonatal jaundice and decreasing the number of blood samples.

Human milk for low birthweight infants: immunology, nutrition and newer practical technologies.

Human milk has a number of unique properties which can be of benefit to high risk low birthweight and preterm infants. Immunological features are of particular importance. Growth is better with the use of the mother's own milk than with pooled bank milk. The quality of the latter can be improved by various measures noted in the text. Growth can be further improved by enriching the milk with human milk factors, powder formula or protein supplements. As breast-feeding is best for infants, the maternal milk supply should be maintained during the hospital stay of infants by frequent expression, galactogogues used where necessary under supervision, encouraging maternal contact with the infant, promotion of suckling initially on the "empty" breast after expression of milk, and subsequently institution of direct breast-feeding. With proper interventions and motivation of both staff and mothers, even very low birthweight infants below 1,500 gm can go on, in time, to exclusive breast-feeding.

Ear infection and infant feeding practices.

Feeding practices were studied in 128 infants aged 18 months and below with middle ear infection, belonging to the low socio-economic group. By the age of one year, 117 (91.4%) had acquired the infection. At the onset of the first episode, 105 (82.0%) were breast-fed, 42 not receiving any other milk. There were no differences in the feeding practices between infants who had single and those who had multiple episodes. Ninety-six infants were being given water by spoon or bottle and 42, semisolids by spoon. Among the 105 breast-fed infants, in 93 (88.6%), the infants' heads were often flat during feeding. In contrast, in the 86 infants on 'top' feeds 53 (61.6%) of the mothers said that they kept the infants' head raised during feeding. The difference was significant (x2 = 53.18, P less than 0.001). Mothers should avoid feeding infants with the latter's head flat, although the former may adopt any comfortable position.

Spoon vs bottle: a controlled evaluation of milk feeding in young infants.

Fifty infants under the age of six months who were on artificial milk and who had attended the hospital for diarrhea, were taken up for study. They were divided into two groups. In Group I (n = 25) infants were given milk by spoon and in Group II (n = 25) by bottle. Mothers were given education relevant to the method of feeding on an individual basis. Follow up over a period of 3 months showed a fall in the number of diarrheal episodes which was similar in the two groups. Maternal compliance was significantly better in the bottle-fed group where only one mother expressed a desire to change over to the use of cup and spoon. The weight gain was better in the bottle-fed group, the difference being statistically significant relevant to the weight gain in the second and third month and to the total weight gain in the three months period (t = 3.24, p less than 0.01; t = 2.03 p less than 0.05; and t = 2.24, p less than 0.05, respectively).