Improving survival of preterm babies in low- to middle-income countries ­ what can we do?

Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia;prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP),including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective,evidence-based interventions can be implemented in LMICs to reduce neonatal mortality

The impact of a new educational strategy on acquiring neonatology skills.

OVERVIEW: A shortage of staff for teaching neonatology skills to large numbers of students, in small groups and following a new curriculum, necessitated an innovative educational strategy. This entailed the development and implementation of an interactive multimedia program (CD-ROM) to deliver information about skills and to demonstrate them. METHODS: Students had to study a specific skill using the CD-ROM and then practise in the Skills Laboratory, supported by lecturers who provided formative evaluation. OBJECTIVES: The aims of this study were to assess the students' perspectives on the new strategy, and to compare the skills of students following the new curriculum to those of students following the traditional curriculum, who do not follow structured programmes on practical skills but experience a practical neonatology rotation. RESULTS: The evaluation of the CD-ROM program was very favourable. The majority of students still preferred live demonstrations but found the CD-ROM useful for revision purposes. With the exception of one skill, endotracheal intubation, the new curriculum students were found to be as competent as the students following the traditional curriculum and performed mask ventilation and cardiac massage significantly better than them.

Bilateral oblique facial cleft--tissue expansion with primary reconstruction.

The oblique facial cleft may present as a cutaneous and/or an osseous cleft, with or without a cleft lip, and with or without a cleft palate. This particular case was born with complete bilateral cutaneous-osseous oblique facial clefts which extended from the oral cavity to the eye sockets with anophthalmia on the right side. The first surgical intervention included a midline nasal skeleton alignment and bilateral cleft lip and alveolus reconstruction. Urinary Foley catheters were used as facial tissue expanders and inserted adjacent to the oblique facial clefts. The second surgical procedure consisted of a partial pyramidal Le Fort II osteotomy for an inferiorly displaced nasal maxillary skeleton and a rotation and advancement of the cheek as a flap for reconstruction of the palpebral cleft and inner canthus.

Ornithine-vasopressin gangrene and reconstruction of the upper lip. Case report.

A bilateral cleft lip and palate case received ornithine-vasopressin intra-operatively in preparation for a vasoconstricted field of the various lip segments prior to the repair of the cleft lip. A cyanotic tinge appeared immediately. This eventually led to total necrosis of the upper lip. Various relevant blood tests were done and a mild thrombocytosis was found. Surgical reconstruction of the upper lip was performed by means of a forked cross-lip flap--the main blood supply coming from the columella--as well as by means of an inferiorly pedicled cheek flap from the para-nasal area.

Nasomaxillo-acrodysostosis.

Thirteen patients with nasomaxillo-acrodysostosis are described. Some have the facial appearance of this syndrome only, although the others are more severely affected, with skull, eyes, ears, vertebrae and peripheral extremity involvement. The features of the 13 patients were studied and compared with those described in the literature as belonging to 'maxillonasal dysostosis' and 'acrodysostosis'. It seems certain that there is in fact only one syndrome, which differs only in extent of involvement.