Care of the low birthweight babies /neonatal intensive care (original) (raw)
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Facility readiness in low and middle- income countries to address care of high risk/ small and sick newborns, 2019
Background: The successful promotion of facility births in low and middle-income countries has not always resulted in improved neonatal outcome. We evaluated key signal functions pertinent to Level II neonatal care to determine facility readiness to care for high risk/ small and sick newborns. Method: Facility readiness for care of high risk/ small and sick babies was determined through self-evaluation using a pre-designed checklist to determine key signal functions pertinent to Level II neonatal care in selected referral hospitals in Uganda (10), Indonesia (4) and India (2) with focus on the Sub-Saharan country with greater challenges. Results: Most facilities reported having continuous water supply, resources for hand hygiene and waste disposal. Delivery rooms had newborn corners for basic neonatal resuscitation, but few practiced proper reprocessing of resuscitation equipment. Birth weight records were not consistently maintained in the Ugandan hospitals. In facilities with records of birth weights, more than half (51.7%) of newborns admitted to the neonatal units weighed 2500 g or more. Neonatal mortality rates ranged from 1.5 to 22.5%. Evaluation of stillbirths and numbers of babies discharged against medical advice gave a more comprehensive idea of outcome. Kangaroo Mother Care was practiced to varying extents. Incubators were more common in Africa while radiant warmers were preferred in Indian hospitals. Tube feeding was practiced in all and cup feeding in most, with use of human milk at all sites. There were proportionately more certified pediatricians and nurses in Indonesia and India. There was considerable shortage of nursing staff, (worst nurse –bed ratio ranging from 1 to 15 in the day shift, and 1 to 30 at night). There was significant variability in facility readiness, as in data maintenance, availability of commodities such as linen, air -oxygen blenders and infusion pumps and of infection prevention practices. Conclusions: Referral neonatal units in LMIC have challenges in meeting even the basic level II requirements, with significant variability in equipment, staffing and selected care practices. Facility readiness has to improve in concert with increased facility births of high risk newborns in order to have an impact on neonatal outcome, and on achieving Sustainable Development Goals 3.2.2. Keywords: Newborn, Preterm babies, Prematurity, Low birthweight, Facility-based care, Special care newborn units, Level II newborn care, Equipment for newborn care, Commodities for newborn care, Low and middle-income countries, Health policies
Care of the Newborn in Developing Countries
Journal of Neonatal Biology, 2014
The newborn period is the most challenging period of human life and it is the period most susceptible to morbidity and mortality. Neonatal morbidity and mortality contribute significantly to infant mortality rate and under-five mortality rate globally; which are important indices for determining the level of development of any country. In most African countries and other developing parts of the world, there are inadequate resources and these reflect on the care given to their newborns. Therefore, there is need to understand the peculiarities, challenges and common problems newborns face in these countries with the aim of providing optimal care for the newborns: the goal of this review.
BMC Pediatrics, 2015
Background: Health protocols need to be guided by current data on survival and benefits of interventions within the local context. Periodic clinical audits are required to inform and update health care protocols. This study aimed to review morbidity and mortality in very low birth weight (VLBW) infants in 2013 compared with similar data from 2006/2007. Methods: We performed a retrospective review of patients' records from a neonatal computer database for 562 VLBW infants. These neonates weighed between 500 and 1500 g at birth, and were admitted within 48 hours after birth between 01 January 2013 and 31 December 2013. Patients' characteristics, complications of prematurity, and therapeutic interventions were compared with 2006/2007 data. Univariate analysis and multiple logistic regression were performed to establish significant associations of various factors with survival to discharge for 2013. Results: Survival in 2013 was similar to that in 2006/2007 (73.4% vs 70.2%, p = 0.27). However, survival in neonates who weighed 750-900 g significantly improved from 20.4% in 2006/2007 to 52.4% in 2013 (p = 0.001). The use of nasal continuous positive airway pressure (NCPAP) increased from 20.3% to 62.9% and surfactant use increased from 19.2% to 65.5% between the two time periods (both p < 0.001). Antenatal care attendance improved from 54.4% to 70.6% (p = 0.001) and late onset sepsis (>72 hours after birth) increased from 12.5% to 19% (p = 0.006) between the two time periods. Other variables remained unchanged between 2006/2007 and 2013. The main determinants of survival to discharge in 2013 were birth weight (odds ratio 1.005, 95% confidence interval 1.003-1.0007, resuscitation at birth (2.673, 1.375-5.197), NCPAP (0.247, 0.109-0.560), necrotising enterocolitis (4.555, 1.659-12.51), and mode of delivery, including normal vaginal delivery (0.456, 0.231-0.903) and vaginal breech (0.069, 0.013-0.364). Conclusions: There was a marked improvement in the survival of neonates weighing between 750 and 900 g at birth, most likely due to provision of surfactant and NCPAP. Provision of NCPAP, prevention of necrotising enterocolitis, and control of infection need to be prioritised in VLBW infants to improve their outcome.
BMC Pediatrics, 2010
Background: Audit of disease and mortality patterns provides essential information for health budgeting and planning, as well as a benchmark for comparison. Neonatal mortality accounts for about 1/3 of deaths < 5 years of age and very low birth weight (VLBW) mortality for approximately 1/3 of neonatal mortality. Intervention programs must be based on reliable statistics applicable to the local setting; First World data cannot be used in a Third World setting. Many neonatal units participate in the Vermont Oxford Network (VON); limited resources prevent a significant number of large neonatal units from developing countries taking part, hence data from such units is lacking. The purpose of this study was to provide reliable, recent statistics relevant to a developing African country, useful for guiding neonatal interventions in that setting.
Outcomes and Disease Spectrum of LBW Neonates in a Secondary Health Facility
Journal of Healthcare Engineering, 2022
Globally, 30 million low birth weight (LBW) babies are born every year and 95% of them are from developing countries. LBW neonates are at a high risk of mortality, morbidity, and long-term disability. The objective of this study is to investigate outcomes and disease spectrum among low birth weight neonates. This is a prospective, observational study conducted on 540 neonates admitted in the Mother and Child Hospital, Akure, Ondo State, Nigeria, from 2017 to 2018. Questionnaire, interview, clinical, and diagnostic procedures were used as research tools. There were 137 low birth weight (LBW) neonates, with the mean mothers' age of 31.92 ± 6.60. Of the 540 neonates, 69 (50.4%) and 68 (49.6%) were term and preterm, respectively. There were 64 female neonates (46.7%) and 73 male neonates (53.3%). The mean weight of the neonates was 1.82 ± 0.44 kg, and mean number of days on admission was 6.42 ± 6.75 days. Neonatal sepsis (NNS) was the highest morbidity 51 (37.2%) among the LBW neona...
Neonatal mortality: a scenario in a tertiary level hospital of a developing country
Pediatric Reports, 2010
This study was designed to observe the overall neonatal mortality and pattern of neonatal death in a developing country. The factors related to neonatal mortality are also analyzed. This retrospective study was carried out in all pediatric patients in a tertiary level hospital of a developing country in the year 2008. Total neonatal (0-28 days) and non-neonatal (after 28 days-12 years) admissions and death records were analyzed. There were a total of 3,194 admissions in the year 2008. Neonatal and non-neonatal admissions numbered 942 and 2,252, respectively. There were a total of 146 (15.5%) neonatal deaths among neonatal admissions and 114 (5.06%) non-neonatal deaths among non-neonatal admissions. There were 87 (59.59%) preterm related deaths and 98 (67.12%) deaths due to Low Birth Weight (LBW). There were 102 (70%) deaths among neonates who had no antenatal follow-up. Mother's age was under 20 years in 80 (55%) cases of neonatal death. The number of neonatal deaths is high in developing countries. Preterm with Low Birth Weight (LBW) is the major cause of mortality. Regular antenatal care and social discouragement of early marriage can greatly reduce neonatal death. Skilled and trained nursing care is necessary for the survival of the preterm and Low Birth Weight (LBW) baby in the hospitals of developing countries.
Determinants of Mortality among Low Birthweight Infants
Public Health and Preventive Medicine Archive, 2016
Background and purpose: Infant mortality rate in Indonesia is still high and is largely related to low birthweight (LBW) infants. Previous studies reported the sociodemographic and clinical factors as determinants of mortality of LBW infants, but rarely examined factors related to their health services. This study aims to determine the demographic, clinical and health services as determinants of mortality of LBW infants during hospitalization. Methods: This study was a retrospective using cohort data of medical record of LBW infants in Karangasem Hospital since January 2012 to October 2014. Logistic regression was done to determine the relationship between demographic, clinical and health services factors with LBW infants' mortality. Results: The proportion of mortality among LBW infants during hospitalization was 12.12%. Most parents (64.6%) live in good access to health services. The proportion of female infants (51.4%) was higher than male. LBW infants who were born in hospital (85.7%) greater than born outside hospital. Vaginal delivery (75.3%) was greater than C-section. Preterm infants (57.1%) was greater than at term with median of birthweight was 2100 grams. Proportion of asphyxia, respiratory distress syndrome (RDS), sepsis, hypoglycemia and hypothermia, respectively 24.1%, 4.66%, 0.78%, 7.92% and 3.73%. Variables associated with LBW mortality were increasing of 50 grams of birthweight, asphyxia, RDS and referred infants. Conclusion: The mortality of LBW infants during hospitalization was 12.12% with increasing of 50 grams of birthweight, asphyxia, RDS and referred infants found as determinant factors.