Pub Date : 2024-02-06DOI: 10.1177/09732179231220238
Shubha Athreya, Abhishek Paul, Venkatesh Ha, Karthik Nagesh, Ravi Swamy
Background: Survival of preterm babies has improved and the focus now is on intact survival. Early detection of developmental delay is crucial so that diagnostic-specific early intervention can be commenced to optimize neuroplasticity. Objective: Primary: To assess the neurodevelopmental outcome by measuring preterm infants’ mean composite score for cognition, language, and motor skills. Secondary: To calculate the degree of developmental delay. Study design: A Cohort Study. Participants: Preterm neonates. Intervention: Bayley-III assessment done between 18 and 42 months. Results: Seventy preterm neonates were assessed between 18 and 42 months of age. They were divided into two groups based on gestational age. Mean composite score for cognition (<30 weeks = 79.84 ± 7.88 and >30 weeks = 86.32 ± 9.28; 95%CI: 81.16–85.55), language (<30 weeks = 79.16 ± 11.55 and >30 weeks = 89.37 ± 11.61; 95%CI: 81.90–87.70), and mean Motor scores (<30 weeks 81.69 ± 17.82 and >30 weeks = 89.84 ± 10.46; 95%CI: 82.59–89.63) were statistically significant. There was more than half the standard deviation deficit of composite scores between the two groups. Eighty-one percent had a moderate delay in cognition in the <30 weeks group as compared to 65.8% in >30 weeks. Similarly, for language and motor scores, 43.8% and 31.3% had a moderate delay in <30 weeks as compared to 39.5% and 42.1% for >30 weeks, respectively. Conclusion: Higher composite scores were observed among infants >30 weeks gestation. There was more than half a standard deviation deficit in composite scores among those <30 weeks of gestational age. The most affected was the language component.
{"title":"Neurodevelopmental Outcomes of Preterm Infants Using Bayley Scale of Infant Development-III (BSID-III): A Tertiary Care Centre Study","authors":"Shubha Athreya, Abhishek Paul, Venkatesh Ha, Karthik Nagesh, Ravi Swamy","doi":"10.1177/09732179231220238","DOIUrl":"https://doi.org/10.1177/09732179231220238","url":null,"abstract":"Background: Survival of preterm babies has improved and the focus now is on intact survival. Early detection of developmental delay is crucial so that diagnostic-specific early intervention can be commenced to optimize neuroplasticity. Objective: Primary: To assess the neurodevelopmental outcome by measuring preterm infants’ mean composite score for cognition, language, and motor skills. Secondary: To calculate the degree of developmental delay. Study design: A Cohort Study. Participants: Preterm neonates. Intervention: Bayley-III assessment done between 18 and 42 months. Results: Seventy preterm neonates were assessed between 18 and 42 months of age. They were divided into two groups based on gestational age. Mean composite score for cognition (<30 weeks = 79.84 ± 7.88 and >30 weeks = 86.32 ± 9.28; 95%CI: 81.16–85.55), language (<30 weeks = 79.16 ± 11.55 and >30 weeks = 89.37 ± 11.61; 95%CI: 81.90–87.70), and mean Motor scores (<30 weeks 81.69 ± 17.82 and >30 weeks = 89.84 ± 10.46; 95%CI: 82.59–89.63) were statistically significant. There was more than half the standard deviation deficit of composite scores between the two groups. Eighty-one percent had a moderate delay in cognition in the <30 weeks group as compared to 65.8% in >30 weeks. Similarly, for language and motor scores, 43.8% and 31.3% had a moderate delay in <30 weeks as compared to 39.5% and 42.1% for >30 weeks, respectively. Conclusion: Higher composite scores were observed among infants >30 weeks gestation. There was more than half a standard deviation deficit in composite scores among those <30 weeks of gestational age. The most affected was the language component.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"345 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139799209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-06DOI: 10.1177/09732179231220238
Shubha Athreya, Abhishek Paul, Venkatesh Ha, Karthik Nagesh, Ravi Swamy
Background: Survival of preterm babies has improved and the focus now is on intact survival. Early detection of developmental delay is crucial so that diagnostic-specific early intervention can be commenced to optimize neuroplasticity. Objective: Primary: To assess the neurodevelopmental outcome by measuring preterm infants’ mean composite score for cognition, language, and motor skills. Secondary: To calculate the degree of developmental delay. Study design: A Cohort Study. Participants: Preterm neonates. Intervention: Bayley-III assessment done between 18 and 42 months. Results: Seventy preterm neonates were assessed between 18 and 42 months of age. They were divided into two groups based on gestational age. Mean composite score for cognition (<30 weeks = 79.84 ± 7.88 and >30 weeks = 86.32 ± 9.28; 95%CI: 81.16–85.55), language (<30 weeks = 79.16 ± 11.55 and >30 weeks = 89.37 ± 11.61; 95%CI: 81.90–87.70), and mean Motor scores (<30 weeks 81.69 ± 17.82 and >30 weeks = 89.84 ± 10.46; 95%CI: 82.59–89.63) were statistically significant. There was more than half the standard deviation deficit of composite scores between the two groups. Eighty-one percent had a moderate delay in cognition in the <30 weeks group as compared to 65.8% in >30 weeks. Similarly, for language and motor scores, 43.8% and 31.3% had a moderate delay in <30 weeks as compared to 39.5% and 42.1% for >30 weeks, respectively. Conclusion: Higher composite scores were observed among infants >30 weeks gestation. There was more than half a standard deviation deficit in composite scores among those <30 weeks of gestational age. The most affected was the language component.
{"title":"Neurodevelopmental Outcomes of Preterm Infants Using Bayley Scale of Infant Development-III (BSID-III): A Tertiary Care Centre Study","authors":"Shubha Athreya, Abhishek Paul, Venkatesh Ha, Karthik Nagesh, Ravi Swamy","doi":"10.1177/09732179231220238","DOIUrl":"https://doi.org/10.1177/09732179231220238","url":null,"abstract":"Background: Survival of preterm babies has improved and the focus now is on intact survival. Early detection of developmental delay is crucial so that diagnostic-specific early intervention can be commenced to optimize neuroplasticity. Objective: Primary: To assess the neurodevelopmental outcome by measuring preterm infants’ mean composite score for cognition, language, and motor skills. Secondary: To calculate the degree of developmental delay. Study design: A Cohort Study. Participants: Preterm neonates. Intervention: Bayley-III assessment done between 18 and 42 months. Results: Seventy preterm neonates were assessed between 18 and 42 months of age. They were divided into two groups based on gestational age. Mean composite score for cognition (<30 weeks = 79.84 ± 7.88 and >30 weeks = 86.32 ± 9.28; 95%CI: 81.16–85.55), language (<30 weeks = 79.16 ± 11.55 and >30 weeks = 89.37 ± 11.61; 95%CI: 81.90–87.70), and mean Motor scores (<30 weeks 81.69 ± 17.82 and >30 weeks = 89.84 ± 10.46; 95%CI: 82.59–89.63) were statistically significant. There was more than half the standard deviation deficit of composite scores between the two groups. Eighty-one percent had a moderate delay in cognition in the <30 weeks group as compared to 65.8% in >30 weeks. Similarly, for language and motor scores, 43.8% and 31.3% had a moderate delay in <30 weeks as compared to 39.5% and 42.1% for >30 weeks, respectively. Conclusion: Higher composite scores were observed among infants >30 weeks gestation. There was more than half a standard deviation deficit in composite scores among those <30 weeks of gestational age. The most affected was the language component.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"94 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139858816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231225532
B. Shah, Ashish Mehta, Jinal Kamdar
Title: Quality Improvement project for reducing hypothermia on admission in newborns admitted to a neonatal care unit in a large academic tertiary (Level 3A) NICU in Ahmedabad, Western India. Background: Neonatal hypothermia is a common and dangerous condition around the world. Moderate and severe hypothermia increase mortality and morbidity and predispose the fragile neonate to an increased risk of late-onset neonatal sepsis (LONS), intraventricular hemorrhage, and worsening of respiratory distress. Around 60% of neonates who are admitted to level 3 tertiary NICU in Ahmedabad, Gujarat, India, had a temperature below 36.5°C on admission. Method: We conducted plan-do-study-act (PDSA) cycles to test and adapt solutions for decreasing hypothermia in neonates admitted to NICU. Identifying the root cause of hypothermia in terms of Manpower, Material, and Methods and enlisting them as fishbone diagrams. We adopted the strategy of using a transport incubator in the Ambulance and turning on the incubator before thirty minutes of delivery for preventing neonatal hypothermia. Results: Within 8 months of starting our quality improvement project, the proportion of neonates who were hypothermic on admission decreased from 57% to 8%, Normothermic on admission increased from 23% to 53%, with an increase in mean admission temperature from 35.4°C during the pre-intervention phase to 36.6°C during post-intervention. There was also a reduction in the incidence of late-onset sepsis from 23% (pre-intervention phase) to 13% and subsequently 5% in the post-intervention period. Conclusion: This study is a cost-effective approach to reducing admission hypothermia in NICU in a resource-limited setting with all outborn babies. Our study also emphasizes the importance of maintaining euthermia, not only in delivery rooms but also during transportation.
{"title":"Quality Improvement Project for Reducing Hypothermia on Admission in Neonates Admitted in A Tertiary Care (Level 3A) NICU in Ahmedabad, Western India","authors":"B. Shah, Ashish Mehta, Jinal Kamdar","doi":"10.1177/09732179231225532","DOIUrl":"https://doi.org/10.1177/09732179231225532","url":null,"abstract":"Title: Quality Improvement project for reducing hypothermia on admission in newborns admitted to a neonatal care unit in a large academic tertiary (Level 3A) NICU in Ahmedabad, Western India. Background: Neonatal hypothermia is a common and dangerous condition around the world. Moderate and severe hypothermia increase mortality and morbidity and predispose the fragile neonate to an increased risk of late-onset neonatal sepsis (LONS), intraventricular hemorrhage, and worsening of respiratory distress. Around 60% of neonates who are admitted to level 3 tertiary NICU in Ahmedabad, Gujarat, India, had a temperature below 36.5°C on admission. Method: We conducted plan-do-study-act (PDSA) cycles to test and adapt solutions for decreasing hypothermia in neonates admitted to NICU. Identifying the root cause of hypothermia in terms of Manpower, Material, and Methods and enlisting them as fishbone diagrams. We adopted the strategy of using a transport incubator in the Ambulance and turning on the incubator before thirty minutes of delivery for preventing neonatal hypothermia. Results: Within 8 months of starting our quality improvement project, the proportion of neonates who were hypothermic on admission decreased from 57% to 8%, Normothermic on admission increased from 23% to 53%, with an increase in mean admission temperature from 35.4°C during the pre-intervention phase to 36.6°C during post-intervention. There was also a reduction in the incidence of late-onset sepsis from 23% (pre-intervention phase) to 13% and subsequently 5% in the post-intervention period. Conclusion: This study is a cost-effective approach to reducing admission hypothermia in NICU in a resource-limited setting with all outborn babies. Our study also emphasizes the importance of maintaining euthermia, not only in delivery rooms but also during transportation.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"61 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231215889
Grace Mary Minj, Vindhya Narayanaswamy, Karthik Nagesh
Background: There is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth. Methods: A quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done. Results: A total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours. Conclusion: A simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.
{"title":"Quality Initiative Program to Improve the Percentage of Very Preterm Neonates Receiving Expressed Breast Milk Within 24 Hours of Birth in a Tertiary Care (Level III-B) NICU","authors":"Grace Mary Minj, Vindhya Narayanaswamy, Karthik Nagesh","doi":"10.1177/09732179231215889","DOIUrl":"https://doi.org/10.1177/09732179231215889","url":null,"abstract":"Background: There is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth. Methods: A quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done. Results: A total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours. Conclusion: A simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"8 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231226026
Jemberu Nigussie, Bekahegn Girma, Tewodros Mulugeta, M. Sibhat, A. Molla
Background: Due to anatomical and physiological immaturity low-birth-weight (LBW) neonates are at risk for different complications which may lead to death at a specified period after birth. Therefore, this study aimed to assess the survival rate and predictors of mortality among LBW neonates. Methods: A hospital-based prospective cohort study design was conducted among 768 LBW neonates. The Cox proportional hazard model was used to identify predictors of mortality among LBW neonates. Result: The mortality rate of low birth weight was 38.8 (95% CI: 33.9–44.3) per 1,000 child-day observations. Parity (AHR = 1.47 [95% CI: 1.06–2.05]), Birth weight <1000 gram (AHR = 4.70 [95% CI: 2.36–9.35]), Birth weight <1500 gram (AHR = 1.62 [95% CI: 1.16–2.27]), Neonatal sepsis (AHR = 2.41 [95% CI: 2.25–2.91]), Birth asphyxia (AHR = 1.46 [95% CI = 1.02–2.08]), Kangaroo mother care (KMC) (AHR = 0.35 [95% CI: 0.24–0.49]), were statistically significantly associated with mortality. Conclusions: The findings of this study revealed that the incidence rate of mortality among LBW neonates was high. Practising KMC for all LBW neonates and appropriate treatment of neonatal sepsis and birth asphyxia were strongly recommended to reduce mortality among LBW neonates.
{"title":"Survival Status and Predictors of Mortality Among Low-birth-weight Neonates in Southern Ethiopia: A Prospective Follow-up Study","authors":"Jemberu Nigussie, Bekahegn Girma, Tewodros Mulugeta, M. Sibhat, A. Molla","doi":"10.1177/09732179231226026","DOIUrl":"https://doi.org/10.1177/09732179231226026","url":null,"abstract":"Background: Due to anatomical and physiological immaturity low-birth-weight (LBW) neonates are at risk for different complications which may lead to death at a specified period after birth. Therefore, this study aimed to assess the survival rate and predictors of mortality among LBW neonates. Methods: A hospital-based prospective cohort study design was conducted among 768 LBW neonates. The Cox proportional hazard model was used to identify predictors of mortality among LBW neonates. Result: The mortality rate of low birth weight was 38.8 (95% CI: 33.9–44.3) per 1,000 child-day observations. Parity (AHR = 1.47 [95% CI: 1.06–2.05]), Birth weight <1000 gram (AHR = 4.70 [95% CI: 2.36–9.35]), Birth weight <1500 gram (AHR = 1.62 [95% CI: 1.16–2.27]), Neonatal sepsis (AHR = 2.41 [95% CI: 2.25–2.91]), Birth asphyxia (AHR = 1.46 [95% CI = 1.02–2.08]), Kangaroo mother care (KMC) (AHR = 0.35 [95% CI: 0.24–0.49]), were statistically significantly associated with mortality. Conclusions: The findings of this study revealed that the incidence rate of mortality among LBW neonates was high. Practising KMC for all LBW neonates and appropriate treatment of neonatal sepsis and birth asphyxia were strongly recommended to reduce mortality among LBW neonates.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139806210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179241228025
Brij Bhushan Yadav, B. Maini, Prabhjot Jhinger, B. Gaur
Introduction: There is a need to increase the diagnostic capability of the traditional septic screen by adding additional markers. Platelet indices are one such marker that is readily available in routine hemogram reports. Materials and Methods: In this cross-sectional study, all newborn babies were recruited who had signs or symptoms of sepsis or had high-risk factors. Those who had clinical sepsis with positive cultures and/or a positive sepsis screen were classified under group “cases” ( n = 174), whereas all neonates suspected to have sepsis but who had a negative blood culture and a negative sepsis screen were classified under group “control” ( n = 126). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)] were performed on all babies. Babies with congenital or acquired causes of platelet abnormalities (including medication use by mothers with antiplatelet activity) were excluded from this study. Results: In this study, a total of 300 newborn babies were recruited for final analyses. Overall culture positivity was 38%. The mean platelet count was lower in the cases group ( P < 0.001). MPV and PDW were higher in septic babies with statistically significant differences ( P < 0.0001 and P = 0.012, respectively). Thrombocytopenia was the most sensitive marker (85.60%). However, it had low specificity (28.2%). On combining all three platelet markers, specificity increased to 48.4% (with a sensitivity of 64.5%) in detecting babies with neonatal sepsis. The sensitivity of the septic screen alone was 58% (with a specificity of 32.62%). When combining the sepsis screen and platelet indices, the specificity for the diagnosis of neonatal sepsis increased to 62.6%. On receiver operator curve analyses, thrombocytopenia had the highest area under the curve (0.692), followed by MPV (0.644). Conclusion: Platelet indices may be used as sensitive markers in combination with traditional sepsis screening to make an early diagnosis of neonatal sepsis.
{"title":"Assessment of Platelet Indices as Biomarker for Neonatal Sepsis","authors":"Brij Bhushan Yadav, B. Maini, Prabhjot Jhinger, B. Gaur","doi":"10.1177/09732179241228025","DOIUrl":"https://doi.org/10.1177/09732179241228025","url":null,"abstract":"Introduction: There is a need to increase the diagnostic capability of the traditional septic screen by adding additional markers. Platelet indices are one such marker that is readily available in routine hemogram reports. Materials and Methods: In this cross-sectional study, all newborn babies were recruited who had signs or symptoms of sepsis or had high-risk factors. Those who had clinical sepsis with positive cultures and/or a positive sepsis screen were classified under group “cases” ( n = 174), whereas all neonates suspected to have sepsis but who had a negative blood culture and a negative sepsis screen were classified under group “control” ( n = 126). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)] were performed on all babies. Babies with congenital or acquired causes of platelet abnormalities (including medication use by mothers with antiplatelet activity) were excluded from this study. Results: In this study, a total of 300 newborn babies were recruited for final analyses. Overall culture positivity was 38%. The mean platelet count was lower in the cases group ( P < 0.001). MPV and PDW were higher in septic babies with statistically significant differences ( P < 0.0001 and P = 0.012, respectively). Thrombocytopenia was the most sensitive marker (85.60%). However, it had low specificity (28.2%). On combining all three platelet markers, specificity increased to 48.4% (with a sensitivity of 64.5%) in detecting babies with neonatal sepsis. The sensitivity of the septic screen alone was 58% (with a specificity of 32.62%). When combining the sepsis screen and platelet indices, the specificity for the diagnosis of neonatal sepsis increased to 62.6%. On receiver operator curve analyses, thrombocytopenia had the highest area under the curve (0.692), followed by MPV (0.644). Conclusion: Platelet indices may be used as sensitive markers in combination with traditional sepsis screening to make an early diagnosis of neonatal sepsis.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"7 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231225532
B. Shah, Ashish Mehta, Jinal Kamdar
Title: Quality Improvement project for reducing hypothermia on admission in newborns admitted to a neonatal care unit in a large academic tertiary (Level 3A) NICU in Ahmedabad, Western India. Background: Neonatal hypothermia is a common and dangerous condition around the world. Moderate and severe hypothermia increase mortality and morbidity and predispose the fragile neonate to an increased risk of late-onset neonatal sepsis (LONS), intraventricular hemorrhage, and worsening of respiratory distress. Around 60% of neonates who are admitted to level 3 tertiary NICU in Ahmedabad, Gujarat, India, had a temperature below 36.5°C on admission. Method: We conducted plan-do-study-act (PDSA) cycles to test and adapt solutions for decreasing hypothermia in neonates admitted to NICU. Identifying the root cause of hypothermia in terms of Manpower, Material, and Methods and enlisting them as fishbone diagrams. We adopted the strategy of using a transport incubator in the Ambulance and turning on the incubator before thirty minutes of delivery for preventing neonatal hypothermia. Results: Within 8 months of starting our quality improvement project, the proportion of neonates who were hypothermic on admission decreased from 57% to 8%, Normothermic on admission increased from 23% to 53%, with an increase in mean admission temperature from 35.4°C during the pre-intervention phase to 36.6°C during post-intervention. There was also a reduction in the incidence of late-onset sepsis from 23% (pre-intervention phase) to 13% and subsequently 5% in the post-intervention period. Conclusion: This study is a cost-effective approach to reducing admission hypothermia in NICU in a resource-limited setting with all outborn babies. Our study also emphasizes the importance of maintaining euthermia, not only in delivery rooms but also during transportation.
{"title":"Quality Improvement Project for Reducing Hypothermia on Admission in Neonates Admitted in A Tertiary Care (Level 3A) NICU in Ahmedabad, Western India","authors":"B. Shah, Ashish Mehta, Jinal Kamdar","doi":"10.1177/09732179231225532","DOIUrl":"https://doi.org/10.1177/09732179231225532","url":null,"abstract":"Title: Quality Improvement project for reducing hypothermia on admission in newborns admitted to a neonatal care unit in a large academic tertiary (Level 3A) NICU in Ahmedabad, Western India. Background: Neonatal hypothermia is a common and dangerous condition around the world. Moderate and severe hypothermia increase mortality and morbidity and predispose the fragile neonate to an increased risk of late-onset neonatal sepsis (LONS), intraventricular hemorrhage, and worsening of respiratory distress. Around 60% of neonates who are admitted to level 3 tertiary NICU in Ahmedabad, Gujarat, India, had a temperature below 36.5°C on admission. Method: We conducted plan-do-study-act (PDSA) cycles to test and adapt solutions for decreasing hypothermia in neonates admitted to NICU. Identifying the root cause of hypothermia in terms of Manpower, Material, and Methods and enlisting them as fishbone diagrams. We adopted the strategy of using a transport incubator in the Ambulance and turning on the incubator before thirty minutes of delivery for preventing neonatal hypothermia. Results: Within 8 months of starting our quality improvement project, the proportion of neonates who were hypothermic on admission decreased from 57% to 8%, Normothermic on admission increased from 23% to 53%, with an increase in mean admission temperature from 35.4°C during the pre-intervention phase to 36.6°C during post-intervention. There was also a reduction in the incidence of late-onset sepsis from 23% (pre-intervention phase) to 13% and subsequently 5% in the post-intervention period. Conclusion: This study is a cost-effective approach to reducing admission hypothermia in NICU in a resource-limited setting with all outborn babies. Our study also emphasizes the importance of maintaining euthermia, not only in delivery rooms but also during transportation.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179241228025
Brij Bhushan Yadav, B. Maini, Prabhjot Jhinger, B. Gaur
Introduction: There is a need to increase the diagnostic capability of the traditional septic screen by adding additional markers. Platelet indices are one such marker that is readily available in routine hemogram reports. Materials and Methods: In this cross-sectional study, all newborn babies were recruited who had signs or symptoms of sepsis or had high-risk factors. Those who had clinical sepsis with positive cultures and/or a positive sepsis screen were classified under group “cases” ( n = 174), whereas all neonates suspected to have sepsis but who had a negative blood culture and a negative sepsis screen were classified under group “control” ( n = 126). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)] were performed on all babies. Babies with congenital or acquired causes of platelet abnormalities (including medication use by mothers with antiplatelet activity) were excluded from this study. Results: In this study, a total of 300 newborn babies were recruited for final analyses. Overall culture positivity was 38%. The mean platelet count was lower in the cases group ( P < 0.001). MPV and PDW were higher in septic babies with statistically significant differences ( P < 0.0001 and P = 0.012, respectively). Thrombocytopenia was the most sensitive marker (85.60%). However, it had low specificity (28.2%). On combining all three platelet markers, specificity increased to 48.4% (with a sensitivity of 64.5%) in detecting babies with neonatal sepsis. The sensitivity of the septic screen alone was 58% (with a specificity of 32.62%). When combining the sepsis screen and platelet indices, the specificity for the diagnosis of neonatal sepsis increased to 62.6%. On receiver operator curve analyses, thrombocytopenia had the highest area under the curve (0.692), followed by MPV (0.644). Conclusion: Platelet indices may be used as sensitive markers in combination with traditional sepsis screening to make an early diagnosis of neonatal sepsis.
{"title":"Assessment of Platelet Indices as Biomarker for Neonatal Sepsis","authors":"Brij Bhushan Yadav, B. Maini, Prabhjot Jhinger, B. Gaur","doi":"10.1177/09732179241228025","DOIUrl":"https://doi.org/10.1177/09732179241228025","url":null,"abstract":"Introduction: There is a need to increase the diagnostic capability of the traditional septic screen by adding additional markers. Platelet indices are one such marker that is readily available in routine hemogram reports. Materials and Methods: In this cross-sectional study, all newborn babies were recruited who had signs or symptoms of sepsis or had high-risk factors. Those who had clinical sepsis with positive cultures and/or a positive sepsis screen were classified under group “cases” ( n = 174), whereas all neonates suspected to have sepsis but who had a negative blood culture and a negative sepsis screen were classified under group “control” ( n = 126). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)] were performed on all babies. Babies with congenital or acquired causes of platelet abnormalities (including medication use by mothers with antiplatelet activity) were excluded from this study. Results: In this study, a total of 300 newborn babies were recruited for final analyses. Overall culture positivity was 38%. The mean platelet count was lower in the cases group ( P < 0.001). MPV and PDW were higher in septic babies with statistically significant differences ( P < 0.0001 and P = 0.012, respectively). Thrombocytopenia was the most sensitive marker (85.60%). However, it had low specificity (28.2%). On combining all three platelet markers, specificity increased to 48.4% (with a sensitivity of 64.5%) in detecting babies with neonatal sepsis. The sensitivity of the septic screen alone was 58% (with a specificity of 32.62%). When combining the sepsis screen and platelet indices, the specificity for the diagnosis of neonatal sepsis increased to 62.6%. On receiver operator curve analyses, thrombocytopenia had the highest area under the curve (0.692), followed by MPV (0.644). Conclusion: Platelet indices may be used as sensitive markers in combination with traditional sepsis screening to make an early diagnosis of neonatal sepsis.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"61 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231218821
Dayasis Sahu, Smitamayee Sahu, Naresh R. Godara, Yayathee Subbarayalu
Introduction: Special newborn care unit (SNCU) Quality of Care Indices (SQCIs) are specific indicators that help in assessing and evaluating the quality of care provided to newborns in SNCUs. Aims and Objectives: The study described the quality of care at SNCUs in aspirational districts of Odisha by using 7 quality of care indices, 2020-2022. Materials and Methods: We conducted a cross-sectional descriptive study on all newborns who received care at SNCUs of 10 aspirational districts in Odisha using the data from the SNCU online database for 2020-2022. Every quarter of the year, all the parameters were extracted and entered into an already designed spreadsheet. The 7 indices generated the SQCI score. We used MS Excel (2021) for data analysis. Results: A total of 50,226 admissions were registered. Perinatal asphyxia caused the significant morbidity (14,421, 29%). Throughout the 12 quarters, composite SQCI showed satisfactory performance (0.59-0.66). Rational admission of all units was good, and their scores were 0.71 to 0.87. Mortality in normal weight babies showed good performance. The Low Birth Weight Admission Index score ranged from 0.22 to 0.30, that is, unsatisfactory performance. During 2020 to 2022, the overall composite SQCI score of the 10 SNCUs corresponded to satisfactory care (0.56-0.68). Conclusion: SQCI is an essential tool for assessing the SNCU quality evaluation. It should be regularly used at the district level to enhance quality care. Health facilities’ preparedness for managing perinatal asphyxia is to be studied.
{"title":"“Special Newborn Care Unit” Quality Care Assessment Using SNCU Quality of Care Indices (SQCIs) at Aspirational Districts, Odisha, 2020-2022","authors":"Dayasis Sahu, Smitamayee Sahu, Naresh R. Godara, Yayathee Subbarayalu","doi":"10.1177/09732179231218821","DOIUrl":"https://doi.org/10.1177/09732179231218821","url":null,"abstract":"Introduction: Special newborn care unit (SNCU) Quality of Care Indices (SQCIs) are specific indicators that help in assessing and evaluating the quality of care provided to newborns in SNCUs. Aims and Objectives: The study described the quality of care at SNCUs in aspirational districts of Odisha by using 7 quality of care indices, 2020-2022. Materials and Methods: We conducted a cross-sectional descriptive study on all newborns who received care at SNCUs of 10 aspirational districts in Odisha using the data from the SNCU online database for 2020-2022. Every quarter of the year, all the parameters were extracted and entered into an already designed spreadsheet. The 7 indices generated the SQCI score. We used MS Excel (2021) for data analysis. Results: A total of 50,226 admissions were registered. Perinatal asphyxia caused the significant morbidity (14,421, 29%). Throughout the 12 quarters, composite SQCI showed satisfactory performance (0.59-0.66). Rational admission of all units was good, and their scores were 0.71 to 0.87. Mortality in normal weight babies showed good performance. The Low Birth Weight Admission Index score ranged from 0.22 to 0.30, that is, unsatisfactory performance. During 2020 to 2022, the overall composite SQCI score of the 10 SNCUs corresponded to satisfactory care (0.56-0.68). Conclusion: SQCI is an essential tool for assessing the SNCU quality evaluation. It should be regularly used at the district level to enhance quality care. Health facilities’ preparedness for managing perinatal asphyxia is to be studied.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"27 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-05DOI: 10.1177/09732179231215889
Grace Mary Minj, Vindhya Narayanaswamy, Karthik Nagesh
Background: There is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth. Methods: A quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done. Results: A total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours. Conclusion: A simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.
{"title":"Quality Initiative Program to Improve the Percentage of Very Preterm Neonates Receiving Expressed Breast Milk Within 24 Hours of Birth in a Tertiary Care (Level III-B) NICU","authors":"Grace Mary Minj, Vindhya Narayanaswamy, Karthik Nagesh","doi":"10.1177/09732179231215889","DOIUrl":"https://doi.org/10.1177/09732179231215889","url":null,"abstract":"Background: There is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth. Methods: A quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done. Results: A total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours. Conclusion: A simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"11 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：