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":"29 1-2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139864393","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":"21 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139866089","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 : 2024-01-23DOI: 10.1177/09732179231220195
Lily Chartrand, Alexandra Zabeid, Jacques Lacroix, A. Villeneuve
A restrictive red blood cell (RBC) transfusion guideline was established in 2019 in a neonatal intensive care unit (NICU), suggesting a hemoglobin concentration threshold of 7 g/dL. (a) To determine its impact on the number of RBC transfusions and donor exposure; (b) to characterize RBC-transfusion determinants and justifications. Single-center retrospective historical control study comparing all neonates consecutively admitted to the NICU during two five-month periods: 401 patients in 2013 before and 402 patients in 2021 after restrictive guideline implementation. Possible determinants were assessed via logistic regressions and justifications via a questionnaire. In 2021, 9.2% of neonates received at least one RBC transfusion compared to 13.5% in 2013 ( p = .075). Adherence to protocol thresholds was 50%. Implementation of a restrictive transfusion protocol had some impact on determinants related to neonatal morbidity and illness severity and some impact on justifications being mainly based on hemoglobin value. Our study demonstrates that the implementation of a restrictive RBC transfusion protocol tended to decrease transfusion rates and donor exposure in the NICU, but the trend was not statistically significant. Future work should focus on improving protocol adherence.
{"title":"Red Blood Cell Transfusion Practice Pattern Before and After Implementation of a Local Restrictive Transfusion Protocol in a Neonatal Intensive Care Unit","authors":"Lily Chartrand, Alexandra Zabeid, Jacques Lacroix, A. Villeneuve","doi":"10.1177/09732179231220195","DOIUrl":"https://doi.org/10.1177/09732179231220195","url":null,"abstract":"A restrictive red blood cell (RBC) transfusion guideline was established in 2019 in a neonatal intensive care unit (NICU), suggesting a hemoglobin concentration threshold of 7 g/dL. (a) To determine its impact on the number of RBC transfusions and donor exposure; (b) to characterize RBC-transfusion determinants and justifications. Single-center retrospective historical control study comparing all neonates consecutively admitted to the NICU during two five-month periods: 401 patients in 2013 before and 402 patients in 2021 after restrictive guideline implementation. Possible determinants were assessed via logistic regressions and justifications via a questionnaire. In 2021, 9.2% of neonates received at least one RBC transfusion compared to 13.5% in 2013 ( p = .075). Adherence to protocol thresholds was 50%. Implementation of a restrictive transfusion protocol had some impact on determinants related to neonatal morbidity and illness severity and some impact on justifications being mainly based on hemoglobin value. Our study demonstrates that the implementation of a restrictive RBC transfusion protocol tended to decrease transfusion rates and donor exposure in the NICU, but the trend was not statistically significant. Future work should focus on improving protocol adherence.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"133 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605069","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 : 2024-01-18DOI: 10.1177/09732179231222727
Vijay Kulkarni, Anita Nyamagoudar, Soumya M, Unnati Bhat, Reshma Ramachandra Awatade, and Suman Uppin
Introduction: Human milk banking is an essential perinatal service. The present study evaluates the impact of gestational age on the volumes of milk. Further, it also re-evaluates the definition of “Coming to Volume” in pump-based expression of milk. Methodology: This cohort study was conducted at a tertiary care centre in south India over 10 months from September 2022 to June 2023. The primary objective of the study was to compare the volume of donor milk secreted in relation to postnatal day among mothers delivered at term and preterm gestation. The secondary objective of the study was to compare the definition of “Coming to Volume” (secretion of 500 mL per day by postnatal day 14) with the volumes of milk in the present study. A surrogate marker for “Coming to Volume”, that is, an expression of at least 80 mL in one sitting of the donation was considered. Results: Of the total 458 mothers, there were 349 (Term) and 109 (preterm) mothers. The average volumes of donor human milk were 142 mL and 122 mL among term and preterm mothers, respectively ( p-value .0068). Further, 80% of the term mothers and 75% of the preterm mothers were able to secrete>80 mL per sitting. This volume was attained by postnatal day 7 in 80% (223/280) of term mothers and 65% (53/82) of preterm mothers.
{"title":"A Cohort Study on Comparison of Volumes of Breast-Pump-Expressed Human Milk Donor Among Term and Preterm Gestational Mothers in South India––Time to Redefine “Coming to Volume” in the Milk Bank?","authors":"Vijay Kulkarni, Anita Nyamagoudar, Soumya M, Unnati Bhat, Reshma Ramachandra Awatade, and Suman Uppin","doi":"10.1177/09732179231222727","DOIUrl":"https://doi.org/10.1177/09732179231222727","url":null,"abstract":"Introduction: Human milk banking is an essential perinatal service. The present study evaluates the impact of gestational age on the volumes of milk. Further, it also re-evaluates the definition of “Coming to Volume” in pump-based expression of milk. Methodology: This cohort study was conducted at a tertiary care centre in south India over 10 months from September 2022 to June 2023. The primary objective of the study was to compare the volume of donor milk secreted in relation to postnatal day among mothers delivered at term and preterm gestation. The secondary objective of the study was to compare the definition of “Coming to Volume” (secretion of 500 mL per day by postnatal day 14) with the volumes of milk in the present study. A surrogate marker for “Coming to Volume”, that is, an expression of at least 80 mL in one sitting of the donation was considered. Results: Of the total 458 mothers, there were 349 (Term) and 109 (preterm) mothers. The average volumes of donor human milk were 142 mL and 122 mL among term and preterm mothers, respectively ( p-value .0068). Further, 80% of the term mothers and 75% of the preterm mothers were able to secrete>80 mL per sitting. This volume was attained by postnatal day 7 in 80% (223/280) of term mothers and 65% (53/82) of preterm mothers.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"107 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614602","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 : 2024-01-18DOI: 10.1177/09732179231214421
Chinonye Oruruo-Eriobu, J. Guillen-Hernandez, Supriya Sivadanam, D. Tumin, U. Akpan
Steroids are a key component of the management of bronchopulmonary dysplasia (BPD) in preterm neonates, but certain steroids are associated with an increased risk of neurodevelopmental impairment. Hydrocortisone may be a viable option due to milder side effects, but optimal dosing and timing of use have not been established. We aimed to determine whether early administration of stress dose hydrocortisone to preterm babies during acute illness is associated with decreased incidence of BPD at 36 weeks of gestation. We retrospectively identified extremely premature neonates admitted to our neonatal intensive care unit before 24 hours of age. The primary exposure was receipt of a course of stress dose hydrocortisone (at least 3 mg/kg/day for 3 days or more) in the first 14 days of life. Our control group comprised of neonates who did not receive stress dose hydrocortisone in the first 14 days of life. We analyzed data for 375 neonates, 21 of whom received stress dose hydrocortisone in the first 14 days of life. About 90% of intervention group developed BPD vs. 64% in the control group ( P = .016). Incidence of severe BPD was significantly higher in the stress steroid group—62% vs. 23% in the control group ( P < .001). We noted that stress dose hydrocortisone administered during acute illness in the first 14 days of life was not associated with decreased incidence of BPD at 36 weeks among extremely preterm neonates. More studies are needed to determine the optimal dose and timing of steroid therapy.
{"title":"Association of Stress Dose Hydrocortisone with the Prevention of Bronchopulmonary Dysplasia in Extremely Preterm Neonates","authors":"Chinonye Oruruo-Eriobu, J. Guillen-Hernandez, Supriya Sivadanam, D. Tumin, U. Akpan","doi":"10.1177/09732179231214421","DOIUrl":"https://doi.org/10.1177/09732179231214421","url":null,"abstract":"Steroids are a key component of the management of bronchopulmonary dysplasia (BPD) in preterm neonates, but certain steroids are associated with an increased risk of neurodevelopmental impairment. Hydrocortisone may be a viable option due to milder side effects, but optimal dosing and timing of use have not been established. We aimed to determine whether early administration of stress dose hydrocortisone to preterm babies during acute illness is associated with decreased incidence of BPD at 36 weeks of gestation. We retrospectively identified extremely premature neonates admitted to our neonatal intensive care unit before 24 hours of age. The primary exposure was receipt of a course of stress dose hydrocortisone (at least 3 mg/kg/day for 3 days or more) in the first 14 days of life. Our control group comprised of neonates who did not receive stress dose hydrocortisone in the first 14 days of life. We analyzed data for 375 neonates, 21 of whom received stress dose hydrocortisone in the first 14 days of life. About 90% of intervention group developed BPD vs. 64% in the control group ( P = .016). Incidence of severe BPD was significantly higher in the stress steroid group—62% vs. 23% in the control group ( P < .001). We noted that stress dose hydrocortisone administered during acute illness in the first 14 days of life was not associated with decreased incidence of BPD at 36 weeks among extremely preterm neonates. More studies are needed to determine the optimal dose and timing of steroid therapy.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"110 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614136","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 : 2024-01-18DOI: 10.1177/09732179231222711
B. Mungala, Banker Deepa A, Raj Yashica D, Maheshwari Vimal T
In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.
{"title":"Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital","authors":"B. Mungala, Banker Deepa A, Raj Yashica D, Maheshwari Vimal T","doi":"10.1177/09732179231222711","DOIUrl":"https://doi.org/10.1177/09732179231222711","url":null,"abstract":"In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"116 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139615133","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 : 2024-01-16DOI: 10.1177/09732179231220200
D. S. Gedam, Rajanya Prajapati, Mamta Verma
Objective: To improve the rate of first-hour breastfeeding in term and near-term healthy neonates by a quality improvement (QI) study at Secondary Care District Hospital. Design: QI study. Setting: Labor room-operation theatre of a secondary care district hospital. Participants: Stable newborns ≥35 weeks of gestation born by normal vaginal delivery and by cesarean section under spinal anesthesia. Procedure: A team of nurses, pediatricians, obstetricians, and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by flow chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. Outcome measure: Proportion of eligible babies breastfed within 1 hour of delivery. Results: The rate of first-hour initiation of breastfeeding increased from 69% to 88% in normal vaginal deliveries and from 17% to 61% in the cesarian section over the study period, which were sustained up to 80% in normal vaginal deliveries (NVD) and 55% in lower segment cesarean section. Conclusions: A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in normal and cesarean deliveries.
{"title":"Initiation Rate of First-hour Breastfeeding in Healthy Term and Near Term Babies: Outcome Assessment After Quality Improvement Methods in Secondary Care District Hospital","authors":"D. S. Gedam, Rajanya Prajapati, Mamta Verma","doi":"10.1177/09732179231220200","DOIUrl":"https://doi.org/10.1177/09732179231220200","url":null,"abstract":"Objective: To improve the rate of first-hour breastfeeding in term and near-term healthy neonates by a quality improvement (QI) study at Secondary Care District Hospital. Design: QI study. Setting: Labor room-operation theatre of a secondary care district hospital. Participants: Stable newborns ≥35 weeks of gestation born by normal vaginal delivery and by cesarean section under spinal anesthesia. Procedure: A team of nurses, pediatricians, obstetricians, and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by flow chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles. Outcome measure: Proportion of eligible babies breastfed within 1 hour of delivery. Results: The rate of first-hour initiation of breastfeeding increased from 69% to 88% in normal vaginal deliveries and from 17% to 61% in the cesarian section over the study period, which were sustained up to 80% in normal vaginal deliveries (NVD) and 55% in lower segment cesarean section. Conclusions: A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in normal and cesarean deliveries.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139620673","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 : 2024-01-12DOI: 10.1177/09732179231218825
A. Widodo, Putu Bagus Dharma Permana, Arina Setyaningtyas, M. Wahyunitisari
Introduction: Increasing resistance to multiple classes of antimicrobials, leading to multidrug resistance (MDR), provides a major challenge for the management of bloodstream infections in the neonatal intensive care unit (NICU). The dissemination of Acinetobacter and Enterobacterales species were of great importance owing to their high prevalence and resistance against a broad spectrum of available antimicrobials, thereby exacerbating the prognosis for afflicted patients. This study aimed to highlight neonatal sepsis cases caused by MDR Acinetobacter and Enterobacterales in the NICU of a tertiary healthcare center in Surabaya, Indonesia. Methods: This retrospective cohort study was conducted in Dr. Soetomo General Hospital, Surabaya, from January 2020 to August 2022. Documented cases of neonatal sepsis were identified from electronic medical records under the ICD-10 P36 code. Continuous monitoring of blood culture was performed following the initial suspicion of sepsis, complemented with semiautomated antimicrobial susceptibility testing. Results: A total of 75 out of 125 culture-proven neonatal sepsis cases were reported caused by Acinetobacter baumannii ( n = 19; 15.2%) and Enterobacterales ( n = 56; 44.8%) species. These organisms exhibited the MDR rates of 78.9% and 91.1%, respectively. Klebsiella pneumoniae ( K. pneumoniae) emerged as the predominant Enterobacterales, demonstrating an MDR rate of 92.1%. Possible extensively- and possible pan-drug-resistant organisms were also identified at a concerning rate in Acinetobacter (73.7% and 21.1%, respectively) and Enterobacterales (28.6% and 1.8%, respectively). The susceptibility of Acinetobacter to carbapenems was notably low (26.3%), whereas Enterobacterales exhibited a relatively higher susceptibility rate (75%). Notably, 9 and 37 documented deaths were associated with neonatal sepsis because of MDR Acinetobacter and Enterobacterales, respectively. Lower birth weight and shorter length of NICU stay were significantly related to mortality in neonatal sepsis. Conclusion: The alarming rate of MDR underscores further investigations on the extent of inappropriate antibiotic usage in the unit, particularly concerning neonates requiring invasive medical interventions and those with foundational clinical risk factors.
{"title":"Multidrug-Resistant Acinetobacter and Enterobacterales Causing Neonatal Sepsis at a Tertiary Healthcare Facility in Indonesia","authors":"A. Widodo, Putu Bagus Dharma Permana, Arina Setyaningtyas, M. Wahyunitisari","doi":"10.1177/09732179231218825","DOIUrl":"https://doi.org/10.1177/09732179231218825","url":null,"abstract":"Introduction: Increasing resistance to multiple classes of antimicrobials, leading to multidrug resistance (MDR), provides a major challenge for the management of bloodstream infections in the neonatal intensive care unit (NICU). The dissemination of Acinetobacter and Enterobacterales species were of great importance owing to their high prevalence and resistance against a broad spectrum of available antimicrobials, thereby exacerbating the prognosis for afflicted patients. This study aimed to highlight neonatal sepsis cases caused by MDR Acinetobacter and Enterobacterales in the NICU of a tertiary healthcare center in Surabaya, Indonesia. Methods: This retrospective cohort study was conducted in Dr. Soetomo General Hospital, Surabaya, from January 2020 to August 2022. Documented cases of neonatal sepsis were identified from electronic medical records under the ICD-10 P36 code. Continuous monitoring of blood culture was performed following the initial suspicion of sepsis, complemented with semiautomated antimicrobial susceptibility testing. Results: A total of 75 out of 125 culture-proven neonatal sepsis cases were reported caused by Acinetobacter baumannii ( n = 19; 15.2%) and Enterobacterales ( n = 56; 44.8%) species. These organisms exhibited the MDR rates of 78.9% and 91.1%, respectively. Klebsiella pneumoniae ( K. pneumoniae) emerged as the predominant Enterobacterales, demonstrating an MDR rate of 92.1%. Possible extensively- and possible pan-drug-resistant organisms were also identified at a concerning rate in Acinetobacter (73.7% and 21.1%, respectively) and Enterobacterales (28.6% and 1.8%, respectively). The susceptibility of Acinetobacter to carbapenems was notably low (26.3%), whereas Enterobacterales exhibited a relatively higher susceptibility rate (75%). Notably, 9 and 37 documented deaths were associated with neonatal sepsis because of MDR Acinetobacter and Enterobacterales, respectively. Lower birth weight and shorter length of NICU stay were significantly related to mortality in neonatal sepsis. Conclusion: The alarming rate of MDR underscores further investigations on the extent of inappropriate antibiotic usage in the unit, particularly concerning neonates requiring invasive medical interventions and those with foundational clinical risk factors.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"54 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139531831","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 : 2024-01-12DOI: 10.1177/09732179231221041
Shazia Shadab, R. K. Kumar, Prakash Kini, Ruth Patterson, S. Managoli, Namitha Sachin
Background: Breastfeeding is crucial for maternal and child health. However, mastitis and lactational breast abscesses (LBAs), pose serious health risks for nursing mothers and are traditionally treated with minor surgery, that often separates mother and child, and causes significant maternal distress. This study investigates dynamic tape (DT) as a nonsurgical intervention for LBAs that will allow breastfeeding even during treatment in postpartum Indian women. Methods: This prospective, observational cohort study was conducted at a tertiary maternity center (Karnataka, India) between October 2017 and December 2018 [CTRI Number/2018/05/013788]. Twenty postpartum women with mastitis and LBA were subjected to dynamic taping (using DT Beige Tattoo or DT Eco based on breast size and abscess location). LBA resolution was confirmed through ultrasonography and clinical examination. Results: Twenty participants (median age = 30 years) completed the study without adverse reactions; 65% practiced exclusive breastfeeding. Lump sizes and pus volumes were significantly reduced after treatment; 60% experienced self-drainage, 35% experienced resolution without self-drainage, and only 5% did not experience resolution; average time to resolution was 13.95 days, with each taping session lasting 3.85 days. The mean lump measurement and pus volume significantly reduced post-treatment from 108.7 cm 3 and 54.58 ml to 3.14 cm 3 and 1.07 ml, respectively, with 95% experiencing abscess resolution. The positive outcomes were observed during the three-month follow-up, with no recurrence of LBAs. Conclusions: Dynamic taping resolves LBAs without surgery, by aiding lymphatic flow, reducing inflammation, and supporting breastfeeding. Larger randomized studies are required to validate its efficacy and safety.
{"title":"Dynamic Taping: A Promising Non-surgical Management Technique for Lactational Breast Abscess","authors":"Shazia Shadab, R. K. Kumar, Prakash Kini, Ruth Patterson, S. Managoli, Namitha Sachin","doi":"10.1177/09732179231221041","DOIUrl":"https://doi.org/10.1177/09732179231221041","url":null,"abstract":"Background: Breastfeeding is crucial for maternal and child health. However, mastitis and lactational breast abscesses (LBAs), pose serious health risks for nursing mothers and are traditionally treated with minor surgery, that often separates mother and child, and causes significant maternal distress. This study investigates dynamic tape (DT) as a nonsurgical intervention for LBAs that will allow breastfeeding even during treatment in postpartum Indian women. Methods: This prospective, observational cohort study was conducted at a tertiary maternity center (Karnataka, India) between October 2017 and December 2018 [CTRI Number/2018/05/013788]. Twenty postpartum women with mastitis and LBA were subjected to dynamic taping (using DT Beige Tattoo or DT Eco based on breast size and abscess location). LBA resolution was confirmed through ultrasonography and clinical examination. Results: Twenty participants (median age = 30 years) completed the study without adverse reactions; 65% practiced exclusive breastfeeding. Lump sizes and pus volumes were significantly reduced after treatment; 60% experienced self-drainage, 35% experienced resolution without self-drainage, and only 5% did not experience resolution; average time to resolution was 13.95 days, with each taping session lasting 3.85 days. The mean lump measurement and pus volume significantly reduced post-treatment from 108.7 cm 3 and 54.58 ml to 3.14 cm 3 and 1.07 ml, respectively, with 95% experiencing abscess resolution. The positive outcomes were observed during the three-month follow-up, with no recurrence of LBAs. Conclusions: Dynamic taping resolves LBAs without surgery, by aiding lymphatic flow, reducing inflammation, and supporting breastfeeding. Larger randomized studies are required to validate its efficacy and safety.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":" 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139624948","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}
Background: Though early enteral nutrition with Mother’s own milk (MOM) is the norm in preterms, it is a difficult challenge to get it into the intensive care unit due to various medical and logistic issues. Awareness about this among pregnant ladies and their caregivers from the antenatal period may help to overcome some of these difficulties. Objective: To compare the effect of the implementation of an antenatal breast milk care bundle on the availability of adequate breast milk on day 7 for preterm babies ≤ 32 weeks when compared to a postnatal breast milk care bundle alone. Methodology: This prospective study was conducted among neonates ≤32 weeks born in Government Medical College, Thiruvananthapuram from January 2021 to May 2022. Antenatal bundles were implemented in the antenatal OPDs and wards. Postnatal bundles were implemented in the NICU and postnatal wards. The outcome was compared among babies of mothers who got both the care bundles and those who received only the postnatal care bundle. Results: A total of 110 babies were included in the study. There was a 1.32 times increase in the adequacy of milk volume on day 7 (CI: 1.04–1.68), a significant increase in the proportion of mothers expressing within 24 hours, and babies getting discharged on exclusive MOM in those who received the antenatal BMC bundles. The risk for inadequate milk volume was high in those who have <2 ml of milk at 48 hours (RR: 1.67, CI:1.26–2.20]. Conclusion: Antenatal breast milk care bundles can increase the availability of adequate MOM for preterm babies.
{"title":"The Effect of Antenatal Breast Milk Care Bundles on the Availability of Breast Milk in Preterms ≤32 Weeks: A Cohort Study","authors":"Kris Wilson, Aswathy Rahul, Radhika Sujatha, Sobhakumar Saraswathy Amma, Anu Sharma","doi":"10.1177/09732179231211464","DOIUrl":"https://doi.org/10.1177/09732179231211464","url":null,"abstract":"Background: Though early enteral nutrition with Mother’s own milk (MOM) is the norm in preterms, it is a difficult challenge to get it into the intensive care unit due to various medical and logistic issues. Awareness about this among pregnant ladies and their caregivers from the antenatal period may help to overcome some of these difficulties. Objective: To compare the effect of the implementation of an antenatal breast milk care bundle on the availability of adequate breast milk on day 7 for preterm babies ≤ 32 weeks when compared to a postnatal breast milk care bundle alone. Methodology: This prospective study was conducted among neonates ≤32 weeks born in Government Medical College, Thiruvananthapuram from January 2021 to May 2022. Antenatal bundles were implemented in the antenatal OPDs and wards. Postnatal bundles were implemented in the NICU and postnatal wards. The outcome was compared among babies of mothers who got both the care bundles and those who received only the postnatal care bundle. Results: A total of 110 babies were included in the study. There was a 1.32 times increase in the adequacy of milk volume on day 7 (CI: 1.04–1.68), a significant increase in the proportion of mothers expressing within 24 hours, and babies getting discharged on exclusive MOM in those who received the antenatal BMC bundles. The risk for inadequate milk volume was high in those who have <2 ml of milk at 48 hours (RR: 1.67, CI:1.26–2.20]. Conclusion: Antenatal breast milk care bundles can increase the availability of adequate MOM for preterm babies.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"52 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139533053","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}
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