Pub Date : 2024-01-11DOI: 10.1177/09732179231219554
Shazia Afreen, Ummey Tamima Nasrin, K.M. Mahbubur Rahman, I. Jahan, S. Dey, M. Shahidullah, R. M. Chowdhury, Md Abdul Mannan
Background: Mother’s own milk for preterm infants is a complete nutrition. In NICUs, there is a delay in starting and decreased frequency of breast milk expression leading to inadequate supply of mother’s own milk for preterm babies. There is a lack of knowledge about the importance of mother’s own milk for preterm babies in the general population and a paucity of studies on this topic from Bangladesh. This quality improvement initiative will serve as a baseline study for increasing the use of mother’s own milk for preterm babies in our country. Objectives: To observe the effects of the quality improvement initiative to increase the supply of mother’s own milk for preterm newborns admitted in the NICU. Methods: This QI study was conducted in the Department of Neonatology, in collaboration with the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, over the period of 1 year. Inborn Preterm neonates ≤34 weeks and/or ≤1800 gm and mother dyads, anticipated to stay in NICU for ≥ 7 days, were included in this study. In the observation phase, baseline data were collected. The intervention phase was started with a comprehensive counseling package, the demonstration of breast milk expression, and the early (within 6 h of delivery) and frequent (2 h) expression of breast milk. Results: A total of 96 preterm newborns and mother dyads were enrolled. There was an improvement in the percentage of mothers expressing breast milk within 6 h of birth and on day 1 from 0% to 100% and from 14.5% to 100%, respectively, after implementing the QI initiative. The amount of expressed breast milk on days 1, 3, and 7 in the intervention group was higher than that of the observation group. The percentage of neonates receiving only mother’s own milk on day 1 was increased from 14.5% to 100% after giving intervention. Conclusion: A significant improvement in early expression of breast milk, an increase in total amount of expressed breast milk, and an exclusive mother’s own milk feeding among the preterm neonates admitted in the NICU were observed.
{"title":"A Quality Improvement Initiative to Increase the Supply of Mother’s Own Milk for Preterm Newborn Admitted in Neonatal Intensive Care Unit of Bangabandhu Sheikh Mujib Medical University","authors":"Shazia Afreen, Ummey Tamima Nasrin, K.M. Mahbubur Rahman, I. Jahan, S. Dey, M. Shahidullah, R. M. Chowdhury, Md Abdul Mannan","doi":"10.1177/09732179231219554","DOIUrl":"https://doi.org/10.1177/09732179231219554","url":null,"abstract":"Background: Mother’s own milk for preterm infants is a complete nutrition. In NICUs, there is a delay in starting and decreased frequency of breast milk expression leading to inadequate supply of mother’s own milk for preterm babies. There is a lack of knowledge about the importance of mother’s own milk for preterm babies in the general population and a paucity of studies on this topic from Bangladesh. This quality improvement initiative will serve as a baseline study for increasing the use of mother’s own milk for preterm babies in our country. Objectives: To observe the effects of the quality improvement initiative to increase the supply of mother’s own milk for preterm newborns admitted in the NICU. Methods: This QI study was conducted in the Department of Neonatology, in collaboration with the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, over the period of 1 year. Inborn Preterm neonates ≤34 weeks and/or ≤1800 gm and mother dyads, anticipated to stay in NICU for ≥ 7 days, were included in this study. In the observation phase, baseline data were collected. The intervention phase was started with a comprehensive counseling package, the demonstration of breast milk expression, and the early (within 6 h of delivery) and frequent (2 h) expression of breast milk. Results: A total of 96 preterm newborns and mother dyads were enrolled. There was an improvement in the percentage of mothers expressing breast milk within 6 h of birth and on day 1 from 0% to 100% and from 14.5% to 100%, respectively, after implementing the QI initiative. The amount of expressed breast milk on days 1, 3, and 7 in the intervention group was higher than that of the observation group. The percentage of neonates receiving only mother’s own milk on day 1 was increased from 14.5% to 100% after giving intervention. Conclusion: A significant improvement in early expression of breast milk, an increase in total amount of expressed breast milk, and an exclusive mother’s own milk feeding among the preterm neonates admitted in the NICU were observed.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":" 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139626422","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 : 2024-01-10DOI: 10.1177/09732179231199326
G. Ramya, Umamaheswari Balakrishnan, S. Shaik, P. Amboiram, Susmitha Tangirala
Acute kidney injury (AKI) is a commonly encountered condition in the neonatal intensive care unit (NICU), especially among micro-preemies. Management of AKI is challenging in these micro-preemies and peritoneal dialysis (PD) is the preferred modality when medical treatment fails. A 27-week-old female baby with a birth weight of 940 grams was delivered via emergency cesarean section for grade 2 abruption. She developed AKI secondary to necrotizing enterocolitis. PD was initiated on day 19 with a neonatal pigtail catheter and discontinued 24 hours after normalization of kidney function tests with adequate urine output on day 20. However, the patient died due to complications of short bowel syndrome. This is the first case report of a micro-premie on whom PD was performed sucessfully using a pigtail catheter. PD is a safe, effective, feasible, and life-saving therapy in micro-preemies with AKI and necrotizing enterocolitis.
{"title":"Peritoneal Dialysis in Micro-preemie With NEC Using Pigtail Catheter: Case Report and Literature Review","authors":"G. Ramya, Umamaheswari Balakrishnan, S. Shaik, P. Amboiram, Susmitha Tangirala","doi":"10.1177/09732179231199326","DOIUrl":"https://doi.org/10.1177/09732179231199326","url":null,"abstract":"Acute kidney injury (AKI) is a commonly encountered condition in the neonatal intensive care unit (NICU), especially among micro-preemies. Management of AKI is challenging in these micro-preemies and peritoneal dialysis (PD) is the preferred modality when medical treatment fails. A 27-week-old female baby with a birth weight of 940 grams was delivered via emergency cesarean section for grade 2 abruption. She developed AKI secondary to necrotizing enterocolitis. PD was initiated on day 19 with a neonatal pigtail catheter and discontinued 24 hours after normalization of kidney function tests with adequate urine output on day 20. However, the patient died due to complications of short bowel syndrome. This is the first case report of a micro-premie on whom PD was performed sucessfully using a pigtail catheter. PD is a safe, effective, feasible, and life-saving therapy in micro-preemies with AKI and necrotizing enterocolitis.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"86 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440640","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 : 2024-01-10DOI: 10.1177/09732179231220203
Das Sayan Kumar, Nisha Prajapati, Geet Gunjana A. Khaitan
Background: In the era of the 21st Century, Human Milk Bank (HMB) is making its tortoise steps towards revolution. The goals and objectives of this study is to compare five years of data between the Pre Human Milk Bank phase (2018–2021) and Post Human Milk Bank phase (2021–2023) in order to evaluate the morbidity and mortality profile of neonates fed with PDHM (pasteurized donor human milk) or MOM (Mother’s Own Milk). Methods: A retrospective observational study was done in HMB, Neonatal Intensive Care Unit, Department of Paediatrics, Gmers Medical College, Gandhinagar, Gujarat. Data obtained retrospectively comparing pre-HMB Phase (4th August, 2018–3rd August, 2021) and post-HMB Phase (4th August, 2021–3rd August, 2023). Results: Around 1822 newborns benefited from the establishment of the HMB and 2.89 lakh ml of milk from 188 donor mothers were gathered during the study. Bacterial contamination of PDHM was reduced. There was a reduction in mortality and morbidity profiles like sepsis rate, NEC/Feed intolerance and ROP. Duration of NICU stay was improved in all preterm babies. Conclusions: In this study, mortality and morbidity outcomes improved and sepsis decreased after the establishment of the HMB with reduced time to reach full feeds and shorter hospital stay. It helps significantly in NEC cases. We concluded that the creation of an HMB will be more advantageous and useful for all preterm babies in order to achieve better results.
{"title":"‘Human Milk Bank (HMB): The Journey till Now and the Road Ahead’: A Retrospective Observational Study in a Tertiary Care Centre of Western India","authors":"Das Sayan Kumar, Nisha Prajapati, Geet Gunjana A. Khaitan","doi":"10.1177/09732179231220203","DOIUrl":"https://doi.org/10.1177/09732179231220203","url":null,"abstract":"Background: In the era of the 21st Century, Human Milk Bank (HMB) is making its tortoise steps towards revolution. The goals and objectives of this study is to compare five years of data between the Pre Human Milk Bank phase (2018–2021) and Post Human Milk Bank phase (2021–2023) in order to evaluate the morbidity and mortality profile of neonates fed with PDHM (pasteurized donor human milk) or MOM (Mother’s Own Milk). Methods: A retrospective observational study was done in HMB, Neonatal Intensive Care Unit, Department of Paediatrics, Gmers Medical College, Gandhinagar, Gujarat. Data obtained retrospectively comparing pre-HMB Phase (4th August, 2018–3rd August, 2021) and post-HMB Phase (4th August, 2021–3rd August, 2023). Results: Around 1822 newborns benefited from the establishment of the HMB and 2.89 lakh ml of milk from 188 donor mothers were gathered during the study. Bacterial contamination of PDHM was reduced. There was a reduction in mortality and morbidity profiles like sepsis rate, NEC/Feed intolerance and ROP. Duration of NICU stay was improved in all preterm babies. Conclusions: In this study, mortality and morbidity outcomes improved and sepsis decreased after the establishment of the HMB with reduced time to reach full feeds and shorter hospital stay. It helps significantly in NEC cases. We concluded that the creation of an HMB will be more advantageous and useful for all preterm babies in order to achieve better results.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"11 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439244","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 : 2024-01-10DOI: 10.1177/09732179231220213
Sonu Kumar, Bhrajishna Pallapothu, Mayank Priyadarshi, S. Chaurasia, Poonam Singh, Sriparna Basu
The case series aims to provide insights into the clinical presentation, diagnosis, management, and outcomes of neonates infected with COVID-19 during the third wave. We highlight the unusual clinical features, especially incessant cough even in extremely premature neonates, and the mode of horizontal transmission that led to this outbreak. A high index of suspicion and timely diagnosis of COVID-19 in neonates can help avoid the overdiagnosis of clinical sepsis and limit the inadvertent use of antibiotics. The report adds valuable information to the literature for clinicians caring for neonates during the ongoing COVID-19 pandemic.
{"title":"COVID-19 Outbreak in a Neonatal Intensive Care Unit During Third Pandemic Wave: A Case Series","authors":"Sonu Kumar, Bhrajishna Pallapothu, Mayank Priyadarshi, S. Chaurasia, Poonam Singh, Sriparna Basu","doi":"10.1177/09732179231220213","DOIUrl":"https://doi.org/10.1177/09732179231220213","url":null,"abstract":"The case series aims to provide insights into the clinical presentation, diagnosis, management, and outcomes of neonates infected with COVID-19 during the third wave. We highlight the unusual clinical features, especially incessant cough even in extremely premature neonates, and the mode of horizontal transmission that led to this outbreak. A high index of suspicion and timely diagnosis of COVID-19 in neonates can help avoid the overdiagnosis of clinical sepsis and limit the inadvertent use of antibiotics. The report adds valuable information to the literature for clinicians caring for neonates during the ongoing COVID-19 pandemic.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"6 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439482","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 : 2024-01-10DOI: 10.1177/09732179231211564
Ishita Singh, Rabindran Chandran, U. B, P. Amboiram
Early Initiation of Breastfeeding (EIBF) reduces neonatal mortality up to three times, particularly in preterm and low-birth weight infants. Existing Lactation Support Program (LSP) of the institute tackles breastfeeding-related issues to achieve EIBF as early as possible for all delivered healthy infants. LSP was reformed by introducing new policy in February 2021 to achieve EIBF <1 hour in all healthy delivered neonates. The aim of the study was to study the efficacy of new lactation policy of LSP on rates of EIBF and time to attain the first breastfeeding in late preterm neonates of gestational age 35+0 weeks -36+6 weeks. A ‘before-and-after’ design was used to study the effect of the new policy on EIBF at a tertiary care institute in India from January 2018 to March 2023. Impact was assessed by comparing baseline data in pre-policy (group A) with that of new policy (group B). Among 417 babies included, 336 and 81 belonged to group A and B, respectively. EIBF rates were 42% and 99% in group A and group B, respectively ( p < .0001). Median time to initiate EIBF was 100 min IQR [85–117] in group A compared to 26 minutes IQR [19–37] in group B ( p < .0001). Lactation support program is an invaluable key practice for attainment of EIBF. Through simple measures, significant improvement in EIBF was possible in healthy late preterm population. This LSP can be considered as ideal model to be adapted at national level to improvise EIBF.
{"title":"Improving Early Initiation of Breastfeeding in Healthy Late Preterm Neonates Through Reformed Lactation Support Program: A Before and After Study","authors":"Ishita Singh, Rabindran Chandran, U. B, P. Amboiram","doi":"10.1177/09732179231211564","DOIUrl":"https://doi.org/10.1177/09732179231211564","url":null,"abstract":"Early Initiation of Breastfeeding (EIBF) reduces neonatal mortality up to three times, particularly in preterm and low-birth weight infants. Existing Lactation Support Program (LSP) of the institute tackles breastfeeding-related issues to achieve EIBF as early as possible for all delivered healthy infants. LSP was reformed by introducing new policy in February 2021 to achieve EIBF <1 hour in all healthy delivered neonates. The aim of the study was to study the efficacy of new lactation policy of LSP on rates of EIBF and time to attain the first breastfeeding in late preterm neonates of gestational age 35+0 weeks -36+6 weeks. A ‘before-and-after’ design was used to study the effect of the new policy on EIBF at a tertiary care institute in India from January 2018 to March 2023. Impact was assessed by comparing baseline data in pre-policy (group A) with that of new policy (group B). Among 417 babies included, 336 and 81 belonged to group A and B, respectively. EIBF rates were 42% and 99% in group A and group B, respectively ( p < .0001). Median time to initiate EIBF was 100 min IQR [85–117] in group A compared to 26 minutes IQR [19–37] in group B ( p < .0001). Lactation support program is an invaluable key practice for attainment of EIBF. Through simple measures, significant improvement in EIBF was possible in healthy late preterm population. This LSP can be considered as ideal model to be adapted at national level to improvise EIBF.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"10 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439811","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}
Multiple gestation neonates are commonly found in older age women along with increasing use of assisted reproductive techniques. They are at an increased risk of complications and also impose financial, emotional, social, and psychological burdens on the family. There is a paucity of studies on multiple gestations in India, hence this study was conducted to evaluate the clinical profile and associated comorbidities in neonates born through multiple gestations which can help in anticipating, preparing, and managing possible complications. This was a prospective observational study conducted in a Level III neonatal intensive care unit of a tertiary care hospital. All intramural neonates delivered with multiple gestations were included. Data regarding the antenatal, perinatal, and hospital course of the neonates were documented. A total of 75 intramural neonates (36 twins and 1 triplet) were enrolled in the study. About 67.6% were delivered via caesarean section and 81.1% were spontaneous conception. The most common maternal complications observed were hyperemesis gravidarum (56.76%) followed by pregnancy-induced hypertension (PIH) (40.54%). About 80% of twin neonates were diamniotic dichorionic (DADC) and 42% of twin neonates had vertex-vertex presentation. Almost 22.7% of neonates required neonatal resuscitation and 98% had a birth weight <2.5 kg. Initiation of breastfeeding was delayed, and longer hospital stay was observed in preterm neonates with birth weight ≤1.5 kg and birth weight discordance. Multiple gestations are associated with significant neonatal complications owing to prematurity and low birth weight. Thorough knowledge of these complications helps in better fetal and neonatal surveillance and prevention of adverse outcomes.
{"title":"Multiple Gestations: Neonatal and Maternal Characteristics","authors":"Hetal Budh, Anish Sinha, Avishek Agrawal, Gunjan Jain","doi":"10.1177/09732179231214412","DOIUrl":"https://doi.org/10.1177/09732179231214412","url":null,"abstract":"Multiple gestation neonates are commonly found in older age women along with increasing use of assisted reproductive techniques. They are at an increased risk of complications and also impose financial, emotional, social, and psychological burdens on the family. There is a paucity of studies on multiple gestations in India, hence this study was conducted to evaluate the clinical profile and associated comorbidities in neonates born through multiple gestations which can help in anticipating, preparing, and managing possible complications. This was a prospective observational study conducted in a Level III neonatal intensive care unit of a tertiary care hospital. All intramural neonates delivered with multiple gestations were included. Data regarding the antenatal, perinatal, and hospital course of the neonates were documented. A total of 75 intramural neonates (36 twins and 1 triplet) were enrolled in the study. About 67.6% were delivered via caesarean section and 81.1% were spontaneous conception. The most common maternal complications observed were hyperemesis gravidarum (56.76%) followed by pregnancy-induced hypertension (PIH) (40.54%). About 80% of twin neonates were diamniotic dichorionic (DADC) and 42% of twin neonates had vertex-vertex presentation. Almost 22.7% of neonates required neonatal resuscitation and 98% had a birth weight <2.5 kg. Initiation of breastfeeding was delayed, and longer hospital stay was observed in preterm neonates with birth weight ≤1.5 kg and birth weight discordance. Multiple gestations are associated with significant neonatal complications owing to prematurity and low birth weight. Thorough knowledge of these complications helps in better fetal and neonatal surveillance and prevention of adverse outcomes.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"74 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440485","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 : 2024-01-10DOI: 10.1177/09732179231215885
Olety Priyanka, S. Sindgikar
Nutritional status of neonates is best assessed using clinical assessment of nutrition (CAN) score and proportionality indices. The onset of malnutrition that begins in utero, termed fetal malnutrition (FM), can induce a state of inflammation. This study is aimed at estimating the prevalence of FM in different classes of births along with analysis of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in cord blood as markers of inflammation. It was a cross-sectional, descriptive study. The proportionality indices—body mass index (BMI), ponderal index (PI), and CAN score—were calculated. PI <2.2, BMI<11.2 kg/m2, and CAN score <25 were indicators of FM. The Chi-square test was used to test the sensitivity and specificity of CAN score against PI and BMI. A total of 100 term neonates were included, divided into 3 groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Fetal malnutrition was present in 16% of total neonates. The sensitivity and specificity of the CAN score was more than 85% with significant p-value {χ 2 = 33 (PI), χ 2 = 58.8 (BMI)}. Median NLR in FM was 1.63 ± 0.65, significantly ( P < .001) higher than well-nourished neonates. Platelet lymphocyte ratio did not have a significant difference. Clinical assessment of nutrition score showed a positive correlation with maternal ( r = 0.806, P < .001) and neonatal BMI ( r = 0.368, P < .001). Proportionality indices and CAN score can be interchangeably used to diagnose FM. The presence of higher NLR values in neonates with FM suggesting an underlying inflammatory process requires closer follow-up.
新生儿营养状况的最佳评估方法是使用营养临床评估（CAN）评分和比例指数。胎儿营养不良（FM）始于子宫内，可诱发炎症状态。本研究旨在估算不同类别新生儿的 FM 患病率，并分析作为炎症标志物的脐带血中中性粒细胞淋巴细胞比值（NLR）和血小板淋巴细胞比值（PLR）。这是一项横断面描述性研究。研究计算了比例指数--体重指数（BMI）、腹围指数（PI）和 CAN 评分。PI<2.2、BMI<11.2 kg/m2和CAN评分<25是FM的指标。采用卡方检验（Chi-square test）来检验 CAN 评分与 PI 和 BMI 的敏感性和特异性。共纳入 100 名足月新生儿，分为三组：小于胎龄组（SGA）、适于胎龄组（AGA）和大于胎龄组（LGA）。所有新生儿中有 16% 存在胎儿营养不良。CAN评分的灵敏度和特异性均超过85%，P值显著{χ 2 = 33（PI），χ 2 = 58.8（BMI）}。FM 新生儿的 NLR 中位数为 1.63 ± 0.65，明显高于营养良好的新生儿（P < .001）。血小板淋巴细胞比率没有明显差异。临床营养评估评分与产妇体重指数（r = 0.806，P < .001）和新生儿体重指数（r = 0.368，P < .001）呈正相关。比例指数和 CAN 评分可交替用于诊断 FM。如果患有 FM 的新生儿出现较高的 NLR 值，表明存在潜在的炎症过程，则需要进行更密切的随访。
{"title":"Diagnostic Utility of the CAN Score and Proportionality Indices and Variations in Neutrophil—and Platelet—Lymphocyte Ratios in Fetal Malnutrition","authors":"Olety Priyanka, S. Sindgikar","doi":"10.1177/09732179231215885","DOIUrl":"https://doi.org/10.1177/09732179231215885","url":null,"abstract":"Nutritional status of neonates is best assessed using clinical assessment of nutrition (CAN) score and proportionality indices. The onset of malnutrition that begins in utero, termed fetal malnutrition (FM), can induce a state of inflammation. This study is aimed at estimating the prevalence of FM in different classes of births along with analysis of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in cord blood as markers of inflammation. It was a cross-sectional, descriptive study. The proportionality indices—body mass index (BMI), ponderal index (PI), and CAN score—were calculated. PI <2.2, BMI<11.2 kg/m2, and CAN score <25 were indicators of FM. The Chi-square test was used to test the sensitivity and specificity of CAN score against PI and BMI. A total of 100 term neonates were included, divided into 3 groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Fetal malnutrition was present in 16% of total neonates. The sensitivity and specificity of the CAN score was more than 85% with significant p-value {χ 2 = 33 (PI), χ 2 = 58.8 (BMI)}. Median NLR in FM was 1.63 ± 0.65, significantly ( P < .001) higher than well-nourished neonates. Platelet lymphocyte ratio did not have a significant difference. Clinical assessment of nutrition score showed a positive correlation with maternal ( r = 0.806, P < .001) and neonatal BMI ( r = 0.368, P < .001). Proportionality indices and CAN score can be interchangeably used to diagnose FM. The presence of higher NLR values in neonates with FM suggesting an underlying inflammatory process requires closer follow-up.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"67 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440979","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 : 2024-01-10DOI: 10.1177/09732179231221885
Sara Subodh Dhanawade, Ruchika Chouksey, Gracy Bhore
Background: Breast crawl is known to be the most natural, spontaneous, and logical method of initiating breastfeeding; however, not practiced routinely in many labor rooms. Objective: The study’s primary objective was to examine the effect of breast crawl on breastfeeding in the first 48 hours. Method: 60 mother-infant dyads were included. Thirty infants were assigned to either Group 1 (breast crawl) or Group 2 (standard care) using a quasi-experimental design. All babies were observed for 1 hour. A blinded investigator did the LATCH (Latch Audible Swallowing Type of Nipple Comfort Hold) score and IBFAT (Infant Breast Feeding Assessment Tool) score at 24 and 48 hours. Result: Out of 30 babies in the breast crawl group, 25 (83.3%) successfully completed breast crawl. 20 (80%) of 25 babies completed breast crawl within 45 minutes, and 5 (20%) completed within 60 minutes. LATCH and IBFAT scores were significantly higher in the breast crawl group than in the standard care group at 24 and 48 hours ( p > .01). Scores were significantly higher after 48 hours compared to 24 hours in both groups ( p > .01). Conclusion: Most babies in the study successfully crawled the breast and took their first feed within 60 minutes. The breast crawl group had better LATCH and IBFAT scores, indicating a positive impact in the early postnatal period.
{"title":"The Impact of Breast Crawl on the Effectiveness of Breastfeeding in the First 48 Hours: A Quasi-experimental Study","authors":"Sara Subodh Dhanawade, Ruchika Chouksey, Gracy Bhore","doi":"10.1177/09732179231221885","DOIUrl":"https://doi.org/10.1177/09732179231221885","url":null,"abstract":"Background: Breast crawl is known to be the most natural, spontaneous, and logical method of initiating breastfeeding; however, not practiced routinely in many labor rooms. Objective: The study’s primary objective was to examine the effect of breast crawl on breastfeeding in the first 48 hours. Method: 60 mother-infant dyads were included. Thirty infants were assigned to either Group 1 (breast crawl) or Group 2 (standard care) using a quasi-experimental design. All babies were observed for 1 hour. A blinded investigator did the LATCH (Latch Audible Swallowing Type of Nipple Comfort Hold) score and IBFAT (Infant Breast Feeding Assessment Tool) score at 24 and 48 hours. Result: Out of 30 babies in the breast crawl group, 25 (83.3%) successfully completed breast crawl. 20 (80%) of 25 babies completed breast crawl within 45 minutes, and 5 (20%) completed within 60 minutes. LATCH and IBFAT scores were significantly higher in the breast crawl group than in the standard care group at 24 and 48 hours ( p > .01). Scores were significantly higher after 48 hours compared to 24 hours in both groups ( p > .01). Conclusion: Most babies in the study successfully crawled the breast and took their first feed within 60 minutes. The breast crawl group had better LATCH and IBFAT scores, indicating a positive impact in the early postnatal period.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"14 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439675","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 : 2024-01-10DOI: 10.1177/09732179231218059
Anish Sinha, Reshma Pujara, Shradha Patel, D. Patel, S. Nimbalkar
Introduction: WHO and UNICEF recommend initiating early skin-to-skin contact (SSC) of newborns as an important intervention to reduce neonatal mortality. In India, it has been reported that only 15% of babies receive early SSC, and at our institution, only 22% of stable babies delivered vaginally were receiving SSC at birth. Aim: To increase the early initiation of SSC practice in neonates born through vaginal delivery ≥36 weeks from the observed baseline of 22% to ≥85% over 3 months. Methods: The study was conducted in the labor room of a tertiary care hospital over 3 months (December 2022 to February 2023) and a sustenance phase from April 2023 to June 2023. A root cause analysis was done using the fishbone framework, focusing on barriers related to mothers, hospital staff, policy, place, and practices. Based on this, a comprehensive early initiation of SSC intervention was planned utilizing Plan-Do-Study-Act cycles. Results: At the end of the three months, we achieved 100% compliance in the early initiation of SSC from a baseline of 22%, and the same compliance was maintained during the sustenance phase. The line chart used for interpretation showed an increase in compliance and increased duration of SSC till early initiation of breastfeeding was established.
{"title":"Improving Early Initiation of Skin-to-Skin Contact Among Newborns Delivered Vaginally at a Tertiary Care Hospital: A Quality Improvement Study","authors":"Anish Sinha, Reshma Pujara, Shradha Patel, D. Patel, S. Nimbalkar","doi":"10.1177/09732179231218059","DOIUrl":"https://doi.org/10.1177/09732179231218059","url":null,"abstract":"Introduction: WHO and UNICEF recommend initiating early skin-to-skin contact (SSC) of newborns as an important intervention to reduce neonatal mortality. In India, it has been reported that only 15% of babies receive early SSC, and at our institution, only 22% of stable babies delivered vaginally were receiving SSC at birth. Aim: To increase the early initiation of SSC practice in neonates born through vaginal delivery ≥36 weeks from the observed baseline of 22% to ≥85% over 3 months. Methods: The study was conducted in the labor room of a tertiary care hospital over 3 months (December 2022 to February 2023) and a sustenance phase from April 2023 to June 2023. A root cause analysis was done using the fishbone framework, focusing on barriers related to mothers, hospital staff, policy, place, and practices. Based on this, a comprehensive early initiation of SSC intervention was planned utilizing Plan-Do-Study-Act cycles. Results: At the end of the three months, we achieved 100% compliance in the early initiation of SSC from a baseline of 22%, and the same compliance was maintained during the sustenance phase. The line chart used for interpretation showed an increase in compliance and increased duration of SSC till early initiation of breastfeeding was established.","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"79 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440601","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 : 2024-01-10DOI: 10.1177/09732179231220208
Kavya Goyal, Sugandha Arya, BP Guliani
Introduction: Human milk has many antioxidants like Docosahexaenoic acid (DHA), inositol, and vitamin E that combat oxidative stress deregulating VEGF which is implicated in the pathogenesis of retinopathy of prematurity (ROP). Thus, it is biologically plausible that human milk is protective towards ROP. Aim and objective: The study aimed to find the association between ROP and breast milk feeding. Methodology: The prospective cohort study was carried out for 18 months at the Newborn unit, SJH. In our study, mothers were asked to maintain a feeding diary (type of milk fed) and history was taken from the mother regularly. Each neonate was later assigned a feeding category including exclusively breast milk fed, more than 50% breast milk fed, more than 50% top milk-fed, and exclusively top milk fed. At four weeks of age, all these neonates were called to undergo screening for ROP. In the case of immature retina, neonates were followed up for repeat fundus exams and results were included in the study. Result: A study on 521 neonates between birth weight of 1–1.8 kgs found that predominant breast milk feeding reduces the chance of any stage ROP (needing repeat screening or intervention). The total incidence of any stage ROP in this study was noted to be 16.2% where 4.1% of total neonates from the predominantly breastfed group as compared to 37.8% from the predominantly top-fed group developed any stage ROP. Conclusion: Breast milk feeding has a significant benefit in reducing any stage ROP and ROP needing intervention, thus it has the potential to prevent a significant cause of childhood blindness. What is already known – Breast milk feeding may be protective towards ROP What the study adds – Breast milk feeding is independently protective towards ROP
{"title":"Effect of Breast Milk Feeding on Retinopathy of Prematurity in Neonates Less than 1800 Grams: A Cohort","authors":"Kavya Goyal, Sugandha Arya, BP Guliani","doi":"10.1177/09732179231220208","DOIUrl":"https://doi.org/10.1177/09732179231220208","url":null,"abstract":"Introduction: Human milk has many antioxidants like Docosahexaenoic acid (DHA), inositol, and vitamin E that combat oxidative stress deregulating VEGF which is implicated in the pathogenesis of retinopathy of prematurity (ROP). Thus, it is biologically plausible that human milk is protective towards ROP. Aim and objective: The study aimed to find the association between ROP and breast milk feeding. Methodology: The prospective cohort study was carried out for 18 months at the Newborn unit, SJH. In our study, mothers were asked to maintain a feeding diary (type of milk fed) and history was taken from the mother regularly. Each neonate was later assigned a feeding category including exclusively breast milk fed, more than 50% breast milk fed, more than 50% top milk-fed, and exclusively top milk fed. At four weeks of age, all these neonates were called to undergo screening for ROP. In the case of immature retina, neonates were followed up for repeat fundus exams and results were included in the study. Result: A study on 521 neonates between birth weight of 1–1.8 kgs found that predominant breast milk feeding reduces the chance of any stage ROP (needing repeat screening or intervention). The total incidence of any stage ROP in this study was noted to be 16.2% where 4.1% of total neonates from the predominantly breastfed group as compared to 37.8% from the predominantly top-fed group developed any stage ROP. Conclusion: Breast milk feeding has a significant benefit in reducing any stage ROP and ROP needing intervention, thus it has the potential to prevent a significant cause of childhood blindness. What is already known – Breast milk feeding may be protective towards ROP What the study adds – Breast milk feeding is independently protective towards ROP","PeriodicalId":16516,"journal":{"name":"Journal of Neonatology","volume":"76 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440826","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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